Esophageal, Gastric and Rectal Anastomoses – Portal System

by James Pickering, PhD

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    00:01 So, let’s have a look, these portal-systemic anastomoses, here on the screen we can see the normal portal system in this purple colour and the systemic circulation in this blue.

    00:13 And we can see that if blood can’t pass through in this direction typically it goes into the portal vein and into the liver in this direction, if this is blocked, if this is prevented then blood can actually pass up via these oesophageal veins into your azygous system and that will take it back to the heart that way. Now what we can see if we look into the internal aspect of the oesophagus we see normal nice, flat architecture to the inside wall of the stomach. But if we look with these oesophageal varices where these usually quiescent blood vessels are now swollen, we can see that they are actually causing these bulges into the wall of the oesophagus. These can potentially rupture and leak blood into the oesophagus and you may cough up or vomit blood. So, that’s one of them, the oesophageal and gastric anastomosis, the connection between these gastric and oesophageal veins connect to the azygous system in the thorax and like I said if these were to rupture you can get some quite severe bleeding.

    01:21 If we now look at second portal-systemic anastomosis, we can see these occurring at the rectum, by these rectal veins. We can see that typically the superior rectal vein is draining blood up in this direction but we can also see that if blood is prevented from passing through the liver then it can actually drain into the internal iliac vein via some other rectal veins, by your inferior, middle rectal veins perhaps and these can pass back into the internal iliac vein, these can pass back into these directions. Now, because again these blood vessels aren’t use to receiving this proportion of blood then we can have what are known as haemorrhoids, we can have bulging of these blood vessels into the wall of the anal and the rectal canal and we can see some internal ones here and we can see some external haemorrhoids here. So that’s the second portal-systemic anastomosis.

    About the Lecture

    The lecture Esophageal, Gastric and Rectal Anastomoses – Portal System by James Pickering, PhD is from the course Abdomen.

    Included Quiz Questions

    1. Azygos
    2. Inferior rectal
    3. Superficial epigastric
    4. Retroperitoneal
    1. Internal iliac
    2. External iliac
    3. Paraumbilical
    4. Sigmoidal
    5. Gastro-omental

    Author of lecture Esophageal, Gastric and Rectal Anastomoses – Portal System

     James Pickering, PhD

    James Pickering, PhD

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