Львівський клінічний вісник (Sep 2013)
Visual Signs of Chronic Diffuse Liver Diseases: the Stigma of Skin, its Appendages and Mucous Membranes
Abstract
Introduction. The condition of the skin has always been a reflection of the state of the internal organs, in particular, organs of the gastrointestinal system, liver. Most skin symptoms are not specific to the hepatobiliary system, and therefore can be observed in other diseases. However, often the presence of skin stigma and patient complaints can be very helpful in verifying the diagnosis. According to the results of research in the world, palmar erythema occurs in 23.0%, telangiectasias (vascular “spiders”) – in 33.0%, and the triad of symptoms – palmar erythema, telangiectasias and white nails – in 21.0% of the patients with the liver cirrhosis. Despite all the importance, the topic is not sufficiently covered in the medical literature. Aim. Comprehensively describe stigmata of the skin, its appendages and mucous membranes in patients with chronic digguse liver diseases (CDLD). Materials and methods. The results of complex clinical-laboratory and instrumental examination of 2 007 patients with CDLD that were treated during the period of 2005-2013 in the Lviv Regional Hepatologic Center, which was created on the basis of the Department of Internal Medicine N 1 of the Danylo Halytsky Lviv National Medical University and the Gastroenterological Department of the Lviv Regional Clinical Hospital are presented. Among these patients there were 1 508 men (75.1%) and 499 women (24.9%) at the age of 47.9 ± 0.2 years. Before the start of treatment in a hospital, they were examined (according to the order of the Ministry of Health of Ukraine N 271 dated 13.06.05 “On Approval of Protocols of the Providing of Medical Care on the Specialty “Gastroenterology”), on the basis of the results of which the clinical diagnoses were set. Results. Skin changes are often the first predictors of CDLD. For example, a combination of pigmentation, jaundice and xanotomy confirms the diagnosis of primary liver biliary cirrhosis. In the vast majority of patients with chronic liver diseases there are pathogenetically syntropical co- and polistigmata of the skin, which are of great diagnostic value. They allow an experienced doctor to suspect or to set the diagnosis before the special comprehensive examination and to determine the tactics of treatment. The most widespread disorders found in the cirrhotic patients were dyschromia, in particular, jaundice, spider nevi, palmar erythema, «cardinal» tongue, «paper-money» skin, «caput medusae», «lacquer» nails. Conclusions. Chronic diffuse liver diseases are mainly accompanied by the pathogenic syntropic skin, its appendages and mucous membranes lesions, which are of important diagnostic value and help the experienced physician suspect or set the diagnose before a special comprehensive examination, choose the treatment tactics before the getting the results of this examination.
Keywords
