Introduction

These A tables are ordered according to the physiological systems of the body. Each A table lists the red flags which are related to disease of that physiological system. The red flags are defined according to symptoms (the patient’s experience of disease) and/or signs (measurable physiological changes of disease). These tables also offer a brief explanation as to why the constellation of symptoms and signs constitute a red flag. These tables are introduced and explained in more depth in the relevant chapters of the companion text The Complementary Therapist’s Guide to Clinical Medicine to which the readers are referred should they wish to study these patterns of disease in more depth.

The A tables show the categorisation of urgency of referral which is described in Chapter 1:

The order of the A tables can be found in the contents pages of this text.

A1: Red flags of cancer

Cancer is characterized by progressive growth of diseased tissue over the course of weeks to months and the loss of function which can result from the damage caused by this growth. The patient may therefore experience a deterioration in function which may either be gradual or may appear with the sudden development of new symptoms which do not go away. The red flags of cancer include any progressive unexplained symptoms which persist over the course of weeks to months without resolution. Also unexplained sizeable lumps and lymph nodes may be indicative of cancerous change.

TABLE A1 Red flags of cancer

Figure 2.1 A child with right-sided cervical lymphoma (see A1.6).

(From Kumar and Clark, 6th edn, Figure 9.14.)

A2: Red flags of infectious diseases: vulnerable groups

Infections are more likely to cause problems in individuals who cannot sustain a strong immune response, either because of immaturity, old age, illness, pregnancy or because of exposure to unusual organisms (such as occurs during foreign travel).

TABLE A2 Red flags of infectious diseases: vulnerable groups

A3: Red flags of infectious diseases: fever, dehydration and confusion

Fever can be assessed by means of thermometers of various designs which may measure body temperature from various locations in the body (e.g. forehead skin, ear, rectum and mouth). The measured temperature is slightly different according to the site, so it is important to be clear from the thermometer manufacturer’s instructions what the normal range is for the device which is being used.

The core temperature of a well person tends to follow a diurnal variation with core temperature peaking in the late afternoon at up to 1°C (1.8F) higher than the temperature measured in the early morning. Also, for temperatures less then 37.5°C (99.5F) what is normal for one person may represent a fever in another who tends to run at a generally lower core temperature. This makes interpretation of lower levels of fever difficult, and in such cases it is very helpful to know what the normal range is for that person in health.

Increasingly the tympanic (eardrum) temperature is rapidly assessed by means of user-friendly hand-held devices. The normal ranges below represent tympanic readings in adults. The tympanic temperature range is higher than the oral range by up to 0.7°C, and so the guidance below should be adjusted accordingly if oral readings are being interpreted. It must also be remembered that the normal range of temperature for children is slightly higher than for adults (see below).

TABLE A3 Red flags of infectious diseases: fever, dehydration and confusion

A4: Red flags of diseases of the mouth

TABLE A4 Red flags of diseases of the mouth

Figure 2.2 The position of the salivary glands (see A4.3).

(From CTG Figure 3.1a-IV.)

A5: Red flags of diseases of the oesophagus

TABLE A5 Red flags of diseases of the oesophagus

A6: Red flags of diseases of the stomach

TABLE A6 Red flags of diseases of the stomach

A7: Red flags of diseases of the pancreas

TABLE A7 Red flags of diseases of the pancreas

A8: Red flags of diseases of the liver

TABLE A8 Red flags of diseases of the liver

Figure 2.3 The physical signs seen in cirrhosis of the liver (see A8.4).

(From CTG Figure 3.1d-II.)

A9: Red flags of diseases of the gallbladder

TABLE A9 Red flags of diseases of the gallbladder

A10: Red flags of diseases of the small and large intestines

TABLE A10 Red flags of diseases of the small and large intestines

A11: Red flags of diseases of the blood vessels

TABLE A11 Red flags of diseases of the blood vessels

Figure 2.4 Varicose ulcer of the inner aspect of the lower leg (see A11.6).

(From CTG Figure 3.2c-III.)

A12: Red flags of hypertension

TABLE A12 Red flags of hypertension

A13: Red flags of angina and heart attack

TABLE A13 Red flags of angina and heart attack

A14: Red flags of heart failure and arrhythmias

TABLE A14 Red flags of heart failure and arrhythmias

A15: Red flags of pericarditis

TABLE A15 Red flags of pericarditis

A16: Red flags of upper respiratory disease

TABLE A16 Red flags of upper respiratory disease

A17: Red flags of lower respiratory disease

TABLE A17 Red flags of lower respiratory disease

A18: Red flags of anaemia

TABLE A18 Red flags of anaemia

A19: Red flags of haemorrhage and shock

TABLE A19 Red flags of haemorrhage and shock

A20: Red flags of leukaemia and lymphoma

TABLE A20 Red flags of leukaemia and lymphoma

A21: Red flags of raised intracranial pressure

TABLE A21 Red flags of raised intracranial pressure

A22: Red flags of brain haemorrhage, stroke and brain tumour

TABLE A22 Red flags of brain haemorrhage, stroke and brain tumour

A23: Red flags of headache

TABLE A23 Red flags of headache

A24: Red flags of dementia, epilepsy and other disorders of the central nervous system

TABLE A24 Red flags of dementia, epilepsy and other disorders of the central nervous system

A25: Red flags of diseases of the spinal cord and peripheral nerves

TABLE A25 Red flags of diseases of the spinal cord and peripheral nerves

A26: Red flags of diseases of the bones

TABLE A26 Red flags of diseases of the bones

A27: Red flags of localised diseases of the joints, ligaments and muscles

TABLE A27 Red flags of localised diseases of the joints, ligaments and muscles

A28: Red flags of generalised diseases of the joints, ligaments and muscles

TABLE A28 Red flags of generalised diseases of the joints, ligaments and muscles

A29: Red flags of diseases of the kidneys

TABLE A29 Red flags of diseases of the kidneys

A30: Red flags of diseases of the ureters, bladder and urethra

TABLE A30 Red flags of diseases of the ureters, bladder and urethra

A31: Red flags of diseases of the thyroid gland

TABLE A31 Red flags of diseases of the thyroid gland

Figure 2.5 Symptoms and signs of hypothyroidism (see A31.2).

(From CTG Figure 5.1c-I.)

Figure 2.6 The symptoms and signs of hyperthyroidism (see A31.3).

(From CTG Figure 5.1c-II.)

A32: Red flags of diabetes mellitus

TABLE A32 Red flags of diabetes mellitus

A33: Red flags of other endocrine disease

TABLE A33 Red flags of other endocrine disease

Figure 2.7 The features of Cushing’s syndrome (See A33.1).

(From CTG Figure 2.2c-I.)

Figure 2.8 The symptoms and signs of acromegaly (see A33.6).

(From CTG Figure 5.1e-III.)

A34: Red flags of menstruation

TABLE A34 Red flags of menstruation

A35: Red flags of sexually transmitted diseases

TABLE A35 Red flags of sexually transmitted diseases

A36: Red flags of structural disorders of the reproductive system

TABLE A36 Red flags of structural disorders of the reproductive system

A37: Red flags of pregnancy

TABLE A37 Red flags of pregnancy

A38: Red flags of the puerperium (the 8 weeks that follow delivery)

TABLE A38 Red flags of the puerperium (the 8 weeks that follow delivery)

A39: Red flags of diseases of the breast

TABLE A39 Red flags of diseases of the breast

A40: Red flags of childhood diseases

TABLE A40 Red flags of childhood diseases

A41: Red flags of diseases of the skin

TABLE A41 Red flags of diseases of the skin

Figure 2.9 The crusting rash of impetigo (see A41.1).

(From CTG Figure 5.4d-VI.)

Figure 2.10 Shingles on the back of the leg (see A41.4).

(From CTG Figure 5.4d-IV.)

Figure 2.11 A malignant but slow growing basal cell carcinoma on the cheek (see A41.10).

(From CTG Figure 6.1c-XIX.)

Figure 2.12 A malignant but slow growing squamous cell carcinoma on the earlobe (see A41.10).

(From CTG Figure 6.1c.)

Figure 2.13 A malignant skin tumour (nodular melanoma) (see A41.10).

(From Kumar and Clark, 6th edn, Figure 23.34.)

Figure 2.14 Pre-malignant solar keratoses on the sun-exposed forehead (see A41.10).

(From CTG Figure 6.1c-XVIII.)

Figure 2.15 Benign seborrhoeic warts on the skin of the back (see A41.10).

(From CTG Figure 6.1c-XVI.)

Figure 2.16 Wheals on the arm in urticaria, one of the features of angio-oedema (see A41.11).

(From CTG Figure 6.1c-XXIII.)

A42: Red flags of diseases of the eye

TABLE A42 Red flags of diseases of the eye

A43: Red flags of diseases of the ear

TABLE A43 Red flags of diseases of the ear

A44: Red flags of mental health disorders

TABLE A44 Red flags of mental health disorders