Hepatic Portal System-1/7/16 Flashcards
What veins form the portal vein?
Splenic v, Superior mesenteric v, Inferior mesenteric v
The liver is drained by ___ veins
Hepatic
The hepatic portal system runs through the ____ to enter the liver at the porta hepatis
Hepatoduodenal ligament (part of lesser omentum)
Describe the “typical arrangement” of the contents of the Porta Hepatis
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.)
What are the DIRECT tributaries of the portal vein
- Paraumbilical v.
- Cystic v.
- Left Gastric v.
- Right Gastric v.
What are the tributaries of the Splenic vein?
- “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.
What are the tributaries of the Superior Mesenteric v.?
- Jejunal v
- Ileal v
- Ileocolic v
- Right colic v
- Middle colic v
- Right gastro-omental v.
- Pancreaticoduodenal v.
The superior mesenteric v. Joins the ____ vein to form the portal vein posterior to the neck of the pancreas
Splenic
What are the tributaries for the inferior mesenteric v. And what does it drain into?
Left colic v, Superior rectal v, Sigmoidal v
It drains into splenic v or the superior mesenteric v to form the portal vein
Where do esophageal veins normally drain superiorly? Inferiorly?
Superiorly-Into the azygos and hemiazygos system
Inferiorly-Into the left gastric v (and ultimately to the portal v)
Veins from the body & tail of the pancreas drain into the ___ vein
Splenic
The ___ vein drains directly into the portal vein from the gall bladder
Cystic
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 ____
IVC
Common iliac veins join to form the IVC at approximately ___ vertebral level
L5
What is the relationship of the formation of the IVC to the aortic bifurcation?
Formation of IVC is posterior to and inferior to aortic bifurcation and is to the right and parallel to the aorta
What are the main tributaries of the IVC?
Common iliacs
Lumbar (segmental) veins
Renal veins
Hepatic veins
These veins drain into the left renal vein instead of directly into IVC
Left suprarenal v and gonadal veins
Diagram the Portal drainage that leads to Esophageal Varicies
Portal Drainage (normal)=Left gastric v. –> Portal v.
Esophageal varicies=Portal v. –> Left gastric v. –> Esophageal v.
Diagram the Caval drainage of the esophagus
Esophageal v. –> Azygos v. –> SVC
What are clinical signs of esophageal varicies?
Bleeding
Black tarry stools
In the formation of Caput Medusae, blood from the Portal vein takes what course?
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
What is the normal portal drainage of colic veins to retroperitoneal veins?
What is the normal caval drainage of retroperitoneal veins?
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
Rectal varicies may lead to this (clinically)?
Hemorrhoids
A hemorrhoid above the pectinate line will have what type of pain?
Not painful–> receive visceral innervation; Pain is vague and not well localized
A hemorrhoid below the pectinate line will have what type of pain?
Painful hemorrhoids–> receive somatic innervation; Pain is dull or aching
What is the course of veins followed during a TIPS (Transjugular Intrahepatic Portosystemic Shunting) procedure?
Jugular v. –> SVC and IVC –> Hepatic V tributary = liver parenchyma –> Portal V.
Stent placement
What is the normal Portal-Caval Anastomoses?
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
What type of blood does the portal vein drain?
O2-poor, nutrient rich blood from:
A) GI tract
B) lower esophagus to upper anal canal
