Digestive pathologies

Question 1

Abscess

Answer 1

A localized pocket of pus surrounded by inflammation (can occur anywhere)

Causes:
A defensive reaction of the tissue to prevent spread of infection elsewhere

Signs and symptoms:
Pain, redness, local swelling
Fever, malaise

Allopathic treatment;
Antibiotics(adverse effects), drainage

Question 2

Gastritis (acute)

Answer 2

Acute inflammation of the stomach mucosa causing breakdown of the stomach lining

Causes:
• Helicobacter Pylori
• NSAIDS (lower prostaglandin levels + reduces gastric mucosal barrier)
• Alcohol, food poisoning, stress

Signs and symptoms:
• Epigastric (upper abdomen) pain usually worse with food intake
• Nausea / vomiting, loss of appetite

Complications:
• Bleeding and anaemia

Pathophysiology;
• Insufficient mucus production (due to reduction of prostoglandin synthesis), which protects mucosa from erosion
• Acute inflammation characterised by neutrophil infiltrate

Question 3

Angular Stomatitis

Answer 3

Fissuring and dry scaling of the surface of the lips and angles of the mouth

Causes:
• Vit B deficiencies; Riboflavin(B2) & folic acid (B9)
• Iron deficiency
• Candida albicans (opportunistic) & staph)

Question 4

Appendicitis

Answer 4

Inflammation of the appendix

Signs and symptoms:
• Initially umbilical pain- may come/go.
• Right iliac fossa pain - constant & severe
• Rebound tenderness at McBurney’s Point and local muscle guarding
• Pallor, sweating and fever, nausea, vomiting and diarrhea
• May have tachycardia, hypotension and septic shock

Diagnostic:
• Rebound tenderness on palpation CT scan, U/S
• High ESF on blood tests
• Hypotension

Allopathic treatment;
• Surgery (appendectomy) & anti-biotics
• The most common surgical emergency

Complications:
• Rupture; Pain subsiding it usually = rupture
• Peritonitis; Release of faecal matter can result in infection which spreads to peritoneum

Pathophysiology;
• The appendix becomes obstructed, usually by faecal matter

Question 5

Ascitis
(Peritoneum pathologies)

Answer 5

The accumulation of fluid in the peritoneal cavity.

Question 6

Gastritis (chronic)

Answer 6

Chronic stomach mucosal inflammation for more than four-six weeks

Causes:
• Autoimmune (e.g. pernicious anaemia)
• Bacterial (H. Pylori)
• Chronic irritation (e.g. Long term NSAIDS)

Signs and symptoms:
• Few symptoms: Epigastric discomfort, feeling full & discomfort with heavy meals
• Nausea and poor appetite

Complications:
• Anaemia: Megablastic, iron, pernicious
• Gastric carcinoma

Pathophysiology:
• Lymphocytes & macrophages in lamina propia
• Prolonged low grade inflammation resulting in fibrosis & hence loss of elasticity and peristalsis
• May be associated with ulcers

Question 7

Cleft lip / palate

Answer 7

Cleft Lip: Malformation of the lip in the embryonic development
Cleft palate: Malformation of the hard palate in embryonic development

Causes:
• Genetic defect
• Environmental (maternal disease, dietary)
• Teratogens (chemotherapy, radiation, alcohol, excess Vitamin A, anticonvulsant medications, smoking, substance abuse)

Signs and symptoms:
Cleft lip;
•Can be unilateral/bilateral, complete/incomplete
Cleft palate:
•Causes difficulty in speech, feeding and hearing

Question 8

Coeliac’s disease

Answer 8

An autoimmune condition where the body’s immune system attacks its own mucosa tissue in the small intestine in response to ingestion of gluten

Causes:
• Genetically susceptible: HLA-DQ2 and DQ8.

Signs and symptoms:
Classic GI Signs and Symptoms:
•Chronic diarrhoea / constipation.
•Pale, foul-smelling stools.
•Steatorrhoea (fatty stools).
•Bloating.
•Flatulence.
•Abdominal pain.
•Loss of appetite.
•Weight loss.
•Lactose intolerance (loss of brush border enzymes).

Extra-intestinal symptoms:
•Lethargy, fatigue (iron deficiency anaemia) and irritability.
•Delayed growth in childhood
•Mouth ulcers.
•Neurological problems (anxiety, depression).
•Dermatitis herpetiformis (blistering rash).
•Muscle / joint pain.
•Osteopenia / osteoporosis.
•Infertility.

Diagnostic:
• Blood test - anti-transglutaminase antibodies (IgA, tTG).
• Stool test, endoscopy.
• Biopsy of the small intestinal mucosa

Allopathic treatment;
• Gluten free diet
• Avoid cross contamination

Pathophysiology:
• Gliadin is modified by tissue transglutaminase (tTG), an enzyme found in the mucosa of the small intestine.
• This modification allows the protein to be presented to the immune system.
• In Coeliac’s, the immune system mistakenly identifies parts of gliadin as foreign.
• The immune system produces antibodies and an inflammatory / immune reaction which strips the microvilli and villi, causing atrophy.

Complications:
• Osteoporosis, anaemia (iron / B9/ B12).
• Bowel cancer.

Question 9

Cold sores
(Herpes)

Answer 9

A viral infection that lies dormant and activates when immunity is low

Causes:
Herpes simplex virus (normally Type 1)
Stress, steroid use, trauma, local infections, sunlight exposure

Signs and symptoms:
Tingling, itching, burning sensation around mouth
Small fluid-filled sores - on the lower lip

Allopathic treatment;
Antiviral creams (acyclovir)

Pathophysiology:
The virus remains dormant in sensory ganglion (nerves) – often the trigeminal nerve
When immunity is low, the virus migrates along the nerve to the skin or mucosa around the mouth – causing tingling / burning sensation

Question 10

Colonic Polyps

Answer 10

Benign epithelial growths of colonic mucosa.

Signs and symptoms:
• Usually asymptomatic
• Occult (hidden) blood in the stool.

Diagnostic:
• Colonoscopy.

Allopathic:
• Surgery

Complications:
• May become malignant (<1% become malignant).

Question 11

Colorectal Cancer

Answer 11

Malignant tumour that is locally invasive.

Causes:
• Diet high in meat, low fibre
• Lack of vitamin D
• Polyps,
• Family history.

Signs and symptoms:
• Initially few symptoms.
• Fluctuating bowels (constipation/diarrhoea)
• Blood (and mucus) in stools. Abdominal pain.

Diagnostic:
• Colonoscopy and biopsy.
• Stool analysis (occult blood and M2PK).
• •Blood test (CEA, inflammatory markers & low Hb).

Complications:
• May spread (metastasise) before growth produces symptoms (liver, lungs, brain, bone).

Question 12

Diverticulosis / Diverticulitis

Answer 12

Diverticulosis:
The presence of pea-sized pouches (diverticula), caused by herniations of mucosa bulging out through the colon wall. Usually due to constipation. Most diverticula are asymptomatic

Diverticulitis. Faeces and food trapped in the pea-sized colon pouches and they become infected, inflamed (and bleed). More common >50 years. 15 to 25% of people with diverticulosis develop diverticulitis.

Causes:
• Low fibre diet (slow GI transit) = straining = high intra-abdominal pressure.
• Weak connective tissue.

Signs and symptoms:
• Bloating
• Abdominal pain
• Diarrhoea
• Fever, chills.

Allopathic treatment;
Antibiotics and surgery may be recommended.

Complications:
• Diverticulosis can develop into diverticulitis.
• Rupture —leaking into the peritoneum.

Question 13

Dumping Syndrome

Answer 13

Loss of control of gastric emptying

Causes:
• Bariatric surgery (vagus nerve damage), Cholecystectomy, gastric bypass, gastrectomy, etc.

Signs and symptoms:
Early dumping’ (straight after meal): nausea, vomiting, bloating, cramping, diarrhoea, dizziness and fatigue
• ‘Late dumping’ (one-three hours after meal): weakness, sweating and dizziness (due to hypoglycaemia)

Pathophysiology:
• Duodenum is filled with undigested food
• Water drawn out from surrounding vessels causing sudden and urgent diarrhoea
• Presence of carbohydrates – elevated serum glucose – excessive insulin release from the pancreas = reactive hypoglycaemia (two-three hours later)

Question 14

Dysentery

Answer 14

An infection of the intestines that causes diarrhoea containing blood or mucus

Causes:
• Bacterial (shigella) or Amoebic via faeco-oral contamination

Signs and symptoms:
• Bacterial (shigella) or Amoebic via faeco-oral contamination
• Diarrhoea (watery stools) with mucus and blood
. Cramping and possible nausea / vomiting

Diagnostic:
• Stool microscopy

Allopathic treatment;
• Anti-parasitic / anti-bacterial
• Rehydration / fluid and mineral replacement

Complications:
• Dehydration – dangerous in small children, infants, pregnancy and elderly

Other;
• It is a notifiable disease (required by law to be reported to government authorities)
• More prevalent in developing countries / poor sanitation - travelers

Question 15

Enterobiasis
(Pinworm)

Answer 15

A parasitic ‘Helminth’ infection with a lifespan of approximately two months.

Signs and symptoms:
• Can be asymptomatic; intense itching around anus/vagina particularly at night (when female worms are laying eggs); insomnia.
• Loss of appetite, weight loss, bruxism, enuresis.
• Skin infection around the anus.

Allopathic treatment;
• Anti-parasitic —two doses apart to kill eggs, too
• Whole family may be treated.

Pathophysiology;
• Eggs are ingested (faeco-oral route) and hatch in the duodenum within six hours.
• Worms mature in two weeks and commonly inhabit the terminal ileum and large intestine.
• Female worms migrate to the rectum and, if not expelled, migrate to the anus at night and deposit eggs.

Question 16

Gallstones

Answer 16

One or more stones in the gallbladder.

Causes:
• 5Fs (fat, female, forty, fair, fertile).
• Increasing age, pregnancy, obesity, diabetes, hereditary link, women, taking oestrogen or OCP, liver cirrhosis, age, rapid weight loss.

Signs and symptoms:
• 70% asymptomatic at diagnosis.
• Biliary colic (pain radiating under right shoulder, mostly at 1–2 am).
• Abdominal pain / shoulder pain, jaundice, fever, bloating, nausea.

Allopathic treatment;
• Surgery.

Complications:
• Acute cholecystitis
• Jaundice
• Acute cholangitis
• Acute pancreatitis
• Gallbladder cancer.

Question 17

Gastric Cancer

Answer 17

Cancer in the lining of the stomach.

Causes:
• Male, smoking, age (55 years+)
• H. Pylori infection
• Diet - salted, pickled smoked (N-nitroso compounds)
• Low fruit & vegetable diet

Signs and symptoms:
• Early stages: Persistent indigestion, frequent burping, heartburn, feeling full quickly, bloated, abdominal discomfort
• Advanced stages: Black blood in the stools, loss of appetite, weight loss, tiredness, anaemia, jaundice

Diagnostic:
• Blood in stool, endoscopy, biopsy

Allopathic treatment;
• Gastrectomy, chemo / radiotherapy

Pathophysiology;
• 50 % affects the pylorus and 25% affects the lesser curvature

Other:
Second highest cause of cancer related death in the world (highest prevalence in Korea and Japan – diet)

Question 18

Gastro-Oesophageal Reflux Disease (GORD)

Answer 18

The lower oesophageal sphincter relaxes and acid regurgitates from the stomach into the oesophagus

Causes:
• Obesity
• Hiatus Hernia (stomach pushed into thorax)
• Pregnancy (high intra-abdominal pressure)
• Trigger foods – spicy, fatty foods, alcohol, caffeine, carbonated beverages, onions, chocolate
• Stress

Signs and symptoms:
• Retrosternal pain ‘heartburn’ (can mimic a cardiac pathology) – aggravated by lying down
• Belching

Allopathic treatment;
• Antacids (some contain aluminium)

Complications;
• Damage to oesophageal mucosa increasing risk of ulcers, Barratt’s oesophagus (pre-cancerous oesophageal cell changes) and cancer

Question 19

Gingivitis and Periodontal disease

Answer 19

Gingivitis is a bacterial infection of the gums.
If left untreated, gingivitis may progress to periodontal disease (pathology of the bone around teeth).

Causes:
Plaque build-up, poor dental hygiene, dental amalgams
Long-term steroid medication use
Diabetes melitus
Smokers
Poor nutrition

Signs and symptoms:
• Bleeding gums
• Receding gums

Question 20

Hernia

Answer 20

An internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. 3 Types = Inguinal hernia, Hiatus hernia & Incisional hernia

Causes:
• Often appears after straining —lifting, constipation, heavy coughing (raised intra-abdominal pressure).

Signs and symptoms:
• Swelling / lump in the groin (abdominal region).
• Pain with strain & disappears lying down.
• If strangulation occurs (loss of blood supply or bowel obstruction) there may be necrosis.

Allopathic treatment;
• If no strangulation occurs, it often resolves within a few years.
• Surgery

Pathophysiology;
Inguinal hernia:
• A common type mostly affecting men. Appears as a swelling or lump in the groin (inguinal canal).
• Often appears after straining —lifting, constipation, heavy coughing (raised intra-abdominal pressure).

Hiatus hernia
• Portion of the stomach protrudes into the thoracic cavity through an opening in the diaphragm.
• Rarely symptomatic, but can cause GORD.

Incisional hernia
•Occurs at the site of a previous incision in the abdominal wall.

Question 21

Hiatus Hernia

Answer 21

Part of the stomach protrudes (herniates) into the thoracic cavity through an opening in the diaphragm

Causes:
• Increased abdominal pressure: heavy lifting, hard coughing / sneezing, pregnancy, childbirth, violent vomiting, straining with constipation, obesity, hereditary, smoking, drug abuse, stress

Signs and symptoms:
• Often asymptomatic or GORD

Complications:
• Can cause (GORD)

Question 22

Inflammatory Bowel Disease (IBD)

Answer 22

IBD describes two chronic inflammatory bowel diseases;
1) Ulcerative colitis
2) Crohn’s disease

Causes:
• Suspected AI, dietary links & genetic predisposition
• Environmental triggers (e.g. anti-biotics, infection) with defective immune system

Signs and symptoms:
Symptoms or UC & Crohn’s are similar. Most occurring between 15-35 years. Symptoms include:
• Rectal bleeding
• Abdominal pain / cramps
• Diarrhoea (with blood, mucus)
• Fever and fatigue
• Nausea / vomiting
• Delayed puberty or growth failure
• Weight loss/inability to maintain weight
• Indigestion, feel ‘blocked’
• Anaemia (fatigue etc.)

Diagnostic:
• Blood tests (inflammatory markers) & stool sample (calprotectin)
• Colonoscopy (and biopsy), sigmoidoscopy

Allopathic treatment;
• Anti-inflammatories (steroids)
• Surgery (i.e. bowel resection)

Complications:
• Malnutrition (failure to thrive, growth, osteoporosis etc.)
• Strictures (obstruction)
• Fistulas / fissures
• Abscesses (pus)’
• Toxic megacolon (non-obstructive colon dilation with systemic toxicity)
• Malignancy (higher risk colorectal cancer)

Pathophysiology;
Ulcerative colitis
. Restricted to the colon
• Small ulcers develop on the colon lining which can become inflamed & infected producing blood & pus
. Proximal my continuous
. Thin wall

Crohn’s disease
• Affects the entire GIT, from mouth to anus
• Most common in the terminal ileum
• Transmural inflammation
. Skip lesions.

Question 23

Irritable Bowel Syndrome (IBS)

Answer 23

A functional GI disorder characterized by lower abdominal discomfort and altered bowel habits

Causes:
• Stress: CNS alterations in GI secretions, motility & pain sensitivity
• GIT infection
• Food allergy or intolerance
• Altered microbiome, excessive ABX use

Signs and symptoms:
• Abdominal pain & cramping relieved by passing a stool
• Diarrhoea, constipation or alternating between both
• Bloating, painful flatulence, post-prandial urgency
• Incomplete emptying of bowels & mucus in stools

Diagnostic:
• Diagnosed according to ROME criteria: Three months history of symptoms

Allopathic treatment;
• Antispasmodics

Pathophysiology:
• Absence of organic pathology: inflammation or specific tissue damage

Question 24

Liver Cancer

Answer 24

Cancer of the liver
Primary or secondary (spread from another tissue).

Causes:
• Associated with liver cirrhosis: Alcohol, toxins - necrosis > chronic inflammation & cell proliferation
• Hepatitis B/C - viral integration into host genome affecting DNA.

Signs and symptoms:
• Advanced: Jaundice, ascites, hepatomegaly.
• Pruritus (itchy skin), bleeding oesophageal varices (secondary to portal hypertension), weight loss.
• Vomiting, loss of appetite, feeling very full after eating, feeling sick, pain or swelling in the abdomen, fatigue and weakness.

Allopathic treatment;
• Surgery —transplant.

Question 25

Liver Cirrhosis

Answer 25

Irreversible scarring of liver tissue due to long-term damage.

Causes: • Alcoholic liver disease.
• Hepatitis B / C.
• Bile obstruction, autoimmune liver disease, long-term exposure to toxins.

Signs and symptoms:
• Jaundice
• Fatigue
• Increased appetite
• Itchy skin
• Anaemia
• Oesophogeal varices
• Splenomegaly
• Gynecomastia
• Ascites
• Peripheral Oedema
• Vomiting blood
• Dark tarry stools

Diagnostic:
• Blood tests (raised liver enzymes; ie ALT & AST).
• •Ultrasound, biopsy.

Allopathic treatment;
• Liver transplant.

Pathophysiology;
• Conversion of normal hepatocytes to fibrotic non-functional tissue.
• Scar tissue disrupts hepatic blood and bile flow. Can lead to ‘portal hypertension’.
• ‘Liver failure’ = 80–90% destruction of functional liver tissue

Complications:
Impaired liver function results in:
• Reduced ability to synthesise substances (i.e. clotting factors).
• Decreased removal & conjugation of bilirubin.
• Impaired nutrient absorption.
• Impaired glucose metabolism.
• Decreased inactivation of hormones.
• Decreased removal of toxic substances.

Question 26

Mouth ulcer

Answer 26

Areas of ulceration within the oral cavity that are generally painful (loss of the mucosal layer)

Causes:
Physical trauma
Nutritional deficiencies; iron, zinc, folate and vit B12
Stress
GIT pathologies - Crohn’s disease

Question 27

Oesophageal cancer

Answer 27

A common aggressive tumour with a poor prognosis

Causes:
• Chronic irritation, alcohol, smoking
• GORD and Barratt’s oesophagus
• Obesity
• Low fruit and veg diet
• Age

Signs and symptoms:
• Few early symptoms, later obstruction may occur
• Dysphagia (difficulty swallowing)
• Anorexia & melaena (due to oesophagus bleed)

Question 28

Oral Cancer

Answer 28

Carcinoma of the oral mucosa, lip or tongue

Causes:
• Smoking (including pipes, chewing tobacco)
• Alcohol
• HPV infection

Signs and symptoms;
• Red or white patches on oral mucosa or tongue
• Difficulty eating and breathing

Allopathic treatment;
• Surgery
• Chemotherapy
• Radiotherapy (adverse effects)

Question 29

Oral thrush
(Candida / Candidiasis)

Answer 29

A fungal infection of the mouth which is a sign of low immunity and not contagious

Causes:
Candida albicans (fungus)
Broad-spectrum antibiotics
Immune-suppressant drugs (e.g. steroids).
Nutritional deficiencies (iron, zinc, B12)

Signs and symptoms; •
White patches on oral mucosa
Red / raw appearance
Loss of taste or an unpleasant taste

Allopathic treatments:
Anti-fungals

Question 30

Pancreatic Cancer

Answer 30

Cancer of the pancreas.
Common in older people, uncommon in people under 40 years with a poor prognosis

Causes:
• Cause unknown, risks include: Age, smoking, family history (germline defects in 5–10%).
• Other health conditions (diabetes, chronic pancreatitis, H. pylori).

Signs and symptoms:
• Asymptomatic early.
• Epigastric pain radiating to the back.
• Unexplained weight loss
• Anorexia
• Fatigue.
• Jaundice.
• Post-prandial nausea.
• Glucose intolerance (neuroendocrine tumours).

Allopathic treatment;
• Surgery, chemotherapy, radiotherapy (adverse effects).

Pathophysiology;
• Most arise from the exocrine cells.
• Less commonly from endocrine islet cells (‘pancreatic neuroendocrine tumour’).

Question 31

Pancreatitis (Chronic)

Answer 31

• Chronic inflammation of the pancreas.

Causes:
• 60% long-term alcohol abuse
• Autoimmune pancreatitis
• Pancreatic duct obstruction
• Complication of cystic fibrosis
• Idiopathic.

Signs and symptoms:
• Repeated episodes of abdominal pain.
• Fatty, foul-smelling stools.

Pathophysiology;
• Leading to permanent tissue changes (fibrosis and cysts) and obstruction of the common bile duct with calcified secretions.

Complications:
• Diabetes mellitus, pancreatic cancer, weight loss, malnutrition.

Question 32

Pancreatitis (acute)

Answer 32

Acute inflammation of the pancreas —a medical emergency.

Causes:
• Alcohol abuse
• gall stones
• Cancer.

Signs and symptoms:
• Sudden extreme periumbilical pain
• Nausea
• Vomiting
• Diarrhoea
• Fever.
• Mild cases improve within a week.

Diagnostic:
• Serum amylase (3 x normal level)
• Lipase; raised blood glucose.

Pathophysiology;
• Enzymes (proteases) are activated whilst still inside the pancreas leading to self-digestion of pancreatic tissue.

Question 33

Peptic Ulcer

Answer 33

Ulcer of the GI mucosa (stomach, duodenum)

Causes:
• Helicobacter Pylori
• NSAIDs (10%): Disrupt mucous barrier, lower stomach bicarbonate, disrupt blood flow
. Sress (SNS dominance) can often cause isachaemia (resulting in defective tissue repair)
• Chronic gastritis

Signs and symptoms:
• Gastric: epigastric pain, 30-60 mins after eating, less often at night
• Duodenal: epigastric pain two-three hours after eating and at night
• Pain mostly when stomach is empty
• Burping, nausea, reaction to irritating food (alcohol, coffee, spicy food, fatty/fried food etc.)

Pathophysiology:
• Tissue erosion can be superficial or penetrate down to the submucosa or muscularis

Question 34

Peritonitis
(Peritoneum pathologies)

Answer 34

An acute inflammation of peritoneum.
Periton = peritoneum, -it is = inflammation

Question 35

Salivary Calculi

Answer 35

Metabolic imbalance affecting mineral concentration resulting in stone formation on one of the salivary glands

Causes:
• Dehydration
• Abnormal calcium metabolism
• Sjogren’s syndrome
• Chronic salivary duct infections

Signs and symptoms:
• Intermittent pain & swelling of the gland, esp when eating – ‘mealtime syndrome’. May be a palpable mass

Pathophysiology;
• Calculi can abrade the gland wall causing inflammation, fibrosis and blockage

Question 36

Small Intestinal Bacterial Overgrowth (SIBO)

Answer 36

Small intestinal bacterial overgrowth (SIBO) describes the overpopulation of microflora in the small intestines

Signs and symptoms:
• Excessive gas = bloating, flatulence, belching, a loss of appetite & diarrhoea or constipation

Complications:
• SIBO could ultimately result in malabsorption, anaemia, as well as inflammation & increased small intestinal permeability

Pathophysiology;
• The small intestines are not normally densely populated by microflora. In SIBO, bacterial growth is excessive and can lead to the production of hydrogen & methane gases as a result of carbohydrate use

Question 37

Tonsillitis

Answer 37

Tonsillitis describes inflammation of the tonsils

Causes:
• Viral (common cold or flu virus)
• Bacterial (streptococci)
• Common type of infection in children 5-10 years and 15-25 years
• Short incubation period

Signs and symptoms:
• Sore throat that becomes worse when swallowing
• Fever over 38’C
• Coughing
• Headache
• Red / inflamed tonsils
• Pus

Allopathic treatment;
• Painkillers
• Antibiotics
• Surgery (tonsillectomy)

Complications:
• Middle ear infection (otitis media)
• Quinsy (abscess)

Question 38

Toxoplasmosis

Answer 38

Intracellular protozoan parasite

Causes:
• Eating under-cooked meats, poor food hygiene.
• Handling cat litter trays.
• (Rarely) blood transfusion, organ transplant.
• Immunocompromised.

Signs and symptoms:
• Often asymptomatic
• Mild flu-like symptoms, tender lymph nodes, fever, muscle aches, lethargy.
• Miscarriage, stillborn child.
• Can cause encephalitis and schizophrenia

Complications:
Health risks in pregnancy; miscarriage, stillbirth, (rarely) birth defects.

Question 39

Xerostomia

Answer 39

Dry mouth due to reduced / absent flow saliva

Causes:
• Drugs (antidepressants)
• Sjogrens syndrome
• Stress and anxiety, Dehydration
• Renal failure
• Menopause
• Alcohol
• Smoking
• Radiotherapy

Signs and symptoms:
• Dry mouth
• Burning sensation
• Halitosis (bad breath)
• Speech and swallowing interference

Complications:
• Candidiasis
• Gingivitis
• Tonsilitis
• Pharyngitus