The document discusses the portal circulation system and portal hypertension. The portal vein is formed by the union of the superior mesenteric vein and splenic vein. It carries deoxygenated blood from the digestive organs to the liver. Five sites in the body allow blood to flow between the portal and systemic circulation systems. Portal hypertension occurs when increased blood pressure in the portal vein is caused by liver cirrhosis or thrombosis. Consequences of portal hypertension include esophageal and hemorrhoidal varices, caput medusae, ascites, and splenomegaly. Treatment options consist of band ligation, sclerotherapy, portosystemic shunts, and TIPSS procedures.

2. General Plan of Blood
Circulation
PORTAL
CIRCULATION
Blood is collected from
one set of capillaries and
is passed to a larger
vessel which then again
divides into capillaries
before the blood is
returned to systemic
circulation.

3. Portal Vein
Formed by union of (behind
the neck of pancreas)
1. Superior Mesenteric
Vein
2. Splenic vein
Tributaries:
1. Left gastric vein
2. Right gastric vein
3. Cystic veins
4. Posterior superior
pancreaticoduodenal
vein

4. Location
•Runs almost vertically
upwards in the free margin
on lesser omentum.
•Anteriorly : Pancreas and
first part of duodenum.
•Posteriorly : Inferior vena
cava (but loses contact by
entering between two
layers of lesser omentum.

5. •Hepatic Artery and the common bile duct lie in
the same plane and in front of the Portal vein.

6. SITES OF PORTACAVAL
ANASTOMOSIS
Five sites of portal/systemic
circulation :
1. Lower third of the Esophagus
2. Paraumbilical Area
3. Upper end of Anal canal
4. Retroperitonial
5. Bare area of liver

7. 1. Lower third of the Esophagus
: he esophageal branches of the left gastric vein (portal tributaries)
T
anastomose with the esophageal veins draining the middle third of the
esophagus into the azygos veins. (systemic tributaries)
2. Paraumbilical Area
They connect the left branch of the portal vein with the superficial
veins of the anterior abdominal wall. (systemic tributaries)
3. Anal canal
The superior rectal veins (portal tributary) draining the upper half of
the anal canal anastomose with the middle and inferior rectal veins
(systemic tributaries), which are tributaries of the internal iliac and
internal pudendal veins, respectively.

8. 4. Retroperitonial
The veins of the ascending colon, descending
colon, duodenum, pancreas, and liver (portal tributary) anastomose
with the renal, lumbar, and phrenic veins (systemic tributaries).
5. Bare area of liver
There is some anastomosis between portal venous channels in
the liver and azygous system of veins above the diaphragm across
the bare area of liver.

9. Five sites of portal/systemic
circulation :
1. Lower third of the Esophagus
2. Paraumbilical Area
3. Upper end of Anal canal
4. Retroperitonial
5. Bare area of liver

10. Portal Hypertension
It is defined as increase in blood pressure in the veins of the
portal system caused by obstruction in the liver (due to
cirrhosis, thrombophlebitis), causing enlargement of collateral
veins and splenomegaly.
It is caused by :
1.
2.
Liver Cirrhosis (Interahepatic)
Thrombosis of Portal vein. (Extrahepatic)

11. Consequences of Portal
Hypertension
1.
2.
3.
4.
5.
Esophageal varices
Caput Medusae
Hemorrhoids
Ascites
Splenomegaly

12. Esophageal varices
•Patient typically presents
with Haematemesis & Black
tarry stools.
•It can be visualized using
Esophagogastroduodenoscop
y (endoscopy).

13. Caput Medusae

14. Hemorrhoids
Hemorrhoids are
painful, swollen veins in the
lower portion of the rectum
or anus.
Hematochezia / fresh blood.

15. Ascites
accumulation of fluid in the peritoneal cavity

16. Treatment
Band Ligation
 Sclerotherapy
 Portosystemic Shunts
 TIPSS (Transjuglar Intrahepatic PortoSystemic

Shunting)

17. Band Ligation
A small band is applied to the base of the varix, stopping
the blood supply to it. It will shrink and die within a few
days and the shriveled tissue along with the band will fall
off during normal peristaltic movements.

18. Sclerotherapy
A solution of Sodium
Morrhuate and
Ethanolamine oleate
is introduced into the
varix.

19. Portosystemic Shunts
•A common method for reducing
portal hypertension is to divert
blood from the portal venous
system to the systemic venous
system by creating a
communication between the
hepatic portal vein and the IVC.
•Another way of reducing portal
pressure is to join the splenic
vein to the left renal vein, after
splenectomy.
(splenorenal anastomosis or
shunt)

20. TIPSS (Transjuglar Intrahepatic PortoSystemic Shunting)
• TIPSS is an artificial channel within the liver that establishes
communication between the inflow portal vein and the
outflow hepatic vein.
• This procedure is done by catheterization Right hepatic vein
via internal juglar vein.

21. 
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