A patient is admitted to Shock Trauma with a gunshot wound
to the abdomen. A CT angiogram shows the bullet has transected the common
hepatic artery at the junction of the gastroduodenal artery.
Correct! The common hepatic artery provides blood to the proper
hepatic artery, which in turn splits into the left and right hepatic artery
supplying the left and right regions of the liver. Since the injury is at the
junction of the gastroduodenal artery, this prevents retrograde supply from
the gastroduodenal artery to the proper hepatic artery. Thus, the liver in
this case now has no blood supply and at ischemic risk.
Incorrect. The spleen is supplied by the splenic artery, a direct branch of
the celiac trunk arising from the aorta. It is not part of the common hepatic
artery system.
Incorrect. The bulk of the small intestines are supplied by the superior
mesenteric artery via intestinal branches. These are not part of the common
hepatic artery system.
Correct! The gallbladder is supplied by the cystic artery, which is
most commonly a branch from the right hepatic artery. The common hepatic
artery provides blood to the proper hepatic artery, which in turn splits into
the left and right hepatic artery supplying the left and right regions of the
liver. Since the injury is at the gastroduodenal artery, this prevents
retrograde supply from the gastroduodenal artery to the proper hepatic artery.
Thus, the gallbladder in this case now has no blood supply and at ischemic
risk.
Incorrect. The pancreas has multiple blood supplies that can
compensate for the single branch arising from the common hepatic artery system
(that branch is the pancreaticoduodenal artery, arising from the
gastroduodenal artery which is a branch of the common hepatic artery, but as
there are other branches including splenic and branches from the superior
mesenteric system, the pancreas has sufficient blood to be a lesser ischemic
risk).
Incorrect. The transverse colon is supplied by the middle colic
artery, a branch of the superior mesenteric artery. Thus, no ischemic risk
from a common hepatic artery transection.
Incorrect. The ascending colon is supplied by the right colic artery,
a branch of the superior mesenteric artery. Thus, no ischemic risk from a
common hepatic artery transection.
Incorrect. The descending colon is supplied by the left colic artery,
a branch of the inferior mesenteric artery. Thus, no ischemic risk from a
common hepatic artery transection.