kiranmayi
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A 60-year-old male presents to the ER with a two-hour history of occasional hemoptysis. He has no fever or history of recent infection, but reports that he has had been to the ER in the past for this complaint. Over the past 20 years, he has drunk three to five beers per day. In the last few months, he has been consuming even more alcohol. On exam, you note an enlarged liver and scleral icterus. His lab results are remarkable for macroctic anemia, thrombocytopenia, and an AST:ALT ratio of greater than 2:1. You suspect that the patient's symptoms may be due to portal hypertension secondary to liver disease. Which of the following portal-systemic anastomoses best explains this patient's hemoptysis?
A. Inferior vena cava-hepatic vein
B. Left gastric-azygous veins
C. Paraumbilical-inferior epigastric veins
D. Retroperitoneal-paravertebral veins
E. Superior-middle/inferior rectal veins
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| usmleasr
Forum Guru
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B..lt gastric with azygos
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| asmi
Forum Hero
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B...left gastric
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| kiranmayi
Forum Guru
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correct 
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| Bela
Forum Guru
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What if the patient presented with caput medusa?
What if the patient presented with hemorrhoids?
Where would the anastomosis be? 
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| elena41080
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caput medusae - Ans: C
haemorrhoids - Ans: E
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