II. PHYSICAL EXAM

Petechiae are small (1-3 mm) red lesions, resulting from hemorrhage into the skin. They are usually seen in areas of high venous pressure (lower legs). When petechiae are compressed the red spot remains (i.e. they do not "blanch") since the blood cannot be forced back into the blood vessel. The presence of petechiae indicates a low platelet count, thrombocytopenia or a platelet function abnormality. Thrombocytopenia can be secondary to impaired bone marrow production of platelets, increased peripheral destruction of platelets, or increased sequestration of platelets. 

Platelet function abnormalities can be hereditary or acquired.

Ecchymoses (bruises or "black and blue marks") are large, flat, multicolored (blue, green, yellow) lesions resulting from hemorrhage into the skin. The presence of ecchymoses indicates trauma to the skin or blood vessels; it may also be seen in patients with platelet or coagulation disorders.

Spider angiomata are small red macules with fine red lines radiating from it like "spider legs". They blanch when compressed. They represent tiny dilated collateral blood vessels and are seen in patients with portal hypertension secondary to cirrhosis.