🔴🟡🟢Hepatology Bedside Pearls!
Abdominal Veins in liver disease🧵
🟠Normal veins and drainage: The absolute basic!
Umbilicus is the watershed. Hence flow is cephalad (towards head) above umbilicus and caudad(towards feet) below umbilicus
(Intern Med2019)
🟡 ldentifying the dilated veins on the trunk
(epos.myers.org)
🟡 Porto-systemic anastomotic sites
🔔Colour coded to aid in memorizing ☺
💡 What happens in Portal HTN? 🤔
The normal physiology is accentuated respecting the umbilical watershed!
Lt PV⏩Paraumbilical veins in falciform lig⏩ periumbilical systemic veins⏩IVC
(NEJM2005, QJN2019)
🟡 Caput Medusa (🐍 head)
The legend has it that Medusa was 1 of Gorgon sisters, so horrific that one turned to stone after one look. Perseus, finally slays her with a shield gifted by Athena and thereafter pins it to his shield 🛡 to be invincible!
🟡 Veins in IVC obstruction🤔
The venous flow is cephalad above and below umbilicus.
🟡Veins in SVC obstruction 🤔
A bit tricky.
If ❌ above Azygos inlet, only veins of neck, shoulder girdle & upper thorax distend
If ❌ below Azygos, anterior chest wall & abdo veins also distend
( International Med 2019)
🟡 How to demonstrate flow in veins?
We do the milking method as depicted in the video. The direction of relatively quicker flow is the direction!
🟢Bonus 💲
Cruveilhier-Baumgarten (C.B)
🇫🇷, 🇩🇪 Pathologists
Murmur periumbilical location
CB syndrome- congenital patency of umbilical vein. Ascites❌, Liver maybe atrophic
CB disease- due to portal HTN. Ascites✔
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💡 Caution☠️
The patient should conventionally be in upright posture to demonstrate venous flow.
This is a prerequisite for examiners esp in MD exams in India, MRCP PACES!
💡 Bonus to memorize.
The flow in the collateral will be the same as direction of the blocked vein.
IVC: Cephalad
SVC: Caudad
Just akin to bypass routes one would take to manoeuvre a blocked main road whilst travelling.
🟡💲Bonus 2 for quiz enthusiast!
Wch international brands logo has Medusa on it??
Versace! ☺
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