The portal venous

system
ZAKY MOHAMED ZAKY khallaf
a11
The portal venous system refers to the vessels
involved in the drainage of the capillary beds
of the GI tract and spleen into the capillary
bed of the liver.
The portal system includes all the veins which drain the
blood from the abdominal part of the digestive tube (with
the exception of the lower part of the rectum) and from
the spleen, pancreas, and gall-bladder. From these viscera
the blood is conveyed to the liver by the portal vein. In
the liver this vein ramifies like an artery and ends in
capillary-like vessels termed sinusoids, from which the
blood is conveyed to the inferior vena cava by the hepatic
veins.
• From this it will be seen that the blood of the
portal system passes through two sets of minute
vessels, viz., (a) the capillaries of the digestive
tube, spleen, pancreas, and gall-bladder; and
(b) the sinusoids of the liver. In the adult the
portal vein and its tributaries are destitute of
valves; in the fetus and for a short time after
birth valves can be demonstrated in the
tributaries of the portal vein; as a rule they soon
atrophy and disappear, but in some subjects
they persist in a degenerate form.
The portal vein (vena portæ) is about 8 cm. in length, and is
formed at the level of the second lumbar vertebra by the
junction of the superior mesenteric and lienal veins, the union
of these veins taking place in front of the inferior vena cava
and behind the neck of the pancreas. It passes upward behind
the superior part of the duodenum and then ascends in the right
border of the lesser omentum to the right extremity of the porta
hepatis, where it divides into a right and a left branch, which
accompany the corresponding branches of the hepatic artery
into the substance of the liver. In the lesser omentum it is
placed behind and between the common bile duct and the
hepatic artery, the former lying to the right of the latter.
It is surrounded by the hepatic plexus of nerves, and is
accompanied by numerous lymphatic vessels and some lymph
glands. The right branch of the portal vein enters the right lobe of
the liver, but before doing so generally receives the cystic vein. The
left branch, longer but of smaller caliber than the right, crosses the
left sagittal fossa, gives branches to the caudate lobe, and then
enters the left lobe of the liver. As it crosses the left sagittal fossa
it is joined in front by a fibrous cord, the ligamentum teres
(obliterated umbilical vein), and is united to the inferior vena cava
by a second fibrous cord, the ligamentum venosum (obliterated
ductus venosus).
Tributaries.—The lineal vein receives the short gastric veins, the
left gastroepiploic vein, the pancreatic veins, and the inferior
mesenteric veins.
The left gastroepiploic vein (v. gastroepiploica sinistra) receives
branches from the antero-superior and postero-inferior surfaces of
the stomach and from the greater omentum; it runs from right to left
along the greater curvature of the stomach and ends in the
commencement of the lienal vein.
The short gastric veins (vv. gastricæ breves), four or five in
number, drain the fundus and left part of the greater curvature of the
stomach, and pass between the two layers of the gastrolienal
ligament to end in the lienal vein or in one of its large tributaries.
• The pancreatic veins (vv. pancreaticæ) consist of several small vessels
which drain the body and tail of the pancreas, and open into the trunk of
the lienal vein.

The inferior mesenteric vein (v. mesenterica inferior) returns blood from the rectum and the sigmoid,
and descending parts of the colon. It begins in the rectum as the superior hemorrhoidal vein, which has
its origin in the hemorrhoidal plexus, and through this plexus communicates with the middle and inferior
hemorrhoidal veins. The superior hemorrhoidal vein leaves the lesser pelvis and crosses the left common
iliac vessels with the superior hemorrhoidal artery, and is continued upward as the inferior mesenteric
vein. This vein lies to the left of its artery, and ascends behind the peritoneum and in front of the left
Psoas major; it then passes behind the body of the pancreas and opens into the lienal vein; sometimes it
ends in the angle of union of the lienal and superior mesenteric veins.
• The superior hemorrhoidal vein leaves the lesser pelvis and
crosses the left common iliac vessels with the superior
hemorrhoidal artery, and is continued upward as the
inferior mesenteric vein. This vein lies to the left of its artery, and
ascends behind the peritoneum and in front of the left Psoas
major; it then passes behind the body of the pancreas and opens
into the lienal vein; sometimes it ends in the angle of union of
the lienal and superior mesenteric veins.
• The right gastroepiploic vein (v. gastroepiploica dextra) receives
branches from the greater omentum and from the lower parts of the
antero-superior and posteroinferior surfaces of the stomach; it runs
from left to right along the greater curvature of the stomach between
the two layers of the greater omentum.
• The pancreaticoduodenal veins (vv. pancreaticoduodenales) accompany
their corresponding arteries; the lower of the two frequently joins the
right gastroepiploic vein.
•   The Coronary Vein (v. coronaria ventriculi; gastric vein) derives
tributaries from both surfaces of the stomach; it runs from right to left
along the lesser curvature of the stomach, between the two layers of
the lesser omentum, to the esophageal opening of the stomach, where
it receives some esophageal veins. It then turns backward and passes
from left to right behind the omental bursa and ends in the portal vein.
• The Pyloric Vein is of small size, and runs from left to right along
the pyloric portion of the lesser curvature of the stomach,
between the two layers of the lesser omentum, to end in the
portal vein.
•   The Cystic Vein (v. cystica) drains the blood from the gall-
bladder, and, accompanying the cystic duct, usually ends in the
right branch of the portal vein.
The structure 
• Large veins that are considered
part of the 
• portal venous system are the:
• Hepatic portal vein
• Splenic vein
• Superior mesenteric vein
• Inferior mesenteric vein
• Hepatic portal vein
• Splenic vein
The Function
The portal venous system is responsible for
directing blood from parts of
the gastrointestinal tract to the liver. Substances
absorbed in the small intestine travel first to the
liver for processing before continuing to the
heart. Not all of the gastrointestinal tract is part
of this system. The system extends from about
the lower portion of the esophagus to the upper
part of the anal canal. It also includes venous
drainage from the spleen and pancreas.
Blood flow to the liver is unique in that it receives both
oxygenated and (partially) deoxygenated blood. As a result,
the partial gas pressure of oxygen (pO2) and perfusion
pressure of portal blood are lower than in other organs of
the body. Blood passes from branches of the portal vein
through cavities between "plates"
of hepatocytes called sinusoids. Blood also flows from
branches of the hepatic artery and mixes in the sinusoids to
supply the hepatocytes with oxygen. This
mixture percolates through the sinusoids and collects in a
central vein which drains into the hepatic vein. The hepatic
vein subsequently drains into the inferior vena cava.
The hepatic artery provides 30 to 40% of the oxygen
to the liver, while only accounting for 25% of the total
liver blood flow. The rest comes from the partially
deoxygenated blood from the portal vein. The liver
consumes about 20% of the total body oxygen when at
rest. That is why the total liver blood flow is quite
high, at about 1 litre a minute and up to two litres a
minute. That is on average one fourth of the
average cardiac output at rest.
Clinical significance

Portal hypertension is a condition in