PORTAL VEIN
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Hepatic Portal Vein? Origin & end in capillaries /
venous
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sinusoids
? Size: 8cm X 1 cm
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? Drains? Abdominal part of alimentary
tract (except lower part of anal
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canal)
? Spleen & Pancreas
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? Conveys absorbed products ofdigested food to liver
? Devoid of valves
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? Reservoir of blood : 1200 ml /
min
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Formation
? Union of Sup mesenteric & Splenic vein
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? Between neck of Pancreas & IVC at level L2Course: Extrahepatic part
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Passes upwards & Rt,
behind neck of pancreas &
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1st part of duodenum? Enters rt free margin of
lesser omentum in front of
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epiploic foramen with Bile
Dut & Hepatic artery.
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? Reaches porta hepatis ÷s into rt & Lt
branches.
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Course: Intrahepatic part
? Branches of
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portal vein
? Segmental brs
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? Brs in Portalcanal
? Hepatic
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sinusoids
? Central veins
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? Sublobular veins? Hepatic veins
IVC
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TRIBUTARIES
Rt Branch
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-Shorter, wider
- Receives cystic
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veinLt branch
-Narrower, longer
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- Runs in Porta
hepatis
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from Rt to Lt- Brs to Caudate &
Quadrate
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lobe
-Receives
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Paraumbilicalveins
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TRIBUTARIES? Formative
? Sup Mesenteric vein
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? Splenic vein
? Received by Trunk
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? Rt & lt Gastric veins? Superior PD vein
? Received by branches
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? Cystic vein
? Paraumbilical veins
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? Occasional? Inf mesenteric vein
? Rt gastroepiploic vein
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? Pre-pyloric vein.
PARTS
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Parts
? Infraduodenal
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? Retroduodenal? Supraduodenal
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RELATIONS? Infra duodenal
? Ant: Neck of
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Pancreas
? Post: IVC
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? Retro duodenal? Ant: Duodenum
(1st Part), Bile duct,
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GD artery
? Post: IVC
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? Supra duodenal : Inrt free margin of
lesser omentum
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? Ant : hepatic artery
& bile duct
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? Post: IVCPORTO-CAVAL ANASTOMOSIS
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Liver like lungs has dual blood
supply. The hepatic portal vein
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brings 75-80% blood to liver.Portal vein contains 40% oxygen
than blood returning to the heart
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from systemic circuit.
The hepatic portal vein contains
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virtually all nutrients absorbedfrom the alimentary tract to the
liver with the exception of lipids
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which is absorbed through the
hepatic artery.
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PORTAL HYPERTENSION? > 12 mm of Hg
? Causes :
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? Pre hepatic : Thrombosis of portal
vein
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? Hepatic: Cirrhosis? Post hepatic: Budd-Chiari Syndrome
? Effects: Splenomegaly, Ascites,
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Collateral circulation through sites of
Portasystemic anastomosis
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EXPOSURE OF KIDNEY FROM
BEHIND
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Loin: It is the region on the back of the trunk, bounded
above by the 12th rib, below by the iliac crest, medially
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by the posterior median line, and laterally by flank.SURFACE MARKING OF KIDNEY FROM BACK
It is done within parallelogram of Morris which is drawn in
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the following way:1. First two horizontal lines are drawn one at the level of
spine of T11 and other at the level of spine of L3.
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2. Then two vertical lines are drawn, one 2.5 cm away and
other 9 cm away from the posteromedian plane.
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3. The centre of hilum of the each kidney lies approximatelyat the lower border of L1.
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Layers to be reflected to reach the Kidney
1. Skin.
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2. Superficial fascia.
3. Posterior layer of the
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thoraco-lumbar fasciawith
attached latissimus dorsi
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and serratus posterior
inferior muscles.
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4. Erector spinae(sacrospinalis) muscles.
5. Middle layer of the
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thoraco-lumbar fascia.6. Quadratus lumborum
muscle.
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7. Anterior layer of the
thoraco-lumbar fascia.
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