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Cypress College - Mortuary Science - Anatomy & Pathology II - McCament - Section 2 - Pathology of the Digestive System

Stomatitis

mouth, lips, palate and oral mucosa (means opening on the surface)

Causes of Stomatitis

mechanical, chemical, thermal influences or infectious agents (in the mouth or may be a sign of systemic infection) (Neisseria Gonorrhea and Treponema Pallidum), anaerobes

Manifestations of Stomatitis

patches, ulcers, redness, pain, bleeding or necrosis

Classifications of Stomatitis

Apthous stomatitis, Acute Herpetic, Chronic Herpetic, Thrush

Apthous stomatitis

(Sutton's Disease) canker sores, fever flisters; common in girls and female adolescents; predisposing factors - fatigue, anxiety, fever, trauma, solar exposure, stress, Chron's disease, unclean oral cavity or digestive disturbances; approximately 10% of population has this condition of reoccurring canker sorea; palliative care usually is recommended
i. Minor ulcers heal without leaving scars within a week; 3-10mm
ii. Major ulcers heal within a month; greater than 10 mm

Acute Herpetic

Herpes Simplex I virus is common cause when child is 1-3 years old through salivary droplets; usually self limiting, will have lethargy, sudden mouth pain, fever

Chronic Herpetic

Herpes Simplex II causes vesicles to rupture which forms internal and external lesions; symptoms subside after 2 weeks when virus moves to nervous ganglia; reoccurrence when person experiences stressful events or immune compromised situations

Thrush

Candida albicans; yest fungi, normal flora, white flecks around entire lining of mouth, tongue, etc; when occurring in babies, it is called candidiasis, when occurring in adults it is called candidosis; high risk groups include diabetics, smokers, newborns, people taking antibiotics, immune compromised patients and denture users

Gingivitis

gums ~ causes are the same as stomatitis, sign of hypovitaminosis and diabetes

Types of Gingivitis

Catarrhal, Pyorrhea alveolaris (periodontitis), Ulcero-membranous, Vincent's angina

Catarrhal

a superficial non-ulcerative inflammation caused by mechanical, chemical, thermal or bacterial irritant; inflamed mucous membrane of the buccal cavity

Pyorrhea alveolaris (periodontitis)

chronic gingivitis that has progressed to loss of supporting peridentium; may lead to tooth loss

Ulcero-membranous

similar to trench mouth; ulcers become covered by a dirty, grayish pseudomembrane

Vincent's angina

trench mouth; unclean mouth including neglected teeth; profane salivation, foul breath; bacteria is Vincents' spirochete; necrotizing ulcerative gingivitis

Tonsillitis

tonsils~ acute cases can be bacterial or viral (Epstein Barr virus - "mono"); chronic cases are usually Group A streptococcal in origin; may also lead to removal in order not to block the airway; can be a precursor to other infections; also may be caused by stomatitis or gingivitis

Pharyngitis

pharynx or throat ~ mechanical and physical irritants; complication of rhinitis, sinusitis or influenza most primary infections start here; symptoms include sore throat, painful swallowing, 3-10 days to subside

Acute Pharyngitis

viral includes adenovirus (swollen lymph nodes, sore throat but not red), influenza, Epstein-Barr virus, Herpes Simplex, measles, common cold or even HIV; approx. 40-80% of acute cases are viral in origin; bacterial includes Group A streptococcus, gonorrhea, diphtheria or walking pneumonia; approximately 15-30% are bacterial in origin

Chronic Pharyngitis

when left untreated, it may lead to rheumatic fever or rheumatic heart disease

Esophagitis

esophagus~ causes can be reflux of the stomach acids, muscle spasms, stenosis, achalasia (inability to relax) diverticulum, tumors; other causes are the same as pharynigitis

Dysphagia

difficult or painful swallowing, type of Esophagitis

Varices

dilated or twisted veins; liver cirrhosis primary cause, type of Esophagitis

Gastritis

stomach~ brought on by food infection, bacterial (irritants are alcohol, spicy foods, aspirin, drugs, etc)

Gastritis - Ulcer

stomach (fundus and pylorus) - peptic ulcer (generic term), may become malignant; small intestine~ duodenal ulcer - account for apprx. 80% of all peptic ulcers; usually in men 20-50 years old, usually benign

Predisposing Factors - Gastritis

emotional turmoil, alcohol and drugs, digestive dysfunction

Food Poisoning Types - Gastritis

Staphylococcus aureus, enterotoxins, Clostridium Botulinum, Ergotism

Symptoms from Staphylococcus aureus

(found in nose and skin - 20% of population)~ 2-6 hours after ingestion: nausea, vomiting, diarrhea; usually not fatal; enterotoxins (chromosomally coded exotoxins secreted by the microbe) are produced in intestines (facultative anaerobe)

Other microbes that produce enterotoxins

Escherichia coli (E. Coli, facultative anaerobe); Clostridium perfringens (10% of food poisoning); cholera - vibrio cholerae; Yersinia enterocolitica; shigella dysenteriae (bacillary dysentery; thrives in the human intestine and is commonly spread both through food and by person-to-person contact) and rotavirus

Clostridium Botulinum

(obligate anaerobe, opportunist) rare but not serious illness, enters the body through an infected wound or consuming improperly canned or preserved food; creates spores to live in food products; symptoms appear 8-36 hours after consumption; usually no febrile condition but may have abdominal cramps, dry mouth, double vision, labored breathing, nausea and vomiting (infants may include constipation, weak cry, respiratory distress); most in US are in infants apprx. 100 per year

Ergotism

food poisoning due to ingestion of moldy food, usually rye bread (Salem Witchcraft trials)

Complications from Gastritis

dehydration in almost all cases; arthritis (yersinia and salmonella), bleeding disorders (E. coli & others), kidney problems (shigella, E. coli), nervous system disorders (botulism, campylobacter) pericarditis, (salmonella), respiratory distress, including the need for support on a breathing machine (botulism), and death (from mushrooms, certain fish poisonings, or botulism)

Nosocomial infections

any infection acquired from a health care facility; e.g., pneumonia; blood infection - MRSA (Methicillin-resistant Staphylococcus Aureus)
a. Patients living in hospitals, nursing homes, and other heath care centers who have weaker immune systems
b. Infections can appear around wounds or invasive devices, like catheters or implanted feeding tubes; thrives on polyester (privacy curtains)
c. Rates of infection in hospitals (ICU's) are rising throughout the world. In U.S. hospitals, MRSA causes up to 40%-50% of staphylococcal infections; now considered to be endemic in health care facilities (not seen prior to 1959)

Enteritis

irritating foods and chemicals, infectious agents, TB in Peyer's patches are somewhat common

Regional Enteritis

Chrohn's Disease inflammation of the intestine; usually affecting young adults, particularly women, more common in the Jewish community and least common in the black community; the walls become thick and rigid forming fibrous tissue which leads to a narrowing of the lumen causing chronic obstruction; elevated white blood cells, low levels of potassium and magnesium; treated with anti-inflammatory medications such as corticosteroids

Inflammatory Bowel Disease

(IBD) general term for Crohn's or ulcerative colitis - type of Enteritis

Campylobacter jejuni

camplyobacteriosis; bacillus found in animal feces; bacterial gasteroenteritis (food poisoning - most common form in the world) - type of Enteritis

Colitis

Large intestine; colon or haustra

Types of Colitis

Chronic ulcerative colitis, Diverticula, Diverticulosis, Diverticulitis, Colostomy, Appendicitis

Chronic ulcerative colitis

serious inflammation of the colon with extensive ulcers of the colon and rectum; usually in people 15 - 20 years old; caused by autoimmune disease, E. coli infection, stress or hypersensitivity to certain foods; increased risk of chronic blood loss through the rectum and chance of rectal malignancies

Diverticula

little pouches or sacs formed when mucous membrane pushes through the large intestines underlying muscle layer

Diverticulosis

condition of having the haustra of the large intestine irritated

Diverticulitis

Inflammation of the diverticula; about 50% of older adults develop this condition

Colostomy

opening in the abdominal cavity for fecal material to exit the body early instead of the anus/rectum; the location of the opening will determine the type of fecal material: the closer to the rectum the more solid it will be.

Appendicitis

vermiform Appendix same bacteria as colitis; common obstructions by fecaliths

Amebic dysentery

entamoeba histolytica; amebiasis; portal of entry and exit is the digestive system due to fecal contamination of water or food containing a cyst stage of the parasite - type of colitis

Typhoid fever

salmonella typhi; (enteriditis): acute gastroenteritis usually mild (salmonellosis); acquired by eating focally infected food or animal intestines; found only in humans, not animals - type of colitis

Bacillary dysentery

shigella species - type of colitis

Tuberculosis

mycobacterium tuberculosis - type of colitis

Hemorrhoids

varicosities of the hemorroidal veins caused by anything that impairs venous circulation: cardiac weakness, liver cirrhosis, constipation, etc; aka: piles

Hepatitis

Liver/blood

Causes of Hepatitis

microbial (virus and protozoa), alcohol or other chemicals, congenital infiltrations of fats, etc

Symptoms of Hepatitis

fever, jaundice (icterus), and anorexia

Types of Hepatitis

Infectious, Viral, C

Infectious Hepatitis

Hepatitis A Virus (HAV), fecal/oral route contamination; short incubation period; tissue will regenerate in 8-12 weeks; entry through digestive system and exit by feces; contaminated food, milk, water through infected food handlers

Viral Hepatitis

HBV, serum, blood borne; long incubation period; tissue will not regenerate; transmission usually through parenteral (needle stick, etc.) entry and contaminated fomites; virus can be carried for years

Hepatitis C

Non-A, Non-B

Cirrhosis

crystallization of the liver cells; usually end stage of hepatitis; 2 examples - Related to Hepatitis

Partial Cirrhosis

alcoholic/laennec's; (ETOH = alcoholism) blockage due to fibrosis

Biliary Cirrhosis

autoimmune disease affecting women 9:1 over men; immulogic; affecting the gallbladder and bile ducts; bile builds up in the liver

Common Symptoms of Cirrhosis

mental confusion, spider angiomas on chest, swollen breast tissue and palmar erythema due to gynecomastia, esophageal varices, hobnail liver, splenomegaly, abdominal ascites, edema in lower extremities, various skin hemorrhages and hematemesis (vomiting)

Cholecystitis

gallbladder ~ caused by infectious agents, chemicals, gallstones, retained bile

Acholia

Absence of bile - Type of Cholecystitis

Acholuria

Absence of bile pigment in urine - Type of Cholecystitis

Cholelithiasis

creation of gall stones (aka biliary calculi) caused by precipitation of bile due to inflammation; increase in cholesterol and calcium

Cholangitis

Inflammation of the bile duct; usually accompanied by pain in upper right quadrant, fever, jaundice, mental status change and blood poisoning

Pancreatitis

pancreas ~ can be acute or chronic (ETOH related); about 10% are severe and life threatening; 30% idiopathic; other causes are infectious agents, gallstones, drugs or trauma; fever and pain are symptoms

Peritonitis

peritoneum ~ usually bacterial causes (E. coli and Streptococcus feccalis; can be a result of trauma; postmortem conditions can include ascites, rapid decomposition and dehydration

Pyloric stenosis

narrowing of pyloric sphincter causing obstruction; congenital defect 1 in 200 newborns; in adult it is secondary to ulcer or fibrosis at the outlet

Hernia

congenital/acquired; protrusion of viscera through an opening in the cavity wall; diaphragmatic/ hiatal or abdominal/ ventral or inguinal, 27% men compared to 3% women

Obstruction

Paralysis, Infectious agents

Types of Obstructions

Volvulus, Intussusception, Adhesion

Volvulus

twisting of the bowl itself; most often in the ileum, cecum, or sigmoid colon

Intussusception

prolapsed of a segment of bowel into the lumen of another segment forward of it; ileum into the cecum; most often in infants

Adhesion

two normally separate surfaces are joined together

Other pathological conditions

Hemorrhage, Perforation, Flatus, Dysentery vs. diarrhea

Hemorrhage

melena (dark stool with tarry appearance from blood in the upper digestive system

Perforation

ulcer breaks through gastric or intestinal wall causing peritonitis and gas gangrene

Flatus

gas formed in the intestinal tract

Dysentery vs. diarrhea

...

Hyperplasia/neoplastic

Increased number of cells

Hyperplasia/neoplastic - Benign

papillomas, branching epithelial tissue, cysts (sac like) and fibroma (fibrous tissue)

Hyperplasia/neoplastic - Polyp(s)

small tumor-like growth that projects from the mucous membrane; usually in the large intestine, nose, uterus and rectum (vascular organs)

Hyperplasia/neoplastic - Malignant

carcinomas and sarcomas

Hyperplasia/neoplastic - Malignant - Causes

Chronic infection and chronic irritation; risk factors are alcohol, smoking, chewing tobacco, dental abnormalities

Hyperplasia/neoplastic - Malignant - Cancer Location - Oral

Mouth, lip, tongue, throat, esophagus; oral cancer may begin as a canker sore or lesion that doesn't heal (oral cancer is 4th leading COD in African American men)

Hyperplasia/neoplastic - Malignant - Cancer Location - Stomach

Stomach (4th leading cause of death for Asian women)

Hyperplasia/neoplastic - Malignant - Cancer Location - Colon/Rectal

leading cause of digestive system cancer deaths in the US; 3rd leading cause for women and men

Hyperplasia/neoplastic - Malignant - Cancer Location - Adenocarcinoma of the Pancreas

very high mortality rate; more common in men from 35-70 years old; smoking, high protein and fat diets, food additives, exposure to industrial chemicals such as Benzedrine (used in industrial dyes), beta-naphthalene (found in mothballs) and urea; chronic alcohol abuse, pancreatitis and diabetes mellitus increase risk

Postmortem conditions

...

Ascites/ distention/ edema

any swelling from inflammation or metabolism inability can cause distention (this causes swelling and limits distribution of embalming fluids); dehydrates may be necessary to remove edema; re-aspiration may also be necessary

Dehydration or emaciation

many cancers cause cachexia ("wasting disease"), resulting in disfiguration since the person doesn't look like themselves; arterial humectants & facial fillers may be required in these cases

Rapid decomposition

heat and moisture increase the speed of decomposition, resulting in a high/higher HCHO demand (HCHO is the chemical line formula for formaldehyde)

Rapid coagulation of blood

blood is the 1st vascular component to decompose, one reason we drain blood during embalming process; blood thinners may be added as needed in the embalming fluids

Jaundice

usually associated with a liver disease; first seen in the eyes (sclera icterus) can be any shade of yellow from the bilirubin in the blood re-located in the skin tissue. Remember: when formaldehyde (HCHO) reacts with bilirubin it converts to biliverdin (green); it can be any shade of green, requiring heavier cosmetics

Purge or hemorrhage

any pressure from the abdomen can cause purging from the digestive tract; if there are varicose veins, then hemorrhaging may occur during the embalming process (esophageal and rectal varicose veins will rupture)

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