Inspect the Facies

Are the eyes sunken? Is temporal wasting present? These signs indicate wasting and poor nutrition.

The skin around the mouth and oral mucosa may provide evidence of gastrointestinal disorders. Melanin deposition around and in the oral cavity, especially the buccal mucosa,

Figure 17-7 Lindsay's nails.

Figure 17-7 Lindsay's nails.

Lindsay Nails

Figure 17-8 Osler-Weber-Rendu syndrome.

Figure 17-8 Osler-Weber-Rendu syndrome.

v- T- p suggests Peutz-Jeghers syndrome. Figure 12-12 shows the lips of a patient with the classic brown pigmentary changes of Peutz-Jeghers syndrome. This is an autosomal dominant disorder characterized by generalized gastrointestinal, hamartomatous polyposis, and mucocutaneous pigmentation. The benign polyps are most common in the jejunum and only rarely become malignant. The polyps, however, may bleed, cause intussusception, or cause obstruction. Telangiectases of the lips and tongue are suggestive of Osler-Weber-Rendu syndrome (see Fig. 12-11), in which multiple telangiectases are present throughout the gastrointestinal tract. These lesions may bleed insidiously, causing anemia. The classic oral lesions of a patient with Osler-Weber-Rendu syndrome are shown in Figure 17-8.

Hypercortisolism, or Cushing's syndrome, has a range of clinical manifestations. The most common are obesity, facial plethora, hirsutism, and hypertension. Obesity occurs in 90% of affected patients. Most patients with hypercortisolism characteristically have round, puffy, red faces called moon facies. They also have prominent fat deposits in the supraclavicular and retrocervical areas (buffalo hump). Figure 17-9 shows a patient with Cushing's syndrome and the typical moon facies.

Moon Facies
Figure 17-9 Cushing's syndrome.

Figure 17-10 Ascites.

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