1. ORAL AND GASTROINTESTINAL DISEASES
CHAPTER 22
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2. Anatomy Review Mouth Stomach Hepatobiliary tree Small Intestine
Large Intestine
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3. Bacterial Oral Cavity Disease
Dental Plaque
Accumulations of dextrans (biofilm)
May calcify
Dental Caries
Streptococcus mutans
Lactic acid erodes dental enamel
Periodontal disease
Tooth support structures
Gingivitis – gum inflammation
Periodontitis – root of tooth also affected
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4. Viral / Fungal Oral Cavity Disease
Mumps – Paramyxovirus
URT and salivary glands are affected
Resurgence recently due to complacency and failure to vaccinate
Complications – male sterility, meningitis, eye, ear infections, attack on other exocrine/ endocrine glands
Thrush
© 2012 John Wiley & Sons, Inc. All rights reserved.

5. Bacterial Gastrointestinal Intoxications
Staphylococcal Enterotoxicosis
Staphylococcus aureus
High starch or cream content, high protein foods
Foods subjected to temperature abuse
Cooked foods need to be covered/refrigerated to avoid bacterial growth and toxin production
Toxin can survive 30 minutes of boiling
Low mortality
Diarrhea symptoms 1-8 hr after food consumption
© 2012 John Wiley & Sons, Inc. All rights reserved.

6. Other Enteric Intoxications
Clostridium perfringens Enterotoxicosis
Casseroles
Anaerobic bacterium
Toxin produced during endospore formation
Diarrhea 8-24 hr after food consumption
Self-limiting
*Also causes gas gangrene, see Nervous System diseases
© 2012 John Wiley & Sons, Inc. All rights reserved.

7. Enteric Intoxications
Botulism (Clostridium botulinum)
Consumed toxin can cause flaccid paralysis
Life support needed to prevent suffocation
Bacillus cereus
Food poisoning associated with rice/ meat contamination
Found in water and soil
Pseudomonas cocovenenans
Polynesian coconut contamination
Food poisoning may be fatal
© 2012 John Wiley & Sons, Inc. All rights reserved.

8. Infections - Terminology
Enteritis
Inflammation of the intestine
Physical damage
Invasion of cells by bacteria
Dysentery
Submucosal damage leads to blood and mucus in the stool
Gram negative bacteria may cause fever to accompany symptoms
© 2012 John Wiley & Sons, Inc. All rights reserved.

9. Bacterial Gastrointestinal Infections Salmonellosis
Salmonella enteritidis serotype
Poultry and poultry products
2000 strains
Notifiable disease
Strains help to trace public health problems to their source
Diarrhea 8-24 hr after food consumption
Self limiting, low mortality in infants and elderly
© 2012 John Wiley & Sons, Inc. All rights reserved.

10. Bacterial Infections – Typhoid Fever
Salmonella typhi
Human reservoir only
Fever headache diarrhea
Many organs invaded
Bact. in urine, blood, feces
WBC count decreases
Less than 500 cases/yr in U.S.A.
Fluoroquinolones, chloramphenicol
Good public health measures prevent transmission
© 2012 John Wiley & Sons, Inc. All rights reserved.

11. Bacterial Shigellosis
Shigella dysenteriae and others
Primates are a reservoir
Contaminated water assists spread
10 bacteria may be enough to cause diarrheal disease
450,000 cases/yr in U.S.A.
Symptoms for 2-7 days, self limiting
Day care center transmission
© 2012 John Wiley & Sons, Inc. All rights reserved.

12. Bacterial - Asiatic Cholera
Vibrio cholerae
Developing nations
Rice water stool
Death due to shock/fluid loss
Rehydration therapy may be more effective than antibiotics
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13. Bacterial Gastrointestinal Infections
Vibriosis
Vibrio parahemolyticus
Seafood associated
Marine bacteria, may also infect wounds
Self limiting 2-5 days
Traveler’s Diarrhea
Escherichia coli is a common pathogen
Water sources
Dehydration is biggest danger
Complications – infectious IBS , lactose intolerance
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14. Enterohemorrhagic E. coli
E. coli O157:H7
Shiga toxins cause intestinal hemorrhage, kidney failure, blindness
Children most sensitive
Ground beef, uncooked produce
3000 cases/yr estimated, 30 deaths in U.S.A.
© 2012 John Wiley & Sons, Inc. All rights reserved.

15. Campylobacter Enteritis
Campylobacter jejuni
Food/H2O borne, copious diarrhea
Opportunistic
Second only to Salmonella in incidence
Animal intestines are source
Fluid replacement most important
© 2012 John Wiley & Sons, Inc. All rights reserved.

16. Bacterial Stomach Infections
Peptic Ulcer/Chronic Gastritis
Helicobacter pylori
Neutralizes stomach acid by degrading urea
4 million sufferers in U.S.A.
Treatment
Antibiotics
Acid suppressors
Stomach “liners”, e.g. Pepto Bismol
© 2012 John Wiley & Sons, Inc. All rights reserved.

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18. Clostridium difficile Diseases
Pseudomembranous colitis
Diarrhea
Clostridium difficile
Endospore former
Common after long-term antibiotics
Difficult to eradicate
Nosocomial pathogen
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19. Viral GI Diseases Viral Enteritis Rotavirus Common in children
Enterovirus
Norwalk virus (norovirus)
Hepatitis
Liver inflammation
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20. Hepatitis Types HAV Hepatitis A (HAV) RNA virus
Oral-fecal transmission
Family transmission or contaminated water/shellfish
15 – 40 day incubation
Jaundice, fever, malaise, nausea, diarrhea, abdominal pain, anorexia
50% of cases asymptomatic
Self-limiting, immunity is gained
Vaccine since 1995
© 2012 John Wiley & Sons, Inc. All rights reserved.

21. Hepatitis B (HBV) Double stranded DNA virus
Blood to blood transmission
Sexual
Intravenous drug route/ transfusions
Semen and breast milk
Symptoms as for HAV but liver cell damage is occurring
Vaccine recommended for all health care workers since 1986
Also recommended for infants (90% will become chronic carriers)
Carrier status linked to cirrhosis and liver cancer in later life
© 2012 John Wiley & Sons, Inc. All rights reserved.

22. Hepatitis Types Hepatitis C (HCV) Blood borne like HBV
More temperature resistant
Casual transmission
Hepatits D (HDV)
Requires co-infection with HBV
© 2012 John Wiley & Sons, Inc. All rights reserved.

23. Protozoan GI Diseases Giardiasis Giardia lamblia Backpackers disease
Dysentery from drinking unpurified water
Endemic in mountain areas
Amebiasis
Entameba histolytica
Endemic in developing nations
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24. Protozoan GI Diseases Balantidiasis Balantidium coli
Endemic in developing nations
Cryptosporidiosis
Cryptosporidium parvum
Cows and humans
AIDS patients
Cyclosporiasis
Cyclospora cayentanensis
Soft berries
Imports
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