General Physical Examination in Gastrointestinal Diseases
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The document discusses various signs and symptoms seen in nutritional deficiencies and liver diseases. It covers oral, skin, eye and gastrointestinal manifestations seen in conditions like scurvy, pellagra, liver failure, vitamin A deficiency etc. It also discusses paraneoplastic dermatological manifestations that can be associated with gastrointestinal malignancies.
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General Physical Examination in Gastrointestinal Diseases
- 1. Guide : Dr Kalinga B E (Associate Professor) Student : Dr Chetan K Ganteppanavar 1
- 2. Head to toe examination Signs of nutritional deficiency Oral cavity Skin changes Signs of liver cell failure Eye manifestations GIT Syndromes Paraneoplastic Dermatological Manifestations of GI Malignancy 2
- 3. 3
- 4. Yellowish discolouration of skin and mucous membrane due to excess amount of bilirubin present in the blood. Clinical jaundice-S.bilurubn-3mg/dl Latent jaundice-S.bilurubin-1-3mg/dl 4
- 5. 5
- 6. Carotenaemia Atabrine toxicity (antiprotozoal drug) Diffuse Xanthomatosis Muddy sclera Old subconjunctival haemorrhage 6
- 7. 7
- 8. Acholuric urine Stool-High color Jaundice-Lemon yellow tinge (Sr. Bilirubin is usually <6mg/dl) Anaemia May have typical facies(chipmunk facies in thalassaemia) 8
- 9. Urine-Deep yellow Stool-Pale or clay colored with Steatorrhea Jaundice-Greenish-yellow Generalized pruritis Xanthelasma Petechiae, purpura or ecchymosis secondary to Vit k def 9
- 10. Urine-Yellowish Stool-High colored Orange yellow tinge bulbar conjunctiva Variable pruritus Bleeding manifestations 10
- 11. Stone impaction in CBD Periampullary carcinoma Hemolytic anemia Dubin Johnson syndrome Gilbert syndrome 11
- 12. Due to presence of excessive 1. Sulphaemoglobin >0.5g/dl or 2. Methaemoglobin >1.5g/dl Poisoning by aniline dye Drugs like nitrates and nitrites 12
- 13. 13
- 14. IBD – UC, Crohn’s Liver Abscess Hepatoma Hepatocellular carcinoma Primary Biliary Cirrhosis Malabsorption – Celiac disease GI lymphomas 14
- 15. 15
- 16. 16
- 17. Hypoproteinemia with severe anemia Beriberi Epidemic dropsy 17
- 18. 18
- 19. 19
- 20. 20
- 21. 21
- 22. 22
- 23. 23
- 24. Pale, Dry, Acneform lesions 24
- 25. XN : NIGHT BLINDNESS X1A : CONJUNCTIVAL XEROSIS X1B : BITOT’S SPOT X2 : CORNEAL XEROSIS X3A : KERATOMALACIA (<1/3) X3B : KERATOMALACIA (>1/3) XS : XEROPHTHALMIC SCARRING XF : XEROPHTHALMIC FUNDUS 25
- 26. 26
- 27. 27
- 28. 28
- 29. 29
- 30. 30
- 31. 31
- 32. 32
- 33. 33
- 34. 34
- 35. 35
- 36. 36
- 37. 37
- 38. 38
- 39. 39
- 40. 40
- 41. VitaminA Deficiency Vitamin B2, B6, B12 deficinecy Riboflavin Deficiency Acrodermatitis Enteropathica 41
- 42. 42
- 43. 43
- 44. 44
- 45. Toad skin / Phrynoderma 45
- 46. Acrodermatitis Enteropathica Scarring Alopecia Growth Retardation 46
- 47. 47
- 48. 48
- 49. 49
- 50. 50
- 51. 51
- 52. Glossitis : B6, B12, B2 52
- 53. Scarlet red : Niacin Magenta : Riboflavin deficiency 53
- 54. VitaminA Deficiency Vitamin B2, B6, B12 deficinecy Riboflavin Deficiency Acrodermatitis Enteropathica 54
- 55. 55
- 56. Dentin and Enamel defects : GERD VitaminA 56
- 57. Ulcers Cobble stoning – Crohn’s Painless lip swelling – Crohn’s 57
- 58. 58
- 59. Cracked mucosa – UC Hemorrhagic bullae –Vit K Deficiency 59
- 60. Multiple, painful, irregular Undermined border, Granulating floor, 60
- 61. AlopeciaAreata – IBD Cork Screw hair : Scurvy Flag Sign : Kwashirkor 61
- 62. 62
- 63. 15% in CD & 10% in UC EN are hot, red, tender nodules measuring 1– 5 cm in diameter and are found on the anterior surface of the lower legs, ankles, calves, thighs, and arms 63
- 64. 64
- 65. 65
- 66. 66
- 67. 1–12% of UC patients and less commonly in Crohn’s colitis Begins as a pustule and then spreads concentrically 67
- 68. IBD, RA, CollagenVascular disorders, HIV, carcinoids, intestinal cancers, leukemia, MDS, MPS, Propylthiouracil, gammopathies, Isotretinoin, Soratinib and Geftinib. 68
- 69. 69
- 70. 70
- 71. Large veruccous plaque Irregular margins Pustules may be seen Leukemia Azathioprine use in arthritis IBD Radiations Intestinal malignancy and lymphoma 71
- 72. Erythema Edema Superficial pustules Over buccal mucosa Over Gingiva Silent marker of underlying Crohn’s 72
- 73. 73 • Mild Respiratory Illness •IBD • Pregnancy • G-CSF • Sulfa drugs • Minocycline • Sjogrens • Bechets • SLE • RA
- 74. 74
- 75. 10% cases have psoriatic plaques and psoriatic arthritis 75
- 76. 76
- 77. 77
- 78. Anal fissures, anal fistulae 78
- 79. Polyarteritis Nodosa : IBD Epidermolysis bullosa aquisita : IBD • Paraneoplstic pemphigus, • Cicatricial pemphigoid, • Dermatitis herpetiformis, • Epidermolysis acquisita. • In Adenocarcinoma of GI tract and GI Lymphomas 79
- 80. PAN Pemphigus Epidermolysis Bullosa Dermatitis Herpetiformis 80
- 82. Possibility of an intra-abdominal malignancy should be considered especially if there are large number of plaques, Weight loss, Rapid progression of lesions 82
- 83. • Neoplastic proliferation of the glucagon secreting alpha cells of the pancreas Perineum, abdomen, groin, buttocks and lower extremities celiac disease, ulcerative colitis, crohn’s disease, cirrhosis, hepato cellular 83
- 84. 84
- 85. 85
- 86. 86
- 87. 87
- 88. Liver cell failure 88
- 89. 89
- 90. 90
- 91. 91
- 92. 92
- 93. 93
- 94. 94
- 95. 95
- 96. 96
- 97. 97
- 98. 98
- 99. 99
- 100. Hepatitis C infections 100
- 101. Umbilical subcutaneous nodule caused by a metastases from an intra abdominal malignancy. GI adenocarcinoma 101
- 102. Esopageal carcinoma,adenocarcinoma of the gut, squamous cell cancers of upper aero digestive tract. 102
- 103. Facial Angiofibroma Lipoma Confetti like lesions Pancreatic and GI tract Neuroendocrine tumors (insulinoma, gastrinoma, VIPoma etc) 103
- 104. Extensive, silky nonpigmented lanugo hair on the face, neck, trunk, and on the extremities Adeno carcinoma of the gastro intestinal tract 104
- 105. Infiltrated and violaceous papules and nodular lesions on the hands, knees, shoulders, wrists, hips, elbows ankles , feet, and spine Adeno carcionoma of GI tract 105
- 106. Erythema gyratum repens Figurate erythema Erythema annulare centrifugam Asso. Malignancy : esophageal adeno carcinoma 106
- 107. 107
- 108. 108
- 109. 109
- 110. Malignant tumors arising from pancreas 110
- 111. 111
- 112. 112
- 113. Hemorrhagic lesion over inguinal ligament 113
- 114. 114
- 115. 115
- 116. 116
- 117. IBD 117
- 118. STAPHYLOMA 118
- 119. 119
- 120. 120
- 121. 121
- 122. Black spots (macule): perioral skin, lips, buccal mucosa, tongue 122
- 123. Facial trichilemmomas Acral Keratosis Lipoma Angioma Hamartoma GI tract malignancy and Polyps 123
- 124. Lipoma Angioma Hamartoma 124
- 125. Sebaceous Adenoma BCC Keratocanthoma Asso. With Colorectal cancers 125
- 126. Epidermoid cysts Osteomas GI Polyps Colorectal,thyroid,duodenal,pancreatic cancers and hepatoblastoma 126
- 127. Flushing Cyanotic flush Pellagroid rash Rosacea like 127
- 128. Telangiectasia of dorsum of tongue, oral cavity, buccal mucosa, lips, palate & nasal mucosa Lung, Liver and GI tract AV Malformations 128
- 129. Dysphagia, iron def. anaemia, atrophic glossitis, angular stomatitis, & koilonychia Pre-malignant : Post-cricoid carcinoma 129
- 130. Often on the axillary ,inguinal fold, vulva,or scrotum Adenocarcinoma of the rectum or anal canal 130
- 131. Dysphagia Reflux esophagitis Diarrhoea Vomiting Obstructions Malnutrition CREST Syndrome 131
- 132. 132
- 133. Aphthous ulcers Underlying IBD 133
- 134. Deformities : RA Dactylitis Sausage Digitis 134
- 135. Acanthosis Nigricans Palmo Plantar Keratoderma Acrokeratosis paraneoplastica (Bazex Syndrome) LesserTrelat Syndrome (multiple seborrheic keratosis) 135
- 136. 136
- 137. 137
- 138. Multicentric Reticulo-Histiocytosis Acquired Hypertrichosis Lanuginosa Trosseau Syndrome Sweet syndrome Pyoderma Gangrenosum Necrolytic Erythema Migrans Sister Mary Joseph Nodule 138
- 139. Harrison’s Principle’s of Internal Medicine 20th edition Bailey and Love Surgery 26th edition Sherlock’s diseases of the liver and biliary diseases 12th edition Fitzpatrick’s text book of dermatology 9th edition Maheshwari’s essential orthopaedics 6th edition Internet Sources 139
- 140. 140
Editor's Notes
- Inflammation of skin and subcutaneous fatty layer. It is usually secondary to ciculating antigens. Mcc = streptococcal infections. Sulfa drugs, sufonylureas, leprosy, OCP are also causatives. Bechets, sarcoidosis, lymphoma, hodgkins, rarely pregnancy. M:F=1:4
- Unknown etiology. Mimicing lesions are infections, malignancy, vasculitis, CTD, diabetes and rarely trauma. Diagnosis of exclusion. Causes : IBD, RA, Collagen vasc disorders, HIV, carcinoids, intestinal cancers, leukemia, MDS, MPS, Propylthiouracil, gammopathies, Isotretinoin, Soratinib and Geftinib.
- Rheumatic fever, SABE, Henoch Schonlein purpura, Cefaclor drug hypersensitivity, Septicemia, Hep B and Hep C , Lyme’s disease
- Episcleritis is usually idiopathic, acute and associated with mild pain, redness and irritation. Vessels are mobile, blach with phenylephrine and reddish huw. Self limited condition. Scleritis is autoimmune and subacute in onset with severe pain and pain with ocular movements. Blurred vision and photophobia may be seen. Visual loss can occur. Vessels are adherent, don’t blanch and slit lamp may show nodules, scleral thinning, corneal opacity.