Increased iron requirements and insufficient iron intake

iron malabsorption

Too much iron loss

Systemic manifestations: manifestations of the primary disease caused by iron deficiency (tissue iron deficiency manifests as mental and behavioral abnormalities; susceptibility to infection; pale skin and mucous membranes; delayed growth and development in children, mental retardation; common fatigue, tinnitus, dizziness, fatigue, etc.)

Oral manifestations: pale mucous membranes of the lips, mainly the lips, tongue, and gums; often foreign body sensation; filiform papillae and fungiform papillae on the back of the tongue atrophy and disappear

Blood picture: microcytic hypochromic anemia

Bone marrow imaging, iron metabolism, porphyrin metabolism in red blood cells, serum transfer receptor detection, etc.

Etiological testing

treat

Prevention: correct partial eclipse, timely iron supplementation, and preventive measures

Food is not nutritious enough

Malabsorption

Metabolic abnormalities

Increase in demand

Barriers to use

Systemic manifestations: Systemic manifestations start slowly, often with pale complexion, fatigue, decreased endurance, dizziness, palpitations and other general symptoms of anemia. In severe cases, pancytopenia, repeated infections and bleeding. Have gastrointestinal symptoms such as loss of appetite, bloating, diarrhea, etc. Nervous system manifestations and psychiatric symptoms include: symmetrical distal limb numbness, deep sensory impairment, ataxia or unstable gait, difficulty walking, etc.; decreased sense of smell, decreased vision, and positive pyramidal tract sign. Folic acid deficiency can cause psychiatric symptoms such as irritability and delusions.

Oral manifestations: Atrophic glossitis is the most common, and pernicious anemia may also cause Müller's glossitis or Hunter's glossitis.

Blood picture: macrocytic anemia

Serum vitamin B12 or folic acid testing

Bone marrow image etc.

treat

Prevention: Correct a partial eclipse and supplement vegetables; take folic acid and vitamin B if necessary

Systemic manifestations: acute onset, rapid progression, and severe condition. The main symptoms are anemia, bleeding and infection. Symptoms such as pale complexion, fatigue, dizziness, and palpitations gradually worsen; petechiae and ecchymosis on skin and mucous membranes, nose bleeding, and menorrhagia. In severe cases, hematemesis, hemoptysis, hematuria, fundus hemorrhage, and intracranial hemorrhage may occur. Most patients have fever, with body temperature above 39°C, and respiratory infections are the most common.

Oral manifestations: The oral mucosa is pale, and petechiae, ecchymoses or hematomas may appear. Gums are prone to bleeding, especially in patients with periodontal disease before the onset of aplastic anemia. The susceptibility of the mucous membrane to infection increases, especially in areas prone to irritation or trauma. Recurrent infections and necrotic ulcers often occur.

Blood picture: severe pancytopenia

Bone marrow picture: Severe reduction of bone marrow proliferation in multiple locations

treat

prevention

Decreased neutrophil production

Neutrophil destruction or excessive consumption

Abnormal neutrophil distribution

Systemic manifestations: According to the degree of neutropenia, it can be divided into mild ≥1.0x10°/L, moderate (0.5~1.0)x10°/ and severe <0.5x10/L. Severe neutropenia is agranulocytosis. . Patients with mild degeneration do not have special clinical symptoms and mostly show symptoms of the primary disease. People with moderate and severe reductions are prone to infection and non-specific symptoms such as fatigue, weakness, dizziness, and loss of appetite. Common infection sites are the skin, respiratory tract, digestive tract, and genitourinary tract. High fever, necrotic mucosal ulcers, and severe sepsis, sepsis, or septic shock may occur.

Oral manifestations: Necrotic ulcers appear on the gums. In severe cases, the necrotic surface may appear gray-black gangrene. The mucous membranes of the gums, cheeks, soft palate, etc. are prone to secondary infection, resulting in necrotizing gingivostomatitis and putrid bad breath with positive characteristics, which may be accompanied by pain, salivation, lymph node enlargement, etc.

treat

Prevention: Patients with risk factors should undergo regular check-ups

Systemic manifestations: Anemia develops progressively in patients with acute leukemia. Half of the patients present with fever as an early manifestation. High fever often indicates secondary infection, which can occur at any site. Nearly 40% of patients have bleeding as the early manifestation, which can occur in various parts of the body, with skin petechiae, ecchymoses, nose bleeding, gum bleeding, and menorrhagia being the most common. Due to the proliferation and infiltration of leukemia cells, lymph nodes, liver and spleen are enlarged throughout the body, and local tenderness at the lower end of the sternum; the central nervous system is the most common extramedullary infiltration site of leukemia, which manifests as headache, dizziness, and in severe cases, vomiting, neck stiffness, and even convulsions and coma. . Chronic leukemia has a slow onset, and patients often have symptoms such as low fever, excessive sweating, weight loss, hemorrhage, hemorrhage, and splenomegaly.

Oral manifestations: All types of leukemia can have oral manifestations. The most vulnerable part is the gums, especially the acute type. Gum bleeding is often spontaneous and difficult to stop. This type of bleeding for which no other cause can be found may be an early symptom of leukemia. Due to a large number of abnormal white blood cells infiltrating into the gingival tissue, the gingiva is obviously hyperplasia and swollen. The lesions spread to the marginal gingiva, interdental papilla and attached gingiva. The shape is irregular, nodular, with a bright surface and medium hardness. Gum necrosis, periodontitis, loose teeth, toothache, etc. may also occur. Petechiae, ecchymosis, or hematoma may appear on the oral mucosa. The oral mucosa and gums are pale in color, and sometimes irregular ulcers may appear, which are often difficult to heal and prone to secondary infection.

Hematology department presides over treatment

Mainly conservative treatment

Use hemostatic drugs for bleeding gums

Pay attention to hygiene and prevent infection

Systemic manifestations: Painless progressive lymphadenopathy or local masses are common clinical manifestations of lymphoma. HL is more common in young people and less common in children. The first symptom is often painless progressive enlargement of cervical or supraclavicular lymph nodes, followed by axillary lymph node enlargement. There are symptoms such as fever, night sweats, itching, and weight loss all over the body. Extralymphatic organ involvement is rare. NHL performance has the following characteristics: ① Systemic: It can occur in any part of the body, among which lymph nodes, tonsils, spleen and bone marrow are the most vulnerable parts. Often accompanied by systemic symptoms. ② Diversity: Different tissues and organs have different scope and degree of oppression and infiltration, and the symptoms caused are also different. ③The incidence increases with age and is more common in men than women; except for indolent lymphoma, it generally develops rapidly. ④The compression and infiltration of various organs are more common in NHL than in HL, and high fever or symptoms of various organs and systems are often the main clinical manifestations.

Oral manifestations: Most oral lymphomas are extranodal. In the early stage, they are often single lesions, which can occur in the gums, palate, tongue base, nasopharynx, tonsils, cheeks, parotid glands, jaws, maxillary sinuses, etc. at. The clinical manifestations are diverse. Those occurring in the gums and palate often show inflammation, ulceration, and necrosis; the areas near the pharyngeal cavity often show diffuse swelling, unclear boundaries, and invasion of multiple anatomical areas, resulting in sore throat and obstruction of swallowing; Masses may appear in the cheeks and parotid glands; multiple unexplained superficial lymph node enlargements in the head and neck are movable, solid and elastic in texture, and have no symptoms of acute inflammation or tuberculosis. A high degree of suspicion should be considered after anti-inflammatory treatment fails. sick.

Blood and bone marrow tests

Laboratory examination

Film degree exam

Comprehensive Hematology Treatment

Oral treatment

Systemic manifestations: Adult ITP generally has an insidious onset, and fatigue is one of its clinical symptoms. Most bleeding tendencies are mild and localized, but they are prone to recurrence. It can manifest as skin and mucosal bleeding, such as petechiae, purpura, ecchymosis, difficulty in stopping bleeding after trauma, etc. Epistaxis is also common, severe visceral bleeding is less common, but menorrhagia is more common, and in some patients it may be the only clinical symptom. The patient's condition may suddenly worsen due to infection, etc., causing extensive and severe bleeding of the skin, mucous membranes and internal organs.

Oral manifestations: Spontaneous gum bleeding is often an early manifestation of the disease. Brushing, sucking, cleaning, tooth extraction or minor trauma can aggravate the condition. Petechiae, ecchymoses, and hematomas are prone to occur on the oral mucosa, especially the lipstick, tongue edges, palate, floor of the mouth, and cheeks. The hematoma may rupture on its own or rupture and bleed due to food friction, leaving a round or oval erosion surface with clear edges.

Hematology leading treatment

Maintain oral hygiene

People with severe bleeding should take rest

Systemic manifestations: The course of the disease is chronic, with alternating attacks and remissions, and a few symptoms persist and gradually worsen. It may be accompanied by other symptoms such as abdominal distension, lack of appetite, nausea, and vomiting. Mild and moderate patients only have mild tenderness in the right lower abdomen, and sometimes the spasmodic descending colon or sigmoid colon can be palpated. Severe and explosive patients often have significant tenderness or even intestinal type. Systemic reactions may include fever and malnutrition

Extraintestinal manifestations: including peripheral arthritis, erythema nodosum, pyoderma gangrenosum, epimembranous inflammation, uveitis, etc. These extraintestinal manifestations can be relieved or recovered after colitis control or colon resection.

Oral manifestations: Mainly aphthous ulcers, which are characterized by recurrent multiple ulcers in the oral cavity, mostly round or oval small and shallow ulcers, which usually appear during the active stage of UC and are related to the activity of the disease. With the relief of UC symptoms. The symptoms of cheilitis are similar to those caused by nutritional deficiencies, with vertical chapped lips accompanied by peeling, which can lead to secondary infection in severe cases. Proliferative suppurative stomatitis (pyostomatitis veget-ans) is a rare oral lesion that can occur at any age. It is characterized by the formation of many small pustules on the thickened mucosa and erythema. After the pustules rupture, The formation of extensive ulcers and erosions and a "snail-track" appearance. The most common lesions are the labial attached gingiva, soft and hard palate, vestibular sulcus and tonsil area. The mucosa of the floor of the mouth and tongue are usually not affected. Proliferative purulent Stomatitis is considered a specific sign of UC

Gastroenterology-led treatment

Oral local symptomatic treatment

genetic factors

immune factors

Infectious factors

Systemic manifestations: There are systemic manifestations such as low-grade fever, fatigue, and weight loss in the afternoon. Anemia may also be caused by malabsorption of iron, vitamin B, and folic acid due to lesions and dysfunction of the digestive tract.

Digestive tract manifestations: The patient had recurrent abdominal distension, abdominal pain, abdominal masses, increased stool frequency, and paroxysmal colic, diarrhea, and bloody and purulent stools in the right lower abdomen. In the late stage, intestinal obstruction or even intestinal perforation may occur, resulting in severe abdominal pain, bloating, vomiting, constipation, etc. Intra-abdominal abscesses and fistulas can form due to adhesion and penetration of lesions and adjacent tissues.

Oral manifestations: Oral lesions occur in approximately 10% of cases. Oral mucosa, cheeks, lips, gums, palate, pharynx and other parts can be affected, forming linear ulcers or aphthous ulcers. Granulomas, small nodules and gingival hyperplasia can also form. Linear ulcers are like knife incisions with raised edges, much like ulcers caused by irritation on the edge of a dental tray. The oral mucosa may also undergo cord-like hyperplasia, folds, and granular, gravel-like nodular hyperplasia. The lips may become diffusely swollen and indurated. The gums may also appear visibly red and granular on the surface

Other extraintestinal manifestations: Other lesions outside the digestive tract may include sacroiliitis, spondylitis, uveitis, skin erythematous nodules, pyoderma gangrenosum, etc. Disorders of intestinal function may also lead to disorders of uric acid metabolism and the formation of kidney stones.

laboratory tests

Intestinal barium angiography

CT examination

Ultrasonography

endoscopy

Behcet's disease

sarcoidosis

medical treatement

Surgical treatment

Oral treatment

Systemic manifestations

Oral manifestations

Urine, blood routine

autoantibodies

Hyperglobulinemia

Tear gland function test

labial gland biopsy

treat

Prognosis: The prognosis is good for patients whose lesions are limited to the salivary glands, lacrimal glands, and exocrine glands of the skin and mucous membranes. Patients with pulmonary fibrosis, central neuropathy, renal insufficiency, and malignant lymphoma have a poor prognosis

Systemic manifestations

Oral manifestations: (1) Lip and perioral manifestations: lips are red, swollen, dry, and chapped, oral mucosa is diffusely congested, tongue papilla is red and swollen, and strawberry tongue appears. (2) Cervical lymph node enlargement: unilateral or bilateral, hard and tender, but the surface is not red and does not suppurate. The disease appears initially and subsides when the fever subsides.

Blood test: mild anemia, increased peripheral leukocytes, mainly neutrophils

If you have fever for more than 5 days and are accompanied by 4 of the following 5 clinical manifestations, you can be diagnosed with Kawasaki disease after excluding other diseases: (1) Changes in the limbs: palmoplantar erythema, hard edema of the hands and feet in the acute phase; finger (toe) symptoms in the recovery phase Endomembranous peeling; (2) Polymorphic rash; (3) Conjunctival membrane congestion, non-suppurative; (4) Congestive and chapped lips, diffuse congestion of oral mucosa, protruding and congested tongue papilla, strawberry tongue; (5) ) Swollen lymph nodes in the neck. Note: If there are less than 4 of the 5 clinical manifestations, but coronary artery damage is found on echocardiography, Kawasaki disease can also be diagnosed.

Comprehensive Internal Medicine Treatment

Oral symptomatic treatment

UV exposure, trauma

Infectious factors

Other factors: Certain drugs and foods can also cause

Mucosal damage: It is characterized by round or oval erythematous erosions that are concave and disk-shaped, with slightly raised edges, redness or visible telangiectasia around them, and thin short white streaks arranged radially around the redness. The red mucous membrane of the lower lip tends to develop.

Skin damage: keratin plugs or butterfly spots may appear

Systemic symptoms: Some patients may have systemic symptoms, such as gastrointestinal symptoms, irregular fever, joint pain or arthritis, etc.

Routine inspection

Antinuclear antibodies and other immune indicators

systemic lupus erythematosus

chronic cheilitis

Lymphoproliferative cheilitis in both sexes

Lichen planus

erythema multiforme

Try to avoid or reduce sunlight exposure

Early diagnosis and early treatment

Topical corticosteroids

Metabolic disorder symptom cluster: symptoms of polyuria, polydipsia, polyphagia, and weight loss, which may be accompanied by skin itching and blurred vision.

Complications: acute and severe metabolic disorders, infectious diseases, chronic complications, etc. may occur

Oral manifestations: Diabetes is closely related to oral diseases, especially when blood sugar is poorly controlled, it is more likely to cause oral diseases ① Gingivitis and periodontitis: It is easy to cause or aggravate periodontal disease, and periodontal infection can aggravate diabetes. . The symptoms are as follows: gingival inflammation is obvious, dark purple in color, easy to bleed, and the gingival margin appears granulation tissue-like; periodontal abscesses occur repeatedly, alveolar bone is absorbed rapidly, causing teeth to loosen and fall out; a large amount of calculus is easily formed in a short period of time. ② Dry mouth, thirsty and desire to drink, mucosa should not be dry and dull, and occasionally painless diffuse swelling of the parotid gland ③ Oral candida infection or abnormal taste. ④ Burning mouth syndrome manifestations ⑤ Lichen-like damage to the oral mucosa. ⑥ The tongue is fat and enlarged, the tongue is dark red, the filiform papillae may appear atrophic, the fungiform papillae may be congested, and sometimes the tongue may appear like a geographic tongue or a cracked tongue. ⑦The prevalence of dental caries, pulpitis, and apical periodontitis increases. ⑧Slow wound healing. Even minor trauma or erosion is not easy to heal, and may even lead to the spread of inflammation and infection of the jawbone and perimaxilla.

Urine glucose measurement

OGTT

Glycated hemoglobin test

Health management: education, regular monitoring

Medication: Insulin

Oral Treatment: Maintain good oral hygiene and have a thorough understanding of the patient’s health or blood sugar levels during treatment

Resection of pituitary microadenomas is the first choice

Drug therapy as an auxiliary

Maintain oral hygiene

clinical manifestations

disease management

Clinical manifestations: 1. Systemic manifestations. Typical manifestations are dermatitis, diarrhea and dementia, with dermatitis and diarrhea being the most common. The onset is slow, and usually has non-specific symptoms such as loss of appetite, fatigue, weight loss, abdominal pain and discomfort, indigestion, inability to concentrate, and insomnia. Dermatitis often occurs or worsens in spring and summer, and symmetrical dermatitis occurs on the limbs and exposed parts of the body, resembling sunburn. Digestive system symptoms such as loss of appetite, nausea and vomiting, abdominal pain and diarrhea may occur. Neuropsychiatric symptoms vary widely among individuals, with neurasthenia being the most common. 2. Early oral manifestations include congestion at the tongue tip and edges, redness and swelling of the fungiform papillae, and then redness of the whole tongue with burning pain. In patients with a longer course of the disease, tongue filamentous papillae and fungiform papillae atrophy, and the tongue surface becomes red, shiny, and beefy. Red, particularly sensitive to trauma or other stimulation, prone to ulcers. The oral mucosa and pharynx may also become red and burning, and erosion or superficial ulcers may occur. The corners of the mouth are wet and white or eroded. Gingivitis and periodontitis are prone to occur.

disease management

Clinical manifestations: 1. Systemic manifestations: slow onset, general fatigue, loss of appetite, weight loss, mental depression, pale complexion, skin petechiae, ecchymosis, internal bleeding such as hematuria, blood in the stool, menorrhagia, wound healing Delay and other symptoms. Children with bone, joint and muscle pain may have hip abduction, knee half flexion, foot external rotation, and frog-like posture. 2. Oral manifestations: People with vitamin C deficiency are prone to involvement of gums and periodontal tissue. Gingivitis and gum bleeding are early manifestations of protrusion. The gums are congested and edematous, soft in texture, and dark red in color, most notably at the gingival papilla. They bleed easily, and erosion and ulcers may appear on the surface. They are prone to secondary infection, and are often accompanied by pain and bloody halitosis. If there are local irritating factors or poor oral hygiene, the symptoms can be aggravated. Especially for patients with periodontitis, teeth can become loose and fall out in a short period of time. Alveolar bone loss is often an early X-ray finding. A few patients may have spots and ecchymoses on the palate, cheeks, and tongue edges. Wound healing is delayed, susceptibility to infection increases, and may be complicated by necrotizing gingivitis and necrotizing stomatitis.

disease management

Immunoglobulin light chain amyloidosis

Amyloid A amyloidosis

β2 microglobulin amyloidosis

transthyretin amyloidosis

Systemic manifestations: Amyloidosis has a variety of clinical manifestations depending on the organs invaded. The initial symptoms are mostly fatigue and weight loss. Systemic AL amyloidosis most commonly affects the kidneys and heart. Renal lesions are mainly manifested as proteinuria or nephrotic syndrome, and cardiac lesions are often manifested as arrhythmia, congestive heart failure, ventricular thickening, etc. In addition, hepatomegaly with elevated alkaline phosphatase, orthostatic hypotension, intestinal pseudo-obstruction, diarrhea and constipation, periorbital purpura, etc. can also be seen. Localized AL amyloidosis often affects the airways (nasopharynx, larynx, bronchi), lungs, periorbita, bladder, gastrointestinal tract, lymph nodes, and skin. AA amyloidosis most commonly affects the kidneys, and may also cause hepatomegaly and gastrointestinal symptoms. Heart and nerve involvement are rare. Aβ2M amyloidosis mainly affects joints, periarticular tissues, and bones, manifesting as arthritis, carpal tunnel syndrome, and bone cysts. ATTR amyloidosis mainly affects the heart and peripheral (and/or autonomic) nervous system, manifesting as cardiomyopathy, sensory impairment, sweating disorder, or orthostatic hypotension.

Oral manifestations: The tongue is the site most commonly affected by AL amyloidosis in the head and neck region, and can form typical progressive macroglossia. In the early stage, the tongue body is still soft and has unrestricted movement. With the deposition of amyloid material, the tongue body gradually becomes enlarged, hardened, widespread and symmetrical, and tooth marks and nodular protrusions can be seen on the tongue edge. In the late stage, the tongue body is large and protrudes outside the mouth, making it difficult to close the lips. The tongue tie becomes thickened, stiff, and loses elasticity. The movement of the tongue body is limited, which affects speech, eating, and swallowing. When lying on the back, the tongue falls behind and makes a snoring sound.

blood test

Urine test

bone marrow examination

Film degree exam

Specific treatments are still lacking. Comprehensive internal medicine treatment is the mainstay.

Symptomatic treatment is mainly used for local lesions in the oral cavity

Note that patients with systemic AL amyloidosis may be complicated by multiple myeloma and have a poor prognosis.

Systemic manifestations: Incubation period is 2 to 5 days. The onset is sudden, with mostly persistent high fever and sore throat. The rash begins one day after the onset of illness. The rash appears sequentially on the neck, chest, trunk, and limbs, and spreads all over the body in about 36 hours. The typical rash is pinpoint-sized papules evenly distributed on the diffusely congested skin, which fade when pressed. , accompanied by itching, purple-red lines can be seen in skin folds such as armpits, elbow fossa, groin, etc. The rash lasts for 2 to 4 days and subsides in the order in which the rash occurred. After the rash subsides, the skin will peel off.

Oral manifestations: The facial skin is congested and flushed without a rash, and the congestion around the mouth and nose is not obvious. Compared with the congested face, it appears white, which is called "perioral pale circle". In the early stages of the disease, the tongue coating is white, the tongue fungiform papillae are swollen, and the swollen tongue papillae protrude from the tongue surface covered with white coating, which is called "white bayberry tongue". After 3 to 4 days, the tongue coating falls off, the tongue surface is smooth and crimson, the tongue papilla is raised, which is called "red bayberry tongue", and the submandibular lymph nodes are swollen. The tonsils are red and swollen, with gray-white exudative pseudomembranes that are easy to be wiped off, soft palate mucosa is congested, punctate erythema and scattered petechiae

General treatment: Isolation of the child, systemic supportive therapy, bed rest

Antibiotic treatment, penicillin is preferred

Traditional Chinese Medicine Treatment

Oral local cleaning

Whole body performance:

Oral manifestations: 1 to 2 days before the rash occurs, 0.5 to 1 mm needle-sized gray-white or purple dots appear on the buccal mucosa corresponding to the patient's bilateral second molars, surrounded by redness, which are called measles mucosal spots or Koplicks. Koplik spots, which gradually increase in number during the rash stage, can spread to the entire cheekbone membrane and the inner side of the lips, merge with each other, and sometimes expand into patches, resembling thrush. Most mucosal plaques begin to fade 1 to 2 days after the rash occurs. Such mucosal spots can be used as early specific signs of measles and have early diagnostic value.

Treatment: Isolate the child and rest in bed; treat symptoms and prevent complications; keep the oral cavity clean

Prevention: Get vaccinated; pay attention to your health; keep exercising

Systemic manifestations: high fever, fatigue, headache, loss of appetite, vomiting, etc. In severe cases, toxic myocarditis and peripheral nerve paralysis may be complicated.

Oral manifestations: Dot-like and flaky gray-white pseudomembranes of varying degrees appear in the pharynx, larynx, uvula, tonsil area and oral mucosa. The edges are clear and difficult to wipe off. If the pseudomembrane is forcibly removed with tweezers, bleeding wounds will be left. . accompanied by swollen and tender submandibular and cervical lymph nodes

Isolate and rest for more than three weeks

Inject diphtheria antitoxin and give adequate amount of penicillin as early as possible

Maintain oral hygiene