PREVENTION, DETECTION AND

TREATMENT OF DISEASES OF THE

DIGESTIVE SYSTEM
•Due to our modern lifestyle of
consuming high calorie fast food,
alcohol, and limited intake of fibers
and green leafy vegetables,
diseases of the digestive system
known as gastrointestinal diseases,
are becoming common today.
•A change in bowel habits.
•Sudden weight loss
•Severe abdominal pain
•Heartburn and release of
gas
 • Diarrhea
• Constipation
COMMON • Hepatitis
DISORDERS AND • Gallstones
DISEASES OF THE
• Peptic ulcer
DIGESTIVE SYSTEM
• Hemorrhoids
• Appendicitis
 DIARRHEA
• Diarrheal disease is the second leading cause of death in
children under five years old. It is both preventable and
treatable.
• Each year diarrhea kills around 525 000 children under five.
• A significant proportion of diarrheal disease can be
prevented through safe drinking-water and adequate
sanitation and hygiene.
• Globally, there are nearly 1.7 billion cases of childhood
diarrheal disease every year.
• Diarrhea is a leading cause of malnutrition in children under
five years old.
•Diarrhea is defined as the passage of
three or more loose or liquid stools per
day (or more frequent passage than is
normal for the individual). Frequent
passing of formed stools is not diarrhea,
nor is the passing of loose, "pasty"
stools by breastfed babies.
•Diarrhea is usually a symptom of an
infection in the intestinal tract, which
can be caused by a variety of
bacterial, viral and parasitic organisms.
Infection is spread through
contaminated food or drinking-water,
or from person-to-person as a result of
poor hygiene.
 There are three clinical types of diarrhea:

•acute watery diarrhea – lasts several hours

or days, and includes cholera;
•acute bloody diarrhea – also called
dysentery; and
•persistent diarrhea – lasts 14 days or longer.
 SCOPE OF DIARRHEAL DISEASE
• Diarrheal disease is a leading cause of child
mortality and morbidity in the world, and mostly
results from contaminated food and water
sources. Worldwide, 780 million individuals lack
access to improved drinking-water and 2.5
billion lack improved sanitation. Diarrhea due
to infection is widespread throughout
developing countries.
•In low-income countries, children under
three years old experience on average
three episodes of diarrhea every year.
Each episode deprives the child of the
nutrition necessary for growth. As a result,
diarrhea is a major cause of malnutrition,
and malnourished children are more likely
to fall ill from diarrhea.
•Dehydration
•The most severe threat posed by diarrhea
is dehydration. During a diarrheal
episode, water and electrolytes (sodium,
chloride, potassium and bicarbonate) are
lost through liquid stools, vomit, sweat,
urine and breathing. Dehydration occurs
when these losses are not replaced.
 THE DEGREE OF DEHYDRATION IS
RATED ON A SCALE OF THREE.
• Severe dehydration (at least two of the following signs):
• lethargy/unconsciousness
• sunken eyes
• unable to drink or drink poorly
• skin pinch goes back very slowly ( ≥2 seconds )
• Some dehydration (two or more of the following signs):
• restlessness, irritability
• sunken eyes
• drinks eagerly, thirsty
• No dehydration (not enough signs to classify as some or severe
dehydration).
•Malnutrition: Children who die from
diarrhea often suffer from underlying
malnutrition, which makes them more
vulnerable to diarrhea. Each diarrheal
episode, in turn, makes their malnutrition
even worse. Diarrhea is a leading cause of
malnutrition in children under five years
old.
 CAUSES
• Infection: Diarrhea is a symptom of infections caused by a
host of bacterial, viral and parasitic organisms, most of
which are spread by feces-contaminated water. Infection is
more common when there is a shortage of adequate
sanitation and hygiene and safe water for drinking, cooking
and cleaning. Rotavirus and Escherichia coli, are the two
most common etiological agents of moderate-to-severe
diarrhea in low-income countries. Other pathogens such
as cryptosporidium and shigella species may also be
important. Location-specific etiologic patterns also need to
be considered.
• Other causes: Diarrheal disease can also
spread from person-to-person, aggravated by
poor personal hygiene. Food is another major
cause of diarrhea when it is prepared or stored
in unhygienic conditions. Unsafe domestic
water storage and handling is also an
important risk factor. Fish and seafood from
polluted water may also contribute to the
disease.
•Source: Water contaminated with
human feces, for example, from
sewage, septic tanks and latrines,
is of particular concern. Animal
feces also contain microorganisms
that can cause diarrhea.
 PREVENTION AND TREATMENT
Key measures to prevent diarrhea include:
• access to safe drinking-water;
• use of improved sanitation;
• hand washing with soap;
• exclusive breastfeeding for the first six months of life;
• good personal and food hygiene;
• health education about how infections spread; and
• rotavirus vaccination
 KEY MEASURES TO TREAT DIARRHOEA
INCLUDE THE FOLLOWING:
•Rehydration: with oral rehydration salts
(ORS) solution. ORS is a mixture of clean
water, salt and sugar. It costs a few
cents per treatment. ORS is absorbed in
the small intestine and replaces the
water and electrolytes lost in the feces.
•Zinc supplements: zinc
supplements reduce the duration
of a diarrhea episode by 25% and
are associated with a 30%
reduction in stool volume.
•Rehydration: with intravenous fluids
in case of severe dehydration or
shock.
• Nutrient-rich foods: the vicious circle of
malnutrition and diarrhea can be broken by
continuing to give nutrient-rich foods –
including breast milk – during an episode, and
by giving a nutritious diet – including exclusive
breastfeeding for the first six months of life – to
children when they are well.
• Consulting a health professional , in particular
for management of persistent diarrhea or when
there is blood in stool or if there are signs of
dehydration
 WHAT IS CONSTIPATION?
•Constipation is when a person is not
passing stools (poo) regularly, or cannot
completely empty their bowels.
•Constipation is common and affects
around 1 in 7 adults and 1 in 3 children.
•It is more common in older age and in
pregnancy.
 HOW OFTEN SHOULD I POO?
• Most people have a poo or bowel movement
somewhere between 3 times a day and 3 times a
week.
• A lot depends on diet, age and daily activity, but
'being regular', not getting constipated and not
straining is the important thing.
• The longer waste material stays in the colon, the
harder the poo gets, making it difficult to pass.
• Normal poo should not be either unusually hard or
soft.
 WHAT CAUSES CONSTIPATION?
• People's regular toilet habits can be affected
by many things, including:
• Busy lifestyles
• Changes of routine, including holidays, starting
school
• Not eating enough fiber
• Not drinking enough water or fluids
• Not taking enough exercise, being sedentary
•Ignoring natural urges to go to the
toilet, sometimes due to not being near
a toilet you are comfortable using
•Emotional and psychological problems
•Health conditions, including Parkinson's
disease, an under-active thyroid gland
and depression.
 WHAT ARE THE SYMPTOMS
OF CONSTIPATION?
•Constipation symptoms include:
•Hard, compacted poo that is difficult or
painful to pass
•Straining during bowel movements
•No bowel movements after 3 days
•Age and circumstances
•Bottle-feeding for babies
•Some medications, including
narcotic-type pain killers such
as codeine, iron supplements and
some drugs used to control blood
pressure.
•Complications of constipation include:
•Dry, hard poo collecting in the rectum,
called fecal impaction.
•Leakage of liquid stools, called fecal
incontinence.
•Straining on the toilet and constipation
leading to piles.
• Constipation lasts 2 to 3 weeks, with abdominal
pain. This could be a sign of lead poisoning or
other serious problems.
• You are elderly or disabled and have been
constipated for a week or more, which may
indicate an impacted stool.
• There is unplanned weight loss
• There is severe pain with bowel movements.
•Stomach aches that are relieved by bowel
movements
•Bloody stools due to hard poo, piles
(hemorrhoids) and anal fissures
•Leaks of wet, almost diarrhea-like poo
between regular bowel movements
•Complications of constipation
 DIAGNOSING
CONSTIPATION
• Because occasional constipation is so common, it
does not usually need medical attention. However, if
it is a recurring problem, seek medical advice.
• Health professionals will ask about symptoms,
medical history and will often examine your
abdomen for any sign of a hardened mass and
conduct a rectal examination with a lubricated
gloved finger.
• Further tests may be arranged, including blood tests
or a colon examination.
 SEEKING MEDICAL ADVICE
Seek medical advice about constipation if:
• Constipation is associated with a fever and
lower abdominal pain, and your stools are thin or
loose. This could be a sign of diverticulitis or other
bowel conditions.
• There is blood in poo. As well as being caused by
anal fissures or piles, it is a possible symptom of
bowel cancer.
• Constipation begins after starting a new medication
or supplement.
 WHAT ARE THE TREATMENTS
FOR CONSTIPATION?
•Constipation 'lifestyle'
treatments include:
•Eating more fiber
•Exercise
 HOW CAN I PREVENT
CONSTIPATION?
Constipation cannot always be prevented, but
steps to help avoid it include:
• Eating enough fiber with 5-a-day portions of
fruit and vegetables
• Drinking enough water - 6 to 8 glasses a day
• Keeping active
• Answering 'the call of nature' as soon as you
can.
 HEPATITIS
•Hepatitis is inflammation
of the liver caused by a
virus or damage to the
liver, often from alcohol
abuse.
 Hepatitis can be either acute, lasting less than
six months, or chronic, lasting longer than six
months.

• Several viruses are known to cause hepatitis.

• As well as hepatitis caused by viruses there is a
less common type called autoimmune hepatitis
(AIH), which is due to the body's immune
system defenses wrongly attacking the liver.
 COMMON FORMS OF VIRAL HEPATITIS
INCLUDE:
•Hepatitis A: Hepatitis A is a virus that causes
liver disease. This form of hepatitis never
leads to a chronic infection and usually has
no complications. The liver usually heals
from hepatitis A within two months.
However, occasional deaths from hepatitis
A have occurred due to massive liver
infection. Hepatitis A can be prevented by
vaccination.
 COMMON FORMS OF VIRAL HEPATITIS
INCLUDE:
•Hepatitis B: This form of hepatitis causes
liver damage. Most people recover from
the virus within six months, but sometimes
the virus will cause a lifelong, chronic
infection, resulting in serious liver damage.
Once infected, a person can spread the
virus even if he or she does not feel sick.
Hepatitis B can be prevented by
vaccination.
 COMMON FORMS OF VIRAL HEPATITIS
INCLUDE:
•Hepatitis C: One of the most common
causes of liver disease in the UK, hepatitis C
is the number one reason for liver
transplant. At least 80% of patients with
hepatitis C develop a chronic liver
infection. It often does not show any
symptoms. No vaccine is yet available to
prevent hepatitis C.
 VIRAL HEPATITIS IS OFTEN PREVENTABLE.
HOWEVER, IT IS STILL CONSIDERED A SERIOUS
HEALTH RISK BECAUSE IT CAN:
•Destroy liver tissue
•Spread from person to person
•Weaken the body's immune system
•Cause the liver to fail
•Cause liver cancer (hepatitis B and C)
•Cause death
 HOW DO YOU GET HEPATITIS?
You are at a higher risk of developing hepatitis if you:

• Share needles to take drugs

• Practice unprotected oral, vaginal or anal sex
• Have many sexual partners
• Drink a lot of alcohol
• Have poor nutrition
• Work in a hospital
• Work in a nursing home
• Receive long term kidney dialysis
• Travel to areas with poor sanitation
 HOW DOES SOMEONE GET OR SPREAD
HEPATITIS?
The answer to that question depends on the
form of hepatitis.

•Hepatitis A
•A person can get hepatitis A from eating
food or drinking water contaminated with
the virus. Infected food is usually a
problem in developing nations where poor
sanitation is common.
•Hepatitis B
•Hepatitis B may be transmitted by:
•Having sex with an infected person
•Sharing contaminated needles
•Being in direct contact with infected
blood
•Getting needle-stick injuries
•Mother to child
•Being in contact with an infected person's
body fluids
 CAN HEPATITIS BE TREATED?
• There are no treatments that will cure hepatitis
A, other than to monitor carefully the liver's
function.
• Hepatitis B, where chronic, can often be treated
successfully. Peginterferon, tenofovir, and
entecavir are all used to treat hepatitis B.
• For hepatitis C, some people (approximately 40
to 80%) respond to a combination of the
medications peginterferon and ribavirin.
•Hepatitis C
•A person can get hepatitis C from:
•Sharing contaminated needles
•Being in direct contact with infected
blood
•Suffering a needle-stick injury
•Having sex with an infected person (less
common)
 WHAT ARE THE SYMPTOMS OF
HEPATITIS?
• The most common symptoms of hepatitis include:
• Dark urine
• Stomach pain
• Yellow skin or eye whites
• Pale or clay-colored stool
• Low-grade fever
• Loss of appetite
• Fatigue
• Feeling sick ( nausea)
• Aching joints
WHAT IS THE PROGNOSIS FOR HEPATITIS?
• Most people recover from acute hepatitis even
though it may take several months for the liver to
heal. To help improve your health and to help speed
up recovery:
• Avoid alcohol
• Have a healthy diet
• If you feel sick, rest
• Take any medication as prescribed for you. Check
with your doctor before taking any new medication,
including over-the-counter drugs, herbs and dietary
supplements.
 GALLSTONES
•What are gallstones?
•Gallstones are small stones that build-up in
the gallbladder. Around one in 10 people
have gallstones but most won’t be aware
of them because they don’t always cause
any symptoms. However, gallstones can
be very painful and may require treatment
or an operation to remove the gallbladder.
• What causes gallstones?
• Gallstones develop when cholesterol levels in
the bile are too high and excess
cholesterol turns into stones.
• Most gallstones are mixed stones
or cholesterol stones, mostly made up of
cholesterol. They are usually yellow or green.
• Another type of gallstones are pigment stones,
which are mostly made up of bilirubin and are
smaller and darker.
•The gallbladder
•The gallbladder is a small organ
beneath the liver. It plays a role
in digestion of fats from food by storing
bile and delivering it to the small
intestine when food arrives. Bile is
produced by the liver and
comprises cholesterol, bilirubin and bile
salts.
 WHO IS AT RISK OF HAVING
GALLSTONES?
Risk factors for developing gallstones include:

• Being overweight or obese

• Being female
• Being over 40
• A woman who's had more than one pregnancy
• Having cirrhosis of the liver
• Having Crohn’s disease or IBS ( irritable bowel
syndrome)
• A family history of gallstones
• Having weight loss surgery or recently having lost
weight
• Being on the Pill
• Women taking high-dose estrogen therapy
• Having type 2 diabetes is suspected of being a risk
factor
• A lack of exercise is also thought to increase the risk
of gallstones
• Gallstone symptoms
• Most gallstones don’t cause any symptoms,
known as asymptomatic gallstone disease.
• Biliary colic pain is constant and affects the
center of the abdomen above the bellybutton
to below the breastbone and the upper right
hand side of the abdomen towards
the shoulder blade.
• Symptoms may also include sweating and
feeling sick.
• Biliary colic does not get better by going to the
toilet, passing wind or being sick. This pain may
be caused by eating fatty food.
• Biliary colic is also called uncomplicated
gallstone disease and can last from a few
minutes, but usually lasts over an hour.
• Seek medical advice if the biliary colic is so
painful that nothing you do or any position you
sit in or lie in helps, or if the pain lasts for longer
than eight hours.
•Other warning signs requiring medical
advice include yellowing of the skin or
eyes, called jaundice, or a high
temperature and chills.
•Having episodes of biliary colic doesn't
automatically mean a person will
develop more serious gallbladder
conditions, known as complicated
gallstone disease.
 GALLSTONES TREATMENT
• Treatment for gallstones will depend on the symptoms and
how they are affecting daily life.
• If gallstones are found during routine tests, but they are not
causing symptoms, doctors may recommend ‘active
monitoring’ rather than immediate treatment.
• The most common treatment for gallstones is an operation
to remove the gallbladder. This is usually done with keyhole
surgery called laparoscopic cholecystectomy.
• During this operation, the surgeon's special instruments and
a light and a camera are passed through several small cuts
in the abdomen.
 GALLSTONES PREVENTION
• Although lifestyle changes cannot eliminate the
risk of developing gallstones for everyone,
avoiding fatty food and cutting cholesterol and
consuming a healthy balanced diet may be
recommended.
• Losing weight can help reduce the risk of
gallstones. However, a gradual approach is
better as rapid weight loss can increase the risk
of gallstones.
• A newer type of this operation is also available. Single-
incision laparoscopic cholecystectomy is done in a similar
way but with just one cut.
• If laparoscopic surgery is not appropriate, Open
cholecystectomy may be recommended. This involves a
larger incision beneath the ribs.
• Another option is endoscopic retrograde cholangio
pancrea tolography (ERCP). This is a procedure that aims to
remove bile duct stones. In some patients this is the only
treatment required. However, the gallbladder and stones in
the gallbladder remain. A heated wire is passed through an
instrument called an endoscope to widen the opening in
the bile duct and remove bile duct stones.
 WHAT IS PEPTIC ULCER?
•Peptic ulcer disease is a term
sometimes used for stomach
ulcers. Ulcers from peptic ulcer
disease can also affect the
small intestine, called duodenal
ulcers.
 WHAT CAUSES ULCERS?
Ulcers can be caused by:
• Infection with a type of bacteria called
Helicobacter pylori(H pylori). This is responsible
for about 80% of stomach ulcers and about 95%
of duodenal ulcers.
• Use of painkillers called non-steroidal anti-
inflammatory drugs ( NSAIDs), such as aspirin,
naproxen, ibuprofen and many others. Even
coated aspirin can cause ulcers.
 WHAT ARE THE SYMPTOMS OF AN
ULCER?
An ulcer may or may not produce
symptoms. When symptoms occur, they
include:
•A gnawing or burning pain in the middle or
upper stomach between meals or at night
•Bloating
•Heartburn
•Nausea or vomiting
In severe cases, symptoms can include:
•Dark or black stool (due to bleeding)
•Vomiting blood (which may look like
" coffee grounds")
•Weight loss
•Severe pain in the mid- to
upper abdomen
 WHO IS MORE LIKELY TO GET ULCERS?
• You may be more likely to develop ulcers if you:
• Are infected with the H pylori bacterium
• Take NSAIDs such as aspirin, ibuprofen or naproxen
• Have a family history of ulcers
• Have another illness, such
as liver, kidney or lung disease
• Drink alcohol regularly
• Smoke
• Are 50 or over
 ULCER MEDICATIONS
• Ulcer medications can include
• Proton pump medications (PPI). Proton pump inhibitors
reduce acid levels and allow the ulcer to heal. They
include omeprazole, esomeprazole, lansoprazole and
rabeprazole.
• Antibiotics. Usually you will be prescribed a combination of
two antibiotics along with a PPI treatment known as "triple
therapy". You usually need to take these for one to two
weeks and then have another test to make sure that the H
Pylori has cleared up. If tests are still positive, you may
need another course of treatment with different antibiotics.
•Other treatment
•Upper endoscopy Some bleeding
ulcers can be treated through an
endoscope.
•Surgery Sometimes an operation is
needed if the ulcer has created a hole
in the wall of the stomach or if there is
severe bleeding.
HEMORRHOIDS
•Hemorrhoids are swollen veins in the
lowest part of your rectum and anus.
Sometimes the walls of these blood
vessels stretch so thin that the veins
bulge and get irritated, especially when
you poop.
•Swollen hemorrhoids are also called
piles.
•Hemorrhoids are one of the most
common causes of rectal bleeding.
•They're rarely dangerous and usually
clear up in a couple of weeks. But you
should see your doctor to make sure it's
not a more serious condition.
•He can also remove hemorrhoids that
won't go away or are very painful.
 INTERNAL AND EXTERNAL
HEMORRHOIDS
• Internal hemorrhoids are far enough inside the
rectum that you can't usually see or feel them.
They don't generally hurt because you have
few pain-sensing nerves there. Bleeding may
be the only sign of them.
• External hemorrhoids are under the skin around
the anus, where there are many more pain-
sensing nerves, so they tend to hurt as well as
bleed.
 WHAT CAUSES THEM?
• Some people may be more likely to get hemorrhoids if other family
members, like their parents, had them.
• A buildup of pressure in your lower rectum can affect blood flow
and make the veins there swell. That may happen from extra
weight, when you're obese or pregnant. Or it could come from:
• Pushing during bowel movements
• Straining when you do something that's physically hard, like lifting
something heavy
• People who stand or sit for long stretches of time are at greater risk,
too.
• You may get them when you have constipation or diarrhea that
doesn't clear up. Coughing, sneezing, and vomiting could make
them worse.
 HOW TO PREVENT THEM
•Eat fiber. A good way to get it is from plant
foods -- vegetables, fruits, whole grains,
nuts, seeds, beans, and legumes.
•Drink water. It will help you avoid hard
stools and constipation, so you strain less
during bowel movements. Fruits and
vegetables, which have fiber, also have
water in them.
•Exercise. Physical activity, like
walking a half-hour every day, is
another way to keep your blood
and your bowels moving.
•Don't wait to go. Use the toilet as
soon as you feel the urge.
 APPENDICITIS
• Appendicitis is a painful inflammation or swelling of the appendix, a 5-10 cm
tube of tissue connected to the large intestine.

Appendicitis is a medical emergency and a person should be taken to A&E as

soon as possible by car or by ambulance.

The appendix doesn’t seem to do anything useful, and the treatment for
appendicitis is an operation to remove the appendix, as the body can live
without it.

Around 1 in 13 people in the UK will get appendicitis at some point in their lives.
It is more common in men than it is in women, usually occurring between the
ages of 10 and 20.
• Left untreated, an inflamed appendix can burst or perforate, spilling infectious
materials into the abdominal cavity. This can lead to peritonitis, a serious
inflammation of the abdominal cavity's lining (the peritoneum) that can be fatal
unless it is treated quickly with antibiotics.
 WHAT CAUSES APPENDICITIS?
•Appendicitis occurs when the
appendix becomes blocked, often
by a stool, a foreign body,
or cancer. The blockage may also
be due to an infection, since the
appendix swells up in response to
any infection in the body.
 WHAT ARE THE SYMPTOMS OF APPENDICITIS?
The classic symptoms of appendicitis include:
• Dull pain near the navel or the upper abdomen that
becomes sharp as it moves to the lower right
abdomen. This is usually the first sign.
• Loss of appetite.
• Nausea or vomiting soon after the abdominal
pain begins.
• Abdominal swelling.
• A raised temperature.
• Inability to pass wind.
 IN AROUND 50% OF CASES THERE ARE OTHER
SYMPTOMS, INCLUDING:
•Dull or sharp pain anywhere in the upper or
lower abdomen, back or rectum.
•Painful urination.
•Vomiting that precedes the abdominal
pain.
•Severe cramps.
•Constipation or diarrhoea with wind.
 HOW IS APPENDICITIS DIAGNOSED?
• Diagnosing appendicitis can be tricky. The symptoms are
often vague or extremely similar to other ailments,
including gall bladder problems, bladder orurinary tract
infections, Crohn's disease, gastritis, intestinal infection
and ovary problems.
• The following tests are usually used to make the diagnosis:
• An abdominal examination to detect inflammation.
• A urine test to rule out a urinary tract infection.
• A rectal examination.
• A blood test to see if your body is fighting infection.
• CT (computerised tomography) scans and ultrasound.
 HOW IS APPENDICITIS TREATED?
• Surgery to remove the appendix, which is
called an appendectomy, is the standard
treatment for appendicitis.
• If appendicitis is even suspected, doctors tend
to err on the side of caution and quickly
remove the appendix to avoid it rupturing. If the
appendix has formed an abscess, you may
have two procedures: one to drain the abscess
of pus and fluid, and a later one to remove the
appendix.
• Antibiotics are given before an appendectomy to
lessen the risk of peritonitis. General anaesthesia is
given, and the appendix is removed through open
surgery (a single large cut, approx10cm) or by key-
hole surgery (laparoscopy) which involves three
small cuts. If you have peritonitis, the abdomen is
also irrigated and drained of pus.
• Within 12 hours of surgery, you may get up and move
around. You can usually return home after a week in
hospital. If keyhole surgery is performed the incisions
are smaller and recovery is faster and you are
usually able to return home after a few days.
• After an appendectomy, seek medical
advice if you have:
• Uncontrolled vomiting.
• Increased pain in your abdomen.
• Dizziness or feelings of faintness.
• Blood in your vomit or urine.
• Increased pain and redness in your incision.
• High temperature.
• Pus in the wound.
•Can appendicitis be prevented?
•There is no way to prevent
appendicitis. However, it is less
common in people who eat foods
high in fiber, such as fresh fruit and
vegetables.