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Very active healthy male with spider naevi

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I'm a 22 year old male very active I work as an EMT in a very busy 911 system, lift weights 5 days a week, and eat very healthy. Last year I had my gallbladder removed by lap cholecystectomy (chronic mild cholecystitis with no stones), ever since I have been concerned about my liver. I have numerous spider nevi type veins on my flanks that seem to be increasing. My GP,surgeon, and GI doc all seem to think it's nothing, however, from everything I read multiple lesions are an issue almost always associated with liver disease and thats what scares me. I have had all normal LFT's for the past year and a half, normal cbc's, hep panels were fine, normal ultrasound, and the surgeon even said "my liver looked very healthy". My main concern is something is being missed here. Why would a young fit male like me have these type of lesions for any other reason than a liver problem? I do not consume alcohol regularly, MAYBE 4 times in the past 3 years. I drank a bit in highschool but that's about it. Should I be concerned about liver issues? If not what can be causing these?

Category: Hematologist

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Category: Hepatologist
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Thank you for asking your query at DoctorSpring.

No, you need not be concerned about the spider nevi like lesions at all. These can be present in upto 20% of normal individuals. As you may be aware pregnancy, hormone supplementation etc can also cause spider nevi. In short this sign is not specific of liver disease at all. Since all the investigations are negative this should be normal variant in your skin. Multiple lesions are more commonly associated with liver disease, but this doesn’t mean all multiple lesions are liver related. In fact this is just an observation, not an evidence based fact.

I would say for a spider nevi you have been thoroughly evaluated. Normal LFT and USG completely rule out any chance of a liver issue.
No need to worry at all, you should carry on with your usual business.
Hope this helps
Please feel free to ask followup questions
Thank you

Patient replied :

Now another concern of mine is the fact that all my bloodwork has been completely normal the last year +, other than a slightly decreased WBC. I have been getting LFT's/CBC's every 6 months for the last year +. My doctor doesn't seem concerned with the WBC count but can't this be a indication of some type of liver disease? Is a slightly low WBC of any significance in this case? Also when I had my cholecystectomy done the doctor said my liver looked very healthy, could cirrhosis even in beginning stages be detected by gross liver examination during laprascopic cholecystectomy? Could you get a good feel for liver health during lap cholecystectomy? What could cause chronic cholecystitis without stones? Thank you doc, I very much appreciate your time and response.


WBC counts can vary in normal individuals. In Fact they are supposed to vary when the body goes through various infections and inflammations. So an occasional low WBC shows the cells are working fine. They have no diagnostic significance for a liver disease. So low or high count is not an indication of liver disease.

NO cirrhosis in the early stage cannot be diagnosed by looking at the liver. Even though at later stages it might be possible. But LFT + normal USG is good enough to rule out cirrhosis in your case. That should be the reason your Doctor commented your live looks healthy (looks healthy on appearance with the background knowledge of normal LFT + USG ). Once won't get a feel of the liver during Lap Cholecystectomy but can see the surface of the liver. Acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder with a multifactorial causes from unknown infection to inflammation. Since its taken care, you need not worry about that.

Hope this helps
Thank you

Patient replied :

Liver disease in early stage would present with inflammation correct? Then shrinkage and necrosis? My concern is ultrasound and lft's are possibly missing something as I've read that LFT's can remain pretty normal in individuals with cirrhosis. The gastro,GP, and surgeon seem to think there is no concern of such a issue for me but the spider nevi type veins are definitely increasing in number and I do not have an answer for this and from everything I read it does worry me quite a bit. So you could not tell a cirrhotic liver by gross evaluation? or even get a general feel of liver health by looking at it through lap? You think that LFT+USG is a viable way to rule out cirrhosis or major liver disease? Even with the spider nevi type veins? Thank you very much.


The only definitive way diagnose an early Cirrhosis is a Liver Biopsy. Doing a Lap and having a general feel or look of the liver is not conclusive. I mean it might be possible in some cases, but not better than a USG + LFT for sure. Yes, LFT + USG + Medical History + Clinical Examination is a pretty good way rule out any major liver disease or cirrhosis. True early cirrhosis can still be missed, but let me assure you having spider nevi type of veins does not mean you have liver disease. It is a non specific finding.

Hope this helps
Thank you

Patient replied :

The spider nevi that are result of liver disease, do they usually present in early stages or late stages? Also where do they usually present?

Spider Nevi can occur both in early and later stage. They present in the upper body usually in trunk the face, neck, upper part of arms etc. The only sure method to rule out cirrhosis (though highly unlikely) in Biopsy. USG + AST/ALT monitoring periodically (6-10) months can also be done, if recommended by your Doctor.
Thank you

Dr. Ratnakar Kini
Category: Hepatologist
Fellowship - DM - TN Dr.MGR Medical UniversityResidency - TN Dr.MGR Medical University Medical School - Stanely Medical College, TN Dr.MGR Medical University
Dr. Ratnakar Kini and 4 other Medical Specialists are ready to help you

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