Caput Medusae

[AnonUser15]

Hey folks,

I was wondering at what stage of liver disease do caput medusae start showing?

A few months ago I started have right quadrant pain and the appearance of spider veins/broken capillaries on my ribs. I got my liver functions tests and a myriad of other blood work and it was all fine. My ultrasound showed mild steatosis.

I haven’t had a drink for 3 months and have overall been feeling pretty optimistic since. However recently I started noticing a dilated vein from the center of my chest to my navel which had some small bumps in it along the way. There has also been slight discomfort and burning in this area. I know i might seem like a bit of a hypochondriac but with the pain and the spider veins and now this it’s hard not to worry. Any input of caput medusea and what I should watch for or when they it would appear?

[Hidden]

Caput medusa can be a symptom of cirrhosis or liver failure. What you described is not Caput medusa based on what Melissa Palmer says in her book 'Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease':

"Dilated blood vessels can snake out from the belly button—an appearance appropriately termed caput medusa."

Blood tests measure liver function not liver damage. In your situation I'd want a FibroScan done to check for fibrosis or cirrhosis however after 3 months alcohol free I'm not sure I'd trust a FibroScan result. A biopsy would be the soundest way of determining the true state of your liver. I'd see a hepatologist to discuss the symptom you noticed.

[AnonUser15 in reply to Hidden]

Wouldn’t a GGT blood test and an ultrasound be able to detect damage in most cases however? I would have much preferred a fibroscan or biopsy but it was hard enough to get the ultrasound.

[Hidden]

Your 3 months of not drinking could explain your normal blood test results despite your liver possibly being fibrotic or cirrhotic. An ultrasound can detect liver damage if the liver is enlarged, shrunken or irregular in shape but it can miss subtle damage such as fibrosis or even serious damage like cirrhosis. Again quoting Melissa Palmer from her book 'Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease':

"Many exciting breakthroughs have been made that have enhanced the diagnostic accuracy of these imaging studies. However, even these advanced techniques don't tell the whole story of what's going on with the liver. It is very important to understand that the liver is a master of camouflage. Even people with severe liver disease and cirrhosis may have normal imaging studies. This is a key point to remember, and it bears repeating. Sonograms, CT scans, and MRIs can look totally normal at any stage of liver disease. That is why doctors have come to rely on the liver biopsy as the gold standard for evaluating liver disease."

Checking Melissa Palmer's book I found the symptom you described under the heading 'Signs That Suggest Cirrhosis'. That would be enough reason for me to want a FibroScan and to be referred to a gastroenterologist or hepatologist!

"Enlarged blood vessels found on the upper chest, back, face, and arms, resembling little red spiders, are known as spider angiomatas. They characteristically blanch (turn white) if light pressure is applied to their centers."

If your current doctor won't send you for a FibroScan given your symptom of the spider veins appearing on your chest then I'd change doctors.

[Hidden]

Caput Medusae is extremly uncommon to see these days since medical advancments have come such a long way. Without of course being a doctor.. id say with a degree of high confidence that you do not have caput medusae.

[Hidden]

Edwards advice is sound. Spider angiomas appearing on more than one spot or in multiple locations of the body are quite often linked to liver disease. So to reitterate my friend. If yoyr doctor wont send you to at least get a fibroscan than get a doctor that will.