Gastrointestinal Flashcards
Acanthosis nigricans
Describe
Ddx
Brown velvety elevation of epidermis
Usually in axilla or neck
GI carcinoma, lymphoma
Endocrinopathies (acromegaly, DM…)
Slate grey or brown bronze pigmentation on face, predominantly at UV exposed areas
Likely condition
Associated GI symptoms
Haemochromatosis
Hepatomegaly
Signs of chronic liver disease
Signs specific for obstructive jaundice
→ Greenish jaundice (bile regurgitation)
→ Xanthelasma (↓Ch excretion)
→ Xanthomas (↓Ch excretion)
→ Scratch marks (pruritus due to retention of bile acid content)
Cause of xanthelesma
Hypercholesterolemia
May occur in cholestasis, esp primary biliary cirrhosis
Common cause of black eye syndrome after proctosigmidoscopy
Periorbital purpura due to amyloidosis
Amyloid factor binds to factor 10 causing coagulopathy
How to palpate for parotid glands?
Causes of unilateral parotid gland enlargement?
Palpate for enlargement:
→ Ask pt to clench teeth to tighten masseter
→ Normal = impalpable
→ Enlarged = palpable behind masseter and in front of ear
Unilateral:
- Mixed parotid tumour
(occ. bilateral) - Tumour infiltration
- Duct blockage
Causes of bilateral parotid gland enlargement
Bilateral:
- Mumps (may be unil.)
- Sarcoidosis (painless)
- Lymphoma (painless)
- Mikulicz syndrome (painless)
- Alcoholism (fatty infiltration)
- Malnutrition
- Severe dehydration
List 5 abnormal fetor and their underlying causes
□ Poor oral hygiene
□ Fetor hepaticus: sweet smell
→ Indicates severe hepatocellular disease (late sign)
□ Ketosis: sickly sweet smell
→ Indicates diabetic ketoacidosis
□ Uraemic fetor: fishy ammonia smell → Indicates uraemia
□ Putrid smell:
→ Due to anaerobic chest infection with large amounts of sputum
□ Alcohol and cigarette smokin
Cause of lingua nigra and geographic tongue
Lingua nigra: bismuth compound or benign keratin accumulation
Geographic tongue: benign or vitamin b12 deficiency
Causes of leukoplakia
Leukoplakia: white-coloured thickening of mucosa of tongue and mouth → A premalignant condition → Causes: ‘5S’ - Sore teeth (poor dental hygiene) - Smoking - Spirits - Sepsis - Syphilis
Causes of glossitis
Glossitis: smooth tongue surface ± erythema
→ May present with shallow ulceration in later stages
→ Indicates nutritional deficiencies, eg. Fe, B9, B12
- Alcoholics (common)
- Carcinoid syndrome
- Elderly people
Causes of macroglossia
Macroglossia: enlargement of the tongue
→ Congenital conditions, eg. Down syndrome
→ Endocrine diseases, eg. acromegaly
→ Tumour infiltration, eg. haemangioma, lymphangioma
→ Amyloidosis infiltration
Cause of cracks at corners of mouth
Angular stomatitis: cracks at corners of mouth
→ Indicates nutritional deficiencies incl. B6, B9, B12, iron
Spider angioma
Sites
How to exam
Causes
□ Site: SVC drainage areas, i.e. arms, neck, chest
→ Can be found in oral and nasal mucous membrane
→ Rarely found below nipples
□ Central arteriole from which radiate numerous small vessels
□ Confirmed by pressing on central arteriole
→ Should result in blanching of whole lesion
→ Release → rapid refilling from centre to legs
□ Possible causes:
→ Normal variation
→ Cirrhosis (esp if ≥3 or new spider naevus formation)
→ Pregnancy (2nd to 5th month)
→ Hepatitis (may occur transiently in viral hepatitis)
→ Rheumatoid arthritis
→ Scleroderma
Mimics of spider angioma
Common mimics: → Cherry angioma (Campbell de Morgan spots): - Elevated red circular lesions - Occurs on abdomen or anterior chest - Do not blanch upon pressure - Very common in elderly and benign
→ Venous stars (spider veins):
- Usually located on the leg, but can occur elsewhere near major veins
- Not obliterated by pressure
- Cause: chronic venous insufficiency
Causes of gynaecomastia
How to confirm in exam
Confirmed by feeling under nipple for genuine breast tissues (cf fat)
□ D/dx:
→ Healthy adolescence
→ Chronic liver disease5, esp alcoholic cirrhosis and chronic autoimmune hepatitis
→ Alcoholism
→ Chronic starvation (↓gonadotropin and testosterone production)
→ Oestrogen-secreting testicular tumours
→ Drugs, eg. spironolactone, digoxin, cimetidine
GI causes of lymphadenopathy
Cervical lymphadenopathy: palpate L supraclavicular node ± other cervical nodes
□ D/dx: infections (esp TB), malignancies
□ Troisier’s sign: large Lt supraclavicular (Virchow’s) node + CA stomach
GI cause of generalised scratch marks
Scratch marks may indicate obstructive jaundice
□ Mechanism: retention of bile acids → pruritus
□ Significance: generalized pruritus a common presenting feature of
primary biliary cholangitis before other signs are apparent
GI causes of ecchymoses and petechiae
□ Ecchymoses: large bruises >1cm
→ Indicates clotting factor abnormalities
- Hepatocellular damage → ↓clotting factor synthesis
- Obstructive jaundice → ↓bile acid for vitamin K absorption
□ Petechiae: small bruises <3mm7 → Indicates thrombocytopenia - Chronic alcoholism → BM depression → thrombocytopenia - Portal hypertension → hypersplenism - Severe liver diseases (esp acute hepatic necrosis) → DIC
Signs at axilla that may indicate CA stomach
□ Inspect for acanthosis nigricans
→ paraneoplastic manifestation of CA stomach
□ Palpate for lymphadenopathy
→ for Irish nodes of CA stomach