MedSchool: Ace Your OSCEsThe Medical Company
GET - On the App Store
Gastro Exam

Inspection of the Arms

November 26th, 2019


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.


  • 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
Next Page
Want more info like this?
  • Your electronic clinical medicine handbook
  • Guides to help pass your exams
  • Tools every medical student needs
  • Quick diagrams to have the answers, fast
  • Quizzes to test your knowledge
Sign Up Now

Snapshot: Initialising...