Portal vein

Template:Short description Template:About Template:Infobox vein The portal vein or hepatic portal vein (HPV) 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.

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 two portal venous systems in the human body; the other being the hypophyseal portal system. Some reptiles have an additional renal portal system not present in mammals.

The portal vein is usually formed by the confluence of the superior mesenteric, splenic veins, inferior mesenteric, left, right gastric veins and the pancreatic vein.

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. In abdominal obesity fats, inflammatory cytokines and other toxic substances are transported by the portal vein from visceral fat into the liver, leading to hepatic insulin resistance and metabolic dysfunction–associated steatotic liver disease.<ref name="pmid23107257">Template:Cite journal</ref><ref name="pmid32818561">Template:Cite journal</ref>

Structure

Measuring approximately 8 cm (3 inches) long in adults,<ref name="isbn0-7817-7174-9">Template:Cite book</ref> the portal vein is located in the right upper quadrant of the abdomen, originating behind the neck of the pancreas.<ref name="phtn"/>

In most individuals, the portal vein is formed by the union of the superior mesenteric vein and the splenic vein.<ref name="isbn1-55009-364-9">Template:Cite book</ref> For this reason, the portal vein is occasionally called the splenic-mesenteric confluence.<ref name="phtn">Template:Cite book</ref> 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.<ref name="grays"/> and also pararumbilical vein and prepyloric vein.

Tributaries of the hepatic portal vein<ref name="grays">Template:Cite book</ref>
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.<ref name="grays"/>

Portacaval anastomoses

The portal venous system has several anastomoses with the systemic venous system. In cases of portal hypertension these anastomoses 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.<ref name="phtn"/>

Function

The portal vein and hepatic arteries form the liver's dual blood supply, with 90% of hepatic blood flow and 70% of oxygen supplied by the portal vein, and the remainder by hepatic arteries. Due to its double blood supply, the liver is far less affected by vascular disease compared to other major internal organs.<ref>Template:Cite book</ref>

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

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Increased blood pressure in the portal vein, called portal hypertension, is a major complication of liver disease, most commonly cirrhosis.<ref name="isbn0-632-05582-0">Template:Cite book</ref> 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%.<ref>Template:Cite journal</ref> On Doppler ultrasonography, the main portal vein (MPV) peak systolic velocity normally ranges between 20 cm/s and 40 cm/s.<ref name="IranpourLall2016">Template:Cite journal</ref> A slow velocity of <16 cm/s in addition to dilatation in the MPV are diagnostic of portal hypertension.<ref name="IranpourLall2016"/>

Clinical signs of portal hypertension include those of chronic liver disease: ascites, esophageal varices, spider nevi, caput medusae, and palmar erythema.<ref name="isbn1-85996-164-9">Template:Cite book</ref>

Pulsatility

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).<ref name="IranpourLall2016">Template:Cite journal</ref> 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<ref name="IranpourLall2016"/>	0.5<ref name="IranpourLall2016"/>
Max-based	(Max - Min) / Max<ref name="GoncalvesovaVarga2013">Template:Cite journal</ref>	0.5<ref name="GoncalvesovaVarga2013"/><ref name=Dancygier2009>Page 367 in: Template:Cite book</ref> - 0.54<ref name=Dancygier2009/>

Infection

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Pylephlebitis is infection of the portal vein, usually arising from an infectious intra-abdominal process such as diverticulitis.<ref name="pmid8589130">Template:Cite journal</ref><ref name="pmid8488411">Template:Cite journal</ref>

Portal venous gas

Hepatic portal venous gas is a rare finding on radiological exams. Gas is shown to enter the portal venous system. It is most commonly caused by intestinal ischemia but has also been associated with colon cancer.<ref name="Li">Template:Cite journal</ref>

Additional images

Human embryo with heart and anterior body-wall removed to show the sinus venosus and its tributaries
Section across the portal triad of the 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.