Portacaval Anastomosis

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portacaval anastomosis, anastomosis between portal and systemic circulation. portal hypertension and related clinical conditions.

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Portacaval Anastomosis

  1. 1. General Plan of Blood Circulation PORTAL CIRCULATION Blood is collected from one set of capillaries and is passed to a larger vessel which then again divides into capillaries before the blood is returned to systemic circulation.
  2. 2. Portal Vein Formed by union of (behind the neck of pancreas) 1. Superior Mesenteric Vein 2. Splenic vein Tributaries: 1. Left gastric vein 2. Right gastric vein 3. Cystic veins 4. Posterior superior pancreaticoduodenal vein
  3. 3. Location •Runs almost vertically upwards in the free margin on lesser omentum. •Anteriorly : Pancreas and first part of duodenum. •Posteriorly : Inferior vena cava (but loses contact by entering between two layers of lesser omentum.
  4. 4. •Hepatic Artery and the common bile duct lie in the same plane and in front of the Portal vein.
  5. 5. SITES OF PORTACAVAL ANASTOMOSIS Five sites of portal/systemic circulation : 1. Lower third of the Esophagus 2. Paraumbilical Area 3. Upper end of Anal canal 4. Retroperitonial 5. Bare area of liver
  6. 6. 1. Lower third of the Esophagus : he esophageal branches of the left gastric vein (portal tributaries) T anastomose with the esophageal veins draining the middle third of the esophagus into the azygos veins. (systemic tributaries) 2. Paraumbilical Area They connect the left branch of the portal vein with the superficial veins of the anterior abdominal wall. (systemic tributaries) 3. Anal canal The superior rectal veins (portal tributary) draining the upper half of the anal canal anastomose with the middle and inferior rectal veins (systemic tributaries), which are tributaries of the internal iliac and internal pudendal veins, respectively.
  7. 7. 4. Retroperitonial The veins of the ascending colon, descending colon, duodenum, pancreas, and liver (portal tributary) anastomose with the renal, lumbar, and phrenic veins (systemic tributaries). 5. Bare area of liver There is some anastomosis between portal venous channels in the liver and azygous system of veins above the diaphragm across the bare area of liver.
  8. 8. Five sites of portal/systemic circulation : 1. Lower third of the Esophagus 2. Paraumbilical Area 3. Upper end of Anal canal 4. Retroperitonial 5. Bare area of liver
  9. 9. Portal Hypertension It is defined as increase in blood pressure in the veins of the portal system caused by obstruction in the liver (due to cirrhosis, thrombophlebitis), causing enlargement of collateral veins and splenomegaly. It is caused by : 1. 2. Liver Cirrhosis (Interahepatic) Thrombosis of Portal vein. (Extrahepatic)
  10. 10. Consequences of Portal Hypertension 1. 2. 3. 4. 5. Esophageal varices Caput Medusae Hemorrhoids Ascites Splenomegaly
  11. 11. Esophageal varices •Patient typically presents with Haematemesis & Black tarry stools. •It can be visualized using Esophagogastroduodenoscop y (endoscopy).
  12. 12. Caput Medusae
  13. 13. Hemorrhoids Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus. Hematochezia / fresh blood.
  14. 14. Ascites accumulation of fluid in the peritoneal cavity
  15. 15. Treatment Band Ligation  Sclerotherapy  Portosystemic Shunts  TIPSS (Transjuglar Intrahepatic PortoSystemic  Shunting)
  16. 16. Band Ligation A small band is applied to the base of the varix, stopping the blood supply to it. It will shrink and die within a few days and the shriveled tissue along with the band will fall off during normal peristaltic movements.
  17. 17. Sclerotherapy A solution of Sodium Morrhuate and Ethanolamine oleate is introduced into the varix.
  18. 18. Portosystemic Shunts •A common method for reducing portal hypertension is to divert blood from the portal venous system to the systemic venous system by creating a communication between the hepatic portal vein and the IVC. •Another way of reducing portal pressure is to join the splenic vein to the left renal vein, after splenectomy. (splenorenal anastomosis or shunt)
  19. 19. TIPSS (Transjuglar Intrahepatic PortoSystemic Shunting) • TIPSS is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. • This procedure is done by catheterization Right hepatic vein via internal juglar vein.
  20. 20.  QUESTIONS BETTER DON’T ASK :P

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