Case ; A patient has been admitted for hematemesis (vomiting of blood). Endoscopic examination reveals bleeding esophageal varices resulting from portal obstruction. These varices represent anastomoses between branches of which of the following? A) inferior vena cava with a patent ductus venosus B ) left gastric, azygos, and hemiazygos veins C) right gastric vein and the inferior vena cava D) superior, middle, and inferior rectal veins E) veins running on the ligamentum teres and the epigastric veins Is the right Answer: (B) ? (B) Obstruction of the portal vein results in an increase in the collateral circulation between veins that normally drain to the portal vein and those that drain to the systemic veins. Choices A, B, D, and E all represent possible collateral venous circulation in case of portal obstruction. Choice A is rare because the ductus venosus closes after birth. Choice B is correct because varicose veins in this region give rise to esophageal varices. Choice D results in varicose veins in the rectal region. Choice C is incorrect because there is no connection between the right gastric vein and the inferior vena cava. In choice E, enlargement of the epigastric veins results in varicose veins radiating from the umbilicus, the caput medusae.
Posted on: Mon, 26 Aug 2013 08:48:13 +0000