While Vic was walking through the large mall an old nurse friend of his recognized him. Sandy asked him what he was doing and how he was. They used to be close friends in high school and always could seem to talk about anything with neither getting offended. Never boyfriend /girlfriend. They knew each other all through grade school. Sandy noted his chest and said asked him what was going on with his liver. He asked what she meant. Sandy said she recently was working at a liver doctor’s office and the red prominent vessels on his skin on his chest suggested he may have cirrhosis. Vic stated he felt fine but Sandy asked him if he was still drinking as much as he had in the past. Vic replied “that much and a lot more”. Sandy told him to ‘Google’ spider angiomas and read about his liver – then go see a doctor to get his blood checked and then she told him what to do to save his life!
Spider angioma or spider neva are fairly bright red vessels usually on the upper central part of the chest that have a central core and then thin walled vessels that shoot out from them in a random fashion. Viewed quickly, they look like red spider – hence, the name. They usually are about a ¼ inch in size but can get up to almost an inch.
The spiders can mean that a benign condition exists as well. Female hormones and oral contraceptives can cause them as well as pregnancy. The more spiders there are, the more likely the person has cirrhosis. They can be over the face, neck, upper arms and upper trunk. They usually are above the nipples. In children they can be on the hands. They are associated with high estrogen/testosterone ratios. When men develop spiders, their testosterone levels are usually low secondary to the testicular atrophy associated with alcohol and cirrhosis. (That one thing should scare the man from heavy drinking – but, alas, it doesn’t stop them!)
Patients who have cirrhosis usually have a very dynamic circulation which is often associated with spiders. Other vessels are usually enlarged as well. People with many spiders usually have very dilated veins in their esophagus (swallowing tube) that can rupture and bleed quickly. Patients often also have red palms, white nails, a glossy tongue, and small testicles in the male. In early cirrhosis, there often are just spiders on the chest – midline around the neck.
Patients with spiders and cirrhosis should be checked for liver damaging medication use like Tylenol and many others. Blood clots for liver damage, clotting and complete blood counts should be checked.
Spiders can be confirmed by pressing on the central core and to see if the spidery legs that radiate will disappear for a few seconds then reappear as the vessels refill from the core. Lesions can also be on the face. Spiders that develop during pregnancy usually resolve after delivery.
Spiders can be removed with lasers and electrical cautery. More important, however, is the real underlying problem – often a scarred cirrhotic liver screaming for help. Sandy told Vic the most important one thing he could do to prolong his life – stop drinking!!!