Objectives • Circulation of blood-----from the level of lower 1/3 of oesophagus to the level of upper part of anal canal. Hepatic Portal Circulation • What are the major vessels -- their branches and tributaries. • Formation of Portal vein---its course and relations. • Features of portal circulation • Anastamotic sites between Portal circulation and Systemic circulation. • Effect of Portal hypertension at the anastomotic sites. Territories of ForeGut, MidGut and HindGut Parts of G.I Tract, Subserved by Hepatic Portal System. Arteries – Foregut----- From the junction of middle 1/3 and lower • Coeliac artery for------------------- Foregut part 1/3 of esophagus close to the level of Major duodenal papilla (in the 2nd part of duodenum). • Superior Mesenteric artery for ----Midgut part – Midgut--------From just below the level of Major • Inferior Mesenteric artery for------Hindgut part duodenal papilla to the level of distal part of transverse colon (at the junction of middle and distal 3 rd). These are the branches of Abdominal aorta. – Hindgut-------From the above level to the level of upper part of the Anal canal (Junction of upper 2/3 and lower 1/3). Features of Portal circulation Areas of G.I T. in the hepatic portal system • It commences like a vein and ends like anartery • Fore gut • It has no valves • Right and left streams of blood flow • Carries products of digestion. • Mid gut • Hind gut 1 Hepatic portal Vein and Its Tributeries Formation of Portal vein Hepatic Portal vein is formed where the Splenic vein joins Hepatic Portal vein is formed where the Splenic vein joins the Superior mesenteric vein. the Superior mesenteric vein. See next slide for enlarged picture. Portal vein. Contributing Tributaries • Lower esophageal veins via left gastric vein. • Left gastric vein, Splenic vein. • Right gastric vein, Superior mesenteric vein. • Pre-Pyloric vein,(not represented in the picture) • Right Gastro-epiploicvein, • Superior Pancreatico Duodenal vein • Cystic vein. Tributaries - continued • Superior Mesenteric vein receives, • Inferior Pancreatico duodenal vein. Jejunal veins, – Ileal veins, – Ileocolic vein, – Right colic vein, – Middlecolic vein Tributaries-continued Tributaries -continued • Splenicvein Receives • Inferior Mesenteric vein receives – Veins from the Spleen, Superior Rectal vein continues upwards – Short gastric veins, as – Left gastro epiploicveins, – Inferior Mesenteric vein, – Pancreatic veins, – Sigmoid veins, – Inferior Mesenteric vein. – Lower left colic, – Upper left colic. Inferior mesenteric vein joins splenic vein. 2 Course and ralations of portal vein Portal / Systemic Anastomotic Sites •Oesophageal-- between azygos veins and oesophageal tributaries of left gastric vein. •Umbilical-- rudiment of umbilical vein and superficial epigastric vein. •Porto-caval- Tributeries of the portal vein and inferior vena cava. A. Ano-rectal--- superior ,middle , inferior rectal veins B. Retro-peritoneal vein with the venous radicals of colon C. Bare area of the liver. Portal / Systemic Portal / Systemic Anastomotic Sites cntd AnastomoticSites contd Oesophageal Umbilicl Portal / Systemic Portal / Systemic Anastomotic Sites Anastomotic Sites contd cntd Porto-caval Ano-rectal--- Porto-caval Retro- peritoneal 3 Portal / Systemic Anastomotic Sites cntd Portal venous pressure • 8 to 15 mm of mercury Bare area of the liver. Effects of Portal hypertension on The Anastamotic Sites. Caput Medusae--------Varices at umbilicus • Esophageal varices ---Haematemesis • Internal haemoroids ---Haematochesia. • Caput Medusae--------Varices at umbilicus • Retroperitoneal varices . End of topic. Good luck To God Be The Glory. 4.