Caput medusae

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Caput medusae
Other namesPalm tree sign
Caput medusae CT ax 002.jpg
Axial CT showing portosystemic collateral circulation via the umbilical vein: caput medusae in liver cirrhosis
Specialty Gastroenterology

Caput medusae is the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen. The name caput medusae (Latin for "head of Medusa") originates from the apparent similarity to Medusa's head, which had venomous snakes in place of hair. It is also a sign of portal hypertension. [1] When the portal vein, that transfers the blood from the gastrointestinal tract to the liver, is blocked, the blood volume increases in the peripheral blood vessels making them appear engorged. [2] It is caused by dilation of the paraumbilical veins, which carry oxygenated blood from mother to fetus in utero and normally close within one week of birth, becoming re-canalised due to portal hypertension caused by liver failure.The appearance is due to cutanous portosystemic collateral formation between distended and engorged paraumbilical veins that radiate from the umbilicus across the abdomen to join systemic veins. [3]

Contents

Differential diagnosis

Inferior vena cava obstruction

Determine the direction of flow in the veins below the umbilicus. After pushing down on the prominent vein, blood will:

See also

In Liver Cirrhosis , the paraumbilical veins open up to transfer portal venous blood into systemic circulation. It results in caput medusae. [5]

Related Research Articles

<span class="mw-page-title-main">Vein</span> Blood vessels that carry blood towards the heart

Veins are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation, arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart, in the deep veins.

<span class="mw-page-title-main">Portal vein</span> Short thick vein formed by the union of the superior mesenteric vein and the splenic vein

The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approximately 75% of total liver blood flow is through the portal vein, with the remainder coming from the hepatic artery proper. The blood leaves the liver to the heart in the hepatic veins.

<span class="mw-page-title-main">Inferior vena cava</span> One of two veinous trunks bringing deoxygenated blood back to the heart

The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the fifth lumbar vertebra.

<span class="mw-page-title-main">Budd–Chiari syndrome</span> Medical condition

Budd–Chiari syndrome is a very rare condition, affecting one in a million adults. The condition is caused by occlusion of the hepatic veins that drain the liver. The symptoms are non-specific and vary widely, but it may present with the classical triad of abdominal pain, ascites, and liver enlargement. It is usually seen in younger adults, with the median age at diagnosis between the ages of 35 and 40, and it has a similar incidence in males and females. The syndrome can be fulminant, acute, chronic, or asymptomatic. Subacute presentation is the most common form.

<span class="mw-page-title-main">Umbilical vein</span> Vein running from the placenta to the fetus

The umbilical vein is a vein present during fetal development that carries oxygenated blood from the placenta into the growing fetus. The umbilical vein provides convenient access to the central circulation of a neonate for restoration of blood volume and for administration of glucose and drugs.

<span class="mw-page-title-main">Esophageal varices</span> Medical condition

Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. People with esophageal varices have a strong tendency to develop severe bleeding which left untreated can be fatal. Esophageal varices are typically diagnosed through an esophagogastroduodenoscopy.

<span class="mw-page-title-main">Portal hypertension</span> Abnormally increased portal venous pressure

Portal hypertension is defined as increased portal venous pressure, with a hepatic venous pressure gradient greater than 5 mmHg. Normal portal pressure is 1–4 mmHg; clinically insignificant portal hypertension is present at portal pressures 5–9 mmHg; clinically significant portal hypertension is present at portal pressures greater than 10 mmHg. The portal vein and its branches supply most of the blood and nutrients from the intestine to the liver.

<span class="mw-page-title-main">Abdominal aorta</span> Largest artery in the abdomen

In human anatomy, the abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta.

<span class="mw-page-title-main">Hepatic veins</span> One of two sets of veins connected to the liver

In human anatomy, the hepatic veins are the veins that drain venous blood from the liver into the inferior vena cava. There are usually three large upper hepatic veins draining from the left, middle, and right parts of the liver, as well as a number (6-20) of lower hepatic veins. All hepatic veins are valveless.

<span class="mw-page-title-main">Inferior vena cava syndrome</span> Medical condition

Inferior vena cava syndrome (IVCS) is a very rare constellation of symptoms resulting from either an obstruction, or stenosis of the inferior vena cava. It can be caused by physical invasion or compression by a pathological process or by thrombosis within the vein itself. It can also occur during pregnancy. Pregnancy leads to high venous pressure in the lower limbs, decreased blood return to the heart, decreased cardiac output due to obstruction of the inferior vena cava, sudden rise in venous pressure which can lead to placental separation, and a decrease in kidney function. All of these issues can arise from lying in the supine position during late pregnancy which can cause compression of the inferior vena cava by the uterus. Symptoms of late pregnancy inferior vena cava syndrome consist of intense pain in the right hand side, muscle twitching, hypotension, and fluid retention.

<span class="mw-page-title-main">Transjugular intrahepatic portosystemic shunt</span> Artificial channel within the liver

Transjugular intrahepatic portosystemic shunt is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension which frequently leads to intestinal bleeding, life-threatening esophageal bleeding and the buildup of fluid within the abdomen (ascites).

<span class="mw-page-title-main">Portal vein thrombosis</span> Disease of the liver

Portal vein thrombosis (PVT) is a vascular disease of the liver that occurs when a blood clot occurs in the hepatic portal vein, which can lead to increased pressure in the portal vein system and reduced blood supply to the liver. The mortality rate is approximately 1 in 10.

<span class="mw-page-title-main">Falciform ligament</span> Ligament attaching the liver to the front body wall

In human anatomy, the falciform ligament is a ligament that attaches the liver to the front body wall and divides the liver into the left lobe and right lobe. The falciform ligament is a broad and thin fold of peritoneum, its base being directed downward and backward and its apex upward and forward. It droops down from the hilum of the liver.

<span class="mw-page-title-main">Hepatic portal system</span> System of veins comprising the hepatic portal vein and its tributaries

In human anatomy, the hepatic portal system or portal venous system is the system of veins comprising the portal vein and its tributaries. The other portal venous systems in the body are the renal portal system, and the hypophyseal portal system.

<span class="mw-page-title-main">Round ligament of liver</span> Attaches the liver to the abdominal wall

The round ligament of the liver, ligamentum teres or ligamentum teres hepatis is a ligament that forms part of the free edge of the falciform ligament of the liver. It connects the liver to the umbilicus. It is the remnant of the left umbilical vein. The round ligament divides the left part of the liver into medial and lateral sections.

The thoracoepigastric vein runs along the lateral aspect of the trunk between the superficial epigastric vein below and the lateral thoracic vein above and establishes an important communication between the femoral vein and axillary vein. This is an especially important vein when the inferior vena cava (IVC) becomes obstructed, by providing a means of collateral venous return. It creates a cavocaval anastomosis by connecting with superficial epigastric veins arising from femoral vein just below inguinal ligament.

In the course of the round ligament of the liver, small paraumbilical veins are found which establish an anastomosis between the veins of the anterior abdominal wall and the portal vein, hypogastric, and iliac veins. These veins include Burrow's veins, and the veins of Sappey – superior veins of Sappey and the inferior veins of Sappey.

A portacaval anastomosis or portocaval anastomosis is a specific type of circulatory anastomosis that occurs between the veins of the portal circulation and the vena cava, thus forming one of the principal types of portasystemic anastomosis or portosystemic anastomosis, as it connects the portal circulation to the systemic circulation, providing an alternative pathway for the blood. When there is a blockage of the portal system, portocaval anastomosis enables the blood to still reach the systemic venous circulation. The inferior end of the esophagus and the superior part of the rectum are potential sites of a harmful portocaval anastomosis.

<span class="mw-page-title-main">Congenital stenosis of vena cava</span> Medical condition

Congenital stenosis of vena cava is a congenital anomaly in which the superior vena cava or inferior vena cava has an aberrant interruption or coarctation.

Anorectal varices are the dilation of collateral submucosal vessels due to backflow in the veins of the rectum. Typically this occurs due to portal hypertension which shunts venous blood from the portal system through the portosystemic anastomosis present at this site into the systemic venous system. This can also occur in the esophagus, causing esophageal varices, and at the level of the umbilicus, causing caput medusae. Between 44% and 78% of patients with portal hypertension get anorectal varices.

References

  1. Mohammed AA (June 2020). "Caput medusae sign; a unique finding during abdominal examination in patients with portal hypertension; case report". Annals of Medicine and Surgery. 54: 54–56. doi:10.1016/j.amsu.2020.04.004. PMC   7191313 . PMID   32373342.
  2. https://www.webmd.com/digestive-disorders/what-is-caput-medusae
  3. Sharma B, Raina S (April 2015). "Caput medusae". The Indian Journal of Medical Research. 141 (4): 494. doi: 10.4103/0971-5916.159322 . PMC   4510739 . PMID   26112857.
  4. Liu CH, Hsu CH (September 2011). "Caput medusae". Clinical Gastroenterology and Hepatology. 9 (9): A26. doi:10.1016/j.cgh.2011.03.035. PMID   21565282.
  5. Chaurasia BD (2023). "Chapter 21: Large Blood Vessels of the Gut". Human Anatomy (Ninth ed.). CBS Publishers & Distributors Pvt Ltd. ISBN   978-93-5466-476-2.