A 52-year-old man with a 30 year history of heavy alcohol consumption presents with abdominal distension and ascites. Based on the appearance of his abdomen and the recording taken at the level of his umbilical hernia, what is your diagnosis? What is the sound called and what is its significance? What is the periumbilical venous pattern called and what is its significance?
Diagnosis: The Cruveilhier-Baumgarten syndrome secondary to alcoholic cirrhosis and consequent portal hypertension. The periumbilical sound is called a Cruveilhier-Baumgarten murmur (hum); it is due to increased blood flow in varices surrounding the falciform ligament and may be audible anywhere from the umbilicus to the xiphoid process.The periumbilical venous pattern is a classic caput medusae, again reflecting portal hypertension. In the Cruveilhier-Baumgarten syndrome, the liver is typically contracted (not enlarged to palpation) whereas the spleen is readily palpated.
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