GI Dermatology Flashcards
cirrhosis symptoms: scleral icterus
*yellow discoloration of eye sclera
*classic PE finding in cirrhosis patients
*due to affinity of scleral tissue for bilirubin because of high elastin content
*early sign of liver dysfunction
*earliest location for jaundice is under the tongue
cirrhosis symptoms: “feminization” symptoms often seen in males
*gynecomastia
*sparse body hair
*hypogonadism
cirrhosis symptoms: palmar erythema
*increased red or “ruddy” discoloration of palmar skin
*due to increase in estrogen levels from liver inability to metabolize estrogen
cirrhosis symptoms: spider angiomas
*small central arterioles with radiating capillaries
*blanches with pressure
*seen in liver dysfunction due to elevated levels of serum vascular endothelial growth factor (VEGF) and estrogen
*found mostly on trunk and proximal limbs, face
cirrhosis symptoms: caput medusae
*engorged superficial gastric veins
*appears as tortuous dilated veins on abdomen around umbilicus
*often accompanied by protuberant abdomen with ascites
*seen in patients with liver cirrhosis due to backup of portal venous system
cirrhosis symptoms: Dupuytren’s contractures
*can be associated with multiple diseases, including cirrhosis
*fascia of palms becomes thickened, creating a raised firm linear plaque on palmar skin
*contractures can limit movement and full extension of hands
cirrhosis symptoms: nail changes
*“Terry’s nails”
*white discoloration of the nail bed
*caused by hypoalbuminemia (can be seen in anyone with low albumin levels)
*seen in liver dysfunction patients
examples of cirrhosis skin findings
*scleral icterus
*gynecomastia
*palmar erythema
*spider angiomas
*caput medusae
*Dupuytren’s contractures
*nail changes
derm finding: bronze skin
*hyperpigmentation of the skin
*seen in HEMOCHROMATOSIS
*thought to be due to an increase in melanin in skin
*iron excess may stimulate ACTH or melanocyte-stimulating hormone which also causes increased pigment production
dermatitis herpetiformis
*EXTREMELY itchy small pustules or vesicles on elbows, knees, buttocks
*associated with CELIAC DISEASE
*often confused with eczema or scabies
*antibodies against tissue transglutaminase in the gut react with tissue transglutaminase in the skin
*pathology shows clefts at junction of epidermis and dermis full of neutrophils
*immunofluorescence shows deposition of IgA in dermal papillae
*aphthous ulcers can also be associated with celiac disease
skin findings associated with celiac disease
*dermatitis herpetiformis
*aphthous ulcers
IgA vasculitis
*aka Henoch Schoenlein Purpura
*clinical tetrad of palpable purpura, abdominal pain, arthritis, and hematuria
*common is children & young adults
*prodromal sx of malaise, headache, and arthralgias
*most common triggers: URI, strep infection, drug exposure
*an individual episode may persist for 3-6 weeks
*severe abdominal pain, vomiting, hematemesis, diarrhea, and hematochezia occur in about 50%
leukocytoclastic vasculitis
*small purpuric papules and macules that do not blanch, usually on lower half of body
*seen in many illnesses but is characteristic skin finding in IgA vasculitis
*histology shows destruction of blood vessels with neutrophils and histiocytes with leakage of RBCs into tissue
*can see in infections, paraneoplastic, autoimmune diseases, etc
pyoderma gangrenosum
*ulcerative skin condition commonly affecting the LEGS
*associated with inflammatory bowel disease, especially ULCERATIVE COLITIS
*starts as pustule and rapidly enlarges
*extremely painful
*treat with prednisone + steroid-sparing systemic agents like methotrexate
*do NOT debride these
peristomal pyoderma gangrenosum
*patients with stoma can develop pyoderma gangrenosum around the ostomy site, typically on lower abdomen
*interferes with ostomy bag adhesion and it very difficult to treat
