Blok 4.

2 DIGESTIVE
DISORDERS
Agen penyebab kelainan pada saluran
pencernaan dan hepatobilier
 Figure 22.3 Every day we swallow large numbers of
microorganisms. Because of the body's defense mechanisms,
however, they rarely succeed in surviving the passage to the
intestine in sufficient numbers to cause infection.

Normal Flora in the gut: Most bacteria belong to the genera Bacteroides,
Clostridium, Fusobacterium, Eubacterium, Ruminococcus, Peptococcus,
Peptostreptococcus, and Bifidobacterium. Other genera, such as Escherichia and
Lactobacillus, are present to a lesser extent. The currently known genera of fungi of
the gut flora include Candida, Saccharomyces, Aspergillus, and Penicillium.
Figure 22.4 Infections of the gastrointestinal tract can be grouped into those that remain localized in the
gut and those that invade beyond the gut to cause infection in other sites in the body. In order to spread to
a new host, pathogens are excreted in large numbers in the feces and must survive in the environment for
long enough to infect another person directly or indirectly through contaminated food or fluids.
Bacillary Dysentery
Pathogen Shigella spp.
S. sonnei
S. flexneri
S. boydii
S. dysenteriae
Symptoms Tissue damage and
dysentery (Blood and mucus
in stools, abdominal cramps,
fever)
Intoxication/Infection Infection
Endotoxin and Shiga
exotoxin
Transmission fecal-oral route (without an
animal reservoir)
 Salmonellosis
Pathogen Salmonella spp.
S. enterica
S. enteritidis
S. choleraesuis
Animal reservoir cattle, sheep, rodents, poultry
and wild birds
Symptoms Nausea, fever and diarrhea
Intoxication/Infection Infection
Endotoxin
Transmission contaminated food (poultry
and dairy products )
Diagnosis Isolation of bacteria
Treatment Oral rehydration
Figure 22.10 The recycling of salmonellae. With the exception of
Salmonella typhi, salmonellae are widely distributed in animals,
providing a constant source of infection for man. Excretion of large
numbers of salmonellae from infected individuals and carriers allows
the organisms to be 'recycled'.
 Campylobacter Gastroenteritis
Pathogen Campylobacter jejuni
Animal reservoir cattle, sheep, rodents, poultry
and wild birds
Symptoms fever, cramping abdominal
pain, and diarrhea or
dysentery
Intoxication/Infection Infection
Transmission contaminated food (poultry,
milk or water)
Diagnosis Isolation of bacteria
Treatment Oral rehydration
Figure 22.13 Campylobacter jejuni infection.
Gram stain showing Gram-negative, S-shaped
bacilli. (Courtesy of I Farrell.)

Figure 19.1. Campylobacter infections life

cycle.
 Vibrios
• Cholera
– Vibrio cholerae serotypes that produce cholera
toxin
– Toxin causes host cells to secrete Cl–, HCO–, and
water
• Noncholera vibrios
– Usually from contaminated crustaceans or mollusks
– V. cholerae serotypes other than O:1, O:139, eltor
– V. parahaemolyticus
– V. vulnificus
 Vibrios

Disease Cholera Noncholera vibrios

Pathogen Vibrio V. V. vulnificus
cholerae O:1 parahaemolyticus
and O:139
Symptoms Diarrhea with Cholera-like Rapidly
large water diarrhea, but spreading tissue
loss generally milder destruction
Intoxication/I Cholera toxin Infection, Infection,
nfection (exotoxin) enterotoxin siderophores

Transmission contaminated contaminated food wound infection

food (shellfish (crustaceans or (in coastal sea
in fresh water) mollusks in salt waters)
water)
 Vibrio cholerae

Figure 22.18 Rice water stool in

Figure 22.15 Scanning electron micrograph of Vibrio cholera. (Courtesy of AM Geddes.)
cholerae showing comma-shaped rods with a single
polar flagellum. ×13000. (Courtesy of DK Banerjee.)
 Escherichia coli Gastroenteritis
• Pathogenic E. coli
– Attach to intestinal cells with fimbriae
– Produce toxins
– May aggregate
 Escherichia coli Gastroenteritis
Disease Traveler’s Diarrhea STEC
Pathogen Enterotoxigenic, Shiga-toxin-
enteroinvasive, producing E. coli
enteraggregative E.
coli
Symptoms Watery diarrhea Shigella-like
dysentery;
hemorrhagic colitis
and hemolytic uremic
syndrome
Intoxication/ Infection Infection
Infection Endotoxin Shiga exotoxin
Transmissio contaminated food, contaminated food
n contaminated water (dairy products)
 Typhoid Fever
• Caused by Salmonella typhi
• Bacteria spread throughout body in phagocytes
• 1–3% of recovered patients become chronic
carriers
Disease Salmonellosis Typhoid Fever
Pathogen Salmonella S. typhi
enterica
Symptoms Nausea and High fever,
diarrhea significant
mortality
Intoxication/ Infection Infection
Infection Endotoxin Endotoxin
Transmission contaminated Fecal-oral route
food (poultry and
dairy products )
Diagnosis Isolation of Isolation of
bacteria; bacteria;
serotyping serotyping
Helicobacter Peptic Ulcer Disease

Pathogen Helicobacter pylori

Symptoms Peptic ulcers (abdominal
pain, bloating and abdominal
fullness; nausea; copious
vomiting; loss of appetite and
weight loss; vomiting of
blood and malena)
Intoxication/Infection Infection
Diagnosis Isolation of bacteria
Treatment Antimicrobial drugs
Helicobacter Peptic Ulcer Disease
 Hepatitis
• An inflammation of the liver
• May result from drug or chemical toxicity, EB virus, CMV, or
the hepatitis viruses
Hepatitis A Virus (HAV)
Hepatitis B Virus (HBV)

Figure 25.15