Portal hypertension

The Portal Venous System

Definition and Comparison Between Portal and Systemic Venous Systems

Spleen The Portal Venous System The System Venous System 1- It is formed of Portal Vein and Its Tributaries 1- It is formed of I.V.C and Its Tributaries Gall Bladder 2- Drains The Blood of G.I.T 2- Drains Other Body Sites Liver 3- Empties in The Liver 3- Empties in The Heart Liver Stomach 4- Has 2 sets of Capillaries 4- Has One set of Capillaries Portal Vein Spleen 5- The Drained Blood is Loaded with Digested Material 5- Loaded with Waste Products Duodenum Pancreas 6- Developed from Vitelline Veins Pancreas 6- From Cardinal Veins 7- Usually Has No Valve System 7- Usually Has Valve System Small Intestine

Portal Vein

Formation of Portal Vein

Formation of Portal Vein A- Union of: 1- The Superior Mesenteric Vein and 2- The Splenic Vein B- Behind The Neck of Pancreas C- In Front of Inferior Vena Cava D- At The Level of Lower Border of 1st Lumbar Vertebra

Course and Termination of Portal Vein

Porta Hepatis Cystic Vein Drains into The Right Branch of Portal Vein Ligamentum Teres of The Liver Portal Vein Ligamentum Venosum of The Liver Right Branch of Portal vein Left Branch of Portal vein

Tributaries of Portal Vein

2- Superior Mesenteric Vein 5- Para-umbilical Vein 3- Left Gastric Vein 1- Splenic Vein 6- Cystic Vein 4- Right Gastric Vein 2- Superior Mesenteric Vein

Porto-Systemic Anastomosis

a- Para-umbilical Vein and b- Ant. Abdominal Wall Veins 3- At The Umbilicus between a- Para-umbilical Vein and b- Ant. Abdominal Wall Veins 1- At Lower End of Esophagus between a- Esophageal Tributaries of Lt. G. V. and b- Esophageal Tributaries of Azygos 4- Inside The Liver between a- Tributaries of Portal Vein and b- Tributaries of Hepatic Veins 5- At Bare Area of The Liver between a- Twigs of Portal Vein and b- Phrenic Veins on Under-surface of Diaphragm 6- Retro-peritonial between a- Veins of The Gut (Colonic Veins). and b- Veins of Posterior Abdominal Wall (Lumbar Veins) 2- At Lower End of Anal Canal between a- Superior Rectal Vein and b- Middle and Inferior Rectal.

Complications of Opening of Porto-Systemic Anastomoses

Esophageal Varices

Endoscopy of Esophageal Varices Endoscopy of Normal Esophagus

Hemorrhoids (Piles)

Hepatomegaly and Splenomegaly

Hugely Enlarged Spleen Lower Edge of The Spleen

Ascitis

Caput Medusae