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Gastro Exam

Assessing Skin Colour

November 26th, 2019


In the context of the gastrointestinal examination, it is important to inspect for jaundice as well as bronzing of the skin, as these signs may suggest the presence of liver disease or haemochromatosis.


  • Look For

  • Yellow discolouration of the skin and mucous membranes, due to deposition of bilirubin.
  • Causes of Jaundice

  • Haemolytic Jaundice

  • Erythrocyte defects - sickle cell anaemia, thalassaemia, B12 / folate / iron deficiency anaemia, sideroblastic anaemia, spherocytosis, lead poisoning
  • Excessive erythrocyte destruction - haemolytic anaemia, thermal injury, DIC, haemodialysis, breast milk jaundice
  • Hepatocellular Jaundice

  • Dysfunctional uptake - drugs
  • Dysfunctional conjugation - Crigler-Najar, Gilbert's disease
  • Dysfunctional bilirubin storage / excretion - Dubin-Johnson
  • Hepatocyte damage - cirrhosis, hepatitis, tuberculosis, EBV, CMV, varicella, drug-induced hepatitis, autoimmunity, alpha-1 antitrypsin deficiency, Wilson's disease
  • Cholestatic Jaundice

  • Intrahepatic cholestasis - drugs, pregnancy, cystic liver disease, sepsis, TPN, Hodgkin's disease, biliary cirrhosis, sclerosing cholangitis, liver cancer (primary / metastatic)
  • Extrahepatic cholestasis - cholangitis, cholelithiasis, pancreatitis, tumours (eg. pancreatic), bile duct (stenosis or extrinsic compression)

Bronzed Skin

  • Look For

  • Bronze discolouration of the skin.
  • Significance

  • An indicator of haemochromatosis, a genetic disorder of iron metabolism resulting in excessive iron deposition.
  • Manifestations of Haemochromatosis

  • Systemic - fatigue / lethargy
  • Skin - hyperpigmentation
  • Hepatic - chronic liver disease, cirrhosis, hepatocellular carcinoma
  • Pancreatic - diabetes mellitus ("bronze diabetes")
  • Joints - arthralgias, arthritis
  • Hypogonadism - male impotence, loss of libido
  • Cardiac - arrhythmia, myopathy


General inspection of the patient may provide some clue regarding pallor, though it is more significant to assess pallor of the nail beds, palmar creases and conjunctivae.
  • Causes of Pallor

  • Physiologically pale skin
  • Anaemia
  • Chronic disease
  • Low cardiac output, due to cardiac disease
  • Peripheral shutdown, due to increased sympathetic activity
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