The Importance Of The Tongue In Disease Diagnosis

Tongue is a muscular organ associated with the function of taste and speech.It acts as an easily accessible organ for the assessment of  health of an individual and shows the state of hydration of the body.

It is said that tongue is the mirror of the gastrointestinal system and any abnormal functioning of the stomach and intestines will be reflected on the tongue.

Some characteristic changes occur in the tongue in some particular diseases.That is why the examination of the tongue is very essential and will give some clues for diagnosis.All doctors examine the tongue and they consider the changes in size,shape,,colour,moisture,coating,nature of papillae and movements etc.

Appearance of tongue in some abnormal conditions:-

1) Movements of the tongue:-

a) In one sided paralysis of the body(hemiplegia)tongue moves towards the paralysed side when protruded.   

b) Tremulus movement of the tongue is seen in diseases like thyrotoxicosis,delirium tremens and parkinsonisum.Tremor is also seen in nervous patients.

c) In progressive bulbar palsy there will be wasting and paralysis of the tongue with fibrillation.Eventually the tongue gets shriveled and lies functionless in the floor of the mouth.This condition is associated with dribbling of saliva and loss of speech.

d) In chorea(involuntary rhythmic movements) the patient may not be able to keep the protruded tongue in rest,it will be moving involuntarily.

2) Moistness of the tongue:-

The moistness of the tongue gives some indication about the state of hydration of the body.
Water volume depletion leads to peripheral circulatory failure characterized by weakness,thirst,restlessness,anorexia,nausea,vomiting ,dry and parched tongue.

Dryness of the tongue is seen in following conditions.

a) Diarrhea
b) Later stages of severe illness
c) Advanced uraemia
d) Hypovolumic shock
e) Heat exhaustion
f) Hyponatraemia
g) Acute intestinal obstruction
h) Starvation
i) Prolonged fasting.

3) Change in colour of tongue:-

a) Central cyanosis:-

Cyanosis is the bluish discolouration of the mucus membrane due to decrease in the amount of oxygen in the blood.This is seen in heart failure,respiratory failure and in anoxia. In cyanosis tongue,lips becomes pale bluish.

b) Jaundice:-

This is the yellowish discoloration of all mucus surfaces of the body (including tongue)due to increase of bilirubin in the blood.Jaundice is seen in hepatitis,bile duct obstruction,increased destruction of RBCs and etc...

c) Advanced uremia:-

This is the increase of urea and other nitrogenous waste products in the blood due to kidney failure.Here the tongue become brown in colour.

d) Keto acidosis:-

This is the acidosis with accumulation of ketone bodies seen mainly in diabetes mellitus.Here the tongue become brown with a typical ketone smell from the mouth.

e) Riboflavin deficiency:-

Deficiency of this vitamin (vitamin B2) produces magenta color of the tongue with soreness and fissures of lips.     

f) Niacin deficiency:-

Deficiency of niacin (vitamin B3)and some other B complex vitamins results in bright scarlet or beefy red tongue.

g) Anemia:-

It is the decrease in hemoglobin percentage of the blood.In severe anemia tongue becomes pale.

4) Coating on the tongue:-

a) Bad breath:-

The main cause for bad breath is formation of a pasty coating(bio film) on the tongue which lodges thousands of anaerobic bacteria resulting in the production of offenssive gases.Those who complain about bad breath may have thick coating on the posterior part of the tongue.

b) Typhoid fever:-

In typhoid fever tongue becomes white coared like a fur.

c) Candidiasis;-

It is a fungal infection which affects the mucus surfaces of the body.On the tongue there will be sloughing white lesions.

d) In diabetes and hypoadrenalism there will be sloughing white lesions.

e) Secondary syphilis:-

Syphilis is a sexually transmitted diseased caused by trepenoma pallidum infection.In secondary stage of this disease we can see mucous patches which are painless,smooth white glystening opalescent plaques which can not be scraped off easily.

f) Leokoplakia:-

Here white keratotic patches are seen on the tongue and oral cavity.This is a precancerous condition.

g) AIDS:-

In these patients hairy leukoplakia is seen.

h) Peritonitis:-

It is the inflammation of the peritonium(inner covering of abdominal cavity which also covers the intestines and keep them in position) in this condition there is white furring of the tongue.

i) Acute illness:-

Furring is also seen in some acute diseases.

5) Papillae:-

These are small projections on the tongue associated with taste.There are different type of papillae on the healthy tongue.In some diseases there are some abnormal changes which are following.

a) Hairy tongue:-

This condition is due to elongation of filiform papillae seen in poor oral hygiene ,general debility and indigestion.

b) Geographic tongue:-

Here irregular red and white patches appear on the tongue.These lesions looks like a geographic map.The excact cause is not known.

c) Median rhomboid glossitis:-

In this condition there is smooth nodular red area in the posterior mid line of the tongue.This is a congenital condition.

d) Nutritional deficiency:-

In nutrional deficiency there is glossitis(inflammation of tongue) leading to papillary hypertrophy followed by atrophy.    

e) Benign migratory glossitis:-

It is an inflamatory condition of the tongue where multiple annular areas of desquamation of papillae appear on the tongue which shift from area to area in few days.

f) Thiamine and riboflavin deficiency:-

Deficiency of these vitamins cause hypertrophied filiform and fungiform papillae.

g) Niacin and iron deficiency:-

In this condition there is atrophy of papillae.Smooth tongue is encountered in iron deficiency.

h) Vitamin A deficiency:-

This causes furrowed tongue.

i) In nutritional megaloblastic anaemia tongue becomes smooth.

j) Folic acid deficiency:-

Here macrocytic megaloblastic anaemia with glossitis is seen.

k) Cyano coblamine deficiency:-

Here glossitis with macrocytic megaloblastic anaemia and peripheral neuropathy is encountered.  

l) Scarlet fever;-

In this streptococcal infection there is bright red papillae standing out of a thick white fur ,later the white coat disappear leaving enlarged papillae on the bright red surface and is called strawberry tongue. 

6) Ulcers on the tongue:--

a) Apthous ulcer:-

These are round painful ulcers appear in stressed individuals frequently. May be associated with food allergy.Usual sites are tongue,lips,oral mucosa e.t.c

b) Herpes simplex:-

It is an acute vesicular eruptions produced by herpes simplex virus.When these vesicles rupture it forms ulcers.

c) Ulcer in cancer:-

Cancerous ulcers are having everted edges with hard base.Bleeding is also seen.Cancer of the tongue is common in tobacco chewers.

d) Syphilitic ulcers:-

Syphilitic fissures are longitudinal in direction.In primary syphilis extra genital chancre is seen on the tongue.In secondary syphilis multiple shallow ulcers are seen on the under surface and sides of the tongue.In tertiary syphilis gumma may be seen on the midline of the dorsum of the tongue.

e) Dental ulcers:-
These ulcers are produced by sharp edges of carious teeth.

5 Importance Of Nails In Health And Disease Diagnosis

The nails are present at the end of each finger tip on the dorsal surface.

The main function of nail is protection and it also helps for a firm grip for holding articles.It consists of a strong relatively flexible keratinous nail plate originating from the nail matrix.

Under the nail plate there is a soft tissue called nail bed.Between the skin and nail plate there is a nail fold or cuticle.

Normal healthy nail is slight pink in colour and the surface is convex from side to side.Finger nails grow 1 cm in three months and toe nails take 24 months for the same.

Importance of nails in disease diagnosis:

The colour ,appearance,shape and nature of the nails give some information about the general health and hygiene of a person .

Nails are examined as a routine by all doctors to get some clues about underlying diseases.Just looking at nails we can make out the hygiene of a person.

The abnormal nail may be congenital or due to some diseases.The cause for changes in the nail extend from simple reasons to life threatening diseases.Hence the examination by a doctor is essential for diagnosis .Some abnormal findings with probable causes are discussed here for general awareness.

1) Hygiene:- We can make out an unhygienic nail very easily .Deposition of dirt under the distal end of nail plate can make a chance for ingestion of pathogens while eating.If nail cutting is not done properly it can result in worm troubles in children.

When the worms crawl in the anal orifice children will scratch which lodges the ova of worms under the nails and will be taken in while eating.Prominent nail can also complicate a skin disease by habitual scratching.Sharp nails in small kids cause small wounds when they do feet kicking or hand waving.

2) Colour of the nails:-

a) Nails become pale in anaemia.

b) Opaque white discolouration(leuconychia) is seen in chronic renal failure and nephrotic syndrome.

c) Whitening is also seen in hypoalbuminaemia as in cirrhosis and kidney disorders.
                              
d) Drugs like sulpha group,anti malarial and antibiotics ect can produce discolouration in the nails.
                       
e) Fungal infection causes black discolouration.

f) In pseudomonas infection nails become black or green.

g) Nail bed infarction occures in vasculitis especially in SLE and polyarteritis.

h) Red dots are seen in nails due to splinter haemorrhages in subacute bacterial endo carditis, rheumatoid arthritis, trauma, collagen vascular diseases.

i) Blunt injury produces haemorrhage and causes blue/black discolouration.

j) Nails become brown in kidney diseases and in decreased adrenal activity.

k) In wilsons disease blue colour in semicircle appears in the nail.

l) When the blood supply decreases nail become yellow .In jaundice and psoriasis also nail become yellowish.

m) In yellow nail syndrome all nails become yellowish with pleural effusion.

3) Shape of nails:-

a) Clubbing: Here tissues at the base of nails are thickened and the angle between the nail base and the skin is obliterated.

The nail becomes more convex and the finger tip becomes bulbous and looks like an end of a drumstick. When the condition becomes worse the nail looks like a parrot beak.

Causes of clubbing:-

Congenital Injuries

Severe chronic cyanosis

Lung diseases like empyema,bronchiactesis,carcinoma of bronchus and pulmonary tuberculosis.
Abdominal diseases like crohn's disease,polyposis of colon,ulcerative colitis,liver cirrhosis ect...

Heart diseases like fallot's tetralogy,subacute bacterial endocarditis and ect..
             
b) Koilonychia:-

Here the nails become concave like a spoon.This condition is seen in iron deficiency anaemia.In this condition the nails become thin,soft and brittle.The normal convexity will be replaced by concavity.

c) Longitudinal ridging is seen in raynaud's disease.

d) Cuticle becomes ragged in dermatomyositis.

e) Nail fold telangiectasia is a sign in dermatomyositis ,systemic sclerosis and SLE.

4) Structure and consistancy:-

a) Fungal infection of nail causes discolouration,deformity,hypertrophy and abnormal brittleness.

b) Thimble pitting of nail is characteristic of psoriasis ,acute eczema and alopecia aereata.
  
c) The inflammation of cuticle or nail fold is called paronychia.

d) Onycholysis is the seperation of nail bed seen in psoriasis,infection and after taking tetracyclines.

e) Destruction of nail is seen in lichen planus,epidermolysis bullosa.

f) Missing nail is seen in nail patella syndrome.It is a hereditary disease.

g) Nails become brittle in raynauds disease and gangrene.

h) Falling of nail is seen in fungal infection,psoriasis and thyroid diseases.

5) Growth:- Reduction in blood supply affects the growth of nails. Nail growth is also affected in severe illness. when the disease disappears the growth starts again resulting in formation of transverse ridges.

These lines are called Beau's lines and are helpful to date the onset of illness.

Some Causes Of Low Back Pain

Low back pain is a usual symptom among the modern civilized people.It affects mainly the middle aged and young adults of both sexes.People who work on the chair with out exercise and those who carry heavy loads regularly are prone to get this complaint.

We can hardly find a person who has not suffered from back pain at least once in life.The causes of  low backpain ranges from simple reasons like muscular strain to cancer of spine and hence backache should not be ignored.The pain is felt in lumbar and sacral region and may radiate to nearby sites.

The following are some causes for backache.

1) Backache due to diseases in the back.

2) Backache due to gynaecological problems.

3) Backache due to problems in other parts of the body.

1) Backache due to diseases in the back:--
                            
a) Injuries :-

     1) Compression fracture of the vertebral column.
     2) Rupture of intervertebral discs.
     3) Injuries to ligaments and muscles of back.
     4) Lumbosacral strain.
     5) Intervertebral joint injuries. 
     6) Fracture of processes of vertebra.

b) Functional backache due to imbalance:-

     1) During pregnancy.
     2) Pot belly.
     3) Diseases of the hip joint.
     4) Curvature in the spine due to congenital defect.
     5) Short leg in one side.
 
c) Backache due to inflammatory conditions:-

     1) Infection of the bone due to bacteria.
     2) Tuberculosis of the spine.
     3) Arthritis.
     4) Brucellosis.
     5) Lumbago or fibrositis.
     6) Inflamation of the muscles.
     7) Anchylosing spondylitis.

d) Backache due to degenerative diseases in the back.

     1) Osteoarthritis.
     2) Osteoporosis in old people.
     3) Degenaration of the intervertebral disc.

e) Tumour in the spine:--

     1) Primory tumour of the bones in the spine.
     2) Metastatic tumours from other sites like prostate,lungs,kidneys,intestine ect.

2) Backache due to gynaecological problems:-

     a) After childbirth.
     b) After gynaecological operations.
     c) Prolapse of the uterus.
     d) Pelvic inflammatory diseases.
     e) Cancerous lesions of the pelvic organs.
     f) Endometriosis.

3) Backache due to problems in other parts of the body.

     a) Renal stones.
     b) Ureteric stone.
     c) Cancer of prostate.
     d) Pancreatitis.
     e) Biliary stones.
     f) Peptic ulcer.
     g) Inflammations of pelvic organs.
     h) Occlusion of aorta and illiac arteries.

Investigation of a case of backache:-

1) Complete blood count.

2) Routine urine examination.

3) Ultrasonography of the abdomen and pelvis.

4) X-ray of the lumbar and sacral region.

5) MRI of the spine.

5) CT scan of abdomen and pelvic region.

6) Examination of rectum,prostate,genito urinary organs.


Treatment of back ache:-

1) Removing the cause for backache.

2) Symptomatic treatment.

2) Back exercises.

3) Traction.

3) Yoga.

5) Surgery.

7) Homoeopathy.