Spleen and Portal Venous System

Question 1

Where does the spleen lie

Answer 1

• Posterior to stomach
• Against the diaphragm
• Between ribs 8 (9)- 11 on left side

Question 2

Where is the long axis of the spleen

Answer 2

Along the 10th rib

Question 3

Functions of the spleen

Answer 3

• Removal of blood-borne antigens
• Removal and destruction of aged/defective RBCs
• Haematopoiesis in foetus
• Storing blood platelets

Question 4

Where is the spleen in relation to the peritoneum

Answer 4

Intraperitoneal (except hilum)

Question 5

What is the spleen surrounded by

Answer 5

A fibrous capsule, from which trabeculae extend inwards

Question 6

What is the spleen related to

Answer 6

• Colon (left colic flexure)
• Stomach
• Left kidney

Question 7

Describe the superior border of the spleen

Answer 7

Notched

Question 8

What connects the spleen to the stomach

Answer 8

Gastrosplenic ligament

Question 9

What does the gastrosplenic ligament contain

Answer 9

• Left gastroepiploic and short gastric vessels

- May contain accessory spleen

Question 10

What connects the spleen to the posterior abdominal wall

Answer 10

Splenorenal ligament

Question 11

What does the splenorenal ligament contain

Answer 11

• Splenic vessels

- Tail of the pancreas

Question 12

Arterial supply of spleen

Answer 12

Splenic artery (runs along upper border of pancreas)

Question 13

Venous drainage of spleen

Answer 13

-Splenic vein (rungs along tail and body of pancreas) and receives short gastric and left-gastroepiploic veins

Question 14

Where is the hepatic portal vein formed

Answer 14

Behind the neck of the pancreas

Question 15

Lymphatic drainage of spleen

Answer 15

Splenic hilar lymph nodes - pancreatic-splenic nodes - coeliac nodes

Question 16

Nerve supply of spleen

Answer 16

• Greater splanchnic nerve - coeliac plexus

- Parasympathetics from vagus

Question 17

Which artery do the nerves follow

Answer 17

Splenic artery

Question 18

What arteries form the hepatic portal system

Answer 18

• Splenic
• Superior mesenteric
• Inferior mesenteric

Question 19

What does the hepatic portal vein drain

Answer 19

• Lower 1/3 of oesophagus
• Distal half of anal canal
• Spleen
• Pancreas
• Gallbladder

Question 20

Which omentum does the hepatic portal vein enter

Answer 20

Lesser omentum

Question 21

Which ligament does the hepatic portal vein run in

Answer 21

Hepatoduodenal ligament

Question 22

Describe the hepatic portal system

Answer 22

• Portal vein enters liver and its branches supply the sinusoids from which blood passes into central veins (which pass to IVC)
• In sinusoids, portal venous blood mixes with oxygenated blood from the hepatic artery proper

Question 23

Describe the oesophageal anastamosis

Answer 23

• Lower 1/3 of oesophagus
• Oesophageal branches of left gastric vein (portal vein)
• Oesophageal veins drainage the middle 1/3 of oesophagus (azygous to SVC)

Question 24

Describe the anastomosis halfway down the anal canal

Answer 24

• Superior rectal vein drainage the upper 1/2 of the anal canal (portal vein)
• Middle and inferior rectal veins (internal iliac and internal pudendal to IVC)

Question 25

Describe the anastomosis around the umbilicus

Answer 25

- Para-umbilical veins (left branch of portal vein) | - Epigastric veins (femoral external iliac, internal thoracic and axillary veins to IVC and SVC)

Question 26

Describe the anastamosis around the posterior abdominal wall

Answer 26

- Veins of secondarily retroperitoneal organs (portal vein) | - Veins of body wall (systemic veins)

Question 27

What is a re-canalized ductus arteriosus called

Answer 27

Vein of Retzius

Question 28

Prehepatic causes of portal hypertension

Answer 28

- Portal vein thrombosis | - Splenic vein thrombosis

Question 29

Hepatic causes of portal hypertension

Answer 29

- Hepatic tumours - Cirrhosis - Parasitic infections (e.g. Schistosomiasis)

Question 30

Posthepatic causes of portal hypertension

Answer 30

- Cardiac disease (tricuspid stenosis, constrictive pericarditis) - Hepatic vein thrombosis

Question 31

Consequences of portal hypertension

Answer 31

- Oesophageal varices - Caput medusae - Haemorrhoids

Question 32

Describe the position of the abdominal aorta

Answer 32

- Retroperitoneal - Begins at T12 - Descends to level of L4

Question 33

What does the abdominal aorta bifurcate into

Answer 33

Common iliac arteries (slightly left of midline)

Question 34

Visceral branches of abdominal aorta

Answer 34

- Coeliac trunk (T12/L1) - Middle suprarenal arteries - Superior mesenteric artery (L1) - Renal arteries (L1/2 disk) - Testicular or ovarian arteries (L2) - Inferior mesenteric artery (L3)

Question 35

Parietal branches of abdominal aorta

Answer 35

- Inferior phrenic arteries - x4 lumbar arteries - Median sacral artery

Question 36

Describe the position of the IVC

Answer 36

-Retroperitoneal

Question 37

What forms the IVC and where

Answer 37

- Union of common iliac veins | - Behind right common iliac artery at level of L5

Question 38

Describe the ascension of IVC

Answer 38

- Right side of aorta | - Pierces the diaphragm at T8

Question 39

What veins does the IVC receive

Answer 39

- Hepatic veins - Right inferior phrenic vein - Right suprarenal vein (left drains into left renal/left inferior phrenic) - Both renal veins - Right gonadal vein (left drains into left renal) - Lumbar veins

Question 40

What are the veins of origin of the SVC

Answer 40

- 2 common iliac veins | - Median sacral vein

Question 41

Where do the 1st and 2nd lumbar veins drain

Answer 41

Both into IVC and ascending lumbar veins - azygous and hemiazygous