Supplies left lobe of the liver
left portal vein
Vein formed by union of the splenic vein and superior mesenteric
vein; serves as the posterior border of the pancreas; enters the liver
at the porta hepatis
MPV
Supplies the right lobe of the liver; branches into anterior and
posterior segments
right portal vein
Main portal vein enters the liver at the _______ _______.
porta hepatis
What does the portal venous system drain? [4]
spleen
digestive organs
pancreas
GB
What is presinusoidal portal hypertension?
Prehepatic
thrombosis in the mesenteric, splenic of portal vein
What is intrahepatic portal hypertension?
offending process occurs at the hepatic level
What is the most common cause of intrahepatic portal hypertension?
Cirrhosis
What is posthepatic portal hypertension?
Budd-Chiari
offending process after the hepatic level
thrombosis of the IVC or hepatic veins
Hepatofugal blood flow may be seen in the main portal vein in
patients with?
Portal Hypertension
The portal triad consists of what three things?
MPV, Hepatic Artery, CBD
A 30 year old patient presents with abdominal pain and abnormal liver
function tests. The abdominal ultrasound reveals a dilated portal and
superior mesenteric vein with hepatofugal blood flow. This is most
characteristic of?
Portal HTN
What is the waveform of the portal vein?
low resistance with some phasity
The MPV divides into _____ and ______ branches.
Left and right
The RPV divides into ______ and ______ branches.
anterior and posterior
The portal vein should not exceed _____mm.
13mm (1.3cm)
Portal veins have ______ walls than the hepatic veins.
brighter
The LPV divides into _____ and _____ branches.
Medial and lateral
What are 3 sequelae of cirrhosis?
portal vein thrombosis, portal hypertension, splenomegaly
Normal flow toward the liver in the portal veins is termed?
Hepatopetal
What carries the majority of the oxygen and nutrients to the liver?
Portal Vein
Which portion of the liver receives both right and left portal branches?
Caudate lobe
Define Hepatopetal.
Define Hepatofugal.
Flow toward the liver
Flow away from the liver
Which vessels are considered to be intrasegmental within the liver?
Portal triad
*Relationship*
The caudate lobe is bordered ________ by the proximal LPV.
anteroinferiorly
*Relationship*
The caudate lobe is bordered__________ by the MPV.
inferiorly
Describe the sonographic appearance of acute hepatitis.
hypoechoic, large, hyperechoic portal vein walls
Describe the sonographic appearance of chronic hepatitis.
hyperechoic, small, decreased echogenicity of portal vein walls
What are the clinical signs of portal hypertension?
ascites, splenomegaly, varices
In patients with portal hypertension, transjugular intrahepatic
portosystemic shunts (TIPS) decompress the portal system. How is the
functionality of the TIPS assessed?
flow within the shunt, presence of hepatofugal flow within the right
and left portal veins
With a properly funtions TIPS, what is the flow direction in a
patient with a recanalized umbilical vein?
left portal branch may flow hepatopedally, exiting not by way of the
shunt, but thru the recanalized umbilical vein collateral
What does the presence of portal venous gas indicate?
bowel infarction seen in ulcerative colitis or necrotizing enterocolitis
What is the sonographic appearance of portal venous gas?
linear echogenic branches in the periphery of the liver, echogenic
foci within the lumen of the portal vein
Periportal collateral channels in patients with chronic portal vein obstruction
cavernous transformation of the portal vein
Arises from the celiac trunk to supply the liver
CHA
Formed by the union of the superior mesenteric vein and the splenic
vein near the porta hepatis of the liver
portal vein
Caused by increased resistance to venous flow through the liver;
sonographic findings include dilation of the portal and splenic and
mesenteric veins, reversal of portal venous blood flow, and the
development of collateral vessels
portal venous HTN