Hepatic Portal System-1/7/16

Question 1

What veins form the portal vein?

Answer 1

Splenic v, Superior mesenteric v, Inferior mesenteric v

Question 2

The liver is drained by ___ veins

Answer 2

Hepatic

Question 3

The hepatic portal system runs through the ____ to enter the liver at the porta hepatis

Answer 3

Hepatoduodenal ligament (part of lesser omentum)

Question 4

Describe the “typical arrangement” of the contents of the Porta Hepatis

Answer 4

Proper hepatic a-Left (sort of middle but anterior to Portal v.)

Portal v-Posterior

Bile duct-Right and anterior (in front of Proper Hepatic a.)

Question 5

What are the DIRECT tributaries of the portal vein

Answer 5

• Paraumbilical v.
• Cystic v.
• Left Gastric v.
• Right Gastric v.

Question 6

What are the tributaries of the Splenic vein?

Answer 6

• “Proper” splenic v.
• Short gastric v.
• Left gastro-omental v.
• Pancreatic v.
• Inferior mesenteric v. Which receives: left colic v., sigmoid v., superior rectal v.

Question 7

What are the tributaries of the Superior Mesenteric v.?

Answer 7

• Jejunal v
• Ileal v
• Ileocolic v
• Right colic v
• Middle colic v
• Right gastro-omental v.
• Pancreaticoduodenal v.

Question 8

The superior mesenteric v. Joins the ____ vein to form the portal vein posterior to the neck of the pancreas

Answer 8

Splenic

Question 9

What are the tributaries for the inferior mesenteric v. And what does it drain into?

Answer 9

Left colic v, Superior rectal v, Sigmoidal v

It drains into splenic v or the superior mesenteric v to form the portal vein

Question 10

Where do esophageal veins normally drain superiorly? Inferiorly?

Answer 10

Superiorly-Into the azygos and hemiazygos system

Inferiorly-Into the left gastric v (and ultimately to the portal v)

Question 11

Veins from the body & tail of the pancreas drain into the ___ vein

Answer 11

Splenic

Question 12

The ___ vein drains directly into the portal vein from the gall bladder

Answer 12

Cystic

Question 13

Veins draining structures related to the posterior abdominal wall (organs of the genitourinary system and posterior abdominal wall muscles) and from the liver drain into the ____

Answer 13

IVC

Question 14

Common iliac veins join to form the IVC at approximately ___ vertebral level

Answer 14

L5

Question 15

What is the relationship of the formation of the IVC to the aortic bifurcation?

Answer 15

Formation of IVC is posterior to and inferior to aortic bifurcation and is to the right and parallel to the aorta

Question 16

What are the main tributaries of the IVC?

Answer 16

Common iliacs
Lumbar (segmental) veins
Renal veins
Hepatic veins

Question 17

These veins drain into the left renal vein instead of directly into IVC

Answer 17

Left suprarenal v and gonadal veins

Question 18

Diagram the Portal drainage that leads to Esophageal Varicies

Answer 18

Portal Drainage (normal)=Left gastric v. –> Portal v.

Esophageal varicies=Portal v. –> Left gastric v. –> Esophageal v.

Question 19

Diagram the Caval drainage of the esophagus

Answer 19

Esophageal v. –> Azygos v. –> SVC

Question 20

What are clinical signs of esophageal varicies?

Answer 20

Bleeding

Black tarry stools

Question 21

In the formation of Caput Medusae, blood from the Portal vein takes what course?

Answer 21

Portal drainage= Portal vein –> Paraumbilical v to the umbilicus

Caval drainage=Superficial epigastric veins; Inferior epigastric and superficial epigastric veins of anterior abdominal wall empty into external iliac and femoral veins

Question 22

What is the normal portal drainage of colic veins to retroperitoneal veins?

What is the normal caval drainage of retroperitoneal veins?

Answer 22

Portal drainage- Veins draining ascending colon (superior mesenteric v.) and descending colon (inferior mesenteric v.)

Caval drainage-Retroperitoneal veins that drain the posterior body wall (Veins of Retzius)-> Veins of Retzius drain into lumbar veins which in turn drain into the IVC

Question 23

Rectal varicies may lead to this (clinically)?

Answer 23

Hemorrhoids

Question 24

A hemorrhoid above the pectinate line will have what type of pain?

Answer 24

Not painful–> receive visceral innervation; Pain is vague and not well localized

Question 25

A hemorrhoid below the pectinate line will have what type of pain?

Answer 25

Painful hemorrhoids–> receive somatic innervation; Pain is dull or aching

Question 26

What is the course of veins followed during a TIPS (Transjugular Intrahepatic Portosystemic Shunting) procedure?

Answer 26

Jugular v. –> SVC and IVC –> Hepatic V tributary = liver parenchyma –> Portal V.

Stent placement

Question 27

What is the normal Portal-Caval Anastomoses?

Answer 27

Normal flow=Portal v. & Hepatic a. —> sinusoids of liver —> hepatic v. —> IVC

This system is functionally valveless

Obstruction (i.e., cirrhosis) causes portal hypertension, often with ascites

Question 28

What type of blood does the portal vein drain?

Answer 28

O2-poor, nutrient rich blood from:
A) GI tract
B) lower esophagus to upper anal canal