ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY: THE DIGESTIVE SYSTEM Consists of (1) an alimentary canal- a long muscular tube beginning at the lips and ending at the anus, including the mouth, pharynx (oral and laryngeal portions),esophagus, stomach, and small and large intestine, and (2) Accessory glands that empty secretions into the tube- salivary glands, pancreas, liver, and gallbladder. 1 . Teeth

a. Crown projects above the gum, root below. Dentin (bulk of tooth) surrounds pulp cavity. Enamel covers dentin of crown; cemented covers dentin of root and anchors tooth to periodontal ligament. b.Each quadrant of mouth has eight teeth-two incisors, one canine, two premolars, and three molars. 2 . Esophagus a. Mucous membrane lined with stratified squamous epithelium rather than simple columnar epithelium, as in stomach and intestine, b. muscular layer of upper third, striated; lower third, smooth; middle, both striated and smooth. C .S e g me n t a b o v e s t o ma c h ( i n d i s t in g u i s h a b l e a n a t omi c a l l y f r o m r e ma i n d e r o f esophagus) functions as sphincter, remaining closed until reflexively relaxed as peristaltic wave approaches, 3. Stomach
A.

Consists o f u p p e r f u n d u s , c e n t r a l b o d y, a n d c o n s t r ic t e d l o we r p yl o r i c p o r t i o n (antrum).

b . Musculature contains an oblique inner layer of smooth muscle in addition toexternal longitudinal and underlying circular smooth muscle layers foundelse where in digestive tract. c. Thick circular muscle in pyloric portion forms pyloric sphincter. d. Openings: cardia, between esophagus and stomach; pylorus, between stomach and duodenums.

4. Small Intestine a. Divided into duodenum, jejunum, and ileum. b. Surface area, serving absorptive function, increased by: 1. Circular folds (plicae circulares)- permanent, transverse folds. 2 . Vi l l i f i n g e r l i k e p r o je c t i o n s 3. Microvilli- processes on free surface of epithelial cells that form the brush order. c. Invagination of ileum into cecum the first part of the large i n t e s t i n e f o r ms ileocecal valve, which opens rhythmically during digestion, permitting gradual emptying of ileum and preventing regurgitation.

5. Large Intestine. a. Extends from the end of the ileum to the anus and is divisible into the cecum,c o l o n , r e c t u m, a n d a n a l c a n a l . Th e ma jo r p a r t i s t h e c o l o n , wh i c h c o n s i s t s o f ascending, transverse, descending, and sigmoid portions. b . Th e l o n g i t u d in a l mu s c l e o f t h e c e c u m a n d c o l o n f o r ms t h r e e c o n s p i c u o u s bands (teenage coli). c. Thickened circular smooth muscle of anal canal forms the internal anal sphincter.Surrounding skeletal muscle forms the external sphincter.

6. Salivary Glands a. Three pairs (parotid, sub maxillary, and sublingual), with ducts opening into the mouth. b. Two types of secretions: 1. Serous containing ptyalin enzyme initiating digestion of the starch. 2. Mucous viscous, containing mucus, which facilitates mastication.

7. Pancreas a. Two types of secretory cells in exocrine pancreas: 1. Enzyme- secreting acinar cells. 2. Bicarbonate-and-water-secreting intraocular duct cells. b. Pancreatic duct empties pancreatic juice into duodenum.

8. Liver and Gallbladder

a.

Bile secreted by liver is essential for normal absorption of digested lipids. Bile salts combine with products of lipid digestion to form watersoluble complexes (micelles) which are absorbed by intestinal cells. b. Gallbladder concentrates and stores bile. c . Hepatic duct, formed from the bile duct system of liver, joins cystic duct of gallbladder to form common bile duct, which empties into duodenum. Motility of Digestive Tract 1. S w a l l o w i n g a. In buckle stage (voluntary) bolus pushed toward pharynx .b. In pharyngeal and esophageal stages (involuntary) bolus passes through pharynx into esophagus and through esophagus into stomach.

c. Reflexes raise soft palate, raise larynx, adduct aryepiglottic folds and trueand false vocal cords, and inhibit respiration. When food enters thepharynx, ref lex contraction of the superior constrictor muscle initiatesperistalsis, propelling

the food, and relaxation of the upper and lower esophageal sphincters allows food to pass first into the esophagus andthen into the stomach. 2 . Pe r i s t a l s i s i n S t o ma c h a. Mixes contents and forces chime through pylorus. b. Three waves each beginning every 20 seconds near midpoint of stomach, lasting about one minute, and ending with contraction of pyloric sphincter travel down stomach at one time. c. Rate of emptying determined largely by strength of contractions. D . Feedback from duodenum regulates gastric emptying. T w o c o n t r o l mechan isms, one neuronal (enterogastric reflex), the other hormonal (mediated mainly by enterogastrone), inhibit gastric motility. 3. Contractions of the Small Intestine a . Segmenting: rhythmic contractions along a section dividing it into segments: primarily mixing action. b. Peristaltic waves superimposed upon segmenting contractions. c.Ingestion of food increases ileal peristalsis and frequency of opening of ileocecal valve (gastrulae reflex).

4. Contractions of Large Intestine A . S i mu l t a n e o u s c o n t r a c t i o n o f c i r c u l a r a n d l o n g i t u d i n a l mu s c l e , f o r mi n g haustra,

b . I n f r e q u e n t u s ua l l y t wo o r t h r e e t i me s d a i l y o f m o s t ma s s mo v e me n t s transferring contents from proximal to distal colon and into rectum. Mostcommonly occur shortly after a meal (gastro colic reflex).

5. Defecation reflex a. Distention of rectum triggers intense peristaltic contractions of colon and rectum and relaxation of internal anal sphincter. B . Reflex preceded by voluntary relaxation of external s p h i n c t e r a n d compression of abdominal contents. Digestion 1 . a . Mouth Enzymatic action: i n i t i a t i o n o f t h e d i g e s t i o n o f c a r b o h yd r a t e b y p t ya l i n , wh i c h splits starch into the disaccharide maltose. Action in mouth slight, but continues in stomach until acid medium inactivates ptyalin. b. Regulation: exclusively nervous- impulses transmitted from center in medullaactivated principally by taste, smell, or sight of food to salivary glands byp arasympathetic nerve fibers.

2 . Stomach a. Enzymatic action: initiation of protein digestion by pepsin, producing proteases, peptones, and polypeptides. Pepsinogen secreted by chief cells converted to pepsin by auto activation process in presence of acid secreted by parietal cells. b. Regulation 1. Cephalic phase- initiated by taste, sight, or smell of food; secretion stimulated directly or indirectly by the hormone gastrin. Gastrin, released from so

called Gcells in the pyloric region of the stomach, stimulates the secretion of an acid-rich gastric juice. 2 . Gastric phase initiated by food in stomach; secretion triggered directly or indire ctly, as in cephalic phase. 3. Intestinal phase- initiated by digestive products in upper small intestine; mediated by hormone released by duodenum acting on stomach. 4. Inhibition- strong acid in antrum inhibits gastrin release. Fat, acid, or hypertonic salt solutions in duodenum stimulate release of hormones which inhibit gastric secretion.

3. Intestine a . E n z y m a t i c action- fat digestion and continuation of carbohydrate and protein digestion. 1. Pancreatic lipase splits fat into monoglycerides, fatty acids, and glycerol. 2 . P a n c reatic amylase converts starch and glycogen into maltose. Intestinaldisacc haridases split maltose, sucrose, and lactose into their constituentmonosaccharides, 3. Pancreatic enzymes trypsin and chymotrypsin both end peptidases split proteins and the products of pepsin digestion into peptides. Peptidases split peptides into amino acids. B . Regulation of pancreatic secretion: by vagus nerve during cephalic and gastricp h a s e o f g a s t r i c s e c r e t i o n a nd b y t wo d u o d e n a l h o r mo n e s c h o l e c ys t o k i n i n - pancreozymin and secretin. Vagus stimulation and cholecystokinin-pancreaozyminstimulate enzyme secretion; secretin stimulates bicarbonate secretion.

Absorption

1. Occurs almost exclusively in the small intestine. 2. Simple sugars, amino acids, short-chain fatty acids, and glycerol are absorbed into blood stream via capillary network of villi. Products of lipid digestion are absorbed as chylomicrons into intestinal lymphatics via central lacteal of villi.

Digestion process- the digestive system prepares food for consumption by the cells through five basic activities: 1. Ingestion- is an active, voluntary process of taking in food. Food must be placed in the mouth before it can be acted on. 2 . Propulsion is movement of food along the digestive tract. Swallowing is one example of food movement that depends largely on the propulsive process called peristalsis. Peristalsis is involuntary and involves alternating waves of contraction and relaxation of the muscles in the organ wall to squeeze food along the tract. 3. Digestion- the breakdown of food by both chemical and mechanical processes. 4 . Absorption the passage of digested food from the digestive tract into thecardiova scular and lymphatic systems for distribution to cells. For absorption to occur, the digested foods must first enter the mucosal cells by active or passivetransport processes. The small intestine is the major absorptive site. 5. Defecation- the elimination of indigestible substances from the body

INTRODUCTION

Diarrhea is one of the most common diagnoses in general practice. I t i s estimated that each year US adults experience 99 million episodes of acute diarrhea or gastroenteritis. In the United States, there are about 8 million physician visits and more than 250,000 hospital admissions each year (1.5% of adult hospitalizations) due to diarrhea or gastroenteritis.Most of the deaths associated with diarrhea illness occur in the very young and the elderly populations, whose health may be put at risk from a moderate amount of dehydration. The rate of diarrhea illnesses is 2 to 3 times greater in developingcountries. The prevalence of diarrhea is not uniform in the general population. Foodand water-borne outbreaks involving a relatively small subset of population and recurrent bouts of illness in others make up the bulk of the cases. Diarrhea is more prevalent among adults who are exposed to children and non-toilettrained infants, particularly in a d a yc a r e s e t t i n g ; travelers to tropical regions; homosexual males; persons withunderlying immunosuppressant; and those living in unhygienic environments and having exposure to contaminated water or foods. Every baby or child has different bowel habits. Your baby may have as many as4 to 10 stools a day or as few as 1 every 3 days. Many breast -fed babies will have a bowel movement with each feeding and sometimes between feedings. During infancy, normal stool may be runny or pasty, especially if the baby is breast-fed. The presence of mucus in the stool is not uncommon. Unless there is a change in your baby's normal habits, loose and frequent stools are not considered to be diarrhea. Children can have acute or chronic forms of diarrhea. Causes include bacteria, viruses, parasites, medications, functional disorders, and food sensitivities. Infection with the rotavirus is the most common cause of acute childhood diarrhea. Rotavirus diarrhea usually resolves in 3 to 9 days.

Medications to treat diarrhea in adults can be dangerous to children and shouldbe given only under a doctor's guidance.

The definition of diarrhea depends on what is normal for you. For some, diarrheacan be as little as one loose stool per day. Others may have three daily bowelmovements normally and not be having what they consider diarrhea as long as they arenot dehydrated. So the best description of diarrhea is "an abnormal increase in the frequency and liquidity of your stools. But we have to know how serious it is and what to-do about it. We usually catch infectious types of diarrhea by actually eating microscopic viruses, bacteria, or parasites. These microbes then flourish in our intestines, causing damage and diarrhea. The offending microbes usually are passed from the diarrhea of others. For example, if we dont wash our hands after having bowel movements, we can easily pass these infections through preparation of food, shaking hands or other casual contact. And mind you this mode of transmission can be just as contagious as a cold or respiratory flu. Here are some helpful tips to prevent the transmission of the disease: Prevention is a matter of good hygiene. Always wash your hands before preparing your own food or for others. Keep your hands away from your hands and mouth in general. Wash after shaking hands with a number of people. Of course, always wash your hands after using the bathroom, and be wary of those who dont!

B. Objective of the study The aim of this study is to help and give much information for the patients condition and providing also comfort while the patient is not well and not on right condition and helps the patient while having some discomfort in his recovery. Having this information and reference can help other students having the same case. All the given care to the patient while he is admitted in the pediatric ward is reflected in this study in the one week rotation at . This could be a guide and helps to improve skills in handling patient having the same case of diarrhea. It helps also to be a reference for more studies to come.

C. Scope and Limitation of the study This study focuses on determining the main concern or problems of the patient that impedes their progress towards the improvement of health condition. During this short span of our Hospital exposure at pediatric ward through duties at krishi trust hospital and data gathered through interview and observation were recorded. It mainly covers about, history of his present illness, his lifestyle, and current condition. It is however limited only up to what it is written on the chart of the patient and to the extent of the resources (verbal and nonverbal) provided to us by his mother.

HEALTH HISTORY: My patient Mr. vepadajayavardhan, age 7years, admitted in children ward in krishi hospital complains of diarrhea. My Patient has loose stools and abdominal pain in last 5days. patients present in condition is weak .there is no allergy of any food items.5days back they had dinner in hotel sudha after coming home he started to pass motion as evidence by mother.

HISTORY OF PRESENT ILLNESS: A case of, 7 Years old, male, Came in at krishi trust hospital due to diahorrea and vomiting. Patient was admitted last June30 at 6:30p.m.Condition started on that day, vardhan had three consecutive defecation within an interval of 30minutes with watery, no blood seen associated with vomiting at least two times after such intake of foods/fluids as stated by the mother where prompt to admission. There was no associated symptom like fever during that day. vepadajayavardhan was diagnosed to have an acute gastroenteritis.

D. CHIEF COMPLAINT The patient was admitted due to diahorrea three consecutive defecation within an interval of 30minutes with watery, no blood seen associated with vomiting at least two times after such intake of foods/fluids

DEVELOPMENTAL HISTORY: Sigmund Freuds Psychosocial Development: According to Freud, the source of bodily pleasure is

c o n c e n t r a t e d i n z o n e s around the musculocutaneous junctions. These erotogenic zones displace one another in sequence as the child matures. Initially, the infants erotogenic zone is the mouth, thus gratification of the id is derived through oral satisfaction. During the first 6 months of life,the infant is in the oral dependent or oral passive stage, as evidenced by sucking. After the first teeth erupt at about 5 to 7 months of age, the infant enters the oral aggressive stage with biting and sucking as the means of gratification. Infants enjoy sucking and later biting anything that touches the erogenous zoneof the lips and mouth. Some infants enjoy this oral activity more than the

others. Whilesome may be satisfied by sucking at the breast or bottle, others require pacifiers, toys or other objects that can be orally manipulated. The young infant operates on the basis of primary narssism or self-love, wanting what is wanted immediately and unable to tolerate a delay in gratification. This process, the pleasure principle, later becomes a part of the ego structure that operates on thereality principle, giving up what is wanted now for something better in the future. If the mother or her substitute always sees to it that the infants need before there is evidence of these needs, the infant will feel no control over the environment. On the other hand, if required to wait too long after expressing a need, the infant will feel unable to control the environment and thus learns to mistrust the caregiver.