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Gastro Exam

The Tongue

November 26th, 2019

Common Signs on the Tongue

Dry TongueDehydration
Microglossia: small tonguePseudobulbar palsy
Macroglossia: large tongueDown syndrome, acromegaly, amyloidosis, sarcoidosis
Smooth tongue (atrophic glossitis): loss of the normal texture of the tongue.Use of dentures, iron / folate / B12 deficiency, low oestrogen
Fissured tongue - deep grooves, especially on the edges of the tongueAcromegaly, psoriasis, Sjogren's
Geographic tongue (benign migratory glossitis): painless discoloured patches with a punched-out appearance, that may resolve and reappear in a new configuration.Benign - 2% of the population
Tongue mass - note the size, shape, consistency and colourTraumatic fibroma, SCC, papilloma
Thrush - painless white plaques that are easily scraped offCandida infection
Leukoplakia: white patches that don't scrape off.Premalignant, or EBV infection in HIV patients
Black hairy tongueAspergillosis

Tongue Ulcers

  • Look For

  • Ulcers on the tongue, noting their number, size, colour and distribution.
  • Causes of Tongue Ulcers

  • Trauma - mechanical / chemical / radiation
  • Aphthous stomatitis
  • Dermatoses - pemphigus, lichen planus, erythema multiforme
  • Infection - herpes simplex (cold sore), coxsackie (hand, foot and mouth), syphilis, bacterial, candidiasis
  • Rheumatological - SLE, Reiter's syndrome
  • GIT - Crohn's disease, coeliac disease
  • Drugs - antineoplastics
  • Malignancy
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