Caput medusae

Nonspecific signs on physical exam include jaundice, tea-colored urine, bruising, hepatomegaly, splenomegaly, spider angiomata, caput medusae, palmar erythema, gynecomastia, and testicular atrophy. 

Fig. 14.13 External caput Medusae in liver cirrhosis. The thick paraumbilical vein (diameter 2 cm) is shown subcutaneously at the exit of the vessel from Glisson s capsule. The colour-encoded vessel with a varicose enlargement at the exit point of the paraumbilical vein from Glisson s capsule is visible immediately below the ventral layers of the abdominal wall...

Fig. 35.13 Cirrhosis with regenerative node ("4=), recanalized umbihcal vein (= caput Medusae) (- ) and ascites ( ) in CT...

The liver is covered with an anterior reflection of the peritoneum known as Ghsson s capsule. Other extensions of the peritoneum form ligaments that hold the Hver in place. Internal extensions of the capsule provide an internal supporting framework that divides the liver into lobules and ultimately surrounds blood vessels and nerves. One of the ligaments, the ligamentum teres, is the vestigial remnant of the umbilical vein and connects the umbilicus to the inferior border of the liver. When portal hypertension occurs, the umbilical veins may reopen, leading to venous dilation around the umbilicus (termed caput medusae). 

Interestingly, traces of ipalbidine could be identified by GC/MS analysis in the aerial parts of Convolvulus caput-medusae Lowe, C. scoparius L. f (Schimming 2003), Ipomoea batatas (L.) Lam., I. eremnobroclia D.F.Austin, and Odenellia hirtiflora (Mart. Gal.) K.Rob. (Tofern 1999). This indicates that the principal capability to synthesize this type of alkaloids might be widespread in the family. 

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