Question

Can I please get some help with these four question I just don't know the answers to them.

1. Name the three communications between the portal circulation and the systemic circulation (Inferior vena cava) that provide blood flow?

2. Which element of the antireflux mechanism is become involved in formation of the Paraesophageal Hiatal hernia?

A. Increase the size of the diaphragmatic ring (hiatus)

B. Increase of muscle tone around the diaphragmatic opening (hiatus)

C. Loss of the muscle tone of the cardiac sphincter

3. Which element of the antireflux mechanism is become involved in formation of the Paraesophageal Hiatal hernia?

A. Increase the size of the diaphragmatic ring (hiatus)

B. Increase of muscle tone around the diaphragmatic opening (hiatus)

C. Loss of the muscle tone of the cardiac sphincter D. Vanishing of the Angle of His

4. In case of the Sliding Hiatal hernia, Cardiac sphincter (gastroesophageal junction) is always positioned _______________

A. Below the diaphragm

B. Above the diaphragm

C. Does not matter

D. On the level of diaphragm

Answer 1

1/ The anastomosis between the left gastric veins, which are portal veins, and the lower branches of oesophageal veins that drain into the azygos and hemiazygos veins, which are systemic veins. The site of this anastomosis is the lower oesophagus.

• The anastomosis between the superior rectal veins, which are portal veins, and the inferior and middle rectal veins, which are systemic veins. The site of this anastomosis is the upper part of the anal canal.
• The anastomosis between the paraumbilical veins, which run in the ligamentum teres as portal veins, and small epigastric veins, which are systemic veins. The site of this anastomosis is the umbilicus.
• The anastomosis between the intraparenchymal branches of the right division of the portal vein and retroperitoneal veins (systemic veins) that drain into the azygos, hemiazygos and lumbar veins (systemic veins). The site of this anastomosis is the bare area of the liver.
• The anastomosis between omental and colonic veins (portal veins) with the retroperitoneal veins (systemic veins) in the region of hepatic and splenic flexure.

• Another anastomosis is between the ductus venosus (portal vein) and the inferior vena cava (systemic vein). This is very rare and at the site of patent ductus venosus.

2/ A. Increase the size of the diaphragmatic ring (hiatus)

3/ A. Increase the size of the diaphragmatic ring (hiatus)

4/  In case of the Sliding Hiatal hernia, Cardiac sphincter (gastroesophageal junction) is always positioned On the level of diaphragm