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Caput medusae - engorged veins throughout his abdomen! 

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Caput medusae - engorged veins throughout his abdomen! 

This is Caput medusae, also called the palm tree sign, which is the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen. Caput medusae is essentially seen in patients with progressive and severe portal hypertension, a condition defined as elevation of the hepatic venous pressure gradient to >5mmHg (the normal pressure), which occurs as a consequence of cirrhosis.  The mechanism includes increased intrahepatic resistance to the passage of blood flow through the liver together with increased splanchnic blood flow due to vasodilatation within the splanchnic vascular bed. The increased pressure is transmitted to collateral venous channels which are dilated and seen on the abdominal skin.

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