so you've got the abdominal aorta that's obviously descending downward throughout the abdomen and the celiac trunk is the really the first major exit point from this abdominal aorta in the abdomen now the first really high-yield thing that you should know is that the exit of the celiac trunk off of the abdominal aorta is going to occur around the level of t12 so that's the first really high-yield thing that you should commit to memory t12 is where the celiac trunk comes out of the abdominal aorta now from the celiac trunk there are three major arteries that come off the celiac trunk and then each of these three arteries will give rise to further arteries but you can't learn the downstream arteries without first understanding how this celiac trunk initially splits into these three arteries so the three arteries that are really important are the common hepatic artery the left gastric artery and the splenic artery now for the purposes of this video and to simplify I'm just going to abbreviate so we've got the common hepatic at the top the left gastric kind of going diagonally through the middle and the splenic artery going downward obviously because I'm putting this on a slide this isn't going to be in 3d but I think that I'll organize this in a really easy way so that you can still follow what we're doing so I think we should take these one step at a time so let's start with the common hepatic artery so again abdominal aorta major blood supply going downward through the abdomen gives off the celiac trunk at the level of t12 after all this video is the celiac trunk anatomy so we're talking about everything that branches off of the celiac trunk so the first major branch is the common hepatic artery now the common hepatic artery is going to split into two arteries that come off of it and those are going to be the proper hepatic going upward and the gastroduodenal going downward let's follow the proper hepatic and then toward the end of this video we'll come back and talk about the significance of the gastroduodenal artery the proper hepatic splits again the first split is going to be the left hepatic and the second split is the right hepatic so proper hepatic gives off everything else that has hepatic in the name so common hepatic gave way to proper hepatic and then proper hepatic split into the left and right hepatic so obviously this is the blood supply that's going toward the liver off of the right hepatic you're gonna have a split right there and that's going to be the Cystic artery so really really high yield here is to know that the Cystic artery is coming off of the right hepatic artery that's the case in most people in most anatomy you'll see the Cystic artery coming off the right hepatic artery and then usually the left hepatic artery is not going to give rise to anything significant for the purposes of USMLE complex preclinical years or even your clerkship and surgery this is really how you'll to know if you want to do surgery you have to understand how the blood vessels will move throughout the abdomen so this is the common hepatic branch of the celiac trunk so just to summarize what i've said here's the map we've got the celiac trunk coming out at t12 giving rise to its first major branch which is the first of three major branches the common hepatic the common hepatic will split into the proper hepatic which will kind of control all blood that goes toward the liver and gallbladder as well as the gastroduodenal artery which we'll talk about toward the end of this video the proper hepatic splits into the left hepatic and the right hepatic and then off of the right hepatic in most people you get the Cystic artery so this is what you should know for the celiac trunk first major branch the common hepatic artery so here's where we are so far that's the first of three major branches off the celiac trunk now let's talk about the second of three major branches off the celiac trunk so recall from the you know the beginning of this video that the next one was the left gastric artery which is abbreviated here as LGA there's really only one major branch that comes off of the left gastric artery and those are branches that will actually go toward the esophagus so the trunk comes out of t12 gives rise to the left gastric artery which then gives rise to the esophageal branches so here's where we are so far we've done two of three major branches off the celiac trunk and now let's wrap up and do our third branch the splenic artery so the splenic artery abbreviated here as sa is our third major branch now there are a couple of things you need to know about what comes off of the splenic artery we've got two branches here the short gastric artery and the left gastroepiploic artery and that's it that's all you need to know about the splenic artery so to summarize we've got our celiac trunk coming off of the abdominal aorta at the level of t12 giving rise to the splenic artery and then the splenic artery gives rise to the short gastrics and the left gastroepiploic so here's where we are and at this point we've talked about the three major branches that come off of the celiac trunk the common hepatic the left gastric and the splenic each of those three major branches gave rise to several downstream arteries each going to different end organs what we need to do now is talk about the really strong anastomosis that are connecting different branches in this system so when I say anastomosis really what I'm saying is connection okay that's a fancy word for connection so the first connection or the first anastomosis is going to be between the gastroduodenal and the left gastroepiploic and to be a little bit more specific it's really between the left gastroepiploic and the right gastroepiploic now when I talked about the common hepatic artery I told you that it gave rise to the gastroduodenal artery and then actually off of that gastroduodenal artery you get another artery called the right gastroepiploic I didn't originally draw this in on the slide because I really don't think that it's important to to memorize but just for completeness sake know that the right gastroepiploic comes off of the gastroduodenal and then the right gastroepiploic will connect to the left gastroepiploic so what's really high yield to take away from this slide is that the right gastroepiploic came from the common hepatic artery but the left gastroepiploic came from the splenic artery so our first anastomosis our first major connection between these three different major branches connects the common hepatic to the splenic because downstream in the common hepatic you have the right gastroepiploic and downstream in the splenic you have the left gastroepiploic and those connect as shown here on the slide so know that but also know that this is what gives rise to problems with bleeding ulcers in peptic ulcer disease so it's this connection or this anastomosis that makes the bleeding pretty potent in peptic ulcer disease so that's our first major anastomosis our second major anastomosis is going to occur between the left gastric artery and the right gastric artery now I know what you're thinking you're saying to yourself dirty you didn't put the right gastric artery on the slide so how am I supposed to know where it's coming from and you would technically be correct but again I don't think it's super important to memorize where the right gastric artery is when you're initially learning to three major branches but now that we're learning the anastomotic Annette gastric artery is coming off the common hepatic artery so the common hepatic artery gives rise to the right gastric artery and that will connect to the left gastric artery which obviously in and of itself is one of the three major branches of the celiac trunk so to summarize there are two really strong connections are really strong anastomosis if you will that you need to memorize the left gastroepiploic coming off the splenic will connect to the right gastroepiploic coming off the gastroduodenal which came off the common hepatic the second one is to know that the left gastric which is a major branch of itself connects to the right gastric which comes off the common hepatic so that's where we are you see the two anastomosis here shown in blue and green so this is everything we've talked about so far and I told you that at the end of this video we were going to talk about the gastroduodenal artery the gastro duodenum artery has one super high-yield fact about it that you absolutely need to know for USMLE and comlex so the gastroduodenal gives rise to several arteries as you've already seen in this video that I didn't originally put on the slide and one of the other arteries that I didn't originally put on the slide it's called the superior pancreaticoduodenectomy which as you see on the slide comes from the common hepatic so we've got this superior pancreaticoduodenectomy enteric artery sometimes referred to as the SMA the SMA is like the celiac trunk in the sense that it itself gives off several branches kind of like what you see here coming off the celiac trunk the major point that you need to commit to memory and understand is that from the SMA you actually get an artery called the inferior pancreaticoduodenectomy attic oh duodenal artery connects to the inferior pancreaticoduodenectomy rear pancreaticoduodenectomy which is the next major trunk down the abdominal aorta after the celiac trunk so clinically this is relevant and this is exactly why it shows up on USMLE and comlex all the freaking time is because if you have an occlusion or a thrombus in the celiac trunk or in the SMA because of this anastomosis you can still provide blood to the next major trunk so if the celiac trunk is blocked the SMA which gives rise to the inferior pancreaticoduodenectomy reopen radical duodenal artery which then can shoot blood into all these other branches so yes a thrombus in the celiac trunk or a thrombus in the SMA is really really potentially deadly but there is still a little bit of collateral blood flow that's coming from this anastomosis so this is the only anastomosis that is connecting two major trunks the celiac trunk to the superior mesenteric artery trunk so that's incredibly important to know so please know this anastomosis understand that the superior pancreaticoduodenectomy common hepatic which comes from the celiac and the inferior pancreaticoduodenectomy rear mesenteric trunk so that's it for today's video I knew it I know that I flew through this this is anatomy it's not fun to memorize but the best way to learn this is to watch this video over and over and over again keep drawing out these branches on your USMLE or complex you could be asked about what organ will have a problem if blood supply is not working or if there's too much bleeding going into things like the esophageal branches etc etc so that's it I hope that this was helpful to you if you 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