significance of spider angiomata

[pvk]

I'm genotype 1b, probably have been infected for 30 years.  Diagnosed last August.  Bloodwork has all been normal, viral load 100,000 to 400,000, biopsy says stage 1 grade 2.  At first this was a relief: two different hepatologists said I could safely forget about treatment for now.

However, during yesterday's checkup with hepatologist #1 he noticed that I have prominent spider angiomas on my chest.  My hepatologist says that this usually means there's a problem with blood flow through the liver and that I need to get an upper endoscopy to check for varices.  He had noticed them on my initial consultation a few months ago but was more concerned about them this time.  Yikes!  

Anybody out there have experience with this?  Do spider angiomas usually mean trouble?  I'm really surprised because there's a big difference between stage 1 (biopsy result) and the advanced disease, varices, etc., that are suggested now by the spider veins.  Don't varices mean cirrhosis or end stage liver disease?

One more question: has anyone had an upper endoscopy?  How painful/uncomfortable is it?





  

[Nandalal108]

I have had numerous endoscopies for varices, geno type 2 cirhossis, the endoscopy where varicies were capped, I had some discomfort the next few days, but when they were not capped it wasn't so bad.  The first endoscopy I had they didn''t give enough fentanyl and I woke up with the pipes all down my throat.  Lucky I did some yoga and was able to back out of there but after that they increased the dose of knock out drugs, fentanyl and as I said, unless they cap the varicies there was no discomfort, when they cap them, yes it felt like scraping still going on inside even a few days after.  I have had probably about twelve endoscopies now, 8 last year on again in a month.  Hope you will  be okay, but its not really that bad.  

[ChrisDDD]

I had an endoscopy/colonoscopy and don't remember a thing.  I was scared to death, for nothing.  They gave me IV Versed before they started.  Hope this helps.

[FlGuy]

I have the spider stuff, early cirrhosis, low platelets but no varices.  First time I met treatment doc, the spider stuff was the first thing he noticed and declared 'you have liver damage'.  Nice to meet you too, doc.  That was before I even sat down and before biopsy.  Since then (on second round of tx) I've had a couple of endos, and colon scopes - to keep track of that stuff. It's possible to have/not have a combination of stuff with hcv.  But, it's a good idea to be fully assessed with the scopes, labs, imaging and endocrine stuff to know where you are, in total.

[Forseegood]

one of my best friends has hep c, and he had those, but when he biopsied he was only a stage one...he also smoked, so that might of had something to do with it, the doc told him...I've just seen on here and read that sometimes you can have no symptoms at all and have cirrhosis, and have some of the symptoms of cirrhosis, and be a stage 1, this disease can be all over the place...I'd just get the tests you need and talk it over with the doc...

[HCA]

I've had an endoscopy,they sedated me although I do remember gagging during the procedure.
After half an hour's rest I was fine.
Varices are sign of portal hypertension when the blood cant make it through the main artery and varicose veins are formed to find a way through.The risk is that they bleed,which is life threatening.

[mikesimon]

Anybody out there have experience with this? Yes

Do spider angiomas usually mean trouble? Not necessarily but they are can be a sign of liver disease.

Don't varices mean cirrhosis or end stage liver disease? Varices are not a good sign and are often a result of cirrhosis.

has anyone had an upper endoscopy? How painful/uncomfortable is it? I had bleeding varices and have undergone at least 20 endoscopies. The first few I did without any anesthesia and those were not pleasant at all, particularly because they were injecting my varices with sclerosing drugs. After that I had a combination of versed and demerol(I think it was demerol) and I had no problems at all. In fact, I sort of looked forward to the endoscopies if you can believe that - I was under a lot of stress at the time and when the IV started it was the only time I felt good.

I would not assume or worry too much that because you have one spider angioma that you have varices but I do think it is wise to get examined.

Good luck - I hope they see a nice smooth and healthy esophagus with no distended vessels. Mike

[Kalio1]

It is not unusual for doctors to recommend an endoscopy for Hep C patients. Do you have other signs and symptoms?

Here are a few exerpts from this article http://tinyurl.com/yqcst8 about them:


"Spider nevi may be benign or indicative of underlying systemic disease. They are seen in 10-15% of healthy adults and young children. Most lesions are unrelated to internal disease. Lesions developing during pregnancy or due to oral contraceptives usually resolve spontaneously after delivery or on discontinuing the medication. They may also be seen in thyrotoxicosis, patients with rheumatoid arthritis receiving estrogen therapy and women on oral contraceptives.[1] Numerous prominent spider angiomas are one of the strong clinical pointers to severe liver dysfunction in patients with alcoholic liver disease. Spider nevi can be used as one of the most useful parameters for predicting the grade and stage of Hepatitis C with moderate accuracy.[2] Spider nevi also assist in the diagnosis of hepatopulmonary syndrome (HPS).
Many recent studies have highlighted the importance of spider nevi as a useful sign for the assessment of severity of various hepatic diseases. Romagnuolo et al[2] found that spider nevi and thrombocytopaenia, with either splenomegaly or hypoalbuminaemia, were useful for predicting the presence of hepatic fibrosis in patients with Hepatitis C infection. Hepatopulmonary syndrome occurs in individuals with advanced hepatic cirrhosis and the intra-pulmonary arteriovenous shunts that occur in this condition significantly compound the existing haemodynamic status. Patients with HPS have significantly higher incidence of dyspnea, platypnea, clubbing and spider nevi.[13] Thus, this small, yet valuable, physical sign must be carefully looked for in patients with liver disease as it can provide important information not only regarding severity but also prognosis of the illness."