Descriptive Anatomy of Hepatic and Portal Veins with Special Reference
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Portal Vein Stenting for Jejunal Variceal Bleeding After Recurrence of Pancreatic Adenocarcinoma: a Case Report and Review of the Literature
Case Report Portal Vein Stenting for Jejunal Variceal Bleeding after Recurrence of Pancreatic Adenocarcinoma: A Case Report and Review of the Literature 1) Department of Radiology, Kyushu University Beppu Hospital, Japan 2) Department of Surgery, Kyushu University Beppu Hospital, Japan 3) Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, Japan Seiichiro Takao1), Masakazu Hirakawa1), Kazuki Takeishi2), Yushi Motomura1), Katsumi Sakamoto1), Hajime Otsu2), Yusuke Yonemura2), Koshi Mimori2), Kousei Ishigami3) Abstract A 73-year-old woman with portal vein stenosis caused by tumor recurrence after pancreatoduodenectomy was treated with stent placement without embolization of the jejunal varix. Anticoagulation therapy using heparin followed by rivaroxaban was administered after the procedure. She continued to receive systemic chemotherapy as an outpatient. Neither restenosis nor stent thrombosis was observed after 7 months. Based on the presented case and literature review, portal vein stenting is an effective treatment option for jejunal variceal bleeding caused by malignant portal venous stricture after pancreaticoduodenectomy. Antithrombotic therapy following portal venous stenting is required to prevent stent thrombosis in the majority of cases, al- though it has a risk of inducing recurrent variceal bleeding. Adjunctive jejunal variceal embolization can pos- sibly be omitted in selected cases to obtain sufficient portal-SMV flow reconstruction. Key words: Portal vein, Constriction, Stents (Interventional Radiology 2021; 6: 44-50) port describes a case of successful stenting for a patient Introduction with portal venous stenosis and bleeding from jejunal varices after pancreatoduodenectomy, along with the relevant Recurrent pancreatic cancer can cause portal venous literature. stenosis, resulting in symptoms of portal hypertension, such as hemorrhagic tendencies and liver dysfunction. -
Heart Vein Artery
1 PRE-LAB EXERCISES Open the Atlas app. From the Views menu, go to System Views and scroll down to Circulatory System Views. You are responsible for the identification of all bold terms. A. Circulatory System Overview In the Circulatory System Views section, select View 1. Circulatory System. The skeletal system is included in this view. Note that blood vessels travel throughout the entire body. Heart Artery Vein 2 Brachiocephalic trunk Pulmonary circulation Pericardium 1. Where would you find the blood vessels with the largest diameter? 2. Select a few vessels in the leg and read their names. The large blue-colored vessels are _______________________________ and the large red-colored vessels are_______________________________. 3. In the system tray on the left side of the screen, deselect the skeletal system icon to remove the skeletal system structures from the view. The largest arteries and veins are all connected to the _______________________________. 4. Select the heart to highlight the pericardium. Use the Hide button in the content box to hide the pericardium from the view and observe the heart muscle and the vasculature of the heart. 3 a. What is the largest artery that supplies the heart? b. What are the two large, blue-colored veins that enter the right side of the heart? c. What is the large, red-colored artery that exits from the top of the heart? 5. Select any of the purple-colored branching vessels inside the rib cage and use the arrow in the content box to find and choose Pulmonary circulation from the hierarchy list. This will highlight the circulatory route that takes deoxygenated blood to the lungs and returns oxygenated blood back to the heart. -
Vessels and Circulation
CARDIOVASCULAR SYSTEM OUTLINE 23.1 Anatomy of Blood Vessels 684 23.1a Blood Vessel Tunics 684 23.1b Arteries 685 23.1c Capillaries 688 23 23.1d Veins 689 23.2 Blood Pressure 691 23.3 Systemic Circulation 692 Vessels and 23.3a General Arterial Flow Out of the Heart 693 23.3b General Venous Return to the Heart 693 23.3c Blood Flow Through the Head and Neck 693 23.3d Blood Flow Through the Thoracic and Abdominal Walls 697 23.3e Blood Flow Through the Thoracic Organs 700 Circulation 23.3f Blood Flow Through the Gastrointestinal Tract 701 23.3g Blood Flow Through the Posterior Abdominal Organs, Pelvis, and Perineum 705 23.3h Blood Flow Through the Upper Limb 705 23.3i Blood Flow Through the Lower Limb 709 23.4 Pulmonary Circulation 712 23.5 Review of Heart, Systemic, and Pulmonary Circulation 714 23.6 Aging and the Cardiovascular System 715 23.7 Blood Vessel Development 716 23.7a Artery Development 716 23.7b Vein Development 717 23.7c Comparison of Fetal and Postnatal Circulation 718 MODULE 9: CARDIOVASCULAR SYSTEM mck78097_ch23_683-723.indd 683 2/14/11 4:31 PM 684 Chapter Twenty-Three Vessels and Circulation lood vessels are analogous to highways—they are an efficient larger as they merge and come closer to the heart. The site where B mode of transport for oxygen, carbon dioxide, nutrients, hor- two or more arteries (or two or more veins) converge to supply the mones, and waste products to and from body tissues. The heart is same body region is called an anastomosis (ă-nas ′tō -mō′ sis; pl., the mechanical pump that propels the blood through the vessels. -
Ministry of Education and Science of Ukraine Sumy State University 0
Ministry of Education and Science of Ukraine Sumy State University 0 Ministry of Education and Science of Ukraine Sumy State University SPLANCHNOLOGY, CARDIOVASCULAR AND IMMUNE SYSTEMS STUDY GUIDE Recommended by the Academic Council of Sumy State University Sumy Sumy State University 2016 1 УДК 611.1/.6+612.1+612.017.1](072) ББК 28.863.5я73 С72 Composite authors: V. I. Bumeister, Doctor of Biological Sciences, Professor; L. G. Sulim, Senior Lecturer; O. O. Prykhodko, Candidate of Medical Sciences, Assistant; O. S. Yarmolenko, Candidate of Medical Sciences, Assistant Reviewers: I. L. Kolisnyk – Associate Professor Ph. D., Kharkiv National Medical University; M. V. Pogorelov – Doctor of Medical Sciences, Sumy State University Recommended for publication by Academic Council of Sumy State University as а study guide (minutes № 5 of 10.11.2016) Splanchnology Cardiovascular and Immune Systems : study guide / С72 V. I. Bumeister, L. G. Sulim, O. O. Prykhodko, O. S. Yarmolenko. – Sumy : Sumy State University, 2016. – 253 p. This manual is intended for the students of medical higher educational institutions of IV accreditation level who study Human Anatomy in the English language. Посібник рекомендований для студентів вищих медичних навчальних закладів IV рівня акредитації, які вивчають анатомію людини англійською мовою. УДК 611.1/.6+612.1+612.017.1](072) ББК 28.863.5я73 © Bumeister V. I., Sulim L G., Prykhodko О. O., Yarmolenko O. S., 2016 © Sumy State University, 2016 2 Hippocratic Oath «Ὄμνυμι Ἀπόλλωνα ἰητρὸν, καὶ Ἀσκληπιὸν, καὶ Ὑγείαν, καὶ Πανάκειαν, καὶ θεοὺς πάντας τε καὶ πάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶ ξυγγραφὴν τήνδε. -
Review Article
JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2008, 59, Suppl 2, 231238 www.jpp.krakow.pl Review article H. CICHO¯-LACH, K. CELIÑSKI, M. S£OMKA, B. KASZTELAN-SZCZERBIÑSKA PATHOPHYSIOLOGY OF PORTAL HYPERTENSION Department of Gastroenterology Medical University of Lublin, Poland In last years significant progress in recognizing mechanisms of portal hypertension pathophysiology was done. However, some unclear topics in this disease still exist. Portal hypertension is primarily caused by the increase in resistance to portal outflow and secondly by an increase in splanchnic blood flow. Portal hypertension is associated with changes in the intrahepatic, systemic, and portosystemic collateral circulation. Alterations in vasoreactivity (vasodilation and vasoconstriction) play a central role in the pathophysiology of portal hypertension by contributing to increased intrahepatic resistance, hyperdynamic circulation, and expansion of the collateral circulation. Among vasoactive substances which are activated in portal hypertension nitric oxide (NO) is considered as the most important vasodilator. Endothelin-1 and cyclooxygenase-derived prostaglandins are the main vasoconstrictor factors. The imbalance between the hyperresponsiveness and overproduction of vasoconstrictors and the hyporesponsiveness and impaired production of vasodilators are the mechanisms responsible of the increased vascular tone in the sinusoidal area of the liver. New concepts in the pathophysiology of portal hypertension find the significant role of hepatic stellate cells activated by endothelial factors which cause vascular remodeling as an adaptive response of the portal vessels wall. The most frequent causes of portal hypertension include portal vein thrombosis, storage diseases of the liver, hepatic cirrhosis (independent of etiology), hepatic veins thrombosis and schistosomiasis. Understanding the pathophysiology of portal hypertension could be of great utility in preventing and curing the complications of portal hypertension, such as esophageal varices, hepatic encephalopathy, ascites. -
A Rare Case of Jejunal Arterio-Venous Fistula
© Springer ScienceϩBusiness Media, Inc., 2004 Cardiovasc Intervent Radiol (2004) 27:671–674 CardioVascular Published Online: 12 August 2004 DOI: 10.1007/s00270-004-0101-x and Interventional Radiology A Rare Case of Jejunal Arterio-Venous Fistula: Treatment with Superselective Catheter Embolization with a Tracker-18 Catheter and Microcoils Martin J. Sonnenschein, Suzanne E. Anderson, Steven Lourens, Juergen Triller Department of Diagnostic Radiology, Inselspital Bern, University of Berne, Freiburgstrasse 10, 3010, Berne, Switzerland Abstract jejunal arteries frequently manifest with isolated signs such as bleeding, abdominal pain, diarrhea, weight loss and a steal phe- Arterio-venous fistulas may develop spontaneously, following nomenon, suggesting that only a segment of the portal venous trauma or infection, or be iatrogenic in nature. We present a rare system (segmental portal hypertension) is involved [1]. The aim of case of a jejunal arterio- venous fistula in a 35-year-old man with a patient management is treatment of the underlying cause to prevent history of pancreatic head resection that had been performed two the development of portal hypertension complications such as years previously because of chronic pancreatitis. The patient was variceal hemorrhage and ascites. admitted with acute upper abdominal pain, vomiting and an ab- dominal machinery-type bruit. The diagnosis of a jejunal arterio- Case Report venous fistula was established by MR imaging. Transfemoral A 35-year-old male presented with upper abdominal pain and vomiting. angiography was performed to assess the possibility of catheter Significantly, 2 years ago the patient had an episode of chronic pancreatitis, embolization. The angiographic study revealed a small aneurysm of which was treated surgically by partial pancreatectomy. -
Cirrhosis and Its Complications Catch This Liver Scarring Problem Early, Because Its Effects Can Be Life-Threatening
Cirrhosis and Its Complications Catch this liver scarring problem early, because its effects can be life-threatening By Scott R. Snyder, BS, NREMT-P, Sean M. Kivlehan, MD, MPH, NREMT-P, & Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT This month’s CE article looks at cirrhosis and its complications. In an attempt to best understand the signs and symptoms and progression of this disease, we will review the anatomy, physiology and pathophysiology of the liver and cirrhosis and the clinical manifestations of the disease and its complications. ANATOMY OF THE LIVER The liver is the largest visceral organ in the body, and the majority of its mass is located in the upper right abdominal quadrant and extends into the upper left quadrant, lying directly below the diaphragm. It weighs about 3.3 lbs. (1.5 kg) in the average adult male. The liver is encased in a tough, fi brous capsule (Glisson’s capsule) and covered by a layer of visceral peritoneum. It is held in place in the abdomen by several ligaments, including the falciform, round and coronary ligaments. The gallbladder is a small, hollow, pear-shaped muscular sac that lies on the posterior surface of the liver. While not a true part of the liver, it works closely with the liver to store and secrete bile produced in the liver to aid digestion. Blood Supply The liver is the largest blood reservoir in the body, receiving about 25% of the cardiac output. It is unique in that it has a double blood supply, receiving blood from both the hepatic portal vein and hepatic arteries. -
Question 1. Why Do We Have the Portal Vein Or the Liver Receiving More
Question 1. why do we have the portal vein or the liver receiving more blood from the vein than it receives from the artery? The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approximately 75% of total liver blood flow is through the portal vein, with the remainder coming from the hepatic artery proper. The blood leaves the liver to the heart in the hepatic veins. The portal vein is not a true vein, because it conducts blood to capillary beds in the liver and not directly to the heart. It is a major component of the hepatic portal system, one of only two portal venous systems in the body – with the hypophyseal portal system among the other. The portal vein is usually formed by the confluence of the superior mesenteric to splenic veins and also receives blood from the inferior mesenteric left and right gastric veins and cystic veins. Conditions involving the portal vein cause considerable illness and death. An important example of such a condition is elevated blood pressure in the portal vein. This condition, called portal hypertension, is a major complication of cirrhosis. Unlike most veins, the portal vein does not drain into the heart. Rather, it is part of a portal venous system that delivers venous blood into another capillary system, the hepatic sinusoids of the liver. In carrying venous blood from the gastrointestinal tract to the liver, the portal vein accomplishes two tasks: it supplies the liver with metabolic substrates and it ensures that substances ingested are first processed by the liver before reaching the systemic circulation.This accomplishes two things. -
Hepatic Portal System (Advanced) USMLE, Limited Edition > Gross Anatomy > Gross Anatomy
Hepatic Portal System (Advanced) USMLE, Limited Edition > Gross Anatomy > Gross Anatomy Hepatic portal system • A special circulation system that transports venous blood from the digestive organs to the liver. • Transports blood from the stomach, spleen, pancreas, and small and large intestines to the liver. This distinct circulatory pathway exists to allow the liver to metabolize nutrients and toxins from blood that leaves the digestive organs. Primary tributaries of the hepatic portal vein: Superior mesenteric vein Drains tissues of the right side of the abdomen. - Ileocolic vein drains blood from the distal small intestine and the proximal large intestine - Right colic vein courses from the right side of the abdomen to drain blood from the large intestine - Middle colic vein drains blood from the large intestine. - Intestinal veins drain the jejunum and ileum of the small intestine. These drain into the left side of the superior mesenteric vein. - Pancreatic and duodenal veins - Right gastro-omental vein, which runs along the inferior border of the stomach (aka, greater curvature), drains into the superior mesenteric vein. • The "omental" portion of the gastro-omental name is derived from the greater "omentum," the apron-like fold of peritoneum that drapes over the intestines anteriorly. Splenic vein Drains structures on the left side of the abdomen. - Merges with superior mesenteric vein to form hepatic portal vein - Short gastric veins from stomach - Left gastro-omental vein, which courses along the inferior border of the stomach and meets the right gastro-omental vein. - Pancreatic veins - Inferior mesenteric vein Inferior mesenteric vein 1 / 2 Drains tissues of the lower left side of the abdomen into the splenic vein. -
Practical Class 2 ACCESSORY DIGESTIVE ORGANS
Practical class 2 ACCESSORY DIGESTIVE ORGANS OBJECTIVES By the end of the practical session you should be able to: 1. Outline the gross structure, relations, neurovascular supply and lymph drainage of the liver. 2. Define the anatomical features, relations, function and clinical considerations of the extra- hepatic biliary system. 3. Describe the anatomical relations, development, vascular supply and functions of the pan- creas. 4. Describe the origin, course, distribution and relations of the arteries supplying the gastrointestinal tract. 5. Describe the portal venous system and explain its role in nutrition, and the nature and location of portosystemic anastomoses. Background reading Rogers: chapter 32: The liver, biliary system and pancreas 40: (Arterial supply to the gut, The hepatic portal venous system) 27: (Nerve supply to the gastrointestinal tract) 17 HUMB2040/ABD/SHP 18 LIVER The liver is the largest visceral organ, and is situated in the right hypochondriac and epigastric regions. Study the prosections of the liver and note that: a) the liver is superficially divided into four lobes i) two major lobes, a larger right and a smaller left lobe: divided superiorly by the falciform ligament and posteriorly by the left limb of an H-shaped arrangement of ligaments and fossae. ii) two subsidiary lobes on the posteroinferior aspect of the liver between the limbs of the ‘H’: the quadrate lobe in inferiorly, and the caudate lobe superiorly. b) the left lobe extends across the epigastrium c) the right lobe is situated in the right hypochondrium d) the cross bar of the 'H' is the hilum of the liver called the porta hepatis from which the lesser omentum runs to the lesser curvature of the stomach. -
Intervention in the Hepatic Portal Venous System the Sanctuary Of
Intervention in the Hepatic Portal Venous System Christopher Hannegan, MD Definition Portal venous system – Venous vasculature fed and drained by capillary vessels. Hypophyseal portal system Hepatic portal system What do we want to do? • Look at it – diagnostic imaging • Improve flow – plasty, stents, lysis, thrombectomy • Impede flow - embolization • Divert flow – shunts • Make the liver grow • Grow islet cells Diagnostic methods • Conventional radiological techniques – U/S, CT, MR • Catheter directed techniques Indirect – Late phase visceral angiography, wedged hepatic venography Direct – Transjugular or percutaneous transhepatic portal access Anatomy Ultrasound Computed Tomography Magnetic Resonance Late phase visceral angiography Wedged hepatic venography Quick review TIPS • Decompress symptomatic hypertensive portal system after failed medical management. • Mainly used to treat bleeding varices and refractory ascites. • Reduce portal systemic gradient below 12 mmHg to minimize risk of bleeding. Lower for ascites. • Contraindicated in coagulopathy, biliary obstruction, severe liver disease, encephalopathy and right heart failure. Gore Via-Torr Stent TIPS reversal • Worsening encephalopathy • Onset right heart failure • Worsening hepatic function Methods • Occlusive devices Coils, plugs, excluders • Reduced diameter stents Maintain shunt with smaller diameter Varix embolization • Common in the pre-Tips era for controlling variceal bleeding. • Now performed after TIPS in patients that continue to have bleeding episodes or in patients -
Hepatic Portal Circulation
Hepatic Portal Circulation The liver receives venous blood from the digestive tract, which is oxygen poor but nutrient rich. The liver filters the blood: 1) detoxifying alcohol and drugs, 2) converting ammonia to usable urea, 3) storing fat-soluble vitamins, 4) converting glucose to glycogen and storing it. Phagocytes, called Kupffer cells, lining the liver’s sinusoids, filter out any remaining bacteria that sur- vived the trip through the stomach. After percolating through the liver (the hepatic portal system), the blood drains into the hepatic veins and then into the inferior vena cava. It is now back in systemic circulation and on its way back to the heart and lungs. The blood from the digestive organs is brought to the liver through the hepatic portal vein. The hepatic portal vein is only about 3 inches (8 cm) long. It receives blood from the following blood vessels: 1) superior mesenteric vein - which collects blood from the stomach, small intestine and the ascending and transverse portion of the large intestine. 2) splenic vein - which collects blood from the spleen, pancreas and part of the stomach. 3) inferior mesenteric vein - which collects blood from the descending colon, sigmoid colon and the rectum. ©Sheri Amsel www.exploringnature.org inferior vena cava esophagus Hepatic Portal hepatic vein Circulation liver stomach hepatic gall portal bladder vein common pancreas bile duct inferior mesenteric duodenum vein (small intestine) superior mesenteric ascending vein descending colon colon cecum appendix sigmoid colon ileum rectum ©Sheri Amsel anus www.exploringnature.org inferior vena cava esophagus Hepatic Portal hepatic vein Circulation (with intestines cut out to see blood liver vessels) stomach hepatic gall portal bladder vein common pancreas bile duct inferior mesenteric duodenum vein (small intestine) superior mesenteric ascending vein descending colon colon cecum appendix sigmoid colon ileum rectum ©Sheri Amsel anus www.exploringnature.org.