Hepatic and portal circulation

Question 1

Coeliac trunk spinal level

Answer 1

T12/L1

Question 2

SMA spinal level

Answer 2

L1

Question 3

IMA spinal level

Answer 3

L3

Question 4

Divisions of coeliac artery

Answer 4

Hepatic artery, left gastric artery, splenic artery

Question 5

Gastro-duodenal artery divisions

Answer 5

R gastro-epiploic artery - this anastomoses with L gastro-epipoloic at lesser curvature

Question 6

Common hepatic artery divisions

Answer 6

Middle, left and right hepatic arteries -> liver

Question 7

What is the arc of Riolan

Answer 7

Anastomoses between SMA and IMA

Question 8

Blood supply to pancreas

Answer 8

Splenic artery

Question 9

SMV drainage

Answer 9

Right bowel, small bowel and pancreas areas

Question 10

IMV drainage

Answer 10

Left colon

Question 11

Splenic vein drainage

Answer 11

Stomach and pancreas

Question 12

gastric vein drainage

Answer 12

Stomach and gall bladder

Question 13

Foetal circulation

Answer 13

Baby received blood from umbilical vein (blood is oxygenated)

Ductus venosus shunts to IVC from liver

RA to LA via foramen ovale

Babies have massive head because so much blood diverted here

Ductus arteriosus between pulmonary artery and aorta

Question 14

Causes of portal hypertension

Answer 14

Sinusoid obstruction

Question 15

Why do varices occur?

Answer 15

Portal hypertension means blood will now use middle and inferior rectal veins instead of superior

Question 16

oesophageal varices

Answer 16

Blood now uses azygos veins instead of left gastric veins

Question 17

Umbilical anastomoses

Answer 17

Caput medusa sign

Blood now uses superficial epigastric veins instead of paraumbilical veins

Question 18

TIPS procedure

Answer 18

using a guide wire, the stent is passed via a vein in the neck into the hepatic vein and then through the liver into the portal vein