Dilated Abdominal Veins and Caput Medusae - Direction of Blood Flow
Vein Milking technique can be used to determine the cause and direction of blood flow.
• Normal veins: Umbilicus is the watershed. Hence flow is cephalad (towards head) above umbilicus and caudad (towards feet) below umbilicus.
• Portal Hypertension: The normal physiology is accentuated respecting the umbilical watershed.
• IVC Obstruction: The venous flow is cephalad above and below umbilicus.
• SVC Obstruction:
- If obstruction above Azygos inlet, only veins of neck, shoulder girdle & upper thorax distend
- If obstruction below Azygos, anterior chest wall & abdominal veins also distend
Dr. Arun Valsan @DrArunKValsan
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