Portal Venous System & Porto-Caval Anastomosis (Tributaries and Clinical Significance) - Anatomy

Content:
Introduction: 0:00
Superior Mesenteric Vein Tributaries: 1:25
Inferior Mesenteric Vein Tributaries: 02:30
Splenic Vein Tributaries: 04:05
Portal Vein Tributaries: 05:15
Porto-Caval Anastomoses: 07:00
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Portal Venous System
- Drain the blood from the unpaired visceral organs (large intestine, small intestine, pancreas, stomach, spleen, gall bladder)
Portal Vein (vena portae hepatis) formed by:
- Superior Mesenteric Vein (vena mesenterica superior)
- Splenic Vein (vena splenica)
- Inferior Mesenteric Vein (vena mesenterica inferior)
Superior Mesenteric Vein:
- Jejunal and ileal veins (venae jejunales et ileales)
- Right Colic Vein (vena colica dextra)
- Ileocolic vein (vena ileocolica)
- Appendicular vein (vena appendicularis)
- Midle colic vein (vena colica media)
- Right gastro-omental vein (vena gastroomentalis dextra)
Inferior Mesenteric Vein:
- Opens into either the Splenic Vein, Superior mesenteric or the portal vein
- Superior Rectal Vein (vena rectalis superior)
- Sigmoid vein (vena sigmoideae)
- Left Colic Vein (vena colica sinistra)
Splenic Vein
- Starts from the Splenic Hilum
- Left Gastro-omental vein (vena gastroomentalis sinstra)
- Short gastric Veins (venae gastricae breves)
- Pancreatic Veins (venae pancreaticae)
Portal Vein
- Left Gastric Vein (vena gastrica sinistra)
- Oesophageal Veins (venae oesophageae)
- Right gastric Vein (vena gastrica sinistra)
- Prepyloric Vein (vena prepylorica)
- Pancreaticoduodenal Veins (venae pancreaticoduodenales)
- Cystic Vein (vena cystica)
- Paraumbillical veins (venae paraumbilicales)
Porto-Caval Anastomoses
- System that connects the portal system with the caval system
- Causes of portal hypertension:
○ Hepatic Causes (alcoholic liver damage, nonalcoholic fatty liver disease, Hepatitis C infection, other metabolic causes) lead to liver cirrhosis
○ Pre-haptic causes (Portal vein thrombosis or tumor)
○ Post-hepatic causes (Right-sided heart failure)
- Anastomoses between the oesophageal veins
○ Through Azygos and Hemiazygos veins which empty into superior vena cava
○ Increased pressure in the portal system leads to Esophageal Varices
- Anastomoses in the rectum
○ Through superior rectal vein
○ Middle rectal vein, which drains into the internal iliac
○ Inferior rectal vein, which drains into the internal pudendal vein
○ An increase in portal pressure may lead to internal hemorrhoids
- Anastomoses between the paraumbilical veins and the subcutaneous veins around the umbilicus
○ Lead to caput medusae (name originate from medusa)
○ Anastomoses happen between the thoraco-epigastric veins, superficial epigastric veins, and the paraumbilical veins
- Increased portal pressure also leads to ascites (water in the peritoneal space)

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