A 52-year-old man is brought to the emergency department for hematemesis that began an hour earlier. He has regularly consumed large amounts of alcohol for the last 20 years and has been hospitalized numerous times due to ethanol intoxication. Temperature is 36.7 C (98 F), blood pressure is 90/60 mm Hg, pulse is 106/min, and respirations are 22/min. Physical examination shows jaundice and scleral icterus. Examination of the abdomen reveals a palpable spleen and moderate ascites. Endoscopy reveals bleeding esophageal varices. This patient's current condition most likely resulted from chronic shunting of blood through which of the following veins?

Question

A 52-year-old man is brought to the emergency department for hematemesis that began an hour earlier.  He has regularly consumed large amounts of alcohol for the last 20 years and has been hospitalized numerous times due to ethanol intoxication.  Temperature is 36.7 C (98 F), blood pressure is 90/60 mm Hg, pulse is 106/min, and respirations are 22/min.  Physical examination shows jaundice and scleral icterus.  Examination of the abdomen reveals a palpable spleen and moderate ascites.  Endoscopy reveals bleeding esophageal varices.  This patient's current condition most likely resulted from chronic shunting of blood through which of the following veins?

Quizplus · Accepted Answer

11ec160b_357d_a2f7_9249_d9b76e43995a_MD0001_00 This patient has numerous cirrhotic stigmata including ascites, jaundice, and splenomegaly. An important cause of cirrhosis-related morbidity and mortality is the development of variceal hemorrhaging as a direct consequence of portal hypertension. Cirrhosis (of any type) represents the end stage of progressive hepatic fibrosis. It is characterized by distortion of the hepatic architecture and formation of regenerative nodules. Cirrhosis is the most common cause of portal hypertension, which arises from increased resistance to portal flow at the hepatic sinusoids. Chronic portal hypertension leads to dilation of small, pre-existing vascular channels between the portal and systemic circulations. These dilated collateral vessels (portosystemic anastomoses) commonly form in the anterior abdomen (caput medusae), lower rectum (anorectal varices), and inferior end of the esophagus (esophageal varices). Treatment sometimes includes inserting a transjugular intrahepatic portosystemic shunt (TIPS) between the portal vein and hepatic vein percutaneously, relieving portal hypertension by shunting blood to the systemic circulation. (Choice B) The middle colic vein drains the transverse colon. (Choices C and F) In cirrhosis, the paraumbilical veins can shunt blood from the portal system to superficial epigastric veins in the abdominal wall, causing caput medusae. (Choice D) The right gastroepiploic vein drains venous blood from the inferior portions of the stomach. It runs along the greater curvature of the stomach. (Choice E) The splenic vein drains blood from the spleen. It joins with the superior mesenteric vein to form the hepatic portal vein. Patients with portal hypertension can develop splenomegaly due to congestion of the splenic red pulp. Educational objective: In cirrhosis, portal hypertension arises from increased resistance to portal flow at the hepatic sinusoids. This causes increased pressure in the portosystemic collateral veins within the lower end of the esophagus, anterior abdomen, and lower rectum. Dilation of these collateral vessels is responsible for the esophageal varices, caput medusae, and anorectal varices commonly seen in patients with cirrhosis.

A 52-Year-Old Man Is Brought to the Emergency Department for Hematemesis