MICRO FLORA 2 (1).pptx

MICRO FLORA OF GASTRO INTESTINAL TRACT MODULATOR : DR. BONGE BUDE(ASS. PROFESSOR OF SURGERY) BY : DR. BIRUK TESFAYE (GSR1) MAY,20241 GIT MICRO-FLORA OUT LINE Objectives Introduction Definition and advanta...

MICRO FLORA OF GASTRO INTESTINAL TRACT MODULATOR : DR. BONGE BUDE(ASS. PROFESSOR OF SURGERY) BY : DR. BIRUK TESFAYE (GSR1) MAY,20241 GIT MICRO-FLORA OUT LINE Objectives Introduction Definition and advantage of micro bioma. Common and clinically important micro-flora Clinically important GIT micro flora. Pre operation bowel preparation. 2 GIT MICRO-FLORA OBJECTIVES Define micro flora and their anatomic distribution. Describe physiologic importance of GIT micro flora. List some of clinically important GIT micro flora. Discuss practice bowel preparation in elective surgery. 3  GIT MICRO-FLORA INTRODUCTION Life is phenomenal entity expertly designed to operate in environment with certain essentials. As such, every living thing ceaselessly interact within and with its immediate surrounding and beyond. Bacteria are uni-celular organisms found in every habitat from radioactive waste, stratosphere, deep sea and hot springs. 4  GIT MICRO-FLORA INTRODUCTION Human fetus is sterile until the amniotic membrane rupture and came in contact external environment. The skin and the mucosa serves as an interface between the sterile internal body and external environment. 5  GIT MICRO-FLORA INTRODUCTION The mucosa comprising of the GIT, upper air ways and genital tract is continuation of the skin like a hole in the donut. 6  GIT MICRO-FLORA INTRODUCTION Gut mucosa – Extends mouth to anus. 0.1mm thick single layer columnar epithelium. Covers an estimated area of 300m2. It is dynamic ecosystem supporting more than 700 species of viruses, bacteria, fungi and protozoa. 7  GIT MICRO-FLORA DEFINITION Normal microbial flora denotes microorganisms that inhabit the skin and mucous membranes of healthy normal persons. They can be, 1) The resident flora- relatively fixed residents of a given area at a given age; if disturbed, it promptly reestablishes itself. (2) The transient flora- nonpathogenic or potentially pathogenic microbes inhabit there for short period, does not establish itself permanently on the surface. 8 Fig.3 Scanning electron micrograph of a cross-section of colonic mucosa. The bar indicates the thick layer of bacteria between the mucosal surface and the lumen 9 GIT MICRO-FLORA DEFINITION 10  GIT MICRO-FLORA DETERMINANT FA C T O R S Types of microorganisms and their concentration along the alimentary tract is determined by factors such as; Environment Microbe factor Host factor 11  GIT MICRO-FLORA DETERMINANT FA C T O R S Perturbation of physiology of the GIT due to these factors impacts the growth and proliferation of the microbes. Eg. Salmonella typhimurium survical in gastiric juice at different pH levels, a common cause of infectious enteritis in humans.. 12  GIT MICRO-FLORA DETERMINANT FA C T O R S Epithelial cells receptor expression varies based on the health status of a person. the epithelial lining of health subject express receptors that bind harmless saprophytes (lactobacillus). The same epithelial cells in seriously ill patients express receptors that bind pathogenic organisms (e.g., P. aeroginosa). The presence of a serious illness somehow induces the epithelial cells to express a different receptor for bacterial adherence. 13  GIT MICRO-FLORA PHYSIOLOGIC I M P O RTA N C E Normal flora of the GIT confers indispensable benefits like, Metabolic functions; production of Vit. K and B Bacillus subtilis var. natto- is a well-known vitamin K producer bacteia. Produce short chain fatty acid. Fermentation of non digestible dietary residue. 14  GIT MICRO-FLORA PHYSIOLOGIC I M P O RTA N C E Prevent colonization & infection by pathogens. Bacterial interference through elaboration of toxic metabolites, low pH, depletion of nutrients. Interference with adhesion. 15  GIT MICRO-FLORA PHYSIOLOGIC I M P O RTA N C E Priming of Immune System Gnoto-biotic animals (animals raised under sterile env’t).  poorly developed reticuloendothelial system.  low serum levels of immunoglobulins.  none of the antibodies to normal floral antigens 16  GIT MICRO-FLORA PHYSIOLOGIC I M P O RTA N C E Probiotics- live microorganisms that are intended to have health benefits when consumed or applied to the body. They're meant to prevent and treat dysbiosis — an imbalance or a deficit of beneficial microbes in your microbiome. Currently though to be helpful in treateing IBS, IBD , Infectious diarrhea (caused by viruses, bacteria, or parasites) Diarrhea caused by antibiotics 17  GIT MICRO-FLORA PHYSIOLOGIC I M P O RTA N C E Prebiotics- a non-digestible food ingredient selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus improves host health. Fecal microbiota transplantation and fecal virome transplantation. The fecal microbiota transplantation (FMT) consists in the introduction of liquefied or encapsulated pre-processed stool from a healthy donor into a recipient’s colon. Used in treatment mainly C. difficile , but also, intriguingly, in the treatment of other disorders like obesity and diabetes, as well as the metabolic syndrome. 18 GIT MICRO-FLORA C L I N I C A L LY I M P O RTA N T B A C T E R I A CLINICALLY IMPORTANT MICROBES 19  GIT MICRO-FLORA B U C A L C AV I T Y Inhabited by Facultative and strict anaerobes. sterpt. are predominant mostly harmless saprophytes. Strep. mutants – cariogenic Candida A- part of micro-biota-overgrows infants and immune-compromised indviduals. 20  GIT MICRO-FLORA STOMACH The gradient of acid in the stomach reaches 10 million times the concentration of hydrogen in blood, PH ranges 1.5- 3.5. Acid of this strength disintegrate any tissue in the body. Less than 1000 organism/ml of juice reside. The density of microbes can be altered change PH. 21  C L I N I C A L LY I M P O R T A N T H. PYLORI BACTERIA It is Gram -ve spiral bacillus with 1-5 unipolar flagella. It has two major lineages, the gastric Helicobacter species and the entero-hepatic (nongastric). Causes gastric disease ranging from gastritis to ulcer, cancer and MALT lymphoma. 22  C L I N I C A L LY I M P O R T A N T H. PYLORI BACTERIA It is stock pilled with armamentarium like Urease, catalase, lipase, phospholipase proteases, vacuolating cytotoxin and immunogenic proteins. causes gastric cancer altering imbalance between proliferation and apoptosis of stomach mucosa. 23 C L I N I C A L LY I M P O R T A N T H. PYLORI BACTERIA 24  C L I N I C A L LY I M P O R T A N T H. PYLORI BACTERIA Tests for the presence of H. pylori can be, Invasive -analysis of gastric biopsy specimens. Non invasive- The urea breath test, the stool antigen test. 25  GIT MICRO-FLORA S M A L L I N T E S T I N E Under normal physiology only limited number of microbes pass the stomach to to proximal small bowel. Lactobacilli, enterococci, gram-positive aerobes or facultative anaerobes make < 104 organisms/mL inhabit the jejunum. The coliforms rarely exceed 103 organisms/ml. Bacteroides, the predominant organism in the colon, is rarely found in the proximal small bowel. 27  GIT MICRO-FLORA SMALL INTESTINE Payer’s patch – exhibit micro fold M which detect pathogenic microbes and induce immune response. Goblet cells secrete mucinous gell and conctinues sloughing of epithelium keeps the lumen microbe in check at necessary level. 28  GIT MICRO-FLORA TERMINAL ILEUM It is transitional zone between the aerobic flora in proximal SB and the densely populated colon. The concentration of organisms may be as high as 109 /mL, and include entero-bacteria and other coliforms. If the ileocecal valve is dysfunctional or surgically absent, the microbiology of the terminal ileum resembles that of the colon. 29  GIT MICRO-FLORA COLON The highly colonized part of the gut. More than 90% are anaerobes, predominantly members of the genera Bacteroides, Fusobacterium, Bifidobacterium and Clostridium redide in. It contains 1011 to 1012 CFU/g of feces. The proportion of Anaerobic to aerobic species is 100:1. An adult feces comprise bacteria, sloughed epithelium, mucus, undigested food all constituting 25%. 30  GIT MICRO-FLORA COLITIS Refers to inflammation of the colon by infectious agents; Direct- invasion of mucosal cell. Indirect – preformed toxins ingested in the food damages the mucosa. These patients present with purulent, bloody, and mucoid loose bowel motions, fever, tenesmus, and abdominal pain. 31 GIT MICRO-FLORA COLITIS 32  GIT MICRO-FLORA INTESTINE Diagnosiss – high index of suspicion is importatnt. Stool culture yields