2 Upper GIT DisordersDisorders of the esophagus are caused by Obstruction, Inflammation or De-arrangement of the swallowing mechanism
3 EsophagitisInflammation of the esophagus. The esophagus is that soft tube-like portion of the digestive tract connecting the pharynx with the stomach.
4 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).
5 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.
6 Causes of EsophagitisIrritation causing esophagitis may be caused by any of thefollowing:----GERD, or gastro esophageal reflux diseaseVomitingSurgeryMedications such as aspirin and other anti-inflammatory drugsTaking a large pill with too little water or just before bedtimeSwallowing a toxic substanceHerniasRadiation injury (after receiving radiation for cancer treatment)
7 Symptoms Heartburn Mouth sores Difficult and/or painful swallowing A feeling of something of being stuck in the throatNauseaVomiting
8 Diagnosis for Esophagitis Upper endoscopy.A test in which a long, flexible lighted tube, called an endoscope, is used to look at the esophagus.BiopsyDuring this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope
9 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.
10 Nutritional care & management Diet is often a key to limiting symptoms of esophagitis1. GoalDecrease exposure to gastric contentsAvoid:. Large meals. Dietary fat. Alcohol2. Goal:Decrease acidity of gastric secretions. Coffee. Fermented alcoholic beverages3. Goal:Prevent pain and irritationAvoid:. Acid pH foods. Spices
11 Avoid smoking Avoid tight clothing Life style changes Take small bites and chew slowlyAvoid eating with in 3hrs. of bedtimeAvoid tight clothing
12 Dysphasia Any difficulty, discomfort or pain when swallowing. How dysphasia occurs ?DysphasiaThe normal process of swallowing acts in 3 phases:the oral, pharyngeal and esophagealThis 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.
13 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 diseaseMotor neuron diseaseMuscular dystrophy2) Stroke or head injury
14 Symptoms 3) Physical obstruction:- pharyngeal pouch Goitre Foods sticking in the throatChoking when swallowingDifficulty to initiate when swallowingRecent pneumoniaChange in dietary habits (difficulty to swallow hard foods)Weight lossHurt burn
15 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.
16 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
17 Esophageal Manometry – Measure the pressure generated by the muscle contractions in the esophagusUsing a pressure-sensitive, thin tube that is passed into the esophagus through the nose.Determines if the muscles of the esophagus are working properly
18 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.
19 Hiatal hernia An outpouching of a portion of the stomach into the chest through the esophageal hiatus of the diaphragm.
20 Hiatal herniaAny 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 diaphragmThe 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.
22 There are two main types of hiatal hernias: A sliding hiatal herniathe 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 herniaThe esophagus and stomach stay in their normal locationspart of the stomach squeezes through the hiatusplacing 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.)
24 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.
25 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.
26 Symptoms of hiatal hernia Heartburninflammationnauseabitter or sour taste in the back of the throat.bloating and belching, or discomfort or pain in the stomach or esophagus.
27 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.
28 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.
29 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.
30 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 indigestionBurning 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.
32 Factors that contribute to heart burn: Pregnancy – It also causes abdominal pressure, affecting acid reflux.smokingwearing 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.
33 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 insteadgastritis - an inflammation of the stomach lining.body's positionEating too muchEating too rapidlyConsuming too much caffeineConsuming too much alcoholConsuming too much chocolate
34 symptomsThe main symptoms are burning sensation in the center of the chest and belching.typically occurs minutes after mealsRegurgitation (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 stoolsSevere pain, dizziness, or lightheadednessDifficulty swallowingDehydrationweight loss
35 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. ManometryManometer is pass through the mouth into the esophagus.Measures the lower esophageal sphincter directly.3. Biopsysmall sample of tissue from the esophagus is removed.studied to check for inflammation, cancer, or other problems.
36 Nutritional management Watch food intake and limit fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruit and juices, and tomato products.Quit smokingTake restAvoid overeating.Watch consumption of alcohol.Do not lie down or go to bed right after a meal. Instead, wait a couple of hours.Lose weightMonitor the medications that are taking - some may irritate the lining of the stomach or esophagus.
37 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.
38 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.
40 Causes - Symptoms- Backflow (regurgitation) of food Chest pain, which may increase after eating or may be felt in the back, neck, and armsCoughDifficulty swallowing liquids and solidsHeartburnUnintentional weight lossDamage to the nerves of the esophagusCancer of the esophagus or upper stomach.heredity or an abnormality of the immune system that causes the body itself to damage the esophagus.
41 DiagnosisManometry- 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.
42 Barium swallow testPatient swallows a barium solution, with continuous X-ray recording.Observe the flow of fluid through the Esophagus.
43 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.
44 Nutritional management: eat slowlychew very welldrink plenty of water with mealsavoid eating near bedtimefoods that can aggravate reflux, including ketchup, citrus, chocolate, alcohol, and caffeine, may need to be avoided.
45 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.
46 How it occurs-Stomach acid coming into contact with the mucosa of the digestive systemStomach acids break down the mucosa,causing irritation and inflammation, which trigger the symptoms of indigestion.
47 Causes of dispepsia Eating too much Eating too rapidly Consuming fatty or greasy foodsConsuming spicy foodsConsuming too much caffeineConsuming too much alcoholConsuming too much chocolateConsuming too many fizzy drinksGallstonesGastritis (inflammation of the stomach)Hiatus herniaInfection, especially with bacteria known as Helicobacter pyloriNervousnessObesity - caused by more pressure inside the abdomenPancreatitis (inflammation of the pancreas)Peptic ulcersSmokingSome medications, such as antibiotics and NSAIDs (non-steroidal anti-inflammatory drugs)Stomach cancer
48 Medications that cause indigestion Aspirin and many other painkillersEstrogen and oral contraceptivesSteroid medicationsCertain antibioticsThyroid medicines
49 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 lossVomitingBlack stoolsJaundice (yellow coloring of eyes and skin)Chest pain when your exert yourselfShortness of breathSweating
50 Diagnosis Esophageal ph test EndoscopyTests 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.
52 Nutritional careDietary 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.
53 GastritisGastritis is an inflammation of the stomach lining. In some cases, gastritis can lead to ulcers in the lining of the stomach.
54 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 injuryregular use of certain pain relieversdrinking too much alcoholSmokingSevere illnessSurgery
55 BurnsLiver or kidney diseaseShockRespiratory failureBacterial infection, such as Helicobacter pyloriFungal infectionInjury to the blood vessels that bring blood to the stomachExcess production of stomach acidAtrophy of the lining of the stomach (atrophic gastritis), usually associated with older age
56 Symptoms- Indigestion Burping Hiccupping Loss of appetite Stomach painIndigestionBurpingHiccuppingLoss of appetiteNausea and vomitingBloody or black vomitingDark black, tarry stoolsAbdominal bloatingVomitingBurning feeling in the stomach between meals or at night
57 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 lastingChronic gastritis may be caused by prolonged irritationthe 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
58 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 waythe stomach lining can become inflamed, resulting in gastritis
59 Nutritional care- Include Protein foods Less acidic foods Avoid consumption of large amt. of alcoholAvoid tea coffee caffeineAvoid spicesUse antioxidants and omega-3 fatty acids.Chew properlyAvoid foods with hard skinTake small meals
60 Diagnosis- Endoscopy— Upper GI Series (Barium Swallow)— A series of x-rays of the upper digestive system taken after drinking a barium solutionEndoscopy—A thin, lighted tube inserted down the throat and into the stomach to examine the inside of the stomach.
61 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
62 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.
63 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.
64 Peptic ulcerIt 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
65 A peptic ulcer is a break in the inner lining of the esophagus, stomach, or duodenum.
66 There are three main regions for peptic ulcer……… Gastric ulcer- Peptic ulcer located in the stomachDuodenum - peptic ulcer located at the level of the duodenumEsophagus ulcer - peptic ulcer developed at the level of the esophagus
67 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.
68 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.
69 Symptoms of peptic ulcers A dull or burning pain in stomachThe pain may fell anywhere between belly button and breastbone.The pain often:-starts between meals or during the nightbriefly stops if you eat or take antacidslasts for minutes to hourscomes and goes for several days or weeksother symptoms of peptic ulcers may include:-weight losspoor appetitebloatingburpingvomitingfeeling sick to your stomach
70 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
72 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.
73 Causes-Duodenal ulcer is a stomach infection associated with the Helicobacter pylori (H pylori) bacteria.Other risk factors for duodenal ulcers include overuse ofalcohol,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.
74 Symptoms – Some people with duodenal ulcers have no symptoms at all while others may haveburning pain,severe nausea,vomitingserious symptomssuch as severe abdominal pain, bloody or black tarry stools, or bloody or black vomit.
75 Diagnostic test-EndoscopyA test to detect the H. pylori bacterium
76 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.
77 Causes-Ulcers can be caused by a bacterial infection or medical condition --Respiratory failureHeart failure,Reflux of bile acidjaundice renal failurestrokehypertensionPrevious gastrointestinal disease andTreatment with corticosteroids, NSAIDS, heparin, or warfarin.
78 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 andvomiting of blood.
79 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.
80 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.
81 Causes – An imbalance between stomach acid and pepsin. Risk factors for benign gastric ulcers include:Use of aspirin and NSAIDsHelicobacter pylori (H. pylori) infectionChronic gastritisSmokingIncreasing age
82 Symptoms - Abdominal pain Nausea Abdominal indigestion Vomiting, especially vomiting bloodBlood in stools or black, tarry stoolsUnintentional weight lossFatigueNote: There may be no symptoms.
83 Signs and Tests EGD (esophagogastroduodenoscopy) and biopsy showing a benign gastric ulcerUpper GI series showing a gastric ulcerBreath testBlood testStool test
84 Management for peptic ulcer Suppression of Strong acid secretion .Treat for elimination of helicobacter- pylori bacteriaDrug therapy and antibiotics.Elimination of secretion strengthening mucosal resistance using drugsGastric acid neutralizerPatients Life style should changed.Use of proton pump inhibitors
85 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 .
86 DIETARY MANAGEMENTCalories - Adequate ( according to his age ,sex ,and occupation.)Proteins - adequate about 1-2gm./ kg body wt. is necessaryBest 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.
87 Vitamins – Should include for healing ulcers. Food allowed –(bland diet )Milk and milk productsweak tea , strained bland soupwhite bread ,soft chapattiFine cooked cereals and vegetablesegg (not fried )overripe fruits without seedsDesserts , baked puddingsOmega 3 , omega 6 fatty acidsAvoided food –Alcohol ,strong tea coffee, colabeverages , graviespickles , spices chilies, curries, fried food.Pastries ,cakes, heavy sweets like halwa, burfiraw ,unripe veg. ,like cucumber , onion radish etc.
88 (excessive secretion of gastric acid) Hypochlorhydria(diminished secretion)Factors that decrease flow of acid secretions-large amount of fat, especially as fried foods, pastries , nutsother protein sourceslarge mealspoor mastication of foodfoods of poor appearance flavor and texturefoods acutely dislikedworry ,anger ,fear and painHyperchlorhydria-(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 happinessPleasant surroundings for meal
89 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 .
90 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)
91 Inhibitors are used for --- Proton pump inhibitors are used in the treatment of GERD, stomach and duodenal ulcers, erosive esophagitisPPIs 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.
93 Doses of PPIsDose 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 organismsthat contribute to a healthy microbial environment andsuppress potential harmfirl microbes. Prebiotics: oligosaccharide components of the diet (e.g.,fructo-oligosaccharides, inulin) thar are the preferredenergy substrates of "friendly''microbes in the GI ract.
94 Dumping syndromeDumping 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..
95 CAUSES Surgical operations of the abdomen Inflammatory bowel disease or sclerodermaSmall intestinediverticulosis
96 symptoms Loss of appetite Nausea Diarrhea Fullness after a meal Fatty stoolsUnintentional weight lossweakness
97 Diagnostic tests Abdominal X-ray Abdominal computerized tomography (CT) scanBarium X-ray of the small intestineHydrogen breath testto 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.
98 Treatment DIET MANAGEMENT Use antibiotics for the bacterial overgrowth surgical correction of the obstruction to allow better flow of food through the intestineDIET MANAGEMENTNutritional supplementsEat five or six smaller meals a day .Don’t drink anything with the mealsLie down after eatingLactose-free diet
99 Nutritional care guidelines -- Small mealsHigh-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.
101 Diarrhoea Is a symptom of various illnesses and bowel disturbances during which someone passes more frequent, loose, watery stools.
102 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 dysenteryDiarrhoea can cause dehydration loss of water.Children are more likely than adults to die from diarrhea because they become dehydrated more quickly
103 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.
104 Types of diarrhoea Acute Diarrhoea sudden onset and lasts less than two weeksIt refers to diarrhoea that begins acutely with passage of loose or watery stools without visible blood .vomiting and fever may occur .
105 Clinical features Stools Sudden onset of bowel frequency LooseBlood stainedOffensive smellSteatorrhea (floating, oily, difficult to flush)Sudden onset of bowel frequencyCrampy abdominal painUrgencyFeverLoss of appetiteLoss of weight
106 Causes of acute diarrhoea Infections Viral, Bacterial,Protozoa (90%)Medications - drugs like arsenic ,lead , mercury poisoning .Ingestion of environmental preformed toxin such as seafoodLaxatives or diuretic abuseIschemic ColitisMalnutrition - PEM, deficiency of vitamin -B, AOther infections - cholera , typhoid , ear infections , tonsils etc.Psychological infections - tension , anxiety .
107 Causative Pathogens – Bacterial Campylobacter jejuni - from raw or undercooked poultry.Salmonella- often found in raw eggs & raw poultry.Shigella - from-contaminated food and waterEscherichia 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 enterocolitisBacillus cereusClostridium perfringensClostridium botulinumGastrointestinal tuberculosis
108 ViralProtozoaRotavirus- the most common cause of severe diarrhea among childrenAdenoviruseasily transmitted in contaminated drinking water and on the hands of infected persons.Endameba histolyticaCryptosporidiumGiardia intestinalisVisitors usually become infected by eating or drinking something that has been contaminated with the parasites.
109 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.
110 Clinical features of chronic diarrhoea - WateryBloodyurgency (having to go right away)Cramping abdominal painNausea, +/- VomitingFeverLoss of appetiteLethargy - state of being lazy• Dehydration.Bloating
111 Causes of chronic Stomach or gallbladder surgery Irritable Bowel SyndromeDiverticular diseaseColon CancerMalabsorption syndromes - celiac disease , lactose intoleranceInflammatory Bowel Disease -- crohn’ s diseasechronic alcoholismCarcinoid tumor - ( tumor arising from GIT).Stomach or gallbladder surgery• Endocrine diseases, such as diabetes and thyroid diseaseLong term use of Laxatives & Purgatives.Food allergies like lactose intolerance & Mal- absorption.Mind & Neurological factors- Anxiety, Worries, Excessive thinking, Tension & Stress.
112 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.
113 Management for diarrhoea Aims/Goals of management:Prevent, identify and treat dehydrationEradicate causative pathogensTetracycline, CiprofloxacinPrevent spread by early recognition and institution of infection-control measuresImmunization, chemoprophylaxis, good hygiene, improve sanitation
114 Prevent ,and treatment of dehydration -- Moderate to severe dehydration need referral to hospitalOral Rehydration Solution (ORS)componentsamounts gm./lt.glucose20sodium chloride3.5trisodium citrate2.9or sodium carbonate2.5potassium chloride1.5
115 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.
116 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 etcFATS- 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.
117 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.
118 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.
119 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 yogurtsauerkrautpickleswinesourdough breadTofusoy yogurtA prebiotic is a nutrient which specifically stimulates the growth of the naturally occurring microorganisms in the digestive tract, specifically Lactobacillifood sources - prebiotics are found in whole grains, bananas, onions, garlic, honey and artichokesbarleygarlicfruitonionssoybeanswhole grainshoneyfortified foods and drinks