Site of Anastomosis Clinical Sign Portal ↔ Systemic
  • Esophageal varices
  • Left gastric ↔ esophageal
  • Caput medusae
  • Paraumbilical ↔ superficial and inferior epigastric
  • Anorectal varices (someterims referred to as internal hemorrhoids though they are different)
  • Superior rectal ↔ middle and inferior rectal

  • Portal hypertension
    • symptoms
      • varices of "gut, butt, and caput (medusae)"
        • esophageal varices
        • caput medusae
        • anorectal varices (sometimes referred to as hemorrhoids)
    • portal-systemic anastomoses
      • inferior esophagus
        • systemic circulation: esophageal branches of azygos vein
        • portal circulation: esophageal branch of left gastric vein
        • clinical symptom: esophageal varices
      • anal canal (rectum)
        • systemic circulation: middle and inferior rectal vein
        • portal circulation: superior rectal vein
        • clinical symptom: anorectal varices (sometimes referred to as hemorrhoids)
      • paraumbilical region
        • systemic circulation: superficial and inferior epigastric vein
        • portal circulation: paraumbilical veins
        • clinical symptom: caput medusae
    • treatment
      • relieve portal hypertension by shunting blood to systemic circulation by
        • inserting a portocaval shunt between portal and hepatic vein
        • connecting portal vein to IVC



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