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Forgot your password? Get help. Because the lateral side of the knee is struck more often e. The unhappy triad of athletic knee injuries involves: Tibial collateral ligament Medial meniscus Anterior cruciate ligament. Rounded cord between lateral epicondyle of femur and head of fibula Does NOT blend with joint capsule and does NOT attach to lateral meniscus Limits extension and adduction of leg at knee.
Broad flat band extending from medial epicondyle of femur to medial condyle and shaft of tibia Blends with capsule and firmly attaches to medial meniscus Limits extension and abduction of leg at knee. With rupture of the anterior cruciate ligament, the tibia can be pulled forward excessively on the femur, exhibiting anterior drawer sign. In the less common rupture of the posterior cruciate ligament, the tibia can be pushed backward excessively on the femur, exhibiting posterior drawer sign.
Prepatellar bursa: between superficial surface of patella and skin. May become inflamed and swollen prepatellar bursitis. Suprapatellar bursa: superior extension of synovial cavity between distal end of femur and quadriceps muscle and tendon. Usual place for intraarticular injections. May become inflamed and swollen suprapatellar bursitis.
Posterior to Rectus femoris m and vastis intermedialis m. The patellar reflex is tested by tapping the patellar Rectus femoris m ligament with a reflex hammer to elicit extension at the knee joint. Both afferent and efferent limbs of the reflex arch are in the femoral nerve L2-L4. Sprains are the most common ankle injuries A sprained ankle is nearly always an inversion injury, involving twisting of the weightbearing plantarflexed foot.
The lateral ligament anterior talofibular ligament is injured because it is much weaker than the medial ligament. In severe sprains, the lateral malleolus of the fibula may be fractured. It is fracture-dislocations of the ankle joint Reason - forced eversion abduction of the foot The Deltoid ligament avulses the medial malleolus and after that fibula fractures at a higher level. Achilles tendon reflex is tested by tapping the calcaneal tendon to elicit plantar flexion at the ankle joint.
Both afferent and efferent limbs of the reflex arc are carried in the tibial nerve S1, S2. May cause an injury to the common nerve which winds peroneal nerve, laterally around the neck of the fibula. This injury results in paralysis of all muscles in the anterior and lateral compartments of the leg dorsiflexors and evertors of the foot and loosing sensation on the dorsum of the foot. Causing foot drop. Ankle jerk reflex: tests spinal nerves S1-S2.
Flexors take over Plantar flexion. Triceps surae muscle: l 2 Heads of Gastrocnemius m. Plantar fasciitis is the most common hindfoot problem in runners. It causes pain on the plantar surface of the foot and heel. Point tenderness is located at the proximal attachment of the plantar aponeurosis to the medial tubercle of the calcaneus and on the medial surface of this bone.
In popliteal fossa: loss of plantar flexion of foot mainly gastrocnernius and soleus muscles and weakened inversion tibialis posterior muscle , causing calcaneovalgus. Inability to stand on toes Loss of sensation and paralysis of intrinsic muscles. On soil of the foot there are two terminal branches of tibial n: l Medial plantar nerve supplies: 1.
Abductor hallucis, 2. Flexor hallucis brevis 3. Flexor digitorum brevis 4. Lymphatic drainage of the breast Carcinomas of the breast are malignant tumors, usually adenocarcinomas arising from the epithelial cells of the lactiferous ducts in the mammary gland lobules 1. It enlarges, attaches to suspensory Coopers ligaments, and produces shortening of the ligaments, causing depression or dimpling of the overlying skin.
It is important because of its role in the metastasis of cancer cells. Most of the remaining lymph, particularly from the medial breast quadrants, drains to the parasternal lymph nodes or to the opposite breast.
Radical mastectomy, a more extensive surgical procedure, involves removal of the breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in the axilla and pectoral region. During a radical mastectomy, the long thoracic nerve may be lesioned during ligation of the lateral thoracic artery.
A few weeks after surgery, the female may present with a winged scapula and weakness in abduction of the arm above 90 because serratus anterior m. The intercostobrachial nerve may also be damaged during mastectomy, resulting in skin deficit of the medial arm.
T2 intercostal n branch gives. Mastitis is an infection of the tissue of the breast that occurs most frequently during the time of breastfeeding 1 to 3months after the delivery of a baby. This infection causes pain, swelling, redness, and increased temperature of the breast. It can occur when bacteria, often from the baby's mouth, enter a milk duct through a crack in the nipple.
It can occur in women who have not recently delivered as well as in women after menopause. Intercostal blood vessels and nerves: l run between the internal intercostal and innermost intercostal muscles in the costal groove l arranged from superior to inferior as vein, artery, nerve.
Paralysis of the half of the Diaphragm may result from injury or operative division of the phrenic nerve of same side It can be detected radiologically. Paradoxical movement: dome of diaphragm of injured side pushed superiorly by abdominal viscera during inspiration Flail Chest: One or more broken ribs in two separate places instead of descending upon inspiration the broken area will sink in as chest wall moves out upon expiration the broken area will push out as chest wall moves in Dangerous bc lungs can be punctured Dr.
Most vulnerable structures intercostal nerve and posterior intercostal artery because they are not covering by ribs. Bochdalek Hernia: common hernia on the posterolateral L side of diaphragm, fatal congenital hernia that causes pulmonary hypoplasia. Arises from the anterior branches C3-C5 nerves and lies in front of the anterior scalene muscle.
Runs anterior to the root of the lung,, whereas the vagus nerve runs posterior to the root of the lung. Innervates the fibrous pericardium, the mediastinal and diaphragmatic pleurae sensory innervation , and the diaphragm for motor and its central tendon for sensory. Diaphragmatic injuries are relatively rare and result from either blunt trauma or penetrating trauma.
I ate 10 eggs at noon! Vessels entering the diaphragm Dr. P-A projection. Cardiac hypertrophy Left atrial enlargement hypertrophy secondary to mitral valve failure may compress on the esophagus and manifest as dysphagia difficulty in swallowing.
Right border is formed by: 1. SVC, 2. Right atrium Left border is formed by: 1. Aortic arch 2. Pulmonary trunk 3. Left auricle 4. Left ventricle Dr. It supplies major parts of the right atrium and the right ventricle. It anastomoses with the marginal branch of the left coronary artery posteriorly Branches: 1. Anterior cardiac branches supplies the right atrium 2. Nodal branch supplies the 1 SA node, 2 AV node 3.
Marginal artery supplies the right ventricle Small cardiac vein 4. Purkinje Fibers throughout walls of ventricles stimulate contractile cells Dr. Mavrych, PhD,ofDSc prof. Circumflex artery winds around the left margin of the heart in the atrioventricular groove to anastomose with the right coronary artery posteriorly; supplies the left atrium and left ventricle.
AV bundle and moderator band - LCA mo When l a MI occurs, a coronary bypass graft can be completed using the internal thoracic artery used to be Great saphenous v. It is less frequent than VSD l Ventricular septal defect VSD is the most common l It results from failure to of the congenital heart defects close of the foramen l It may be found in the ovale after birth failure of membranous part of the the septum primum and ventricular septum and septum secundum to results from failure to fuse of fuse Patent Foramen Ovale the membranous portion with the muscular portion of the l Postnatally, ASDs result ventricular septum in left-to-right shunting l In this case, present leftto between right and left right shunt right ventricular atrium and are nonhypertrophy RVH and cyanotic conditions.
Patent Ductus Arteriosus PDA It results from failure of the ductus arteriosus a connection between the pulmonary trunk and aorta to constrict and close after birth. In great danger is left recurrent nerve wrapping aorta arch.
Injure of this nerve results in hoarseness. Ductus arteriosus fetal lung bypass from pulmonary trunk to aorta should immediately close post birth by contraction of muscular wall and become lig. Mavrych, MD, PhD, prof. Aneurysm of the aortic arch: compresses the left recurrent laryngeal nerve,, leading to coughing, hoarseness, and paralys is of the ipsilateral vocal cord.
It may cause dysphagia difficulty in swallowing , resulting from pressure on the esophagus, and dyspnea difficulty in breathing , resulting from pressure on the trachea, root of the lung, or phrenic nerve. Aneurysm of the thoracic aorta may compress and tug on the trachea with each cardiac systole so that the aneurysm can be felt by palpating the trachea at the sternal notch T2.
It is a localized dilatation of the aorta. It is typically happened just above of the bifurcation at level of L4 and crossed by 3rd part of duodenum. Pulsations of a large aneurysm can be detected to the left of the midline at the umbilical region. Surgeons can repair an aneurysm by opening it and inserting a prosthetic graft. It results from congenital narrowing of the aorta distal to the offshoot of the left subclavian artery. Mavrych, PhD, prof. Laying down on back, it will go into posterior superior lobe Dr.
Superior lobe: 1. Apical 2. Anterior 3. Posterior Middle lobe: 4. Lateral 5. Medial Inferior lobe: 6. Superior 7. Anterior basal 8. Posterior basal 9.
Lateral basal Medial basal. Left lung: 9 bronchopulmonary segments Superior lobe: 1. Apicoposterior 2. Superior lingularsurrounds cardiac notch 4. Inferior lingular Inferior lobe: 5. Superior 6. Anterior basal 7. Posterior basal 8. Lateral basal 9. Pneumonia is an inflammation of the lung, caused by an infection or chemical injury to the lungs. Three common causes are bacteria, viruses and fungi. Symptoms: cough, chest pain, fever, and difficulty in breathing.
Chest x-rays: areas of opacity seen as white of the lung parenchyma and enlargement of bronchomediastinal lymph nodes mediastinal widening. Arises in the mucosa of the large bronchi Produces as persistent, productive cough or hemoptysis spitting blood Early metastasis to thoracic bronchomediatinal lymph nodes Hematogenous spread to the brain, bones, lungs,malignant cells suprarenal glands spread through blood A tumor at the apex of the lung Pancoast tumor may result in thoracic outlet syndrome.
It results in pain down the medial side of the Blue arm forearm and hand and atrophy of the intrinsic hand muscles 2. Bronchogenic carcinoma may lead to: 3. Dysphagia as a result of esophageal obstruction 5. Hoarseness as a result of recurrent laryngeal nerve involvement 6. Paralysis of the diaphragm as a result of phrenic nerve involvement. It is entry of air into a pleural cavity causing lung collapse.
Open pneumothorax due to stab wounds of the thoracic wall which pierce the parietal pleura so that the pleural cavity is open to the outside air via the lung or through the chest wall. Air moves freely through the wound during inspiration and expiration. During inspiration, air enters the chest wall and the mediastinum will shift toward other side and compress the opposite lung.
During expiration, air exits the wound and the mediastinum moves back toward the affected side. For breath sounds from the middle lobe of the right lung, the stethoscope is placed on the anterior chest wall between the 4th and 6th ribs For the inferior lobes of both lungs, breath sounds are primarily heard on the posterior chest wall.
Cervical pleura may be affected in case of improper subclavian venipuncture. Costodiaphragmatic Recess is deepest place in pleural cavity, around the chest wall, there are two rib interspaces separating the inferior limit of parietal pleural reflections from the inferior border of the lungs and visceral pleura: Midclavicular line - between ribs Midaxillary line - between ribs Paravertebral line between ribs Parietal Pleura sensitive to general sensibilities pain, temperature, touch, and pressure - somatic sensory innervation: l costal pleura intercostal nerves block may be used to decrease thoracic pain l mediastinal pleura phrenic nerve l diaphragmatic pleura phrenic nerve over the domes and lower 6 intercostal nerves around the periphery.
Improperly done sternal puncture may affect structures related to the posterior surface of the manubrium sternum: l In upper part Left brachiocephalic vein l In lower part Aortic arch Azygous vein and ascending aortic arches Trachea and Pulmonary artery bifurcations esophagus and thoracic duct change directions cross over l. Visceral Pleura sensitive to stretch but insensitive to general sensibilities; autonomic nerve supply from the pulmonary plexus.
Cervicothoracic Stellate Gangion down to T11 and Subcostal sympathetic ganglion comprise the thoracic Ribs down to transverse thoracic sympathetic trunk Dr. Mavrych, MD,plane Vagus CNX assists plexus of thorax for vocal cords and swallowing, and gives off recurrent laryngeal and superior external laryngeal to the larynx muscles. Tributaries at the root of the neck l Left jugular lymph trunk l Left subclavian lymph trunk l Left bronchomediastinal lymph trunk.
There are sites where ingested foreign bodies can lodge or where strictures may develop following ingestion of caustic fluids, common sites of esophageal carcinoma. C6 - where the pharynx joins the upper end 6" from the 15cm upper incisors 2. T4-T5 - where the aortic arch and left main bronchus cross T10 - where it passes through the diaphragm into the stomach 16" from the upper 40cm incisors.
The liver and gallbladder are in the right upper quadrant; The stomach and spleen are in the left upper quadrant; RH. The cecum and appendix are in the right lower quadrant; The end of the descending colon and sigmoid colon are in the left lower quadrant.
Pain arising out of the foregut derived structures is referred to the epigastric region. Pain arising out of the midgut derived structures is referred to the umbilical region. Pain arising out of the hindgut derived structures is referred to the hypogastric region. Arcuate line is where lateral abdominal ms tendons merge with Rectus abdominus linea semilunaris , Above arcuate line int oblique superficial fascia is above rectus abdominus 3 layers of fascia , Below arcuate line ALL fascias above rectus abdominis 6 layers typically inferior to umbilicus.
Superior epigastric internal thoracic a 2. Posterior intercostals arteries 3. Lumbar arteries 4. Deep circumflex iliac artery external iliac a 5.
Inferior epigastric from femoral a just past femoral ring inguinal lig. PortalMD, Caval anastamosis of paraumbilical veins off hepatic portal v with superficial Dr. Mavrych, PhD, DSc prof.
Hernial sac is a pouch diverticulum of peritoneum and has a neck and a body Hernial contents may consist of any structure found in the abdominal cavity more offen loops of small intestine and piece of omentum major Hernial coverings are formed from the layers of the abdominal wall through which the hernial sac passes. Superficial epigastric from femoral a 2. Superficial circumflex iliac. Therefore totally 7 nerves: lower 5 intercostals, 1 subcostal and L1 iliphypogastric and ilioinguinal nerves supply ilioinguinal the anterior abdominal wall.
L1 can be anaesthetized by injecting 1 inch 2. All nerves and deep blood vessels lie in the neurovascular plane: between internal oblique and transversus muscles. Indirect inguinal hernia is the most common form of hernia and is believed to be congenital in origin boys years.
It passes through the deep inguinal ring lateral to the inferior epigastric vessels, inguinal canal, superficial inguinal ring and descend into the scrotum. It is more common on the right normally, the right processus vaginalis becomes obliterated after the left; the right testis descends later than the left. During a direct inguinal hernia, the abdominal contents will protrude through the weak area of the posterior wall of the inguinal canal medial to the inferior epigastric vessels in the inguinal [Hesselbach's] triangle and after that through superficial inguinal ring.
It never descends into the scrotum. It is a disease of old men with weak abdominal muscles. Direct inguinal hernias are rare in women, and most are bilateral. If you can feel something lateral to finger it is direct hernia pushing towards Hesselbach's triangle medial inguinal fossa between medial and lateral umbilical folds.
The inferior epigastric vessels reside within Lateral umbilical fold functional , the inferior border is the inguinal lig. Anteriorly: The free border of the hepatoduodenal ligament, containing portal triad DVA. Site of Pringles Manuver to block blood supply to liver and investigate Dr. Mavrych, DSc prof. Use thumb anterior, and index posterior within Winslow foramen.
Rectouterine pouch pouch of Douglas : deeper point of peritoneal space in vertical position of the female body between the rectum and the cervix of uterus. It is space of the pelvic abscess location. Culdocentesis is aspiration of fluid from the cul-de-sac of Douglas rectouterine pouch by a needle puncture of the posterior vaginal fornix near the midline between the uterosacral ligaments Because the rectouterine pouch is the lowest portion of the female peritoneal cavity, it can collect inflammatory fluid pelvic abscess.
Males have a vesicorectal pouch, fluid can accumulate in these peritoneal areas if there is a pelvic abscess. Sympathetic innervation: Preganglionics: greater splanchnic nerves, T5-T9 Postganglionics: celiac ganglion. Sympathetic innervation: Preganglionics: lesser splanchnic nerves, T10T11 Postganglionics: superior mesenteric ganglion. Sympathetic innervation: Preganglionics: lumbar splanchnic nerves, L1-L2 Postganglionics: inferior mesenteric ganglion.
Posterior gastric ulcer 1. Posterior gastric ulcer may erode through the posterior wall of the stomach into the Omental bursa Lesser peritoneal sac and affect pancreas resulting in referred pain to the back. Erosion of splenic artery is very common in posterior gastric ulcers as well because of the proximity of the artery to this wall. This can damage the vagal trunks as they pass through the hiatus and resulting in hyposecretion of gastric juice.
Often due to shortened esophagus. Appendices epiploic Sacculations haustrations Taeniae coli The taeniae coli meet together at the base of the appendix where they form a complete longitudinal muscle coat for the appendix.
Meckel's diverticulum is a congenital anomaly representing a persistent portion of the vitellointestinal duct. This condition is often asymptomatic but occasionally becomes inflamed if it contains ectopic gastric, pancreatic, or endometrial tissue, which may produce ulceration.
Meckel's diverticulum is located on the Ileum about 2 feet 61 cm before the ileocecal junction and SMA supply it. The diverticulum is clinically important because diverticulitis, liberation, bleeding, perforation, and obstruction are complications requiring surgical intervention and frequently mimicking the symptoms of acute appendicitis. It is seen in infants and the mortality rate is high because of left lung hypoplasia.
A sliding hiatal hernia which occurs in individuals past middle age is caused by the hernia of cardia of the stomach into the thorax through the esophageal hiatus of the diaphragm. Fundus of stomach through. Hernia of stomach or intestine through a posterolateral defect in diaphragm foramen of Bochadalek. Improper fusion of pleuroperitoneal membranes with septum transversarus Most L sided bc liver and R side closes first. The ascending colon lies retroperitoneally and lacks a mesentery.
It is continuous with the transverse colon at the right hepatic flexure 1 of colon. The transverse colon 3 has its own mesentery called the transverse mesocolon intraperitoneal position.
It becomes continuous with the descending colon at the left splenic flexure 2 of colon. The sigmoid colon 4 is suspended by the sigmoid mesocolon intraperitoneal position. In appendicitis, first pain is referred around the umbilicus. Visceral pain in the appendix is produced by distention of its lumen or spasm of its muscle. The afferent pain fibers enter the spinal cord at the level of T10 segment, segment and a vague referred pain is felt in the region of the umbilicus.
Later if parietal peritoneum gets involved, and then the pain is shifted laterally to the Mc Burneys point. Here the pain is precise, severe, and localized second pain. Because of its extreme mobility, the Jejunum, Ileum and Sigmoid colon sometimes rotates around its mesentery. It results in avascular necrosis corresponding part of interstine. This may correct itself spontaneously, or the rotation may continue until the blood supply of the gut is cut off completely.
It is a rare congenital abnormality that results in obstruction because the intestines do not work normally. It is commonly found in Down Syndrome children. In a newborn, the main signs and symptoms are failure to pass a meconium stool within days after birth, reluctance to eat, bile-stained green vomiting, and abdominal distension. Treatment is removal of the aganglionic portion of the colon. NCCs did not travel correctly to the colon resulting in lack of Dr.
Celiac trunk CA originates from the aorta at the lower border of T12 vertebra Superior mesenteric artery originates at the lower border of L1 vertebra Renal arteries originate at approximately L2 vertebra Inferior mesenteric artery originates at L3 vertebra Two terminal branches are common iliac arteries at the level of L4 vertebra.
Origin: T12, just below the aortic opening of the between crura of diaphragm diaphragm. The CA passes above the superior border of the pancreas and then divides into three retroperitoneal branches: Left gastric artery 1 Common hepatic artery 2 Splenic artery 3.
The left gastric artery 1 courses upward to the left to reach the lesser curvature of the stomach and may be subject to erosion by a penetrating ulcer of the lesser curvature of the stomach. Branches: l Esophageal branches 2 - to the abdominal part of the esophagus l Gastric branches 3 supply the left side of the lesser curvature of the stomach and make anastomosis with right gastric artery. The common hepatic artery 1 passes to the right to reach the superior surface of the first part of the duodenum, where it divides into its two terminal branches: Proper hepatic artery 2 Gastroduodenal artery 3.
Proper hepatic artery 1 gives off right gastric artery 2 and then ascends within the hepatoduodenal ligament of the lesser omentum to reach the porta hepatis, where it divides into the right 4 and left 3 hepatic arteries. The right and left arteries enter the two lobes of the liver,, right hepatic artery gives cystic artery 5 to the gallbladder. Right gastric artery 2 supplies the right side of the lesser curvature of the stomach where it anastomoses the left gastric artery.
Gastroduodenal artery 1 descends posterior to the first part of the duodenum may be subject to erosion by a penetrating ulcer in this place and divides into two branches: Right gastroepiploic artery 2 supplies the right side of the greater curvature of the stomach where it anastomoses the left gastroepiploic Superior pancreaticoduodenal arteries 3 supply the head of the pancreas, where they anastomoses the inferior pancreaticoduodenal arteries from the SMA.
The hepatic artery may be ligated proximal to the origin of its gastroduodenal branch, a collateral circulation to the liver is established through the left and right gastric arteries, left and right gastroepiploic and gastroduodenal arteries. The right hepatic artery may be mistakenly ligated during holecystectomy in Calot triangle together with the cystic artery, right lobe hepatic necrosis commonly occurs. Anastamoses of the L gastric, L gastroepiploic, and Lgastroduodenal Dr. Splenic artery 1 runs a tortuous horizontal course to the left along the upper border of the pancreas, behind the peritoneum of the posterior wall of the lesser sac, forming a part of the stomach bed.
The splenic artery may be subject to erosion by a penetrating ulcer of the posterior wall of the stomach into the lesser sac. The splenic vein runs a more straight course below the artery and behind of the pancreas. SMA Branches: l 1 Inferior pancreaticoduodenal arteries l 2 Jejunal and 3 Ileal branches l 4 Ileocolic artery l Ascending branch l Anterior cecal artery l Posterior cecal artery l 5 Appendicular artery l 6 Right colic artery l 7 Middle colic artery.
Atherosclerosis, which slows the amount blood flowing through arteries, is a frequent cause of chronic mesenteric ischemia. Ischemia occurs when blood cannot flow through arteries as well as it should, and intestines do not receive the necessary oxygen to perform normally. Mesenteric ischemia usually involves SMA and small intestine. Usually blood supply of the Jejunum and Ileum is most compromised. Mesenteric ischemia typically occurs in people older than age 60 with history of smoking and high cholesterol level.
The common bile duct descends in hepatoduo ligament, the hepatoduodenal ligament, then passes posterior to the first part of the duodenum duo It penetrates the t head of the pancreas where whe it joins the main and they form the pancreatic duct d hepatopancreatic ampulla hepatopancre sphincter of o Oddi Oddi , which drains into posteromedial wall the second part of the duodenum at the major duodenal papilla.
Tumor in the head of the pancreas can block the duct and cause jaundice Dr. The distal end of the hepatopancreatic ampulla Bile duct is the narrowest part of the biliary passages and is the common site for impaction of gallstones.
As result of common hepatic 1 , bile duct 2 , or hepatopancreatic ampulla 3 obstruction patient will have yellow eyes and jaundice Gallstones may also lodge in the cystic duct. A stone lodged in the cystic duct 4 causes biliary colic intense, spasmodic pain in the gallbladder but doesn't produce jaundice.
Gall stone the cystic will cause backflow to the gall bladder burst Dr. The fundus [1] of the gallbladder is in contact with the transverse colon and thus gallstones erode through the posterior wall of the gallbladder and enter the transverse colon. They are passed naturally to the rectum through the descending colon and sigmoid colon.
Gallstones lodged in the body [2] of the gallbladder may ulcerate through the posterior wall of the body of the gallbladder into the duodenum because the gallbladder body is in contact with the duodenum and may be held up at the ileocecal junction, producing an intestinal obstruction.
The liver receives parasympathetic innervation from the vagi nerves CNX , reaching it through the celiac plexuses around the supplying arteries. The preganglionic fibers synapse on the cells of the uxtramural plexuses in hilum of the liver and shot postganglionic fibers supply organs. Portal hypertension is a common clinical condition, and for this reason portal-systemic anastomoses should be remembered. Sympathetic fibers of preganglionic neurons T5-T9 segments IML come through the sympathetic trunk and form greater splanchnic nerves.
They contribute to the celiac plexus, where postganglionic neurons are located. Branches of celiac plexus reach the liver wrapping around the branches of the celiac artery. Sensory innervation of the liver: by the right phrenic nerve C3-C5 C3-C5.
Pain may radiate to the right shoulder. Metastases of the Large intestine cancer typically rich the Liver via portal venous system: Rectum IMV - splenic vein - portal vein Liver If there is an obstruction to flow through the portal system portal hypertension , blood can flow in a retrograde direction and pass through anastomoses to reach the caval system.. Sites for these anastomoses include: 1 esophageal veins 2 paraumbilical veins 3 rectal veins.
Diverting blood from portal venous system to the systemic venous system by creating a communication between the hepatic portal vein and the IVC. And typical splenorenal central shunt all allow portion of blood to IVC to decrease flow to liver. Anastomosis between the tributaries of the left gastric vein portal vein and the tributaries of the azygous vein SVC in the wall of the lower end of the esophagus.
In portal hypertension these veins enlarge in the wall of the esophagus and later burst into the lumen of the esophagus esophageal varices resulting in hematemesis vomiting red blood. Anastomosis between the paraumbilical veins portal vein and the superior and inferior epigastric veins SVC and IVC in anterior abdominal wall around the umbilicus. In portal hypertension, this anastomosis gets enlarged and dilated veins form caput Medussae around the umbilicus.
Anastomosis between the superior rectal vein inferior mesenteric vein and then portal vein vein and inferior rectal vein which drains into the internal iliac vein from IVC system. In portal hypertension chronic alcoholics this anastomosis gets dilated resulting in internal hemorrhoids and bleeding per anus from superior rectal vein. Internal hemorrhoids are painless superior to pectinate line at internal rectal venous plexus.
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