TONGUE IN DISEASE DIAGNOSIS

Introduction:

The tongue is a muscular structure that plays a crucial role in swallowing, taste perception, and articulation. It serves as a readily observable indicator of a person's health and can reveal information about the body's hydration levels. Often referred to as a reflection of the gastrointestinal system, any irregularities in the functioning of the stomach and intestines are likely to manifest on the tongue.

 

Certain distinctive alterations can manifest on the tongue in specific diseases. Consequently, a thorough examination of the tongue is crucial, as it can provide valuable diagnostic insights. Physicians routinely assess the tongue, taking into account variations in size, shape, color, moisture, coating, the characteristics of the papillae, and mobility, among other factors.

Appearance of tongue in some abnormal conditions:-

1) Tongue movements:-

A) In cases of hemiplegia, where one side of the body is paralyzed, the tongue tends to deviate towards the affected side when extended.

 

B) Tremulous movement of the tongue can be observed in conditions such as thyrotoxicosis, delirium tremens, and parkinsonism. Additionally, tremors may occur in individuals experiencing nervousness.

 

C) In progressive bulbar palsy, the tongue experiences atrophy and paralysis accompanied by fibrillation. Over time, the tongue becomes shriveled and rests motionless on the floor of the mouth. This condition is characterized by excessive salivation and a decline in the ability to speak.

 

D) In cases of chorea, characterized by involuntary rhythmic movements, the patient may find it difficult to maintain the tongue in a protruded position, resulting in involuntary movements.

 

2) Humidity of the tongue:-

The moisture level of the tongue can provide insight into the body's hydration status. A decrease in water volume can result in peripheral circulatory failure, which is marked by symptoms such as weakness, thirst, restlessness, loss of appetite, nausea, vomiting, and a dry tongue.

The following conditions are associated with a dry tongue.

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 refers to the bluish tint observed in the mucous membranes, resulting from a reduced level of oxygen in the bloodstream. This condition is commonly associated with heart failure, respiratory failure, and anoxia. In cases of cyanosis, areas such as the tongue and lips may appear pale and bluish in color.

 

b) Jaundice:-

Jaundice is characterized by a yellowish tint affecting all mucous membranes of the body, including the tongue, resulting from elevated bilirubin levels in the bloodstream. This condition can occur in various medical situations, such as hepatitis, bile duct obstruction, and increased breakdown of red blood cells.

 

c) Advanced uremia:-

This condition refers to the elevated levels of urea and other nitrogenous waste substances in the bloodstream resulting from kidney failure. In this scenario, the tongue may appear brown.

 

d) Keto acidosis:-

This condition involves acidosis characterized by the buildup of ketone bodies, primarily observed in diabetes mellitus. In this scenario, the tongue may appear brown, accompanied by a distinctive ketone odor emanating from the mouth.

 

e) Riboflavin deficiency:-

A lack of vitamin B2 results in a magenta-colored tongue, accompanied by soreness and cracks in the lips.

 

f) Niacin deficiency:-

A lack of niacin (vitamin B3) and certain other B complex vitamins can lead to a tongue that appears bright scarlet or beefy red.

 

 

g) Anaemia:-

The reduction in the percentage of hemoglobin in the blood is referred to as anemia. In cases of severe anemia, the tongue may appear pale.

 

 

4) Coating on the tongue:-

a) Bad breath:-

The primary reason for halitosis is the development of a thick biofilm on the tongue, which harbors numerous anaerobic bacteria that generate unpleasant odors. Individuals experiencing bad breath often exhibit a substantial coating on the back of their tongues.

 

b) Typhoid fever:-

In cases of typhoid fever, the tongue develops a white, fur-like coating.

 

c) Candidiasis:-

It is a fungal infection that impacts the mucous membranes of the body. The tongue may exhibit white lesions that appear as sloughing patches.

 

b) In cases of diabetes and hypoadrenalism, one may observe the presence of sloughing white lesions.

 

e) Secondary syphilis:-

Syphilis is a sexually transmitted infection resulting from an infection with Treponema pallidum. During the secondary stage of this condition, one may observe mucous membrane lesions characterized by painless, smooth, white, glistening opalescent plaques that are difficult to remove.

 

f) Leokoplakia:-

White keratotic lesions are observed on the tongue and within the oral cavity, indicating a precancerous state.

 

g) AIDS:-

In these individuals, hairy leukoplakia is observed.

 

h) Peritonitis:-

Peritonitis refers to the inflammation of the peritoneum, the inner lining of the abdominal cavity that envelops the intestines and maintains their position. In this condition, individuals may exhibit a white coating on the tongue.

 

i) Acute illness:-

Furring can also be observed in certain acute illnesses.

 

5) Papillae:-

Small projections on the tongue, known as papillae, play a crucial role in the sense of taste. A healthy tongue features various types of papillae. However, certain diseases can lead to abnormal changes in these structures.

a) Hairy tongue:-

This condition arises from the elongation of filiform papillae, which is often associated with inadequate oral hygiene, overall weakness, and digestive issues.

b) Geographic tongue:-

Irregular red and white patches can be observed on the tongue, resembling a geographic map. The precise cause of these lesions remains unidentified.

c) Median rhomboid glossitis:-

A smooth, nodular red region is observed along the posterior midline of the tongue in this condition. It is classified as a congenital anomaly.

d) Nutritional deficiency:-

Nutritional deficiencies can result in glossitis, which is the inflammation of the tongue. This condition may lead to papillary hypertrophy, eventually followed by atrophy.

e) Benign migratory glossitis:-

It is a condition characterized by inflammation of the tongue, marked by the presence of several ring-shaped patches where the papillae have shed. These areas can change location over the course of a few days.

f) Thiamine and riboflavin deficiency:-

A lack of these vitamins leads to the enlargement of filiform and fungiform papillae.

g) Niacin and iron deficiency:-

In this condition, there is a reduction in the size of the papillae. A smooth tongue is commonly observed in cases of iron deficiency.

 

h) Vitamin A deficiency:-

 

This results in a wrinkled tongue.

 

i) In nutritional megaloblastic anemia, the tongue often appears smooth.

 

j) Folic acid deficiency:-

 

Macrocytic megaloblastic anemia accompanied by glossitis is observed.

 

k) Cyano coblamine deficiency:-

 

This case presents glossitis associated with macrocytic megaloblastic anemia and peripheral neuropathy.

l) Scarlet fever:-

 

In this case of streptococcal infection, prominent red papillae emerge from a thick white coating. Subsequently, the white layer fades, revealing enlarged papillae against a vivid red background, a condition commonly referred to as strawberry tongue.

 

6) Ulcers on the tongue:-

a) Apthous ulcer:-

These are circular, painful sores that often occur in individuals experiencing stress. They may be linked to food allergies and typically manifest on the tongue, lips, and oral mucosa, among other areas.

b) Herpes simplex:-

It is a sudden outbreak of vesicles caused by the herpes simplex virus. When these vesicles break open, they develop into ulcers.

c) Ulcer in cancer:-

Cancerous ulcers exhibit raised edges and firm bases, often accompanied by bleeding. Tongue cancer is frequently observed among individuals who chew tobacco.

d) Syphilitic ulcers:-

Syphilitic fissures exhibit a longitudinal orientation. In the primary stage of syphilis, an extragenital chancre can be observed on the tongue. During the secondary stage, numerous shallow ulcers appear on the underside and lateral aspects of the tongue. In the tertiary stage, gummas may be present along the midline of the tongue's dorsum.

e) Dental ulcers:-

These ulcers are caused by the jagged edges of decayed teeth.