Oral Dental GI Liver Biliary tract infections Topics

Oral & Dental, GI, Liver & Biliary tract infections (Topics 11, 18 & 19) Dr. Gayathri Attanayake

Alimentary canal & accessory organs

Alimentary canal is a continuous tube comprising of: • Mouth (oral cavity) • Pharynx • Oesophagus • Stomach • Small intestine Duodenum, Jejunum & Ileum • Large intestine (colon) Ascending, Transverse, Descending & Sigmoid parts • Rectum • Anal canal & Anus

Accessory Organs include: These generally produce or store secretions which are necessary for the chemical digestion of the food. 12/04/2020 4

Oral & Dental Infections

Normal flora in the oral cavity

Infections in the oral cavity

Infection/Inflammation of pharynx: Pharyngitis Infection/Inflammation of salivary glands: Sialadenitis Infection/Inflammation of mucus membrane of the oral cavity: Stomatitis Infection/Inflammation of angles of the mouth: Angular stomatitis Infection/Inflammation of tongue: Glossitis Infection/Inflammation of gums: Gingivitis Cavity formation in teeth/ tooth decay: Dental caries Infection/Inflammation of pulp cavity of tooth: Pulpitis Severe inflammation of gum & supporting structure of teeth:

Infection/Inflammation of pharynx Pharyngitis

Infection/Inflammation of gums: Gingivitis

Candida infection of oral cavity: Oral thrush

Ulcers in the oral cavity

Oral ulcers can occur in following viral infections: HSV HIV HPV

Dental infections Cavity formation in teeth/ tooth decay: Dental caries Infection/Inflammation of pulp cavity of tooth: Pulpitis pocket of pus that's caused by a bacterial infection: Tooth abscess Severe inflammation of gum & supporting structure of teeth: Periodontitis

Causes for development of dental caries • Poor dental hygiene Not taking proper care of your teeth and gums — such as not brushing your teeth twice a day and not flossing can increase your risk of tooth decay, gum disease, tooth abscess, and other dental and mouth complications. • A diet high in sugar Frequently eating and drinking foods rich in sugar, such as sweets and sodas, can contribute to dental cavities and turn into a tooth abscess. • Dry mouth Having a dry mouth can increase your risk of tooth decay. Dry mouth is often due to the side effect of certain medications or aging issues.

Infection/Inflammation of tongue: Glossitis

Infection/Inflammation of salivary glands: Sialadenitis

Infection/Inflammation of mucus membrane of the oral cavity: Stomatitis Infection/Inflammation of angles of the mouth: Angular stomatitis

Infections in the stomach and small intestine

Gastroenteritis

Causes for gastroenteritis: Bacteria Virus Protozoa

Bacterial causes: Coliform bacteria: Ex: E. coli Klebsiella pneumoniae Noncoliform bacteria: Ex: Salmonella typhi, Salmonella paratyphi Shigella dysenteriae

Fig. 22. 18, Rotavirus, spoke wheeled shape, very common cause of viral diarrhea

Commonest symptom of Gastroenteritis Frequent passage of loose stools (Diarrhoea) If blood & mucus passes with loose stools Dysentery

Major bacterial Gastroenteritis Shigellosis (Shigella dysentery) Typhoid/ Enteric fever Cholera E coli diarrhoea Clostridium difficile pseudomembranous enterocolitis

Shigellosis (Shigella dysentery) Caused by the bacteria Shigella dysenteriae Transmission: Oral/fecal route Shiga toxin: cause fever, inflammation & lesions in the intestine that cause bleeding & heavy mucus secretions

Treatment: Antibiotic and rehydration Prevention: by proper sanitation and good hygiene No effective vaccine

Fig. 22. 11, Shigella infection

Typhoid/ Enteric fever Historically, this disease was a killer Caused by the bacteria Salmonella typhi Transmission: Oral/fecal route Exotoxin as well as endotoxin: spread from small intestine into blood stream resulting in septicemia, fever, and other organ damage

Cholera Caused by gram negative curved rod Vibrio cholera Enterotoxins: disrupts the function of the small intestine by damaging the epithelial layers. Causes an imbalance in the electrolytes. Results in loss of lot of fluid This makes stool so watery “rice water” Loss of a lot of water can cause dehydration and

Transmitted by contaminated water & food Treatment: Electrolyte and fluid replacement by oral rehydration therapy Prevention: Oral & Killed vaccines are available

Fig. 22. 13, Vibrio cholera

E coli diarrhoea Caused by the bacteria Escherichia coli, a gram negative coliform Escherichia coli is common as normal flora of the intestine but some strains cause disease Transmission: Oral/fecal route Some strains of E. coli can cause bloody diarrhoea Ex: Enterohemorrhagic E. coli

Clostridium difficile enterocolitis Caused by anaerobic rod Clostridium difficile which is normal flora but can be opportunistic. Causes antibiotic-associated enterocolitis in large intestine known as pseudomembranous colitis

Fig. 22. 14 Antibiotic associated colitis, C. difficile, note (c), pseudomembranes

Protozoan dysentry Amebiasis

Amebiasis Caused by protozoa Entamoeba histolytica Transmitted by ingesting water or food contaminated with Entamoeba histolytica cysts Results in dysentery, abdominal pain & fever In some cases can also invade liver and lungs Can be prevented by proper sanitation, safe drinking water, adequate cooking of food.

Helicobacter pylori (H. pylori) infection

Helicobacter pylori (H. pylori) is a bacteria that causes stomach inflammation (gastritis), peptic ulcer disease, and certain types of stomach cancer.

Liver & biliary infections

Infection/Inflammation of the liver: Hepatitis