MRCS Part B (OSCE) - Online Resources

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The stomach is supplied by branches of the coeliac trunk:

• Left and right gastric arteries anastomose along the lesser curve of the stomach (the left gastric artery arises from the coeliac trunk, and the right gastric from the hepatic artery).
• Left and right gastro-omental (gastroepiploic) arteries anastomose along the greater curvature of the stomach (the left gastro-omental artery arising from the splenic artery, and the right from the gastroduodenal artery).
• Posterior and short gastric branches of the splenic artery supply the fundus and posterior part of the stomach.

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"An ulcer in the lesser curve of the stomach may erode into the right or left gastric arteries. "

"The lesser sac, or omental bursa, is an area of the peritoneal cavity situated in the upper abdomen, posterior to the lesser omentum, stomach and associated structures. "

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The borders of the lesser sac are:

Anterior         :      Quadrate lobe of liver, lesser omentum, stomach and                                     gastrocolic ligament.

Posterior        :      Pancreas, left kidney and adrenal gland

Superior         :      Superior recess of the lesser sac lies behind the caudate lobe of the liver.

Inferior           :      Inferior recess of the lesser sac lies between the layers of the greater omentum (superior part).

To the left      :      Lies the gastrosplenic and lienorenal ligaments.

To the right   :      The epiploic foramen (foramen of Winslow).

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"The epiploic foramen (also known as the omental foramen or foramen of Winslow) is the opening through which the lesser sac communicates with the greater sac (the main peritoneal cavity). "

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The boundaries of the epiploic foramen are:

• Anterior :    Hepatic artery, portal vein and bile duct - lie within the                           hepatoduodenal ligament (free edge of lesser omentum).
• Posterior :     IVC and right crus of diaphragm (retroperitoneal).
• Superior :     Caudate lobe of liver.
• Inferior :    First part of duodenum.

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Calot’s triangle, also known as the cystohepatic triangle, is bounded by:

• Superior :     Inferior border of the liver.
• Medial :     Common hepatic artery.
• Lateral :     Cystic duct.

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"Pringle’s manoeuvre is compression of the hepatic artery  and portal vein between the index finger in the epiploic foramen and the thumb anteriorly, to prevent liver haemorrhage, usually secondary to trauma. "

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• Skin
• Subcutaneous fat
• External oblique
• Internal oblique
• Transverse abdominis
• Transversalis fascia
• Extraperitoneal fat
• Parietal peritoneum

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"The bile and main pancreatic ducts open into the 2nd part of the duodenum at the Ampulla of Vater. The second part of the duodenum also corresponds to the transition of the embryological development between the midgut and foregut. "

Up to the second part, the duodenum is supplied by the superior pancreaticoduodenal artery from the coeliac trunk (via the gastroduodenal artery),and beyond it from the inferior pancreaticoduodenal artery from the superior mesenteric artery.

An ulcer in the posterior duodenum can erode into the gastroduodenal artery, due to its close proximity to the 1st part of the duodenum.