Distended abdominal veins

Introduction Refers to the chronic partial or complete obstruction of the portal or intrahepatic portal vein, which causes the portal vein blood flow to be blocked, causing the portal vein pressure to increase. To relieve the portal hypertension, the collateral circulation or the recanalization around the portal vein is located around the umbilicus. The superficial vein of the abdominal wall can be varicose.

Cause

Cause

In the case of hepatic portal hypertension, mainly manifested as portal hypertension and secondary esophageal varices and/or portal hypertensive gastropathy, patients can repeatedly hematemesis and tar, accompanied by mild to moderate spleen Large and spleen function, so the liver function of patients is good, so ascites, jaundice and hepatic encephalopathy rarely occur. Occasionally, the cavernous degeneration of the collateral vessels can compress the common bile duct in the superficial vein of the abdominal wall around the umbilicus. For patients with repeated upper gastrointestinal bleeding, mild or moderate spleen, and normal liver function, CTPV should be considered. Possibly, a diagnosis of B-ultrasound or color Doppler examination combined with portal venography is required.

an examination

Related inspection

Abdominal plain film abdominal MRI

1. Abdominal B ultrasound:

The normal portal vein structure disappears and is replaced by an irregular curved vascular shadow, or a honeycomb shape. The blood flow is seen in the blood flow direction, and the blood flow direction is irregular. The thickening of the blood vessel wall is enhanced, and the intravascular thrombus is visible. Ueno divides CTPV into 3 types according to color Doppler imaging: Type I shows that the normal structure of the portal vein is unclear, only the portal vein is honeycomb structure, and the primary CTPV belongs to this type; the type II is the portal vein. Can be displayed, but the internal embedding stuffing, collateral veins can be seen around it; type III is the presence of a mass echo near the portal vein, and the portal vein is compressed to cause collateral vein formation. Type II and III are secondary CTPV manifestations.

2. Abdominal CT:

The direction of blood flow is irregular, and intravascular thrombosis can be seen.

(1) The structure of the portal vein is disordered, and the structure of the normal portal vein disappears. In the direction of the portal vein, a network of similar agglomerate soft tissue formed by entangled collateral veins can be seen, and the boundary between them is unclear, and the portal vein is enhanced after scanning. Obviously strengthen the interlaced into the net, sinus-like or tube-like soft tissue structure, in the hepatic hilum can be seen to extend the thin strip density around the intrahepatic portal vein.

(2) Abnormal liver parenchymal perfusion. In the arterial phase, the contrast agent accumulates in the peripheral part of the liver parenchyma, forming a high-density band-like shadow, sometimes showing the proximal dilated arterial shadow, while the entire liver is uniformly equi-density in the portal vein phase. Shadow.

Differential diagnosis

Identification:

1. The subcutaneous vein is reticular: it is one of the clinical symptoms of thrombophlebitis. The disease is a venous disease characterized by acute non-suppurative inflammation of the vein wall and intraluminal thrombosis. Slow blood flow and eddy current formation, increased blood coagulation and endometrial damage are the main causes. Clinically, it is divided into superficial thrombophlebitis and deep vein thrombosis. Need to be differentiated from venous edema and lymphedema. Limiting thrombosis and inflammation; eliminating swelling and restoring venous function as much as possible; preventing the development of fatal pulmonary embolism is the main purpose of treating this disease.

2, retinal vein angulation anger: retinal vein occlusion is a more common fundus vascular disease. Its incidence is higher than arterial obstruction. Most cases occur in middle-aged and older, males are slightly more than females, often with monocular onset. The main symptoms are central vision loss, or a partial visual field defect, but the incidence is far less acute and severe than arterial occlusion. Generally, part of the visual acuity can be retained. About 3 to 4 months after central venous obstruction, about 5 to 20% of patients can Iris neovascularization occurs and secondary to neovascular glaucoma.

3, jugular vein engorgement: normal person standing or sitting position, the external jugular vein is not exposed, a little filling in the supine position, but only 2 / 3 of the distance from the upper edge of the clavicle to the mandibular angle, if more than the above level or When the semi-recumbent position is 45 degrees, the jugular vein is filled, swollen, and full, which is called jugular vein engorgement, indicating that the venous pressure is increased, which is an abnormal phenomenon. The symptoms described by the patient are not only the main clues for judging the presence or absence of jugular vein engorgement, but also provide the main reference for the diagnosis of the cause. Long-term chronic cough with progressive dyspnea is mostly right heart failure caused by pulmonary heart disease; sudden onset, severe chest pain, coughing red bloody sputum, dyspnea that is not commensurate with lung signs, suggesting pulmonary embolism; irregular fever Heart. Patients with dyspnea and pain in the precordial area should consider pericardial effusion and constrictive pericarditis after other infections; young or juvenile onset, shortness of breath, fatigue, palpitations, and shortness of the heart, such as primary pulmonary artery High pressure, pulmonary stenosis, Ebstein malformation, Eisenmenger syndrome, atrial septal defect, etc. Adolescent onset has heart palpitations and difficulty breathing, suggesting restrictive cardiomyopathy, but it is rare. Young and middle-aged onset, a history of rheumatic fever, fatigue after activity, palpitations and abdominal distension, suggesting rheumatic valvular disease, such as tricuspid stenosis and/or regurgitation.

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