Portal Caval Anastomoses

Question 1

What forms the portal vein?

What are 2 special characteristics of it?

Answer 1

Splenic vein, SMV, IMV

2 inches long, valveless

Question 2

Where does the hepatic portal system form anatomically?

Answer 2

Posterior to the neck of the pancreas

Question 3

Where does the hepatic portal system enter the liver?

Through what?

Answer 3

Porta hepatis (does not include hepatic vein)

Hepatoduodenal ligament

Question 4

What are the direct tributaries to the portal vein?

Answer 4

Paraumbilical vein
Cystic vein
R and L gastric veins

Question 5

What are the tributaries to the splenic vein?

Answer 5

Proper splenic vein
Pancreatic vein
short gastric veins
Left gastro-omental v

Question 6

What are the tributaries to the SMV?

Answer 6

Right gastro-omental vein
Pancreaticoduodenal v.
Middle colic v
Right colic v
Jejunal v
Ileal v

Question 7

What are the tributes to the IMV?

Answer 7

Left colic v
Sigmoid v
Superior Rectal v

Question 8

Where do posterior structures like the kidneys drain to?

Answer 8

IVC

Question 9

What veins drain the liver?

What do these veins form?

Answer 9

R, M, L hepatic veins

IVC

Question 10

Where do the common iliac veins join to form IVC?

Where does the IVC lie in relation to the aorta?

Where does it pierce the central tendon of the diaphragm?

Answer 10

L5

Parallel and to the right

T8

Question 11

What are the main tributaries to the IVC?

Answer 11

Common iliacs
Lumbar veins
Renal veins
Hepatic veins

Question 12

What veins contribute to the IVC at the level of T8?

Answer 12

R and L inferior phrenic v

Question 13

What veins contribute to the IVC at L1 on the right side?

Answer 13

R suprarenal v
R renal v
R gonadal v

Question 14

What vein directly contributes to the IVC on the left side at L1?

Answer 14

Left renal v.

L gonadal and suprarenal veins drain to the left renal vein

Question 15

What is portal HTN?

Answer 15

The pressure in the portal system is unusually high compared to the systemic circulation

Question 16

What vein drains directly to the portal in the esophageal area?

What does this vein drain to?

Answer 16

Left gastric v

Esophageal veins

Question 17

What does the esophageal vein drain to?

Answer 17

Azygos vein and then to the SVC

Question 18

What are the clinical signs of esophageal varicies?

Answer 18

Bleeding
Black tarry stools
Medical emergency

Question 19

What is the portal drainage of caput medusae?

Caval drainage?

Answer 19

Paraumbilical veins in the falciform ligament

Superior and inferior epigastric veins that will empty into the external iliac and femoral veins

Question 20

What is the portal drainage of rectal varicies?

Caval drainage?

Answer 20

Superior rectal veins

Middle and inferior rectal veins empty into internal iliac veins which empty into the common iliac veins

Question 21

Clinical sign of rectal varicies?

Answer 21

Hemorrhoids

Veins prolapse through rectum and are painless above Pectinate line

Question 22

What is the TIPS procedure?

Answer 22

Transjugular intrahepatic portosystemic shunting

Stent placed between portal vein and hepatic veins

Question 23

What is the portal drainage of colic veins to Retroperitoneal veins?

Caval drainage?

Answer 23

SMV drains asc. Colon and IMV drains desc. Colon

Retroperitoneal veins that drain the posterior body wall (veins of Retzius and lumbar veins)
Retroperitoneal veins are veins like the renal, suprarenal, gonadal, and paravertebral veins

Question 24

Veins draining the liver are characterized as what?

Answer 24

Intersegmental

Question 25

What does the portal venous system drain?

After blood is filtered by the liver it is returned to the heart via what?

What are the characteristics of the blood?

Answer 25

Spleen, pancreas, all GI organs

IVC

O2 poor, nutrient rich