TONGUE IN DISEASE DIAGNOSIS:
Introduction:
Tongue is a muscular organ associated with the function ofdeglutition,taste and speech.It acts as an easily accessible organ forthe assessment of health of an individual and shows the stateof hydration of the body.It is said that tongue is the mirror of thegastrointestinal system and any abnormal functioning of the stomach andintestines will be reflected on the tongue.
Some characteristic changes occur in the tongue in some particulardiseases.That is why the examination of the tongue is very essentialand will give some clues for diagnosis.All doctors examine the tongueand they consider the changes insize,shape,,colour,moisture,coating,nature of papillae and movementsect.
Appearance of tongue in some abnormal conditions:-
1) Movements of the tongue:-
a) In one sided paralysis of the body(hemiplegia)tongue moves towardsthe parylised side when protruded.
b) Tremulus movement of the tongue is seen in diseases likethyrotoxicosis,delirium tremens and parkinsonisum.Tremor is also seenin nervous patients.
c) In progressive bulbar palsy there will be wasting and paralysis ofthe tongue with fibrillation.Eventually the tongue gets shrivelled andlies functionless in the floor of the mouth.This condition isassociated with dribbling of saliva and loss of speech.
d) In chorea(involuntary rhythmic movements) the patient may not beable to keep the protruded tongue in rest,it will be movinginvoluntarily.
2) Moistness of the tongue:-
The moistness of the tongue gives some indication about the state ofhydration of the body.Water volume depletion leads to peripheralcirculatory failure characterised byweakness,thirst,restlessness,anorexia,nausea,vomiting ,dry and parchedtongue.
Dryness of the tongue is seen in following conditions.
a) Diarrhoea
b) Later stages of severe illness
c) Advanced uraemia
d) Hypovolumic shock
e) Heat exhaustion
f) Hyponatraemia
g) Acute intestinal obstruction
h) Starvation
i) Prlonged fasting.
3) Change in colour of tongue:-
a) Central cyanosis:-
Cyanosis is the bluish discolouration of the mucus membrane due todecrease in the amount of oxygen in the blood.This is seen in heartfailure,respiratory failure and in anoxia.In cyanosis tongue,lips ectbecomes pale bluish.
b) Jaundice:-
This is the yellowish discolouration of all mucus surfaces of the body(including tongue)due to increase of bilirubin in the blood.Jaundice isseen in hepatitis,bile duct obstruction,increased destruction of RBCsand ect...
c) Advanced uremia:-
This is the increase of urea and other nitrogenous waste products inthe 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 indiabetes mellitus.Here the tongue become brown with a typical ketonesmell from the mouth.
e) Riboflavin deficiency:-
Deficiency of this vitamin (vitamin B2) produces megenta colour of thetongue with soreness and fissures oflips.
f) Niacin deficiency:-
Deficiency of niacin (vitamin B3)and some other B complex vitaminsresults in bright scarlet or beefy red tongue.
g) Anaemia:-
It is the decrease in haemoglobin percentage of the blood.In severeanaemia 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 inthe production of offenssive gases.Those who complain about bad breathmay 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 thebody.On the tongue there will be sloughing white lesions.
d) In diabetes and hypoadrenalism there will be sloughing whitelesions.
e) Secondary syphilis:-
Syphilis is a sexually transmitted diseased caused by trepenomapallidum infection.In secondary stage of this disease we can see mucouspatches which are painless,smooth white glystening opalescent plaqueswhich can not be scraped off easily.
f) Leokoplakia:-
Here white keratotic patches are seen on the tongue and oralcavity.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 abdominalcavity which also covers the intestines and keep them in position) inthis 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 rongue associated with taste.Thereare different type of papillae on the healthy tongue.In some diseasesthere are some abnormal changes which are following.
a) Hairy tongue:-
This condition is due to elongation of filiform papillae seen in poororal hygeine ,general debility and indigestion.
b) Geographic tongue:-
Here irregular red and white patches appear on the tongue.These lesionslooks 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 midline 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 byatrophy.
e) Benign migratory glossitis:-
It is an inflamatory condition of the tongue where multiple annularareas of desquamation of papillae appear on the tongue which shift fromarea to area in few days.
f) Thiamine and riboflavin deficiency:-
Deficiency of these vitamins cause hypertrophied filiform and fungiformpapillae.
g) Niacin and iron deficiency:-
In this condition there is atrophy of papillae.Smooth tongue isencountered 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 peripheralneuropathy is encountered.
l) Scarlet fever;-
In this streptococcal infection there is bright red papillae standingout of a thick white fur ,later the white coat disappear leavingenlarged papillae on the bright red surface and is called strawberrytongue.
6) Ulcers on the tongue:--
a) Apthous ulcer:-
These are round painful ulcers appear in stressed individualsfrequently. May be associated with food allergy.Usual sites aretongue,lips,oral mucosa and ect.
b) Herpes simplex:-
It is an acute vesicular eruptions produced by herpes simplexvirus.When these vesicles rupture it forms ulcers.
c) Ulcer in cancer:-
Cancerous ulcers are having everted edges with hard base.Bleeding isalso seen.Cancer of the tongue is common in tobacco chewers.
d) Syphilitic ulcers:-
Syphilitic fissures are longitudinal in direction.In primary syphilisextra genital chancre is seen on the tongue.In secondary syphilismultiple shallow ulcers are seen on the under surface and sides of thetongue.In tertiary syphilis gumma may be seen on the midline of thedorsum of the tongue.
e) Dental ulcers:-
These ulcers are produced by sharp edges of carious teeth.
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