inferior vena cava, PORTAL VENOUS SYSTEM

• Inferior vena cava


  • Anterior visceral
  • Lateral visceral
  • Lateral abdominal
  • Veins of origin
• Anterior visceral


  • R/L hepatic
• Lateral visceral


  • R suprarenal
  • R/L renal
  • R gonadal
• Lateral abdominal


  • Inferior phrenic
  • Lumbar
• Veins of origin


  • R/L common iliac
  • Median sacral
• Portal venous system tributaries

  • Superior mesenteric
  • Splenic
  • Inferior mesenteric
  • Left gastric
  • Paraumbilical
• Portal hypertension


  • Frequently accompanied by congestive enlargement of the spleen
• Portal-caval shunts


  1. Anastomosis of the portal vein to the anterior wall of the IVC behind the entrance into the lesser sac

  2. Splenic vein may be anastomosed to the left renal vein after removing the spleen
• Normal route (PORTAL-CAVAL ANASTOMOSES)

  portal vein → liver → hepatic vein → IVC
• If blocked(PORTAL-CAVAL ANASTOMOSES)

  1. GASTROESOPHAGEAL ANASTOMOSIS

  2. ANORECTAL ANASTOMOSIS

  3. PARAUMBILICAL ANASTOMOSIS

  4. RETROPERITONEAL ANASTOMOSIS
• GASTROESOPHAGEAL ANASTOMOSIS


  Esophageal branch of L gastric = Esophageal of Azygos
• ANORECTAL ANASTOMOSIS


  Superior rectal = Middle and Inferior rectal
• PARAUMBILICAL ANASTOMOSIS


  Paraumbilical veins connect the left branch of the Portal vein = Superficial veins of anterior abdominal wall (Superficial and Inferior Epigastric)
• RETROPERITONEAL ANASTOMOSIS


  Veins of Retroperitoneal organs ( Duodenum. Pancreas, Ascending and Descending colons (Renal, Suprarenal, Gonadal) plus the liver / portal tributaries = Renal, Lumbar and Phrenic veins
• Liver cirrhosis


  Causes portal HPN which can produce esophageal varices, caput medusae & internal hemorrhoids
• Portal hypertension


  A complication of liver cirrhosis, but may also be caused by thrombosis
• It is important to differentiate between the clinical presentation of a patient with cirrhosis and the clinical presentation of a patient who has already progressed to portal hypertension
• Symptoms of portal hypertension

  • Ascites
  • Edema
  • Encephalopathy
  • Coagulopathy
  • Esophageal varices
• Symptoms of liver cirrhosis

  • Palmar erythema
  • Spider angioma
  • Icterus
  • Hepatomegaly
  • Splenomegaly
  • Skin excoriations
  • Signs of hyperestrogenemia (gynecomastia, testicular atrophy, loss of male-pattern hair distribution)
• R and L hepatic veins


  Drains into IVC
• R gonadal and R suprarenal

  Into IVC
• L gonadal and L suprarenal

  Into L renal
• R gastroepiploic


  Into superior mesenteric vein
• L gastroepiploic


  Into splenic vein
• Right colic

  Into superior mesenteric vein
• L colic


  Into IMV