Answer to Buffalo Cowboy

Correct answer is A. The indicated vessels are the left gastric veins. The left gastric veins feed into the portal system, while the esophageal veins feed into the systemic circulation. The systemic and portal circulation can form various portal-caval anastomosis, and this is a principal location of clinical relevance. Portal hypertension can cause an increase in hydrostatic pressure in the left gastric vein which anastomoses with the systemic esophageal veins in the lower esophagus, resulting in esophageal varices. If left untreated, the varices can rupture true the lining of the esophagus and the patient can vomit fresh blood. If the portal hypertension is not surgically relieved, patients are likely to die.

Answer to this question is based on material presented in lectures 9 of the Abdomen Lecture Series.