Porto-caval anastomosis

Absolutely — this is a classic portal–systemic (portocaval) anastomosis, and I’ll break it down slowly and clearly, step by step, using your notes and the diagram 👌

🌐 Para-umbilical (Portocaval) Anastomosis — explained simply

1⃣ Key structure: Round ligament of the liver

• The round ligament (ligamentum teres hepatis) is the remnant of the fetal umbilical vein

• It runs in the falciform ligament

• It connects:

  • The umbilicus (anterior abdominal wall)

  • To the left branch of the portal vein in the liver

✅ So your first bullet point is correct.

2⃣ Para-umbilical veins (portal side)

• Small veins run alongside the round ligament

• These are called para-umbilical veins

• They drain into the left portal vein
  ➡ Portal venous system

✔ Your statement:

3⃣ Systemic veins at the umbilicus

Around the umbilicus, the para-umbilical veins anastomose with superficial veins of the anterior abdominal wall, including:

Systemic veins

• Superficial epigastric vein → femoral vein → IVC

• Inferior epigastric vein → external iliac → IVC

• Lateral thoracic vein → axillary vein → SVC

• Internal thoracic vein → brachiocephalic vein → SVC

✔ Your last bullet point is also correct.

4⃣ What the anastomosis actually is

👉 A connection between:

This allows blood to bypass the liver if portal pressure is high.

5⃣ Clinical relevance – Caput medusae 🐍

• In portal hypertension:

  • Blood is forced from the portal vein

  • Through para-umbilical veins

  • Into superficial abdominal wall veins

• This causes dilated, radiating veins around the umbilicus
  ➡ Caput medusae

🧠 One-sentence exam answer

👉 The para-umbilical anastomosis is a portocaval connection between the para-umbilical veins draining into the portal vein and the superficial veins of the anterior abdominal wall that drain into the SVC and IVC.

🔑 Ultra-simple flow (memorise this)

Portal vein → Para-umbilical veins → Superficial abdominal veins → SVC / IVC

If you want next, I can:

• Compare all 4 portocaval anastomoses in one table

• Help you write a perfect 5-mark exam answer

• Explain why veins of Sappey are mentioned in some books

Just tell me 👍