Overview
The arms can provide a lot of information regarding a patient's liver disease; spider naevi and Bier spots are signs of chronic liver disease, purpura may suggest an underlying coagulopathy and scratch marks suggest an obstructive cause of liver disease.
Spider Naevi
Look For
- A central red vessel with multiple small twisted vessels radiating from it, that disappears when pressure is applied. Commonly over the face, neck, forearms, hands and chest.
Significance
- Dilatation of the capillaries due to oestrogen excess.
Causes of Spider Naevi
- Normal in children
- Cirrhosis
- Hyperthyroidism
- Rheumatoid arthritis
- Pregnancy
- Exogenous oestrogen - OCP, HRT
- Paraneoplastic syndrome
Bier Spots
Look For
- Small, irregular hypopigmented patches on the arms or legs that disappear when pressure is applied.
Significance
- A general sign of liver disease.
Purpura
Look For
- Red / purple lesions that do not blanch with pressure. May be present over the head, arms, legs, chest or abdomen.
Causes of Purpura
Trauma
Platelet Disorders
- Idiopathic thrombocytopaenic purpura (ITP)
- Thrombotic thrombocytopaenic purpura (TTP)
- Disseminated intravascular coagulation (DIC)
- Bone marrow failure - aplastic anaemia, leukaemia, chemotherapy
- Platelet sequestration - splenomegaly, haemangioma
- Haemolytic-uraemic syndrome
- Inherited disorders of platelet function
Disorders of Coagulation
- Factor deficiencies - haemophilia, Von Willebrand disease
- Vitamin K deficiency - malabsorption, poor diet
- Anticoagulants
- Disseminated intravascular coagulation (DIC)
Vascular Disorders
- Connective tissue diseases - Ehlers-Danlos, scurvy
- Infection - mengingococcal, streptococcal, viral
- Henoch-Schönlein purpura
- Senile purpura
- Steroids
Scratch Marks
Look For
- Scratch marks over the skin of the face, arms, chest or abdomen.
Significance
- An indicator that the patient has been pruritic.
Causes of Pruritis
- Obstructive jaundice (bile acid deposition)
- Chronic kidney disease (urea deposition)
- Skin conditions - dry skin, atopic eczema, psoriasis, lichen planus, ichthyosis
- Infection - herpes zoster, scabies, fungal infections
- Myeloproliferative disorders
- Hyperthyroidism
- Pregnancy
- Neuropathic itch
- Psychogenic itch
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