Gastrointestinal Signs and Symptoms Overview

Gastrointestinal (GIT) General Physical Signs

• Key signs related to GIT conditions can be identified and described.
• Mechanisms behind these signs are understood where applicable.
• Physiological mechanisms governing abnormal signs are described.
• Specific examination techniques for GIT conditions are detailed.
• Expected findings and variations in general examination for GIT diseases are outlined.
• Signs are differentiated from symptoms.

Signs vs Symptoms

• Signs are objective physical manifestations of a disease detectable and measurable by an examiner.
  • Examples include: rapid pulse, high temperature, low blood pressure, bruising, open wounds, etc.
• Symptoms are subjective experiences of the disease, felt by the patient.
  • Examples include: pain.
• Patients may have symptoms (complaints) accompanied by signs on examination or laboratory abnormalities. Conversely, patients may have signs or abnormalities without experiencing symptoms.

Acanthosis Nigricans

• A skin condition characterized by dark, velvety discoloration in skin folds and creases.
• Associated with: Cushing's disease, diabetes mellitus, hypothyroidism, and cancers (prostate/ovarian).
• During examination, inspect the skin, focusing on skin folds (neck, armpits, groin, navel, forehead).
• Underlying mechanism: endocrine dysfunction, particularly insulin resistance and hyperinsulinemia, activates the insulin-like growth factor receptors, which leads to keratinocyte and fibroblast proliferation in the skin.

Angular Stomatitis/Cheilitis

• Inflammation of the corners of the lips, often with maculopapular, vesicular or scaly lesions.
• Risk factors include lip licking, drooling, hypersalivation, malocclusion, Down syndrome, orthodontic treatment, denture use, nutritional deficiencies, hypervitaminosis A, atopic dermatitis, HIV, and immunodeficiency.
• Physical exam: look for bleeding, redness, swelling, cracking, blistering, itching, or pain.

Aphthous Ulceration

• Recurrent round or oval sores/ulcers inside the mouth, not tightly bound to underlying bone (lips, cheeks, and tongue).
• Associated with emotional stress, lack of sleep, mechanical trauma (self-inflicted bites), deficiencies in vitamin B, iron, and folic acid, certain foods (chocolate), certain toothpastes, menstruation, and viral infections.

Asterixis

• Motor disturbance characterized by intermittent lapses in assumed posture, due to intermittent lapses in sustained muscle contractions.
• Associated with hepatic encephalopathy, renal failure, metabolic encephalopathy, and Wilson's disease.

Candidiasis

• A yeast infection caused by Candida albicans characterized by white patches in the mouth or vagina.
• Associated with antibiotic use, pregnancy, uncontrolled diabetes, impaired immune systems, oral contraceptives, hormone therapy that increases estrogen levels, and HIV.
• Clinical exam: inspect the mouth or vagina for white plaques or erythematous patches.

Clubbing

• Bulbous enlargement of the distal ends of fingers or toes.
• Associated with: infective endocarditis, cyanotic heart disease, atrial myxoma, primary biliary cirrhosis, ulcerative colitis, Crohn's disease, lung abscess, bronchiectasis, cystic fibrosis, lung cancer, benign mesothelioma, hyperthyroidism, neurogenic tumours, and Familial Pachydermoperiostosis (PDP).
• During exam, ask patients to hold up their hands and place the thumbs' tips together. Check the angles formed and massage the nail bed to evaluate for softness and spongy texture.

Dupuytren's Contracture

• A condition where one or more fingers become permanently bent in a flexed position due to thickening of the palmar fascia.
• Associated with thyroid problems, liver disease, epilepsy, and diabetes.
• During exam, inspect the hands for thickening of flexion contractures; palpate the hands, wrists, and fingers for swelling or tenderness in the palm for nodules. Have patients try to straighten their fingers.

Ecchymosis (Bruising)

• Discoloration of the skin due to blood escaping from ruptured blood vessels.
• Associated with trauma, amyloidosis, lymphocytic leukaemia, clotting factor deficiencies (haemophilia), vitamin K deficiency, scurvy, defective platelet actions, hereditary haemorrhagic telangiectasia, and Cushing's syndrome.
• Inspect skin for discoloration (red, black, blue, purple, or a combination).

Erythema Nodosum

• A skin disorder with red, tender nodules/plaques predominantly on the lower extremities (extensor surfaces).
• Associated with inflammatory diseases, infections (streptococcal, tuberculosis), sarcoidosis, and rheumatoid disorders.

Glossitis

• Inflammation of the tongue characterized by loss of surface papillae, resulting in a smooth, red appearance.
• Associated with nutritional deficiencies (celiac disease, protein-calorie deficiency, vitamin B12 malnutrition), pernicious anemia, carcinoid syndrome, and Sjögren's syndrome.

Gynecomastia

• Enlargement of glandular tissue in the male breast.
• Associated with hepatic cirrhosis, hyperthyroidism, radiotherapy, renal failure, hypogonadism, and testicular tumors.

Jaundice

• Yellowing of the skin, sclera, and mucous membranes due to increased bilirubin levels.
• Associated with liver cirrhosis, acute pancreatitis, haemochromatosis, liver/gallbladder/pancreatic cancers, hepatitis (viral and toxic), malaria, and porphyria.
• Clinically: inspect the eyes, to detect discoloration (jaundice).

Leukonychia

• Whitening of the nail plate due to abnormal vasculature.
• Associated with trauma, hereditary factors, hypoalbuminaemia, hepatic cirrhosis, chronic renal failure, congestive heart failure, and diabetes.
• Clinically: inspect patient nails for discoloration

Leukoplakia

• Thick, white, or grayish patches in the mouth; associated with mouth injuries, rough teeth, poorly fitting dentures, inflammatory conditions, long-term alcohol use, and infections (HIV, HPV).
• Clinical exam: inspect the mouth, gums, inside of cheeks, tongue, or lips for patches.

Muscle Wasting

• Also known as muscle atrophy, signifying loss of muscle tissue.
• Associated with amyotrophic lateral sclerosis (ALS), Multiple Sclerosis (MS), arthritis, myositis, radiculopathy, peripheral neuropathy, and peripheral vascular disease.

Pallor

• Paleness of skin and mucous membranes due to reduced oxyhemoglobin or decreased peripheral perfusion.
• Associated iron deficiency, anemia, leukaemia, chronic renal disease, and rheumatoid arthritis.

Palmar Erythema

• Symmetrical redness on the thenar and hypothenar prominences of the palms, potentially with a mottled appearance that blanches with pressure.
• Associated with chronic liver disease, autoimmune conditions (rheumatoid arthritis), neoplastic conditions, endocrine disorders (thyroid, diabetes), and infectious conditions.

Petechiae

• Pinpoint, round, red/brown spots on the skin due to bleeding from broken capillaries.
• Associated with vitamin C deficiencies, blood disorders (thrombocytopenia, idiopathic thrombocytopenic purpura, leukaemia), vasculitis, and infections.
• Clinically: note if clustered or disseminated, if discoloration remains on application of pressure.

Pruritus (Itchy Skin)

• Uncontrollable itching sensation.
• Associated with internal disorders (bile duct obstruction, cirrhosis, anaemia), nervous system disorders (diabetes, multiple sclerosis), and skin conditions (psoriasis, eczema).
• Other causes: medications (antifungals, narcotics, anticonvulsants, antibiotics).

Skin Pigmentation

• Skin discoloration (blotchy, darker, lighter).
• Associated with liver disease, skin cancer, chronic renal disease, vitiligo, albinism, Chediak-Higashi syndrome, and Hermansky-Pudlak syndrome.
• Clinically: inspect skin colour, texture, and tone.

Spider Naevus

• Small, central red spots with reddish extensions radiating outward (spider-like).
• Associated with liver disease, hormonal changes (oral contraceptives, pregnancy!), liver failure, liver cirrhosis.
• During examination, apply pressure to the center of the spot, observe if color changes.

Xanthomas

• Papules or nodules of skin or mucous membranes containing lipids.
• Associated with diabetes, liver disease, hyperlipidaemia (hypercholesterolaemia), hypothyroidism, late-stage kidney disease, HIV, and sarcoidosis.
• Clinically: observe for papules or nodules, presence on skin/tendons/fascia.

Explore the key physical signs associated with gastrointestinal conditions and understand the physiological mechanisms behind them. Learn to differentiate between objective signs and subjective symptoms, and familiarize yourself with examination techniques specific to GIT diseases. This quiz will enhance your knowledge of GIT examination practices.