Hepatic portal vein

&portal

hypertension Submitted by: jyoti Group: 21 Semester: 7th

How did…

…Devdas die?

Portal system

Portal circulationThe portal vein is a blood vessel that carries all the deoxygenated blood and nutrients from GIT and spleen to liver.

Hepatic Portal Vein Origin & end in capillaries / venous

sinusoids

Size: 8cm X 1 cm

Diameter 0.8 to 0.9

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

Formation Union of Sup mesenteric & Splenic vein Between neck of Pancreas & IVC at level L2

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.

Course: Intrahepatic part Branches of portal vein

Segmental brs

Brs in Portal canal

Hepatic sinusoids Central veins

Sublobular veins

Hepatic veins

IVC

Tributaries

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.

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

Parts

3

12

• Infraduodenal• Retroduodenal• Supraduodenal

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

Relations

Portocaval anastomosis

The portal venous system have several anastomosis with systemic venous system. In case of portal hypertension these anastomosis may become engorged , dilated or rupture.

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

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

> 12 mm of Hg Causes :

Pre hepatic : Thrombosis of portal vein, congenital atresia

Hepatic: Cirrhosis, hepatic fibrosis: wilsons disease, congenital fibrosis and hemochromatosis.

Post hepatic: liver to right side of heart. Hepatic vein thrombosis, IVC thrombosis, congenital malformation of IVC, constrictive pericarditis.

Effects: Splenomegaly, Ascites, Collateral circulation through sites of Portasystemic anastomosis

Portal hypertension

Signs and symptoms

Ascites Splenomegaly Thrombocytopenia Hepatic encephalo[athy Anastmosis: esophageal varices (bleedings) gastric varices anorectal varices caput medusa(around umbilicus)

Internal piles (Hemorrhoids)

Caput Medusae

Esophageal varices

MANAGEMENT

HEMORRHAGES : selective beta blockers ASCITES: diuretics(spironolactone) Antibiotics:vancomycin TIPS PROCEDURE: TRANSJUGULAR INTRAHEPATICPORTAL SYSTEMIC SHUNT artificial channel within the liver establishing communication between portal vein and hepatic vein