Pathology: ecchymosis

Why should the liver patient have ecchymosis?  There are several reasons.  Here is a list: thrombocytopenia, synthetic dysfunction (high INR), low fibrinogen levels, on prednisone for autoimmune hepatitis, on warfarin for portal vein thrombosis, on aspirin for vascular stents (post-transplant anastamotic stenoses), on plavix for coronary stents (NASH patients die of cardiovascular disease), older age (from excellent liver care over the years). 

When the ecchymosis is limited to hands and forearms, as is typical, there is not much to be concerned with.  When it is noted in the thighs, particularly with bilateral symmetry, beware.  The lower extremities can hold an enormous volume of blood, and you may want to check a CBC.

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