25 Vessels of the liver

The arteries described in this chapter serve as witnesses before and after liver lifting maneuvers. These gauges are the celiac trunk and hepatic artery.

25.1 Anatomy

25.1.1 Celiac trunk

Origin

The celiac trunk (Fig. 25.1) arises just below the aortic hiatus, at the caudal part of the 12th vertebral body, two fingerwidths below the xiphoid process.

Fig. 25.1 Celiac trunk.

Course

The celiac trunk is 1.5–2 cm long, passing almost horizontally anteriorly and slightly to the right. It divides into the hepatic, splenic, and left gastric arteries. This is referred to as a tripod division (ad modum tridentis). Usually the left gastric artery arises cephalad of the others.

Relations

The celiac trunk relates:

• anteriorly and slightly to the right to the caudate (Spiegel) lobe of the liver

• posteriorly to the superior border of the pancreas

• on the left, to the stomach.

Comments

The celiac trunk is an excellent indicator to verify the effects of our vascular manipulations, not only of the liver, but also of the spleen and pancreas. Because it is surrounded by the solar plexus, the celiac trunk is very sensitive to the glide–induction technique.

25.1.2 Hepatic artery

Origin

The hepatic artery arises from the celiac trunk at the caudal border of T12, to the right of the xiphoid–umbilical line.

Course

The hepatic artery passes almost horizontally anteriorly and laterally toward the pylorus. It passes between layers of the lesser omentum, medial to the common bile duct, to reach the porta hepatis.

Branches

The branches of the hepatic artery are:

• the pyloric artery

• the right gastroepiploic artery

• the pancreaticoduodenal arteries

• the gastric and omental branches

• the cystic artery

• the proper hepatic artery.

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