95 40 歲男性，已知是 B 型肝炎帶原者近 20 年，最近由於全身倦怠就醫。去年他曾因上消化道出血住 院治療。身體檢查發現肝臟較小，實驗室檢查發現血中白蛋白值較低且凝血時間較長。下列何種身 體檢查結果最不可能出現？
(A)蛇女頭（caput medusae）
(B)男性女乳症（gynecomastia）
(C)蜘蛛血管瘤（spider angioma）
(D)裂片形出血（splinter hemorrhage）

Spider angioma/spider telangiectasia: If you press down on this, the little tentacles will go away (therefore it blanches)–called spider angioma.   It is due to hyperestrinism.   This is normal in pregnancy.  If a male has spider angioma, he has cirrhosis (MCC cirrhosis = alcohol).  Why would a male have a spider angioma? B/c if you have cirrhosis, you cannot metabolize estrogen – so it builds up, leading to gynecomastia, warm skin, palmer erythema, and spider angioma related to hyperestrinism. Another reason would be b/c they  cannot metabolize 17 ketosteroids  either, therefore they will be aromatized those in the adipose tissue into estrogen. So, they are 2 ways of getting hyperestrinism in cirrhosis.  So, how is this different from petechia? It looks diff; also, it will blanch when you press it in b/c it’s an AV fistula – in other words, the blood goes directly from arteriole to a venule and is bypassing the capillaries.