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| {{Dysphagia}} | | {{Dysphagia}} |
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| | {{CMG}}; {{AE}}{{FT}}{{KS}} |
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| {{CMG}}; {{AE}} {{FK}} {{KS}}
| | ==Overview== |
| | Dysphagia can be caused by many diseases such as neurological disorders, structural disorders of esophagus, tumors and motor disorders. |
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| ==Overview==
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| Life threatening causes of dysphagia include [[lead poisoning]], [[rabies]], and [[stroke]]. Other common causes of dysphagia include [[Esophageal food bolus obstruction|food impaction]], [[gastroesophageal reflux]], and [[pharyngitis]].
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| ==Causes== | | ==Causes== |
| ===Life Threatening Causes=== | | Depending upon the type of dysphagia, causes can be categorized into two subsections.<ref name="pmid23943072">{{cite journal| author=Starmer HM, Riley LH, Hillel AT, Akst LM, Best SR, Gourin CG| title=Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery. | journal=Dysphagia | year= 2014 | volume= 29 | issue= 1 | pages= 68-77 | pmid=23943072 | doi=10.1007/s00455-013-9482-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23943072 }} </ref><ref name="pmid27840183">{{cite journal| author=Inayat F, Hussain Q, Shafique K| title=Dysphagia Caused by Extrinsic Esophageal Compression From Mediastinal Lymphadenopathy in Patients With Sarcoidosis. | journal=Clin Gastroenterol Hepatol | year= 2017 | volume= 15 | issue= 7 | pages= e119-e120 | pmid=27840183 | doi=10.1016/j.cgh.2016.11.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27840183 }} </ref><ref name="pmid16187198">{{cite journal| author=Oda K, Iwakiri R, Hara M, Watanabe K, Danjo A, Shimoda R et al.| title=Dysphagia associated with gastroesophageal reflux disease is improved by proton pump inhibitor. | journal=Dig Dis Sci | year= 2005 | volume= 50 | issue= 10 | pages= 1921-6 | pmid=16187198 | doi=10.1007/s10620-005-2962-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16187198 }} </ref><ref name="pmid25341679">{{cite journal| author=Roman S, Kahrilas PJ| title=The diagnosis and management of hiatus hernia. | journal=BMJ | year= 2014 | volume= 349 | issue= | pages= g6154 | pmid=25341679 | doi=10.1136/bmj.g6154 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25341679 }} </ref> |
| *[[Lead poisoning]] | | |
| *[[Rabies]] | | ===Common Causes of Oropharyngeal Dysphagia=== |
| *[[Stroke]] | | {| class="wikitable" |
| *[[Tetanus]] | | ! colspan="3" |Common causes of oropharyngeal dysphagia |
| | |- |
| | !Neurological |
| | !Medication side effects |
| | !Others |
| | |- |
| | | |
| | * [[Stroke]] |
| | * [[Parkinson's disease]] |
| | * Occulopharyngeal dystrophy |
| | * [[Amyotrophic lateral sclerosis]] |
| | * [[Myasthenia gravis]] |
| | | |
| | * [[Sedatives]] |
| | * [[Hypnotics|Hypnotic agents]] |
| | * [[Anticonvulsants]] |
| | * [[Neuroleptics]] |
| | * [[Antihistamines]] |
| | * [[Barbiturates]] |
| | * [[Antiepileptics]] |
| | * [[Corticosteroids]] |
| | * [[Tetracycline]] |
| | * [[L-tryptophan]] |
| | * [[Anticholinergics|Anticholinergics.]] |
| | | |
| | * [[Radiation therapy|Radiotherapy]] of the head and neck |
| | * [[Pharyngitis]] |
| | * Cervical web or rings |
| | * Dental disease |
| | * [[Oral candidiasis]] |
| | * [[Tetanus]] |
| | * [[Lead poisoning]] |
| | * [[Rabies]] |
| | |} |
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| |
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| ===Common Causes=== | | ===Common causes of Esophageal Dysphagia=== |
| *[[Esophageal food bolus obstruction|Food impaction]] | | The common causes of esophageal dysphagia can be divided into four categories.<ref name="pmid24513804">{{cite journal| author=Xiao Y, Kahrilas PJ, Nicodème F, Lin Z, Roman S, Pandolfino JE| title=Lack of correlation between HRM metrics and symptoms during the manometric protocol. | journal=Am J Gastroenterol | year= 2014 | volume= 109 | issue= 4 | pages= 521-6 | pmid=24513804 | doi=10.1038/ajg.2014.13 | pmc=4120962 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24513804 }} </ref><ref name="pmid21480936">{{cite journal| author=Enestvedt BK, Williams JL, Sonnenberg A| title=Epidemiology and practice patterns of achalasia in a large multi-centre database. | journal=Aliment Pharmacol Ther | year= 2011 | volume= 33 | issue= 11 | pages= 1209-14 | pmid=21480936 | doi=10.1111/j.1365-2036.2011.04655.x | pmc=3857989 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21480936 }} </ref><ref name="pmid1398223">{{cite journal| author=Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC| title=Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. | journal=Gut | year= 1992 | volume= 33 | issue= 8 | pages= 1011-5 | pmid=1398223 | doi= | pmc=1379432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1398223 }} </ref><ref name="pmid25965233">{{cite journal| author=Pandolfino JE, Gawron AJ| title=Achalasia: a systematic review. | journal=JAMA | year= 2015 | volume= 313 | issue= 18 | pages= 1841-52 | pmid=25965233 | doi=10.1001/jama.2015.2996 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25965233 }} </ref><ref name="pmid12850684">{{cite journal| author=Gockel I, Lord RV, Bremner CG, Crookes PF, Hamrah P, DeMeester TR| title=The hypertensive lower esophageal sphincter: a motility disorder with manometric features of outflow obstruction. | journal=J Gastrointest Surg | year= 2003 | volume= 7 | issue= 5 | pages= 692-700 | pmid=12850684 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12850684 }} </ref> |
| *[[Gastroesophageal reflux]] | | {| class="wikitable" |
| *[[Oral candidiasis]] | | ! colspan="4" |Structural (Mechanical) disorders |
| *[[Pharyngitis]] | | ! colspan="2" |Motor disorders |
| | ! rowspan="2" |Esophageal tumors |
| | ! rowspan="2" |Systemic diseases |
| | ! rowspan="2" |Miscellaneous |
| | |- |
| | ! colspan="2" |'''Intrinsic compression''' |
| | ! colspan="2" |'''Extrinsic Compression''' |
| | !'''Primary''' |
| | !'''Secondary''' |
| | |- |
| | |'''Mucosal rings and webs''' |
| | * [[Schatzki ring|Schatzki]] |
| | * [[Plummer-Vinson syndrome|Plummer-Vinson]] |
| | * Multiringed esophagus [[Eosinophilic esophagitis|(eosinophilic esophagitis]]) |
| | |'''Strictures:''' |
| | * [[Peptic ulcer|PUD]] |
| | * [[Caustic]] |
| | * Pill-induced |
| | * Radiation-induced |
| | |'''Vascular compression:''' |
| | * Dysphagia lusoria (aberrant right subclavian artery) |
| | * Dysphagia aortica (right-sided aorta) |
| | * [[Cardiomegaly|Cardio-megaly]] (enlarged left atrium) |
| | | |
| | * '''Mediastinal masses:''' |
| | ** [[Lung cancer]] |
| | ** [[Lymphoma]] |
| | ** [[Lymphadenopathy]] |
| | ** [[Thyromegaly]] |
| | | |
| | * [[Achalasia]] |
| | * [[Diffuse esophageal spasm]] |
| | * Hypertensive lower esophageal sphincter |
| | * Ineffective esophageal motility disorder |
| | * [[Nutcracker esophagus]] |
| | | |
| | * Connective tissue diseases |
| | * [[Scleroderma]] |
| | * [[CREST syndrome]] |
| | * [[Diabetes mellitus|Diabetes]] |
| | * [[Chagas disease]] |
| | * [[Paraneoplastic syndrome]] |
| | | |
| | * [[Adenocarcinoma]] |
| | * [[Squamous cell carcinoma]] |
| | * Metastatic (breast or melanoma) |
| | * [[Leiomyoma]], [[lymphoma]], or [[granular cell tumor]] |
| | | |
| | * [[Scleroderma]] (multifactorial) |
| | * Pemphigus/pemphigoid |
| | * [[Lichen planus]] |
| | * [[Crohn's disease|Crohn’s disease]] |
| | | |
| | * Postsurgery ([[Laryngeal cancer|laryngeal]], [[Esophageal cancer|esophageal]], or [[Stomach cancer|gastric cancers]]) |
| | * Acute [[Esophagitis|esophageal infections]] |
| | * Esophageal diverticulae |
| | * Foreign bodies |
| | |} |
| | |
| | ===Less Common Causes=== |
| | Less common causes of dysphagia include: |
| | * Scleredema adultorum<ref name="pmid29280826">{{cite journal| author=Chatterjee S, Hedman BJ, Kirby DF| title=An Unusual Cause of Dysphagia. | journal=J Clin Rheumatol | year= 2017 | volume= | issue= | pages= | pmid=29280826 | doi=10.1097/RHU.0000000000000666 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29280826 }} </ref><ref name="pmid7064968">{{cite journal| author=Wright RA, Bernie H| title=Scleredema adultorum of Buschke with upper esophageal involvement. | journal=Am J Gastroenterol | year= 1982 | volume= 77 | issue= 1 | pages= 9-11 | pmid=7064968 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7064968 }} </ref> |
| | * Post chemotherapy and radiation therapy<ref name="pmid11920484">{{cite journal| author=Nguyen NP, Sallah S, Karlsson U, Antoine JE| title=Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. | journal=Cancer | year= 2002 | volume= 94 | issue= 4 | pages= 1131-41 | pmid=11920484 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11920484 }} </ref> |
| | * Descending thoracic aorta aneurysm<ref name="Conte1966">{{cite journal|last1=Conte|first1=Blagio A.|title=Dysphagia Caused by an Aneurysm of the Descending Thoracic Aorta|journal=New England Journal of Medicine|volume=274|issue=17|year=1966|pages=956–957|issn=0028-4793|doi=10.1056/NEJM196604282741710}}</ref> |
| | * Hypertrophy of cricopharyngeal muscles<ref name="BenedictSweet1955">{{cite journal|last1=Benedict|first1=Edward B.|last2=Sweet|first2=Richard H.|title=Dysphagia Due to Hypertrophy of the Cricopharyngeus Muscle or Hypopharyngeal Bar|journal=New England Journal of Medicine|volume=253|issue=26|year=1955|pages=1161–1162|issn=0028-4793|doi=10.1056/NEJM195512292532607}}</ref> |
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| ===Causes by Organ System=== | | ===Causes by Organ System=== |
| {|style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1" | | The causes of dysphagia based on the organ system are as follows:<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref> |
| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | | {| style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1" |
| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Aberrant subclavian artery]], [[amyloidosis]], [[anomalous left pulmonary artery]],[[aortic aneurysm]], [[aortic arch anomalies]], [[CHARGE syndrome|charge syndrome]], [[double aortic arch]], [[enlarged aorta]], [[enlarged left atrium]], [[hypokalemia]], [[mitral valve stenosis]], [[pericarditis]], [[superior vena cava syndrome]] | | | style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular''' |
| | | style="width:75%" bgcolor="Beige" ; border="1" |[[Aberrant subclavian artery]], [[amyloidosis]], [[anomalous left pulmonary artery]],[[aortic aneurysm]], [[aortic arch anomalies]], [[CHARGE syndrome|charge syndrome]], [[double aortic arch]], [[enlarged aorta]], [[enlarged left atrium]], [[hypokalemia]], [[mitral valve stenosis]], [[pericarditis]], [[superior vena cava syndrome]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Chemical / poisoning''' | | | '''Chemical / poisoning''' |
| |bgcolor="Beige"|[[Arizona bark scorpion|Arizona bark scorpion poisoning]], [[arsenic poisoning]], [[botulism]], [[cobra poisoning]], [[fluoride poisoning]], [[lead poisoning]] | | | bgcolor="Beige" |[[Arizona bark scorpion|Arizona bark scorpion poisoning]], [[arsenic poisoning]], [[botulism]], [[cobra poisoning]], [[fluoride poisoning]], [[lead poisoning]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Dermatologic''' | | | '''Dermatologic''' |
| |bgcolor="Beige"|[[Behcet's syndrome]], [[dermatomyositis]], [[polymyositis]], [[Stevens-Johnson syndrome]], [[systemic lupus erythematosus]] | | | bgcolor="Beige" |[[Behcet's syndrome]], [[dermatomyositis]], [[polymyositis]], [[Stevens-Johnson syndrome]], [[systemic lupus erythematosus]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Drug Side Effect''' | | | '''Drug Side Effect''' |
| |bgcolor="Beige"|[[Antipsychotic drugs|Antipsychotic medications]], [[artemether and lumefantrin]], [[atropine]], [[botulinum toxin]], [[bicalutamide]][[chemotherapy]], [[Cyclosporine|cyclosporine toxicity]], [[cytarabine]], [[dactinomycin]], [[doxycycline]], [[eletriptan]], [[hydroxocobalamin]][[hyoscyamine]], [[ibandronate]], [[ioxilan]], [[ixabepilone]], [[minocycline hydrochloride]], [[nabumetone]], [[neuroleptics]], [[oxcarbazepine]], [[pergolide]], [[rimabotulinumtoxinb]], [[riociguat]], [[ropinirole]], [[sargramostim]], [[sertraline]], [[scarlet fever]], [[tiagabine]] | | | bgcolor="Beige" |[[Antipsychotic drugs|Antipsychotic medications]], [[artemether and lumefantrin]], [[atropine]], [[botulinum toxin]], [[bicalutamide]][[chemotherapy]], [[Cyclosporine|cyclosporine toxicity]], [[cytarabine]], [[dactinomycin]], [[doxycycline]], [[eletriptan]], [[hydroxocobalamin]][[hyoscyamine]], [[ibandronate]], [[ioxilan]], [[ixabepilone]], [[minocycline hydrochloride]], [[nabumetone]], [[neuroleptics]], [[oxcarbazepine]], [[pergolide]], [[rimabotulinumtoxinb]], [[riociguat]], [[ropinirole]], [[sargramostim]], [[sertraline]], [[scarlet fever]], [[tiagabine]] |
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| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Ear Nose Throat''' | | | '''Ear Nose Throat''' |
| |bgcolor="Beige"|[[Carcinoma of the vocal tract]], [[cricopharyngeal spasm]], [[Eagle syndrome|eagle syndrome]], [[epiglottitis]], [[Larynx|Impaired sensitivity in the larynx]], [[laryngeal cancer]], [[nasopharyngeal carcinoma]], [[oral pharyngeal disorders]], [[palatine tonsil]], [[pharyngeal pouch]], [[pharyngitis]], [[Head and neck cancer|pharynx cancer]], [[quinsy]], [[retropharyngeal abscess]], [[Tonsil cancer|tonsillar cancer]] | | | bgcolor="Beige" |[[Carcinoma of the vocal tract]], [[cricopharyngeal spasm]], [[Eagle syndrome|eagle syndrome]], [[epiglottitis]], [[Larynx|Impaired sensitivity in the larynx]], [[laryngeal cancer]], [[nasopharyngeal carcinoma]], [[Pharynx|oral pharyngeal disorders]], [[Oral submucous fibrosis|oral submucous fibrosis]], [[palatine tonsil]], [[pharyngeal pouch]], [[pharyngitis]], [[Head and neck cancer|pharynx cancer]], [[quinsy]], [[retropharyngeal abscess]], [[Tonsil cancer|tonsillar cancer]] |
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| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Endocrine''' | | | '''Endocrine''' |
| |bgcolor="Beige"|[[Cushing's syndrome]], [[diabetic neuropathy]], [[goiter]], [[hyperthyroidism]], [[hypokalemia]], [[hypothyroidism]], [[paraganglioma]], [[Riedel thyroiditis]], [[subacute granulomatous thyroiditis]], [[thymoma]], [[thyroglossal cyst]], [[Thyroid cancer|thyroid cancer, anaplastic]],[[thyrotoxicosis]], [[vagal paraganglioma]], [[De Quervain's thyroiditis]], [[solitary thyroid nodule]] | | | bgcolor="Beige" |[[Cushing's syndrome]], [[diabetic neuropathy]], [[goiter]], [[hyperthyroidism]], [[hypokalemia]], [[hypothyroidism]], [[paraganglioma]], [[Riedel thyroiditis]], [[subacute granulomatous thyroiditis]], [[thymoma]], [[thyroglossal cyst]], [[Thyroid cancer|thyroid cancer, anaplastic]],[[thyrotoxicosis]], [[vagal paraganglioma]], [[De Quervain's thyroiditis]], [[solitary thyroid nodule]] |
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| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Environmental''' | | | '''Environmental''' |
| |bgcolor="Beige"| No underlying causes | | | bgcolor="Beige" | No underlying causes |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Gastroenterologic''' | | | '''Gastroenterologic''' |
| |bgcolor="Beige"|[[Achalasia]], [[adjustable gastric band]], [[aerophagia]], [[aspiration of foreign body]], [[Barrett's esophagus|Barret's syndrome]],[[Candida esophagitis (patient information)|candida esophagitis]], cascade stomach, [[esophagitis|caustic esophagitis]], [[Crohn's disease|Crohn's disease of the esophagus]], [[diffuse esophageal spasm]], [[diverticulum]], [[eosinophilic esophagitis]], [[eosinophilic gastroenteritis]], [[esophageal atresia]], [[esophageal cancer]], [[esophageal cyst]], [[esophageal diverticulum]], [[Leiomyoma|esophageal leiomyoma]], [[Foreign body|esophageal obstruction by a foreign body]], [[esophageal pouch]], [[esophageal spasm]], [[esophageal stricture]], [[esophageal web]], [[esophageal moniliasis]], [[esophageal sarcoidosis]], [[Trauma|esophageal trauma]], [[esophagitis]], [[esophagotracheal fistula]], external esophageal compression, [[gastric cancer]], [[gastric volvulus]], [[gastritis]], [[gastroesophageal reflux]], [[gastrointestinal stromal tumor]], [[gastroparesis]], [[Gaucher disease]], [[globus pharyngis]], [[globus syndrome]], [[hiatal hernia]], [[Nutcracker esophagus|hypertensive lower esophageal sphincter]], [[esophagitis|infectious esophagitis]], [[Esophageal intramural pseudodiverticulosis|intramural pseudodiverticulosis]], [[esophagitis|lymphocytic esophagitis]], [[mitochondrial neurogastrointestinal encephalopathy syndrome]], [[mucositis]], [[myoneurogastrointestinal encephalopathy syndrome]], [[nutcracker esophagus]], [[odynophagia]], [[peptic esophagitis]], [[Surgery|post surgery]], [[Esophageal stricture|peptic stricture]], [[pharyngeal pouch]], [[Esophagitis|pill esophagitis]], [[Plummer-Vinson syndrome]], [[presbyphagia]], [[pseudoachalasia]], [[pyloric stenosis]], [[radiation|radiation esophagitis]], [[Schatzki ring]], [[stomach cancer]], [[upper oesophageal sphincter dysfunction]], [[Wilson disease]], [[zenker's diverticulum]] | | | bgcolor="Beige" |[[Achalasia]], [[adjustable gastric band]], [[aerophagia]], [[aspiration of foreign body]], [[Barrett's esophagus|Barret's syndrome]],[[Candida esophagitis (patient information)|candida esophagitis]], [[Stomach|cascade stomach]], [[esophagitis|caustic esophagitis]], [[Crohn's disease|Crohn's disease of the esophagus]], [[diffuse esophageal spasm]], [[diverticulum]], [[eosinophilic esophagitis]], [[eosinophilic gastroenteritis]], [[esophageal atresia]], [[esophageal cancer]], [[esophageal cyst]], [[esophageal diverticulum]], [[Leiomyoma|esophageal leiomyoma]], [[Foreign body|esophageal obstruction by a foreign body]], [[esophageal pouch]], [[esophageal spasm]], [[esophageal stricture]], [[esophageal web]], [[esophageal moniliasis]], [[esophageal sarcoidosis]], [[Trauma|esophageal trauma]], [[esophagitis]], [[esophagotracheal fistula]], [[Esophagus|external esophageal compression]], [[gastric cancer]], [[gastric volvulus]], [[gastritis]], [[gastroesophageal reflux]], [[gastrointestinal stromal tumor]], [[gastroparesis]], [[Gaucher disease]], [[globus pharyngis]], [[globus syndrome]], [[hiatal hernia]], [[Nutcracker esophagus|hypertensive lower esophageal sphincter]], [[esophagitis|infectious esophagitis]], [[Esophageal intramural pseudodiverticulosis|intramural pseudodiverticulosis]], [[esophagitis|lymphocytic esophagitis]], [[mitochondrial neurogastrointestinal encephalopathy syndrome]], [[mucositis]], [[myoneurogastrointestinal encephalopathy syndrome]], [[nutcracker esophagus]], [[odynophagia]], [[peptic esophagitis]], [[Surgery|post surgery]], [[Esophageal stricture|peptic stricture]], [[pharyngeal pouch]], [[Esophagitis|pill esophagitis]], [[Plummer-Vinson syndrome]], [[presbyphagia]], [[pseudoachalasia]], [[pyloric stenosis]], [[radiation|radiation esophagitis]], [[Schatzki ring]], [[stomach cancer]], [[Esophagus|upper oesophageal sphincter dysfunction]], [[Wilson disease]], [[zenker's diverticulum]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Genetic''' | | | '''Genetic''' |
| |bgcolor="Beige"|[[Aberrant subclavian artery]], [[achalasia-addisonian syndrome]], [[achromatopsia]], [[adrenoleukodystrophy]], [[Behcet's syndrome]], [[Chromosome 1, 1p36 deletion syndrome|chromosome 1p36 deletion syndrome]], [[Chromosome 22 (human)|chromosome 22 ring]], [[Trisomy 22|chromosome 22 trisomy mosaic]], [[Connective tissue disease|connective tissue disease]], [[Emanuel syndrome ]], [[Spinal curvature|extreme spinal curvature]], [[Gaucher disease]],[[Huntington disease]], [[Lissencephaly|lissencephaly, type 1, x-linked ]], [[muscular dystrophy, Duchenne and Becker type]] ,[[myotonic dystrophy]], [[Congenital myopathy|nemaline myopathy1]], [[oculopharyngeal muscular dystrophy]], pseudoadrenoleukodystrophy , [[spinal muscular atrophy type I]], [[spinocerebellar ataxia 17 ]], [[Spinocerebellar ataxia|spinocerebellar ataxia 22]], [[Spinocerebellar ataxia|spinocerebellar ataxia, autosomal recessive 1]] [[Stuve-wiedemann dysplasia]] , [[Vascular ring|vascular ring with right aortic arch]], [[Wiedemann–Rautenstrauch syndrome]], [[Wilson disease]] | | | bgcolor="Beige" |[[Aberrant subclavian artery]], [[achalasia-addisonian syndrome]], [[achromatopsia]], [[adrenoleukodystrophy]], [[POLG|ataxia neuropathy spectrum]],[[Behcet's syndrome]], [[Chromosome 1, 1p36 deletion syndrome|chromosome 1p36 deletion syndrome]], [[Chromosome 22 (human)|chromosome 22 ring]], [[Trisomy 22|chromosome 22 trisomy mosaic]], [[Connective tissue disease|connective tissue disease]], [[CRLF1|crisponi syndrome]], [[Emanuel syndrome ]] , [[Spinal curvature|extreme spinal curvature]], [[Gaucher disease]],[[Huntington disease]], [[Lissencephaly|lissencephaly, type 1, x-linked]] , [[muscular dystrophy, Duchenne and Becker type]] ,[[myotonic dystrophy]], [[Congenital myopathy|nemaline myopathy1]], [[oculopharyngeal muscular dystrophy]], [[Autosomal dominant opitz G/BBB syndrome|Opitz-frias syndrome]], [[ACOX1|pseudoadrenoleukodystrophy]], [[spinal muscular atrophy type I]], [[spinocerebellar ataxia 17 ]] , [[Spinocerebellar ataxia|spinocerebellar ataxia 22]], [[Spinocerebellar ataxia|spinocerebellar ataxia, autosomal recessive 1]], [[Schwartz–Jampel syndrome|Stuve-wiedemann dysplasia]], [[Vascular ring|vascular ring with right aortic arch]], [[Wiedemann–Rautenstrauch syndrome]], [[Wilson disease]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Hematologic''' | | | '''Hematologic''' |
| |bgcolor="Beige"|[[Agranulocytosis]], [[mononucleosis]], [[Plummer-Vinson syndrome]] | | | bgcolor="Beige" |[[Agranulocytosis]], [[mononucleosis]], [[Plummer-Vinson syndrome]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Iatrogenic''' | | | '''Iatrogenic''' |
| |bgcolor="Beige"| No underlying causes | | | bgcolor="Beige" | No underlying causes |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Infectious Disease''' | | | '''Infectious Disease''' |
| |bgcolor="Beige"|[[Abscess]], [[angina tonsillaris]], [[botulism]], [[Candida esophagitis (patient information)|candida esophagitis]], [[Chagas disease]], [[cytomegalovirus]], [[diphtheria]], [[epiglottitis]], [[gastritis]], [[herpangina]], [[herpes simplex virus]], [[esophagitis|infectious esophagitis]],[[laryngeal papillomatosis]], [[lassa fever]], [[Ludwig's angina]], [[lyme disease]], [[Lymphomatoid granulomatosis|lymph granulomatosis]], [[Lymphadenopathy]],[[esophagitis|Medication-induced esophagitis]], [[mumps]], [[neonatal tetanus ]], [[oral candidiasis]], [[paracoccidioidomycosis]], [[Pharyngitis]], [[polio]], [[poliomyelitis]], [[Post-polio syndrome overview|postpolio syndrome]], [[quinsy]], [[rabies]], [[retropharyngeal abscess]], [[snakebites]], [[syphilis]], [[tetanus]], [[tetrodotoxin]], [[tonsillar abscess]], [[ulcer]] | | | bgcolor="Beige" |[[Abscess]], [[angina tonsillaris]], [[botulism]], [[Candida esophagitis (patient information)|candida esophagitis]], [[Chagas disease]], [[cytomegalovirus]], [[diphtheria]], [[epiglottitis]], [[gastritis]], [[herpangina]], [[herpes simplex virus]], [[esophagitis|infectious esophagitis]],[[laryngeal papillomatosis]], [[lassa fever]], [[Ludwig's angina]], [[lyme disease]], [[Lymphomatoid granulomatosis|lymph granulomatosis]], [[Lymphadenopathy]],[[esophagitis|Medication-induced esophagitis]], [[mumps]], [[neonatal tetanus ]] , [[oral candidiasis]], [[paracoccidioidomycosis]], [[Pharyngitis]], [[polio]], [[poliomyelitis]], [[Post-polio syndrome overview|postpolio syndrome]], [[quinsy]], [[rabies]], [[retropharyngeal abscess]], [[snakebites]], [[stomatitis]], [[syphilis]], [[tetanus]], [[tetrodotoxin]], [[tonsillar abscess]], [[ulcer]], [[Vincent's angina]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Musculoskeletal / Ortho''' | | | '''Musculoskeletal / Ortho''' |
| |bgcolor="Beige"|[[Diffuse idiopathic skeletal hyperostosis]], [[distal myopathy 2]], [[elongated styloid process]], [[Spinal curvature|extreme spinal curvature]], [[inclusion body myositis]], [[muscular dystrophy, Duchenne and Becker type]], [[osteophytes]], [[Pierre Robin's sequence ]] | | | bgcolor="Beige" |cytoplasmic body myopathy, [[Diffuse idiopathic skeletal hyperostosis]], [[distal myopathy 2]], [[elongated styloid process]], [[Spinal curvature|extreme spinal curvature]], [[inclusion body myositis]], [[muscular dystrophy, Duchenne and Becker type]], [[osteophytes]], [[Pierre Robin's sequence ]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Neurologic''' | | | '''Neurologic''' |
| |bgcolor="Beige"|[[10th cranial nerve disorder]], [[amyotrophic lateral sclerosis]], [[Arnold–Chiari malformation]], ataxia neuropathy spectrum, [[Dysautonomia|autonomic nerve disorders]], [[autonomic neuropathy]], [[Hereditary spastic paraplegia|autosomal recessive spastic paraplegia, type 11]], [[Avellis syndrome]], [[Babinski–Nageotte syndrome]], [[basal ganglia disease]], [[basilar artery insufficiency syndrome]], [[brain stem gliomas]], [[brainstem stroke]], [[Brain stem tumor|brainstem tumors]], [[pseudobulbar palsy]], [[bulbar palsy]], [[carotid paraganglioma]], [[central pontine myelinosis]], [[central vagal nucleus lesion]], [[central hypoglossal nerve paralysis]], [[cerebellar Infarction]], [[Cerebellar stroke syndrome|cerebellar stroke]], [[cerebral palsy]], [[cerebrovascular accident]], [[congenital myasthenic syndrome]], [[osteophytes|cervical osteophytes]], [[dementia]], [[diabetic neuropathy]], [[dystonia]], [[Ohtahara syndrome|epileptic encephalopathy, early infantile, 1]], [[Facial Onset Sensory Motor Neuropathy syndrome|fosmn syndrome]], [[Guillain-Barre Syndrome]], [[head trauma]], [[Huntington disease]], [[infantile striato-thalamic degeneration]], [[Lateral funiculus|lateral funiculus angina]], [[lateral medullary syndrome]], [[Lissencephaly|lissencephaly, type 1, x-linked]], [[mass brain lesion]], [[Encephalopathy classification|metabolic encephalopathies]], [[microcephaly brain defect spasticity hypernatremia]], [[mitochondrial neurogastrointestinal encephalopathy syndrome]], [[motor neuron disease]], [[multiple sclerosis]], [[multiple system atrophy]], [[muscular dystrophy, Duchenne and Becker type]], [[myasthenia gravis]], [[myoneurogastrointestinal encephalopathy syndrome]], [[myopathy]], [[myotonic dystrophy]], [[neuroferritinopathy]], [[neurosarcoidosis]], [[osmotic demyelination syndrome]],[[paraganglioma]], [[paraneoplastic limbic encephalitis]], [[Parkinson disease]], [[peripheral neuropathy]], [[peripheral tongue paralysis]], [[polyradiculitis]], [[Pontocerebellar hypoplasia|pontocerebellar hypoplasia type 2a]], [[Primary lateral sclerosis|primary lateral sclerosis, adult]], [[Esophageal motility disorder|primary motility disorders]], [[Pseudobulbar paralysis]],[[pseudodysphagia]], [[Esophageal motility disorder|secondary motility disorders]], [[Shy-Drager syndrome]], [[Hereditary spastic paraplegia|spastic paraplegia 11, autosomal recessive]], [[spinal muscular atrophy type I]], [[Spinocerebellar ataxia|spinocerebellar ataxia 17 ]], [[spinocerebellar ataxia|spinocerebellar ataxia 22 ]], [[Spinocerebellar ataxia|spinocerebellar ataxia, autosomal recessive 1]], [[striatonigral degeneration infantile]], [[stroke]], [[syringobulbia]], [[tardive dyskinesia]], [[vagus nerve|vagus nerve palsy]], [[Lateral medullary syndrome|Wallenberg's syndrome]] | | | bgcolor="Beige" |[[10th cranial nerve disorder]], [[amyotrophic lateral sclerosis]], [[Arnold–Chiari malformation]], [[POLG|ataxia neuropathy spectrum]], [[Dysautonomia|autonomic nerve disorders]], [[autonomic neuropathy]], [[Hereditary spastic paraplegia|autosomal recessive spastic paraplegia, type 11]], [[Avellis syndrome]], [[Babinski–Nageotte syndrome]], [[basal ganglia disease]], [[basilar artery insufficiency syndrome]], [[brain stem gliomas]], [[brainstem stroke]], [[Brain stem tumor|brainstem tumors]], [[pseudobulbar palsy]], [[bulbar palsy]], Canomad syndrome, [[carotid paraganglioma]], [[central pontine myelinosis]], [[central vagal nucleus lesion]], [[central hypoglossal nerve paralysis]], [[cerebellar Infarction]], [[Cerebellar stroke syndrome|cerebellar stroke]], [[cerebral palsy]], [[cerebrovascular accident]], [[congenital myasthenic syndrome]], [[osteophytes|cervical osteophytes]], [[dementia]], [[diabetic neuropathy]], [[dystonia]], [[Ohtahara syndrome|epileptic encephalopathy, early infantile, 1]], [[Facial Onset Sensory Motor Neuropathy syndrome|fosmn syndrome]], [[Guillain-Barre Syndrome]], [[head trauma]], [[Huntington disease]], [[infantile striato-thalamic degeneration]], [[Lateral funiculus|lateral funiculus angina]], [[lateral medullary syndrome]], [[Jean Lhermitte |Lhermitte-cornil-quesnel syndrome]], [[Lissencephaly|lissencephaly, type 1, x-linked]], [[Encephalopathy classification|metabolic encephalopathies]], [[microcephaly]], [[mitochondrial neurogastrointestinal encephalopathy syndrome]], [[motor neuron disease]], [[multiple sclerosis]], [[multiple system atrophy]], [[muscular dystrophy, Duchenne and Becker type]], [[myasthenia gravis]], [[myoneurogastrointestinal encephalopathy syndrome]], [[myopathy]], [[myotonic dystrophy]], [[neuroferritinopathy]], [[neurosarcoidosis]], [[osmotic demyelination syndrome]], [[Parkinson's disease|Pallidopyramidal syndrome]], [[paraganglioma]], [[paraneoplastic limbic encephalitis]], [[Parkinson disease]], [[peripheral neuropathy]], [[Tongue|peripheral tongue paralysis]], [[polyradiculitis]], [[Pontocerebellar hypoplasia|pontocerebellar hypoplasia type 2a]], [[Primary lateral sclerosis|primary lateral sclerosis, adult]], [[Esophageal motility disorder|primary motility disorders]], [[Pseudobulbar paralysis]],[[pseudodysphagia]], [[Esophageal motility disorder|secondary motility disorders]], [[Shy-Drager syndrome]], [[Hereditary spastic paraplegia|spastic paraplegia 11, autosomal recessive]], [[spinal muscular atrophy type I]], [[Spinocerebellar ataxia|spinocerebellar ataxia 17]] , [[spinocerebellar ataxia|spinocerebellar ataxia 22]] , [[Spinocerebellar ataxia|spinocerebellar ataxia, autosomal recessive 1]], [[Striatonigral degeneration|striatonigral degeneration infantile]], [[stroke]], [[syringobulbia]], [[tardive dyskinesia]], [[vagus nerve|vagus nerve palsy]], [[Lateral medullary syndrome|Wallenberg's syndrome]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Nutritional / Metabolic''' | | | '''Nutritional / Metabolic''' |
| |bgcolor="Beige"|[[Adrenoleukodystrophy]], [[amyloidosis]], [[Gaucher disease]], [[hydroxocobalamin]], [[hypokalemia]], [[Plummer-Vinson syndrome]], [[Wilson disease]] | | | bgcolor="Beige" |[[Adrenoleukodystrophy]], [[amyloidosis]], [[Gaucher disease]], [[hydroxocobalamin]], [[hypokalemia]], [[Plummer-Vinson syndrome]], [[Wilson disease]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Obstetric/Gynecologic''' | | | '''Obstetric/Gynecologic''' |
| |bgcolor="Beige"|[[Leiomyoma]] | | | bgcolor="Beige" |[[Leiomyoma]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Oncologic''' | | | '''Oncologic''' |
| |bgcolor="Beige"|[[Acoustic neuroma]], [[Brain Stem Gliomas|brain stem gliomas]], [[Brain stem tumor|brain stem tumors]], [[bronchial carcinoma]], [[carcinoma of the vocal tract]], [[carotid body tumor]], [[chordoma]], [[esophageal cancer]], [[gastric cancer]], [[laryngeal cancer]], [[laryngeal carcinoma]], [[leiomyoma]], [[lymphadenopathy]], [[malignant lung cancer]], [[malignant mesothelioma]], [[nasopharyngeal carcinoma]], [[Head and neck cancer |neck cancer]], [[odontoma]], [[Oral cancer|Oral cavity tumor]], [[oropharyngeal cancer]], [[Oral cancer|palate cancer]], [[paraganglioma]], [[paraneoplastic limbic encephalitis]], [[paraneoplastic syndrome]], [[Head and neck cancer|pharynx cancer]], [[small cell lung cancer]], [[stomach cancer]], [[supraglottic laryngeal cancer]], [[Head and neck cancer|throat cancer]], [[Anaplastic thyroid cancer|thyroid cancer, anaplastic]], [[tongue cancer]], [[tonsil cancer|tonsillar cancer]], [[vagal paraganglioma]] | | | bgcolor="Beige" |[[Acoustic neuroma]], [[Brain Stem Gliomas|brain stem gliomas]], [[Brain stem tumor|brain stem tumors]], [[bronchial carcinoma]], [[carcinoma of the vocal tract]], [[carotid body tumor]], [[chordoma]], [[esophageal cancer]], [[gastric cancer]], [[laryngeal cancer]], [[laryngeal carcinoma]], [[leiomyoma]], [[lymphadenopathy]], [[malignant lung cancer]], [[malignant mesothelioma]], [[nasopharyngeal carcinoma]], [[Head and neck cancer |neck cancer]], [[odontoma]], [[Oral cancer|Oral cavity tumor]], [[oropharyngeal cancer]], [[Oral cancer|palate cancer]], [[paraganglioma]], [[paraneoplastic limbic encephalitis]], [[paraneoplastic syndrome]], [[Head and neck cancer|pharynx cancer]], [[small cell lung cancer]], [[stomach cancer]], [[supraglottic laryngeal cancer]], [[Head and neck cancer|throat cancer]], [[Anaplastic thyroid cancer|thyroid cancer, anaplastic]], [[tongue cancer]], [[tonsil cancer|tonsillar cancer]], [[vagal paraganglioma]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Opthalmologic''' | | | '''Opthalmologic''' |
| |bgcolor="Beige"|[[Achromatopsia]], [[oculopharyngeal muscular dystrophy]] | | | bgcolor="Beige" |[[Achromatopsia]], [[oculopharyngeal muscular dystrophy]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Overdose / Toxicity''' | | | '''Overdose / Toxicity''' |
| |bgcolor="Beige"|[[Alcoholism]] | | | bgcolor="Beige" |[[Alcoholism]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Psychiatric''' | | | '''Psychiatric''' |
| |bgcolor="Beige"|[[Anxiety disorders]], [[dementia]], [[frontotemporal dementia]], [[functional disorders]], [[global hystericus]], [[rumination disorder]], [[tardive dyskinesia]] | | | bgcolor="Beige" |[[Anxiety disorders]], [[dementia]], [[frontotemporal dementia]], [[functional disorders]], [[global hystericus]], [[rumination disorder]], [[tardive dyskinesia]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Pulmonary''' | | | '''Pulmonary''' |
| |bgcolor="Beige"|[[Bronchial carcinoma]], [[Bronchogenic cyst|congenital bronchogenic cyst]], [[epiglottitis]], [[malignant lung cancer]], [[malignant mesothelioma]][[mediastinal mass]], [[mediastinitis]], [[Ondine's curse]], [[pharyngitis]], [[pleuritis]], [[sarcoidosis]] | | | bgcolor="Beige" |[[Bronchial carcinoma]], [[Bronchogenic cyst|congenital bronchogenic cyst]], [[epiglottitis]], [[malignant lung cancer]], [[malignant mesothelioma]][[mediastinal mass]], [[mediastinitis]], [[Ondine's curse]], [[pharyngitis]], [[pleuritis]], [[sarcoidosis]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Renal / Electrolyte''' | | | '''Renal / Electrolyte''' |
| |bgcolor="Beige"|[[Hypomagnesemia|Hypomagnesemia primary]], [[hypophosphatemia]], [[systemic lupus erythematosus]] | | | bgcolor="Beige" |[[Hypomagnesemia|Hypomagnesemia primary]], [[hypophosphatemia]], [[systemic lupus erythematosus]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Rheum / Immune / Allergy''' | | | '''Rheum / Immune / Allergy''' |
| |bgcolor="Beige"|[[Allergic swelling]], [[amyloidosis]], [[Behcet's syndrome]], [[bone spur|cervical osteophytes]], [[CREST syndrome]], [[dermatomyositis]], [[Systemic scleroderma|diffuse systemic sclerosi]], [[fibrosis]], [[graft-versus-host disease]], [[inclusion body myositis]], [[muscular dystrophy]], [[oculopharyngeal muscular dystrophy]], [[osteophytes]], [[paraneoplastic syndrome]], [[polymyalgia rheumatica]], [[polymyositis]], [[rheumatoid arthritis]], [[sarcoidosis]], [[scleroderma]], [[systemic lupus erythematosus]], [[systemic sclerosis]], [[trismus]] | | | bgcolor="Beige" |[[Allergic swelling]], [[amyloidosis]], [[Behcet's syndrome]], Canomad syndrome, [[bone spur|cervical osteophytes]], [[CREST syndrome]], [[dermatomyositis]], [[Systemic scleroderma|diffuse systemic sclerosi]], [[fibrosis]], [[graft-versus-host disease]], [[inclusion body myositis]], [[muscular dystrophy]], [[oculopharyngeal muscular dystrophy]], [[osteophytes]], [[paraneoplastic syndrome]], [[polymyalgia rheumatica]], [[polymyositis]], [[rheumatoid arthritis]], [[sarcoidosis]], [[scleroderma]], [[stomatitis]], [[systemic lupus erythematosus]], [[systemic sclerosis]], [[trismus]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Sexual''' | | | '''Sexual''' |
| |bgcolor="Beige"| No underlying causes | | | bgcolor="Beige" | No underlying causes |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Trauma''' | | | '''Trauma''' |
| |bgcolor="Beige"|[[Head trauma]] | | | bgcolor="Beige" |[[Head trauma]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Urologic''' | | | '''Urologic''' |
| |bgcolor="Beige"| No underlying causes | | | bgcolor="Beige" | No underlying causes |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Dental''' | | | '''Dental''' |
| |bgcolor="Beige"| No underlying causes | | | bgcolor="Beige" |[[Vincent's angina]] |
| |- | | |- |
| |-bgcolor="LightSteelBlue" | | |- bgcolor="LightSteelBlue" |
| | '''Miscellaneous''' | | | '''Miscellaneous''' |
| |bgcolor="Beige"|Canomad syndrome, crisponi syndrome, cytoplasmic body myopathy, Franek-bocker-kahlen syndrome, [[Jean Lhermitte |Lhermitte-cornil-quesnel syndrome]], [[Autosomal dominant opitz G/BBB syndrome|Opitz-frias syndrome]], [[Oral submucous fibrosis|oral submucous fibrosis]], [[palatoplegia]], Pallidopyramidal syndrome, [[stomatitis]], [[Tongue disease|tongue conditions]], [[Vascular anomaly|vascular abnormality]], [[Vincent's angina]] | | | bgcolor="Beige" | Franek-bocker-kahlen syndrome, [[palatoplegia]], [[Tongue disease|tongue conditions]], [[Vascular anomaly|vascular abnormality]] |
|
| |
|
| |- | | |- |
| |} | | |} |
|
| |
| ===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
| |
| {{columns-list|3|
| |
| * [[10th cranial nerve disorder]]
| |
| * [[Aberrant subclavian artery]]
| |
| * [[Abscess]]
| |
| * [[Achalasia]]
| |
| * [[Achalasia-addisonian syndrome]]
| |
| * [[Achromatopsia]]
| |
| * [[Acoustic neuroma]]
| |
| * [[Adrenoleukodystrophy]]
| |
| * [[Aerophagia]]
| |
| * [[Agranulocytosis]]
| |
| * [[Alcoholism]]
| |
| * [[Allergic swelling]]
| |
| * [[Amyloidosis]]
| |
| * [[Amyotrophic Lateral Sclerosis]]
| |
| * [[Angina tonsillaris]]
| |
| * [[Anxiety disorders]]
| |
| * [[Aortic aneurysm]]
| |
| * [[Arizona Bark Scorpion poisoning|Arizona bark scorpion poisoning]]
| |
| * [[Arnold-Chiari malformation classification|Arnold-chiari malformation type 3]]
| |
| * [[Artemether and lumefantrin]]
| |
| * [[Aspiration of foreign body]]
| |
| * [[Dysautonomia|Autonomic nerve disorders]]
| |
| * [[Autonomic neuropathy]]
| |
| * [[Hereditary spastic paraplegia|Autosomal recessive spastic paraplegia, type 11]]
| |
| * [[Avellis syndrome]]
| |
| * [[Babinski–Nageotte syndrome]]
| |
| * [[Barrett's esophagus|Barret's syndrome]]
| |
| * [[Basal ganglia disease]]
| |
| * [[Basilar artery insufficiency syndrome ]]
| |
| * [[Behcet's Syndrome]]
| |
| * [[Botulinum toxin]]
| |
| * [[Botulism]]
| |
| * [[Brainstem stroke]]
| |
| * [[Bronchial carcinoma]]
| |
| * [[Bulbar palsy]]
| |
| * [[Candidiasis]]
| |
| * Canomad syndrome
| |
| * [[Carcinoma of the vocal tract ]]
| |
| * [[Carotid body tumor]]
| |
| * [[Carotid paraganglioma ]]
| |
| * Cascade stomach
| |
| * [[Esophagitis|Caustic esophagitis]]
| |
| * [[Central pontine myelinosis]]
| |
| * [[Central hypoglossal nerve paralysis]]
| |
| * [[Central vagal nucleus lesion]]
| |
| * [[Cerebellar stroke syndrome|Cerebellar stroke]]
| |
| * [[Cerebral palsy]]
| |
| * [[Cerebrovascular accident]]
| |
| * [[Chagas Disease]]
| |
| * [[CHARGE syndrome|Charge syndrome]]
| |
| * [[Chemical burns]]
| |
| * [[Chemotherapy]]
| |
| * [[Chordoma]]
| |
| * [[Chromosome 1, 1p36 deletion syndrome|Chromosome 1p36 deletion syndrome]]
| |
| * [[Chromosome 22 (human)|Chromosome 22 ring]]
| |
| * [[Trisomy 22|Chromosome 22 trisomy mosaic]]
| |
| * [[Cobra poisoning]]
| |
| * [[bronchogenic cyst|Congenital bronchogenic cyst]]
| |
| * [[Connective tissue disease|Connective tissue disease ]]
| |
| * [[CREST syndrome|Crest syndrome]]
| |
| * [[Cricopharyngeal spasm]]
| |
| * [[CRLF1|Crisponi syndrome]]
| |
| * [[Crohn's disease|Crohn's disease of the esophagus]]
| |
| * [[Cushing's syndrome]]
| |
| * [[Cyclosporine|Cyclosporine toxicity]]
| |
| * [[Cytarabine]]
| |
| * [[Cytomegalovirus]] ([[CMV]])
| |
| * Cytoplasmic body myopathy
| |
| * [[Dementia]]
| |
| * [[Dermatomyositis]]
| |
| * [[Diabetic neuropathy]]
| |
| * [[Diffuse esophageal spasm]]
| |
| * [[Diffuse idiopathic skeletal hyperostosis]]
| |
| * [[Diphtheria]]
| |
| * [[Distal myopathy 2]]
| |
| * [[Diverticulum]]
| |
| * [[Double aortic arch]]
| |
| * [[Dystonia]]
| |
| * [[Eagle syndrome ]]
| |
| * [[Elongated styloid process]]
| |
| * [[Emanuel syndrome]]
| |
| * [[Enlarged aorta]]
| |
| * [[Left Atrial Enlargement|Enlarged left atrium]]
| |
| * [[Eosinophilic esophagitis]]
| |
| * [[Eosinophilic gastroenteritis]]
| |
| * [[Epiglottitis]]
| |
| * [[Ohtahara syndrome|Epileptic encephalopathy, early infantile, 1]]
| |
| * [[Esophageal achalasia]]
| |
| * [[Esophageal atresia]]
| |
| * [[Esophageal cancer]]
| |
| * [[Esophageal cyst]]
| |
| * [[Crohn's disease|Esophageal Crohn's disease]]
| |
| * [[Esophageal diverticulum]]
| |
| * [[Foreign body|Eesophageal foreign body]]
| |
| * [[Esophageal moniliasis]]
| |
| * [[Esophageal disease|Esophageal ring]]
| |
| * [[Esophageal web]]
| |
| * [[sarcoidosis|Esophageal sarcoidosis]]
| |
| * [[Esophageal spasm]]
| |
| * [[Trauma|Esophageal trauma]]
| |
| * [[Esophagotracheal fistula]]
| |
| * [[Esophageal web]]
| |
| * [[Esophagitis]]
| |
| * [[External esophageal compression]]
| |
| * [[Spinal curvature|Extreme spinal curvature]]
| |
| * [[Fibrosis]]
| |
| * [[Fluoride|Fluoridated toothpaste]]
| |
| * [[Esophageal food bolus obstruction|Food bolus]]
| |
| * [[Facial Onset Sensory Motor Neuropathy syndrome]]
| |
| * Franek-bocker-kahlen syndrome
| |
| * [[Frontotemporal dementia]]
| |
| * [[Functional disorders]]
| |
| * [[Gastric cancer]]
| |
| * [[Gastric volvulus]]
| |
| * [[Gastritis]]
| |
| * [[Gastroesophageal reflux]]
| |
| * [[Gastroparesis]]
| |
| * [[Gaucher disease]]
| |
| * [[Gastroparesis]]
| |
| * [[Global hystericus]]
| |
| * [[Globus syndrome]]
| |
| * [[Goiter]]
| |
| * [[Graft-versus-host disease]]
| |
| * [[Guillain-Barre Syndrome]]
| |
| * [[Herpangina]]
| |
| * [[Herpes simplex virus]]
| |
| * [[Hiatal hernia]]
| |
| * [[Huntington's chorea]]
| |
| * [[Huntington disease]]
| |
| * [[Hydroxocobalamin]]
| |
| * [[Hyperthyroidism]]
| |
| * [[Hypokalemia]]
| |
| * [[Hypomagnesemia|Hypomagnesemia primary]]
| |
| * [[Hypophosphatemia ]]
| |
| * [[Hypothyroidism]]
| |
| * Idiopathic human immunodeficiency virus ulcers
| |
| * [[Larynx|Impaired sensitivity in the larynx]]
| |
| * [[Inclusion body myositis]]
| |
| * Infantile striato-thalamic degeneration
| |
| * [[Esophagitis causes|Infectious esophagitis]]
| |
| * [[Esophageal intramural pseudodiverticulosis|Intramural pseudodiverticulosis]]
| |
| * [[Ixabepilone]]
| |
| * [[Laryngeal cancer]]
| |
| * [[Laryngeal papillomatosis]]
| |
| * [[Lead poisoning]]
| |
| * [[Leiomyoma]]
| |
| * [[Jean Lhermitte|Lhermitte-cornil-quesnel syndrome]]
| |
| * [[Lissencephaly|Lissencephaly, type 1, x-linked ]]
| |
| * [[Ludwig's angina]]
| |
| * [[Lyme disease]]
| |
| * [[Lymphomatoid granulomatosis|Lymph granulomatosis]]
| |
| * [[Lymphadenopathy]]
| |
| * [[esophagitis|Medication-induced esophagitis]]
| |
| * [[Encephalopathy|Metabolic encephalopathies]]
| |
| * [[Microcephaly brain defect spasticity hypernatremia]]
| |
| * [[Mitochondrial neurogastrointestinal encephalopathy syndrome]]
| |
| * [[Mitral valve stenosis]]
| |
| * [[Mononucleosis]]
| |
| * [[Motor neuron disease]]
| |
| * [[Mucositis]]
| |
| * [[Multiple Sclerosis]]
| |
| * [[Multiple system atrophy]]
| |
| * [[Mumps]]
| |
| * [[Muscular dystrophy, Duchenne and Becker type]]
| |
| * [[Myasthenia Gravis]]
| |
| * [[Congenital myasthenic syndrome]]
| |
| * [[Myoneurogastrointestinal encephalopathy syndrome]]
| |
| * [[Myopathy]]
| |
| * [[Myotonic dystrophy]]
| |
| * [[Nasopharyngeal carcinoma ]]
| |
| * [[Head and neck cancer|Neck cancer]]
| |
| * [[Congenital myopathy|Nemaline myopathy1]]
| |
| * [[Neonatal tetanus]]
| |
| * [[Neoplastic]] (external compression)
| |
| * [[Neuroferritinopathy]]
| |
| * [[Neuroleptics]]
| |
| * [[Neurosarcoidosis ]]
| |
| * [[Nutcracker esophagus]]
| |
| * [[Oculopharyngeal muscular dystrophy]]
| |
| * [[Odontoma]]
| |
| * [[Ondine's curse]]
| |
| * [[Autosomal dominant opitz G/BBB syndrome|Opitz-frias syndrome]]
| |
| * [[Oral candidiasis]]
| |
| * [[Oral cancer|Oral cavity tumor]]
| |
| * [[Oral pharyngeal disorders]]
| |
| * [[Oral submucous fibrosis]]
| |
| * [[Oropharyngeal cancer]]
| |
| * [[Osteophytes]]
| |
| * [[Oral cancer|Palate cancer]]
| |
| * [[Palatoplegia]]
| |
| * Pallidopyramidal syndrome
| |
| * [[Paracoccidioidomycosis]]
| |
| * [[Paraganglioma ]]
| |
| * [[Paraneoplastic limbic encephalitis]]
| |
| * [[Paraneoplastic syndrome]]
| |
| * [[Parkinson's Disease]]
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| * [[Peptic esophagitis]]
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| * [[Esophageal stricture|Peptic stricture]]
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| * [[Pergolide]]
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| * [[Pericarditis]]
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| * [[Peripheral neuropathy]]
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| * [[Tongue|Peripheral tongue paralysis]]
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| * [[Pharyngitis]]
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| * [[Head and neck cancer|Pharynx cancer]]
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| * [[Pierre Robin syndrome]]
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| * [[esophagitis|Pill esophagitis]]
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| * [[Esophagitis|Pill injury]]
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| * [[Pleuritis]]
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| * [[Plummer-Vinson Syndrome]]
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| * [[Polio]]
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| * [[Poliomyelitis]]
| |
| * [[Polyradiculitis]]
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| * [[Pontocerebellar hypoplasia|Pontocerebellar hypoplasia type 2a]]
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| * [[Surgery|Post surgery]] ([[laryngeal]], [[esophageal]], [[gastric]])
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| * [[Post polio syndrome]]
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| * [[Primary lateral sclerosis|Primary lateral sclerosis, adult]]
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| * [[Esophageal motility disorder|Primary motility disorders]]
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| * [[Pseudoachalasia]]
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| * Pseudoadrenoleukodystrophy
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| * [[Pseudobulbar paralysis]]
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| * [[Pyloric stenosis]]
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| * [[Quinsy]]
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| * [[Rabies]]
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| * [[Radiation esophagitis]]
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| * [[Radiation therapy]]
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| * [[Tracheotomy|Recent tracheotomy]]
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| * [[Reflux esophagitis]]
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| * [[Retropharyngeal abscess]]
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| * [[Rheumatoid Arthritis]]
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| * [[Riedel thyroiditis]]
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| * [[Riociguat]]
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| * [[Rumination disorder]]
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| * [[Sarcoidosis]]
| |
| * [[Sargramostim]]
| |
| * [[Scarlet Fever]]
| |
| * [[Schatzki ring]]
| |
| * [[Scleroderma]]
| |
| * [[Esophageal motility disorder|Secondary motility disorders]]
| |
| * [[Sensory ataxic neuropathy, dysarthria, and ophthalmoparesis ]]
| |
| * [[Shy-Drager Syndrome]]
| |
| * [[Small cell lung cancer ]]
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| * [[Hereditary spastic paraplegia|Spastic paraplegia 11, autosomal recessive]]
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| * [[Spinal muscular atrophy type I]]
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| * [[Spinocerebellar ataxia 17 ]]
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| * [[Spinocerebellar ataxia|Spinocerebellar ataxia 22]]
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| * [[Spinocerebellar ataxia|Spinocerebellar ataxia, autosomal recessive 1 ]]
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| * [[Stevens-Johnson Syndrome]]
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| * [[Stomach cancer]]
| |
| * [[Stomatitis]]
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| * Striatonigral degeneration infantile
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| * [[Stroke]]
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| * [[Stuve-wiedemann dysplasia]]
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| * [[Subacute granulomatous thyroiditis ]]
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| * [[Subacute thyroiditis]]
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| * [[Supraglottic laryngeal cancer ]]
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| * [[Syphilis]]
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| * [[Syringobulbia]]
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| * [[Systemic Lupus Erythematosus]]
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| * [[Systemic sclerosis]]
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| * [[Tardive dyskinesia]]
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| * [[Tetanus]]
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| * [[Head and neck cancer|Throat cancer]]
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| * [[Thyroglossal tract cyst ]]
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| * [[Anaplastic thyroid cancer|Thyroid cancer, anaplastic ]]
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| * [[Thyrotoxicosis]]
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| * [[Tiagabine]]
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| * [[Tongue cancer]]
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| * [[Tongue disease|Tongue conditions]]
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| * [[The '''tongue''' is a [[muscular hydrostat]] on the floor of the mouth of most [[vertebrate]]s that manipulates food for [[mastication]]. It is the primary [[organ (anatomy)|organ]] of [[taste]] (gustation), as much of its upper surface is covered in [[taste buds]]. The tongue's upper surface is also covered in numerous [[lingual papilla]]e. It is sensitive and kept moist by [[saliva]], and is richly supplied with nerves and blood vessels. In humans a secondary function of the tongue is [[Articulatory phonetics|phonetic articulation]]. The tongue also serves as a natural means of [[oral hygiene|cleaning]] the teeth.<ref>{{cite book |last1=Maton |first1=Anthea |last2=Hopkins |first2=Jean |last3=McLaughlin |first3=Charles William |last4=Johnson |first4=Susan |last5=Warner |first5=Maryanna Quon |last6=LaHart |first6=David |last7=Wright |first7=Jill D. |title=Human Biology and Health |publisher=Prentice Hall |year=1993 |location=Englewood Cliffs, New Jersey, USA |isbn=0-13-981176-1}}</ref> The ability to perceive different tastes is not localised in different parts of the tongue, as is widely believed.<ref>[http://www.scientificamerican.com/article.cfm?id=the-taste-map-all-wrong The Taste Map: All Wrong], ''[[Scientific American]], March 18, 2001.</ref> This error arose because of misinterpretation of some 19th-century research (see [[tongue map]]).
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|
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| ==Structure==
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| [[File:Facies inferior linguae.JPG|right|thumb|175px|The underside of a human tongue]]
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| The tongue is a muscular structure that forms part of the floor of the [[oral cavity]]. The left and right sides of the tongue are separated by the [[lingual septum]]. The human tongue is divided into [[Anatomical terms of location#Anterior and posterior|anterior and posterior]] parts. The anterior part is the visible part situated at the front and makes up roughly two-thirds the length of the tongue. The posterior part is the part closest to the throat, roughly one-third of its length. These parts differ in terms of their embryological development and nerve supply. The two parts of the tongue are divided by the [[Terminal sulcus (tongue)|terminal sulcus]].<ref name=GRAYS2005>{{cite book|last=Drake|first=Richard L.|title=Gray's anatomy for students|year=2005|publisher=Elsevier/Churchill Livingstone|location=Philadelphia|isbn=978-0-8089-2306-0|author2=Vogl, Wayne |author3=Tibbitts, Adam W.M. Mitchell |author4=illustrations by Richard |author5= Richardson, Paul }}</ref>{{rp|989–990}}
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|
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| The anterior tongue is, at its apex, thin and narrow, it is directed forward against the lingual surfaces of the lower [[incisor]] teeth. The posterior part is, at its root, directed backward, and connected with the [[hyoid bone]] by the [[hyoglossi]] and [[genioglossi]] muscles and the [[hyoglossal membrane]], with the [[epiglottis]] by three folds (glossoepiglottic) of mucous membrane, with the [[soft palate]] by the [[glossopalatine arches]], and with the [[pharynx]] by the [[superior pharyngeal constrictor muscle]] and the [[mucous membrane]]. It also forms the anterior wall of the [[oropharynx]].
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|
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| In [[phonetics]] and [[phonology]], a distinction is made between the '''tip''' of the tongue and the '''blade''' (the portion just behind the tip). Sounds made with the tongue tip are said to be [[apical consonant|apical]], while those made with the tongue blade are said to be [[laminal consonant|laminal]].
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|
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| ===Muscles===
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| The eight muscles of the human tongue are classified as either ''intrinsic'' or ''extrinsic''. The four intrinsic muscles act to change the shape of the tongue, and are not attached to any bone. The four extrinsic muscles act to change the position of the tongue, and are anchored to bone.
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|
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| <gallery>
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| File:Gray1020.png |Coronal section of tongue, showing intrinsic muscles
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| File:Gray1019.png |Lateral view of the tongue, with extrinsic muscles highlighted.
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| </gallery>
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|
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| ====Extrinsic====
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| The extrinsic muscles originate from bone and extend to the tongue. Their main functions are altering the tongue's position allowing for protrusion, retraction, and side-to-side movement.<ref name=GRAYS2005 />{{rp|991}}
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| # [[Genioglossus]], which arises from the [[mandible]] and protrudes the tongue. It is also known as the "safety muscle" of the tongue since it is the only muscle having the forward action.
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| # [[Hyoglossus]], which arises from the [[hyoid bone]] and depresses the tongue
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| # [[Styloglossus]], which arises from the [[styloid process]] of the temporal bone and elevates and retracts the tongue
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| # [[Palatoglossus]], which arises from the [[palatine aponeurosis]], and depresses the [[soft palate]], moves the ''palatoglossal fold'' towards the midline, and elevates the back of the tongue.
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|
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| ====Intrinsic====
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| Four paired intrinsic muscles of the tongue originate and insert within the tongue, running along its length. These muscles alter the shape of the tongue by: lengthening and shortening it, curling and uncurling its apex and edges, and flattening and rounding its surface. This provides shape, and helps facilitate speech, swallowing, and eating.<ref name=GRAYS2005 />{{rp|991}}
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| # The [[superior longitudinal muscle of tongue|superior longitudinal muscle]] runs along the superior surface of the tongue under the mucous membrane, and elevates, assists in retraction of, or deviates the tip of the tongue. It originates near the [[epiglottis]], the [[hyoid bone]], from the median fibrous septum.
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| # The [[inferior longitudinal muscle of tongue|inferior longitudinal muscle]] lines the sides of the tongue, and is joined to the styloglossus muscle.
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| # The [[vertical muscle of tongue|vertical muscle]] is located in the middle of the tongue, and joins the superior and inferior longitudinal muscles.
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| # The [[transverse muscle of tongue|transverse muscle]] divides the tongue at the middle, and is attached to the [[mucous membrane]]s that run along the sides.
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|
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| ===Blood supply===
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| The tongue receives its [[blood]] supply primarily from the [[lingual artery]], a branch of the [[external carotid artery]]. The [[lingual veins]], drain into the [[internal jugular vein]]. The floor of the mouth also receives its blood supply from the lingual artery.<ref name=GRAYS2005 />{{rp|993–994}} There is also a secondary blood supply to the tongue from the [[tonsillar branch of the facial artery]] and the [[ascending pharyngeal artery]].
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|
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| An area in the neck sometimes called [[Pirogov Triangle|Pirogov's triangle]] is formed by the intermediate tendon of the [[digastric muscle]], the posterior border of the [[mylohyoid muscle]], and the [[hypoglossal]] nerve.<ref>[http://www.whonamedit.com/synd.cfm/3186.html Pirogov's triangle]</ref><ref>{{cite journal |title=Topographic anatomy of lingual arterial anastomoses; Pirogov-Belclard's triangle |last1=Jamrozik |first1=T. |last2=Wender |first2=W. |journal=Folia Morphologica |volume=3 |issue=1 |pages=51–62 |date=January 1952 |pmid=13010300}}</ref> The lingual artery is a good place to stop severe [[hemorrage]] from the tongue.
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|
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| ===Innervation===
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| Innervation of the tongue consists of motor fibers, [[special visceral afferent|special sensory]] fibers for taste, and [[general visceral afferent|general sensory]] fibers for sensation.<ref name=GRAYS2005 />{{rp|994–5}}
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|
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| *Motor supply for all intrinsic and extrinsic muscles of the tongue is supplied by [[efferent nerve fiber|efferent motor nerve fibers]] from the [[hypoglossal nerve]] (CN XII), with the exception of the [[palatoglossus]]. The palatoglossus is innervated by the [[vagus nerve]] (CN X).<ref name=GRAYS2005 />{{rp|995}}
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|
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| Innervation of taste and sensation is different for the anterior and posterior part of the tongue because they are derived from different embryological structures ([[pharyngeal arch]] 1 and pharyngeal arch 3 and 4, respectively).<ref>{{Cite book | edition = Sixth
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| | publisher = LWW | isbn = 9781451190380 | last = PhD | first = Dr Ronald W. Dudek | title = BRS Embryology | date = 2014}}</ref>
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|
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| *Anterior two thirds of tongue (anterior to the [[Lingual papilla#Circumvallate papillae|vallate papillae]]):
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| **Taste: chorda tympani branch of the [[facial nerve]] (CN VII) via [[special visceral afferent]] fibers
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| **Sensation: lingual branch of the mandibular division (V3) of the [[trigeminal nerve]] (CN V) via [[general somatic afferent]] fibers
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|
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| *Posterior one third of tongue:
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| **Taste and sensation: [[glossopharyngeal nerve]] (CN IX) via a mixture of special and general visceral afferent fibers
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|
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| ===Histology===
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| [[File:Human tongue (251 09) Section.jpg|thumb|Section through the human tongue; stained [[Hematoxylin and eosin stain|H&E]]]]
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| The tongue is covered with numerous [[taste bud]]s, and [[filiform papillae|filiform]], [[fungiform papillae|fungiform]], [[vallate papillae|vallate]] and [[foliate papillae|foliate]], [[lingual papilla]]e.<ref name=GRAYS2005 />{{rp|990}}
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|
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| ===Length===
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| The average length of the human tongue from the [[oropharynx]] to the tip is 10cms in length.<ref>{{cite book |year=1997 |last=Kerrod |first=Robin |title=MacMillan's Encyclopedia of Science |publisher=Macmillan Publishing Company, Inc. |volume=6 |isbn=0-02-864558-8}}</ref>
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|
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| ===Development===
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| The anterior tongue is derived primarily from the [[first pharyngeal arch]]. The posterior tongue is derived primarily from the third [[pharyngeal arch]]. The second arch however has a substantial contribution during fetal development, but this later atrophies. The fourth arch may also contribute, depending upon how the boundaries of the tongue are defined.
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|
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| The terminal sulcus, which separates the anterior and posterior tongue, is shaped like a V, with the tip of the V situated posteriorly. At the apex is the [[foramen caecum]], which is the point where the embryological [[thyroid]] begins to descend.<ref name=GRAYS2005 />{{rp|990}}
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|
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| ==Function==
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| {{multiple image
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| | align = right
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| | direction = horizontal
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| | width = 250
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| | image1 = Tongue_and_taste_buds.jpg
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| | width1 = 250
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| | alt1 = Human tongue and taste buds
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| | image2 = 1402 The Tongue.jpg
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| | width2 = 240
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| | alt2 = Taste receptors in papillae
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| | footer = Taste receptors are present on the human tongue in papillae
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| | footer_align = center
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| }}
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|
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| ===Taste===
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| {{main|Taste|Taste receptor|Supertaster}}
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| Chemicals that stimulate [[taste receptor]] cells are known as tastants. Once a tastant is dissolved in [[saliva]], it can make contact with the [[plasma membrane]] of the gustatory hairs, which are the sites of taste [[transduction (physiology)|transduction]].<ref>Tortora. ''Principles of Anatomy and Physiology'' 12th edition, chapter 17, p.602.</ref>
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|
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| The tongue is equipped with many [[taste buds]] on its [[Anatomical terms of location|dorsal]] surface, and each taste bud is equipped with taste receptor cells that can sense particular classes of tastes. Distinct types of taste receptor cells respectively detect substances that are sweet, bitter, salty, sour, spicy, or taste of [[umami]].<ref>Silverhorn. ''Human Physiology: An integrated approach'' 5th edition, chapter 10, p.352.</ref> Umami receptor cells are the least understood and accordingly are the type most intensively under research.<ref>Schacter, Daniel L., Daniel Todd. Gilbert, and Daniel M. Wegner. "Sensation and Perception." Psychology. 2nd ed. New York: Worth, 2009. 166. Print.</ref>
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|
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| ===Mastication===
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| The tongue is also used for crushing food against the hard palate, during mastication. The [[epithelium]] on the tongue’s upper, or dorsal surface is [[keratin]]ised. Consequently, the tongue can grind against the hard palate without being itself damaged or irritated.<ref>Atkinson. "Anatomy for dental students'' 4th edition.</ref>
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| ===Swallowing===
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| ===Speech===
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| ==Clinical relevance==
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|
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| ===Disease===
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| {{Main|Tongue disease}}
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|
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| After the [[Gingiva|gum]]s, the tongue is the second most common [[soft tissue]] site for various [[pathology|pathologies]] in the [[oral cavity]].{{medical citation needed|date=July 2013}} Examples of pathological conditions of the tongue include [[glossitis]] (e.g. [[geographic tongue]], [[median rhomboid glossitis]]), [[burning mouth syndrome]], [[oral hairy leukoplakia]], [[oral candidiasis]] and [[squamous cell carcinoma]].<ref name="SCC">{{cite journal |last1=Lam |first1=L. |last2=Logan |first2=R. M. |last3=Luke |first3=C. |title=Epidemiological analysis of tongue cancer in South Australia for the 24-year period, 1977-2001 |journal=Aust Dent J |volume=51 |issue=1 |pages=16–22 |date=March 2006 |pmid=16669472 |doi=10.1111/j.1834-7819.2006.tb00395.x}}</ref> Food debris, desquamated epithelial cells and bacteria often form a visible tongue coating.<ref name=Newman2012>{{cite book|last=(editors) Newman MG, Takei HH, Klokkevold PR, Carranza FA|title=Carranza's clinical periodontology|year=2012|publisher=Elsevier/Saunders|location=St. Louis, Mo.|isbn=978-1-4377-0416-7|pages=84–96|edition=11th}}</ref> This coating has been identified as a major contributing factor in bad breath ([[halitosis]]),<ref name=Newman2012 /> which can be managed by brushing the tongue gently with a toothbrush or using special oral hygiene instruments such as tongue scrapers or mouth brushes.<ref name=Outhouse2006>{{cite journal|last=Outhouse|first=TL|author2=Al-Alawi, R |author3=Fedorowicz, Z |author4= Keenan, JV |title=Tongue scraping for treating halitosis.|journal=The Cochrane database of systematic reviews|date=Apr 19, 2006|issue=2|pages=CD005519|pmid=16625641 |doi=10.1002/14651858.CD005519.pub2}}</ref>
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| ===Medical delivery===
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| The [[sublingual]] region underneath the front of the tongue is a location where the [[oral mucosa]] is very thin, and underlain by a plexus of veins. This is an ideal location for introducing certain medications to the body. The sublingual route takes advantage of the highly [[Blood vessel|vascular]] quality of the oral cavity, and allows for the speedy application of medication into the cardiovascular system, bypassing the gastrointestinal tract. This is the only convenient and efficacious route of administration (apart from [[Intravenous therapy|I.V.]] administration) of [[Glyceryl trinitrate (pharmacology)|nitroglycerin]] to a patient suffering chest pain from [[angina pectoris]].
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| ==Society and culture==
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|
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| ===Figures of speech===
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| The tongue can be used as a [[metonymy|metonym]] for ''language'', as in the phrase ''[[mother tongue]]''. Many languages<ref>[[Afrikaans language|Afrikaans]] ''tong''; [[Danish language|Danish]] ''tunge''; [[Albanian language|Albanian]] ''gjuha''; [[Armenian language|Armenian]] ''lezu'' (լեզու); [[Greek language|Greek]] ''glóssa'' (γλώσσα); [[Irish language|Irish]] ''teanga''; [[Manx language|Manx]] ''çhengey''; [[Latin]] and [[Italian language|Italian]] ''lingua''; [[Catalan language|Catalan]] ''llengua''; [[French language|French]] ''langue''; [[Portuguese language|Portuguese]] ''língua''; [[Spanish language|Spanish]] ''lengua''; [[Romanian language|Romanian]] ''limba''; [[Bulgarian language|Bulgarian]] ''ezik'' (език); [[Polish language|Polish]] ''język''; [[Russian language|Russian]] ''yazyk'' (язык); [[Czech language|Czech]] and [[Slovak language|Slovak]] ''jazyk''; [[Slovene language|Slovene]], [[Bosnian language|Bosnian]], [[Croatian language|Croatian]], and [[Serbian language|Serbian]] ''jezik''; [[Kurdish language|Kurdish]] ''ziman'' (زمان); [[Persian language|Persian]] and [[Urdu]] ''zabān'' (زبان); [[Arabic]] ''lisān'' (لسان); [[Aramaic language|Aramaic]] ''liššānā'' (ܠܫܢܐ/לשנא); [[Hebrew language|Hebrew]] ''lāšon'' (לָשׁוֹן); [[Maltese language|Maltese]] ''ilsien''; [[Estonian language|Estonian]] ''keel''; [[Finnish language|Finnish]] ''kieli''; [[Hungarian language|Hungarian]] ''nyelv''; [[Azerbaijani language|Azerbaijani]] and [[Turkish language|Turkish]] ''dil''; [[Kazakh language|Kazakh]] and [[Khakas language|Khakas]] ''til'' (тіл)</ref> have the same word for "tongue" and "[[language]]".
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| A common temporary failure in word [[Recollection|retrieval]] from [[memory]] is referred to as the ''[[Tip of the tongue|tip-of-the-tongue]]'' [[phenomenon]]. The expression ''[[Tongue-in-cheek|tongue in cheek]]'' refers to a statement that is not to be taken entirely seriously – something said or done with subtle ironic or sarcastic humour. A ''[[tongue twister]]'' is a phrase made specifically to be very difficult to pronounce. Aside from being a [[Ankyloglossia|medical condition]], "tongue-tied" means being unable to say what you want to due to confusion or restriction. The phrase "cat got your tongue" refers to when a person is speechless. To "bite one's tongue" is a phrase which describes holding back an opinion to avoid causing offence. A "slip of the tongue" refers to an unintentional utterance, such as a [[Freudian slip]]. [[Speaking in tongues]] is a common phrase used to describe ''glossolalia'', which is to make smooth, language-resembling sounds that is no true spoken language itself. A deceptive person is said to have a [[forked tongue]], and a smooth-talking person said to have a {{Linktext|silver tongue}}.
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|
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| ===Gestures===
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| Sticking one's tongue out at someone is considered a childish gesture of [[rudeness]] and/or defiance in many countries; the act may also have sexual connotations, depending on the way in which it is done. However, in [[Tibet]] it is considered a greeting.<ref>{{cite web |url=http://www.tibetwrites.org/?Tibetan-Culture-in-the-21st |title=Tibetan culture in the 21st century |author=Bhuchung K Tsering |date=27 December 2007 |accessdate=13 February 2012}}</ref> In 2009, a farmer from [[Fabriano]], Italy was convicted and fined by [[Court of Cassation (Italy)|the country's highest court]] for sticking his tongue out at a neighbor with whom he had been arguing. Proof of the affront had been captured with a cell phone camera.<ref name="UPI">[http://www.upi.com/Odd_News/2009/12/19/Sticking-out-your-tongue-ruled-illegal/UPI-71761261272837/ Sticking out your tongue ruled illegal]</ref> [[Blowing a raspberry]] can also be meant as a gesture of derision.{{cn|date=September 2015}}
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| ===Body art===
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| Being a cultural custom for long time, [[tongue piercing]] and [[tongue splitting|splitting]] has become quite common in western countries in recent decades, with up to one-fifth of young adults having at least one piece of body art in the tongue.<ref name="DTLEVIN">{{cite journal |last1=Liran |first1=Levin |last2=Yehuda |first2=Zadik |last3=Tal |first3=Becker |title=Oral and dental complications of intra-oral piercing |journal=Dent Traumatol |volume=21 |issue=6 |pages=341–3 |date=December 2005 |pmid=16262620 |doi= 10.1111/j.1600-9657.2005.00395.x |accessdate=2008-07-16}}</ref>
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| ===As food===
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| {{See also|Beef tongue}}
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|
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| The tongues of some animals are consumed and sometimes considered delicacies. Hot tongue sandwiches are frequently found on menus in [[Kosher]] [[delicatessen]]s in America. [[Taco|Taco de lengua]] (''lengua'' being Spanish for tongue) is a taco filled with [[beef tongue]], and is especially popular in Mexican cuisine. As part of Colombian gastronomy, Tongue in Sauce (Lengua en Salsa), is a dish prepared by frying the tongue, adding tomato sauce, onions and salt. Tongue can also be prepared as [[birria]]. Pig and beef tongue are consumed in Chinese cuisine. [[Duck]] tongues are sometimes employed in [[Szechuan cuisine|Szechuan]] dishes, while [[Lamb (food)|lamb]]'s tongue is occasionally employed in Continental and contemporary American cooking. Fried [[cod]] "tongue" is a relatively common part of fish meals in [[Norway]] and [[Newfoundland and Labrador|Newfoundland]]. In [[Argentina]] and [[Uruguay]] cow tongue is cooked and served in vinegar (''lengua a la vinagreta''). In the Czech Republic and Poland, a pork tongue is considered a delicacy, and there are many ways of preparing it. In Eastern Slavic countries, pork and beef tongues are commonly consumed, boiled and garnished with horseradish or jelled; beef tongues fetch a significantly higher price and are considered more of a delicacy. In Alaska, cow tongues are among the more common.
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| Tongues of seals and whales have been eaten, sometimes in large quantities, by sealers and whalers, and in various times and places have been sold for food on shore.<ref>CHARLES BOARDMAN HAWES. Whaling. Doubleday, 1924</ref>
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| ==History==
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| ===Etymology===
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| The word '''tongue''' derives from the [[Old English]] ''tunge'', which comes from [[Proto-Germanic]] *''tungōn''.<ref name="OED">[http://www.etymonline.com/index.php?term=tongue Online Etymology Dictionary]</ref> It has [[cognates]] in other [[Germanic languages]] — for example ''tonge'' in [[West Frisian language|West Frisian]], ''tong'' in [[Dutch language|Dutch]]/[[Afrikaans]], ''Zunge'' in [[German language|German]], ''tunge'' in [[Danish language|Danish]]/[[Norwegian language|Norwegian]] and ''tunga'' in [[Icelandic language|Icelandic]]/[[Faroese language|Faroese]]/[[Swedish language|Swedish]]. The ''ue'' ending of the word seems to be a fourteenth-century attempt to show "proper pronunciation", but it is "neither etymological nor phonetic".<ref name="OED"/> Some used the spelling ''tunge'' and ''tonge'' as late as the sixteenth century.
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| ==Other animals==
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| [[File:Giraffe's tongue.jpg|thumb|Giraffe's tongue]]
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| [[File:Okapitongue.jpg|thumb|right|An [[okapi]] cleaning its [[snout|muzzle]] with its tongue]]
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| Most [[vertebrate]] animals have tongues. In mammals such as [[dog]]s and [[cat]]s, the tongue is often used to clean the fur and body. The tongues of these species have a very rough texture which allows them to remove oils and parasites. A dog's tongue also acts as a heat regulator. As a dog increases its exercise the tongue will increase in size due to greater blood flow. The tongue hangs out of the dog's mouth and the moisture on the tongue will work to cool the bloodflow.<ref>[http://www.doctordog.com/drdognewsletter/tongue.html A dog's tongue]</ref><ref>{{cite journal |title=Lingual blood flow and its hypothalamic control in the dog during panting |journal=[[Pflügers Archiv European Journal of Physiology]] |date=January 1976 |issn=0031-6768 |doi=10.1007/BF00583652 |pages=25–31 |volume=367 |issue=1 |last1=Krönert |first1=H. |last2=Pleschka |first2=K. |accessdate=June 24, 2011}}</ref>
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| Some animals have tongues that are specially adapted for catching prey. For example, [[chameleon]]s, [[frog]]s, and [[anteater]]s have [[prehensility|prehensile]] tongues.
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| Many species of fish have small folds at the base of their mouths that might informally be called tongues, but they lack a muscular structure like the true tongues found in most [[tetrapod]]s.<ref name=VB>{{cite book |last1=Romer |first1=Alfred Sherwood |last2=Parsons |first2=Thomas S. |year=1977 |title=The Vertebrate Body |publisher=Holt-Saunders International |location= Philadelphia, PA |pages=298–299 |isbn= 0-03-910284-X}}</ref><ref>{{cite book |last=Kingsley |first=John Sterling |year=1912 |title=Comparative anatomy of vertebrates |publisher=P. Blackiston's Son & Co. |pages=217–220 |isbn= 1-112-23645-7}}</ref>
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| Other animals may have organs that are [[analogy (biology)|analogous]] to tongues, such as a [[butterfly]]'s [[proboscis]] or a [[radula]] on a [[mollusca|mollusc]], but these are not [[Homology (biology)|homologous]] with the tongues found in vertebrates, and often have little resemblance in function, for example, butterflies do not lick with their proboscides; they suck through them, and the proboscis is not a single organ, but two jaws held together to form a tube.<ref name= "isbn0-412-61390-5">{{cite book |last1=Richards |first1=O. W. |last2=Davies |first2=R. G. |title=Imms' General Textbook of Entomology: Volume 1: Structure, Physiology and Development Volume 2: Classification and Biology |publisher=Springer |location=Berlin |year=1977 |isbn=0-412-61390-5}}</ref>
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| [[File:Macroglossum stellatarum anatomy - MHNT.jpg|thumb|''[[Macroglossum]]'': View of the extended proboscis, which inspired the name of the animal, literally "long-tongue"]]
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| ==Additional Images==
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| <gallery>
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| File:Tongue.agr.jpg|The human tongue
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| </gallery>
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| ==See also==
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| {{Anatomy-terms}}
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| {{col-begin}}{{col-break}}
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| * [[Ankyloglossia]]
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| * [[Electronic tongue]]
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| * [[Language]]
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| * [[Licking]]
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| * [[List of Mendelian traits in humans]] {{nb10}}
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| * [[Oral cancer]]
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| * [[Taste bud]]
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| * [[Tip of the tongue]]
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| {{col-break}}
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| * [[Tongue splitting]]
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| * [[Tongue cleaner]]
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| * [[Tongue disease]]
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| * [[Tongue piercing]]
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| * [[Tongue rolling]]
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| * [[Tongue-twister]]
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| * [[Vocal tract]]
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| {{col-end}}
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| ==References== | | ==References== |
| {{Gray's}}
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| {{Reflist|2}} | | {{Reflist|2}} |
| | {{WH}} |
| | {{WS}} |
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| ==External links==
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| {{Commons category|tongue}}
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| {{wikiquote}}
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| {{Wiktionary}}
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| *[http://www.umanitoba.ca/faculties/arts/linguistics/russell/138/sec1/anatomy.htm University of Manitoba, Anatomy of the Vocal Tract]
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|
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| {{Mouth anatomy}}
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| {{Gustatory system}}
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| {{Taste}}
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| {{Authority control}}
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| [[Category:Sensory organs]]
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| [[Category:Gustatory system]]
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| [[Category:Tongue|*]]
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| [[Category:Digestive system]]
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| [[Category:Human mouth anatomy]]
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| * [[Tonsil cancer|Tonsillar cancer]]
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| * [[Tonsillar abscess]]
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| * Typhoid fever angina
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| * [[Ulcer ]]
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| * [[Upper oesophageal sphincter dysfunction]]
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| * [[Vagal paraganglioma ]]
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| * [[Vascular anomaly|Vascular abnormality]]
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| * [[Vascular ring|Vascular ring with right aortic arch]]
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| * [[Vincent's angina]]
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| * [[Lateral medullary syndrome|Wallenberg's syndrome]]
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| * [[Wiedemann–Rautenstrauch syndrome]]
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| * [[Wilson disease]]
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| * [[Zenker's Diverticulum]]
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| }}
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| ===Common Causes of Oropharyngeal Dysphagia===
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| * A [[stroke]] can trigger a rapid onset of dysphagia with a high occurrence of aspiration. The function of normal [[swallowing]] may or may not return completely following an acute phase lasting approximately 6 weeks. <ref name="Murray">Murray, J. (1999). ''Manual of Dysphagia Assessment in Adults''. San Diego: Singular Publishing. </ref>
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| * [[Parkinson's disease]] can cause "multiple prepharyngeal, pharyngeal, and esophageal abnormalities". The severity of the disease most often correlates with the severity of the swallowing disorder.<ref name="Murray"> </ref>
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| * Neurologic disorders such as [[stroke]], [[Parkinson's disease]], [[amyotrophic lateral sclerosis]], [[Bell's palsy]], or [[myasthenia gravis]] can cause weakness of facial and lip muscles that are involved in coordinated mastication as well as weakness of other important [[Mastication#Muscles of mastication|muscles of mastication]] and swallowing.
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| * [[Oculopharyngeal muscular dystrophy]] is a genetic disease with palpebral [[ptosis (eyelid)|ptosis]], oropharyngeal dysphagia, and proximal limb weakness.
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| * Decrease in salivary flow, which can lead to dry mouth or [[xerostomia]], can be due to [[Sjogren's syndrome]], [[anticholinergics]], [[antihistamines]], or certain [[antihypertensives]] and can lead to incomplete processing of food bolus.
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| * [[Xerostomia]] can reduce the volume and increase the [[viscosity]] of oral secretions making [[Bolus (digestion)|bolus]] formation difficult as well as reducing the ability to initate and swallow the bolus<ref name="Murray"> </ref>
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| * Dental problems can lead to inadequate chewing.
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| * Abnormality in oral mucosa such as from [[mucositis]], aphthous [[ulcer]]s, or [[Herpes simplex virus|herpetic lesions]] can interfere with [[Bolus (digestion)|bolus]] processing.
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| * Mechanical obstruction in the oropharynx may be due to malignancies, cervical rings or webs, or cervical [[osteophytes]].
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| * Increased upper esophageal sphincter tone can be due to [[Parkinson's disease]] which leads to incomplete opening of the UES. This may lead to formation of a [[Zenker's diverticulum]].
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| * [[Pharyngeal pouch]]es typically cause difficulty in swallowing after the first mouthful of food, with regurgitation of the pouch contents. These pouches are also marked by malodorous breath due to decomposing foods residing in the pouches. (See [[Zenker's diverticulum]])
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| * Dysphagia is often a side effect of surgical procedures like anterior [[cervical spine]] surgery, [[carotid endarterectomy]], head and neck resection, oral surgeries like removal of the tongue, and parietal laryngectomies <ref name="Murray"> </ref>
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| * [[Radiotherapy]], used to treat head and neck cancer, can cause tissue [[fibrosis]] in the irradiated areas. Fibrosis of [[tongue]] and [[larynx]] lead to reduced tongue base retraction and laryngeal elevation during swallowing<ref name="Murray"> </ref>
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| * Infection may cause [[pharyngitis]] which can prevent swallowing due to [[Pain and nociception|pain]].
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| * Medications can cause [[central nervous system]] effects that can result in an oropharyngeal dysphagia. Examples: [[sedatives]], hypnotic agents, [[anticonvulsants]], [[antihistamines]], [[neuroleptics]], [[barbiturates]], and antiseizure medication. Medications can also cause [[peripheral nervous system]] effects resulting in an oropharyngeal dysphagia. Examples: [[corticosteroids]], [[tetracycline]], [[L-tryptophan]], and [[anticholinergic]]s<ref name="Murray"> </ref>
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| ===Common Causes of Esophageal Dysphagia===
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| * '''''Peptic stricture''''', or narrowing of the esophagus, is usually a complication of acid reflux, most commonly due to [[gastroesophageal reflux]] ([[GERD]]). These patients are usually older and have had [[GERD]] for a long time. Acid reflux can also be due to other causes, such as [[Zollinger-Ellison syndrome]], NG tube placement, and [[scleroderma]]. Other non-acid related causes of peptic strictures include infectious esophagitis, ingestion of chemical irritant, pill irritation, and radiation. Peptic stricture is a progressive mechanical dysphagia, meaning patients will complain of initial intolerance to solids followed by inability to tolerate liquids. Usually the threshold to solid intolerance is 13 mm of the esophageal lumen. Symptoms relating to the underlying cause of the stricture usually will also be present.
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| * '''''[[Esophageal cancer]]''''' also presents with progressive mechanical dysphagia. Patients usually come with rapidly progressive dysphagia first with solids then with liquids, weight loss (> 10 kg), and anorexia (loss of appetite). Esophageal cancer usually affects the elderly. Esophageal cancers can be either squamous cell carcinoma or [[adenocarcinoma]]. [[Adenocarcinoma]] is the most prevalent in the US and is associated with patients with chronic GERD who has developed [[Barrett's esophagus]] (intestinal [[metaplasia]] of esophageal mucosa). Squamous cell carcinoma is more prevalent in Asia and is associated with tobacco smoking and alcohol use.
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| {{main|esophageal cancer}}
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| * '''''Esophageal rings and [[esophageal web|web]]s''''', are actual rings and webs of tissue that may occlude the esophageal lumen.
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| ** ''Rings'' --- Also known as [[Schatzki ring]]s from the discoverer, these rings are usually mucosal rings rather than muscular rings, and are located near the gastroesophageal junction at the squamo-columnar junction. Presence of multiple rings may suggest [[eosinophilic esophagitis]]. Rings cause intermittent mechanical dysphagia, meaning patients will usually present with transient discomfort and regurgitation while swallowing solids and then liquids, depending on the constriction of the ring.
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| ** ''Webs'' --- Usually squamous mucosal protrusion into the esophageal lumen, especially anterior cervical esophagus behind the [[cricoid]] area. Patients are usually asymptomatic or have intermittent dysphagia. An important association of esophageal webs is to the [[Plummer-Vinson syndrome]] in [[iron deficiency]], in which case patients will also have anemia, koilonychia, fatigue, and other symptoms of [[anemia]].
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| {{main|esophageal web}}
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|
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| * '''''[[Achalasia]]''''' is an idiopathic motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation as well as loss of [[peristalsis]] in the distal esophagus, which is mostly smooth muscle. Both of these features impair the ability of the esophagus to empty contents into the stomach. Patients usually complain of dysphagia to both solids and liquids. Dysphagia to liquids, in particular, is a characteristic of achalasia. Other symptoms of achalasia include regurgitation, night coughing, chest pain, weight loss, and heartburn. The combination of achalasia, adrenal insufficiency, and alacrima (lack of tear production) in children is known as the triple A (Allgrove) syndrome. In most cases the cause is unknown (idiopathic), but in some regions of the world, achalasia can also be caused by [[Chagas disease]] due to infection by ''[[Trypanosoma cruzi]]''.
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| {{main|achalasia}}
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| * '''''[[Scleroderma]]''''' is a disease characterized by [[atrophy]] and [[sclerosis]] of the gut wall, most commonly of the distal esophagus (~90%). Consequently, the lower esophageal sphincter cannot close and this can lead to severe gastroesophageal reflux disease (GERD). Patients typically present with progressive dysphagia to both solids and liquids secondary to motility problems or peptic stricture from acid reflux.
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| {{main|scleroderma}}
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| * '''''Spastic motility disorders''''' include [[diffuse esophageal spasm]] (DES), [[nutcracker esophagus]], hypertensive lower esophageal sphincter, and nonspecific spastic esophageal motility disorders (NEMD).
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| ** ''DES'' can be caused by many factors that affect muscular or neural functions, including acid reflux, stress, hot or cold food, or carbonated drinks. Patients present with intermittent dysphagia, chest pain, or heartburn.
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| * [[Diverticulum]]
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| * [[Aberrant subclavian artery]], or ([[Ortner's syndrome|dysphagia lusoria]])
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| * Cervical osteophytes
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| * [[Enlarged aorta]]
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| * [[Enlarged left atrium]]
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| * [[Mediastinal tumor]]
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| ==References==
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| {{Reflist|2}}
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| [[Category:Crowdiagnosis]] | | [[Category:Crowdiagnosis]] |
| [[Category:Geriatrics]] | | [[Category:Geriatrics]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Otolaryngology]] | | [[Category:Otolaryngology]] |
| [[Category:Primary care]]
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| {{WH}}
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| {{WS}}
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