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Portal hypertension clinical features

  • Dilated veins are seen radiating from the umbilicus.
  • The direction of flow is away from the umbilicus.
  • Portosystemic anastomoses occurs between the paraumbilical vein of the left branch of portal vein to the anterior abdominal wall veins. 
  • Because of their engorged appearance, these vessel resemble medusa's hair after minerva had turned it into snakes and this sign is called caput medusae.
How abdominal wall veins are formed in portal hypertension ?
Dilated and tortuous veins suggest venous obstruction. They are formed due to blood passing
through a large umbilical or paraumbilical vein in the falciform ligament from the left branch of portal vein to the superior epigastric, internal mammary or inferior epigastric veins present in the abdominal wall (i.e. opening of anastomotic channels between portal and systemic veins)