Portal Caval Anastomoses Flashcards
What forms the portal vein?
What are 2 special characteristics of it?
Splenic vein, SMV, IMV
2 inches long, valveless
Where does the hepatic portal system form anatomically?
Posterior to the neck of the pancreas
Where does the hepatic portal system enter the liver?
Through what?
Porta hepatis (does not include hepatic vein)
Hepatoduodenal ligament
What are the direct tributaries to the portal vein?
Paraumbilical vein
Cystic vein
R and L gastric veins
What are the tributaries to the splenic vein?
Proper splenic vein
Pancreatic vein
short gastric veins
Left gastro-omental v
What are the tributaries to the SMV?
Right gastro-omental vein Pancreaticoduodenal v. Middle colic v Right colic v Jejunal v Ileal v
What are the tributes to the IMV?
Left colic v
Sigmoid v
Superior Rectal v
Where do posterior structures like the kidneys drain to?
IVC
What veins drain the liver?
What do these veins form?
R, M, L hepatic veins
IVC
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?
L5
Parallel and to the right
T8
What are the main tributaries to the IVC?
Common iliacs
Lumbar veins
Renal veins
Hepatic veins
What veins contribute to the IVC at the level of T8?
R and L inferior phrenic v
What veins contribute to the IVC at L1 on the right side?
R suprarenal v
R renal v
R gonadal v
What vein directly contributes to the IVC on the left side at L1?
Left renal v.
L gonadal and suprarenal veins drain to the left renal vein
What is portal HTN?
The pressure in the portal system is unusually high compared to the systemic circulation
What vein drains directly to the portal in the esophageal area?
What does this vein drain to?
Left gastric v
Esophageal veins
What does the esophageal vein drain to?
Azygos vein and then to the SVC
What are the clinical signs of esophageal varicies?
Bleeding
Black tarry stools
Medical emergency
What is the portal drainage of caput medusae?
Caval drainage?
Paraumbilical veins in the falciform ligament
Superior and inferior epigastric veins that will empty into the external iliac and femoral veins
What is the portal drainage of rectal varicies?
Caval drainage?
Superior rectal veins
Middle and inferior rectal veins empty into internal iliac veins which empty into the common iliac veins
Clinical sign of rectal varicies?
Hemorrhoids
Veins prolapse through rectum and are painless above Pectinate line
What is the TIPS procedure?
Transjugular intrahepatic portosystemic shunting
Stent placed between portal vein and hepatic veins
What is the portal drainage of colic veins to Retroperitoneal veins?
Caval drainage?
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
Veins draining the liver are characterized as what?
Intersegmental
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?
Spleen, pancreas, all GI organs
IVC
O2 poor, nutrient rich
