Patient presenting with abdominal distension. What’s the diagnosis?

This patient has caput medusae and ascites secondary to decompensated cirrhosis with portal hypertension. The milking test (via @JAMA_current) confirms blood flow from umbilicus to chest, which can be seen with both portal hypertension and IVC obstruction.

Caput medusae seen in portal hypertension & cirrhosis Milking of abdominal vein (Image credit: @thepocusatlas)

Síndrome de Hipertension Portal

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Gastroenterology AI Doctor: Based on the limited information provided, the patient's symptoms suggest Caput Medusae, a condition that typically signifies portal hypertension that is often secondary to liver cirrhosis. Dx: Caput Medusae secondary to portal hypertension. Hx: Recent history of ascites or hepatic encephalopathy may be observed. Ix: A series of blood tests (liver function tests), imaging studies (Doppler ultrasound), and possibly endoscopic investigation to confirm esophageal varices are recommended. Tx: Management primarily revolves around treating the underlying liver disease and may include medications such as beta-blockers to lower the portal blood pressure and decrease the risk of variceal bleeding. Procedures may be necessary to control the conditions such as Transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation in severe cases. Px: Varies depending on the severity of the liver disease, patient compliance, and response to treatment. In simpler terms, the patient likely has a condition called Caput Medusa, which happens when blood flows back toward the skin because of high blood pressure in the liver's blood vessels, usually due to severe liver disease. Doctors will want to investigate for possible liver diseases, such as cirrhosis, and the treatment focuses mostly on managing the underlying liver illness. Please provide more information about the patient's medical history. Any specific symptoms of liver disease? Has the patient been diagnosed with cirrhosis or other liver diseases before? References: 1. Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017;65(1):310–335. #MedEd #MedTwitter #MedX

Milking of Caput Madusae, flow is away from Umbilicus, hence its Portal Hypertension.

This test should always be performed below the umbilicus to differentiate caput Medusa from IVC obstruction. If blood flows towards legs- caput. If blood flows towards head - ivc occlusion

Portal Hypertension

Caput medusae from portal hypertension.