Tongue`s surface in Prolonged antibiotic use

Which of the following conditions is the skin finding shown in the picture associated with?

• A) Prolonged antibiotic use
• B) Sjögren's syndrome
• C) Addison's disease
• D) Chronic gastroesophageal reflux
• E) Malignant melanoma

The answer is A. 

(Black tongue) Black hairy tongue results from hyperplasia of the filiform papillae with deposition of keratin on the surface. The condition causes the tongue to have ..............

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Photos of Melanosis coli "Pseudomelanosis coli"

Melanosis coli, also pseudomelanosis coli, is a disorder of pigmentation of the wall of the colon, often identified at the time of colonoscopy.
The most common cause of melanosis coli is the extended use of laxatives, this darkening of the colonic mucosa caused by the accumulation of lipofuscin particles within the macrophages of the lamina propria of the colonic mucosa as a result of long term exposure to anthraquinone-containing laxatives as Senna and other plant glycosides. However, other causes are identified, including an increase in colonic epithelial apoptosis.

This is the photograph of the colon, and there is an extremely dark appearance to the wall of the colon. This is seen in patients who have taken laxatives over many years and the pigment from the laxative gets deposited in the wall of the bowel giving an extremely dark appearance to it. This is a benign condition, not cancerous, and does not become cancerous, but often it is quite obvious.

- Melanosis coli is a misnomer, as the pigmentation is due to lipofuscin-laden macrophages - not melanin pigment. Pseudomelanosis coli is a more appropriate descriptor, but not in common usage.

The differential diagnosis of brown pigmentation of the colon is:

* Pseudomelanosis coli.
* Hemosiderin-laden macrophages (old haemorrhage).
* Melanin (rare).

Schatzki Ring as appeared by Endoscope and barium swallow

A Schatzki ring also called Schatzki-Gary ring is a narrowing of the lower part of the esophagus that can cause intermittent dysphagia. The narrowing is caused by a ring of mucosal tissue (which lines the esophagus) or muscular tissue.And This ring is congenital in origin.

Two rings have been identified in the distal esophagus.
1- Muscular ring, or A ring, is a thickened symmetric band of muscle that forms the upper border of the esophageal vestibule and is located approximately 2 cm above the gastroesophageal junction. The A ring is rare; furthermore, it is even more rarely associated with dysphagia.
2- Mucosal ring, or B ring, is quite common and is the subject of discussion in this topic. The B ring is a diaphragmlike thin mucosal ring usually located at the squamocolumnar junction; it may be symptomatic or asymptomatic, depending on the luminal diameter.

Endoscopic image of Schatzki ring.

Patients typically present with intermittent nonprogressive dysphagia for solids. Fortunately, most patients respond well to initial and repeat dilatation therapy. A small number of patients may have stubborn rings that require more aggressive endoscopic or surgical intervention.

This Prone, single-contrast barium esophagogram demonstrating Schatzki ring a thin, ringlike narrowing (arrows) in the lower esophagus just above a hiatal hernia. This view is most sensitive for detecting lower esophageal rings, provided adequate esophageal distention is achieved.

Uvular Necrosis after Endoscopy

This 28-year-old man presented with a sore throat 72 hours after undergoing upper endoscopy. The patient had a 6-month history of intermittent solid-food dysphagia; upper endoscopy revealed a Schatzki ring. A wire was placed endoscopically, and a 20-mm Savary dilator was passed over the wire uneventfully.
The patient felt well after the procedure and was discharged home. He noted a mild sore throat, starting 24 hours after the procedure. When it persisted, he presented for evaluation.
Physical examination revealed necrosis of the distal uvula. No specific therapy was given, and acetaminophen was recommended for discomfort. The patient reported that the tip of the uvula spontaneously sloughed off the next day, and the discomfort resolved completely. He has had no further solid-food dysphagia.

Uvular necrosis is a rare event that can occur after upper endoscopy or direct laryngoscopy. The symptoms are generally mild, and the recovery is usually complete. The mechanism of injury is thought to be impingement of the uvula by the instrument against the hard palate or posterior pharynx, leading to ischemia. Uvular injury has also been reported as a result of aggressive oropharyngeal suctioning.

Dietary Managment of liver disease

What is Geographic Tongue !!

This 61-year-old man was referred for treatment of painless white lesions on his tongue that had appeared 1 month earlier. He had been treated with topical and systemic antifungal drugs for presumed oral candidiasis, but the lesions remained unchanged. The patient reported that a similar episode 1 year earlier had resolved spontaneously.
Lingual examination revealed multiple erythematous patches with an annular, well-demarcated white border. A diagnosis of geographic tongue was made.

Geographic tongue (benign migratory glossitis) is a benign inflammatory condition that affects approximately 2% of the world's population. The classic manifestation is a maplike distribution of erythema caused by atrophy of the filiform papillae of the tongue, surrounded by a white hyperkeratotic rim. The lesions typically resolve spontaneously without sequelae but can develop quickly in other areas of the tongue.

Nonalcoholic Fatty Liver Disease NAFLD