 This demonstration is going to be on the contents and the structures of extrapatic portal triad. So what we have picked up here, these are the parts of the extrapatic portal triad. This patient has undergone surgery. Therefore the margins and all the contents of the extrapatic portal triad are considerably distorted. Contents of the extrapatic portal triad form V like this. Right anterior, left anterior, posterior. Right anterior, this is the common bile duct. Left anterior, this is the hepatic artery proper. Posterior, portal way. So these three structures together constitute the extrapatic portal triad. They are enclosed in a double formed of peritoneum which is referred to as the hepatic diodenum ligament. Which extends from the first inch of the first part of the diodenum which is intraperitoneal and goes up and gets attached to the margins of the portal hepatis. This extrapatic portal triad forms the entrance where my finger has gone in. To this place, that is to the lesser side. And this opening is referred to as the epiploid for a man of been slow. And here we can do a procedure during surgery if there is bleeding and that is known as Pringles maneuver. In Pringles maneuver what we do is we put our finger inside index and the middle finger and put our thumb in front and we can compress the hepatic artery in case of bleeding during cholecystectomy. Now let's mention a few quick words about the other contents of the portal triad. This is the common bile duct which is formed by the union of the right and the left hepatic ducts and the remnant of the cystic duct because the gallbladder has been removed and after that it becomes known as the common bile duct. Behind the first part of the diodenum and goes through the head of the pancreas into the diodenum. The next structure of the extra hepatic portal triad is this one here. This is the hepatic artery proper. This is a continuation of the common hepatic artery. And after the common hepatic artery gives up the gastrodional branch that we can see here then it goes up and becomes known as the hepatic artery. In this patient we see that there is not one but three. So this is the remnant of the cystic artery and after that it is still continuing into the liver. That's one branch. We can see yet another branch and we can see the third branch. So these are all parts of the hepatic artery proper. That's the next content of the extra hepatic portal triad. And the third content is here which we have lifted up. This is the portal vein. So let's take a look at how the portal vein is formed. In order to see the portal vein we have to go behind the pancreas. This is the pancreas in front of us and this is the stomach. So now we are going to turn everything. We are going to turn the pancreas, the stomach and we are also turning part of the uterus. We can see this structure here in front of us. This is the superior miscentric vein which is running on the right side of the superior miscentric artery. The superior miscentric vein unites with the sprenic vein behind the neck of the pancreas. I have reversed the pancreas and you can see this is the under surface of the pancreas. The superior miscentric vein unites with the sprenic vein behind the neck of the pancreas. And after that, if I put my probe here, we can see it is coming here. It becomes only the portal vein. And the portal vein then runs up in the hepatodeuternal ligament as one of the constituents of the extra hepatic portal triad. And it runs to the portal hepatic and in the portal hepatic it divides into a right and a left vein. This clinic vein is also receiving this vein here that we can see. This is the inferior miscentric vein. So this is also one of the structures which contribute to the formation of the portal vein. And while the superior miscentric vein is running here, it raises the fold of the peritoneum here and that produces what is known as the paradeuternal fossa. And that is the potential side of internal herniation which can be risky if we try to reduce the hernia, we might enjoy the inferior miscentric vein. We can see the spleen deep inside the left hypochondrium. And the sprenic vein is here. So it comes from there behind the pancreas. In the earlier days, in order to investigate the portal vein, we used to do what is known as a splenoportovenogram. But that is an invasive procedure. Nowadays, instead, in order to investigate the portal vein, we do what is known as MR portalvenogram. And that outlines the entire portal venous system including the superior miscentric vein, the inferior miscentric vein, sprenic vein and the main portal vein. That is an important investigation which is done in the case of portal hypertension, especially after cirrhosis. This is an MR portalvenogram showing the inferior miscentric vein opening into the sprenic vein close to the spleen. And in this, the inferior miscentric vein is opening into the sprenic vein far from the spleen. In case of cirrhosis of portal hypertension, in order to decompress the esophageal varices, we can do a splenorenal shunt. We are not exposed of the renal vein here, left renal vein, but the left renal vein is situated very close and therefore it can be used to form a splenorenal shunt. The next thing which I would like to draw your attention to, since we are talking about the extrapatic portal triad and the portal vein, is this structure here. This is the remnant of the antriabdominal wall, more specifically the linea alba. This is the umbilicus. I am going to lift up the linea alba now. And we can see the undersurface of the linea alba. And we can see this structure extending from the undersurface of the linea alba. This is the falciform ligament. Why is it called falciform ligament? Because it is shaped like a sickle. It has got three margins. Two of which are attached, one is free. One attached margin is to the inner surface of the abdominal wall from the umbilicus up. This is one attached margin. The other attached margin is to the liver here. And this is the one which divides the liver into a right anatomical lobe and left anatomical lobe. And the third margin is the free margin. And in the free margin of the falciform ligament, we see this structure here, which we can feel and we can see also. This is the round ligament of the liver, which is remnant of the umbilical vein, which carries oxygenate blood from the placenta to the fetus. After birth, it becomes known as the round ligament of the liver. Also running, but not visible here, will be the para-umbilical vein. The para-umbilical vein actually is a pated vein, which communicates with superficial cutaneous veins from the umbilicus, which drain into the superficial epigastric veins. And the para-umbilical vein also communicates inside the liver with the left branch of the portal vein, which I showed just now. So therefore, this constitutes a site of potasystemic anastomosis. And in case of cirrhosis of the portal hypertension, these communications can become enlarged. And they form what is known as the caput medius around the umbilicals. So that's all for now. Thank you very much for watching. If you have any questions or comments, please put them in the comment section below. Have a nice day. Dr. Sanjay Sanyal signing out.