kindly diagnose the case...pt is 45 ys old..labour...alcohalic since a long tym...having this complaints since 10 days..

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varicose veins

caput medusae

Vena caval obstruction portal hypertension

caput medusae after cld

Dear Dr. Obaid Ansari, I believe you are dealing with a case of inferior venacaval obstruction as the duration of the disease is very short just 10 days which is very unlikely in portal hypertension due to cirrhosis of varied etiology. You can easily differentiate between these two by determining the direction of blood flow in these dilated superficial abdominal veins by doing a simple bedside test by milking method. In caput medusae due to cirrhosis of varied etiology, the direction of blood flow is away from the umbilicus just like a star. In IVC obstruction, the direction of blood flow in all veins is below upwards.

thank u very much sir...
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Caput Medusae portal hypertension/cirrhosis of lever,

may be sir..bt there is no sign of jaundice
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caput medusae secondary to CLD if it has gradually developed... if it was acute in insert then some venous obstruction in IVC axis can lead to this site of picture..

Caput medusae, cirrhosis of liver.

portal hypertension.? cirrhosis

Then should look for Inferior vena cava obsruction(flow towards head/vertical)

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