Portal Vein

Portal vein
The portal vein or hepatic portal vein is a

blood vessel that carries blood from the
gastrointestinal tract, gallbladder,
pancreas and spleen to the liver. This
blood contains nutrients and toxins
extracted from digested contents.
Approximately 75% of total liver blood flow
is through the portal vein, with the
remainder coming from the hepatic artery
proper. The blood leaves the liver to the
heart in the hepatic veins.
Portal vein
The portal vein and its tributaries. It is formed by

the superior mesenteric vein, inferior mesenteric
vein, and splenic vein. Lienal vein is an old term
for splenic vein.
Details
Drains from Gastrointestinal tract,

spleen, pancreas
Source splenic vein, superior

mesenteric vein, inferior
mesenteric vein
Drains to liver sinusoid
Identifiers
Latin vena portae hepatis
MeSH D011169
TA A12.3.12.001
FMA 50735
Anatomical terminology
The portal vein is not a true vein, because

it conducts blood to capillary beds in the
liver and not directly to the heart. It is a
major component of the hepatic portal
system, one of only two portal venous
systems in the body – with the
hypophyseal portal system being the
other.
The portal vein is usually formed by the

confluence of the superior mesenteric and
splenic veins and also receives blood from
the inferior mesenteric, left and right
gastric veins, and cystic veins.
Conditions involving the portal vein cause

considerable illness and death. An
important example of such a condition is
elevated blood pressure in the portal vein.
This condition, called portal hypertension,
is a major complication of cirrhosis.
Structure
Measuring approximately 8 cm (3 inches)
in adults,[1] the portal vein is located in the
right upper quadrant of the abdomen,
originating behind the neck of the
pancreas.[2]
In most individuals, the portal vein is

formed by the union of the superior
mesenteric vein and the splenic vein.[3] For
this reason, the portal vein is occasionally
called the splenic-mesenteric
confluence.[2] Occasionally, the portal vein
also directly communicates with the
inferior mesenteric vein, although this is
highly variable. Other tributaries of the
portal vein include the cystic and the left
and right gastric veins.[4]
Tributaries of the hepatic portal vein[4]

Splenic vein
Superior mesenteric vein
Inferior mesenteric vein
Left and right gastric veins
Cystic vein
Immediately before reaching the liver, the

portal vein divides into right and left. It
ramifies further, forming smaller venous
branches and ultimately portal venules.
Each portal venule courses alongside a
hepatic arteriole and the two vessels form
the vascular components of the portal
triad. These vessels ultimately empty into
the hepatic sinusoids to supply blood to
the liver.[4]
Portacaval anastomoses
The portal venous system has several

anastomoses with the systemic venous
system. In cases of portal hypertension
these anastamoses may become
engorged, dilated, or varicosed and
subsequently rupture.
Accessory hepatic portal veins
Accessory hepatic portal veins are those

veins that drain directly into the liver
without joining the hepatic portal vein.
These include the paraumbilical veins as
well as veins of the lesser omentum,
falciform ligament, and those draining the
gallbladder wall.[2]
Function
The portal vein and hepatic arteries form
the liver's dual blood supply.
Approximately 75% of hepatic blood flow
is derived from the portal vein, while the
remainder is from the hepatic arteries.[2]
Unlike most veins, the portal vein does not

drain into the heart. Rather, it is part of a
portal venous system that delivers venous
blood into another capillary system, the
hepatic sinusoids of the liver. In carrying
venous blood from the gastrointestinal
tract to the liver, the portal vein
accomplishes two tasks: it supplies the
liver with metabolic substrates and it
ensures that substances ingested are first
processed by the liver before reaching the
systemic circulation. This accomplishes
two things. First, possible toxins that may
be ingested can be detoxified by the
hepatocytes before they are released into
the systemic circulation. Second, the liver
is the first organ to absorb nutrients just
taken in by the intestines. After draining
into the liver sinusoids, blood from the liver
is drained by the hepatic vein.
Clinical significance
Portal hypertension
Increased blood pressure in the portal

vein, called portal hypertension, is a major
complication of liver disease, most
commonly cirrhosis.[5] A dilated portal vein
(diameter of greater than 13 or 15 mm) is
a sign of portal hypertension, with a
sensitivity estimated at 12.5% or 40%.[6]
On Doppler ultrasonography, the main
portal vein (MPV) peak systolic velocity
normally ranges between 20 cm/s and
40 cm/s.[7] A slow velocity of <16 cm/s in
addition to dilatation in the MPV are
diagnostic of portal hypertension.[7]
Clinical signs of portal hypertension

include those of chronic liver disease:
ascites, esophageal varices, spider nevi,
caput medusae, and palmar erythema.[8]
Pulsatility
Doppler ultrasonography of the portal vein over 5

seconds, showing peaks of maximal velocity, as well
as points of minimal velocity.
Portal vein pulsatility can be measured by
doppler ultrasonography. An increased
pulsatility may be caused by cirrhosis, as
well as increased right atrial pressure
(which in turn may be caused by right
heart failure or tricuspid regurgitation).[7]
Portal vein pulsatility can be quantified by
pulsatility indices (PI), where an index
above a certain cutoff indicates pathology:
Pulsatility indices (PI)

Index Calculation Cutoff
Average-based (Max - Min) / Average[7] 0.5[7]
Max-based (Max - Min) / Max[9] 0.5[9][10] - 0.54[10]
Infection
Pylephlebitis is infection of the portal vein,
usually arising from an infectious intra-
abdominal process such as
diverticulosis.[11][12]
References
1. Harold M Chung; Chung, Kyung Won
(2008). Gross anatomy. Philadelphia:
Wolters Kluwer Health/Lippincott Williams
& Wilkins. p. 208. ISBN 978-0-7817-7174-0.
2. Plinio Rossi; L. Broglia (2000). Portal
Hypertension: Diagnostic Imaging and
Imaging-Guided Therapy. Berlin: Springer.
p. 51. ISBN 978-3-540-65797-2.
3. Benjamin L. Shneider; Sherman, Philip M.
(2008). Pediatric Gastrointestinal Disease.
Connecticut: PMPH-USA. p. 751. ISBN 978-
1-55009-364-3.
4. Henry Gray (1901). Anatomy, Descriptive
and Surgical (16 ed.). Philadelphia: Lea
Brothers. p. 619.
5. Dooley, James; Sherlock, Sheila (2002).
Diseases of the liver and biliary system.
Oxford: Blackwell Science. ISBN 978-0-632-
05582-1.
6. Al-Nakshabandi NA (2006). "The role of
ultrasonography in portal hypertension" .
Saudi J Gastroenterol. 12 (3): 111.
doi:10.4103/1319-3767.29750 .
7. Iranpour, Pooya; Lall, Chandana;
Houshyar, Roozbeh; Helmy, Mohammad;
Yang, Albert; Choi, Joon-Il; Ward, Garrett;
Goodwin, Scott C (2016). "Altered Doppler
flow patterns in cirrhosis patients: an
overview". Ultrasonography. 35 (1): 3–12.
doi:10.14366/usg.15020 . ISSN 2288-
5919 .
8. Key Topics in General Surgery (2 ed.).
Informa Healthcare. 2002. ISBN 978-1-
85996-164-3.
9. Goncalvesova, E.; Varga, I.; Tavacova, M.;
Lesny, P. (2013). "Changes of portal vein
flow in heart failure patients with liver
congestion". European Heart Journal. 34
(suppl 1): P627.
doi:10.1093/eurheartj/eht307.P627 .
ISSN 0195-668X .
10. Page 367 in: Henryk Dancygier (2009).
Clinical Hepatology: Principles and Practice
of Hepatobiliary Diseases. 1. Springer
Science & Business Media.
ISBN 9783540938422.
11. Plemmons RM, Dooley DP, Longfield RN
(November 1995). "Septic thrombophlebitis
of the portal vein (pylephlebitis): diagnosis
and management in the modern era". Clin.
Infect. Dis. 21 (5): 1114–20.
doi:10.1093/clinids/21.5.1114 .
PMID 8589130 .
12. Perez-Cruet MJ, Grable E, Drapkin MS,
Jablons DM, Cano G (May 1993).
"Pylephlebitis associated with
diverticulitis" . South. Med. J. 86 (5): 578–
80. doi:10.1097/00007611-199305000-
00020 . PMID 8488411 .
Additional images
Human embryo with heart and anterior
body-wall removed to show the sinus
venosus and its tributaries.
Section across portal triad of pig.

Longitudinal section of a small portal vein
and canal.
Hepatic portal vein.Plastination technique.

Hepatic portal vein.Abdominal cavity.Deep
dissection.
Hepatic portal vein.Visceral surface of

liver.
External links
Anatomy photo:38:12-0109 at the SUNY
Downstate Medical Center - "Stomach,
Spleen and Liver: The Visceral Surface
of the Liver"
Anatomy image:7959 at the SUNY
Downstate Medical Center
Cross section image: pembody/body8a
—Plastination Laboratory at the Medical
University of Vienna
figures/chapter_30/30-2.HTM : Basic
Human Anatomy at Dartmouth Medical
School
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The portal vein or hepatic portal vein is a

The portal vein and its tributaries. It is formed by

Drains from Gastrointestinal tract,

Source splenic vein, superior

Drains to liver sinusoid

Latin vena portae hepatis

The portal vein is not a true vein, because

The portal vein is usually formed by the

Conditions involving the portal vein cause

In most individuals, the portal vein is

Tributaries of the hepatic portal vein[4]

Superior mesenteric vein

Inferior mesenteric vein

Left and right gastric veins

Immediately before reaching the liver, the

The portal venous system has several

Accessory hepatic portal veins

Accessory hepatic portal veins are those

Unlike most veins, the portal vein does not

Increased blood pressure in the portal

Clinical signs of portal hypertension

Doppler ultrasonography of the portal vein over 5

Pulsatility indices (PI)

Average-based (Max - Min) / Average[7] 0.5[7]

Max-based (Max - Min) / Max[9] 0.5[9][10] - 0.54[10]

Section across portal triad of pig.

Hepatic portal vein.Plastination technique.

Hepatic portal vein.Visceral surface of

Last edited 5 days ago by Citation bot

Content is available under CC BY-SA 3.0 unless

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