Stomach Vasculature and Lymphatics
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Direct answer
Arteries reach the stomach along its two curvatures in a complete circle: the left gastric artery (from the coeliac trunk) meets the right gastric artery (usually from the proper hepatic or common hepatic) along the lesser curvature, while the right gastroepiploic artery (from the gastroduodenal) meets the left gastroepiploic and short gastric arteries (from the splenic) along the greater curvature and fundus. Veins mirror the arteries but drain into the portal system — the left gastric vein meets the lower oesophageal veins at the cardia, the fountainhead of varices. Lymph follows the arteries through named stations along each curvature to the coeliac group — why a radical (D2) gastrectomy clears nodes along the hepatic and splenic arteries and the coeliac axis.
What you must remember
- Lesser curvature supply: left gastric artery, the smallest branch of the coeliac trunk, anastomosing with the right gastric artery, usually a branch of the proper hepatic (origin varies to common hepatic or gastroduodenal).
- Greater curvature and fundal supply: right gastroepiploic from the gastroduodenal artery, left gastroepiploic and four or five short gastric arteries from the splenic artery at the hilum — the short gastrics supply the fundus, the classical site of a Dieulafoy lesion.
- Venous mirror with a clinical twist: right and left gastric veins into the portal vein; right gastroepiploic into the superior mesenteric; left gastroepiploic and short gastrics into the splenic — all portal, so gastric veins varice in portal hypertension.
- Variceal epicentre: the left gastric vein meets the lower oesophageal veins at the cardia; portal hypertension shunts flow up into the azygos system, producing lower oesophageal and gastric fundal varices.
- Lymphatic flow: nodes along the greater and lesser curvatures (gastroepiploic, gastric, and short-gastric splenic-hilum stations) converge on the coeliac nodes — the abdominal counterpart of the thoracic duct's reach, explaining left supraclavicular (Virchow's) deposits.
- D2 gastrectomy logic: radical clearance removes nodes along the left gastric, common hepatic and splenic arteries and the coeliac axis, because submucosal lymphatics of the stomach are dense and cross the midline freely.
- Examination conventions: Indian prof vivas expect the artery-to-curvature assignment cold: which artery, which curvature, which parent trunk.
Reading a bleeding varix through the anatomy
A patient with cirrhosis and haematemesis is demonstrating the left gastric-oesophageal anastomosis. In health it is a trivial meeting of portal and systemic tributaries at the cardia; in portal hypertension the pressure gradient reverses flow, the submucosal veins of the lower oesophagus distend, and the weakest vessel bleeds. The same logic explains the rare anorectal and retroperitoneal portosystemic meeting points, but the gastric-coronary-oesophageal channel dominates because the left gastric vein is short, large and directly connected to the splenic-portal confluence. Endoscopic banding attacks the varix; a shunt or a TIPS attacks the gradient; the anatomist simply draws the circle of stomach veins and marks the one junction that matters.
Gastric cancer follows the same vessels in the opposite direction. Submucosal lymphatic plexuses are so rich that a distal tumour may deposit in nodes along the greater curvature, the splenic hilum and even the left supraclavicular fossa via the cisterna chyli and thoracic duct — Troisier's (Virchow's) node, the bedside sign of inoperability. The D2 dissection of Japanese-convention surgery, now standard in Indian oncology centres, is simply the lymphatic map of the stomach translated into an operation: no station along the coeliac branches is left behind.
Where candidates slip
The commonest slip is the origin of the right gastric artery — stated as "from the coeliac trunk" when it actually comes from the hepatic line (proper or common hepatic, sometimes gastroduodenal). The second is forgetting that the left gastric artery supplies the abdominal oesophagus as well as the stomach, which is why high gastric and junctional tumours need the lower oesophageal lymphatics cleared too. The third is the coeliac trunk mnemonic muddle: left gastric is the smallest, splenic the largest of its three branches — reversed mnemonics cost easy viva marks. And the short gastrics are repeatedly assigned to the left gastric artery instead of the splenic; they live in the gastrosplenic ligament, not the lesser omentum.
Frequently asked questions
Which artery supplies the fundus of the stomach?
The short gastric arteries from the splenic artery, travelling in the gastrosplenic ligament, supplemented by the left gastroepiploic artery along the upper greater curvature.
Why do oesophageal varices form at the cardia?
The left gastric vein (portal) anastomoses with lower oesophageal veins (systemic, via azygos); portal hypertension diverts flow through this junction and dilates the submucosal veins.
What is the lymphatic terminus of the stomach?
The coeliac group of nodes around the coeliac trunk, reached through stations along both curvatures and the splenic hilum.
Which veins drain the greater curvature of the stomach?
The right gastroepiploic vein into the superior mesenteric vein and the left gastroepiploic vein into the splenic vein.
What is Virchow's node and why does gastric cancer reach it?
The left supraclavicular node, receiving lymph from the thoracic duct, which collects coeliac drainage — its enlargement signals abdominal malignancy, classically stomach cancer.