Spider angioma

WikiDoc Resources for Spider angioma
Articles
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Evidence Based Medicine
Cochrane Collaboration on Spider angioma Bandolier on Spider angioma TRIP on Spider angioma
Clinical Trials
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Guidelines / Policies / Govt
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Commentary
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Definitions
Definitions of Spider angioma
Patient Resources / Community
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Healthcare Provider Resources
Symptoms of Spider angioma Causes & Risk Factors for Spider angioma Diagnostic studies for Spider angioma Treatment of Spider angioma
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Experimental / Informatics
List of terms related to Spider angioma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Historical Perspective

• [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
• In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
• In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

• [Disease name] may be classified according to [classification method] into [number] subtypes/groups:

• [group1]
• [group2]
• [group3]

• Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

• The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
• The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
• On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
• On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Causes

Disease name] may be caused by [cause1], [cause2], or [cause3].

OR

Common causes of [disease] include [cause1], [cause2], and [cause3].

OR

The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].

OR

The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.

Differentiating [disease name] from other Diseases

• [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:

• [Differential dx1]
• [Differential dx2]
• [Differential dx3]

Epidemiology and Demographics

• The prevalence of spider angioma is approximately 10,000-15,000 per 100,000 individuals in healthy adults and young children worldwide.

• According to a study, in children without liver involvement, 38% had at least one lesion. 8 of 10 children with cirrhosis had at least one lesion, only 4 of 34 children with chronic liver disease had five or more spiders present. There was an increasing trend with the age.

Age

• Spider angioma is more common in women of childbearing age.

Gender

• There is no documented study showing gender predilection for Spider Angioma in otherwise healthy population.
• However there is an increased incidence in pregnant women, which is attributed to hyperestrogenic states.

Race

• There is no racial predilection for Spider Angiomas, but can have more visibility in light skinned people.

Risk Factors

• Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

• There is no diagnostic criteria for Spider angioma.

History and Symptoms

• Spider angioma, when not extensive, can be benign.
• When present extensively it could be due to an underlying cause.
• About 33% of the patients with advanced liver cirrhosis have spider angioma.
• Alcoholism and higher bilirubin levels were proven to have correlation for development of Spider angiomas.
• Hyperestrogenic states like pregnancy, oral contraceptive pills etc could be the underlying cause in young females with no hepatic etiology.

Physical Examination

• Patients with benign spider angioma usually appear normal.
• Those secondary to underlying cause may have additional symptoms pertaining to the disease.
• A spider angioma has 3 features: a body with small bright red lesions (1mm -10mm) with a central red spot, a leg with radiating thin-walled vessels and surrounding erythema.
• Unusually large presentations with visible pulsatile blood flow have also been reported.
• The blood pressure measures 50 to 70 mm Hg in these small arterioles.
• Spider angiomas are usually present on face, chest and arms in the distribution of Superior Vena Cava. But unusual presentations with Palpebra, Pluera and subpleura, Esophaghus ,and Gastrointestinal tracts have been reported.

Laboratory Findings

• Laboratory work up for hepatic etiology (Liver function tests, Viral markers), pregnancy (urine pregnancy test), hyperestrogenic etiology (Estrogen and FSH levels) and thyrotoxicosis (T3,T4, and TSH) should be done.

Electrocardiogram

• There are no ECG findings associated with Spider angiomas.

X-ray

• There are no x-ray findings associated with Spider angiomas.

Echocardiography or Ultrasound

• There are no echocardiography/ultrasound findings associated with Spider angiomas as such.
• Ultrasound has a high positive predictive value in identifying the underlying liver cirrhosis.
• Ultrasound may be useful in identifying underlying ovarian tumors.

CT scan

• There are no CT scan findings associated with Spider angiomas.
• CT scan is the most sensitive imaging modality for identifying the underlying liver cirrhosis.
• Ct scan can reveal underlying ovarian tumors.

MRI

• There are no MRI findings associated with Spider angiomas.

Other Imaging Findings

• There are no other imaging findings associated with Spider angiomas.

Other Diagnostic Studies

• Biopsy may be helpful in the diagnosis of Spider angioma when the presentation isn't classical. Findings diagnostic of spider angioma include Cutaneous arterial net, Central spider arteriole, Subepidermal ampulla , Star shaped arrangement of efferent spider vessels, and Capillaries.

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].