Ligation of common hepatic artery will impair blood supply in:

Explanation

## Correct Answer: A. Right gastric and right gastroepiploic artery The common hepatic artery (CHA) is the middle branch of the celiac trunk, arising after the left gastric artery branches off. It gives off the **gastroduodenal artery (GDA)** as its first major branch before becoming the proper hepatic artery. The GDA then divides into the right gastroepiploic artery and the superior pancreaticoduodenal artery. Simultaneously, the CHA gives off the **right gastric artery** (also called right gastric or pyloric artery) before or just after the GDA origin. Ligation of the CHA proximal to the GDA origin will therefore interrupt blood supply to both the right gastric artery and the right gastroepiploic artery (via the GDA). The left gastric artery branches directly from the celiac trunk independently, so it remains patent. The short gastric vessels arise from the splenic artery, which is a separate branch of the celiac trunk, and are unaffected by CHA ligation. This anatomical relationship is critical in hepatobiliary surgery and emergency management of upper GI bleeding in Indian hospitals, where CHA ligation may be performed during damage control in severe hepatic trauma. ## Why the other options are wrong **B. Right gastric and left gastric artery** — The left gastric artery is the **first and largest branch of the celiac trunk**, arising independently before the common hepatic artery. It is not a branch of the CHA and therefore remains unaffected by CHA ligation. This option incorrectly assumes the left gastric artery is dependent on the CHA, which is a common anatomical misconception among students. **C. Right gastroepiploic and short gastric vessels** — While the right gastroepiploic artery is correctly identified as a branch of the GDA (and thus affected by CHA ligation), the **short gastric vessels arise from the splenic artery**, not the CHA. The splenic artery is an independent branch of the celiac trunk. This option pairs one correct vessel with an incorrect one, creating a distractor for students who confuse the vascular anatomy of the greater curvature. **D. Right gastric and short gastric vessels** — Although the right gastric artery is correctly identified as a branch of the CHA, the **short gastric vessels originate from the splenic artery**, not the CHA. This option tests whether students can distinguish between branches of the CHA and branches of the splenic artery—a key anatomical distinction in hepatobiliary and gastric surgery planning. ## High-Yield Facts - **Common hepatic artery** gives off right gastric artery and gastroduodenal artery (which branches into right gastroepiploic) before becoming proper hepatic artery. - **Left gastric artery** is the first and independent branch of the celiac trunk—NOT a branch of the CHA. - **Short gastric vessels** arise from the splenic artery (third branch of celiac trunk), not the CHA. - **Gastroduodenal artery** is the first major branch of CHA and is the source of right gastroepiploic artery. - CHA ligation proximal to GDA origin affects all downstream branches: right gastric, right gastroepiploic, and proper hepatic artery. ## Mnemonics **Celiac Trunk Branches (3 main)** **Left Gastric** (first, independent) → **Splenic** (left) → **Common Hepatic** (right). Remember: LGS = Left, Gastric, Splenic, Common Hepatic in order of branching. **CHA Branches (Right-sided vessels)** **Right Gastric** + **Gastroduodenal** (→ Right Gastroepiploic). CHA supplies the 'right' side of stomach and duodenum; left side supplied by left gastric and splenic. ## NBE Trap NBE pairs "right gastroepiploic" with "short gastric" in option C to trap students who know the right gastroepiploic is affected but mistakenly believe short gastric vessels are also CHA-dependent. The trap exploits incomplete knowledge of splenic artery branches. ## Clinical Pearl In Indian trauma centers, CHA ligation during damage control hepatectomy for severe liver injury will preserve gastric blood supply via the left gastric and splenic arteries, preventing gastric ischemia—a critical consideration in preventing postoperative complications in hemorrhage control protocols. _Reference: Bailey & Love Ch. 68 (Hepatobiliary Surgery); Robbins Ch. 17 (Vascular anatomy)_