HALITOSIS AND OTHER BREATH ODORS
What are the various causes of bad breath and how can they be recalled
with ease? The best method is to visualize the respiratory and upper
gastrointestinal (GI.5pt) tree, because this is where the substances (mucus,
sputum, and vomitus or regurgitant material) that produce these odors may be
found.
In the mouth, pyorrhea due to poor dental care and infection may cause
halitosis. A stomatitis (e.g., aphthous) may also be a cause. Sinusitis and
atrophic rhinitis are causes in the nasal passages. Anyone who has a
friend with large tonsils knows that this is a frequent cause, especially
when the tonsils become infected. Any form of pharyngitis may also cause
halitosis. Carcinoma and tuberculosis (TB) of the larynx and lower
respiratory tract may cause halitosis. More likely causes are bronchiectasis
and lung abscess.
Proceeding down the esophagus to the stomach, one should recall
the accumulation of food in diverticula, cardiospasm of the esophagus, and
the frequent foul odor of chronic membranous or granulomatous esophagitis
associated with a hiatal hernia. Carcinoma of the esophagus may also cause
obstruction and allow putrefaction of food that accumulates there. A chronic
gastritis or gastric carcinoma may also cause halitosis.
A sweet odor to the breath may be found in diabetes mellitus and alcoholism.
Uremia will often present with an ammoniac and urinous odor to the breath,
whereas the breath of hepatic coma may be fishy (fetor hepatis). The
feculent odor of a gastrocolic fistula and late states of intestinal
obstructions should also be recalled.
Approach to the Diagnosis
The workup of bad breath involves a careful examination of the mouth
and nasal passages. If this is negative, chest and sinus x-rays and upper GI
series with barium swallow should be done. If the studies are still
unrewarding, then endoscopy of the respiratory and upper GI tract would be
indicated. Appropriate liver and renal function tests will be ordered when
uremia or hepatic coma is suspected. If pyorrhea is suspected, refer the
patient to a dentist.
HAND AND FINGER PAIN
|
| V | I | N | D |
|
| Vascular | Inflammatory | Neoplasm | Degenerative |
|
| | | | and Deficiency |
|
|
Skin
| Periarteritis nodosa Gangrene |
Carbuncle Ulcers Folliculitis Herpes zoster |
Carcinoma |
Fascia, Ligaments, Tendon Sheaths, Subcutaneous Tissue |
|
Felon Abscess Cellulitis Tendon sheath infection |
Sarcoma |
|
Arteries |
Arteriosclerosis |
Subacute bacterial endocarditis |
Macroglobulinemia | |
|
Veins |
| Thrombophlebitis |
|
Muscles |
| Myositis | |
Peripheral Nerves (Carpal Tunnel)
| | Multiple myeloma |
| |
|
Brachial Plexus |
Ischemic neuritis Myocardial infarction |
Bursitis Arthritis Pneumonia |
Pancoast tumor |
Spinal Cord and Cervical Roots |
|
Tuberculosis |
Primary or metastatic tumors of cord |
Cervical spondylosis Syringomyelia |
|
Bone |
| Gonococcal arthritis |
| Osteoarthritis |
| |
| |
|
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Read excerpts from these other book chapters related to Foot odor:
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- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- Breath odor, fecal
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
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