12. Portosystemic anastomoses Flashcards Preview

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Flashcards in 12. Portosystemic anastomoses Deck (18)

Portosystemic anastomosis ?

anastomosis that occurs between the veins of portal circulation and those of systemic circulation


portal and systemic vessels

1. esophagus --> left gastric - azygos
2. umbilicus --> paraumbilical - small epigastric veins of anterior abdominal wall
3. rectum --> superior rectal-middle and inferior rectal


clinical signs / commonly seen in

1. esophagus --> eophageal varices
2. umbulicus --> caput medusa
3. rectum ---> anorectum varices


clinical signs - treatment ( and mechanism

transjugular int rahepatic portosystemic shunt ( TIPS) between the portal vein and hepatic vein relieves portal hypertension by shunting blood to systemic circulation by passing the liver


the portal vein is formed by

the union of the superior mesenteric vein and the spleenic vien left gastric vein ( or coronary vein ) goes in portal vein


left gastric vein is also called superior rectl vein is also called

- coronary vein
-superior hemorrhoidal vein


esophageal normally goes into
midlle and inferior rectal veins goes into
epigastric veins goes into
inferior mesenteric vein go into
lefft gastic vein goes into

left hastric vein ( or coronary vein )
internal iliac veins
external iliac veins
splenic vein
portal vein


transjuhular intrahepatic portosystemic shunt ( TIPS) between the

portal and hepatic vein


para- aortic lymph node cluster drains... (area)

testes, ovaries, kidneys, uterus


superficial inguinal lymph node cluster drains .... (area)

anal canal ( below pectinate line ), skin below umbilicus ( except popliteal territory), scrotum, vulva


• Name three clinical signs of portal hypertension, detectable on physical exam.

Esophageal varices, anorectal varices, and caput medusae (gut, butt, and caput)


• A chronic alcoholic man presents with mental status changes, tense ascites, and hematemesis. What is a likely cause of this presentation?

Bleeding esophageal varices secondary to portal hypertension from his cirrhosis (as evidenced by his ascites)


• A patient with portal hypertension has rectal bleeding from prolapsed, dilated veins around the anus. How did this result?

Portosystemic anastomoses between the superior and middle rectal arteries created anorectal varices (not internal hemorrhoids)


• What clinical finding results from portosystemic anastomoses when it involves the inferior epigastric and superior epigastric veins?

Caput medusae in the abdomen


• An alcoholic patient has refractory gastrointestinal bleeding secondary to cirrhosis. What surgical procedure can be used to stabilize him?

Transjugular intrahepatic portosystemic shunt (TIPS) moves blood from the portal to hepatic veins, shunting blood to systemic circulation


• Trace the blood flow from the anus to the IVC

Superior rectal vein to middle inferior rectal vein to IVC


• Trace the blood flow from the esophagus to the IVC.

Left gastric vein to esophageal veins to azygos vein to IVC


• Trace the blood flow from the umbilicus to the IVC.

Paraumbilical vein to epigastric vein to IVC

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