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GI Midterm > Lecture 8-Hepatic Portal System > Flashcards

Lecture 8-Hepatic Portal System Flashcards

1
Q

Portal venous system drains blood from?

A
  • Portal venous system drains blood from the spleen, pancreas, and all GI organs between distal esophagus and rectum
    • Then the blood is shunted through the liver where it is filtered and then returned to the heart via the IVC
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2
Q

2 main characteristics of the blood in the hepatic portal vein?

A

O2 poor, nutrient rich

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3
Q

Why is the blood filtered?

A

Do not want toxins to enter your blood stream directly so after GI absorption they are put into the liver to be filtered

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4
Q

Caval (systemic) system?

A

Blood from the rest of the body is transferred by systemic veins
-This system directs blood to the heart through the SVC and IVC

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5
Q

Portacaval anastomoses

-What are they?

A

Areas in the body where the portal and systemic circulations are connected
-However, little blood is transferred since the pressures in each are equal

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6
Q

Portacaval anastomoses

-Examples?

A

Esophagus, umbilicus, and rectum

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7
Q

Hepatic portal system

  • Starts as?
  • Ends as?
A
  • Starts as capillaries in the digestive system

- Ends as capillaries in the liver

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8
Q

Hepatic portal vein-MAIN characteristic?

A

VALVELESS

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9
Q

Hepatic portal vein-Function?

A

Brings the blood from GI organs to liver to be filtered (liver is drained by hepatic veins)

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10
Q

Portal vein

-Formed by?

A

-Splenic vein
-Superior mesenteric vein
-Inferior mesenteric vein
(Enters either the superior mesenteric vein or the splenic vein)

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11
Q

Hepatic portal system

-Where does it form?

A

Posterior to the neck of the pancreas

Ends as right and left branches in the liver

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12
Q

Portal triad-3 components and their “typical arrangement?

A
  • Proper hepatic a-left
  • Portal vein-posterior
  • Bile duct-right
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13
Q

The portal triad is surrounded by?

A

The hepatoduodenal ligament (part of the lesser omentum)

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14
Q

Porta hepatis

-What is it?

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

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15
Q

Direct tributaries of the portal vein?

A
  • Paraumbilical vv (anterior wall)
  • Cystic v
  • Left gastric
  • Right gastric
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16
Q

Direct tributaries of the splenic vein?

A
  • Splenic vein (proper)
  • Short gastric vv
  • Left gastro-omental v
  • Pancreatic vv
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17
Q

Direct tributaries of the superior mesenteric vein?

A
  • Right gastro-omental v

- Pancreaticoduodenal vv

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18
Q

Superior mesenteric vein

-Relationship with SMA?

A
  • Parallels the superior mesenteric a on the right

- Tributaries drain the same parts of the small and large intestines supplied by the branches of the SMA

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19
Q

Superior mesenteric vein

-Joins the splenic vein to form?

A

Joins the splenic vein to form the portal vein posterior to the neck of the pancreas

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20
Q

Superior mesenteric vein

-Tributes?

A
  • Intestinal vv-jejunal and ileal vv
  • Ileocolic v-cecal and appendicular v
  • Right colic
  • Middle colic
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21
Q

Inferior mesenteric vein

-Tributaries drain?

A

The same parts of the large intestine that were supplied by branches of the inferior mesenteric artery

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22
Q

Inferior mesenteric vein

-Formed by?

A

The superior rectal vein drains superiorly to join branches of the left colic veins

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23
Q

Inferior mesenteric vein joins the splenic or SMV to form?

A

The portal vein

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24
Q

Inferior mesenteric vein

-Tributes?

A
  • Left colic v
  • Sigmoid v
  • Superior rectal v
25
Q

Veins of the stomach and esophagus

-Blood drains superiorly into?

A

The azygous system

26
Q

Veins of the stomach and esophagus

-Blood drains inferiorly into?

A

Blood drains inferiorly into the portal system

27
Q

Veins from GI tract normally drain into?

A

Portal vein (directly or indirectly)

28
Q

Veins from posterior structures, such as kidneys, drain into?

A

IVC

29
Q

Inferior Vena Cava

  • Veins that join to form IVC? Where do they join?
  • Location relative to aortic bifurcation?
A
  • Common iliac veins join to form IVC at L5

- Formation is posterior to and inferior the aortic bifurcation

30
Q

Where is the IVC relative to the aorta?

A

The IVC lies to the right of the aorta

31
Q

Inferior vena cava

-Drains the posterior body wall?

A
  • Posterior body wall muscles
  • Genitourinary system
  • Lower limbs
32
Q

Inferior vena cava

-Posterior body wall-genitourinary system is drained by?

A

Internal iliac veins

33
Q

Inferior vena cava

-Posterior body wall-lower limbs are drained by?

A

External iliac veins

34
Q

Inferior vena cava

-Main tributaries?

A
  • Common iliacs
  • Lumbar (segmental) veins
  • Renal veins
  • Hepatic veins
  • RIGHT gonadal and suprarenal veins (not left)
35
Q

Where do the left gonadal and suprarenal veins drain into?

A

Enter the left renal vein which goes into IVC

36
Q

Portal hypertension

A

Pressure in the portal system is unusually high compared to the systemic circulation

37
Q

Portal hypertension-How is it related to liver failure (cirrhosis)?

A

Makes blood flow through the liver more difficult

38
Q

Varicies

  • what are they?
  • pneumonic?
A

Weakened sections of veins from being stretched and thin from backflow of portal blood into small systemic veins
-Gut, butt, caput

39
Q

Portal-caval ‘Anastomoses’

-4 main ways for blood to bypass the liver?

A
  • Esophageal varicies
  • Caput medusae
  • Colic veins to retroperitoneal veins
  • Rectal varicies
40
Q

Portal-caval ‘anastomoses’

  • What happens in liver cirrhosis-Blood can’t get into the liver so?
    • How is this possible?
A
  • Blood flows back through the portal system and through the interconnections with the IVC to return to the heart
  • Possible because the portal system does not have valves
41
Q

Portal-caval ‘anastomoses’

-The back up of blood in the systemic system causes?

A

Varicosities

42
Q

Esophageal varicies

-Esophageal branches of? Connect with?

A

-Esophageal branches of left gastric vein connect with veins on lower thoracic esophagus

43
Q

Esophageal varicies

-Portal drainage?

A

Left gastric–>portal vein

44
Q

Esophageal varicies

-Systemic drainage?

A

Esophageal v.–>Azygos v–>SVC

45
Q

Esophageal varicies

-Clinical signs?

A
  • Bleeding
  • Black tarry stools
  • Medical emergency
46
Q

Caput medusae

-Portal drainage?

A

-Paraumbilical veins (in falciform ligament)

47
Q

Caput medusae

-Systemic drainage?

A

Superficial epigastric veins-inferior epigastric and superficial epigastric veins of the anterior abdominal wall empty into the external iliac and femoral veins

48
Q

Colic veins to retroperitoneal veins

-Portal drainage?

A

Veins draining the ascending colon (SMV) and descending colon (IMV)

49
Q

Colic veins to retroperitoneal veins

-Systemic drainage?

A

Retroperitoneal veins that drain the posterior body wall

-The veins of Retzius drain into lumbar veins which in turn drain into the IVC

50
Q

Rectal varicies

-Portal drainage?

A

Superior rectal veins

51
Q

Rectal varicies

-Caval drainage?

A

Middle and inferior rectal veins

Middle/inferior rectal veins–>internal iliac veins–>common iliac veins

52
Q

Rectal varicies

-Clinical sign?

A

Hemorrhoids-veins prolapse through rectum

53
Q

Rectal varicies

-Clinical sign-hemorrhoids-why are they painless?

A

Happens in upper 2/3 of anal canal-visceral innervation

54
Q

Pectinate line

  • Above pectinate line
    • which part of anal canal?
    • Innervation?
A
  • Upper 2/3 of anal canal

- Visceral innervation (not painful)

55
Q

Visceral pain

A
  • Internal organs damaged
  • Caused by activation of pain receptors in chest, abdomen, or pelvis
  • Pain is vague and not well localized
56
Q

Pectinate line

  • Below pectinate line
    • Which part of anal canal?
    • Innervation?
A
  • Lower 1/3 of anal canal

- Somatic innervation (painful)

57
Q

Somatic pain

A
  • Body surface or msk tissues damaged

- Pain is dull or aching

58
Q

TIPS procedure

  • Route to take to get to portal vein?
  • What do you do once you get to the portal vein?
A

Jugular vein–>SVC and IVC–> hepatic vein tributary = liver parenchyma–>portal vein
-Put stent in portal vein to allow blood to flow through the liver normally instead of flowing backward

59
Q

Review the picture on slide 23!!

A

SLIDE 23

GI Midterm (11 decks)

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