Diseases of the Digestive System

Gingivitis
• Gum disease generally doesn't hurt. You
may have it for years before you feel
discomfort.
• Telltale signs and symptoms of gingivitis:
 Tender, swollen or bleeding gums, particularly when
you brush your teeth
 A change in your gums' color from pink to dusky
red
• Causes
– Caused by plaque, a sticky, colorless film of
bacteria that coats your teeth. If allowed to
harden (calcify), the film turns into white-
colored tartar (calculus), which becomes darker
with time.
– If plaque and tartar build up, they can irritate
the gingiva, the part of your gum around the
base of your teeth. This buildup creates pockets
of bacteria between your gum and teeth and can
result in gums that become inflamed and bleed
easily.
• Risk Factors
– Everyone's susceptible to gum disease, and the most
common contributing factor is a long-term lack of
attention to proper oral hygiene. But these factors can
increase your risk:
 Genes. Bacteria that lead to gingivitis are more harmful to
some people's gums than to others. Those who are
susceptible have a hereditary predisposition to gum
disease.
 Medications. Some medications reduce saliva, causing a
dry mouth. Without the cleansing effect of saliva, plaque
and tartar can more easily build up. Hundreds of
prescription and over-the-counter antidepressants and cold
remedies contain ingredients that decrease your body's
production of saliva. Alcohol also can decrease production
of saliva.
 Smoking. Smoking slows your gums' ability to heal
themselves and replace tissue destroyed by bacteria.
 Diabetes. People with uncontrolled or poorly controlled
diabetes are more susceptible to gum disease. Diabetes
may result in a thickening of your blood vessels, making
them less able to carry nutrients to your gum tissue and
remove wastes. This can leave your gums less healthy and
more prone to infection.
 Pregnancy. Hormone changes during pregnancy make
your gums more susceptible to the damaging effects of
plaque.
 Decreased immunity. Illness can weaken your immune
system. This makes you prone to infection, which can lead
to gum disease.
 Treatment: Gingivitis usually clears up after a
professional cleaning by a dentist or hygienist,
followed by proper daily oral hygiene.
 Causative Agents: streptococci,
actinomycetes, and anaerobic G- bacteria
predominate in these infections
 Periodontitis
• Periodontitis is an advanced stage of gum
(periodontal) disease that can threaten the
loss of your teeth.
• Some form of gum disease affects about 75
percent of adults after age 35.
• Signs and symptoms of periodontitis may
include:
 Swollen or recessed gums
 Unpleasant taste in your mouth
 Bad breath
 Pain in one of your teeth when eating hot, cold or
sweet foods
 Dull sound when one of your teeth is tapped
 Loose teeth
 Change in your bite
 Drainage or pus around one or more teeth
• If plaque and tartar extend farther, beneath
your gumline you may develop
periodontitis.
• Your gums gradually withdraw from around
your teeth. Pockets of infection (pus) can
form in this dark, airless region and destroy
the tissue and bone supporting your teeth.
• Untreated, periodontitis will lead to your
teeth loosening and falling out.
• Treatment
– If you have pockets between your gums and your teeth
that are 5 millimeters or less in depth, your dentist may
recommend one of the following nonsurgical
treatments:
 Scaling and root planing. Scaling removes tartar and
bacteria from your tooth surfaces and beneath your gums.
Sometimes, scaling is done with an ultrasonic device. Root
planing smoothes the root surfaces, discouraging further
accumulation of tartar. With good daily oral hygiene,
scaling and root planing may be all the treatment you'll
need.
 Antibiotic therapy. Dentists can pinpoint the specific
strains of bacteria that cause periodontal disease and
prescribe antibiotics to deal with them.
– If you have advanced periodontitis — the depth
of the pockets between your gums and teeth is
more than 5 millimeters — you may need
surgery. The options:
 Flap surgery. If you have a deep infection pocket, your
dentist can "fold up" a section of your gum surgically,
exposing the roots for more effective scaling and planing.
Antibiotics may help fight the infection.
 Bone grafting. If the bone surrounding your tooth root is
destroyed, your dentist can secure sterilized bone
segments from a bone bank to fill the space and keep your
tooth in place.
 Guided tissue regeneration. This technique allows bone
destroyed by bacteria to regrow. Your dentist places a
special piece of biocompatible fabric between existing
bone and your tooth. This material prevents unwanted
tissue from entering the healing area, thereby encouraging
the bone to grow back.
• Prevention
– The best means of preventing gum disease is
good dental hygiene, including regular brushing
and flossing of your teeth and periodic
professional cleaning to prevent buildup of
plaque and tartar.
• Causative Agent: Porphyromonas species
 Diseases of Lower Digestive
System
• Two types: infection and intoxication
– infection: pathogen enters GI tract and
multiplies
– intoxication: ingestion of pre-formed toxin
– Both types of infection often cause diarrhea.
• Dysentery: sever diarrhea accompanied by blood or
mucus
– Both types of infection are frequently
accompanied by abdominal cramps, nausea,
and vomiting
– Gastroenteritis: general term for diseases
causing inflammation of the stomach and
intestinal mucosa.

• Most common causative agents: rotavirus, some E-

coli species and Shigella species.
 Staphyloccocal Food Poisoning
• Leading cause of gastroenteritis
– an intoxication caused by ingesting toxin
produced by S. aureus
– Highly resistant to heat, drying, radiation and
osmotic presures
• Process of infection
• Toxin quickly triggers brain’s vomiting
reflexcenter; abdominal cramps and usually
diarrhea ensue
– Recovery is usually complete within 24 hours
– Mortality rate is almost zero among healthy
people
• Shigellosis:
– a severe form of diarrhea caused by group of
facultative anaerobic G- rods of the genus
Shigella
• Most common species in the US is S. sonnei
(traveler’s diarrhea)
• Infection with S. dysenteriae often results in severe
dysentery and prostration
– Shiga toxin responsible for inhibition of protein synthesis
– Bacteria not really affected by stomach acidity
– Cause damage to intestinal mucosa resulting in fluid loss
and inability to absorb fluid from the intestines.
• Treatment: anitibiotic therapy and oral
rehydration
– Generally self-limiting. (In other words, all the
fluid that is lost from the body during the
disease helps to wash out the bacteria from the
body.)
• Salmonellosis:
– Causative agent: Salmonella enterica
– Every year, approximately 40,000 cases of
salmonellosis are reported in the United States.
– Because many milder cases are not diagnosed or
reported, the actual number of infections may be twenty
or more times greater.
– Children are the most likely to get salmonellosis.
– Young children, the elderly, and the
immunocompromised are the most likely to have severe
infections.
– It is estimated that approximately 1,000 persons die
each year with acute salmonellosis.
– Incubation period of 12-72 hours
– Lasts for 4-7 days
– Invade intestinal mucosa first and multiply
there
– Sometimes manage to pass through intestinal
mucosa and invade lymphatic and
cardiovascular systems
– Symptoms:
• Fever
• Nausea
• Abdominal pain and cramps
• diarrhea
• Treatment:
– Antibiotics are not usually necessary unless the
infection spreads from the intestines, then it can
be treated with ampicillin, gentamicin,
trimethoprim/sulfamethoxazole, or
ciprofloxacin.
– Unfortunately, some Salmonella bacteria have
become resistant to antibiotics, largely as a
result of the use of antibiotics to promote the
growth of feed animals
• Transmission:
– Salmonella live in the intestinal tracts of humans and
other animals, including birds.
– Salmonella are usually transmitted to humans by eating
foods contaminated with animal feces.
– Contaminated foods usually look and smell normal.
– Contaminated foods are often of animal origin, such as
beef, poultry, milk, or eggs, but all foods, including
vegetables may become contaminated.
– Many raw foods of animal origin are frequently
contaminated, but fortunately, thorough cooking kills
Salmonella.
– Food may also become contaminated by the unwashed
hands of an infected food handler, who forgot to wash
his or her hands with soap after using the bathroom.
– Salmonella may also be found in the feces of
some pets, especially those with diarrhea, and
people can become infected if they do not wash
their hands after contact with these feces.
– Reptiles are particularly likely to harbor
Salmonella and people should always wash
their hands immediately after handling a reptile,
even if the reptile is healthy.
– Adults should also be careful that children wash
their hands after handling a reptile.
• Prevention:
– There is no vaccine to prevent salmonellosis.
– Since foods of animal origin may be contaminated with
Salmonella, people should not eat raw or undercooked
eggs, poultry, or meat.
– Raw eggs may be unrecognized in some foods such as
homemade hollandaise sauce, caesar and other salad
dressings, tiramisu, homemade ice cream, homemade
mayonnaise, cookie dough, and frostings.
– Poultry and meat, including hamburgers, should be
well-cooked, not pink in the middle.
– Persons also should not consume raw or unpasteurized
milk or other dairy products.
– Produce should be thoroughly washed before
consuming.
– Cross-contamination of foods should be avoided.
– Uncooked meats should be keep separate from produce,
cooked foods, and ready-to-eat foods.
– Hands, cutting boards, counters, knives, and other
utensils should be washed thoroughly after handling
uncooked foods.
– Hand should be washed before handling any food, and
between handling different food items.
– People who have salmonellosis should not prepare food
or pour water for others until they have been shown to
no longer be carrying the Salmonella bacterium.
– People should wash their hands after contact with
animal feces.
– Since reptiles are particularly likely to have Salmonella,
everyone should immediately wash their hands after
handling reptiles.
– Reptiles (including turtles) are not appropriate pets for
small children and should not be in the same house as
an infant.
 Cholera
• Causative Agent: Vibrio cholerae
– Outbreaks caused by temporary lapses in
sanitation practices
– Cholera bacteria commonly associated with
brackish (salty) waters
– Under unfavorable conditions, the bacterial cell
shrinks drastically into a nonculturable,
spherical, dormant state
• sporelike state without formation of a true spore coat
 – Both sporelike and vegetative forms are
infectious.
• Grows in small intestine and produce an
enterotoxin that results in the secretion of
chlorides, bicarbonates, and water.
• Excess water and mineral electrolytes are
excreted taking on the appearance of “rice
water stools”
– Sudden loss of fluids and electrolytes causes
shock, collapse, and often death (3-5
gallons/day are lost.)
 – Loss of fluid causes blood to become so
viscous that vital organs are unable to function
properly
• Vaccine available but only produces short
term immunity
• Treatment: tetracycline and replacement of
lost fluids
– 50% mortality rate
 Diseases of the Urinary
Reproductive Systems
• Cystitis: inflammation of urinary bladder
– Signs and Symptoms: dysuria (Painful or
difficult urination. This includes burning on
urination.), pyuria (presence of leukocytes in
urine)
– 2 most common causative agents: E-coli and
S. saprophyticus
– Rx.: Trimethoprim-sulfamethoxazole
• Pylonephritis: progression of cystitis to
inflammation of one or both kidneys
– Signs and Symptoms: fever and flank or back
pain.
– Causative agent: E-coli
– Complications: development of scar tissue
forms in kidneys and impairs their function
– Rx: intravenous, broad-spectrum antibiotics
(cephalosporins)
• Leptospirosis: disease of domestic or wild
animals that can pass to humans and cause severe
kidney or liver disease
– Causative agent: Leptospira interrogans, spirochete,
obligate aerobe
– Transmission: shed in urine for extended periods.
Humans become infected upon contact with urine-
contaminated water, soil or animal tissue
– Signs and Symptoms: Incubation period or 1-2
weeks. Fever, chills, headaches, muscular aches.
Several days later, second episode of fever
– Rx.: Body fights off. Antibiotics not very effective
– Complications: can cause kidney failure
• Gonorrhea: one of most common
communicable diseases
– Causative agent: Neisseria gonorrhoeae
– Transmission: attachment of organism to
mucosal cells of epithelial wall
– Signs and Symptoms:
• Males: painful urination, discharge of pus-
containing material from urethra
• If untreated, can result in sterility if testes are
infected
• Females: only cervix infected
• Some abdominal pain later in infection due to
subsequent Pelvic Inflammatory Disease
• Complications: can become systemic
infection
• Transmission: any type of sexual contact
• Rx: typically penicillin used but increases
resistance
– Current drug of choice is cephalosporin:
Ceftriaxone
• Pelvic Inflammatory Disease: bacterial
infection of female pelvic organs (uterus,
cervix, uterine tubes, or ovaries)
– Causative agent: N. gonorrhoeae, Chlamydia
– Signs and Symptoms: severe abdominal pain
– Transmission: bacterial attachment to sperm
cells
– Rx.: combination of doxycycline and cefoxitin
 Syphilis
• Causative agent: Treponema pallidum
• Symptoms:
– Primary stage:
• small, hard based sore (at site of infection)
• serous exudate forms in center (highly infectious)
• lesion disappears w/in few weeks
– Secondary stage:
• skin rashes of varying appearance (widely
distributed on skin, mouth, throat, cervix
• lesions of rash are very infectious
 • loss of patches of hair
• generally lasts a few weeks
• becomes latent
• After latency for 2-4 years, not usually infectious
– Tertiary stage
• usually 10 or more years after onset of latent phase
• most symptoms due to immune system
• cause gummas, rubbery masses of tisse that appear
in many organs and sometimes on external skin
• can cause extensive tissue damage
• Not generally infectious
• most infections today don’t progress to this stage
• Rx: Benzathine penicillin: long acting
formulation that remains effective in body
for about 2 weeks