Transcript Peptic ulcer - DAV College For Girls, Yamunanagar

GIT DISORDERS
Upper GIT
Disorders
Disorders of the esophagus are caused by
Obstruction, Inflammation or De-arrangement of the
swallowing mechanism
Inflammation of the esophagus. The esophagus
is that soft tube-like portion of the digestive tract
connecting the pharynx with the stomach.
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.
• 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)
Difficult and/or painful swallowing
Heartburn
Mouth sores
A feeling of something of being
stuck in the throat
Nausea
Vomiting
•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.
Diet is often a key to limiting symptoms of esophagitis
1. Goal
Decrease exposure to gastric
contents
•
Avoid:
. Large meals
. Dietary fat
. Alcohol
3. Goal:
 Prevent pain and irritation



2. Goal:
Decrease acidity of gastric
secretions
Avoid:
. Coffee
. Fermented alcoholic beverages
Avoid:
. Acid pH foods
. Spices
Avoid
smoking
Avoid
eating
with in
3hrs. of
bedtime
Life style
changes
Avoid tight
clothing
Take
small
bites
and
chew
slowly
DYSPHASIA
Any difficulty,
discomfort or
pain when
swallowing.
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.
1. 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
3) Physical obstruction: pharyngeal pouch
Goitre
•Symptoms
•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
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.
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
• 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.
An outpouching of a portion of the stomach
into the chest through the esophageal hiatus
of the diaphragm.
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.)
1. 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.
• 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.



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?
1. A barium study,
2. 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.
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.
• 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 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
The main symptoms are burning sensation in the center
of the chest and belching.
• typically occurs 30-60 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
1.


Endoscopy
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.








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.
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.
• 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.
Symptoms• 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.
• 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
• 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.
• Patient swallows a barium solution, with continuous X-ray
recording.
• Observe the flow of fluid through the Esophagus.
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.
• 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.
• 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.
•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
• Aspirin and many other painkillers
• Estrogen and oral contraceptives
• Steroid medications
• Certain antibiotics
• Thyroid medicines
• 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
•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 3dimensional image of the inside of the abdomen.
• 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 is an
inflammation of the
stomach lining. In some
cases, gastritis can lead
to ulcers in the lining of
the stomach.
• 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
• 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
• Loss of appetite
• 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
• 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
•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
• 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.
• 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 20-30 years it can lead to
stomach cancer.
It is a chronic ulcer formed in the region of GI tract where
gastric juice(HCL conc. b/w 1.5 - 3.5) 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.
• 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 ulcerThe 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.
Genetic factors- common in blood group A
peoples.
 Sex- men are more affective.
 Age –in 20- 40 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.


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
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
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.
• 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 antiinflammatory drugs (NSAIDs).
• Severe illness has also been implicated as a risk factor in
the development of duodenal ulcer.
• 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.
• Endoscopy
A test to detect the H. pylori bacterium
• 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.
• 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.
• 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.
• 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.
• 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:
1.
2.
3.
4.
5.
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
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
•
 Eat
antioxidant foods, including fruits .
 Eat foods high in B-vitamins and calcium .
 Reduce fried foods.
 Avoid tea , coffee, alcohol, and carbonated
beverages.
 Drink 6 - 8 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 .

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.

 Hyperchlorhydria-
 Hypochlorhydria
(diminished secretion)
(excessive secretion of
gastric acid)
Factors that increase flow
of acid secretions

Chemical stimulation –
Factors that decrease flow
of acid secretions large amount of fat, especially as
fried foods, pastries , nuts
other protein sources
meat extractives,
seasonings, spices ,alcohol ,
acidic foods.


large meals
Attractive , appetizing , wellliked foods.

poor mastication of food


State of happiness

Pleasant surroundings for meal
foods of poor appearance flavor
and texture

foods acutely disliked

worry ,anger ,fear and pain
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 .
• 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)
• 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.
• Dose varies with the indication. The following are
Probiotics: foods or c
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.
organisms
that contribute to a he
environment and
suppress potential ha
. Prebiotics: oligosacc
of the diet (e.g.,
fructo-oligosaccharid
the preferred
energy substrates of "
in the GI ract.
In hypersecretory conditions, doses as high as 60 mg
twice daily have been reported.
• 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..
 Surgical

•
operations of the abdomen
Inflammatory bowel disease or
scleroderma
Small intestine
diverticulosis
• Loss of appetite
• Nausea
• Diarrhea
• Fullness after a meal
• Fatty stools
• Unintentional weight loss
• weakness
• 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.
• 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 -1. Small meals
2. 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.
• 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
• 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.
1. 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 .
• Stools
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
• 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.
• 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
•.
• 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.
• 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.
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
• 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
NUTRITIONAL CARE:1) ENERGY- In Acute diarrhea, over 1500 Kcal/day & in
Chronic about 2500Kcal are advised.
2) PROTEIN- Easily digestible proteins are given- egg,
skimmed milk etc
3) FATS- are restricted as they are not absorbed properly &
increase the symptoms. Limit fats to less than 8 teaspoons
per day.
4) CARBOHYDRATE- Easily digestible CHO such as veg
puree, fruit juices, cereal water, White flour, Bread are
given liberally.
5) VITAMINSOral 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) MINERALSWith 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) FLUIDSLosses 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








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
PREBIOTICS










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