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Gastro Exam

The Palms

November 26th, 2019


During the gastrointestinal examination, inspection of the hands is important as it may reveal signs of chronic liver disease or anaemia.

Palmar Erythema

In the context of chronic liver disease, erythema of the palms may occur in the context of capillary dilatation secondary to oestrogen excess. This finding may also occur in several other conditions such as thyroid disease, contraceptive use and pregnancy.
  • Look For

  • Symmetric, non-painful, non-pruritic, slightly warm erythema over the palms.
  • Causes of Palmar Erythema

  • Cirrhosis - alcoholic liver disease, Wilson's disease, haemochromatosis, hepatitis B / C
  • Hyperthyroidism
  • Rheumatoid arthritis
  • Pregnancy
  • Exogenous oestrogen - OCP, HRT
  • Paraneoplastic syndrome

Palmar Crease Pallor

  • Look For

  • Loss of colour in the creases of the palm.
  • Causes of Palmar Crease Pallor

  • Anaemia
  • Low cardiac output, due to cardiac disease
  • Peripheral shutdown, due to increased sympathetic activity
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