Hepatic Portal System

Question 1

What is the purpose of the portal venous system?

Answer 1

Blood from the spleen, pancreas, and all GI organs are shunted to the liver to be filtered for toxins and nutrients and etc before they can be brought to the systemic circulation.

Question 2

WHere does the Hepatic portal system start and end?

Answer 2

Hepatic portal system starts as capillaries in the digestive system and ends as capillaries in the liver.

Question 3

What structure feature of portal vein, which is different from regular veins, that which allows for portal vein to backflow blood which can create varices.

Answer 3

Portal vein is valveless.

Question 4

What are direct tributaries of the portal vein?

Answer 4

1. Paraumbilical vv (anterior wall)
2. L gastric V
3. R. gastric V.
4. Superior mesenteric V.
5. Splenic V.
6. Cystic V.

Question 5

Where does the hepatic portal system form (anatomical location)?

Answer 5

It’s located directly posterior to the neck of the pancreas.

Question 6

In what ligament (mesentery) does the portal vein run to go to the liver?

Answer 6

hepatoduodenal ligament which is part of the lesser omentum.

Question 7

What is the porta hepatis?

Answer 7

A deep fissure on the inferior surface of the liver through which all neurovascular structures (except hepatic veins) and hepatic ducts enter and leave the liver.

Question 8

In what anatomical orientation are you like to find the strucutres in the porta hepatis?

Answer 8

Proper hepatic a (left)
Portal vein (posterior)
Bile duct (right)

Question 9

Name all the tributaries that drain into the superior mesenteric V.

Answer 9

1. Right Colic
2. Middle Colic
3. Ileocolic
4. Right gastroomental
5. Superior/inferior pancreatiocodudenal
6. Ileal
7. Jejunal

Question 10

Name all the tributaries that drain into the Splenic V

Answer 10

1. Inferior Mesenteric V
2. L. gastroomental v
3. Proper splenic V
4. Short gastric V
   5 Pancreatic

Question 11

Name all the tributaries that drain into the inferior mesenteric V.

Answer 11

1. Superior rectal
2. sigmoidal
3. right colic

Question 12

At what vertebral level does the common iliac V join to form IVC?

Answer 12

L5

Question 13

Where does the IVC form in relationship to where the aorta bifurcates.

Answer 13

posterior to and inferior to the aortic bifurcation

Question 14

At what spinal level does the IVC pierces the central tendon of the diaphragm?

Answer 14

T8.

Question 15

What drains the posterior body wall,

Answer 15

Branches off the IVC.

Question 16

What drains the genitourinary system?

Answer 16

Internal iliac vv.

Question 17

What drains the lower limbs?

Answer 17

External iliac vv.

Question 18

In Esophageal Varices, the left gatric vein carries blood to anatamose with what other vein and where does it go from there?

Answer 18

Esophageal V. to azygos V and then superior vena cava.

Question 19

What are clinical signs of esophageal varices?

Answer 19

• bleeding
• black tarry stools
• medical emergency.

Question 20

In what ligament does the paraumbilical veins run in?

Answer 20

falciform ligament.

Question 21

In Caput medusae, what is the caval drainage?

Answer 21

Superficial epigastric veins which empty into the external iliac and then to the IVC.

Question 22

Blood back flows from the superior and inferior mesenteric veins to go to the ascending and descending colon. where does the blood go from there to reach the caval system?

Answer 22

Retroperitoneal veins that drains the posterior body wall (Veins of retzius (lumbar)

Question 23

In rectal varicies via what vein does the blood back flow and where does it go from the rectum to reach the caval system?

Answer 23

Via superior rectal veins to the rectum anastomoses and from there goes through the middle and inferior rectal veins to internal iliac veins to each the caval system.

Question 24

Where is the pectinate line located?

Answer 24

2/3 way down into the anal canal.

Question 25

why is the pectinate line a significant landmark in with relation to rectal hemmorroids?

Answer 25

Above the pectinate line is visceral innervation and so hemorroids will not be painful. Below the pectinate line is somatic innervation and so hemorroids below the pectinate line will be painful.

Question 26

What is the TIIPS procedure?

Answer 26

Transjugular intrahepatic portosystemic shunting. It’s an artifical channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein.