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The Digestive System

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Chino Vitriolo

on 21 January 2014

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Transcript of The Digestive System

How the Digestive System Works
The digestive system is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. Inside this tube is a lining called the mucosa. In the mouth, stomach, and small intestine, the mucosa contains tiny glands that produce juices to help digest food.
Two solid organs, the liver and the pancreas, produce digestive juices that reach the intestine through small tubes. In addition, parts of other organ systems (for instance, nerves and blood) play a major role in the digestive system.

The Digestive System
Characteristics of the Alimentary Canal
The alimentary canal is a muscular tube about 9 meters long that passes through the body’s ventral cavity. Although it is specialized in various regions to carry on particular functions, the structure of its wall, the method by which it moves food, and its type of innervations are similar throughout its length.
Vitriolo, Navarro, Niverba
Digestion is the process by which food substances are changed into forms that can be absorbed through cell membranes. The digestive system includes the organs that promote digestion and absorb the products of this process. It consists of an alimentary canal that extends from the mouth to the anus, and several accessory organs that release secretions into the canal.
The Alimentary canal includes:
small intestine
large intestine
the accessory organs including:
the salivary glands
This layer is formed of surface epithelium, underlying connective tissue (lamina propria), and a small amount of smooth muscle. In some regions, it develops folds and tiny projections that extend into the lumen of the digestive tube and increase its absorptive surface area. It may also contain glands that are tubular invaginations into which the lining cells secrete mucus and digestive chemicals. The mucosa protects the tissues beneath it and carries on absorption and secretion.
Mucous membrane (mucosa)
The submucosa contains considerable loose connective tissue as well as blood vessels, lymphatic vessels, and nerves. Its vessels nourish the surrounding tissues and carry away absorbed materials.
Muscular layer
This layer which is responsible for the movements of the tube, consists of two coats of smooth muscle tissue. The fibers of the inner coat are arranged so that they encircle the tube, and when these circular fibers contract, the diameter of the tube is decreased. The fibers of the outer muscular coat run lengthwise, and when these longitudinal fibers contract, the tube is shortened.
Serous layer (serosa).
The serous or outer covering of the tube is composed of the visceral peritoneum, which is formed of epithelium on the outside and connective tissue beneath. The cells of the serosa secrete serous fluid that keeps the tube’s outer surface moist. This lubricates the surface so that the organs within the abdominal cavity slide freely against one another.
The mouth is the first portion of the alimentary canal, is
adapted to receive food and prepare it for digestion by mechanically reducing the size of solid particles and mixing them with saliva (mastification
). It is also an organ of speech and of pleasure. The mouth is surrounded by the lips, cheeks, tongue and palate, and includes a chamber between the palate and tongue called the
oral cavity
as well as a narrow space between the teeth, cheeks, and lips called the
The tongue is a thick, muscular organ that occupies the floor of the mouth and nearly fills the oral cavity when the mouth is closed. It is covered by mucous membrane and is connected in the midline to the floor of the mouth by a membranous fold called the
The body of the tongue is composed largely of skeletal muscle whose fibers run in several directions. These muscles aid in
mixing food toward the pharynx during swallowing
. Rough projections on the surface of the tongue, called papillae, provide friction useful in handling food. The
also contain taste buds. The posterior palate or root of the tongue is anchored to the hyoid bone and covered with rounded masses of lymphatic tissue called
Found in the Oral Cavity, the teeth is used to help
break down food
.The teeth develop in socket within the alveolar processes of the mandibular and maxillary bones. Teeth are unique structures in that two sets form during development. The members of the first set, the primary teeth (deciduous teeth), usually erupt through the gums (gingival) at regular intervals between ages 6 months and 2 years.
The Pharynx is a cavity behind the mouth from which the tubular esophagus leads to the stomach. Although neither the pharynx nor the esophagus contributes to the digestive process, both are important passageways, and
their muscular walls functions in swallowing.
superior portion
posterior portion of oral cavity
A straight, collapsible tube about 25 centimeters long. It
provides a passageway for substances from the pharynx to the stomach
. It descends through the thorax behind the trachea, passing through the mediastinum. The esophagus, penetrates the diaphragm thorough an opening, the esophageal hiatus, and is continuous with the stomach on the abdominal side of the diaphragm.
Mucous glands are scattered throughout the mucosa of the esophagus, and their secretions keep the inner lining of the tube moist and lubricated. The muscle layer propel food toward the stomach.
A J-shaped pouch like organ, about 25-30 centimeters long, that hangs under the diaphragm in the upper left portion of the abdominal cavity. It has a capacity of about one liter or more, and this inner lining is marked by thick folds (rugae) that tend to disappear when its wall is distended.
The stomach receives food from the esophagus, mixes it with gastric juice, initiates the digestion of some food molecules, carries on a limited amount of absorption, and moves food into the small intestine

Located behind the parietal peritoneum. It extends horizontally across the posterior abdominal wall, with its head in the C-shaped curve of the duodenum and its tail against the spleen. The cells that produce pancreatic juice are called pancreatic
cells, and they make up the bulk of the pancreas.
*Made up of two types of glands - Exocrine and Endocrine
enzymes secreted by the exocrine gland in the pancreas help break down carbohydrates, fats, proteins, and acids in the duodenum.
These enzymes travel down the pancreatic duct into the bile duct in an inactive form. When they enter the duodenum, they are activated. The exocrine tissue also secretes a bicarbonate to neutralize stomach acid in the duodenum
The hormones secreted by the endocrine gland in the pancreas are
insulin and glucagon
(which regulate the level of glucose in the blood), and
(which prevents the release of the other two hormones).

The liver is the largest gland in the body and is located in the upper right and central portions of the abdominal cavity, just below the diaphragm. It is partially surrounded by the ribs and extends from the level of the fifth intercostals space to the lower margin of the ribs. It is reddish brown in color and is well supplied with blood vessels.
The liver
regulates most chemical levels in the blood and excretes a product called bile, which helps carry away waste products from the liver.
A pear-shaped sac located in a depression on the inferior surface of the liver. It is connected to the cystic duct, which in turn joins the hepatic duct. The gallbladder has a capacity of 30-50 ml, is lined with columnar epithelial cells, and has a strong muscular layer in its wall.
It stores bile between meals concentrates bile by reabsorbing water, and release bile into the duodenum of the small intestine
Small Intestine
1. Ingestion - This process involves taking food and liquids into the mouth.

2. Secretion – Each day, cells within the walls of the GI tract and accessory digestive organs secrete a total of about 7 liters of water, acid, buffers, and enzymes into the lumen (interior space) of the tract.

3. Mixing and propulsion – Alternating contractions and relaxations of smooth muscle in the walls of the GI tract mix food and secretions and propel them toward the anus. This capability of the GI tract to mix material along its length is called motility.

4. Digestion - Mechanical and chemical processes break down ingested food into small molecules. In
mechanical digestion
the teeth cut and grind food before it is swallowed, and then smooth muscles of the stomach and small intestine churn the food. As a result food molecules become dissolved and thoroughly mixed with digestive enzymes. In
chemical digestion
the large carbohydrate, lipid, protein, and nucleic acid molecules in food are split into smaller molecules by hydrolysis.

5. Absorption – The entrance of ingested and secreted fluids, ions, and the products of digestion into the epithelial cells lining the lumen of the GI tract is called absorption. The absorbed substances pass into blood or lymph and circulate to cells throughout the body.

6. Defecation – Waste, indigestible substances, bacteria, cells sloughed from the lining of the GI tract, and digested materials that were not absorbed in their journey through the digestive tract leave the body through the anus in a process called defecation. The eliminated material is called

When we eat such things as bread, meat, and vegetables, they are not in a form that the body can use as nourishment. Our food and drink must be changed into smaller molecules of nutrients before they can be absorbed into the blood and carried to cells.

Why is Digestion Important?
Digestion involves the mixing of food, its movement through the digestive tract, and the chemical breakdown of the large molecules of food into smaller molecules.
Digestion begins in the mouth, when we chew and swallow, and is completed in the small intestine. The chemical process varies somewhat for different kinds of food.

How Is Food Digested?
. The large, hollow organs of the digestive system contain muscle that enables their walls to move. The movement of organ walls can propel food and liquid and also can mix the contents within each organ. Typical movement of the esophagus, stomach, and intestine is called
The action of peristalsis looks like an ocean wave moving through the muscle. The muscle of the organ produces a narrowing and then propels the narrowed portion slowly down the length of the organ. These waves of narrowing push the food and fluid in front of them through each hollow organ.

Movement Of Food Through The System
The first major muscle movement occurs when food or liquid is swallowed. Although we are able to start swallowing by choice, once the swallow begins, it becomes involuntary and proceeds under the control of the nerves.

is the organ into which the swallowed food is pushed. It connects the throat above with the stomach below. At the junction of the esophagus and stomach, there is a ring like valve closing the passage between the two organs. However, as the food approaches the closed ring, the surrounding muscles relax and allow the food to pass

The food then enters the stomach, which has three mechanical tasks to do.
First, the stomach must store the swallowed food and liquid.
This requires the muscle of the upper part of the stomach to relax and accept large volumes of swallowed material.
The second job is to mix up the food, liquid, and digestive juice produced by the stomach.
The lower part of the mach mixes these materials by its muscle action
. The third task of the stomach is to empty its contents slowly into the small intestine.

Several factors affect emptying of the stomach, including the nature of the food (mainly its fat and protein content) and the degree of muscle action of the emptying stomach and the next organ to receive the contents (the small intestine). As the food is digested in the small intestine and dissolved into the juices from the pancreas, liver, and intestine, the contents of the intestine are mixed and pushed forward to allow further digestion.

Finally, all of the digested nutrients are absorbed through the intestinal walls.
The waste products of this process include undigested parts of the food, known as fiber, and older cells that have been shed from the mucosa. These materials are propelled into the colon, where they remain, usually for a day or two, until the feces are expelled by a bowel movement
A tubular organ that extends from the pyloric sphincter to the beginning of the large intestine. It is located in the gastrointestinal tract, which
assists in the digestion and absorption of ingested food.
With its many loops and coils, it fills much of the abdominal cavity. Although it is 5.5-6.0 meters (18-20 feet) long in a cadaver when the muscular wall is relaxed, the small intestine may be only half this long in a living person.
Large Intestine
The Large Intestine is so named because its diameter is greater than that of the small intestine. This portion of the alimentary canal is about 1.5 meters long an begins in the lower right side of the abdominal cavity, where the ileum joins the cecum. From there the large intestine travels upward on the right side, crosses obliquely to the left and descends into the pelvis. At its distal end, the large intestine opens to the outside of the body as the anus.
It reabsorbs water and electrolytes from the chime remaining in the alimentary canal. It also forms and stores the feces until defecation occurs.

membrane that forms the inner lining of the stomach is relatively thick, and its surface is studded with many small openings. These openings called gastric pits are located at the ends of tubular gastric glands. Although their structure and the composition of their secretions vary in different parts of the stomach, gastric glands generally contain three types of secretory cells. One type, the
mucous cell,
occurs in the necks of the glands near the openings of the gastric pits. The other types
chief cells
parietal cells
, are found in the deeper parts of the glands.
Chief cells secrete digestive chemicals and parietal cells release a strong acid (hydrochloric acid) The products of mucous cells, chief cells, and parietal cells together form gastric juice.
Gastric Glands
Gastric Pit
Gastric Gland
Major Salivary Glands
Parotid Glands
are the largest of the major salivary glands. One lies in front of and somewhat below each eat, between the skin of the cheek and the masseter muscle. A parotid duct passes from the gland inward through the buccinators muscle, entering the mouth just opposite the upper second molar on either side of the jaw.
The parotid glands secrete a clear, watery fluid rich in the digestive chemical amylase.
Submandibular (submaxillary) Glands
are located in the floor of the mouth on the inside surface of the lower jaw. The secretory cells of these glands are predominantly serous, although some mucous cells are present. Consequently, the submandibular glands secrete a more viscous fluid than the parotid glands. The submandibular ducts open under the tongue, near the frenulum.
Sublingual Glands
are the smallest of the major salivary glands. They are found on the floor of the mouth under the tongue. Their cells are primarily the mucous type, and as a result their secretions, which enter the mouth through many separate ducts, tend to be thick and stingy

Process by which a person takes in and utilizes food

Chemical substances found in food needed by the body to stay healthy.

Two Kinds Of Nutrients:
Micronutrients - water, vitamins, minerals
Macronutrients - carbohydrates, protein, fat or lipids

1. Energy and metabolism
2. Metabolism - chemical processes in the body that sustains life and provides the body with energy
- sum of energy expended in carrying on the normal body processes
3. Growth/formation of new tissue and tissue repair
4. Energy for muscle contraction
5. Conduction of nerve impulses

Functions of Nutrients
6. Reproduction
7. Social Role: feasts held during special occasions
8. Economic Role: contribute to a country’s economy
9. Psychological Role: “comfort foods”

- Comes from the Greek word “diaita”, (manner of living)
- Food eaten by people everyday
-Balance Diet
Provides the body with the right amounts of nutrients to fulfill the needs of the body
Ensures that the body stays healthy
-Unbalance Diet
Does not supply the right amounts of nutrients needed
Long term consumption may cause harm to the body
Leads to malnutrition

Insufficient or excessive nutrients leading to improper functioning of the body
-Undernutrition and

1. Food shortage
2. Economic constraints
3. Over-indulgence
4. Lack of nutritional knowledge
5. Lack of discipline

Causes Of Malnutrition
Energy nutrients
Non- Energy nutrients
Food Energy
-measured in units of heat called calories

Categories of Nutrients
energy potential of food
amount of heat required to raise 1kg of water by 1degree C
-1g of carbohydrates: 4cal/g
-1g of protein: 4cal/g
-1g of fat: 9cal/g 

Compounds composed of glucose units
Found only in plant foods and milk sugars
Provides 70-80% of human energy needs
50-60% of a person’s daily caloric intake

Functions of Carbohydrates
-Provide energy
-Glucose (stored form: glycogen)
-Facilitate the digestion of food
- Non-Starch Polysaccharides (NSP) or dietary fiber

Types of Carbohydrates
1. Simple Carbohydrates
- found in milk, honey, fruit, maple syrup, refined table sugar
- provide empty calories and very little nutrition in terms of key vitamins and minerals
- helps retain moisture, delay protein coagulation, act as leavening agent, aid in caramelization

2. Monosaccharide: glucose, fructose, galactose (milk products)

3. Disaccharides: sucrose (cane sugar, table sugar), lactose (milk sugar; found naturally in milk and whey), maltose (malt sugar; obtained from cereal grains)
4. Polysaccharides: starch, glycogen, pectin, cellulose

- help maintain the functions of the digestive system
- provides long term energy
- nutritionally dense foods with low calories and high percentage of daily needs in vitamins and minerals
- whole grain breads, cereals (rice, wheat, corn, bread, pasta, noodles), legumes, potato, tapioca, yam

Complex Carbohydrates
Helps the body get rid of toxins through a regular pattern of removal of feces from the body, preventing constipation

Helps lower blood sugar and cholesterol levels

Helps reduce risk of colon cancer

Refer to both solid and liquid fat

Consume no more than 30% of daily calorie needs

Too much fat can shorten life and increase vulnerability to chronic and degenerative diseases (cancer, CV diseases)

Types of Fat
Saturated Fat

Solid at room temperature
Contains fatty acids, found in animal products
High intake elevates blood cholesterol levels increasing the risk for CV diseases and cancer
Major source: fast food hamburgers, hotdogs, chicken and fish sandwiches


waxy and fatty chemical substance manufactured in the body and consumed from foods of animal origin only
non-essential nutrient
used in synthesis of sex hormones, Vit. D and bile salt
meat, organ meats, egg yolks, dairy products, all animal products

Two Basic types of Cholesterol
(high-density lipoprotein)
‘good cholesterol’
carry excess cholesterol in the blood to the liver
salmon, mackerel, fish oils, herring

(low-density lipoprotein)
‘bad cholesterol’
carry excess cholesterol to tissues building a plaque

1. Hamburgers and meat loaf: 63%
2. Hotdogs, ham and luncheon meats: 58%
3. Whole milk: 54%
4. Doughnuts, cakes, cookies; 54%
5. Beefsteak and roasts: 50%

Foods With The Highest Kcal From Fat
Trans-fatty acids
high correlation with CV diseases
counted as polyunsaturated fats in food labels
fast foods, potato chips, doughnuts, peanut butter, commercially processed foods

Essential Fatty Acids (EFA’s)
vital for metabolism, formation of cell walls and tissue repair
important role in maintaining the health of the heart, liver and brain
obtained from food

1.Omega-6 fatty acids
acid, which plays a key role in cell membrane structure and body function
leafy vegetables, seeds, nuts, grains, corn oil, soybean oil, sunflower oil
2.Omega-3 fatty acids
acid, which is important to brain development and vision and helps reduce the risk of heart attack
found in fish and oils
canola oil, walnuts, soy bean oil, soy beans, walnut oil, soy bean kernels

Two Types Of EFA’s
-human breast milk, shellfish, mackerel, salmon, mullet, anchovy, herring, lake trout, sardines, tuna

(Types Of Omega-3 Fatty Acids)
.Unsaturated fat
: liquid at room temperature

monounsaturated fats (olive oil, canola oil, peanut oil, avocado, cashew)
polyunsaturated fats (corn oil, sunflower oil, soy bean oil, nuts, fish)

Visible Fat

these are easily detectable
Invisible Fat

Hidden because these are constituents of food
peanut, avocados, cakes, doughnuts
Sources Of Fats Consumed Either In The Following Forms
Has undergone processing or treatments as freezing, canning, frying or baking

Potato chips, cookies, ice cream, sausages, fast food burgers and fries

Processed Foods
Reduce Fat
reduce total fat in recipes
use lean cuts of meat
reduce saturated fat: substitute olive oil, peanut oil or vegetable oil

What To Do With Fat In The Diet

offer plant-based foods (vegetable lasagna, or increase size of fruit and vegetable side dishes)
change cooking techniques (roast, steam, bake, poach)use seasonings and flavorings (use fresh herbs, spices and wine)
use non-stick pans
increase portion size for vegetables, grains, beans and pastas

Replace Fat
Greek word ‘proteios’ or ‘primary’
Complex substances essential for the structure and function of living cells
Present in our muscles, cartilage, ligaments, skin, hair
12-15% of a person’s daily caloric intake
RDA for adults is .8 grams per kg of body weight per day

Functions of Proteins
1. Growth and repair
amino acids (all 24 should be present for optimal maintenance of body growth and function)
2. Chemical reactions
3. Source of energy
4. Resistance against diseases: work with vitamins and minerals

Complete Proteins Incomplete Proteins
-high biological value - low biological value
-supply all of the - miss one or more
essential amino acid essential amino acid
-meat, fish, poultry, - bread, cereals,
cheese, eggs, milk legumes, nuts, -vegetables

Complementary Proteins
Protein content of one food compensates for the other’s deficiency

Cereal + milk, baked beans on toasted bread, lentil soup with pita bread

Sources of Protein
Beef (cattle), mutton (sheep/lamb), veal (calf), venison (deer), pork (pig), poultry (chicken, duck, goose), offal (internal organs as liver, kidneys), fish, prawn, crabs, lobsters, crayfish, mussels, oysters, milk, dairy products as cheese & yoghurt, eggs

Sources of Protein
Soya beans, lentils, peas, peanuts, almond nuts, cashew nuts

prone to deficiencies in iron, calcium and Vitamin B12
tend to escape heart disease 10 years longer
soy beans or tofu with rice, peas with wheat, beans with corn, rice with beans, peanut butter + whole grain bread, brown bread + baked beans (excellent substitute for meat, egg and dairy proteins)

Types of Vegetarians
Vegan: strict vegetarians who consume only fruits, vegetable and grains
Lacto-vegetarian: fruits, vegetable, grains, dairy products 
Ovolacto-vegetarians: fruits, vegetable, grains, dairy products, eggs

most critical food component
2/3 of the body’s mass
Necessary for energy production, temperature control and elimination
Single most important substance to prevent heat-related illnesses (heat exhaustion, cramps, heat stroke)

Functions of Water
Transportation of nutrients
Removal of wastes
Medium for reactions
Regulation of body temperature
Lubrication of joints
Component of body fluids

Sources of Water
Plain drinking water
Soups and beverages
Fruits and vegetables

Water Needs Of An Individual Depend On The Following:
State of health
Level of activity
Sweat loss

Drinking too much water poses no problem: water rarely toxic and excreted by the kidneys efficiently
If exercising in hot, humid weather, water deficit already created by the time you are thirsty
Most beneficial approach: force down an extra 16-32 ounces of water less than 15 minutes before exercising
Sweat Loss
Hydrate even when no thirst sensation exists to:
minimize water deficit
keep body temperature 1 or 2 degrees lower in hot weather
result in more efficient performance
delay fatigue

Sweat Loss
** weight loss experienced during the early part of a strict diet is usually a loss of water, NOT FAT. Since dieting restricts carbohydrates intake, water content in the body is reduced because much of the water stored in our bodies is accumulated in the process of storing carbohydrates (weight loss due to water reduction is only temporary)

water, sodium, potassium and chloride
capable of producing electric current which are important in preventing cramps, heat exhaustion, heatstroke and dehydration
lost through sweat and water vapor from lungs
water alone does not restore electrolyte balance

Maintaining Electrolyte Balance
Too much salt without water: draws fluid from cells, precipitates nausea, increases urination and potassium loss
Potassium: critical in maintaining regular heartbeat and carbohydrates and protein metabolism
Ionic chloride: maintains strong acidity of the stomach

Nutritional needs to maintain health
Failure to observe RDA in a day does not mean deficient diet already
Should average out over a 5-8 day period
Separate for infant, children, men and women, pregnant and lactating women

Recommended Dietary Allowance
Water soluble vitamins Fat soluble vitamins
-eliminated in the urine - stored in large
-not stored for long periods -amounts in fatty
-Vitamin C and B complex tissues, liver,
kidney, spleen
- absorbed through the intestinal tract
- Vitamin A, D, E & K

Vitamin C
Vitamin C supplements should be taken only by:
people who do not get all the vitamins due to a restricted diet
pregnant and nursing women
elderly people to prevent degeneration of bones
people recovering from illness

‘megavitamin approach’
taking in 10-100 times the RDA
toxic side effects
not necessarily to correct deficiency or prevent or cure a variety of illnesses
increase in percentage of fat cells

Functions Of Minerals
Essential for good health and normal growth
For muscle contraction and blood clotting
Helps prevent diseases
Important components of body fluids

-needed in large amounts
-sodium, potassium, calcium,phosphorus, magnesium, sulfur
Trace Minerals
-required in very small amounts
-iron, iodine, copper, fluoride, zinc

Key components of various hormones and enzymes that aid in certain metabolic processes
Make up an essential part of the body’s bones and teeth
Supply no energy
31 minerals, 24 are essential to sustain life

structural component of hemoglobin and myoglobin
involved in cellular respiration
approximately 85% of our daily iron intake is used to produce new hemoglobin (remaining 15% used to produce new tissues)
affects the body’s capacity and ability to transport oxygen
obtained from meat, liver, egg yolk, dark green vegetables, fish, poultry

Iron Deficiency Anemia (IDA)
loss of strength and endurance
rapid fatigue during exercise
shortens attention span
loss of virtual perception
impaired learning
other physical disorders

Iron Overdose
tissue and liver damage
rapid ingestion can cause sudden death
iron overdose as the 2nd most common cause of accidental poisoning in small children

Mineral and Supplements
Who Should Take Mineral Supplements?
people who have dietary restrictions
pregnant women
elderly people who require calcium
people recovering from illness

Eat a variety of foods
Maintain ideal weight
Avoid too much fat, especially saturated fat and cholesterol
Eat foods with adequate starch and fiber
Avoid too much sugar
Avoid too much sodium
If you drink alcohol do so in moderation

Dietary Guideline
Eat enough calories for energy and body repair
Eat sufficient amount of carbohydrates and fats to spare the body from using protein as fuel
Drink sufficient fluids to prevent dehydration, heat-related illnesses and early fatigue
Replace electrolytes (potassium, sodium and chloride) lost in perspiration
Consider the use of iron supplements (for women)

Special Needs Of An Active Individual
3 Key elements of a sound Nutrition

PHYTOCHEMICALS: Non-nutritive chemicals made by plants which help guard against CV disease, hypertension, diabetes and cancer

- help protect healthy cells from damage by free radicals (formed as a result of normal body functions as breathing and physical activity, as a result of smoking or exposure to environmental hazards which weaken and damage healthy cells making the body more susceptible to heart disease and certain types of cancers)
Phytochemicals and Antioxidants
a summary term for a set of processes, which contribute to health deterioration and ultimately to death with the passage of time (calendar age).
any process, which contributes to age-related decline in performance, productivity and health is a component of the aging process that deserves our attention and intervention.

What happens during the process of aging?
Effects of Aging
The activity of the digestive system slows down
Fewer digestive juices are produced and secreted.
Peristalsis slows down
Peristalsis -An action that looks like an ocean wave moving through the muscles.
Sensations of taste and smell wane.
Eating becomes less appealing.

Effects of Aging
The activity of the digestive system slows down
Fewer digestive juices are produced and secreted.
Peristalsis slows down
Peristalsis -An action that looks like an ocean wave moving through the muscles.
Sensations of taste and smell wane.
Eating becomes less appealing.

Effects of Aging
The body receives fewer nutrients when less food is ingested thus the body systems then weaken and become susceptible to disease.
A reduction in the production of hydrochloric acid, digestive enzymes, and saliva, as well as a reduction in the total number of taste buds occur thus results in gastrointestinal distress, impaired swallowing, and delayed emptying of the stomach.

The breakdown of the absorption of foods may also be impaired resulting in vitamin deficiencies of B, C and K or in extreme cases malnutrition.
Changes in taste and smell. Taste and smell are interrelated and important for eating as well as checking for hazards in the environment such as spoiled food, smoke and fumes. Some consequences of these changes include a decreased interest in food, a desire more salty or highly seasoned food, and a reduced awareness of body odor and environmental hazards such as spoiled foods.

Effects of Aging
Common Digestive Disorders
1.Hiatal Hernia
condition in which a portion of the stomach protrudes upward into the chest, through an opening in the diaphragm.

Milk Allergy
a condition in which the stomach lining—known as the mucosa—is inflamed
 It can occur suddenly (acute) or gradually (chronic).

Colon Cancer
cancer that starts in the large intestine (colon) or the rectum (end of the colon)
can begin as a small polyp, detectable through regular cancer screening, such as colonoscopy

Hiatal Hernia
Causes: The cause is unknown, but hiatal hernias may be the result of a weakening of the supporting tissue. Increasing age, obesity, and smoking are known risk factors in adults.
Children with this condition are usually born with it (congenital). It is often associated with gastroesophageal reflux in infants.
Hiatal hernias are very common, especially in people over 50 years old. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus.

Hiatal Hernia
A hiatal hernia by itself rarely causes symptoms -- pain and discomfort are usually due to the reflux of gastric acid, air, or bile.
Reflux happens more easily when there is a hiatal hernia, although a hiatal hernia is not the only cause of reflux.

Hiatal Hernia
Reducing the backflow of stomach contents into the esophagus (gastroesophageal reflux) will relieve pain.
Medications that neutralize stomach acidity, decrease acid production, or strengthen the lower esophageal sphincter (the muscle that prevents acid from backing up into the esophagus) may be prescribed.

Hiatal Hernia
Other measures to reduce symptoms include:
a. Avoiding large or heavy meals
b. Not lying down or bending over immediately after a meal
c. Not smoking
If these measures failure to control the symptoms or complications appear, surgical repair of the hernia may be necessary.

Hiatal Hernia
When to Contact a Medical Professional:
Call your provider if symptoms indicate you may have developed a hiatal hernia.
Call your provider if you have a hiatal hernia and symptoms worsen or do not improve with treatment, or if new symptoms develop.

Hiatal Hernia
Hiatal Hernia
Controlling risk factors such as obesity may help prevent hiatal hernia.

 a term used to describe inflammation (swelling) of the liver.
It can occur as a result of a viral infection or because the liver is exposed to harmful substances such as alcohol.

How is hepatitis diagnosed?
The diagnosis is confirmed by blood samples, and, in some cases, by a tissue sample from the liver. Some of the blood samples are used for establishing the cause of the disease and excluding other known causes.

Future prospects

Most common type of hepatitis is named for the virus that causes it:
Hepatitis A
Hepatitis B
Hepatitis C

Acute infectious viral hepatitis usually improves on its own. Less than 1 in 300 patients develop liver failure and risk dying. Hepatitis B and hepatitis C can become chronic. Hepatitis A never does.

Hepatitis caused by mononucleosis always improves on its own.

Acute hepatitis caused by medicines or alcohol usually improves once the liver is no longer exposed to these substances.

About one fifth of the patients with chronic hepatitis B and C are at risk of developing.

Cirrhosis can also be caused by other types of chronic hepatitis.

Effects on the liver:
As you may know, chronic hepatitis B is caused by a virus that attacks your liver and causes an infection

A virus is a tiny organism, even smaller than bacteria. Its goal in life is to take over healthy cells and multiply (make more viruses). This process is called "viral replication." The hepatitis B virus "infects" liver cells, using material within those cells to make copies of itself. The more the virus multiplies, the more cells will be infected.


No medical treatment is available for acute viral hepatitis.
Chronic hepatitis B can be treated with interferon alfa or.
Chronic hepatitis C can be treated with interferon alfa and ribavirin (tribavirin).

Diarrhea comes from the Greek word 

means "flow" and 
 means "through". The term "flowing through" was coined by Hippocrates.
 an increase in the frequency of 
bowel movements
 or a decrease in the form of stool (greater looseness of stool).

The most common cause of diarrhea is a virus that infects the gut. The infection usually lasts for two days and is sometimes called "intestinal flu" or "stomach flu.“
Infection by bacteria (the cause of most types of food poisoning)

Infection by bacteria (the cause of most types of food poisoning) and other organisms.
Eating foods that upset the digestive system
Digestive tract surgery

Abdominal cramps
Abdominal pain
An urge to go to the toilet, sometimes this may be sudden

When to see a doctor?
You have blood or pus in your stools or your stool is black
You have that is not relieved by a bowel movement
You have symptoms of such as light-headedness when sitting or standing up
You have a fever above 101°F, or your child has a fever above 100.4°F, along with diarrhea
You have foul-smelling or oily-looking stools
You have severe abdominal or rectal pain

You have eaten with other people who also have diarrhea
You have started on a new medication
Your diarrhea does not get better in 5 days (2 days for an infant or child), or worsens before that
Your child has been vomiting for more than 12 hours (in a newborn under 3 months you should call as soon as vomiting or diarrhea begins)

Questions that the doctor may ask include:
When did your diarrhea start?
How long have you had diarrhea?
What is the color and consistency of your stool?
Are you passing large amounts of mucus with your stool?
What other symptoms do you have?
Do you have abdominal pain or severe cramping with the diarrhea?
Do you have chills?
Are any other family members sick?
Have you recently traveled out of the country?
What makes your pain worse? Stress? Specific foods?
Have you had abdominal surgery?
What medications do you take? Any recent changes to your medications?
Do you drink coffee? How much?
Do you drink alcohol? How much? How often?
Do you smoke? How much each day?
Are you on a special diet?

Drink plenty of fluids
Eat as soon as you feel up to it
Breastfeeding or bottle-feeding babies

Temperature (fever)
Loss of appetite
Loose, watery stools
Blood in stool
Lactose Intolerance
a common digestive problem where the body is unable to digest lactose, a type of sugar mainly found in milk and dairy products.
Children are born with the lactase enzyme functioning correctly. At the age of around 5 years, for reasons unknown, black children partially or completely lose this enzyme.
Children below the age of five who have a severe bout of diarrhea or another severe illness may also develop temporary or permanent lactose intolerance. Because the level of lactase deficiency varies between individuals, some will be able to drink more milk before symptoms occur than others.

Lactose Intolerance
Lactose Intolerance
Lactose Intolerance
Lactose Intolerance
Lactose Intolerance
Lactose Intolerance
Lactose Intolerance
Lactose intolerance occurs when the small intestine  does not make enough of an enzyme called lactase. Your body needs lactase to break down, or digest, lactose
possible genetic link to primary lactase deficiency. Some people inherit a gene from their parents that makes it likely they will develop primary lactase deficiency
 injury to the small intestine that occurs with severe diarrheal illness, celiac disease, Crohn's disease, or chemotherapy. This type of lactase deficiency can occur at any age but is more common in infancy.

Abdominal cramps
Abdominal distension
Passing of flatus (air)
The degree of symptoms depends on the amount of milk taken in (more specifically, the amount of lactose) and the degree to which the body is deficient in lactase enzyme.

How common is Lactose Intolerance?
Among those over the age of five, approximately 90-95% of black individuals and 20-25% of white individuals throughout the world will have partial or complete lactose intolerance.

How is lactose intolerance diagnosed?
There are no blood tests that can be used to support the diagnosis of lactose intolerance
Stool Acidity Test
stool sample can be tested by a laboratory for the presence of "reducing substances“
Hydrogen Breath Test

avoid all lactose-containing products
In infants and young children, calcium may need to be supplemented, as milk may be their only source of this mineral
can also take dietary supplements called lactase products that help digest lactose

Lactose Intolerance is a life-long disease, unless it is a result of an acute severe illness, in which case the individual will recover lactase levels after a few months.

Milk Allergy
Milk Allergy
What comprises MILK?
Carbohydrates (a milk sugar called lactose)
There are over 30 different proteins in milk

Milk Allergy
Abdominal cramps, or symptoms involving the skin

Milk Allergy
Milk Allergy
Milk Allergy
Other Symptoms that may indicate milk allergy:
runny nose
Ear infections
Failure to thrive
Fluid behind ears
Nasal stuffiness
Recurrent diarrhea
Vomiting, abdominal pain

Milk Allergy
How is milk allergy treated?


Milk Allergy
Tips for Living Well With a Milk Allergy
Find other ways to get vitamins and minerals
Try dairy substitutes
Be careful with kosher products
Ask your pediatrician about safe formula
Avoid milk outside the kitchen

Three patterns (symptoms):
Type 1 - Symptoms start within minutes after the intake of small volumes of cow's milk. The reactions seen are mainly on the skin: eczema or urticaria (hives), with or without respiratory or gastro-intestinal symptoms.
Type 2 - Symptoms start several hours after intake of modest volumes of cow's milk. These symptoms are mainly vomiting and diarrhea.
Type 3 - Symptoms develop after more than 20 hours, or even days after intake of large volumes of cow's milk. The main symptom is diarrhea, with or without respiratory or skin reactions.


adverse reactions involving immunoglobulin E (IgE) antibodies to one or more protein fractions of milk, whether belonging to the casein or whey protein group.
an abnormal response by the body's immune system to milk and products containing milk. Cow's milk is the usual cause of milk allergy, but milk from sheep, goats and buffalo also can cause a reaction.
milk allergy usually occurs a few minutes to a few hours after you consume milk

in some children may be due to milk allergy. There is evidence that milk allergy in certain children may result in recurrent or chronic "glue" ear. Occult blood loss associated with cow's milk allergy can be a cause of iron deficiency (anemia) in children.

The majority of young children with milk allergy will outgrow it after avoiding milk for 12-18 months. Individuals who develop the allergy later in life will probably retain it.

Milk Allergy
Acute Cholecystitis
-begins suddenly, resulting in severe, steady pain in the upper abdomen
-The inflammation almost always begins without infection, although infection may follow later. Inflammation may cause the gallbladder to fill with fluid and its walls to thicken.

Acalculous cholecystitis
a form of acute cholecystitis without gallstones
is more serious than other types of cholecystitis

Chronic Choiecystitis
A gallbladder attack, whether in acute or chronic cholecystitis, begins as pain.
The pain of cholecystitis is similar to that caused by gallstones (biliary colic) but is more severe and lasts longer—more than 6 hours and often more than 12 hours.
The pain peaks after 15 to 60 minutes and remains constant.
It usually occurs in the upper right part of the abdomen.
The pain may become excruciating. Most people feel a sharp pain when a doctor presses on the upper right part of the abdomen.
Breathing deeply may worsen the pain.
The pain often extends to the lower part of the right shoulder blade or to the back.
Nausea and vomiting are common.

Within a few hours, the abdominal muscles on the right side may become rigid.
Fever occurs in about one third of people with acute cholecystitis.
The fever tends to rise gradually to above 100.4° F (38° C) and may be accompanied by chills.
Fever rarely occurs in people with chronic cholecystitis.

In older people, the first or only symptoms of cholecystitis may be rather general. For example, older people may lose their appetite, feel tired or weak, or vomit. They may not develop a fever.

It tends to occur after the following:
Major surgery
Critical illnesses such as serious injuries, major burns, and body wide infections (sepsis)
Intravenous feedings for a long time
Fasting for a prolonged time
A deficiency in the immune system

Gallbladder inflammation usually results from a gallstone blocking the flow of bile.
Typically, people have abdominal pain that lasts more than 6 hours, fever, and nausea.
Ultrasonography can usually detect signs of gallbladder inflammation.
The gallbladder is removed, often using a laparoscope

is a gallbladder inflammation that has lasted a long time. It almost always results from gallstones. It is characterized by repeated attacks of pain (biliary colic).
In chronic cholecystitis, the gallbladder is damaged by repeated attacks of acute inflammation, usually due to gallstones, and may become thick-walled, scarred, and small.
The gallbladder usually contains sludge (microscopic particles of materials similar to those in gallstones), or gallstones that either block its opening into the cystic duct or reside in the cystic duct itself.

Typically, an attack subsides in 2 to 3 days and completely resolves in a week. If the acute episode persists, it may signal a serious complication. A high fever, chills, a marked increase in the white blood cell count, and cessation of the normal rhythmic contractions of the intestine suggest pockets of pus (abscesses) in the abdomen near the gallbladder from gangrene (which develops when tissue dies) or a perforated gallbladder.

Doctors diagnose cholecystitis based mainly on symptoms and results of imaging tests.
Ultrasonography is the best way to detect gallstones in the gallbladder.
Ultrasonography can also detect fluid around the gallbladder or thickening of its wall, which are typical of acute cholecystitis.
Often, when the ultrasound probe is moved across the upper abdomen above the gallbladder, people report tenderness.

Cholescintigraphy, another imaging test, is useful when acute cholecystitis is difficult to diagnose. For this test, a radioactive substance (radionuclide) is injected intravenously.
A gamma camera detects the radioactivity given off, and a computer is used to produce an image.
Thus, movement of the radionuclide from the liver through the biliary tract can be followed.
Images of the liver, bile ducts, gallbladder, and upper part of the small intestine are taken.
If the radionuclide does not fill the gallbladder, the cystic duct is probably blocked by a gallstone.

Liver blood tests are often normal unless the person has an obstructed bile duct.
Other blood tests can detect some complications such as a high level of a pancreatic enzyme (lipase or amylase) in pancreatitis.
A high white blood cell count suggests inflammation, an abscess, gangrene, or a perforated gallbladder

If people develop jaundice or pass dark urine and light-colored stools, the common bile duct is probably blocked by a stone, causing a backup of bile in the liver (cholestasis).
Inflammation of the pancreas (pancreatitis) can develop. It is caused by a stone blocking the ampulla of Vater, near the exit of the pancreatic duct.
Acalculous cholecystitis typically causes sudden, excruciating pain in the upper abdomen in people with no previous symptoms or other evidence of a gallbladder disorder.
The inflammation is often very severe and can lead to gangrene or rupture of the gallbladder.
In people with other severe problems (including people in the intensive care unit for another reason), acalculous cholecystitis may be overlooked at first.
The only symptoms may be a swollen (distended), tender abdomen or a fever with no known cause. If untreated, acalculous cholecystitis results in death for 65% of people.

If acute cholecystitis is confirmed and the risk of surgery is small, the gallbladder is usually removed within 24 to 48 hours after symptoms start.
If necessary, surgery can be delayed for 6 weeks or more while the attack subsides.
Delay is often necessary for people with a disorder that makes surgery too risky (such as a heart, lung, or kidney disorder).
If a complication such as an abscess, gangrene, or perforated gallbladder is suspected, immediate surgery is necessary.

Milk Allergy
Milk Allergy
What comprises MILK?
Carbohydrates (a milk sugar called lactose)
There are over 30 different proteins in milk

Milk Allergy
Abdominal cramps, or symptoms involving the skin

Milk Allergy
Milk Allergy
Milk Allergy
Other Symptoms that may indicate milk allergy:
runny nose
Ear infections
Failure to thrive
Fluid behind ears
Nasal stuffiness
Recurrent diarrhea
Vomiting, abdominal pain

Milk Allergy
How is milk allergy treated?


Milk Allergy
Tips for Living Well With a Milk Allergy
Find other ways to get vitamins and minerals
Try dairy substitutes
Be careful with kosher products
Ask your pediatrician about safe formula
Avoid milk outside the kitchen

Three patterns (symptoms):
Type 1 - Symptoms start within minutes after the intake of small volumes of cow's milk. The reactions seen are mainly on the skin: eczema or urticaria (hives), with or without respiratory or gastro-intestinal symptoms.
Type 2 - Symptoms start several hours after intake of modest volumes of cow's milk. These symptoms are mainly vomiting and diarrhea.
Type 3 - Symptoms develop after more than 20 hours, or even days after intake of large volumes of cow's milk. The main symptom is diarrhea, with or without respiratory or skin reactions.
adverse reactions involving immunoglobulin E (IgE) antibodies to one or more protein fractions of milk, whether belonging to the casein or whey protein group.
an abnormal response by the body's immune system to milk and products containing milk. Cow's milk is the usual cause of milk allergy, but milk from sheep, goats and buffalo also can cause a reaction.
milk allergy usually occurs a few minutes to a few hours after you consume milk

in some children may be due to milk allergy. There is evidence that milk allergy in certain children may result in recurrent or chronic "glue" ear. Occult blood loss associated with cow's milk allergy can be a cause of iron deficiency (anemia) in children.

The majority of young children with milk allergy will outgrow it after avoiding milk for 12-18 months. Individuals who develop the allergy later in life will probably retain it.

Milk Allergy
In chronic cholecystitis, the gallbladder is usually removed after the acute episode subsides.
In acalculous cholecystitis, immediate surgery is necessary to remove the diseased gallbladder.

Surgical removal of the gallbladder (cholecystectomy) is usually done using a flexible viewing tube called a laparoscope.
After small incisions are made in the abdomen, the laparoscope and other tubes are inserted, and surgical tools are passed through the incisions and used to remove the gallbladder.

Pain After Surgery: A few people have new or recurring episodes of pain that feel like gallbladder attacks even though the gallbladder (and the stones) have been removed. The cause is not known, but it may be malfunction of the sphincter of Oddi, the muscles that control the release of bile and pancreatic secretions through the opening of the bile and pancreatic ducts into the small intestine.
Pain may occur because pressure in the ducts is increased by sphincter spasms, which hinders the flow of bile and pancreatic secretions. Pain also may result from small gallstones that remain in the ducts after the gallbladder is removed. More commonly, the cause is another problem, such as irritable bowel syndrome or even peptic ulcer disease.

an inflammation of the gallbladder, usually resulting from a gallstone blocking the cystic duct
the most common problem resulting from gallbladder stones. It occurs when a stone blocks the cystic duct, which carries bile from the gallbladder
can either be ACCUTE or CHRONIC

Endoscopic retrograde cholangiopancreatography (ERCP) may be necessary to determine if the cause of pain is increased pressure. For this procedure, a flexible viewing tube (endoscope) is inserted through the mouth and into the intestine, and a device to measure pressure is inserted through the tube. If pressure is increased, surgical instruments are inserted into the tube and used to cut and thus widen the sphincter of Oddi. This procedure (called endoscopic sphincterotomy) can relieve symptoms in people who have an abnormality of the sphincter.

People with acute or chronic cholecystitis need to be hospitalized.
They are not allowed to eat or drink and are given fluids and electrolytes intravenously.
A doctor may pass a tube through the nose and into the stomach, so that suctioning can be used to keep the stomach empty and reduce fluid accumulating in the intestine if the intestine is not contracting normally.
Usually, antibiotics are given intravenously, and pain relievers are given.

Histamine (H2) blockers: Four histamine blockers are available in the many drugstores. Some are available without a prescription; others require a prescription.

a. ) All work by blocking the release of acid from specialized glands in your stomach.
b.) The idea is that producing less acid allows your stomach to heal.
c.) Once healed, the previously inflamed stomach then causes no further symptoms.
d.)Commonly prescribed H2-blockers include Pepcid, Axid, and Zantac.

Blood tests. The doctor may perform various blood tests such as checking your red blood cell count to determine whether you have anemia, which means that you do not have enough red blood cells. He or she can also screen for H. pyloriinfection and pernicious anemia with blood tests.
Fecal occult blood test (stool test). This test checks for the presence of blood in your stool, a possible sign of gastritis.

How Is Gastritis Diagnosed?
To diagnose gastritis, your doctor will review your personal and family medical history, perform a thorough physical evaluation, and may recommend any of the following tests.
Upper Endoscopy. An endoscope, a thin tube containing a tiny camera, is inserted through your mouth and down into your stomach to look at the stomach lining. The doctor will check for inflammation and may perform a biopsy, a procedure in which a tiny sample of tissue is removed and then sent to a laboratory for analysis.

Nausea or recurrent upset stomach
Abdominal bloating
Abdominal Pain
Burning or gnawing feeling in the stomach between meals or at night
Loss of appetite
Vomiting blood or coffee ground-like material
Black, tarry stools

Helicobacter pylori (H. pylori) infection causes most cases of chronic nonerosive gastritis
Traumatic injuries, critical illness, severe burns, and major surgery
autoimmune disorders in which the immune system attacks healthy cells in the stomach lining
some digestive diseases and disorders, such as Crohn’s disease and pernicious anemia
viruses, parasites, fungi, and bacteria other than H. pylori

Erosive Gastritis

 a type of gastritis that often does not cause significant inflammation but can wear away the stomach lining
can cause bleeding, erosions, or ulcers

Proton pump inhibitors (PPIs): These medications are very powerful blockers of the stomach's ability to secrete acid.
a.) A health care provider who prescribes one of these medications to treat your gastritis may be doing so in consultation with a gastroenterologist.
b.) These medications include (Prilosec, Losec).
Coating agents: These medications protect the stomach's lining.
a.) (Carafate) - Coats and protects the stomach lining
b.) (Cytotec) - Also protects the stomach lining, used as a preventive measure for people taking NSAIDs who are at high risk for developing stomach damage
An antibiotic may be prescribed if H pylori is demonstrated to be the cause of your gastritis.

Who is at risk for gallstones?
Certain people have a higher risk of developing gallstones than others
Women are more likely to develop gallstones than men. Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form. Women may have extra estrogen due to pregnancy, hormone replacement therapy, or birth control pills.

The two types of gallstones are cholesterol and pigment stones:
Cholesterol stones
, usually yellow-green in color, consist primarily of hardened cholesterol. In the United States, more than 80 percent of gallstones are cholesterol stones.1
Pigment stones
, dark in color, are made of bilirubin.

What causes gallstones?
Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur. Gallstones also may form if the gallbladder does not empty completely or often enough.

What are the symptoms and complications of gallstones?
Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones. Silent gallstones do not interfere with the function of the gallbladder, liver, or pancreas.
If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack. The pain usually lasts from 1 to several hours.Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night

People over age 40 are more likely to develop gallstones than younger people.
People with a family history of gallstones have a higher risk.

Gallbladder attacks usually stop when gallstones move and no longer block the bile ducts. However, if any of the bile ducts remain blocked for more than a few hours, complications can occur. Complications include inflammation, or swelling, of the gallbladder and severe damage or infection of the gallbladder, bile ducts, or liver.
A gallstone that becomes lodged in the common bile duct near the duodenum and blocks the pancreatic duct can cause gallstone pancreatitis—inflammation of the pancreas.
Left untreated, blockages of the bile ducts or pancreatic duct can be fatal.

Exams and Tests 
Tests used to detect gallstones or gallbladder inflammation include
Abdominal ultrasound
Abdominal CT scan
Endoscopic retrograde cholangiopancreatography (ERCP)
Gallbladder radionuclide scan
Endoscopic ultrasound
Magnetic resonance cholangiopancreatography (MRCP)
Percutaneous transhepatic cholangiogram (PTCA)

Some people have gallstones and have never had any symptoms. The gallstones may not be found until an ultrasound is done for another reason. Surgery may not be needed unless symptoms begin.
In general, patients who have symptoms will need surgery either right away, or after a short period of time.
In the past, open cholecystectomy (gallbladder removal) was the usual procedure for uncomplicated cases. However, this is done less often now.
A technique called laparoscopic cholecystectomy is most commonly used now. This procedure uses smaller surgical cuts, which allow for a faster recovery. Patients are often sent home from the hospital on the same day as surgery, or the next morning.
Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called a sphincterotomy may be done to locate or treat gallstones in the common bile duct.

Medicines called chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be given in pill form to dissolve cholesterol gallstones. However, they may take 2 years or longer to work, and the stones may return after treatment ends.
Rarely, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones. This treatment is not used very often, because it is difficult to perform, the chemicals can be toxic, and the gallstones may return.
Electro- hydraulic shock wave lithotripsy (ESWL) of the gallbladder has also been used for selected patients who cannot have surgery. Because gallstones often come back in many patients, this treatment is not used very often anymore.

Outlook (Prognosis) 
Gallstones develop in many people without causing symptoms. The chance of symptoms or complications from gallstones is low. Nearly all patients who have gallbladder surgery do not have their symptoms return (if the symptoms were actually caused by gallstones).
Possible Complications 
Blockage of the cystic duct or common bile duct by gallstones may cause the following problems:
Acute cholecystitis
Cholecystitis - chronic
Your doctor may order the following blood tests:
Liver function tests
Pancreatic enzymes

are hard particles that develop in the gallbladder
Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can develop a single large gallstone, hundreds of tiny stones, or both small and large stones.
Gallstones can cause sudden pain in the upper right abdomen. This pain, called a gallbladder attack or biliary colic, occurs when gallstones block the ducts of the biliary tract.

Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Many cases of colon cancer have no symptoms. The following symptoms may indicate colon cancer:
A change in bowel habits.
Blood (either bright red or very dark) in the stool.
Diarrhea, constipation, or feeling that the bowel does not empty all the way.
Stools that are narrower than usual.
Frequent gas pains, bloating, fullness, or cramps.
Weight loss for no known reason.
Feeling very tired.

Family history and inherited conditions – having a close relative with bowel cancer puts you at much greater risk of developing the disease.
Related conditions – having certain bowel conditions can put you more at risk of getting bowel cancer
People who eats a a lot of red or processed meats
Have a personal history of breast/ovarian cancer

Healthy weight – leaner people are less likely to develop bowel cancer than obese people
Exercise – being inactive increases the risk of getting bowel cancer
Alcohol and smoking – high alcohol intake and smoking may increase your chances of getting bowel cancer

Who's at risk?
Things that increase your risk of getting bowel cancer include:
Age – around 72% of people diagnosed with bowel cancer are over 65
Diet – a diet high in fibre and low in saturated fat could reduce your bowel cancer risk, a diet high in red or processed meats can increase your risk

Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Stages of colon cancer are:
Stage 0: Very early cancer on the innermost layer of the intestine
Stage I: Cancer is in the inner layers of the colon
Stage II: Cancer has spread through the muscle wall of the colon
Stage III: Cancer has spread to the lymph nodes
Stage IV: Cancer has spread to other organs outside the colon

Colon Cancer
Colon Cancer
Colon Cancer
Treating Advanced Colorectal Cancer
-When colorectal cancer has spread to one or more lymph nodes (stage III), it can still be cured. Treatment typically involves a combination of surgery, radiation (being administered here), and chemotherapy.

Coping With Chemotherapy
-refers to the destruction of cancer cells. However, chemotherapy may also include the use of antibiotics or other medications to treat any illness or infection.
Physical exam and history
Digital rectal exam
Fecal occult blood test
Barium enema

Colorectal Cancer Surgery
Colon Cancer
Radiofrequency Ablation
Radiofrequency ablation (RFA) uses intense heat to burn away tumors. Guided by a CT scan, a doctor inserts a needle-like device that delivers heat directly to a tumor and the
Media file 1:
Cryptococcus colitis
(shown at the arrows). Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.

 This is the most common cause of viral gastroenteritis in children, who are usually infected when they put their fingers or other objects contaminated with the virus into their mouths.
Parasites and protozoans
: These tiny organisms are less frequently responsible for intestinal irritation
Other common causes: Chemical toxins most often found in seafood, food allergies, heavy metals, antibiotics, and other medications also may be responsible for bouts of gastroenteritis that are not infectious to others.

: Viral outbreaks (30-40% of cases in children) can spread rapidly through close contact among children in day care and schools. Poor handwashing habits can spread viruses.
 Both children and adults are affected by noroviruses, the most common cause of foodborne illness worldwide. 

Media file 3:
Strongyloides stercoralis
parasite (highlighted by arrows). Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.
Media file 2: Pathological changes seen in intestinal (indicated by arrows). Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.

Media file 4: (indicated by the arrows). Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.

Media file 5: Normal stain of stool sample looking for. Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.

Dehydration in children
When children are being dehydrated they should be given oral rehydration solutions such, Rehydrate, Resol, and Rice-Lyte. They contain a good balance of electrolytes that allow better absorption in the stomach than water alone.

After each loose stool, children younger than two years should be given 1-3 ounces of any of the rehydration solutions. Older children should be asked to drink 3-8 ounces. Adults should drink as much as possible.
This guideline serves only to replace fluid loss due to diarrhea. Drink additional fluid equal to the amount the patient normally drink.
In underdeveloped nations or regions without available commercial pediatric drinks, the has established a field recipe for fluid rehydration:
Mix 2 tablespoons of sugar (or honey) with ¼ teaspoon of table salt and ¼ teaspoon of baking soda. (Baking soda may be substituted with ¼ teaspoon of table salt.) Mix mixture in 1 liter (1 qt) of clean or previously boiled water.
After 24 hours, begin to offer bland foods with the BRAT diet - bananas, rice, and applesauce without sugar, toast, pasta, or potatoes.

Watery, usually nonbloody diarrhea — bloody diarrhea usually means you have a different, more severe infection
Abdominal cramps and pain
Nausea, vomiting or both
Occasional muscle aches or headache
Low-grade fever
Depending on the cause, viral gastroenteritis symptoms may appear within one to three days after you're infected and can range from mild to severe. Symptoms usually last just a day or two, but occasionally they may persist as long as 10 days.


a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract).
An infection may be caused by bacteria or parasites in spoiled food or unclean water.
Some foods may irritate your stomach and cause gastroenteritis.

Bacteria: These are the most common bacterial causes:
Escherichia coli
- Traveler’s diarrhea, food poisoning, dysentery, colitis, or uremic syndrome 
- Typhoid fever; handling poultry or reptiles such as turtles that carry the germs 
 = Undercooked meat, unpasteurized milk 
- Dysentery

a. The digestive tract is approximately 9 meters (30 feet) in length, open at both ends. The large intestine is about 1.5 meters (5 feet) long and 6.5 centimeters (2.5 inches) in diameter. The small intestine is approximately 3 meters (12 feet) long and 2.5 centimeters (1 inch) in diameter in a living person. The small intestine will measure nearly twice this length in a cadaver when the muscle wall is relaxed.

b. The surface area of the digestive system is 2,000 square feet.

c. The mouth contains more bacteria than the human population of the United States and Canada combined!

d. The average human produces 25,000 quarts of saliva in a lifetime, enough to fill two swimming pools.

e. Enzymes in saliva only digest starchy foods.

f. It takes 4 to 8 seconds for food to travel from your mouth to your stomach.

g. Without enzymes in your stomach, it would take 50 years to digest a single meal.

h. The stomach can stretch to 50 times its empty size and hold about 4.5 quarts.

i. Every minute, about one half million damaged cells that line the stomach are replaced.

j. Vomiting can empty not only the stomach, but also the first foot or so of the small intestine.

k. Water molecules in the gut move at 1,500 miles per hour.

l. The average person releases nearly a pint of intestinal gas by flatulence every day. Most is due to swallowed air. The rest is from fermentation of undigested food.

m. Human feces is normally 25% dead intestinal bacteria.

n. The color of feces comes from leftover bile from the liver

Bleser S, Brunton S, Carmichael B, Older K, Rasch R, Steele J. Management of chronic
BF, eds. Kliegman: Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;
2007:chap 329. digestive.niddk.nih.gov/diseases/pubs/yrdd
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ova, parasites, and leukocytes
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