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



#Caput #Medusae #Direction #Blood #Flow #physicalexam #diagnosis #hepatology #cirrhosis #obstruction #comparison #abdominal #veins #milking