Spider Nevus

Typically seen in patients with Liver failure, this one was seen in an 18 year old healthy female who had come for a rash on her neck that turned out to be tinea corporis. Her liver tests were all normal. It is a sign of hyper-estrogenism which occurs in hepatic failure because the degradation of intrinsic estrogen is slow.  In health, upto 5 spiders in a female and 2 in a male are within normal limits.

Other signs of liver failure and their mechanisms are outlined below. The mechanisms are tested on frequently

GI bleeding: so frequntly asked that the commonest cause for a GI bleed in a patient with known varices is NOT varices but is due to gastritis.

Variceal formation: due to elevated portal pressure

Testicular atrophy: due to high estrogen levels

Ortho - deoxia (hypoxia when one sits up): Due to vasodilatation and AV shunt formation at the base of the lungs. When the patient sits up, blood gravitates and most of it passes through these AV shunts. This leads to deoxygenation of blood in systemic circulatin.

Gynecomastia: due to high estrogen levels

Parotid enlargement: High estrogen level

Mousy breath odor: Due to mercaptans

White nails: low albumin

Encephalopathy: Not only ammonia but also Short chain fatty acids and branched chain amino acids.