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4 Our Digestive System One task we are all familiar with doing ... EATING! Some of us love eating, yet some eat beacuse they have to. Whether we eat to live or we just live to eat... One thing we all have to agree with. TO LIVE.... WE NEED FOOD !!!As human beings we cannot survive without eating - foodgives us strength. At times food may also make our bodysick. Come, let us understand how our body deals with thefood we eat.Our body has a finely tuned system to take careof the food that we eat.This system is also called the digestive system.
4-1 How Do We DigestParts of Our Digestive System The Food We Eat?? The digestive system starts from the mouth and nose Nose and ends at the anus from where we pass stools (or Mouth shit). Throat Once the food has gone into the mouth, the teeth Food Pipe there chew it. Saliva from the salivary glands around the Stomach mouth mixes with the food here so that the Liver & tongue can push it into gall bladder the back of the throat and the food slips down Pancreas into the food pipe. Small intestine From the food pipe, it Large gets into a large sac like intestine organ called the stomach. After staying in the Appendix stomach for a few hours and mixing with juices, Anus the food goes into the small intestine.The large intestine that follows the small intestine is broader in size. In the smallintestine, most of the juices from the liver and pancreas, and from the smallintestine itself break down the food to such small and fine sizes that it easilyabsorbed by the body.Whatever is left behind from the undigested food and from the extra juices getsdry in the large intestine before being passed out as stools (or shit).This journey for the food from the mouth to the anus, usually takes about oneand half days.
4-2 Parts of our Digestive SytemNoseAlthough the nose does not receive any food, we will agree that it plays animportant part in eating food. Good smell from food being cooked or whilebeing served starts off the production of saliva from the salivary glandsand the movement of the food pipe. On the other hand, stale food or some-thing rotten in the smell makes us avoid eating the food. As the nose isconnected behind to the throat where the back of the mouth and tonguealso ends, in accidents and other emergency conditions, we can send in apipe to pass food for the body straight to the stomach. Mouth Holes in Your Starting at the Teeth lips, the mouth Small food particles can get stuck in the small- has a set of teeth est of pits on the surface of the teeth. If not, besides a brushed or rinsed out, millions of small bacte- tongue. ria/germs that normally stay in the mouth will Holes in the act on this food and make it acid. This acid will There are different types of teeth can be cut holes into your teeth giving you cavities or teeth that help us in biting, very painful dental caries. Mouth must be properly rinsed chewing, tearing or grinding and will need or the teeth well brushed. Brushing teeth in the the food we eat. to be filled. night before sleeping is MORE important than brushing in the morning. How Many Teeth Can We Have? Children Must Drink Milk for CalciumAdults have thirty two teeth - sixteen each in theupper and lower jaws. Children below five years Many children get their first teeth late. Teethhave a total of twenty milk teeth. may come later for those children who drink less milk or did not have food with moreA child starts getting milk teeth around six months calcium. Advise mothers to give their smalltill a year and a half years. By the time they are 6 children milk or food with calcium, like daal,years old, their milk teeth gradually start to fall off beans, leafy vegetables and fish.one by one. Permanent teeth replaces milk teeth. Keep Your Mouth & Teeth Clean Mouth: Rinsing the mouth after every meal, tea or snack helps keep the teeth clean and avoids bad breath. Betel nut, paan and tobacco can harm the inner skin of the mouth – they are the reason for the very high occurrence of cancer of the mouth in India. Teeth: Although toothpastes are of no great help, brushing the teeth surely is. Brushing helps remove any food particle stuck next to the teeth and is useful if carried out after meals, not before. Most people brush wrongly and cause more damage than help – the upper teeth must be cleaned by strokes of the brush from top to bottom, while brush strokes from below upwards are required for teeth of the lower jaw. Any cavity in the teeth must be filled up at the earliest to avoid widening of the cavity.
4-3Salivary Glands :What happens when the smell What Are MUMPS?of our favourite food reachesour nose? Or when food is Mumps is a common diseaseplaced in the mouth? Ourmouth waters. This is called of the salivary glands undersaliva. Saliva has some types of the lower jaws. It spreadssubstances that breaks down amongst children playing orour food into small particles staying together through germs breathed out byeven before they reach our a patient.stomach. The patient gets severe pain in opening theTwo sets of salivary (se-laee-va-ree) glands around the mouth mouth, first on one side and later on the other.give out saliva. One set is found One can easily see the swelling on the side ofunder the lower jaw on either the lower jaw that is painful to touch. Mumpsside while another is found on gets well by itself in a week or two.both sides of the face just in frontof the ear lobes.Food Pipe food pipeThe food pipe or oesophagus (ee-so-fa-gus) starts from wherethe throat ends. It passes at the back of the chest along theinside of the backbone. Entering the abdomen, it ends in thestomach.The moment the nose smells food or food is kept in the mouth,the food pipe automatically starts downward squeezingmovements. The muscles on the wall of the food pipe squeezeand relax for hours till all the food and other juices reach thelowest end of the digestive system.Any infection, liquor, strong chillies and medicine may causethe food pipe to get inflamed. This results in pain and burningsensation in the centre of the chest.
4-4ThroatThe throat or pharynx is connected to thenose and the mouth in the front. throatIt ends below into two pipes. The pipe food pipebehind food pipe leads to the stomachinside the abdomen after crossing the wind pipechest.In front of the food pipe lies the wind-pipe going to the lungs.After about twenty years of age, it is thewhole throat and not just the tonsils thatswell up and become sore. This is what lungsis commonly called pharyngitis (fay-rin-jaee-tis). stomach diaphram (seperates abdomen from chest) Remember the “- itis” The suffix ‘-itis’ is added behind the name of an organ to tell us that the organs is inflamed. This means that some germs or some injury has harmed the organ and it is fighting back. An organ becoming swollen, hot, red, painful and working below its nor- mal capacity are the five things that tell us that the organ is inflamed. Tonsill-itis of the tonsils, arthr-itis of the joints (also arthros), appendic-itis of the appendix and sinus–itis of the sinuses are some examples. What are Tonsils? The inside of the mouth ends behind in folds of Tonsils Swelling reddish inner-skin (mucous membrane). These have Swelling of the tonsils again and one tonsil amongst them on each side. These tonsils again can cause repeated illness stand like guards to the throat. Whenever germs and disturb routine of children. start attacking either the breathing organs or the Also, the infection may cause digestive organs, the tonsils swell up and become some problems in the heart in some young painful. This warns us of an infection. children. Hence such children should be either on medicines regularly or else, the Ask your friend to open her/his mouth and shine a tonsils can be removed by a rather simple torch to look at the tonsils. It is not rare to see them operation. swollen and causing pain, especially in children.
4-5 STOMACH stomach The stomach starts where the food pipe finishes. It lies in the upper part of the abdomen. The stomach is a big sac like organ that can store food for about two to four hours. The stomach produces very strong acid and a substance called pepsin. The two things work together to break down the protein present infood like meat, lentils (pulses or daals) and milk, so that thebody can use them later. 109876543210987654321 109876543210987654321Food Poisoning 109876543210987654321 Did you know that the acid 109876543210987654321Any strong infection, infected food (as in food poisoning), liquor 109876543210987654321 produced in your stomach is 109876543210987654321or chillies can cause serious irritation in the lining of the so strong that it can dissolve 109876543210987654321 109876543210987654321 an iron nail. Luckily for usstomach. This leads to hiccupping and also to vomiting. The 109876543210987654321person may also feel pain and burning sensation in the ‘pit’ of 109876543210987654321 in normal times the lining of 109876543210987654321the stomach (the upper part of abdomen just where it meets 109876543210987654321 the stomach does not get 109876543210987654321the centre of the chest). This is what doctors call gastritis (gas- harmed by the acid. Unless 109876543210987654321 109876543210987654321 the lining has been alreadytraee-tis). If this irritation persists for a long time, a wound 109876543210987654321may develop in the lining of the stomach - usually in the lower 109876543210987654321 weakened by infection or 109876543210987654321part of the stomach and in the early part of the small intestine medicines, the acid in the 109876543210987654321 109876543210987654321– that is called Peptic Ulcer or commonly just Ulcer. stomach cannot harm it. 109876543210987654321 109876543210987654321Lemon Juice is Good for “Gas- When Does the Stomach Empty?tric”. The stomach gets empty two to four hoursMany of us call vomiting and pain in after eating a meal. Hence, when a doctorthe upper stomach as ‘gas’ or ‘gastric’. tells you not to take a pill on an emptyA large spoon of lemon juice with some stomach, she means that it is to be takensugar is effective to deal with the WITHIN two hours of taking a meal.irritation and can also stop vomiting.ANTACID tablets that counter the acidare also helpful.Diarrhoeas & Vomitting Are Good For Us !In small quantities, “diarrhoea” (dy-ree-ah) and vomiting is actuallygood for us!! It protects us. Whenever the body finds something in thefood that is not good for the body, it tends to vomit it out at the earliest.If it somehow goes inside the body without being found out, then theintestines (in-tes-taeens) will try to flush it out. Water in huge quantitiesalong with the harmful item and the undigested food is repeatedly thrownout of the body with shit to cause what we call diarrhoea.
4-6SMALL INTESTINEThe small intestine starts where the saclike organ of stomach ends.It is about nine feet long in a living per-son. Coiled inside the abdomen, it re-ceives the food with its juices from thestomach. In the beginning portion, thesmall intestine receives the opening ofthe pipe from the liver. Juices comingfrom the liver have very strong diges-tive substances that can breakdown largemany parts of the food; especially those intestinethat are greasy and oily like butter, oilsand meat. smallNot only the liver but the pancreas alsoempties its juices into the upper part of intestinethe small intestine. These substances arealso very strong and can break down appendixalmost all types of food into very tinypieces. anusThe small intestine itself produces juiceswith strong digestive power. They are 600 times longer?!in charge of acting on small food parti-cles of all types and breaking them down The inner wall of theto the tiniest pieces. These particles have small intestine hasto be small enough to be absorbed by countless folds thatdifferent parts of the small intestine. look like tiny fingers.From here they are sent to the blood for These folds increasebeing used by the body. the amount of surface available for absorbing the n u t r i t i o n a l substances. Without these folds our small intestine would have to be 600 times longer than it is now!Most of the nutrients needed by the body are absorbed by the time the food reaches the last third ofthe small intestine. Things like Vitamins, iron and calcium are absorbed from the upper part of thesmall intestine, but Vitamin B12, the only vitamin not found in plant sources can be absorbed only inthe lower portion. Our Small Intestines Cannot Absorb Water in CholeraIn cholera and some other illnesses with diarrhoea, the germs and the poisonous sub-stance they produce stops the small intestine from absorbing the water. This results in arapid and severe water loss for the body and the person can even die !
4-7LARGE INTESTINE About four feet long when a person is alive, the large intestine is so called because of being much wider than the small intestine before it. Also called the colon (kow-lun), it goes up on the right side, hangs down while going from right to left side, then comes down the left side to end in a big loop before large intestine finishing in a straight stretch behind (see diagram) called the rectum (rek-tum). The rectum ends below into the anus, the opening rectum from which we pass stools or shit. The contents move much slowly in the large anus intestine. Almost all of the last two litres of water that is still present in the contents coming from theThe large intestine starts where the small small intestine is absorbed here. What is left behindintestine ends into it on the right lower side from the contents that came from the small intestineof the abdomen. is what forms the stools or shit.Inside the large intestine live crores of germs or bacteria, many of them eating away nutrients.But many bacteria also provide us vitamins like Vitamin K and Folic Acid. These bacteria also formone third of the solid part of the shit. The dead cells from the entire digestive system also form a majorpart of the shit that we pass daily. New cells replace dead cells every three to five days. So, what weeat hardly makes a difference to the quantity of the stools as our shit is mainly made up of bacteria &dead cells.The inside lining of the large intestine can absorb well. Hence when a patient is vomiting, some of themedicines may also be pushed up the rectum from where they can be absorbed to be effective. Worms Live in Your Intestine The large intestine, as also the lower parts of the small intestine also house most of the worms that we see in the stools of children and adults. These worms can lead to serious nutritional problems as they eat away many of the food products that are necessary for us. Eggs or babies of these worms keep passing out in the shit and can survive for some time. Where people pass shit in the open fields, they are brought back to our houses by the feet of children. When we pick up anything to eat that has been dropped, or we eat vegetables without washing, these eggs can enter our intestines again. Some of the worms like hook worms can enter through the skin if we walk bare feet! DO NOT WALK barefoot and do not allow children to walk bare- foot.
4-8LIVER Dark red-brown in colour, the liver is a solid organ in the abdo- men. It is often said that life depends on the liver and is hence very important. What the Liver Does? a. Makes Building Blocks for the Body: Tiny food nutrients get into the blood from the small intestine and reach the liver. The liver changes them into forms that can be used. The make build- ing blocks for various for different or- gans, tissues and cells. The body needs help of the liver to provide it matter for building and repairing different organs in the body. liver b. The liver also makes antibodies that can fight against germs. gall bladder c. It also changes waste items made in the body into such forms that can be thrown out of the body with urine or with stools.d. Another important function of the liver is to make yellow-green bile that helps in the breakingdown of oily foods in particular.e. The liver also helps dispose off bilirubin. Bilirubin is a waste that is formed from red blood cellsthat have become old or are damaged by illnesses like malaria.Gall BladderThe liver sends out about half a litre of bile every day, but it is stored for some time in the gall (gawl)bladder, a small sac like organ hanging down from the liver. The gall bladder absorbs some waterfrom the bile to make it thicker and squeezes out the bile from time to time. By some signals, whenoily food has been detected to cross the lower part of the stomach, the valve at the mouth of the gallbladder opens out and the contents are pushed out through its tube into the upper part of the smallintestine. Why do we get jaundice? If too much bilirubin - matter from liver - collects in the blood, then our skin, eyes and the lining of the mouth turn Gall Stones yellow. This is called jaundice and can happen because of If some germs enter the bile many reasons. tube or the bile gets very thick, we can get gall stones. These If the liver has some disease (Hepatitis) because of which are found in ten to twenty it cannot change the form of bilirubin to throw it out with percent people in the country. the bile, again jaundice may result. Lastly, if the bile tube If these stones cause repeated has been blocked because of cancer or stones, once again pain or they block the bile, bilirubin collects in the blood to give jaundice. operation may be necessary.
4-9 PANCREAS Another solid organ that looks like a yellow but soft carrot, the pancreas is present in the curve of the upper part of the small intestine. What the Pancreas Does? a. It produces pancreatic juice that helps to break down many of the food particles already broken by other juices into yet finer particles. The substances in the pancreatic juice that help to digest the food are very powerful and can digest almost everything. If ever the outlet of the pancreas is blocked due to infection or stones fromthe bile tube. Very often the tubes join before opening into the small intestine – or cancer, thesubstances may often digest the pancreas itself! Acute Pancreatitis, an inflammation of thepancreas, can bring death and cannot be treated easily.b. The pancreas also produces insulin and some other sunstances. It goes directly into theblood and keep the blood glucose level in check. Insulin, one of such hormones (read moreabout them elsewhere in the manual) may be less or may not be effective in the body. This iswhat is called ‘Diabetes’ or ‘the sugar-disease.’ We shall learn about them later. APPENDIX A small worm like attachment two inches in length at the angle where the small intestine meets the large intestine, the appendix is not known to be if any use. However, if worms, bacteria or other things block its hollow, it may swell up, cause great pain – appendicitis (app-end-i-caee-tis) - and can burst to kill unless operated fast. Important Signs of Appendicitis Anyone having : appendix 1. pain in the right side of the lower abdomen 2. a little fever and 3. some vomiting should be suspected to be having appendicitis and rushed to hospital to save her life.
4-10 Know the Answers Our Digestive System1. What are the parts of the body involved in digestion? a. b. c. d.2. Mark whether “Right” or Wrong”: a. Using toothpaste for brushing is essential for brushing teeth. b. Saliva in the mouth helps to send the food down and also breaks down the carbohydrates in the food. c. Diarrhoea and vomiting are a reflex to protect the body and help throw out germs and poisons from the body. d. Simple germ killer medicines can be given by the health worker to treat appendicitis. e. Juices from pancreas and intestine help to break down all the food into their final form so that the small intestine can absorb it. f. Worms in the intestine are good for the body.3. Fill in the Blanks: a. Liver produces ______________________________ to digest fats in the foods like _________________ , ___________________ , and __________________ . b. Stomach produces acid and pepsin to digest __________________ found in foods like daal, pork, meat, and soyabeans. c. Worms stay in small and large intestines and many of them pass through the _______________________ before settling in the intestine. d. Vitamins, iron and calcium are absorbed in __________ part of the small intestine while Vitamin B12 in the _____________ portion of the small intestine. e. Large intestines absorbs _________________________________.
4-12 4-12 DISEASES OF THE DIGESTIVE SYSTEM What we will learn in this Chapter Page Number 1. General principles of keeping the digestive system fit 4-13 2. Problems of the Mouth, especially toothache & what to do in toothache 4-14 to 4-15 3. Problems of the Stomach a. Gastric & Ulcers 4-16 to 4-17b. Constipation & Piles 4-18 c. Diarrhoea / ORS 4-19 to 4-21 e. Making a Gourd Baby 4-22 to 4-23 d. Dysentery 4-24 e. Giardiasis 4-25 f. Cholera 4-25 3. Worms in the intestine and what to do 4-26 to 4-27 4. Disease of Liver - Hepatitis, Jaundice 4-28 to 4-29 5. Appendicitis 4-29 6. Acute Abdomen 4-30
4-13 DISEASES OF THE DIGESTIVE SYSTEM The digestive system on most occasions can look after itself. However, there are times when things do not work, as we would like them to. Little things like overeat- ing can lead to diarrhoea while a bad smelling toilet may cause the person to get constipated. Germs or their poisonous secretions may cause severe dysentery, while worms can simply stay there and share our nutrition. The abdomen also has great potential to create serious illness, like Acute Appendicitis and Acute Intestinal Ob- struction. In this session, we will learn more about these diseases and how to cure them and to save ourselves from them. How to Keep Your Digestive System FitThe digestive system, as you have already learnt is a well-oiled ma-chine. Food goes in and depending on the amount of nutrients in it,different parts of the digestive system send out different juices to helpthe intestines to absorb them. As discussed earlier, vomiting and di-arrhoea are two types of defense mechanism of the digestive system.Through them, the body tries to remove an undesirable thing thathas entered it from the nearest route at the earliest. Enough fluids - like water, tea, juices and soups - and fibrous fruits and vegetables must be taken daily so that the bowels function smoothly and there is no constipation. Loose motions make us lose a lot of water as well as salt. To make up for this, we must take extra salt and water in our diet whenever we have loose motions. Sugars help the absorption of salt and hence must be added to a salt and water solution given during diarrhoeas. ORS packets have a similar composition, but homemade Rehydration solutions are better and cheaper. ORS treats and corrects any fluid loss; it does not improve diarrhoea. Most diarrhoeas get well on their own even if some germs have started them. Antibiotics may be given only if the loose motions have lasted for more than two full days. Many of children’s diarrhoeas are due to viruses. Antibiotics are NOT required. Medicines that decrease the movement of the gut must not be given in Diarrhoeas and Dysentery. These may actually help the germs remain in the intestines and increase their other effects. In chil- dren do not give drugs that contain Diphenoxylate (as in LOMOTIL) or Loperamide (as in LOMOFEN). Lemon juice is considered very beneficial for the digestive system. So are curds and yoghurt. In all cases of loose motions – except in those who cannot tolerate any milk products – give plenty of curds. Drinking clean potable water is one of the most important ways to maintain a good digestive system. Not eating foods cooked the previous day, preventing flies from sitting on food, ensuring that everyone passes shit only in clean and closed la- trines, washing hands before eating, and eating in moderate quantities – these are simple ways of keeping the digestion in perfect shape.
4-14 Problems of the MouthMouth ulcersIt is common to have small white spots on or inside the mouth that arepainful and keep coming back. Though the cause is not known it isseen to happen when the person is under some stress. These mouthulcers also come during monthly periods of women, and they go awayon their own after a few days time.What to do?Rinse the mouth with a bit of salt water, especially after meals. A cor-ticosteroid ointment like BETAMETHASONE two to three times a dayalso helps, but must be taken only if the pain is too severe or the ulcerhas been around for more than seven days. Toothache Which of us has not suffered from toothache some point in our lives? It is the most common illness among all age groups and all peoples. With a bit of care, we can keep our teeth and gums healthy: Avoid sweets. Do not get children used to sweet things if you want their teeth and gums to be healthy. Cold drinks with soda can wear out the teeth very fast while the sugar in them helps make cavities (holes). Avoid them. Brush after meals. If you have time only for brushing only once a day, this must be done after dinner. Food left behind between teeth and between teeth and gums breeds bacteria which produce acid that cause cavities (or holes) to be formed in the teeth. Brush the teeth correctly. All teeth must be cleaned from the gum side towards the open end. Clean the front, back, top and bottom sides of all teeth.
4-15 Rub a twig of Neem or Babool or apply salt on the gums – this sucks away the water and makes the gum stick firmly to the roots of the teeth. This prevents food from getting in- side and causing cavities. Rinse the mouth after using the salt. Toothpastes and tooth powders have little or no role to play in clean- ing teeth. Mix salt and baking soda (soda bicarb) to make your own tooth powder. Eat a healthy diet which has things like aamlakhi (amla), lemon, oranges or guavas. Milk also helps to build up Calcium in one’s diet and strengthen the teeth. What to do when we have a tooth ache? If there is a cavity already, clean it carefully with a sharpened twig and try to get it filled by a dentist at the earliest. Rinse the mouth well with warm salt water. For pain, chew some cloves. Or get clove oil and use a few drops in the cavity. You may give PARACETAMOL also. If there is swelling in the gums next to such a tooth alongwith pain, it means that a tooth abscess has formed because of bacteria. Start Capsule DOXYCY-CLINE or Tablet COTRIMOXAZOLE.Once the abscess has decreased, show it to a dentist. PYORHHOEA (Py-ria) Pyorrhoea is also very common amongst our populations. It oc- curs because: We do not clean our teeth well enough and often enough, and We do not eat nutritious food. What to do? 1. Clean teeth gently and correctly as explained earlier, es- pecially at nights. Rinse the mouth after every meal or snack. 2. Massage some salt with mustard oil on the gums and leave for a few minutes. Rinse the mouth. Repeat three times a day for at least a month. 3. Give Capsules DOXYCYCLINE or Tablets COTRIMOXAZOLE for seven days also.
4-16 Problems of the Stomach GASTRITIS (acid indigestion, heartburn, also called gastric)Gastritis has nothing to do with gas. It only means that there is aninflammation in the stomach (called gastrum in Latin language).How can we tell if it is Gastritis?These are the ways in which we can tell that a person has Gastritis. Pain in the pit of the stomach, Sour belching, Lack of appetite and Sometimes nausea (vomiting feeling) VomitingSometimes, a person with gastritis also feels a similar pain in the chest i.e. in the food pipe. The causeand the treatment is the same. Chillies and spices, alcohol, smoking, medicines like Aspirin or Chloroquine taken without meals and infection of the stomach with bacteria can cause Gastritis.ULCERSGastric pains can lead to stomachulcersProlonged exposure to irritants may lead toUlcers developing in the stomach or some-what lower in the intestine. Not eating any-thing even when one feels hunger pangs alsohelps in making an ulcer.Ulcers may need prolonged treatment forfour to six weeks with many drugs and ifthe trouble continues, the person may re-quire an operation to cure it.Bleeding UlcersBlood – dark brown or coffee coloured —in the vomit or black tar like stools are in-dications that the ulcer is bleeding. This isa medical emergency. RUSH TO A HOSPI-TAL with facility of a surgeon and opera-tion theatre.
4-17 Taking care of your gastritis 1. Stop the irritating substance from the diet. NO alcohol, NO smoking, NO chillies, NO painkillers on an empty stomach and NO more unclean water for the next few weeks helps in returning the stomach back to normal. 2. Tablets ANTACID to be chewed whenever there is pain or one and three hours after meals for the next two to four weeks or so. 3. If more severe or if the problem continues despite treatment, refer to a doctor. 4. Some doctors still give milk for this illness. It is not recommended any longer as milk is seen to increase the acid.Many doctors now feel that infections are the main cause of gastritis and ulcers; and espe- cially for ulcers, they prefer to treat with antibiotics.
4-18 CONSTIPATIONA person who has hard stools and has not been able to pass stools (shit) for 3 ormore days is said to be constipated. Eating food which has no fibre (got from fruits,green vegetables, or foods with natural fibre like whole grain bread) causes constipa-tion. Lack of exercise or habitually not passing stools on time also makes for hardstools or constipation.Piles & Fissures What To DoA common problem faced by people is pain whilepassing stools (shitting) and also passing of blood If Constipated?along with shit. • Drink more water and eat foods with fibre.1. PILES • Do not take laxativesIn piles, one can feel some fleshy things (veins cov- all the time for constipa-ered with flesh) coming out of the anus (shit hole). tion.Also, blood in good quantities is thrown out (like an • Instead, eat fruits,injection) when the person strains while shitting. To green vegetables, foodsprevent piles and also for relief, one should away from with natural fibre like tapi-constipation. If the pain and bleeding is regular, the oca (cassava), rye (mustard), s u n f l o w e rperson should be referred to a surgeon. By giving an seeds, raisins, nuts and wheat bran.injection on the fleshy part, it can be shrunk. Else, • Vegetables such as carrots, pumpkin,the fleshy part can be cut off by a small operation. turnips are good for constipation.2. FISSURES • One must haveIn fissures too, there is pain while shitting. However, enough exercise forthis pain is due to the anus getting torn during starining easy bowel move-to throw out (hard) stools. The blood is usually ment.smeared on the stool and nevere bleed smore than a • Adding a bit ofdrop at a time. It helps to keep the stools soft by go- vegetable oil to food each day also helps.ing to the toilet regularly and not allowing stools toharden. An operation can heal fissures permanently. Dealing with To Lessen Pain from Piles Piles & Fissures 1. Eat Food with Fibres (vegetables / carrots / radish / fruits etc.) 2. Drink plenty of Fluids 3. If pain is too much and stools cannot be passed, apply BETAMETHASONE ointment.
4-19DIARRHOEADiarrhoea means loose stools passed more often than nor-mal.(since people may pass two to three soft stools even normally, it is usefulto ask if the frequency of passing shit is more than usual).Diarrhoeas can be caused by Viruses, Bacteria and by other germs likeAmoeba (A-mee-baa) and Giardia (Ji-yar-diya).But diarrhoeas may also happen due to: Mental worry – this type of diarrhoea is seen more during the daytime and when in some kind of tension, like during examinations, interviews etc. Relaxing the person until the event of worry is over helps in relieving the diar- rhoea as well. Overeating – eating too much food rich in sugars can cause diarrhoeas. Fasting for sometime helps recovery.Some hormonal diseases also may cause diarrhoea without any other reason. People with excessof thyroid hormone may get diarrhoea. They have wide-open eyes and even the upper edge ofthe black of each eye can be seen in the normal position. Such people also keep sweating and areusually thin and look worried. Unless the hormone levels return to normal, the loose motions donot get well. Diarrhoeas in Children Viruses cause most diarrhoeas of children. Passing of loose stools very often may drain out the person of water and salt. As a result the person feels tired and listless. Even death may occur. All that one needs to do in diarrhoeas caused by viruses is to replace the fluids at the earliest. Rice water with salt, vegetable soups, etc are good to re- place both water and salt. Usually no other treat- ment is required as the viruses die out by themselves. What Are Cold Diarrhoeas?This is a loosely used term for loose motions that are found in the coldseason. Cold Diarrhoeas are seen mainly in children. It need to be treatedjust like any diarrhoea or dysentery.
4-20DEHYDRATION from DiarrhoeaDiarrhoea by itself is not dangerous but losing water from the body is dangerous.If our body loses water fast, we could end up being de-hydrated (with no water). This could kill. Weshould replace quickly replace water (and salt along with it) as soon as possible. This is more true insmall children whose body will die if water is not replaced fast. Signs of Dehydration sunken eyes / tearless eyes a sagging “soft spot” in the baby urine yellow in colour little or no urine dry mouth when pinched, skin sudden loss in weight does not spring back Give Salt - Sugar Solution ! These are signs of Severe Dehydration : • Little or no urine • sunken and tearless eyes • when skin does not spring back, when piched. Start Oral Rehydration and Rush the Child Immediately to the Nearest Health Care Centre ! What To Do In Diarrhoeas? 1. Oral fluids to be given. 2. Curds (if available) should be given. 3. If the diarrhoea has not improved on its own until two full days, tablet COTRIMOXAZOLE twice a day for three to five days should be given. OR else, tablet FURAZOLIDONE four times a day for three days may be given.
4-21ORSThe Oral Rehydration Solution has been one of the simplest wonder solutions of the last hundredyears. The solution itself was not something new and wonderful as people have always used ORSto prevent and treat dehydration.But what has been important has been its final acceptance by the sci-entific community as the best way to avoid unnecessary deaths fromdiarrhoeas. They finally recognised that there was a simple solutionthat cost almost nothing for a problem that killed millions of babiesevery year. And since most of the deaths took place in countries wherepeople could not afford clean drinking water and sanitary latrines, ORS packets as a magicORS came as a magic wand. wand against diarrhoeaWell, almost like a magic wand. ORS at one hat time meant the readymade powder that came inpackets. Poor people were forced to buy them. It was good business for big drug companies andthe power was in the hands of technical people. Poor people who could not afford ORS but whosuffered the most from diarrhoeas continues to die. But now once again, the role of home madefluids as Oral Rehydration Solutions has been accepted.SSS (Salt Sugar Solution) as an alternative to ORS PacketsA measured way of preparing ORS is the Sugar Salt Solution (SSS). Take one normal tumbler (glass)of water that has been previously boiled and cooled (the idea is to avoid unclean water at a timewhen the person already has diarrhoea).Add one heaped teaspoon of sugar. With two fingers and the thumb, take a pinch of salt and alsoadd to the glass. Stir well. A little amount of lemon or orange juice can also be added, especially if theperson has vomitted also or has body ache/leg cramps.This simple solution given repeatedly helps not only in preventing dehydration but can also rehydratesa person very well and very fast. Two glasses per stool for adults and one glass per stool for childrenis a rough guide, but even better is to monitor the colour of the person’s urine. If the person is nottaking any yellow medicine, and if the colour of urine is more yellow than the colour of straw, thenone can safely assume that the person requires more of the ORS solution!
4-22 THE GOURD BABY The gourd baby is so named because the double bell gourd is painted up as a baby to be used as a tool for teaching dehydra- tion. Making a gourd baby eyes mouth urine opening anus1. Get a double 2. Cut off the top 3. Use perma- 4. Drill small holes (abell gourd (one dry it. After that nent markers to pen tip can go through)which has two clean the outside make a face on in both the eyes, thebells). surface with soap one of the bells mouth and at the tip of and water and and mark legs, the penis (or top of the then wipe dry. belly, and vulva) and in the anus. genitals and Make stoppers to cover anus on the these holes. Your gourd other bell. baby is ready for use. Fill us with water and your gourd baby is really for use !
4-23 Demonstrating dehydration in a gourd baby1. Block all the holes of the gourdbaby with stoppers. Fill waterfrom the head side to fill it up.Open each hole except that at theanus. The water comes out fromall holes. Explain that when thebaby is normal, one can see tearsas it weeps, its tongue is also moistand that it passes urine also. 2. Now open the lower stopper at the anus intermittently (keep a vessel below to catch the water). Explain that it is like water level diarrhoea. Keep showing the water level to the trainees. Demonstrate how the water level goes down faster if each stool is large (keep open the anus stopper for a longer time) or if the diarrhoea is more frequent (open and close the anus stopper more frequently).3. Refill the gourd baby. Open all the holesexcept the anus stopper to show that tears are to show howflowing, the tongue is moist and that urine is water which ispassing. Now, open and close the anus stop- lost in diarrhoeaper repeatedly. As the water level keeps fall- needs to being, you will be able to show that first the tears replacedstop flowing, later the tongue becomes dryand as the water level goes down even fur-ther, even the urine stops. After making the gourd baby, one can also discuss : a larger hole can be • how people can make made in the mouth and one can actually out the stages of practice giving of SSS dehydration. to the baby • mild moderate and severe dehydration.
4-24 DYSENTERYDiarrhoea with Blood and Pus is called Dysentery. Dysentery canbe caused by both bacteria as well as other germs like amoeba and Giardia.Bacterial Dysentery (‘B’ Dysentery)Bacteria cause diarrhoea as well as dysentery (which is diar- What to Do In Bacterialrhoea with pus and blood). Very frequent watery stools (nor- Dysentery?mally 7 to 10 times but could go up to even 40 times) that are 1. Curds and enough fluids to be given.very small in quantity and often with pus and blood are sig- 2. Tablet COTRIMOXAZOLE ornals of bacterial dysentery. Very often, mild or high fever FURAZOLIDONE can be given towith stomach cramps will also be seen with bacterial tackle the germs.diarrhoeas.Amoebic (a-mi-bic) dysentery (‘A’ Dysentery) What to do in amoebicSmall germs that are neither viruses nor bacteria may also dysentery?cause dysentery. But in amoebic dysentery, there is no fe- 1. Curds and enough fluids asver to be seen. Also, the shit is smelly, comes out in large learnt before may be given.quantities – “explosive’’ stools – and there are only two to 2. Tablet METRONIDAZOLEfive stools in a full day. Rarely, there may be blood in large 400 mg three times a day for fiveamounts. On pressing the sides of the abdomen, the person days should be givenmay complain of pain. How to differentiate Amoebic & Bacterial Dysentery A (Amoe bic) B (B acte rial) Sign D ys e nte ry D ys e nte ry Usually less than five times a Usually more than seven How ofte n? day times per day How big? Big large stools, explosive Usually small and watery Fe ve r and othe r F ever common, sometimes Usually no fever body s igns ? high. Usually on pressing sides of C ramps in abdomen Pain abdome n? abdomen common. Some mucus - if blood, At times, all stool is mucus B lood and mucus more amount alone. S ome blood also Tab C O TRIM O XAZO LE Tab M ETRO N IDAZO LE twice a day O RTab Tre atme nt 400 mg three times a day for FURAZO LIDO N E four 5 days times a dayfor three days may be needed.
4-25 GIARDIASIS (ji-yar-diya- sis) dysenteryPresenting again with few loose motions a day, classically, giardiasis is seen with alternatingdiarrhoea and constipation in a person. The person may also get signals of gastritis.What to do in giardiasis dysentery? Curds and enough fluids as learnt before may be given. Tablet METRONIDAZOLE 200 mg (half the strength of that given for Amoebiasis) three times a day for five days should be given.How to stop others from getting ALL TYPES of dysentery? If one has loose motions, the person should not feed or cook for another person at least until three days after the diarrhoea has ended. Wash hands carefully with soap or ash after passing shit. Dispose off your shit in clean sanitary latrine only. Do not allow flies to sit on your food.Drink boiled or filtered water.CHOLERACholera is dangerous. The bacteria for cholera can kill and it kills very fast.In India, cases of Cholera are often diagnosed as “gastroenteritis” by thegovernment department for a larger number of cholera cases brings a badname to politicians and the bureaucracy.How will you know it is Cholera?Few large watery stools with hardly a speck of solid, with severe crampsand a general coldness of skin is enough to indicate that the diarrhoea isbecause of cholera. Often there is vomiting and the person’s pulse is diffcultto feel. Usually in Cholera cases the person has no fever. What to do in Cholera? • Cholera needs plenty of fluids if the person is not vomiting. At times, up to forty bottles of drip – saline or Ringer’s Lactate – may be required. • Also give DOXYCYCLINE or COTRIMOXAZOLE for three days. • It is very important in Cholera to be taught how to safely dispose their stools. • Drink cool water from a good source of water. Bury the stools of cholera patients carefully beneath • If there is testing facility ( one just needs a microscope) at least 2 inches of soil. then the stools can be tested for Cholera germs.
4-26 INTESTINAL WORMSWe all know about children having worms which come out with their shit or even when theyvomit! But even adults have worms. While some worms may be as long as a few metres, some ofthem are very small and cannot be seen unless the shit is examined closely. Many types of wormsstay in our intestine and they pass eggs that come out with our shit.Wherever people pass shit in the open - and not in some sanitary latrine – the eggs can go back intothe stomach through: Types of Worms eating unwashed vegetables growing in areas where people shit in the open; eating food without washing hands carefully after passing shit; eating food/ toffees/biscuits that fall on the ground without washing. (Round worms/ Whip Pin worms worms) scratching the anus and then eating anything without washing hands. (Pin worms, Tape worm’s cyst in brain/ lung/liver, etc.) Whip Worms eating improperly cooked meat of pigs or cows that may eat shit or grass with eggs on them. (Tape worm) Round Worms eating improperly cooked fish/ snails/ crabs that have fed on eggs from shit washed into the water . (Broad tape worm, Oriental lung fluke) handling of dogs that have worms (Dog tape worm). walking bare feet in wet soil where baby worms from the eggs may enter Tape Worms the skin and then reach the intestine. (Hook worms) What happens if we have worms? Usually, most people (mainly children) having worms lose nutrition and do not gain weight. They feel hungry and tend to eat sugar, bananas, etc (hence the wrong belief that eating sugar or bananas leads to worms). Pain in the abdomen especially with cramps is very common. Many become potbellied (round worms) as the load increases. In hookworms, the person may lose much blood to the worms and this may cause the person to go pale and weak; such people may get an altered taste and may eat soil, plaster or sour things (hence the wrong belief that eating soil or plaster causes worms). Much scratch- ing of the anus at night indicates pinworms. Many of the worms pass through the lungs during their growing stage (hookworms, round worms, Oriental Lung fluke, etc.) and may cause prolonged dry cough — sometimes so severe that even blood may be coughed out. Those worms that pass their way up through the skin (hookworms) may cause redness and scratching at the place of entry of the baby worms.
4-27Can we know which worm is in the intestine?Testing the stool under a microscope can tell us which worms are in theintestine. The typical shape of the eggs of different worms helps in identi-fying the type of worm. Unless the stools on three continuous days showno worms, we cannot confidently say that a person is free of worms.What to do for worms? 1. On an empty stomach, like early in the morning, give a single dose of ALBENDAZOLE 400mg for all types of worms for all ages above 2 years. Do not give anything by mouth for two hours. For Tapeworms, one tablet twice a day for three days may be required. For Pinworms, it may be necessary to repeat one dose after a week. 2. For those who do not wish to take medicines for getting rid of worms, there are other things one can try. Try this for getting rid of worms Remove the outer layer of a handful of pumpkin seeds, crush and put into a glass of boiling water and keep covered for 20 minutes. On an empty stomach – preferably after a day’s fast — drink such a glass three to four times. Take castor oil the next day if one had suspected tapeworms.How does one stop others and oneself from getting worms? Wash hands well with soap or ash after passing stools. Wash hands well before picking up anything to eat. Wash all vegetables or fruits – if possible with soda — before eating. All meat /fish / crabs, etc should be cooked well before eating. Do not walk bare feet. Shitting must be done only in closed sanitary latrines. Pigs /cattle must not be allowed to roam where people may shit. Giving ALBENDAZOLE to all children once in six months.
4-28DISEASES OF THE LIVERHEPATITISAn infection of the liver causes Hepatitis. Usu-ally caused by a virus, Hepatitis is of varioustypes and can be spread by different ways.Types of HepatitisHepatitis are of types A, B, C, D, E and G. Ofthese B, and E are spread by blood sources likesharing needles during injections or in transfu-sions. Hepatitis A, D and G are spread by foodor water which has been contaminated by thevirus. Other germs like Amoeba and alcohol/medicines may also cause hepatitis. Every Jaundice is NOT Hepati-Hepatitis spread by food & water takes four to tis. Jaundice just means eyessix weeks for the germs to take effect, while the turning yellow. Many diseases –blood borne hepatitis may take a few months todevelop the disease in the body. from malaria to gall stones to cancer of pancreas can causeThe person gets nausea and vomiting to start Jaundice. It is not necessarilywith. The urine turns a deep yellow and other only a liver problem.people may notice that the white of the eye hasturned yellow. In some people this may worsenand the person may have to be admitted. What to do in Hepatitis? 1. Viral Hepatitis cures by itself in a few weeks and there is no medicine as yet for it. Do not waste money on useless medicines. 2. There is no need to stop eating greasy substances like butter, ghee, vanaspati and oils when there is hepatitis. Unless the person does not feel like eating oily things, they should be allowed to eat. In fact we may do more harm by stopping a person from eating oils. We may decrease the person’s already low nutrition on account of poor appetite. Unlike popular belief, oils and butter etc. should be stopped only when a person is sick enough to get admitted in hospital and not otherwise. 3. In Jaundice, do not take medicines without asking your doctor – many medicines can harm the liver further. 4. Try to give food early morning as such patients may have lesser nausea at the time. 5. Tell the person to take rest for about four weeks, by which time the jaundice would have come down. In rare cases, hepatitis gets worse and can cause death also. If the person doesn’t look better within a week or the jaundice is getting worse, the person should be taken to a hospital.
4-29How to stop others from getting Hepatitis? Cover Fod Well Dispose the shit properly Do not share needle with anyone. One person, one needle ! Do not give or take blood unless it has been tested for Australia Antigen (for Hepatitis B). Clean hands before eating Do not let flies sit on your food. refer immediately ! APPENDICITIS This is a well-known emergency. One of the reasons may be worms, but otherwise, we do not know what may cause the infection or inflamma- tion of the appendix. There are three classical signals of an infected appendix: Mild fever Vomiting Pain in the right lower abdomen – midway between the naval and the hip bone on the side. A pain here that becomes worse if someone tries to press at the point should be taken to be Appen- dicitis unless proved otherwise. What to do in Appendicitis? ¨ ALWAYS take such a person to the doctor at a hospital where operation facilities are available. ¨ The person should not be given anything else to eat or drink because empty stomach is required for performing the operation. ¨ At best, a painkiller like Paracetamol may be given till the person reaches the hospital.
4-30 Acute Abdomen refer immediately !At times, people get severe pain in the abdomen.On touching the abdomen, the abdomen is not soft, buthard – the person does not allow us to touch the abdo-men. If the person has not passed shit and not even wind,it indicates that the intestine has got blocked. Vomitingmay also be present.This is called ACUTE ABDOMEN and the person needsto be sent URGENTLY to the hospital where facilitiesfor operation exist – try to get a intravenous drip in-serted at the earliest if possible and do not allow thepatient to eat or drink anything.
4-31 Know the Answers Diseases Of the Digestive System1. Please Fill in the Blanks: a. We Can stop cavitites forming in our teeth by: 1. Avoiding _______________________________________________________ 2. Carrying Out ____________________________________________________ 3. Eating _________________________________________________________ b. Gastritis & Ulcers Can be Treated by: 1. Avoiding _______________________________________________________ 2. Eating _________________________________________________________ 3. Taking Tablets Like______________________________________________ c. Worms can be avoided by: 1. __________________________________________________________ 2. __________________________________________________________ 3. __________________________________________________________ d. Worms can be treated by giving tablet _________________________________2. What are the differences between Dysentery A & Dysentery B? How should we treat them differ-ently?3. Acute Abdomen needs ot be urgently referred to the hospital. How do we make out it is acuteabdomen?4. Different kinds of fluids that can be used in diarrhoeas to correct dehydration are ____________.________________, ______________________, and __________________________.5. The Difference beteen Hepatitis & Jaundice is ________________________________________________________________________________________________________________________.
4-32 Know the Answers Diseases Of the Digestive SystemPlease Mark Whether “Right” or “Wrong”a. We must stop all foods like oil, pork, butter, ghee etc. in Hepatitis.b. Jaundice (yellowness of eyes) can happen because of Hepatitis besides other causes like malaria, cancer etc.c. Worms in the intestine occur because of eating too much sugar.d. Most diarrhoeas require no treatment except good clean water in good quantities.e. ANTACIDS alone are enough for treating GASTRITIS & ULCERS.f. Piles and fissures are the SAME illness and one needs to eat a lot ofproteins like dhaal, meat etc. to cure them.g. Using clean drinking water is one of the best ways to prevent all types of illnesses of the digestive system.