hepatic portal vein and portocaval anatomosis
TRANSCRIPT
![Page 1: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/1.jpg)
Hepatic Portal Vein &
Portocaval Anastomosis
Maj Rishi PokhrelAnatomy
NAIHSwww.slideshare.net
![Page 2: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/2.jpg)
How did…
…Devdas die?
![Page 3: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/3.jpg)
Portal system
Usual circulation Portal circulation
![Page 4: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/4.jpg)
Hepatic Portal Vein• Origin & end in capillaries / venous
sinusoids• Size: 8cm X 1 cm• Drains
– Abdominal part of alimentary tract (except lower part of anal canal)
– Spleen & Pancreas• Conveys absorbed products of
digested food to liver• Devoid of valves• Reservoir of blood : 1200 ml / min
![Page 5: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/5.jpg)
Formation– Union of Sup mesenteric & Splenic vein– Between neck of Pancreas & IVC at level L2
![Page 6: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/6.jpg)
Course: Extrahepatic part
• Passes upwards & Rt, behind neck of pancreas & 1st part of duodenum
• Enters rt free margin of lesser omentum in front of epiploic foramen with BD & HA
• Reaches porta hepatis & divides into rt & Lt branches.
![Page 7: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/7.jpg)
– Branches of portal vein– Segmental brs– Brs in Portal canal– Hepatic sinusoids – Central veins – Sublobular veins – Hepatic veins
IVC
Course: Intrahepatic part
![Page 8: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/8.jpg)
Tributaries
![Page 9: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/9.jpg)
Tributaries• Formative
– Sup Mesenteric vein– Splenic vein
• Received by Trunk– Rt & lt Gastric veins– Superior PD vein
• Received by branches – Cystic vein– Paraumbilical veins
• Occasional– Inf mesenteric – Rt gastro-epiploic – Pre-pyloric vein.
![Page 10: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/10.jpg)
Variations
![Page 11: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/11.jpg)
![Page 12: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/12.jpg)
Splenic vein & inferior mesenteric vein open independently into superior mesenteric vein
![Page 13: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/13.jpg)
Inferior mesenteric vein Opens into superiormesenteric vein
![Page 14: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/14.jpg)
Branches
Rt Branch Shorter, wider Receives cystic vein
Lt branch Narrower, longer Runs in Porta hepatis from
Rt to Lt Brs to Caudate & Quadrate lobe Receives Paraumbilical veins
![Page 15: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/15.jpg)
Parts
3
12
• Infraduodenal
• Retroduodenal
• Supraduodenal
![Page 16: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/16.jpg)
Relations• Infra duodenal
– Ant: Neck of Pancreas – Post: IVC
• Retro duodenal– Ant: Duodenum (1st Part), Bile duct, GD artery – Post: IVC
• Supra duodenal : In rt free margin of lesser omentum– Ant : hepatic artery & bile duct– Post: IVC
• Surrounded by Hepatic plexus of nerves, lymphatics & LN
![Page 17: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/17.jpg)
Relations
![Page 18: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/18.jpg)
Portocaval anastomosis
![Page 19: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/19.jpg)
Site Caval Portal Effect in PHTLower end of esophagus
Esophageal tributaries of hemiazygos V
Oesophageal tributaries of Lt gastric V
Oesophageal varices
Umbilicus Veins of AAW Paraumbilical veins (tributaries of Lt br of Portal V)
Caput medusae
Lower end of rectum & Anal canal
Middle & inf rectal Vs
Sup rectal V Anorectal varices, Internal hemorrhoids
![Page 20: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/20.jpg)
Site Caval PortalPost abd wall • Lt renal V
• Veins of Post Abd wall
• Splenic V
• Veins of retroperitoneal organs like duodenum, Asc & Desc colon
Bare area of liver Diaphragmatic veins Hepatic brs of Portal V
Liver Patent Ductus venosus (rare)
Lt br of portal v
Post wall of vagina Vaginal venous plx Sup rectal v
Falciform lig Diaphragmatic v Paraumblical v
![Page 21: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/21.jpg)
• > 12 mm of Hg• Causes :
– Pre hepatic : Thrombosis of portal vein– Hepatic: Cirrhosis– Post hepatic: Budd-Chiari Syndrome
• Effects: Splenomegaly, Ascites, Collateral circulation through sites of Portasystemic anastomosis
Portal hypertension
![Page 22: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/22.jpg)
Internal piles (Hemorrhoids)
![Page 23: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/23.jpg)
Caput Medusae
![Page 24: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/24.jpg)
Esophageal varices
![Page 25: Hepatic Portal vein and portocaval anatomosis](https://reader036.vdocuments.net/reader036/viewer/2022062523/58edee5c1a28abb52e8b4595/html5/thumbnails/25.jpg)
?