Caput medusae refers to the appearance of varicose veins on the abdomen, which can occur as a result of portal hypertension caused by severe liver disease. The condition is eliminated by treating the liver condition.
What is caput medusae?
The term caput medusae refers to the swelling and appearance of veins in the navel area, which appear intertwined and prominent under the upper abdominal wall. These are visually reminiscent of the snakes on the head of Medusa from Greek mythology. Caput medusae is not an independent disease, but a consequence of high blood pressure in the portal vein (abdominal artery), caused by blood stasis. Portal hypertension is a symptom of severe liver disease and can lead to the development of other varicose veins, for example in the esophagus.
Causes
The causes are found in liver disease, especially cirrhosis, which is why it is highlighted here. The portal vein carries blood from the stomach, intestines, and spleen to the liver. The blood is enriched with nutrients and toxins due to digestion. The toxins are filtered out in the liver. If the blood flow is obstructed by a blockage (tumor, transformed connective tissue, or parasites that enter the liver through food intake), blood stasis occurs. Blood clots can form in the portal vein due to narrowing in the abdominal artery. The cause of cirrhosis can be heavy alcohol consumption, a fatty liver, or infectious liver inflammation. Long-term use of prescription and over-the-counter medications (antibiotics, painkillers, psychotropic drugs) can also lead to liver disease. Rarely, inherited metabolic disorders can cause liver disease.
Symptoms, complaints, and signs
Specific symptoms are difficult to recognize in the early stages of liver disease and are often downplayed. Fatigue, weakness, loss of appetite, decreased performance occur. Upper abdominal pain, flatulence and bloating may be misinterpreted as symptoms of an infection or as menstrual cramps. A whitish discoloration of the fingernails, spider web-like vascular neoplasms on the skin, reddening of the tongue (liver tongue), frequent itching, and susceptibility to infections often accompany the condition. Jaundice may occur as a result of a buildup of bile. Hormonal disturbances (menstrual irregularities) are also possible.
Diagnosis and course
The upper abdomen is examined for liver disease. The diagnosis is made by a specialist in private practice or in a specialized clinic. Major causes of hypertension (cirrhosis of the liver, tumor, ascites) are identified by imaging techniques such as ultrasound, computed tomography, or magnetic resonance imaging. The medical history is crucial: Did the affected person already have liver problems as a child? Does the patient drink alcohol or take strong medication, if so, since when? Were the parents alcoholics? Is there a family history of severe liver disease? Are there any other metabolic disorders? An increase in specific liver values (transaminases) can also give an indication of the restriction of liver function. The course depends on the severity and cause of the underlying disease as well as on the patient’s cooperation. If the disease is not treated, brain function may be affected. Varicose veins in the esophagus may be present and are detected by gastroscopy. These can result in blackening of the stool, gastritis, and vomiting of blood. Unnoticed bleeding in the esophagus poses a risk of hemorrhage. About one in five people die from it. If these varicose veins are treated successfully and the affected person stops drinking alcohol, they can recede. Pathological emaciation due to disturbed digestion is also possible. Since the liver can no longer sufficiently detoxify the body, ammonia acids form in the brain. This can lead to depression, changes in character, and states of confusion and drowsiness. In men, severe liver disease can lead to impotence and breast formation. At worst, liver disease leads to fatal liver failure.
Complications
Usually, caput medusae causes severe discomfort and pain to the liver. Therefore, this is treated in the forefront of this disease. However, the symptoms are not characteristic and often resemble the symptoms of common flu or gastroenteritis.Those affected suffer from severe abdominal pain and flatulence. Not infrequently, there is also a strong feeling of fullness, even if the patient does not eat any food. There is also a loss of appetite, which can lead to underweight. Due to the lack of nutrition, the patient often feels weak and listless and can no longer perform physical tasks. In addition, the skin may become itchy and the affected person is highly susceptible to various infections. The quality of life is extremely reduced by the disease and the patient cannot usually live out his or her daily life. Due to the symptoms, it is not uncommon for depression and a general feeling of confusion to occur. Treatment is causal and is mainly carried out with the help of surgical interventions or beta-blockers. In this process, there are no further complications. The affected person must also follow a strict diet. Severe cases require liver transplantation. In the case of diabetes, it must be treated.
When should one go to the doctor?
If there are swelling veins in the area of the belly button, a doctor should be consulted. Caput medusae indicates a serious underlying condition that needs to be diagnosed and treated. Especially if accompanying symptoms occur, it is important to inform a medical professional. For example, varicose veins that occur in conjunction with fatigue, weakness and loss of appetite indicate liver disease. As the disease progresses, symptoms of jaundice are usually added – at the latest then medical advice is needed. People who already suffer from liver problems or metabolic disorders are particularly susceptible to caput medusae. If these risk factors apply to you, it is best to talk to your family doctor if you have visible varicose veins. If depression, changes of character or states of confusion and drowsiness develop, the disease may already be more advanced. In addition to the doctor, a therapist should also be consulted in this case. In the worst case – if the triggering disease is not adequately treated – liver failure occurs. Then the emergency medical services must be called in and first aid administered.
Treatment and therapy
High pressure is lowered by beta-blockers or by surgical procedures. Varicose veins are life-threatening and must be sclerosed. In severe cases of congestion, a stent is placed in the liver. Alcohol consumption must be discontinued to allow abnormally altered liver tissue to regenerate. If necessary, withdrawal treatment is advised. Instead of heavy medication, natural remedies should be taken if possible. Reduction of excess weight and a balanced diet are important. A special diet is not necessary. Dairy products promote liver function and are therefore recommended. In severe cases of liver cirrhosis, liver transplantation becomes essential to save the patient’s life. Liver values must be checked at regular intervals. The costs of treatment of the liver condition are covered by the statutory health insurance funds. Heavy carrying should be avoided, as a damaged liver can rupture due to the strain. Diabetes should be treated consistently. In the case of abdominal dropsy, drainage agents or a puncture will help. An adequate supply of vitamin B is important. It is stored in the liver and protects against nerve damage. There is currently no drug to cure cirrhosis of the liver. To maintain brain function, a low-protein diet is advised to lower blood ammonia levels. Lactulose can promote the elimination of ammonia through the intestines.
Outlook and prognosis
The prognosis of caput medusae depends on the underlying disease. In the most severe case, there is an early demise of the sufferer or an intermittent course. If the patient suffers from a tumor disease, surgical intervention and subsequent cancer therapy is necessary. There is a potential threat to the life of the affected person. The health situation is particularly critical if cancer cells have already spread in the organism and metastases have developed. Another unfavorable prognosis is present in liver cirrhosis. The tissue damage to the liver is irreparable. The lifespan is shortened and the risk of developing a tumor is increased. Often the only salvation for the patient is an organ transplant. This is associated with numerous side effects and can lead to lifelong impairments.Every fifth person affected dies of caput medusae. The main reason for this is the usually severe underlying disease. There is a chance of recovery as soon as the existing varicose veins have been successfully removed and the underlying cause has been permanently cured. In the case of alcohol addiction, the renunciation of the consumption of alcohol is a prerequisite for a cure. If an eating disorder is diagnosed, the patient must reach the recommended normal weight to experience recovery. In a large number of cases, a special diet is prescribed to minimize the risk of recurrence of caput medusae.
Prevention
The best prevention of liver disease, and therefore of hypertension, is avoidance of excessive alcohol consumption. Pain medications should be taken as infrequently as possible. Travel to countries with a high risk of hepatitis should be discouraged or vaccination should be given in good time. Excess weight should be avoided, as a fatty liver can turn into cirrhosis in the long term. Diabetes should be prevented with a healthy diet and sufficient exercise. Attention should be paid to sufficient exercise.
Follow-up
Aftercare for caput medusae usually depends very much on the underlying disease, so no general advice can be given here. However, since the disease involves a stay in a hospital and surgical procedures, the affected person must recover from these and must not exert himself physically after the procedure. Likewise, care must be taken to maintain a healthy diet so as not to strain the liver. Alcohol should be avoided. Likewise, overweight should be avoided at all costs in the case of caput medusae. If the patient also has diabetes, appropriate treatment for diabetes should be initiated. A direct cure of caput medusae cannot be achieved, although the disease can be limited by a low-protein diet. In the case of liver transplantation, the usual measures for such an operation must be initiated, with permanent monitoring of the wound and the function of the new liver. Whether there will be a decreased life expectancy of the patient despite healing of the caput medusae cannot be universally predicted. If the caput medusae is caused by a tumor, the body must be checked for other tumors or metastases. Regular screening examinations are also useful in this regard.
This is what you can do yourself
“Medusa’s head” becomes visible when the veins on the stream become very prominent due to permanent congestion in the portal circulation of the liver. The cause is almost always severe liver disease. Those affected should therefore by no means play down this symptom as a purely cosmetic problem, but should consult a doctor promptly. What the patient himself can contribute to the therapy depends on the cause of the underlying disease, which is almost always cirrhosis of the liver. The trigger for cirrhosis can be high alcohol consumption over a long period of time, a fatty liver or infectious liver inflammation. If continued alcohol abuse is responsible for the damage to the liver, the affected person must immediately stop or at least drastically reduce his or her alcohol consumption. This usually cannot be accomplished without professional help, as those affected are almost always alcohol dependent. These patients should start a rehab program with accompanying psychotherapy, as the therapy significantly reduces the risks of relapse into dependence. The same applies if the cirrhosis of the liver is not due to alcohol but to the abuse of medications. Diet plays a crucial role in fatty liver. The right diet can lead to a complete regression of the fatty liver. In these cases, however, patients usually need not only medical help, but should also consult a competent ecotrophologist to help them permanently change their diet.
