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MD3002 - GI Anatomy > Spleen and the portal venous system > Flashcards

Spleen and the portal venous system Flashcards

1
Q

What is the spleen?

A

Largest lymphoid organ

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2
Q

Where is the spleen located?

A
  • In the adult, lies just posterior to the stomach, against the diaphragm and between ribs 8(9)-11 on the left side
  • Its long axis is along the 10th rib
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3
Q

What are the functions of the spleen?

A
  • Removal of blood-borne antigens
  • Removal and destruction of aged or defective blood cells
  • Haematopoiesis in the foetus (® 5 months IU)
  • Storing blood platelets
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4
Q

What is the spleen surrounded by?

A
  • Intraperitoneal except hilum
  • Surrounded by a fibrous capsule from which trabeculae extend inward
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5
Q

What is the spleen related to?

A

colon (left colic flexure), stomach and left kidney

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6
Q

Describe the superior border of the spleen

A

notched

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7
Q

How is the spleen connected to the stomach?

A

Connected to the stomach by the gastrosplenic (gastrolienal) ligament

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8
Q

What is contained within the gastrosplenic ligament?

A
  • Contains the left gastroepiploic and short gastric vessels
  • May contain accessory spleen
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9
Q

What is the spleen connected to the abdominal wall by?

A

Connected to the posterior abdominal wall by the splenorenal (lienorenal) ligament

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10
Q

What does the splenorenal ligament contain?

A

Contains the splenic vessels and the tail of pancreas

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11
Q
A

red = gastrosplenic

green = splenorenal

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12
Q

What is the arterial supply of the spleen?

A
  • Splenic artery runs along the upper border of the pancreas
  • Divides into its branches that enter the spleen at its hilum
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13
Q

What is the venous drainge of the spleen?

A
  • Splenic vein runs along the tail and body of pancreas
  • Receives short gastric and left gastroepiploic veins
  • Behind the neck of the pancreas, joins the superior mesenteric vein to form the hepatic portal vein
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14
Q

What is the lymphatic drainage of the spleen?

A

Splenic hilar lymph nodes → pancreatic-splenic nodes → coeliac nodes

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15
Q

What is the nerve supply of the spleen?

A
  • The nerves accompany the splenic artery
  • Sympathetic from T5-9 ⇒ coeliac plexus
  • Parasympathetic from vagus
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16
Q

What can lead to spleen rupture and what is the consequence of this?

A
  • Because the capsule of the spleen is relatively thin, physical injury (rib fractures, trauma) or a serious infection may cause the spleen to rupture
  • Causing considerable intraperitoneal haemorrhage
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17
Q

What are the main methods of managing spleen injury

A

Splenectomy used to be the expected management but nowadays angiography and embolization may be the preferred management along with observation and masterly inactivity

18
Q

Can you live without a spleen?

A

A person can live a relatively healthy life without a spleen, because macrophages in the bone marrow and liver can take over most of the spleen’s functions. Such a person will be more susceptible to infections

19
Q

What does the hepatic portal system carry?

A

Carries 70% of the blood to the liver

20
Q

What does the hepatic portal system drain?

A

Hepatic portal vein drains venous blood between the lower third of the oesophagus and distal half of the anal canal as well as the spleen, pancreas and gall bladder

21
Q

Where is the hepatic portal system formed?

A

Formed posterior to the neck of the pancreas by the union of the splenic and superior mesenteric arteries

22
Q

Where does the does the hepatic portal vein run?

A
  • Cross the 1st (superior) part of the duodenum and enters the lesser omentum
  • Runs cranially in the hepatoduodenal ligament towards the porta hepatis
  • Divides into right and left terminal branches
  • Neither hepatic portal vein nor its tributaries have valves inside
  • The portal vein enters the livers and its branches supply the sinusoids from which blood passes into the central veins → hepatic veins that drain into the inferior vena cava
23
Q

What occurs in the sinusoids?

A

In the sinusoids the portal venous blood mixes with oxygenated blood from the hepatic artery proper

24
Q

Where are the 4 porto-systemic anastomoses?

A
  • lower third of oesophagus
  • halfway down the anal canal
  • around the umbilicus
  • posterior abdominal wall
25
Q
A

red = hepatic artery proper

green = central veins

blue = portal vein

26
Q

Desribe the anastomoses at the lower third of oesophagus

A
  • the oesophageal branches of the left gastric vein (portal vein)
  • oesophageal veins draining the middle third of the oesophagus (the azygos veins  superior vena cava)
    • Oesophageal varices
27
Q

Describe the porto-systemic anastomoses halfway down the anal canal

A
  • The superior rectal vein draining the upper half of the anal canal (portal vein)
  • The middle and inferior rectal veins (internal iliac and internal pudendal veins ⇒ inferior vena cava)
    • Haemorrhoids (piles)
28
Q

Describe the porto-systemic anastomoses around the umbilicus

A
  • Para-umbilical veins (left branch of the portal vein)
  • Epigastric veins (femoral, external iliac, internal thoracic and axillary veins ⇒ inferior and superior vena cava)
    • Caput medusae
29
Q

Describe the porto-systemic anastomoses on the posterior abdomimal wall

A
  • Veins of secondarily retroperitoneal organs (including bare area of liver)(portal vein)
  • Veins of body wall (systemic veins)
30
Q

What occurs when the hepatic portal vein is diminished or bloacked?

A
  • blood will be shunted to the systemic veins via collateral veins
  • Veins will be dilated at sites of porto-systemic anastomoses
31
Q

What are the prehepatic causes of portal hypertension?

A
  • portal vein thrombosis
  • splenic vein thrombosis
32
Q

What are the hepatic causes of portal hypertension?

A
  • hepatic tumours (benign, malignant and metastatic)
  • cirrhosis (alcohol abuse, hepatitis)
  • Parasitic infection (schistomiasis)
33
Q

What are the post hepatic causes of portal hypertension?

A
  • cardiac disease (tricuspid stensosi, restictire cardiomyopathy, contstrive percarditis)
  • hepatic vein thrombosis
  • inferior vena cava thrombosis
34
Q

Describe the course of the abdominal aorta

A
  • Begins at the aortic hiatus of the diaphragm at T12 (in the midline)
  • Lies on vertebral column and descends to the level of L4
  • Bifurcates into common iliac arteries (slightly left of the midline)
35
Q

What are the visceral branches of the abdominal aorta?

A

o Coeliac trunk (L1)

o Middle suprarenal arteries

o Superior mesenteric artery (L1)

o Renal arteries (L1/2disk)

o Testicular or ovarian arteries (L2)

o Inferior mesenteric artery(L3)

36
Q

What are the parietal branches of the abdominal aorta?

A

o Inferior phrenic arteries

o 4x Lumbar arteries

o Median sacral artery

37
Q

Describe the course of the inferior vena cava

A
  • Retroperitoneal
  • Conveys blood from the body below the diaphragm to the right atrium of the heart
  • Formed by the union of the common iliac veins behind the right common iliac artery at the level of L5
  • Ascends on the right side of the aorta piercing the central tendon of the diaphragm at T8
38
Q

What does the IVC recieve?

A

o Hepatic veins

o Right inferior phrenic vein

o Right suprarenal vein (left vein drains into the left renal vein or left inferior phrenic vein)

o Both renal veins

o Right gonadal vein (left vein drains into the left renal vein)

o Lumbar veins

39
Q

What are the veins of origin of the IVC?

A

2 common iliac veins & the median sacral vein

40
Q

Describe the drainage of the lumbar veins

A

1st-2nd lumbar veins drain both into inferior vena cava and the ascending lumbar veins ⇒ azygos and hemiazygos

MD3002 - GI Anatomy (11 decks)

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