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Hepatic Portal vein and portocaval anatomosis

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anatomy of hepatic portal vein

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Hepatic Portal vein and portocaval anatomosis

  1. 1. www.slideshare.net
  2. 2. How did… …Devdas die?
  3. 3. Portal system Usual circulation Portal circulation
  4. 4. 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
  5. 5. Formation – Union of Sup mesenteric & Splenic vein – Between neck of Pancreas & IVC at level L2
  6. 6. 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.
  7. 7. – Branches of portal vein – Segmental brs – Brs in Portal canal – Hepatic sinusoids – Central veins – Sublobular veins – Hepatic veins IVC Course: Intrahepatic part
  8. 8. Tributaries
  9. 9. 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.
  10. 10. Variations
  11. 11. Splenic vein & inferior mesenteric vein open independently into superior mesenteric vein
  12. 12. Inferior mesenteric vein Opens into superior mesenteric vein
  13. 13. 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
  14. 14. Parts 3 1 2 • Infraduodenal • Retroduodenal • Supraduodenal
  15. 15. 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
  16. 16. Relations
  17. 17. Portocaval anastomosis
  18. 18. Site Caval Portal Effect in PHT Lower 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
  19. 19. Site Caval Portal Post 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
  20. 20. • > 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
  21. 21. Internal piles (Hemorrhoids)
  22. 22. Caput Medusae
  23. 23. Esophageal varices

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