GIT DISORDERS.

GIT DISORDERS

Upper GIT Disorders Disorders of the esophagus are caused by Obstruction, Inflammation or De-arrangement of the swallowing mechanism

Esophagitis Inflammation of the esophagus. The esophagus is that soft tube-like portion of the digestive tract connecting the pharynx with the stomach.

What Causes Esophagitis. 1
What Causes Esophagitis? Esophagitis is caused by an infection or irritation in the esophagus An infection can be caused by bacteria, viruses, fungi, or diseases that weaken the immune system. Infections that cause esophagitis include. 3. The esophagus becomes inflammed (swollen, irritated and red).

Infections that cause esophagitis include :
Candida. This is a yeast infection of the esophagus caused by fungus . The infection develops in the esophagus when the body's immune system is weak (such as in people with diabetes or HIV) Herpes. This viral infection can develop in the esophagus when the body's immune system is weak. It is treatable with antiviral drugs.

Causes of Esophagitis Irritation causing esophagitis may be caused by any of the following:---- GERD, or gastro esophageal reflux disease Vomiting Surgery Medications such as aspirin and other anti-inflammatory drugs Taking a large pill with too little water or just before bedtime Swallowing a toxic substance Hernias Radiation injury (after receiving radiation for cancer treatment)

Symptoms Heartburn Mouth sores Difficult and/or painful swallowing
A feeling of something of being stuck in the throat Nausea Vomiting

Diagnosis for Esophagitis
Upper endoscopy. A test in which a long, flexible lighted tube, called an endoscope, is used to look at the esophagus. Biopsy During this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope

Upper GI series (or barium swallow).
During this procedure, x-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and shows up white on an x-ray. Helpful for doctors to view certain abnormalities of the esophagus.

Nutritional care & management
Diet is often a key to limiting symptoms of esophagitis 1. Goal Decrease exposure to gastric contents Avoid: . Large meals . Dietary fat . Alcohol 2. Goal: Decrease acidity of gastric secretions . Coffee . Fermented alcoholic beverages 3. Goal: Prevent pain and irritation Avoid: . Acid pH foods . Spices

Avoid smoking Avoid tight clothing Life style changes
Take small bites and chew slowly Avoid eating with in 3hrs. of bedtime Avoid tight clothing

Dysphasia Any difficulty, discomfort or pain when swallowing.
How dysphasia occurs ? Dysphasia The normal process of swallowing acts in 3 phases: the oral, pharyngeal and esophageal This phases acts together so that the food will be digested in the stomach from the mouth. If there are medical conditions that hinder this process, dysphasia occurs. Any difficulty, discomfort or pain when swallowing.

Types of dysphasia Due to : Or pharyngeal dysphasia — oral dysphasia
related to nerve and muscle problems that can weaken your throat muscles and make it difficult to move food from your mouth into your throat. Due to : 1) Neuromuscular diseases:- Parkinson’s disease Motor neuron disease Muscular dystrophy 2) Stroke or head injury

Symptoms 3) Physical obstruction:- pharyngeal pouch Goitre
Foods sticking in the throat Choking when swallowing Difficulty to initiate when swallowing Recent pneumonia Change in dietary habits (difficulty to swallow hard foods) Weight loss Hurt burn

Causes -- 2. Esophageal dysphasia —
It referring to the sensation of food sticking or getting hung up in the swallowing tube (esophagus). Causes -- Usually due to stricture:- Malignant- ( dysphasia for solid food) Is intermittent at first, as difficulty experienced with both solid and liquids. Esophagus may be cold sensitive than usual.

Diagnostic tests – An esophageal or barium swallow test- - is an imaging test used to visualize the structures of the esophagus swallows liquid barium barium fills and then coats the lining of the esophagus X-ray images obtained Video fluoroscopy - alternative test to the barium swallow - video X-ray images of swallowing process. - better able to evaluate the muscular abnormalities that can affect swallowing

Esophageal Manometry –
Measure the pressure generated by the muscle contractions in the esophagus Using a pressure-sensitive, thin tube that is passed into the esophagus through the nose. Determines if the muscles of the esophagus are working properly

Diet Management- Thin liquids are not recommended. Instead thickened fluids are easier to manage.( Fluids may be thickened with commercially purchased thickeners.) Suitable soft foods that are recommended include cereals with hot milk, such as oatmeal or cream of wheat. Sandwiches with moist fillings, such as egg with mayonnaise, are well tolerated. Stewed fruits, such as apples, mashed bananas and custard, are part of a soft diet.

Hiatal hernia An outpouching of a portion of the stomach
into the chest through the esophageal hiatus of the diaphragm.

Hiatal hernia Any time an internal body part pushes beyond a confining wall into an area where it doesn't belong, it is called a hernia. The hiatus is an opening in the diaphragm The muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus to drain into the stomach. In a hiatal hernia the stomach bulges up into the chest through that opening.

There are two main types of hiatal hernias:
A sliding hiatal hernia the junction of the stomach and the esophagus herniate (slide) up into the chest through the hiatus. This is the most common type of hiatal hernia. A Para esophageal hernia The esophagus and stomach stay in their normal locations part of the stomach squeezes through the hiatus placing it next to the esophagus. this type of hernia have no any symptoms, stomach can become "strangled," (which means its blood supply is cut off.)

Types of hernia

Main causes - A permanent shortening of the esophagus (perhaps caused by inflammation of stomach acid) which pulls the stomach up. 2. An abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards.

Other Causes of hiatal hernia
Strain on the abdominal muscles, as when you lift a heavy object. . Problem can be present from birth (a congenital hernia). Hernias can also result from a marked weight gain. When constipation leads to straining during bowel movements. From repeated coughing attacks. over the age of 50, in overweight people (especially women), and in smokers.

Symptoms of hiatal hernia
Heartburn inflammation nausea bitter or sour taste in the back of the throat. bloating and belching, or discomfort or pain in the stomach or esophagus.

How is a hiatal hernia diagnosed?
A barium study, Esophagoscopy a special X-ray that allows visualization of the esophagus. ( in which the upper digestive system is examined with an endoscope (long-thin flexible instrument). On both the x-ray and endoscopy, the hiatal hernia appears as a separate "sac" lying between what is clearly the esophagus and what is clearly the stomach.

Treatment Main goal of treatment is to relieve symptoms.
Suggestions include: Eat smaller, more frequent meals. Avoid foods and beverages that may cause acid reflux symptoms. Don't eat within three hours before going to bed. Elevate the head of your bed 4 to 8 inches. Don't wear tight clothing around your waist. Avoid bending or stooping after meals.

Don't eat for at least two hours before bedtime.
Avoid constipation. Talk to your doctor if you have a problem with this. Don't do any heavy lifting. Lose weight. Stop smoking. Take any medications the doctor prescribes. Don't eat for at least two hours before bedtime.

Heart burns Also known as pyrosis or acid indigestion
Heart burn is a discomfort or pain caused by the stomach contents traveling up from the stomach into the lower part of your esophagus (gullet) Also known as pyrosis or acid indigestion Burning sensation in the chest, just behind the breastbone. Heartburn has nothing to do with the heart. Heart burn is a digestive problem. Heart burn is usually related to meals and posture and can often be relieved by remedies for indigestion.

Factors that contribute to heart burn:
Pregnancy – It also causes abdominal pressure, affecting acid reflux. smoking wearing tight clothing around the waist. Obesity – Excess weight and fat causes increased pressure in the abdomen. Food and drink intake – Fatty and acidic food and drinks, and carbonated beverages stimulate the secretion of stomach acid.

Medications – Some prescription medications also increase stomach acid secretion.
Hiatal hernia – This happens when a part of the stomach that's suppose to be in the abdomen lies in the chest instead gastritis - an inflammation of the stomach lining. body's position Eating too much Eating too rapidly Consuming too much caffeine Consuming too much alcohol Consuming too much chocolate

symptoms The main symptoms are burning sensation in the center of the chest and belching. typically occurs minutes after meals Regurgitation (back flow) Stomach acid can also affect the respiratory tract, causing asthma, hoarseness, chronic cough, sore throat, or tooth damage (acid eats the enamel on teeth). passing blood in stools Severe pain, dizziness, or lightheadedness Difficulty swallowing Dehydration weight loss

Diagnosis tests- Endoscopy 2. Manometry 3. Biopsy
Thin lighted tube with a tiny camera attached through the mouth. Examine the esophagus and stomach esophageal inflammation can be detected . 2. Manometry Manometer is pass through the mouth into the esophagus. Measures the lower esophageal sphincter directly. 3. Biopsy small sample of tissue from the esophagus is removed. studied to check for inflammation, cancer, or other problems.

Nutritional management
Watch food intake and limit fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruit and juices, and tomato products. Quit smoking Take rest Avoid overeating. Watch consumption of alcohol. Do not lie down or go to bed right after a meal. Instead, wait a couple of hours. Lose weight Monitor the medications that are taking - some may irritate the lining of the stomach or esophagus.

Achalasia What is achalasia?
Achalasia is a rare disease of the muscle of the esophagus. It means "failure to relax" It refers to the inability of the lower esophageal sphincter (a ring of muscle situated between the lower esophagus and the stomach) to open and let food pass into the stomach. patients with achalasia have difficulty in swallowing food.

How Achalasia occurs ? A muscular ring at the point where the esophagus and stomach come together (lower esophageal sphincter) normally relaxes during swallowing. In people with achalasia, this muscle ring does not relax as well. The reason for this problem is damage to the nerves of the esophagus.

Causes - Symptoms- Backflow (regurgitation) of food
Chest pain, which may increase after eating or may be felt in the back, neck, and arms Cough Difficulty swallowing liquids and solids Heartburn Unintentional weight loss Damage to the nerves of the esophagus Cancer of the esophagus or upper stomach. heredity or an abnormality of the immune system that causes the body itself to damage the esophagus.

Diagnosis Manometry - Thin tube is inserted into the nose & patient swallow several times. Measures the muscle contraction in different parts of the esophagus. Endoscopy - Provide direct visualization of the inside of Esophagus.

Barium swallow test Patient swallows a barium solution, with continuous X-ray recording. Observe the flow of fluid through the Esophagus.

Treatment - If medication is ineffective, however, esophageal dilatation can correct the problem. To open the esophagus, a balloon dilator is passed through the mouth down to the level of the lower esophageal sphincter, using an endoscope. The balloon is inflated, thus stretching the sphincter.

Nutritional management:
eat slowly chew very well drink plenty of water with meals avoid eating near bedtime foods that can aggravate reflux, including ketchup, citrus, chocolate, alcohol, and caffeine, may need to be avoided.

Dyspepsia Also known as indigestion or upset stomach.
Describes discomfort or pain in the upper abdomen. It is not a disease, a group of symptoms which often include bloating, nausea and burping.

How it occurs- Stomach acid coming into contact with the mucosa of the digestive system Stomach acids break down the mucosa, causing irritation and inflammation, which trigger the symptoms of indigestion.

Causes of dispepsia Eating too much Eating too rapidly
Consuming fatty or greasy foods Consuming spicy foods Consuming too much caffeine Consuming too much alcohol Consuming too much chocolate Consuming too many fizzy drinks Gallstones Gastritis (inflammation of the stomach) Hiatus hernia Infection, especially with bacteria known as Helicobacter pylori Nervousness Obesity - caused by more pressure inside the abdomen Pancreatitis (inflammation of the pancreas) Peptic ulcers Smoking Some medications, such as antibiotics and NSAIDs (non-steroidal anti-inflammatory drugs) Stomach cancer

Medications that cause indigestion
Aspirin and many other painkillers Estrogen and oral contraceptives Steroid medications Certain antibiotics Thyroid medicines

Symptoms Nausea Belching Feeling bloated (very full)
See your doctor immediately if pain is severe, and the following also occur: Loss of appetite or weight loss Vomiting Black stools Jaundice (yellow coloring of eyes and skin) Chest pain when your exert yourself Shortness of breath Sweating

Diagnosis Esophageal ph test
Endoscopy Tests to diagnose Helicobacter pylori infection - this may include a urea breath test, a stool antigen test, and a blood test. X-rays - usually an upper-gastrointestinal and small bowel series. X-rays are taken of the esophagus, stomach and small intestine. Abdominal ultrasound - high-frequency sound waves make images that show movement, structure and blood flow. Abdominal CT (computed tomography) scan – this may involve injecting a dye into the patient's veins. The dye shows up on the monitor, by which produce a 3-dimensional image of the inside of the abdomen.

Nutritional care Dietary management of uncomplicated dyspepsia is simple & has probably been passed on for generation. Eat slowly, chew thoroughly& don’t eat or drink excessively. Reaction to life stresses may also contribute to abdominal distress in that cases behavioral management and emotional support may also help. less fatty foods, less caffeine, alcohol and chocolates, sleeping at least 7 hours every night, and avoiding spicy foods.

Gastritis Gastritis is an inflammation of the stomach lining. In some cases, gastritis can lead to ulcers in the lining of the stomach.

Causes - The inflammation of gastritis is often the result of infection with the same bacterium that causes most stomach ulcers. However, other factors — such as injury regular use of certain pain relievers drinking too much alcohol Smoking Severe illness Surgery

Burns Liver or kidney disease Shock Respiratory failure Bacterial infection, such as Helicobacter pylori Fungal infection Injury to the blood vessels that bring blood to the stomach Excess production of stomach acid Atrophy of the lining of the stomach (atrophic gastritis), usually associated with older age

Symptoms- Indigestion Burping Hiccupping Loss of appetite
Stomach pain Indigestion Burping Hiccupping Loss of appetite Nausea and vomiting Bloody or black vomiting Dark black, tarry stools Abdominal bloating Vomiting Burning feeling in the stomach between meals or at night

Types of Gastritis- Acute — comes on suddenly and lasts briefly
Acute gastritis is a sudden inflammation and swelling of the stomach lining that may result in a number of symptoms. Chronic — either long lasting Chronic gastritis may be caused by prolonged irritation the use of nonsteroidal anti-inflammatory drugs (NSAIDs) infection with the bacteria Helicobacter pylori, pernicious anemia (an autoimmune disorder) degeneration of the lining of the stomach from age

What causes acute gastritis?
stomach is lined with special cells that secrete mucus to form a protective barrier between stomach acid and stomach wall. When that protective barrier is damaged in some way the stomach lining can become inflamed, resulting in gastritis

Nutritional care- Include Protein foods Less acidic foods
Avoid consumption of large amt. of alcohol Avoid tea coffee caffeine Avoid spices Use antioxidants and omega-3 fatty acids. Chew properly Avoid foods with hard skin Take small meals

Diagnosis- Endoscopy— Upper GI Series (Barium Swallow)—
A series of x-rays of the upper digestive system taken after drinking a barium solution Endoscopy— A thin, lighted tube inserted down the throat and into the stomach to examine the inside of the stomach.

Biopsy— removal of a sample of stomach tissue to examine in a lab
Blood, breath, or stool tests— to check for infection with the bacteria Helicobacter pylori

Treatment- Taking antacids and other drugs to reduce stomach acid, which causes further irritation to inflamed areas. Avoiding hot and spicy foods. If the gastritis is caused by pernicious anemia, B12 vitamin shots will be given.

Helicobactor paylori infection
H. pylori is a helix-shaped Gram-negative bacterium, about 3 mm long with a diameter of about 0.5 mm. Is the most common infection of mankind, that lives in the acidic environment of the stomach. It is acquired by ingesting contaminated food OR water OR through person to person contact. If person carries this for years it can lead to stomach cancer.

Peptic ulcer It is a chronic ulcer formed in the region of GI tract where gastric juice(HCL conc. b/w ) comes into direct contact with the mucous membrane. Peptic ulcers typically show evidence of chronic and repair processes surrounding the lesion

A peptic ulcer is a break in the inner lining of the esophagus, stomach, or duodenum.

There are three main regions for peptic ulcer………
Gastric ulcer- Peptic ulcer located in the stomach Duodenum - peptic ulcer located at the level of the duodenum Esophagus ulcer - peptic ulcer developed at the level of the esophagus

Causes of peptic ulcer-
The lesions can occur in the Gut from an imbalance among following factors----- Amount of gastric acid and pepsin secretion. Extent of the H.pylori infection. (Bacterial infection) The degree of tissue resistance to these secretions and the infection. Non steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.

Other causes of peptic ulcers
Genetic factors- common in blood group A peoples. Sex- men are more affective. Age –in yr. Stress- which are highly nervous ,emotional, worry, fear etc. more affective. potentially irritants substances - caffeine, ethanol, aspirin, nicotine etc. others like chilies , pepper, ginger garam masala, strong coffee and tea.

Symptoms of peptic ulcers
A dull or burning pain in stomach The pain may fell anywhere between belly button and breastbone. The pain often:- starts between meals or during the night briefly stops if you eat or take antacids lasts for minutes to hours comes and goes for several days or weeks other symptoms of peptic ulcers may include:- weight loss poor appetite bloating burping vomiting feeling sick to your stomach

Diagnostic test- Diagnosis of Peptic ulcers is confirmed by:
Endoscopy to evaluate ulcers -- a flexible tube made of fiber optic bundles introduced in the stomach and detect any breaks in the linings. Acid secretion of stomach is measured ,if there is acid output is high it is duodenal ulcer. Radiography • Biopsy may be required • Barium x-rays • Stool examination • Complete blood count

Types of ulcers 1. Duodenal ulcer—

A duodenal ulcer is a type of peptic ulcer that occurs in the duodenum, the beginning of the small intestine. Peptic ulcers are eroded areas in the lining of stomach and duodenum.

Causes- Duodenal ulcer is a stomach infection associated with the Helicobacter pylori (H pylori) bacteria. Other risk factors for duodenal ulcers include overuse of alcohol, tobacco, medications such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Severe illness has also been implicated as a risk factor in the development of duodenal ulcer.

Symptoms – Some people with duodenal ulcers have no symptoms at all
while others may have burning pain, severe nausea, vomiting serious symptoms such as severe abdominal pain, bloody or black tarry stools, or bloody or black vomit.

Diagnostic test- Endoscopy A test to detect the H. pylori bacterium

2. Stress ulcer - Stress ulcers are single or multiple mucosal defects. which can become complicated by upper gastrointestinal bleeding during the physiologic stress of serious illness or serious stressed patients.

Causes- Ulcers can be caused by a bacterial infection or medical condition -- Respiratory failure Heart failure, Reflux of bile acid jaundice renal failure stroke hypertension Previous gastrointestinal disease and Treatment with corticosteroids, NSAIDS, heparin, or warfarin.

Symptoms- Stress ulcers, particularly in their early stages, can be asymptomatic. However, as the extent of ulceration grows, the symptoms will be similar to those experienced by people with regular peptic ulcers. burning pain that comes and goes, loss of appetite, blood in the stool and vomiting of blood.

Diagnosis- Stress ulcer is suspected when there is upper gastrointestinal bleeding . Stress ulcer can be diagnosed after the initial management of gastrointestinal bleeding, the diagnosis can be confirmed by upper GI endoscopy.

3. Gastric ulcers- A gastric ulcer is a break in the normal tissue that lines the stomach. These are normally only found in critically ill or severely stressed patients.

Causes – An imbalance between stomach acid and pepsin.
Risk factors for benign gastric ulcers include: Use of aspirin and NSAIDs Helicobacter pylori (H. pylori) infection Chronic gastritis Smoking Increasing age

Symptoms - Abdominal pain Nausea Abdominal indigestion
Vomiting, especially vomiting blood Blood in stools or black, tarry stools Unintentional weight loss Fatigue Note: There may be no symptoms.

Signs and Tests EGD (esophagogastroduodenoscopy) and
biopsy showing a benign gastric ulcer Upper GI series showing a gastric ulcer Breath test Blood test Stool test

Management for peptic ulcer
Suppression of Strong acid secretion . Treat for elimination of helicobacter- pylori bacteria Drug therapy and antibiotics. Elimination of secretion strengthening mucosal resistance using drugs Gastric acid neutralizer Patients Life style should changed. Use of proton pump inhibitors

Nutritional care- Eat antioxidant foods, including fruits .
Eat foods high in B-vitamins and calcium . Reduce fried foods. Avoid tea , coffee, alcohol, and carbonated beverages. Drink glasses of filtered water daily. Oral iron:-100mg/day as there is blood lose during vomiting. Regular meal time is essential ,and small and frequent interval meal pattern should follow .

DIETARY MANAGEMENT Calories - Adequate ( according to his age ,sex ,and occupation.) Proteins - adequate about 1-2gm./ kg body wt. is necessary Best source milk protein , meat soups are extractives are avoided (which are stimulants of gastric secretion.) Fats- fats are useful for delay the empting of stomach ( cream ,butter ,olive oil ) fried food should avoid. Carbohydrates - adequate amount ( row vegetables and hard meals are not allowed.) cooked vegetables , cereals are recommended.

Vitamins – Should include for healing ulcers.
Food allowed – (bland diet ) Milk and milk products weak tea , strained bland soup white bread ,soft chapatti Fine cooked cereals and vegetables egg (not fried ) overripe fruits without seeds Desserts , baked puddings Omega 3 , omega 6 fatty acids Avoided food – Alcohol ,strong tea coffee, cola beverages , gravies pickles , spices chilies, curries, fried food. Pastries ,cakes, heavy sweets like halwa, burfi raw ,unripe veg. ,like cucumber , onion radish etc.

(excessive secretion of gastric acid)
Hypochlorhydria (diminished secretion) Factors that decrease flow of acid secretions- large amount of fat, especially as fried foods, pastries , nuts other protein sources large meals poor mastication of food foods of poor appearance flavor and texture foods acutely disliked worry ,anger ,fear and pain Hyperchlorhydria- (excessive secretion of gastric acid) Factors that increase flow of acid secretions- Chemical stimulation – meat extractives, seasonings, spices ,alcohol , acidic foods. Attractive , appetizing , well- liked foods. State of happiness Pleasant surroundings for meal

Proton pump inhibitors
(PROTON PUMP INHIBTORS) are a class of compounds that block the acid secretion from parietal cells in the stomach, thereby providing relief from acid-related disorders .

WHAT ARE PROTON PUMP INHIBITORS
The proton pump is a molecule in certain cells of the stomach. It "pumps" acid into the stomach. It takes a non-acidic potassium ion out of the stomach and replaces it with an acidic hydrogen ion. This hydrogen ion makes things acidic. By putting more hydrogen ions into your stomach, the pump makes the contents of your stomach more acidic . But by stopping the action of the pump, acid secretion into the stomach is stopped.(by PPIs)

Inhibitors are used for ---
Proton pump inhibitors are used in the treatment of GERD, stomach and duodenal ulcers, erosive esophagitis PPIs may also be used in combination with certain antibiotics (e.g. amoxicillin and clarithromycin) when treating Helicobacter pylori (a bacterial infection of the stomach), which is thought to be one of the main causes of recurring stomach ulcers.

Doses of PPIs Dose varies with the indication. The following are commonly prescribed doses: Esomeprazole: 20 to 40 mg once a day. Lansoprazole: 15 to 30 mg once a day. Omeprazole: 20 to 40 mg once a day. Pantoprazole: 40 mg once or twice a day. Rabeprazole: 20 mg once a day. In hypersecretory conditions, doses as high as 60 mg twice daily have been reported. Probiotics: foods or concentrates of live organisms that contribute to a healthy microbial environment and suppress potential harmfirl microbes . Prebiotics: oligosaccharide components of the diet (e.g., fructo-oligosaccharides, inulin) thar are the preferred energy substrates of "friendly''microbes in the GI ract.

Dumping syndrome Dumping syndrome is a group of symptoms that are most likely to develop if you've had surgery to remove all or part of your stomach. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach move too rapidly into your small bowel..

CAUSES Surgical operations of the abdomen
Inflammatory bowel disease or scleroderma Small intestine diverticulosis

symptoms Loss of appetite Nausea Diarrhea Fullness after a meal
Fatty stools Unintentional weight loss weakness

Diagnostic tests Abdominal X-ray
Abdominal computerized tomography (CT) scan Barium X-ray of the small intestine Hydrogen breath test to measure the amount of hydrogen that person breathe out after drinking a mixture of glucose and water. A rapid rise in hydrogen indicates poor carbohydrate digestion and bacterial overgrowth in small intestine.

Treatment DIET MANAGEMENT Use antibiotics for the bacterial overgrowth
surgical correction of the obstruction to allow better flow of food through the intestine DIET MANAGEMENT Nutritional supplements Eat five or six smaller meals a day . Don’t drink anything with the meals Lie down after eating Lactose-free diet

Nutritional care guidelines --
Small meals High-protein, moderate-fat foods are recommended, with sufficient calories for weight maintenance or gain as needed. Complex carbohydrates are included as tolerated. 3. Intake of fibrous foods slows upper GI transit and increases viscosity. 4. Taking large amounts of liquids with meals is thought to hasten GI transit, but adequate amounts of liquid should be consumed throughout the day, small amounts at a time. 5. Only very small quantities of hypertonic, concentrated sweets should be ingested. These include soft drinks, juices, pies, cakes, cookies, and frozen desserts (unless made with sugar substitutes). 6. Lactose, especially in milk or ice cream, may be poorly tolerated because of rapid transit and thus may need to be avoided. Cheeses and yogurt are likely to be better tolerated.

Diarrhoea-

Diarrhoea Is a symptom of various illnesses and bowel disturbances during which someone passes more frequent, loose, watery stools.

Diarrhea occurs when the lining of the small or large intestine is irritated
Diarrhea with blood in the stool – with or without mucus is called dysentery Diarrhoea can cause dehydration loss of water. Children are more likely than adults to die from diarrhea because they become dehydrated more quickly

Main causes for diarrhoea -
Diarrhea occurs when fluid take in by mouth, or produced in GI Tract, is not properly absorbed. When food moves too fast, the intestines cannot absorb water, resulting in loose stools. Also occur when excessive water moves into the bowel from the body.

Types of diarrhoea Acute Diarrhoea
sudden onset and lasts less than two weeks It refers to diarrhoea that begins acutely with passage of loose or watery stools without visible blood . vomiting and fever may occur .

Clinical features Stools Sudden onset of bowel frequency
Loose Blood stained Offensive smell Steatorrhea (floating, oily, difficult to flush) Sudden onset of bowel frequency Crampy abdominal pain Urgency Fever Loss of appetite Loss of weight

Causes of acute diarrhoea
Infections Viral, Bacterial, Protozoa (90%) Medications - drugs like arsenic ,lead , mercury poisoning . Ingestion of environmental preformed toxin such as seafood Laxatives or diuretic abuse Ischemic Colitis Malnutrition - PEM, deficiency of vitamin -B, A Other infections - cholera , typhoid , ear infections , tonsils etc. Psychological infections - tension , anxiety .

Causative Pathogens – Bacterial
Campylobacter jejuni - from raw or undercooked poultry. Salmonella- often found in raw eggs & raw poultry. Shigella - from-contaminated food and water Escherichia coli - associated with raw or undercooked beef , and spinach. It causes bloody diarrhea and may lead to hemolytic uremic syndrome, a condition associated with red blood cell destruction and kidney failure. Staphylococcal enterocolitis Bacillus cereus Clostridium perfringens Clostridium botulinum Gastrointestinal tuberculosis

Viral Protozoa Rotavirus- the most common cause of severe diarrhea among children Adenovirus easily transmitted in contaminated drinking water and on the hands of infected persons. Endameba histolytica Cryptosporidium Giardia intestinalis Visitors usually become infected by eating or drinking something that has been contaminated with the parasites.

2. Chronic diarrhoea. It is a long lasting Diarrhoea
2 . Chronic diarrhoea . It is a long lasting Diarrhoea. Patient may pass 4-5 unformed stools in a day The rapid passage of food through the intestines does not allow sufficient time for absorption of nutrients so nutritional deficiency symptoms may develops.

Clinical features of chronic diarrhoea -
Watery Bloody urgency (having to go right away) Cramping abdominal pain Nausea, +/- Vomiting Fever Loss of appetite Lethargy - state of being lazy • Dehydration. Bloating

Causes of chronic Stomach or gallbladder surgery
Irritable Bowel Syndrome Diverticular disease Colon Cancer Malabsorption syndromes - celiac disease , lactose intolerance Inflammatory Bowel Disease -- crohn’ s disease chronic alcoholism Carcinoid tumor - ( tumor arising from GIT) . Stomach or gallbladder surgery • Endocrine diseases, such as diabetes and thyroid disease Long term use of Laxatives & Purgatives. Food allergies like lactose intolerance & Mal- absorption. Mind & Neurological factors- Anxiety, Worries, Excessive thinking, Tension & Stress.

Diagnosis of diarrhoea
The health care send a sample of the stool (or sometimes a cotton swab from the patient's rectum) to the laboratory to evaluate the cause of diarrhea (such as certain bacteria or parasites present in the body). Blood tests are sometimes necessary for patients. A colonoscopy is an endoscope procedure that allows the physician to view the entire colon to evaluate for infections or structural abnormalities that could cause diarrhea. X-rays or CT scans are performed to rule out structural abnormalities when pain is a prominent symptom.

Management for diarrhoea
Aims/Goals of management: Prevent, identify and treat dehydration Eradicate causative pathogens Tetracycline, Ciprofloxacin Prevent spread by early recognition and institution of infection-control measures Immunization, chemoprophylaxis, good hygiene, improve sanitation

Prevent ,and treatment of dehydration --
Moderate to severe dehydration need referral to hospital Oral Rehydration Solution (ORS) components amounts gm./lt. glucose 20 sodium chloride 3.5 trisodium citrate 2.9 or sodium carbonate 2.5 potassium chloride 1.5

Oral rehydration therapy with home made solution 1 glass of boiled cooled water , 1 pinch of salt , 1tbs of sugar can be added Fluids - coconut water , butter milk ,rice kanji with salt nimbupani etc.

NUTRITIONAL CARE:- ENERGY- In Acute diarrhea, over 1500 Kcal/day & in Chronic about 2500Kcal are advised. PROTEIN- Easily digestible proteins are given- egg, skimmed milk etc FATS- are restricted as they are not absorbed properly & increase the symptoms. Limit fats to less than 8 teaspoons per day. CARBOHYDRATE- Easily digestible CHO such as veg puree, fruit juices, cereal water, White flour, Bread are given liberally.

5) VITAMINS- Oral or Dietary vit. such as water soluble vit- B & C are given during the management of persistent diarrhea. • Fruit juice without pulp, Potatoes without skin, Strained vegetable juice etc. 6) MINERALS- With severe diarrhea, Electrolyte balance is lost, so there replacement should be taken care off. • Loss of Na & K should be replaced by liberal intake of fluids such as fruit juices that are rich in proteins.

7) FLUIDS- Losses of fluid is replaced by a liberal intake of water, juices, Vegetable or meat soup. • Fresh Lemon squash prevent dehydration. • drink more than 8 cups of fluid to replace fluids lost to diarrhea. 8) FIBER- Fiber should be decreased & minimal roughage should be given to a diarrhea patient. • Dry fruits, peanuts & green leafy vegetables should be restricted.

Probiotics & Prebiotics-
Probiotics are live strains of 'good' bacteria, which help our digestive system work efficiently. and help to regulate the levels of bacterial in the digestive tract. food sources -Probiotics are found in foods such as yogurt sauerkraut pickles wine sourdough bread Tofu soy yogurt A prebiotic is a nutrient which specifically stimulates the growth of the naturally occurring microorganisms in the digestive tract, specifically Lactobacilli food sources - prebiotics are found in whole grains, bananas, onions, garlic, honey and artichokes barley garlic fruit onions soybeans whole grains honey fortified foods and drinks

Functions of Prebiotics-

Functions of Probiotics-

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