Inspect the Superficial Veins

The venous pattern of the abdomen is usually barely perceptible. If it is visible in the normal individual, the drainage of the lower two thirds of the abdomen is downward. In the presence of vena caval obstruction, superficial veins may dilate, and the veins drain cephalad (toward the head). In patients with portal hypertension, the dilated veins appear to radiate from the

Figure 17-13 Ascites with umbilical hernia.

Figure 17-13 Ascites with umbilical hernia.

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