🔴🟡🟢Hepatology Bedside Pearls!
Abdominal Veins in liver disease🧵
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)
Umbilicus is the watershed. Hence flow is cephalad (towards head) above umbilicus and caudad(towards feet) below umbilicus
(Intern Med2019)
🟡 Porto-systemic anastomotic sites
🔔Colour coded to aid in memorizing ☺
🔔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)
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!
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.
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)
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!
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✔
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✔
@threadreaderapp unroll
@DrAnuraagJ @RohitMehtaniMD @drvishal82 @nipun29j @ajay_duseja @doc_arka @drsuniltaneja @HepatologyPGI @RoyAHep @SaurabhMishraMD @stevenbollipo @ebtapper @DharJahnvi @LIVERDOC88 @JasmohanBajaj @LiverFellow @LiverQs @UjjwalSonika @ashok_doctor @AnandVKulkarni2 @ShubhraMishra91
@syedahmed92 @prasanna_201095 @drkeithsiau @AtoosaRabiee @ashishchauhan__ @drnaveenm @drdeepakmadhu #livertwitter @pachaatt
💡 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!
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.
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! ☺
Wch international brands logo has Medusa on it??
Versace! ☺
"@threadreaderapp unroll"
• • •
Missing some Tweet in this thread? You can try to
force a refresh
