8 sections GI tract

1. mouth

2.pharynx

3. esophagus

4. stomach

5. small intestine

6. large intestine

7. rectum

8. anus

salivary glands

liver

gall bladder

pancreas

1. mucus

2. secretory antibodies

3. peristalsis

4. fluids w/ anti-microbial properties

5. galt tissues

6. microbial antagonism

Salvia

stomach fluid

bile

tonsils

adenoids

lymphoid tissue of esophagus

appedix

Large # normal biota

oral-550 known

esophagus & stomach-103/g contents

large intestine-1011/g contents

s/s:minor-2 comple destruction enamal; deeper=toothache

causative: Steptococcus mutans, Streptococcus sobrinus

P & V: metabolism produce acid sugars dissolve enamel

T & E: normal biota

P & T: oral hygiene, diet, fluride; remove tooth

s/s:initial gingivitis>>persisits then periodontis

causative: microorganisms communities include anaerobes & other species

P & V:calculus, enzymes destroy tissues

T & E:normal biota

P & T:oral hygiene, scaling calculus, surgery reduce pockets

1. extension gingivitis into periodontal memebrane & cementum
2. increase size pockets between tooth & gingiva
3. cause bone reabsorbtion loosens tooth & may lose

Mumps

s/s: incub 2-3 weeks inflammation salivary glands followed by invasion to other organs (testes, ovaries, heart, kidneys, pancreas, meninges

causative: Paramyxovirus

P & V:syncytium

T & E:droplets

P & T:MMR vacine, treat symptoms

s/s: gastritis-sharp pain emanating fr abdomen; ulcers-lesion in mucose of stomach or s.intestine & bloody stools vomiting

causative: Helicobacter pylori

P & V:bores mucous layer, attach eptithelial cell, acidiphile produce urease; immune may damage epithelium deeper erosion & ulcers

T & E:unknown-oral-oral, fecal-oral

P & T:diminish aggravating factors-spicy & sugars;acid suppressors

> 3 loose stool in 24 hr.

Acute diarrhea-caused by infectious agents

Acute diarrhea w/ vomiting-caused by toxins

chronic diarrhea

Acute Diarrhea

Salmonella enterica

s/s:severe-elevated temp,septicemia or mild-vomiting, mucosal irritation; symptoms subside after 2-5 days

causative: Salmonella enterica

P & V:

T & E:contaminated food or poor sanitation

P & T:avoid contact w/ bacterium; fluid & electrolyte replacement; typoid fever>>antibiotics

Acute Diarrhea

Shigella dysenteriae, S. sonnei, S. flexneri

s/s: water stools,  intense abdominal pain, nausea, vomiting, bloody stools

causative: Shigella dysenteriae, S. sonnei, S. flexneri

P & V:entertoxin, exotoxin affect GI tract damages mucose & cells; shiga toxin-binds to ribosome interrupts protein synthesis, small ID

T & E:direct, fecal-oral

P & T:avoid contact, hygiene, some reccomend treatment w/ antibiotics

Acute Diarrhea

E. coli O157:H7 or EHEC

s/s:mild gastroenteritis w/ fever to bloody diarrhea, can cause liver, kidney damage, blindness, seizure or stroke, most virulent E. coli

causative: E. coli O157:H7

P & V: shiga toxin, type III secretion

T & E:undercooked or contaminated beef

P & T:antibiotics inadvisable

1. Enterotoxigenic (ETEC)- travelers diarrhea
2. Enteroinvasive (EIEC)-common developing countries similar to Shigelladysentery
3. Enterpathogenic (EPEC)-similar to EHEC but not shiga toxin
4. Enteroaggregative (EAEC)-chronic, common children & AIDS patients

Acute diarrhea

Campylobacter jejuni

s/s:water stools, fever, vomiting, severe abdominal, symptoms may last beyond 2 weeks; Guillain Barre; most common

causative: Campylobacter jejuni

P & V:

T & E:contaminated food, beverage

P & T:avoid contact

Acute Diarrhea

Yersinia enterocolitica, Y. pseudotuberculosis

s/s: infection usually spreads to blood stream; uncommon U.S.

causative: Yersinia enterocolitica, Y. pseudotuberculosis

P & V:

T & E:contaminated food or beverage

P & T:

Acute Diarrhea

Clostridium dificile

s/s: colon inflamed & slough off pseudomemebranes of fibrin & cells

causative: Clostridium difficile

P & V:2 enterotoxins-A & B cause necrosis intestine wall

T & E: major diarrhea in hospitals, superinfect 

P & T:

Acute diarrhea w/vomiting

food poisoning

Causative: Staphylcoccus aureus, Bacillus cereus, Clostridium perfringens

pericardium-rare site infection

epicardium

myocardium

endocardium-common site infection

1. inflammation endocardium-infection heart vavles (mitral or aortic)
2. acute or subacute-develope slowly over time
3. s/s: fever, anemia, abnormal heartbeat, symtoms similar to MI

s/s: bloodstream challenge w/ bacteria, colonize heart valves, lead to malfunction & death of heart, bacteria create emboli (blockages) other organs 

causative: Staphylcoccus aureus, Steptococcus pyogenes, Steptococcus pneumoniae, Neisseria gonorrhoeae

P & V:

T & E:direct, IV or subcutaneous drug users, traumatic or surgical patients @ risk bacterial ,infection

P & T:avoid intro bacteria into blood, penicillin, vancomycin-continuous blood levels antiobiotics, surgery heart valves

s/s: irregularities heart valves

causative: Streptococcus sanguis, S. oralis, S. mutans

P & V:

T & E:disruptions skin or mucous membrans,vigorous toothbrushing, males more common, rhematic fever suspectible

P & T:prophylactic antibiotics before dentist or surgery decreased, treatment like acute

s/s: altered mental state, chills, GI disturbance, tachypenia w/ alkalosis, decreased BP

causative: Salmonell enterica (typoid fever), Yersinia

P & V:gram - release endotoxin>stimulate inflam response, gram + endotoxic shock

T & E:IV, surgical, UTI, abcesses kidney, prostate, pancreas, gall bladder, meningeal infections

P & T: no vacine, treat symptoms, broad spec antibiotics

s/s: Asymptomatic, Mimics Gonorrhea (F) Discharge Servicidis, PID, Salpingitis (newborn) Respiratory and eye infections.

causative: Chlamydia trachomaitis

P & V: Intracellular Growth

T & E: Sexual Contact, Vertical

P & T: No Vaccine, Screening->Antibiotics->Screen

ASVD = Arteriosclerotic Vascular Disease

condition fatty material collects along walls arteries, thickens & hardens forming calcium deposit

LDLs

Transports cholesterol fr liver to tissues, "bad cholesterol

HDLs

Transports cholesterol fr arteries to liver for excretion or re-utilization, "good cholesterol"

s/s: inflamm & necrosis lymph node, progress septic plague

causative: Yersinia pestis

P & V: small ID, carry 3 plasmids,

T & E: respiratory droplets, contact w/ infected fluids, human-human, animal-human

P & T: death possible 2-4 days, prompt treatment, vaccines-military & lab, controlled trapping rodents,

s/s: tick bit looks like bulls eye,  2⁰chronic & disabling cardiac & neurological symptoms

causative: Borrelia burgdorferi

P & V: antigenic shifting, adhesions

T & E: biological vector

P & T: avoid ticks, treat doxyclcline, amoxicillin

infectious mononucleosis

EBV

s/s: long incuba-30-50, gray/white lesions, enlarged spleen, raised WBC, fatigue

causative: Epstein Barr virus

P & V: latency, ablility to incorp into host cell

T & E:direct, indirect, parenteral

P & T: treat symptoms, hospital if spleen ruptures,

infectious mononucleosis

CMV

s/s: long incuba-30-50, gray/white lesions, enlarged spleen, raised WBC, fatigue

causative: Cytomegalovirus

P & V: latency, syncytium

T & E: direct, indirect, parenteral, vertical

P & T: vaccine in trial, treat symptoms

s/s: progress to oral hemmorrage, nosebleed, jaundice, liver & kidney damage w/ significant mortality

causative: yellow fever virus

P & V: capillary fragility, disrupts blood-clotting, localized bleeding & shock

T & E: biological vector

P & T: live attenuated vaccine, supportive care symptoms

s/s: breakbone fever fr. severe pain in muscles & joints

causative: dengue fever virus

P & V: cap fragility disrupts blood clooting

T & E: human-aedes mosquitos

P & T: treat symptoms, vaccine in test

s/s: incuba 2-21 days, early-rash trunk, fever, aches. later-vomit, diarrehea, inter/exter massive hemorrage, bleed fr. orifices, shock 

causative: Ebola virus

P & V: -none

T & E: direct, body fluids

P & T: treat symptoms

s/s: incuba 3-9 days, rash, similar to ebola inter/exter hemmorrage, bleeding orifices

causative: marburg virus

P & V: disrupts clotting factors

T & E: direct contact, body fluids

P & T: treat symptoms, careful travel, avoid virus

s/s: fluctuating fever, lesions-liver, spleen, bone marrow, kidney muscle aches

causative: Brucella abortus or B suis

P & V: taken up by phagocytes but unharmed

T & E: animals-human

P & T: elimination, quarantine, animal vaccine, combo threrapy doxycycline 3-6 weeks.

s/s: abrupt onset of fever

causative: Coxiella burnetii

P & V: endospore former, intracellular parasite

T & E: ticks, enviromental contamination, airborne, direct, food-borne, occupational

P & T:vaccine for high risk, doxycycline

s/s: sustained fever, distinct spotted rash 2-4 days after prodomal-flat>maculopapular> merge necrotic & gangrene

causative: Rickettsia rickettsii

P & V: induces apoptosis (cell death) cells lining blood vessels

T & E: biological vector-ticks,

P & T:protective clothing, doxycycline

s/s: incubat 10-16 days

causative: protozoan-eukaryoute, Plasmodium 4 types

P & V: multiple life stages, mult antigenic types, GPI, cytoadherence-RBC adhsion to blood vessels in brain, ability to scavenge glucose

T & E: biolocial vector-mosquitos, veritcal

P & T:nets, screens, repellants, prophylactic antiprotozoal agents,

s/s: raised itchy bump, painless, dark center, swelling lymph glands

causative: Bacillus anthracis

P & V: polypeptide capsule, tripartite toxin

T & E: soil, natural-livestock, terror attacks

P & T: vaccine, animal carcasses burned or chemicall decontaminated

s/s: common cold leadin lung infection, incuba 7 days after exposure, untreated death 1-2 days after severe symptoms

causative: Bacillus anthracis

P & V: polypeptide capsule, tripartite toxin

T & E: soil, natural-livestock, terror attacks

P & T: vaccine, animal carcasses burned or chemicall decontaminated

s/s: T cells steadily <; < 200 cells/mL progress to AIDS

causative: human immunodeficiency virus 1 or 2

P & V: latent w/in host, disables immune response,  attachement, syncytia formation, reverse transcriptase, high mutation rate

T & E: direct, sexual, vertical

P & T: reverse transcriptase inhibitors plus protease inhibitors, avoidance infected sex partner, contaminated blood or milk

Genitourinary tract defenses

urinary tract

1. flusing urine
2. sheeding epithelial cells
3. acidity of urine
4. antibacterial proteins in urine
5. lysozyme, lactoferrin
6. secretory antibodies

genitourinary tract defenses

male reproductive

genitourinary tract defenses

female reproductive

1. non-reproductive years-mucous w/ secretory antibodies
2. reproductive- mucous w/ secretory antibodies & low pH;estrogen stimulates glycogen secretions, bacteria ferment sugar>acid lowers pH

only vagina-cervix & above sterile

non-reproductive years-outer region urethra-streptococci, staphylococci, corynebacterium, some lactobacilli; everything else sterile

reproductive years-lactobacillus species, low levels Candida albicans

s/s: pain, urge to empty bladder, dysuria, hematuria, back pain

causative:95% normal bacterial biota fr. GI tract; E.coli most common, Staphylococcus saprophyticus, Proteus mirabilis

P & V:fibriae, motility

T & E: fr. 1 organ system to another, catherters > susceptibility nosocomial

P & T:empty bladder freq, hygiene, cranberry juice, treat symptoms

s/s: zoonosis associated w/ animal urine;early-pathogen appears blood & CSF,later-infection clears, Weil's syndrome 

causative: Leptospira interrogans

P & V: adhsions, invasion proteins

T & E:vehicle contaminated soil or water

P & T: strain specific vaccine limited populations, avoidance, doxycycline, amoxicillian

trichomoniaisis

gonorrhea

chlamydia

syphilis

chancroid

genital herpes

vaginitis

vaninosis

reproductive tract disease

Candida albicans

causative: Candida albicans

P & V: grows thick curd like colonies>white discharge; overgrowth due to disruption normal flora or damage to mucosal epithelium

T & E: sexual contact

P & T: no vaccine

reproductive tract disease

Gardnerella species

causative: Gardnerella species

P & V: no inflammation, asymptomatic >grayish dishcharge w/ fishy order. normal biota shifs good to bad, mixed infection, can lead to PID. pH high but don't know if cause or effect

T & E: not sexual transmitted but associ w/ sexual activity

P & T: no prevention, oral/topical

reproductive tract disease

Trichomonas vaginalis

causative: Trichomonas vaginalis

P & V: asymptomatic >white/green frothy dishcharge

T & E: sexual transmitted 

P & T: no vaccine;some strain resist to anti-protozoal drugs

s/s: pain-pelvic,lower back, genital area, freq urge urinate, dysuria, painful ejaculation, flu-like sympt

causative: normal bioat fr. GI tract or previous UTI

P & V: various

T & E: endogenous

P & T: no prevention, antibiotics & muscle relaxers

s/s: male-urethritis,yellow discharge, can cause infertility. female-urinary & genital infect, mucopurulent or blood vaginal dishcharge, may cause PID. newborn-respiratory & eye infection 

causative: Neisseria gonorrhoeae=gonococcus

P & V: specific attachment fibriae, antigenic variation, enzyme cleaves antibodies associated w/ mucous

T & E: sexual contact, vertical

P & T: strictly human infection, condoms

s/s: 1⁰-hard chancre, 2⁰-red/brown rash w/ lesions, 3⁰-gummas; "latency" may last 20+ yrs.

causative: Treponema pallidum

P & V:binds to epithelium multiplies, penetrates caps & moves to circulation/ mult in tissue

T & E: sexual, vertical, concurrent infect w/ other STD

P & T: detection & treat sexual contacts, treat w/ lrg dose penicillian