MedSchool: Ace Your OSCEsThe Medical Company
GET - On the App Store
Gastro Exam

The Nails

November 26th, 2019


Nail signs such as leukonychia and koilonychia are useful external signs of gastrointestinal or hepatobiliary pathology.


  • Look For

  • Whiteness of the nail beds.
  • Interpretation

  • True Leukonychia

  • Total leukonychia: generalised whitening of the nails.Inherited - rare
  • Transverse leukonychia (Mee's lines): single white bands running parallel to the nail base, that do not disappear when depressed.Intermittent insult during nail growth - arsenic, chemotherapy, trauma, infection
  • Apparent Leukonychia

  • Muehrcke's lines: double white bands that disappear when the nail is depressed.Chronic hypoalbuminaemia
  • Half and half nails (Lindsay's nails): proximal white nail bed and distal brown nail, separated by a transverse ridge.Uraemia
  • Terry's nails: white proximal nail bed with loss of the lunula (proximal white crescent-shaped area).Cirrhosis, heart failure, diabetes, malnutrition, renal transplant


  • Look For

  • Spoon-shaped nails.
  • Causes of Koilonychia

  • Chronic iron deficiency
  • Upper GI carcinoma
  • High altitude
  • Trauma
  • Hypothyroidism
  • Systemic lupus erythematosus
Next Page
Want more info like this?
  • Your electronic clinical medicine handbook
  • Guides to help pass your exams
  • Tools every medical student needs
  • Quick diagrams to have the answers, fast
  • Quizzes to test your knowledge
Sign Up Now

Snapshot: Initialising...