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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