Portal Venous Supply

Introduction

The portal vein is a medium sized to large vein structurally characterised by its portal nature providing connections between liver, spleen, and the gastrointestinal tract and its position in the porta hepatis as it branches to segments of the right lobe of the liver functionally characterised by being the conduit for metabolically rich mesenteric blood and splenic blood arising from the confluens of the splenic, mesenteric and gastric venous circulations branching into right and left portal veins common diseases include portal hypertension portal vein thrombosis congestion clinical presentation portal hypertension hematemesis splenomegaly ascites diagnostic studies include US, CT, MRI, angiography treatment is commonly by interventional radiology endoscopic ablation of varices surgery

The portal system includes all the veins, which drain the blood from the abdominal part of the digestive tube, including the pancreas, spleen, and gall-bladder. The blood and other products of the digestive process are conveyed to the liver by the portal vein. The blood enters the sinusoids, which are the unique capillary system of the liver. The end point of the sinusoid is the central venule. Blood is transferred into the hepatic veins, and eventually to the inferior vena cava (IVC). The portal vein is responsible for 75-80% of the blood flow to the liver. The hepatic artery transports oxygenated blood, while the portal vein transports metabolic products to the liver.

The Porta Hepatis – Portl Vein – A Major Component

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Splenic Vein and Portal Vein

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SMV and Portal Vein

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Superior mesenteric Vein to the Portal Vein

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The Portal vein of Vesalius

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Vesalius historical drawing 13190

The portal triad is the group of connecting structures consisting of hepatic artery portal vein bile duct enclosed in a connective tissue bundle of Glisson’s capsule structurally characterised by position in the periphery of the lobule functionally characterised by contains the structural and functional connections of the liver part of liver capsule and hilum dividing into smaller triads common diseases include diseases of the peritoneum hepatic artery bile duct clinical presentation no specific clinical correlate diagnostic studies include US, CT, MRI treatment no specific treatment is directed to portal triad.

The Porta Hepatis

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The Porta Hepatis – Ultrasound

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Celiac Axis to the Porta hepatis

Meeting of the Triad at the Gates

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Mickey Mouse and the Portal Triad

Here’s Mickey again! The main portal vein enters the porta hepatis with its companions, the hepatic artery and the common hepatic duct. Together they are known as the portal triad. The main portal vein lies posterior to the hepatic artery and bile duct at the porta hepatis.

Intrahepatic Portal Vein

Right and left Branches

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Right portal vein

The right portal vein is a medium sized vein structurally characterised by its portal nature providing connections between liver, spleen, and the gastrointestinal tract and its position in the porta hepatis as it branches to the segments of the right lobe of the liver functionally characterised by being the conduit for mesenteric blood and to lesser extent splenic blood arising from the main portal vein entering into the right segmental veins common diseases include portal hypertension portal vein thrombosis congestion clinical presentation part of portal hypertensive presentation diagnostic studies include US, CT, MRI, angiography treatment is commonly by interventional radiology surgery

Left portal vein

The left portal vein is a medium sized vein structurally characterised by its its portal nature providing connections between liver, spleen, and the gastrointestinal tract and its position in the porta hepatis as it branches to the segments of the right lobe of the liver functionally characterised by being the conduit for mesenteric blood and to lesser extent splenic blood arising from the main portal vein entering into the right segmental veins common diseases include portal hypertension portal vein thrombosis congestion clinical presentation part of portal hypertensive presentation diagnostic studies include US, CT, MRI, angiography treatment is commonly by interventional radiology surgery

The Portal Triad and the Sinusoids

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Applied Anatomy

Acute portal vein thrombosis is an acute thrombotic circulatory disorder of the liver caused by thrombosis resulting in acute loss of portal blood supply characterised by partial or complete obstruction of the portal circulation maintenance of perfusion by hepatic artery pathogenesis disorder causes liver injury results in variable outcome resolution fibrosis acute or chronic liver failure structural disorder acute inflammatory infiltrate swelling hyperemia functional disorder usually of no functional significance until liver extensively involved clinical presentation local pain jaundice mild hepatomegaly systemic fever diagnostic studies include CT treatment is commonly by surgery if unstable

The radiographic feature of portal venous gas is gas that extends almost to the capsule of the liver. There are numerous causes for portal venous gas among the most common is mesenteric ischemia. Many intra-abdominal inflammatory conditions have been reported to cause portal venous gas, including inflammatory bowel disease and intra-abdominal abscesses. Among the rare causes are ingestion of corrosives, bronchopneumonia, and postperoxide enema.

Portal Venous Gas

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HCC Portal Vein Invasion

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Cirrhossis

Bridging Between Portal Triads

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TIPS procedure Porto Systemic Shunt

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Historical Perspectives

Portal vein After Galen

Heat plays a central role part in the theory of Galen. The three ‘faculties’ of the body are the nutritive, vital and logical faculties. The nutritive faculty is related to the stomach which “cooks” the food and converts it into chyle. The chyle is transported to the liver by the portal vein. In the liver further heat converts the food into blood and adds natural spirit. Some of the blood is transported via the veins to the heart where more heat is added to create vital spirit. The blood becomes thinner is distributed to the body by the arteries giving warmth and enables growth. The vital spirit is measured through the pulse. The brain adds psychic pneuma, which provides the rational and logical faculty in the form of thought will and choice. These are distributed to the body via the nerves. The logical faculty reigns supreme and is followed in orderof importance by the vital and nutrtive faculties. The transport systems of the body include the nerves which transmit the logical faculty, the arteries which transport the vital spirit, and the veins which transport the blood with nutritive faculty from the liver.

THE LIVER

Portal Venous Supply

Metabolic Warehouse