DIGESTIVE SYSTEM 


[AKA GASTROINTESTINAL TRACT]

MCS 200
BY DR BONIFACE MWAMBA KAWIMBE
DIGESTIVE SYSTEM
 PHYSIOLOGY OF GASTROINTESTINAL
TRACT
• FORM OR STRUCTURE OR ANATOMY
FOLLOWS FUNCTION [PHYSIOLOGY]
• THE LIVER HAS NO LEGS
• THE BRAIN IS SOFT
• THE SKULL IS HARD
• THE TOOTH ENAMEL IS THE HARDEST
TISSUE
 RAISON DE ETRE OF THE DIGESTIVE
SYSTEM
• WE ARE A COLLECTION OF CELLS
• FUNDAMENTAL NEEDS OF THE CELL:-
1. OXYGEN – EXCEPTION
2. WATER
3. CARBOHYDRATES – ENERGY
4. PROTEINS – BUILDING BLOCKS
5. FATS – BUILDING BLOCKS + ENERGY STORAGE
6. MINERALS AND VITAMINS
 RAISON DE ETRE OF THE DIGESTIVE
SYSTEM
• ALL THESE FUNDAMENTAL NEEDS OF THE
CELL CAN ONLY REACH THE CELL VIA THE
GIT
• FOR THESE FUNDAMENTAL NEEDS TO
REACH THE CELL THEY REQUIRE TO BE
BROKEN DOWN TO INTO THEIR SIMPLEST
UNITS
 DIGESTION OF “AIR”
• WILL BE DISCUSSED UNDER THE
RESPIRATORY SYSTEM
• AIR = 79% NITROGEN: 1% =>HELIUM/CO2/
ARGON/WATER ETC AND 21% OXYGEN
• “DIGESTION” OF AIR IN THE LUNGS
RESULTS IN ONLY OXYGEN BEING TAKEN UP
BY HAEMOGLOBIN
COMPOSITION OF AIR
 WATER
• REQUIRES NO DIGESTION
 THE REST OF THE NUTRIENTS
• CARBOHYDRATES =>
DISACCHARIDES=>MONOSACCHARIDES
DIGESTION OF CARBOHYDRATES
DIGESTION OF CHO
DIGESTION OF FATS
DIGESTION OF PROTEINS
 DEFINITION OF DIGESTION
1. MECHANICAL - PHYSICAL PROCESS OF
BREAKING DOWN THE MACRO TO THE
MICRO
2. CHEMICAL DIGESTION – TAKES THE
PROCESS OF FOOD BREAK DOWN – TO THE
SIMPLEST ABSORBABLE SIZE
 ORGANIZATIONAL STRUCTURE OF THE
DIGESTIVE SYSTEM
1. TUBULAR STRUCTURE FROM MOUTH TO
ANUS
2. FUNCTIONALLY THIS TUBULAR
STRUCTURE IS ARRANGED AS AN ASSEMBLY
LINE WHERE AT DIFFERENT STATIONS
THINGS HAPPEN TO THE FOOD
3. ASSESSORY STRUCTURES
 ACCESSORY STRUCTURES OF THE
DIGESTIVE SYSTEM
• TEETH
• THE HARD PALATE
• THE SOFT PALATE
• THE TONGUE
• THE EPIGLOTTIS
• THE SALIVARY GLANDS => PAROTID/
MANDIBULAR/SUBLINGUAL
• LIVER/GALLBLADDER
• PANCREAS
UPPER MOST DIGESTIVE TRACT
1. MECHANICAL DIGESTION INVOLVING THE
TEETH, TONGUE AND HARD PALATE
2. CHEMICAL DIGESTION OF CARBOHYDRATES
BEGINS WITH SALIVARY AMYLASE [1.5 – 2 L
OF SALIVA PER DAY]
3. MAJOR ROLE OF THE OESOPHAGUS IS
TRANSPORTATION OF FOOD = BOLUS TO THE
STOMACH. THAT IS WHY IT IS LINED BY TOUGH
NON KERATINIZING SQUAMOUS EPITHELIUM
WHICH HAS NO DIGESTIVE ROLE
UPPER MOST DIGESTIVE TRACT
 THE STOMACH
1. PERFORMS STORAGE FUNCTION HENCE ITS
BAG LIKE STRUCTURE
2. CONTINUES WITH MECHANICAL
DIGESTION WITH ITS POWERFUL MUCULAR
LAYERS
3. BEGINS PROTEIN DIGESTION THROUGH
PEPSIN
4. STERILIZES THE FOOD WITH
HYDROCHLORIC ACID
 FAT DIGESTION
1. IS NOT POSSIBLE WITHOUT BILE
PRODUCED BY THE LIVER WHICH
EMULSIFIES THE FAT PANCREATIC LIPASES
THAT BREAK IT FREE FATTY ACIDS
ABSORBABLE VIA THE LYMPHATICS
 PROTEIN DIGESTION
• WOULD BE INCOMPLETE WITHOUT
PANCREATIC TRYPSIN/CHYMOTRYPSIN/
CARBOXYPEPTIDASE
 CARBOHYDRATE DIGESTION
• WOULD SIMILARLY BE INCOMPLETE
WITHOUT PANCREATIC AMYLASE
 SMALL INTESTINES
1. CHEMICAL DIGESTION CONTINUES IN THE
BRUSH BORDER OF VILLI
2. MAJOR ROLE OF THE SMALL INTESTINE IS
TO ABSORB THE FOOD THAT HAS BEEN
REDUCED TO THE ABSORBABLE MOLECULES
3. TO ACCOMPLISH THIS THE MUCOSA IS
FOLDED INTO VILLI AND MICROVILLI WHICH
IF EXPANDED WOULD COVER A TENNIS
COURT
 THE LARGE BOWEL FUNCTIONS
1. STORAGE OF WASTE MATTER - FAECES –
UNTIL A SOCIALLY ACCEPTABLE
OPPORTUNITY COMES ALONG
2. MAJOR SITE OF WATER ABSORPTION
3. CHEMICAL DIGESTION SPONSORED BY
COMMENSAL BACTERIA PRODUCING SOME
ESSENTIAL NUTRIENTS
 FOR THE NUTRIENTS TO REACH THE
CELLS
1. ARE CARRIED BY THE PORTABLE VEIN
INTO THE LIVER FOR PACKAGING BEFORE
ONWARD TRANSMISSION TO THE CELLS OF
THE BODY
2. THE FREE FATTY ACIDS ARE TRANSPORTED
BY THE LYMPHATICS VIA THE THORACIC
DUCT INTO THE SUPERIOR VENA CAVA =>
HEART ETC
 WHAT CAN GO WRONG WITH THE
DIGESTIVE TRACT
1. BLOCKAGE - OBSTRUCTION
2. INDIGESTION – INABILITY TO BREAK DOWN
FOOD
a) BAD TEETH
b) EATING UNDIGESTABLE FOOD
c) LOSS OF CHEMICAL DIGESTIVE CAPABILITY =>
MALABSORPTION SYNDROME
3. PERFORATION
WHAT DO PATIENTS COMPLAIN OF
1. DYSPHAGIA
2. HAEMATEMESIS
3. ANOREXIA
4. HEART BURN
5. NAUSEA AND VOMITING
6. CONSTIPATION/OBSTIPATION – INTESTINAL
OBSTRUCTION
7. ABDOMINAL PAIN SYNDROME
8. PERFORATION OF THE GIT
9. DIARRHOEA
10.ABDOMINAL DISTENTION/MASS
 DIARRHOEA
❖ LOOSE STOOL
❖ INCREASED FREQUENCY
 DYSPHAGIA
• DIFFICULT IN SWALLOWING
• ANATOMY AND PHYSIOLOGY OF
SWALLOWING
 ANATOMY OF SWALLOWING
1. CEREBRAL CORTEX [MOTOR CORTEX]
2. BRAIN STEM – HOME CRANIAL NERVES
A. GLOSSOPHARYNGEAL CRANIAL NERVE
B. HYPOGLOSSAL CRANAIL NERVE
C. VAGUS CRANIAL NERVE
3. OESOPHAGUS:-
A. PROXIMAL ONE THIRD IS STRIATED MUSCLE
B. DISTAL TWO THIRDS IS SMOOTH MUSCLE
 PHYSIOLOGY OF SWALLOWING
• FIRST PART OF SWALLOWING IS
VOLUNTARY

“YOU CAN TAKE A HORSE TO THE RIVER

BUT YOU CANNOT MAKE IT DRINK”

• SECOND PART IS INVOLUNTARY OR

AUTOMATIC
 CAUSES OF DYSPHAGIA
1. CNS – STROKE, CRANIAL NERVE PALSY [POLIO/
MENINGITIS]
2. PERIPHERAL NEUROPATHY – DIABETIC
NEUROPATHY, GUALLAIN - BARRE SYNDROME
3. NEUROMUSCULAR JUNCTION – MAYESTHENIA
GRAVIS
4. OESOPHAGEAL MUSCLE - ACHALASIA
5. MUSCOSAL – STRICTURES, CARCINOMA
6. EXTRINSIC CAUSES – GOITRE, LYMPHOMA,
ANEURYSM
 INVESTIGATIONS
1. HISTORY TO DETERMINE WHETHER THIS IS
CENTRAL OR PERIPHERAL
2. BARIUM SWALLOW
3. OESOPHAGOSCOPY <= TISSUE BIOPSY
4. IF CANCEROUS =>HOW FAR HAS IT SPREAD?:-
A. ENDOSCOPIC ULTRASOUND FOR LOCAL SPREAD
B. CHEST X-RAY
C. ABDOMINAL ULTRASOUND
D. CT SCAN OF CHEST AND ABDOMEN
E. PET SCAN

 TREATMENT
• DEPENDS ON THE UNDERLYING CAUSE
 HAEMATEMESIS
• VOMITING BLOOD
 CAUSES OF HAEMATEMESIS
1. SWALLOWED BLOOD <= EPISTAXIS /
MAXILLOFACIAL TRAUMA
2. OESOPHAGUS <= OESOPHAGEAL VARICES /
MALLORY WEISS TEAR / CARCINOMA OF
OESOPHAGUS
3. STOMACH <= GASTRIC/DUODENAL
ULCER / CARCINOMA OF STOMACH /
GASTROINTESTINAL STROMAL TUMOUR
 INVESTIGATION OF HAEMATEMESIS

1. BARIUM MEAL
2. OESOPHAGOGASTRODUODENOSCOPY
 TREATMENT
• UNDERLYING CAUSE
 ANOREXIA
• LOSS OF APPETITE
PHYSIOLOGY OF APPETITE & HUNGER
 WHY WE EAT & DRINK
• WE NEED:-
1. OXYGEN
2. WATER
3. GLUCOSE
4. FAT
5. PROTEIN
• AND WE DO NOT ADQUATE STORES
 LIMITED BODILY RESERVES
1. OXYGEN – MINUTES WORTH
2. WATER – KIDNEYS CONSERVE/RECYCLE [21
DAYS]
3. GLUCOSE – 72 HOURS [GLYCOGEN
STORES]
4. FATS – 10 DAYS
5. PROTEINS
ENERGY/WATER/NUTRIENT BALANCE
PHYSIOLOGY OF APPETITE & HUNGER

• THERE MUST BE A APPETITE CENTRE OR

HUNGER & SATIETY CENTER IN THE
BRAIN:-

A. HUNGER CENTRE = LATERAL HYPOTHALAMUS

B. SATIETY CENTRE = VENTROMEDIAL
HYPOTHALAMUS
HUNGER CENTRE
INFLUENCES ON THE HUNGER/SATIETY
CENTRE
1. HIGHER CORTICAL CENTRES
[PSYCHOLOGICAL FACTORS]:-
A. THOUGHT OF FOOD
B. SMELL OF FOOD
C. SOUND OF SIZZLING COOKING
D. TASTE OF NICE FOOD/DRINK
E. SIGHT OF FAVOURITES FOODS/DRINKS
F. PRESENCE OF OTHERS
G. SPECIAL OCCASIONS - FESTIVITIES
INFLUENCES ON THE HUNGER/SATIETY
CENTRE
• THESE INFLUENCES REACH THE
HYPOTHALAMUS THROUGH
NEUROTRANSMITTERS IN THE BRAIN
2. SIGNALS FROM THE GIT:-
A. NEURAL SIGNALS =>EMPTY STOMACH=>VIA VAGUS
B. NUTRIENT SIGNALS => FFA/GLUCOSE/AA => VIA
THE BLOOD
 INFLUENCES ON THE HUNGER/SATIETY
CENTRE
3. HORMONAL SIGNALS:-
A. GHRELIN = HUNGER/APPETITE HORMONE PRODUCED
BY STOMACH & PANCREAS
B. LEPTIN = SATIETY HORMONE PRODUCED BY ADIPOSE
TISSUE
C. MISCELLANEOUS HORMONES:-
» ENDORPHINS
» DOPAMINE
» INSULIN
» OREXIN

4. 0THER FACTORS – COLD => STIMULATES

APPETITE
STIMULATOR VS SUPPRESSOR
INTEGRATED PICTURE
PHYSIOLOGY OF HUNGER AND SATIETY
 CAUSES OF LOSS OF ANOREXIA
1. PSYCHOLOGICAL:-
A. BAD NEWS => BEREAVEMENT/DEVORCE/FAILING AN
IMPORTANT EXAM/SEPARATION/JILTED
B. DEPRESSION, ANXIETY, STRESS

2. ORGANIC
A. COMMON SHORT-TERM CAUSES OF ANOREXIA:-
i. COLDS & FLU
ii. PREGNANCY
iii. RESPIRATORY INFECTIONS
COMMON CAUSES OF ANOREXIA
IV. BACTERIAL OR VIRAL INFECTION
V. CONSTIPATION
VI. AN UPSET STOMACH
VII.FOOD POISONING
VIII.ALLERGIES AND FOOD INTOLERANCES
IX. ALCOHOL OR DRUG ABUSE
X. STOMACH BUG OR GASTROENTERITIS
 MEDICAL CONDITIONS CAUSING
ANOREXIA - PROLONGED
i. HIV/AIDS
ii. HEART FAILURE
iii. HYPOTHYROIDISM
iv. CHRONIC LIVER DISEASE
v. CHRONIC KIDNEY DISEASE
vi. ADDISON’S DISEASE
vii. DIABETES
viii. HYPERCALCALCEMIA
ix. COPD AND ASTHMA
x. IRRITABLE BOWEL SYNDROME
xi. ULCERATIVE COLITIS & CHROHNS DISEASE
 SIDE EFFECTS OF MEDICATION &
TREATMENT
i. SOME ANTIBIOTICS
ii. IMMUNOTHERAPY
iii. CHEMOTHERAPY
iv. RADIATION THERAPY TO THE GIT
v. POSTOPERATIVELY [ANAESTHESIA DRUGS]
 MALIGNANCIES CAUSING ANOREXIA

i. PANCREATIC
ii. OVARIAN
iii. STOMACH
 MISCELLANEOUS CAUSE
1. OLD AGE
2. SERIOUS ILLNESS
UNUSUAL CAUSE OF ANOREXIA
 HEARTBURN
• UNPLEASANT BURNING SENSATION IN THE
MID UPPER ABDOMEN OR BEHIND THE
BREAST BONE [NEAR THE HEART]
• MAY BE ASSOCIATED WITH FREQUENT
BURPING, SOUR TASTE IN THE MOUTH OF
REGURGITATED FOOD AND DRINK
HEARTBURN
CAUSE OF HEARTBURN
WHY “HEART”BURN
HEARTBURN VERSUS HEART ATTACK

• IN PATIENTS:-
1. WITH FAMILY HISTORY OF HEART DISEASE
2. > 40 YRS
3. SMOKING
4. HIGH BLOOD PRESSURE
5. DIABETES
• DO ELECTROCARDIOGRAM AND CARDIAC
ENZYEMES
 DIAGNOSIS OF HEARTBURN
• CLINICAL DIAGNOSIS
• THERAPEUTIC TRIAL OF ANTI-REFLUX
TREATMENT
• BARIUM MEAL
• OESOPHAGOGASTRODUODENOSCOPY
• TRANSNASAL AMBULATORY 24HR PH
MONOTORING
• BRAVO REFLUX CAPSULE
• OESOPHAGEAL MANOMETERY
 TREATMENT OF HEARTBURN

GASTROESOPHAGEAL REFLUX DISEASE
1. LIFE STYLE:-
a. STOP SMOKING
b. LOSE WEIGHT
c. AVOID TIGHT CLOTHING
d. ELEVATE HEAD OF THE BED
e. AVOID LARGE MEALS
f. ALLOW 2 HOURS BETWEEN SUPPER AND BEDTIME
g. GERD POTENTIATING MEDICATION MAY NEED TO
BE TAKEN WITH ANTI-REFLUX DRUGS
 NAUSEA AND VOMITING

❖ FEELING SICK TO ONES STOMACH –

FEELING LIKE VOMITING

❖ INVOLUNTARY FORCEFUL EXPULSION OF

CONTENTS OF THE STOMACH AND
INTESTINES
NAUSEA AND VOMITING
 WHY DO WE VOMIT
• PROTECTIVE MECHANISM TO GET RID OF
FOOD AND DRINK PERCEIVED AS HARMFUL
BY THE GIT
• THEREFORE IT IS A NORMAL
PHYSIOLOGICAL FUNCTION
PHYSIOLOGY OF VOMITING
 PHYSIOLOGY OF VOMITING

[chemoreceptor trigger zone]
APPROACH TO A VOMITING PATIENT
❖ IS THE VOMITING CENTRAL OR PERIPHERAL?
❖ CENTRAL :-
1. HIGHER CENTRES =>SIGHT/SMELL
2. DRUG RELATED
3. INNER EAR RELATED => VESTIBULOCOCHLEAR
4. PAIN
❖ PERIPHERAL :-
1. INTESTINAL OBSTRUCTION
2. GASTROENTERITIS
COMMON CAUSES OF VOMITING
• WE CAN ALL INDUCE VOMITING BY
IRRITATING THE OROPHARYNX
 COMMON CAUSES OF VOMITING
1. EARLY PREGNANCY : [50-90% N/25-55%V]
2. MEDICATIONS: CHEMO/NARCOTICS
3. MOTION SICKNESS: CAR/PLANE/SHIP
4. FOOD POISONING
5. INFECTION: STOMACH FLU : G/E IN CHILDREN
6. INTENSE PAIN:HEART ATTACK/ACUTE
CHOLECYSTITIS/APPENDICITIS/PEPTIC ULCER
7. INCREASED INTRACRANIAL PRESSURE:
TUMOUR
8. GASTROINTESTINAL OBSTRUCTION
DRUG TREATMENT OF VOMITING
 CONSTIPATION/OBSTIPATION
[GASTROINTESTINAL OBSTRUCTION]
1. ABDOMINAL PAIN THAT COMES IN WAVES
[COLIKY] => INCREASED BOWEL SOUNDS
2. VOMITING [EARLY=>UPPER/LATE=>LOWER
GIT]
3. ABDOMINAL DISTENTION [MINIMAL=UPPER/
MARKED=>LOWER]
4. CONSTIPATION/OBSTIPATION
5. CONSTANT ABDOMINAL PAIN => PERITONITIS
=> REDUCED BOWEL SOUNDS OR SILENT
 PATHOPHYSIOLOGY OF GIT
OBSTRUCTION
1. PASSAGE OF FOOD AND DRINK => DAMING
2. SECRETION AND ABSORPTION [FINE BALANCE]
=> MORE SECRETION THAN ABSORPTION
3. ARTERIAL SUPPLY => CONTINUES FOR LONGER
PERIOD OF TIME => OEDEMA=>
ASCITIS=>GANGRENE=>PERITONITIS
4. VENOUS SUPPLY => SECOND TO BE
COMPROMIZED=> OEDEMA=>ASCITIS
5. LYMPHATIC DRAINAGE=>FIRST TO BE
COMPROMIZED=>OEDEMA=> ASCITIS
 CAUSES OF MECHANINCAL GIT
OBSTRUCTION
1. POSTOPERATIVE ADHESIONS
2. INFLAMATORY ADHESIONS:PID/APPENDICITIS/
CHOLECYSTITIS/DIVERTICULITIS
3. CONGENITAL BANDS
4. MALROTATION [VOLVULUS IN INFANTS]
5. NEOPLASMS: INTRINSIC/EXTRINSIC
6. HERNIAS
7. VOLVULUS
8. INTUSSUSCEPTION
9. GALLSTONE ILEUS
10. CROHNS DISEASE
DIAGNOSIS OF GIT OBSTRUCTION
• HISTORY => LOOK OUT FOR SYMPTOMS
• PHYSICAL EXAM=>BOWEL SOUNDS/VISIBLE
PERISTALSIS/EARLY =>NO TENDERNESS/
GUARDING. DISTENTION. DRE EMPTY
• TESTS : KUB=> DILATED LOOPS/AIR FLUID
LEVELS/EMPTY RECTUM
• CT SCAN=
NORMAL ABDOMINAL X-RAY
SMALL BOWEL OBSTRUCTION
LARGE BOWEL OBSTRUCTION
AIR FLUID LEVELS
 CAUSES OF NON MECHANICAL GIT
OBSTRUCTION
1. POST OPERATIVE ILEUS
2. HYPOKALEMIA

THIS IS WHEN THE LUMEN IS OPEN

THROUGH OUT BUT THERE IS A
DISTURBANCE WITH PERISTALSIS
 ABDOMINAL PAIN SYNDROME
• “ONE OUTWARD MANIFESTATION BUT
MANY CAUSES”
 FAST KILLER CAUSES OF ABDOMINAL
PAIN
1. HEART ATTACK – MYOCARDIAL INFARCTION
2. ECTOPIC PREGNANCY
3. SUPERIOR MESENTERIC OCCLUSION
4. PERFORATED VISCOUS
5. LEAKING ABDOMINAL ANEURYSM
 SURGICAL VS MEDICAL CAUSES OF
ACUTE ABDOMINAL PAIN
• INTESTINAL • DIABETIC KETO
OBSTRUCTION ACIDOSIS
• ACUTE APPENDICITIS • PID
• PERFORATED • URETERIC COLIKY
DUODENAL ULCER • SICKLE CELL CRISIS
• URINARY TRACT
INFECTION
PERFORATION OF GIT – NON TRAUMATIC

• 1 – PERFORATED APPENDICITIS
• 2 – PERFORATED PEPTIC ULCER
• 3 - TYPHOID PERFORATION OF THE
TERMINAL
ILEUM
• 4 - PERFORATED DIVERTICULITIS
• 5 - PERFORATED ACUTE CHOLECYSTITIS
[GANGRENOUS GALL BLADDER]
PATHOPHYSIOLOGY OF PERFORATION

• PERITONEUM IS STERILE
• GIT LUMEN => BACTERIA + POTENT
DIGESTIVE ENZYMES CAPABLE OF
DIGESTING MEAT, MAIZE, FAT ETC
• => SEVERE PERITONITIS CHEMICAL AS WELL
AS BACTERIAL => DEATH
 DIARRHEOA
• LOOSE STOOL
• INCREASED FREQUENCY
• COMMON AND SELF LIMITING
• NORMAL PHYSIOLOGICAL FUNCTION THAT
ENABLES THE BODY GET RID OF
UNWANTED GIT CONTENTS JUST LIKE
VOMITING
IN ZAMBIA – WATCH OUT FOR CHOLERA!!

• ALWAYS WORRY ABOUT CHOLERA

1. MORE THAN ONE PERSON IN A
HOUSEHOLD IS AFFECTED
2. OUT BREAK OF DIARRHOEA IN A
BOARDING SCHOOL
3. VERY FREQUENT RICE WATER STOOL
 IN ZAMBIA WATCH OUT FOR BLOODY
DIARRHOEA
• DYSTENTRY
 CAUSES OF DIARRHOEA
1. TRAVELLERS DIARRHOEA
2. COMMON PROBLEM IN CHILDREN –
DEVELOPING IMMUNITY – PUT EVERYTHING IN
THEIR LITTLE MOUTHS – BOTTLE FEEDING
WITHOUT HYGIENE – VIRUSES – 1.9 MILLION
DIE
3. INFECTIVE DIARHOEAS:-
a) BACTERIAL => SALMONELA – E COLI – SHIGELLA
b) VIRUSES => ROTAVIRUS DIARRHOEA [VACCINE]
c) PARASITES
 CAUSES OF DIARRHOEA
4. NON INFECTIOUS OR FUNCTIONAL
DIRRHOEA:-
a) IRRITABLE BOWEL SYNDROME
b) INFLAMMATORY BOWEL DISEASE:-
i. CROHNS DISEASE
ii. ULCERATIVE COLITIS

5. MALABSORPTIVE AND MALDIGESTIVE

DIARRHOEA => CHRONIC PANCREATITIS /
CELIAC DISEASE
6. DRUG INDUCED => CHEMOTHERAPY
 TREATMENT
1. FOCUS IS TREATING WATER AND
ELECTROLYTE LOSS => REHYDRATION
WITH ORS
2. IF BACTERIAL CAUSE IS IDENTIFIED =>
ANTIBIOTICS
3. SLOW DOWN PERISTALSIS = LOPERAMIDE
=> USE DISCOURAGED IN CHILDREN TAKES
FOCUS AWAY FROM REHYDRATION
 ABDOMINAL MASS/DISTENTION
1. FOOD
2. FEACES
3. FETUS
4. FIBROID
5. FLUID
6. FAT
 ABDOMINAL MASS/DISTENTION
• ORGANOMEGALY => ENLARGEMENT OF A
NORMAL ORGAN
• COMPARTMENTS OF THE ABDOMEN:-
1. RETROPERITONEUM
2. PELVIS
3. GENERAL ABDOMINAL CAVITY
ANATOMY OF THE RETROPERITONEUM

1. KIDNEYS
2. ADRENAL GLANDS
3. PANCREAS
4. LYMPH NODES
5. ABDOMINAL AORTA
6. MUSCLES
7. BONES
 RETROPERITONEAL MASSES
1. KIDNEYS => WILMS TUMOUR / RENAL CYST
2. ADRENAL GLANDS => PHAEOCHROMOCYTOMA
3. PANCREAS => CANCER / PANCREATIC
PSEUDOCYT
4. LYMPH NODES => LYMPHOMA
5. ABDOMINAL AORTA => ABDOMINAL AORTIC
ANEURYSM
6. MUSCLES => RHADOMYOSARCOMA
7. BONES => OSTEOSARCOMA
8. FAT => LIPOMA
 ANATOMY OF THE PELVIS
1. RECTUM =>FEACES/ADENOCARCINOMA
2. VAGINA => HAEMATOCOLPOS
3. UTERUS => FETUS/FIBROIDS
4. BLADDER => URINARY RETENTION/CANCER
5. PROSTATE => CA PROSTATE
6. OVARIES/TUBES => CYSTS / CANCER /
TUBOOVARIAN MASS
7. BONES/MUSCLES/FAT
 ANATOMY OF GENERAL ABDOMINAL
CAVITY
1. LIVER => HEPATOMEGALY / CYSTS /
HEPATOCELLULAR CARCINOMA / METASTASES
2. SPLEEN => SPLENOMEGALY
3. MESENTERY => CYST / ADENOPATHY
<=LYMPHOMA
4. COLON => ADVANCED ADENOCARCINOMA /
OBSTRUCTION
5. SMALL BOWEL => OBSTRUCTION
6. PERITONEAL CAVITY => ASCITIS