Skin |
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Jaundice |
Yellow discolouration of the skin, sclera and lingual frenulum associated with dark brown urine |
Impaired bilirubin metabolism; prehepatic, hepatic or posthepatic |
Pyoderma gangrenosum |
Ulcerative cutaneous lesion usually found on the skin of the legs and associated with systemic diseases |
Associated with inflammatory bowel disease, and more rarely with primary biliary cirrhosis and hepatitis |
Erythema nodosum |
Tender nodular erythema affecting the skin on the anterior aspect of the lower limbs (hypersensitivity reaction) |
Associated with inflammatory bowel disease, lymphoma, sarcoidosis, TB and streptococcal infections |
Spider naevi (naevi aranei) |
Small, blanching vascular lesion with a central arteriole surrounded by radially placed thin capillaries resembling a spider; usually found above the nipples |
Chronic liver disease, thyrotoxicosis, oestrogen therapy |
Hands |
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Clubbing |
Loss of Lovibond’s angle (angle between distal phalanx and nail bed); Schamroth’s sign (loss of diamond-shaped space between two opposed fingernails); bulbous or drumstick appearance of terminal parts of the fingers |
See Differential diagnoses |
Splinter haemorrhages |
Longitudinal extravasation of blood in the nail bed |
Bacterial endocarditis, mitral stenosis |
Koilonychia |
Spoon-shaped nails |
Iron deficiency anaemia |
Leukonychia |
White discolouration or spots of the nails |
Hypoalbuminaemia (chronic liver or renal disease), lymphoma |
Palmar erythema |
Red palms secondary to increased levels of oestrogen and angiogenic factors |
Chronic liver disease, metastatic cancer, oestrogen therapy, pregnancy, thyrotoxicosis, polycythaemia, idiopathic |
Beau lines |
Arrested nail growth causing transverse nail depression |
Severe systemic disease, sepsis or malnutrition |
Asterixis |
Coarse tremor of the wrists at rest (‘liver flap’) |
Decompensated chronic liver disease/encephalopathy |
Eyes |
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Xanthelasma |
Yellow plaques on the inner canthus of the upper eyelid |
Hyperlipidaemia |
Xanthoma |
Cutaneous lipid plaques (called xanthelasmas if found in the periorbital region) |
Hyperlipidaemia |
Corneal arcus |
White rim of opacity around the border of the cornea; in the elderly it’s known as arcus senilis and may be idiopathic |
Abnormal lipid metabolism, e.g. hypercholesterolaemia |
Mouth |
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Perioral telangiectasia |
Perioral melanin deposits causing pigmentation |
Peutz–Jeghers syndrome: associated with multiple hamartomatous polyps in the GI tract; increased risk of GI cancer; cutaneous melanin deposits also seen at other sites |
Angular stomatitis |
Cracked mouth corners |
Iron deficiency anaemia |
Glossitis |
Inflamed, smooth and erythematous tongue due to depapillation |
Iron deficiency anaemia, vitamin B deficiencies, infections |
