Friday, February 17, 2012

CLINCAL DIAGNOSIS OF TONGUE AND OESOPHAGUS



     


                                                                 Mouth

Thirst, dryness , increased salivation, disorder of taste, difffiucult of speech, swallowing, pain

Thirst & dryness:

Dryness  due to cellular dehyration , excessive water loss.

1.      Increased consumption of salt

2.      Severe diarrhea

3.      Polyuria – diabetes

4.      Renal failure

5.      Increased sweating

6.      Fear

7.      Mouth breathing in nasal obstruction

8.      Mumps, sjorgens syndrome, salaivary calculi ( salivary gland disease)

Increased salivation

1.      Lesions of bucall mucosa – stomatis, teething infants

2.      Parkinsonism

3.      Anxiety

4.      Oesophageal obstruction

Disorders of taste

Taste – sweet, bitter, sour and salt

1.      7th , 9th and 5th cranial nerve lesion

2.      Anorexia nervosa

Difficult in speech , chewing, swallowing:

1.      Diminished salivary secretion

2.      Inadequate teething

3.      Ill fitting denture

4.      Painful condition of mouth

Soreness & pain in mouth:

1.      Stomatitis

2.      Hot or acid food swallowing

3.      Tooth ache

4.      Dental caries

5.      Peridontial abcess

SIGNS OF MOUTH

Teeth :

1.      Caries teeth and deficent teeth causes dyspesia by inadequate chewing.

2.      Hutchinson teeth ( notched incisor)  seen in congential syphilis

3.      Discoloration of teeth by poor and dental hygiene, - by pan masal, betalnut chewing, smoking, improper brushing

4.      Fluorine water content

5.      Pink fluorescence teeth in congenital porphyria

Gums :

1.      Deep red of the gums and bleeding –  gingivitis

2.      Greenish yellow exudates –gingivitisOral sepsis causes bacterial endocarditis or lung abcess

3.      Pale gums seen in anemia

4.      Blue lining seen in lead poisoning

5.      Yellow lining seen in cadmium sulphide

6.      Gums soft, spongy and bleeds easily in scurvy – vitamin c deficiency

7.      Ulceration and sloughing of gingival(gums) with excessive salivation – vincent’s angina

8.      Hypertrophy of gums seen in epileptics taking phenytoin medicine for prolonged period.

Tongue :

1.      Dryness of tongue seen in severe dehydration

2.      Paleness of tongue seen in anemia

3.      Bluish discoloration seen in central cyanosis

4.      Depapiliated tongue seen in pernicious anemia and iron deficiency anemia

5.      Ventral aspect of tongue should be inspected for hemorrhage, neoplastic ulcer and leukoplakia

6.      Large tongue seen in acromegaly and down’s syndrome

7.      Small ulcer of tongue are seen in stomatitis

8.      Sever ulcers of tongue are seen in malignancy and syphilis

9.      Brownish pigment are seen on tongue in addisions disease

Breath :

1.      Offensive fecal odor of mouth due to putrefaction of food fragments retained in teeth and proliferation of organism in tonsils and gums

Foul smell :

1.      Gastric carcinoma

2.      Intestinal obstruction

3.      Bronchiectasis

4.      Lung abcess

Sweet smell:

1.      Acetone- acidosis

2.      Urine smell – hepatic coma

Stomatitis

1.      Exudates, ulceration with increase salivation

2.      Mechanical or traumatic cause – jagged teeth and ill fitting teeth dentures

3.      Leukemia, uremia  .

4.      Apthous ulcers seen commonly in chron’s disease

5.      Angular stomatitis seen commonly in nutritional deficiency of vitamin B.



                                                        OESOPHAGUS

Symptoms : Dysphagia, pain, regurgitation, hemorrhage.

DYSPHAGIA :

Due to poor salivation, paresis of tongue.

High :

1.      Pharynx or oesophagus carcinoma

2.      Cerical tumor – lymphnodes or goiter

3.      Neuromuscular disease – bulbar palsy, myasthenia gravis, psychogenic causes

4.      Oesophageal diverticulum

Middle

1.      Oesophagus carcinoma

2.      Mediastinal tumor

Low

1.      Peptic stricture

2.      Achalsia cardia

PAIN:

1.      Pain in the oesophagus is due to muscular contraction by the obstruction not by the spasm of the oesophagus.

2.      Pain occurs immediately after swallowing can be eased by regurgitation of food( cardiac pain not eased by regurgitation or by exertion)

3.      Persistent pain may be due to rupture or perforation of oesophagus.

4.      Lower sternal pain are increased by stooping and relived by antacids are due to oesophagitis due to acid reflux from stomach.

HEMORRHAGE:

1.      Haematemesis, malena,anemia

2.      Haematemeis are due to peptic oesophagitis, oesophageal varices and 2nd degree portal hypertension

3.      Dark blood are unaltered by the  gastric acids due to varices rupture

4.      Fresh blood are due to traumatic tear at gastro oesphagus junction ( Mallory wisken tear)



Signs:

CARCINOMA OF OESOPHAGUS :

1.      Progressive dyshpagia ( initially the solid substance are difficult to swallow, by contstant chewing the liquid substance can be swallowed, but the day passes, the liquid foods are not able to swallow in ca oesophagus)

2.      Regurgitation of food

3.      Sometimes associated with tylosis ( it s rare hereditary condition – thickening of skin of soles and feet, hand)



ACHALISIA CARDIA

1.      Failure of lower oesophagus to relax

2.      Non – coordinated peristaltic wave

3.      Degeneration of auerbachs plexus



PERFORATION AND RUPTURE

1.      Its surgical emergencies

2.      Mimics  like MI

3.      After the meal containing the sharp bones ( fish, chicken, pork, mutton)

4.      Alcohol and forceful vomiting



REFLUX OESOPHAGITIS

1.      Pregnancy

2.      Obesity

3.      Increase intra abdominal pressure

4.      Barrets oesophagus



INVESTIGATION

The disorders of the oesophagus can be best diagnosed by BariumSulphate  x – rays