1. PROFESSOR M. YOUSRY ABDEL-MAWLA,MD Skin manifestations of some gastrointestinal disorders

27. Inflammatory bowel diseases Inflammatory disorders of the bowel discussed here include ulcerative colitis (UC), Crohn's disease, and bowel bypass syndrome Both UC and Crohn's disease (the traditional inflammatory bowel diseases [IBD]) can present with abdominal pain, GI bleeding, or diarrhea. Bowel bypass syndrome : a bacterial overgrowth in the blind loop associated with a dermatosis-arthritis syndrome

45. Cutaneous syndromes and the GI Tract Cutaneous syndromes associated with gastrointestinal diseases and malignancy Abbreviations : AD, autosomal dominant; BCC, basal cell carcinoma; GI, gastrointestinal; MEN, multiple endocrine neoplasia; MSH. Syndrome Inheritance Cutaneous findings Internal Associations With increased DEFECT risk of malignancy Gardner’s Syndrome AD Osteoma, desmoid Intestinal polyposis, (familial Chromosome 5 tumors epidermoid colon cancer, thyroid Polyposis cysts, dental cancers, retinal Syndrome) anomalies abnormalities

46. Syndrome Inheritance Cutaneous findings Internal Associations Cronkhite Acquired Alopecia, nail GI polyps, colon Canada dystrophy; macular carcinoma, diarrhea Syndrome hyperpigmentation abdominal pain Cowden’s AD Hamartomas of Hamartomas and disease Mutation PTEN mucous membranes malignancy of colon, (multiple Gene / facial breast, thyroid, Hamatoma chromosome tricholemmonas, renal and bladder Syndrome) 10 papillomas Palmar- colon polyps plantar keratoses, scrotal tongue Muir – Torre ADMutation in Sebaceous gland tumors, Nonpolyposis colon cancer BCC with sebaceous differentiation MSH2 gene on

47. Syndrome Inheritance Cutaneous findings Internal Associations Peutz – AD Periorifical and Hamartomas polyps Jeghers mucosal lentigines, throughout GI tract Syndrome pigmented maculae increased incidence hands and feet of malignancy throughout GI tract, ovarian tumors, pancreatic carcinoma gallbladder cancer, GI bleeding, pancreatic carcinoma

48. Cutaneous syndromes associated with gastrointestinal diseases and malignancy Syndrome Inheritance Cutaneous findings Internal Associations Howell- Palmer - plantar Esophageal carcinoma Evans’ hyperkeratosis syndrome Bazex’s Acquired Acrodermatitis, Esophageal, laryngeal, syndrome nail dystrophy tongue carcinoma MEN type I AD Multiple facial Pituitary, parathyroid, (Wermer’s Mutation in angiofibromas, pancreatic endocrine syndrome) MEN I gene collagenomas, abnormalities, peptic U on chromosome lipomas, confetti-like disease,Zollinger-Ellison 11 hypopigmented syndrome, gastronoma, macules insulinoma, carcinoid.

49. Syndrome Inheritance Cutaneous findings Internal Associations MEN IIA AD Amyloidosis Medullary thyroid ( Sipple’s Mutation in RET carcinoma, syndrome) gene on pheochromocytoma, chromosome 10 hyperparathyroidism, Zollinger – Ellison syndrome, Cushing’s syndrome, malignant melanoma, pitutary ad. MEN IIB AD Multiple mucosal Hirschprung’s disease, Mutation in RET neuromas, cervical medulloblasoma gene on marfinoid body increased risk of chromosome 10 habitus, nasal malignancy neuromas

59. Cutaneous syndromes associated with hemorrhage Cutaneous syndromes associated with gastrointestinal hemorrhage. Abbreviations: AD, autosomal dominant, AR, autosomal recessive; AV, arteriovenous; CNS, central nervous system; GI, gastrointestinal; GIT, gastrointestinal tract; SQ, subcutaneous. Syndrome Inheritance Cutaneous findings Internal Associations Hereditary AD Telangiectasia of skin, GI hemorrhage,epistaxis hemorrhagic oral mucosa arterial aneurysms; AV telangiectasia malformations in liver, lung, eye. Blue rubber bleb AD Compressable SQ GI vascular malformations news syndrome hemangiomas GI hemorrhage Kaposi’s sarcoma Violaceous papules, GI lesions, hemorrhage nodules Necrotizing angiitis Palpable purpura GI bleeding, perforation, ischemia

60. Syndrome Inheritance Cutaneous findings Internal Associations Henoch – Palpable purpura Abdominal cramping Sch öenlein and pain, hmaturia, purpura glomerulonephritis Degos’ disease atrophic Erythematous Vasculitis of GIT, papules infarction, bleeding, CNS infarcts Ehler’s – Danlos AD, AR Easy bruising, thin Arterial rupture, GI syndrome type IV translucent skin hemorrhage, uterine rupture Pseudoxanthoma AD, AR Waxy yellow papules, GI hemorrhage, Angioid elasticum flexural areas, streaks in eyes, elastosis perforans coronary heart disease, serpiginosa vascular calcification