Anatomy and Physiology

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ANATOMY AND PHYSIOLOGY ANATOMY AND PHYSIOLOGY: THE DIGESTIVE SYSTEM 

Consists of  (1) an alimen alimentary tary ca canalnal- a lo long ng mus muscular cular ttube ube beg beginnin inning g at the lip lipss an and d en ding di ng at the anus, including the mouth, pharynx (oral and laryngeal  po rt io ns ns), ), es op ha g us us,, st om omaa ch , an d s ma mall ll an d l arg ar g e i nt es tine ti ne , a nd ( 2 ) A c c e s s o r y g l a n d s t h a t em empt pty y sec secre reti tion onss int into o tthe he tube tube-- sal saliv ivar ary yg gla land nds, s, panc pancre reas as,, liver, and gallbladder. 1 .

Teeth 

a. Crown projects above the gum, root below. Dentin (bulk of tooth) su surrroun rounds ds pulp pulp cavity. Enamel cove rs den tin o f crown ; cemen ted c overs d e n t i n o f r o o t a n d an anch chor orss to toot oth h tto op per erio iodo dont ntal al li liga game ment nt..  b.Each quadrant of of mouth has eig eight ht teeth-two incis incisors, ors, one canine, tw two o premolars, and three molars. 2 . Esophagus  a. Mucous membrane lined with stratified squamous epithelium rather  t h a n s i m p l e col column umnar ar epit epithel helium ium,, as in sto stomac mach h aand nd inte intesti stine, ne,  b.  b . mu musc sc ul ar l a ye yerr o f up pe r t hi rd rd,, st ri at ated ed ; l ow owee r th ir d, sm smo o ot h; mi mid d dl e ,  bo th st ri at ed an and d smooth. C.Segment above stomach (indistinguishable anatomically from r  e m a i n d e r o f esopha esophagus gus)) fu funct nction ionss as ssphi phinct ncter, er, rrem emain aining ing cclos losed ed u unti ntill reflex ref lexiv ivel ely y rel relaxe axed d as perist peristal altic tic w wav avee appr approac oaches hes,, 3. Stomach A.

Consists of upper fundus, central  b o d y , a n d c o n s t r i c t e d l o w e r p y l o r i c p o r t i o n (antrum (antrum). ). 

 

 b . Musculatur Musculaturee contains an obli oblique que inner layer of smooth muscle 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 s t o ma c h and and d duo uode denu num ms.

4. Small Intestine

a. Divided into duodenum, jejunum, and ileum.  b.  b . Su rfa rf a ce a re a , se rv i ng ab so rpt rp t iv e fu nc t ion io n , in c re as ed by by:: 1. Circular folds (plicae circulares)- permanent, transverse folds. 2 . V i l l i  –  f i n g e r l i k e p r o j e c t i o n s 3. Microvilli- processes on free surface of epithelial cells that form the brush order. c . I n v a g i n a t i o n o f i l e u m i n t o c e c u m  –  t h e f i r s t p a r t o f t h e l a r g e i n t e s t i n e  –   – ff o r m s ileoc ileocecal ecal valve valve,, which opens rhy rhythmi thmically cally duri during ng digest digestion, ion,  permitting gradual gradual em emp pty tyin ing g of ile ileum and and pr preeven entting regurg urgitat tation.

5. Large Intestine.

a. Extends from the end of the ile um to the anus and is divisible into the c ec ec u um m, c o l o n , r e c t u m , a n d a n a l c a n a l . T h e m a j o r p a r t i s t h e c o l o n , w h i c h c o n s i s t s o f as asce cend ndin ing, g, tran transv sver erse se,, de desc scen endi ding ng,, an and d sigm sigmoi oid d  portions.  b . T h e l o n g i t u d i n a l m u 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 m s t h r e e c o n s p i c u o u s ba ban nds (t (tee een nage cco oli). i). c. Thickened circular smooth muscle of anal canal forms the internal anal sphincter.Surrounding sphincter.Surr ounding 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 type typess of sec ecrretions: 1. Serous containing ptyalin –  ptyalin – enzyme enzyme initiating digestion of the starch. 2. Mucous –  Mucous – viscous, 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 –  Bicarbonate-and-water-secreting – intraocular intraocular duct cells.  b. Panc ncrreatic duct uct em emp ptie iess pa pan ncreatic juic icee int nto o duode den num um.. 8. Liver and Gallbladder a.

Bile secreted by liver i s essential for normal absorption of digested lipids. Bile salts combine with produ cts of lipid digestion to form waters o l u b l e c o m p l e x e s (m (mice icell lles es)) w whic hich h aare re ab abso sorb rbed ed by int intes esti tina nall cel cells. ls.  b. Gallbladder co concentrates ncentrates and sstores tores bile. c . Hepatic duct, formed from the bile duct sys system tem of liver, joins joins cystic duc ductt 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 p asses 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 initiatesper initiatesperistalsis, istalsis,

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. Peristalsis in Stomach

a. Mixes contents and forces chime through pylorus.  b. Three waves each each beginning every 20 seconds near m midpoint idpoint of stom stomach, ach, 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 . Fe Feed edba back ck from from du duod oden enum um re regul gulat ates es ga gast stri ricc em empt ptyi ying ng.. T w o c o n t r o l mech an isms, one neuro nal (ente roga stric refle x), the othe r h ormona l (mediated mainly by enterogastrone), inhibit gastric motility. 3 . Contractions of the Small Intestine   a . Segmenting: rrhythmic hythmic contr contractions actions alon along g a section dividing it into segm segments: ents:  primarily mixing mixing action.  b. Peristaltic waves waves superimpos superimposed ed upon segm segmenting enting contractions. c.Ingestion of food increases ileal peristalsis and frequency of opening o f ileoceca ileocecall valve (gastr (gastrulae ulae ref reflex). lex).

4 . Contractions of Large Intestine   A.Simultaneous contraction of circular and longitudinal muscle, f  orminghaustra,

 

 b . I n f r e q u e n t u s u a l l y t w o o r t h r e e t i m e s d a i l y o f m o s t m a s s movements transferring contents from proximal to distal colon and into rectum. Mostcommonly 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 . Refle eflex x prece ecede ded d by vo vollun unttary ary rel elaaxa xati tio on of exter terna nall s p h i n c t e r a n d compression of abdominal contents. Digestion 1 .

Mouth

a . Enzymatic action: initi atio n of the dig esti on of carb ohyd rate  b y p t y a l i n , w h i c h splits starch into the disacchar disaccharide ide maltose. Action Action in mouth slight, but continues in stomach until acid medium inactivates ptyalin.  b.  b . Re Reg g ul a ti on : e xc xclu lu si ve l y n er vo us - im imp p ul se s t ra ns mi mitt te d fro fr o m ce n te r i n medullaactivated principally 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  pro  p ro te a se ses, s, p ep t on es es,, an d po ly lype pe p ti d es es.. Pe ps i no ge gen n se cr ete et e d by ch i ef ce ll s converted to pepsin by auto activation process in presence of acid secreted by  parietal cells.  b . R e g u l a t i o n   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 aci acid-r d-rich ich gas gastr tric ic jjuic uice. e. 2 . Gastric phase initiated by ffood ood in stomach; secretion triggered directly or   indire ctly, as in cephalic phase. 3. Intestinal phase- initiated by digestive products in upper small in inte test stin ine; e; me medi diat ated ed by hormo hormone ne re releas leased ed by duodenu duodenum m act acting ing o on n sto stomac mach. h. 4. Inhibition- strong acid in antrum inhibits gastrin release. Fat, acid, or  hypertonic salt solutions in duodenum stimulate release of hormones which inhibit inh ibit gastric gast ric se secr cret etio ion. n.

3. Intestine

a . E n z y m a t i c ac acti tion on-- fa fatt di dige gest stio ion n an and d co cont ntin inua uati tion on of ca carb rboh ohy ydrat dratee an d p ro te i n d diige gesstion. 1. Pancreatic lipase splits fat into monoglyceri monoglycerides, des, fatty acids, and glycerol. 2 . P a n c reat reatic ic am amylas ylasee conv converts erts star starch ch and glycogen glycogen iinto nto m maltos altose. e. Int Intesti estinald naldisac isaccc haridases split maltose, sucrose, and lactose into their constituentmonosaccharides, 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 gastricphase of gastric secretion and by two duodenal hormonesc h o l e c y s t o k i n i n - pa panc ncre reoz ozym ymin in and and se secr cret etin in.. Va Vagu guss st stim imul ulat atio ion n an and d cholec cho lecyst ystok okini inin-p n-panc ancre reao aozym zymin insti stimul mulate ate en enzy zyme me sec secre reti tion; on; sec secre reti tin n sstim timula ulates tes  bic  bicaarbona natte 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  li pid pi d dige di ge st stio io n ar aree aabsor bsorbed bed as chylo chylomic microns rons iinto nto in intest testinal inal ly lympha mphatics tics v via ia 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, v oluntary process of taking in food. Food must  be pl a ce d iin n the mout uth h be beffor oree it can be acte ted d 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 tthe he passage of digested food ffrom rom the digesti digestive ve tract into thecardi thecardiova ova 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  passivetransp ort processes processes.. The sma small ll intestine is tthe he major abso absorptive rptive site. 5. Defecation- the elimination of indigestible substances from the body

INTRODUCTION

 

Diarrhea is one of the m most ost 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 daycare setting; 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  bab  b ab i es wi l l ha hav v e 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 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 a b n o r ma l i n c r e a s e i n t h e freq freque uenc ncy y and and li liqu quid idit ity yo off y you ourr ssto tool ols. s. Bu Butt w wee h hav avee tto ok kno now w 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. of  others. For example, if we don’t 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 ffor or 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 of  those who don’t!  don’t! 

 

B. Objective of the study

The aim of this study is to help and give much information for  the patient’s 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 cond co ndit itio ion. n. Du Duri ring ng th this is sh shor ortt span o f our H osp ita l exp osur e at p edi ediatr atr ic w ard 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 r e s o u r c e s (v e r b a l a n d n o n ve verrbal) bal) pr prov ovid ided ed to us by his his mothe other. r.

HEALTH HISTORY:

My patient Mr. vepadajayavardhan, age 7years, admitted in children ward in krishi hospital complains of diarrhea. My Patient Patient has loo loose se stool stoolss and abdom abdominal inal 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, old , male, Came in at krishi trust ho hospital spital due tto o di diah ahor orre reaa 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 associate associated d with vomiting at least two times after such intake of foods/fl foods/fluids uids

DEVELOPMENTAL HISTORY:

Sigmund Freud’s Psychosocial Developm Development ent:: According

to

Freud,

the

source

of

bodily

pleasure

is

concentrated in zones around the musculocutaneous junctions. These erotogenic zones displace one another in sequence as the child matures. Initially, the infant’s erotogenic zone is the mouth, thus gratification of the id is derived 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  pro  pr oces cess, the pleasure principle, later becomes a part of the ego structure that operates on thereality principle, giving up what is wanted now no w for something better  in the future. If the mother or her substitute always sees to it that the infant’s 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.

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