 Welcome to a dissection demonstration of the CDF trunk and all its branches. I am Dr. Sanjo Sanyal, Professor Department Chair. Now we shall reflect the stomach here, we shall reflect the pancreas here and we shall show the origin of the CDF trunk. So this is the CDF trunk that we can see here. The CDF trunk is the shortest trunk which arises from the abdominal aorta as an unpaired visceral branch. This structure which I have lifted up, this is the CDF trunk. The first unpaired visceral branch from the abdominal aorta which arises at the level of T12. This was covered by a thick layer of fibrous tissue here which you can see which actually is not a fibrous tissue but it is the CDF plexus which composed of both sympathetic and parasympathetic which has been cleared of. The CDF trunk is normally very short, sometimes it may also be absent. Rising from the CDF trunk we have three branches coming out. Let us take the first branch, the smallest branch of the CDF trunk is the left gastric artery. The largest branch of the CDF trunk is the splenic artery and the intermediate branch which also is considerably large is the common hepatic artery. Rising from the CDF trunk we have three major vessels. The largest one which we can see here is the splenic artery. The second largest branch is this one. This is the hepatic artery and the smallest branch is this one. This is the left gastric artery. So let us take the course of the left gastric artery. The left gastric artery as it runs it continues along the lesser curvature of the stomach from left to right and it also supplies the abdominal part of the esophagus. The left gastric artery runs within the layers of the lesser momentum which we can see here and then it anastomosis with the right gastric artery which are coming from the hepatic artery proper and which runs also in the lesser curvature within the layers of the lesser momentum from right to left. The left gastric artery runs along the lesser curvature of the stomach from left to right and we can see that this is the course of the left gastric artery. The left gastric artery runs within the layers of the lesser momentum which is here. As it runs it anastomosis with the right gastric artery which is a branch of the proper hepatic artery which runs from right to left. Running with the left gastric artery we can see this big vein here. This is the left gastric vein which drains into the portal vein and the left gastric vein also communicates with the esophageal veins through the esophageal hiatus which then drains into the azygous vein. So therefore the lower end of the esophagus is an important site of portal systemic anastomosis and in cirrhosis with portal hypertension is the branches of this left gastric vein which become large and they form what is known as esophageal varices. Now let's take the next branch. This is the hepatic artery. So the initial part of the hepatic artery is known as the common hepatic artery. Then it goes up and at the point when it goes up it gives up a very big branch and this big branch that we see here, this is the gastrodural artery. Now let's take the second largest branch of the celiac artery and that is the hepatic artery. The hepatic artery has got two portions. The initial portion is horizontal. It runs in the retroperitoneum and then it makes an upward turn. So this portion is referred to as the common hepatic artery and the second portion is known as the proper hepatic artery. And the junction between the two a very big branch is given off and this branch is the gastrodural artery. Ideally the gastrodural artery gives rise to three branches. One is known as a supradural artery of Wilkie which runs in front of the duodenum but in this particular case this artery is running behind the duodenum. So therefore this is most probably not the supradural artery. The rest of the gastrodural artery then divides into two major branches. This is one branch which is called the epiploid or the gastropomentum which runs on the greater curvature of the stomach within the layers of the greater momentum from right to left. It gives gastric branches to the stomach along the greater curvature and it also gives omental branches. The gastropomentum has been removed. It anastomosis with the branches of the left gastroepiploid which are branches of the splinic artery which also run on the greater curvature from the gastro splinic ligament to the gastropolic ligament from left to right. The next branch of the gastrodural artery is this one here. This also a considerably big branch and this is known as the superior pancreatico duodenum. The superior pancreatico duodenum as it is coming down in between the sea loop of the duodenum and the head of the pancreas it gives off an anterior branch and a posterior branch. In this particular case most probably this other branch of the gastroduodenum which is running behind the duodenum is the counterpart of the posterior superior pancreatico duodenum. And these two then run around here and they anastomosis with the inferior pancreatico duodenum which is a branch of the superior mesentric artery. And from here this paired loop of arteries they supply the head of the pancreas as well as the sea loop of the duodenum. The gastroduodenal artery runs behind the first part of the duodenum. The duodenum has been cut here from it's just after the pylorus. It runs behind and here there is a very important clinical correlation. The first part of the duodenum is this and this is an important site of duodenal ulcer. And when a posterior duodenal ulcer perforates it can perforate into the gastroduodenal artery producing profuse hemorrhage into the stomach and produce hematomasis that is vomiting of blood. The gastroduodenal artery then runs and it divides into two further branches. This is the right gastroepiploic artery which runs along the greater curvature of the stomach. It is also referred as the gastromental artery and this gives gastric branches and omental branches and it anastomosis with the left gastro omental or the epiploic artery. And the second branch is this one. This is the superior pancreatico duodenal which divides into an anterior and a posterior. In this case we see a separate posterior superior pancreatic duodenal artery coming out from the gastroduodenal artery. So this is one important branch of the hepatic artery. After the gastroduodenal artery then we have the hepatic artery proper and this branch is the right gastric artery. Which comes out from the hepatic artery proper and it runs on the lesser curvature of the stomach from right to left and it anastomosis with the branches of the left gastric artery. Coming out from the hepatic artery proper we have this branch. This is the right gastric artery. And finally to trace the course of the rest of the hepatic artery in the hepato duodenal ligament. That is the free margin of the lesser momentum which forms the part of the extra hepatic portal triad in the opening of the foremen of Winslow. We notice that the hepatic artery divides into a left branch and a right branch. Normally in 64% of the population the right branch is supposed to go behind the common hepatic duct and in front of the portal main. In 24% of the population and this is one of that case the right hepatic artery is running in front of the bile duct. And the right hepatic artery also gives rise to this artery which I have lifted up here. This is an important artery branch and that is known as the cystic artery which supplies the gallbladder. And when we are doing a gallbladder surgery this region is called the cholecystic hepatic triangle of calode. And we have to ligate the cystic artery to remove the gallbladder. So this is the division of the right and the left branches of the hepatic artery. Now let's come to the third and the largest branch of the celiac trunk and that is this artery. If we were to trace the entire course of this artery we notice that this artery is highly tortuous, this clinic artery. It initially runs along the superior border of the pancreas and it forms part of the bed of the stomach. It also enters through the spleen through its high level. The reason for its tortuosity is because it constitutes part of the bed of the stomach it allows mobility. The spleen artery gives branches to the back of the stomach what is known as the posterior gastric artery. It gives branches to the pancreas known as the greater and the dorsal pancreatic artery. And thereafter it enters the spleen and there it ramifies. Near the greater curvature and fundus of the stomach within the gastro spleen ligament the spleen artery also gives rise to these branches. We can see them here and we can see some of them within the layers of the gastro spleen ligament. These are known as the vasapremia. And it also gives rise to this branch which is the left gastroepiploid or the left gastropomental artery which runs along the greater curvature of the stomach within the layers of the greater omentum and which anastomosis with branches of the right gastropiploid. And this also supplies the stomach by means of gastric branches and it supplies the greater omentum through its omental branches. So this is about the course and the of the spleen artery. Spleen artery aneurysm is a well documented entity and sometimes it can rupture. And when the spleen artery aneurysm ruptures it can produce catastrophic hemorrhage. Another important clinical correlation pertaining to the spleen artery is what is known as the celiac artery or the celiac axis angiogram. For that we cannulate the femoral artery and from there we go through the external aliac, common aliac and went to the abdominal aorta. And then we pass the cannular and we hook it at the celiac trunk and we inject the ligament. And that way we can see the entire course of not only the spleen artery but also the left gastric artery and the hepatic artery. So this is the way to visualize the celiac trunk and all its major branches. So that's all for now. Thank you very much for watching. If you have any questions or comments have put them in the comment section below. Dr. Sanjay Sanyas signing out. Have a nice day. Guys thanks for watching. Make sure you like and subscribe to this video.