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Gastro Exam
 
 

Chest  Inspection

 
 
 
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Overview

Inspection of the chest during the gastrointestinal exam can reveal disease specific rashes, as well as signs of cirrhosis such as spider naevi and loss of normal chest hair distribution.

Rashes Associated with GI Disease

Dermatitis herpetiformis: itchy papules and vesicles found on the scalp and extensor surfaces.Coeliac disease
Erythema nodosum: tender, warm nodules with a bruise-like appearance, typically on the lower limbsCrohn’s / ulcerative colitis, lymphoma / leukaemia, malignancy, drugs
Pyoderma gangrenosum: deep, painful, non-infected ulcers surrounded by erythema. Typically on the legs or around stoma sites.Ulcerative colitis, multiple myeloma, amyloidosis, myeloproliferative disorders
Acanthosis nigricans: dark, velvety, nonerythematous lesions on the axillae, antecubital fossae or around the neck.Obesity, T2DM, GIT malignancy
Prurigo nodularis: firm, crusty, pruritic papules and nodules with a symmetrical distribution.Hepatitis C, HIV, H pylori, CKD, lymphoproliferative disorders
Porphyria cutanea tarda: blisters over sun-exposed areas such as the scalp, dorsal hands and forearms, neck and face.Liver disease (esp. hepatitis C), uraemia

Spider Naevi

  • Look For

  • A central red vessel with multiple small twisted vessels radiating from it, that disappears when pressure is applied. Commonly over the face, neck, forearms, hands and chest.
  • Significance

  • Dilatation of the capillaries due to oestrogen excess.
  • Causes of Spider Naevi

  • Normal in children
  • Liver cirrhosis - alcoholic liver disease, Wilson’s disease, haemochromatosis, hepatitis B / C
  • Hyperthyroidism
  • Rheumatoid arthritis
  • Pregnancy
  • Exogenous oestrogen - OCP, HRT
  • Paraneoplastic syndrome

Loss of Chest Hair Distribution

  • Look For

  • Abnormal chest hair distribution in males, usually manifesting as hair loss.
  • Significance

  • An indicator of oestrogen excess in chronic liver disease.
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