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Gastro Exam
 
 

The Skin

 
 
 
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Overview

During the gastrointestinal examination, inspection of the skin can reveal skin changes that can point toward a specific GI or hepatobiliary pathology.

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

Hyperpigmentation

  • Look For

  • Areas of hyperpigmented skin.
  • Causes of Hyperpigmentation

  • Dermatoses - ephelides (freckles), melanocytosis
  • Post -inflammatory - sunlight exposure (tan), dermatitis, infection, trauma
  • Haemochromatosis
  • Alcoholic liver disease
  • Cirrhosis
  • Renal failure
  • Cutaneous amyloidosis

Purpura

  • Look For

  • Red / purple lesions that do not blanch with pressure. May be present over the head, arms, legs, chest or abdomen.
  • Causes of Purpura

  • Trauma

  • Platelet Disorders

  • Idiopathic thrombocytopaenic purpura (ITP)
  • Thrombotic thrombocytopaenic purpura (TTP)
  • Disseminated intravascular coagulation (DIC)
  • Bone marrow failure - aplastic anaemia, leukaemia, chemotherapy
  • Platelet sequestration - splenomegaly, haemangioma
  • Haemolytic-uraemic syndrome
  • Inherited disorders of platelet function
  • Disorders of Coagulation

  • Factor deficiencies - haemophilia, Von Willebrand disease
  • Vitamin K deficiency - malabsorption, poor diet
  • Anticoagulants
  • Disseminated intravascular coagulation (DIC)
  • Vascular Disorders

  • Connective tissue diseases - Ehlers-Danlos, scurvy
  • Infection - mengingococcal, streptococcal, viral
  • Henoch-Schönlein purpura
  • Senile purpura
  • Steroids
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