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Portocaval Anastamoses
fail
21
Anatomy
Graduate
10/22/2010

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Term
What are the primary tributaries of the portal vein?
Definition
paraumbilical (in ligamentum teres) [left portal]; left gastric and right gastric; sma and splenic veins; imv (via splenic); cystic vein
Term
What are the 5 major portocaval anastamoses?
Definition
umbilical, rectal, retroperitoneal, esophageal, bare surface of liver
Term
Explain esophageal varices
Definition
backup from portal to left gastric to esophageal veins which dilate. then would get blood to svc via azygous/hemiazygous.
Term
What vertebral level is cisterna chyle?
Definition
L1-2
Term
Do all lymphatic vessels have valves?
Definition
yes
Term
Explain rectal portocaval anastamoses?
Definition
Superior rectal vein anastamoses with IMV. Superior rectal vein anastamoses with middle and inferior rectal veins. middle rectal vein anastamoses with the internal iliac. inferior rectal vein anastamoses with the internal pudendal.
Term
explain paraumbilical portocaval anastamoses
Definition
paraumbilical veins come via left portal (in the ligamentum teres). then blood goes to epigastric veins and into systemic circulation.
Term
what are the anastamoses of the epigastric veins? (superior, inferior, superficial)
Definition
The inferior epigastric vein anastamoses with the external iliac vein inferiorly and the superior epigastric vein superiorly. The superior epigastric vein anastamoses with the internal thoracic vein (which terminates in the brachiocephalic vein).

INFERIORLY, the superficial epigastric vein joins the great saphenous vein, which joins the femoral vein, which joins the external iliac vein, which joins the IVC.

SUPERIORLY, the superficial epigastric vein joins the thoracoepigastric vein, which joins the lateral thoracic vein, which joins the axillary vein, which joins the brachiocephalic vein, which joins the IVC.
Term
Besides the abdomen, what else does cisterna chyle get lymph from?
Definition
lumbar lymph trunks and descending thoracic lymph trunks
Term
What are the ascending lumbar veins?
Definition
These become the azygous on the right (through fusion with the subcostal v) and the hemiazygous on the left. The ascending lumbars MAY connect to the external iliacs.
Term
How do the extremities get lymphatic drainage?
Definition
subclavian trunks join with thoracic ducts.
Term
How does head and neck get lymphatic drainage?
Definition
right and left jugular trunks anastamose with the thoracic ducts
Term
What does preaortic lymph nodes mean? Are these the same as lumbar nodes?
Definition
preaortic are anterior to the aorta. lumbar are para lateral aorta
Term
Explain the lumbar veins
Definition
There are up to 5 of them. One per vertebral level. They anastamose directly with the IVC (or into renals/common iliacs). The ascending lumbar vein connects all the lumbar veins and then confluences with the subcostal vein to form the azygous (on the right) or the hemiazygous (on the left). The azygous sometimes connects directly with the IVC (and the hemiazygous sometimes connects with the left renal.)
Term
What drains the posterior thoracic wall?
Definition
On the right, azygous. On the left, hemiazygous.
Term
Where does the hemiazygous vein join the azygous?
Definition
At about T9 it goes posterior to great vessels and joins azygous.
Term
Where does accessory hemiazygous?
Definition
It crosses over to the left side and joins the azygous
Term
What is different about the portal system from regular venous systems?
Definition
It is a two capillary system (ie there is a capillary before the portal vein, and a capillary after the portal vein before the blood goes into the hepatic veins
Term
Does the portal vein have valves?
Definition
No
Term
Does the thoracic duct have valves?
Definition
yes
Term
Do the abdominal visceral veins have valves? (tributaries of portal)
Definition
NO this is how portal hypertension causes varices and stuff
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