There are two major types of gastrointestinal tract disorders - functional and organic. Functional disorders involve disturbances in motility, enzyme production or transport mechanisms without structural changes, while organic disorders involve definite pathological changes. Diarrhea is a common functional disorder characterized by loose, watery stools. It can be acute or chronic. Acute diarrhea has a sudden onset while chronic diarrhea persists for weeks with frequent unformed stools. Oral rehydration therapy is used to treat diarrhea by replacing lost fluids and electrolytes. Dietary management focuses on meeting nutritional needs while reducing residue. Constipation is the retention of stool beyond normal time and can be atonic, spastic or obstructive. Treatment aims to establish regular bowel habits through diet and

1. Gastro-Intestinal
Disorders
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3. ჯ Gastrointestinal System is responsible for
digestion & absorption of various foods &
liquids needed to sustain life
ჯ GI organs have essential roles in digestion of
food, from mastication of food by teeth to
creation of bile by liver
ჯ Problems with GI tract can lead to variety of
ailments, mild to severe. E.g. gas, acid reflux,
diarrhoea, constipation, ulcers, etc

4. Two types:
• Functional: No structural alteration.
Disturbances in motility, enzyme
production, release & transport
mechanisms
• Organic: Involve definite pathological
changes like ulcers or cancers
Disorders of GI tract

5. Diarrhoea

6. ჯ Type of functional GI disorder in which a
person suffers from loose watery stools
ჯ Acute infectious diarrhea is a common cause
of death in many countries accounting to 5-8
millions deaths annually
ჯ It is not a disease but a symptom of an
underlying functional or organic disease

7. acute chronic
Types of Diarrhoea

8. Characterized by sudden onset & frequent
passage of watery stool. Patient may pass
several stools in an hour
Symptoms:
 Abdominal bloating or cramps
 Thin or loose stool
 Watery stool
 Sense of urgency to pass stool
 Nausea & vomiting
Acute diarrhea

9. Bacterial / parasitic infection in GI tract
through contaminated water
Food allergy or sensitivity towards specific
food / faulty feeding practices
Protein energy malnutrition (PEM) /
deficiency of vitamins
Food poisoning
Psychological factors like anxiety, tension,
etc.
Reaction to medicines
Causes

10. Persists for longer time, even several weeks
Patient may pass 4-5 unformed stools / day
Rapid passage of food through intestines
does not allow sufficient time for absorption
of nutrients causing nutritional deficiency
Chronic diarrhea

11.  Dehydration
 Blood, mucus or undigested food in stool
 Weight loss
 Fever
Symptoms

12. Malabsorption syndromes like celiac
disease, lactose intolerance
Metabolic diseases like diabetes mellitus,
uremia
Chronic alchoholism
Cancer of colon
Liver cirrhosis
Causes

13. Can effect any age, gender
Most common in infants
Occurs mostly among people living in
unhygienic conditions
Etiology of Diarrhoea

14. Objectives of dietary treatment are:
 To meet nutritional requirements
 To replenish water & electrolyte
losses
 To provide extra nutrients to
compensate for losses
 To reduce residue to minimum levels
Dietary Management

15. Oral Rehydration Therapy (ORT)-
Simple & inexpensive treatment
Patient is given ORS (Oral Rehydration
Solution) & other fluids through mouth
Important to correct dehydration & loss of
electrolytes
ORS is a dried composition of oral
rehydration salts available in packed form
Treatment of Diarrhoea

16. Composition of ORS
Sodium chloride 3.5g
Sodium bicarbonate 2.5g
Potassium chloride 1.5g
Glucose 20g
Water (dissolved in ) One liter
ORS should be given as soon as loose stools
start. Other fluids like coconut water, dal ka
pani, butter milk, carbonated water etc, can
be given along with ORS

17.  Energy requirements are increased to meet
losses & to overcome weakness & weight
loss
 Fats are not digested completely, thus
intake should be restricted. Being essential
for increased energy needs emulsified fats
are preferable
 Protein intake is increased for tissue
building & replacement. Requirement
increases by 50%

18.  Carbohydrate intake to be increased
for high energy requirements & to
spare proteins (fibre intake to be kept
minimal)
 Minerals to be consumed in ample
amounts especially calcium & iron as
their absorption is impaired

19.  Vitamins: adequate consumption
required. Absorption of fat soluble
ones is impaired, thus should be
provided in diet. B complex
requirements increase due to increased
energy requirements
 Food should be soft & easily digested

20. Refined cereals like maida, bread, suji, chirwa,
murmura, macaroni, noodles, Khichdi (washed
pulse) etc.
Well cooked vegetables like potatoes, bottle gourd,
tinda, etc. as soups / veg
Soft, low fibre fruits like banana.
Strained fruit juices
Custard / ice-cream
 Egg, chicken and fish
Thin gruels
Recommended Foods

21. Foods to be Restricted:
• Red meats like mutton, seafoods, fried
foods like samosas, mathies etc.
• Nuts and oilseeds
• Whole pulses

22. Foods to be avoided
• Whole cereals & their products like whole
wheat flour, dalia
• Whole pulses & split pulses like rajmah,
whole channa , Urad
• Vegetables in raw form, high fiber
vegetables like peas, beans, lotus stem etc.
• Fruits like apples, cherries, peaches, guava,
plums etc.
• Milk & milk based beverages

23. • Nutrient dense foods to be given to meet
increased needs without increasing bulk
• Good quality protein in form of fish,
chicken, egg, etc should be given
• Emulsified fats present in butter, egg etc is
better tolerated
Nutrition Pearls

24. • Vegetables should be well cooked, pureed
etc.
• Soft fruits & strained juices are
recommended
• Patient should drink plenty of water & eat
food at frequent intervals

25. _____: sudden onset & frequent passage
of watery stool
_____: Persists for longer time, patient
passes 4-5 unformed stools / day
_____ rich foods are restricted in
diarrhoea
 What is ORT?
 Name 5 foods recommended, 5 restricted
& 5 foods to be avoided during diarrhoea.
To sum up

26. What are the two major types of GI tract
disorders?
Differentiate between acute & chronic
diarrhoea.
Enumerate the causes of chronic
diarrhoea.
 What are the objectives of dietary
management of diarrhoea?
 Mention the nutrients requirements of
which are altered in diarrhoea. Why?
Home assignment

27. Constipation

28.  Retention of faeces in colon beyond normal
emptying time
 Constipated people find it painful to have a
bowel movement & often experience straining,
bloating & sensation of a full bowel
 It is a symptom, not a disease
 Mostly constipation is temporary & not serious

29. Types of Constipation
1. Atonic constipation (lazy bowel syndrome):
Loss of muscle tone in colon or rectum
causing difficulty in passage of stool
2. Spastic constipation- caused by increase in
muscle tone which narrows cavity &
movement of feaces is retarded
3. Obstructive constipation- is due to
obstruction of large bowel or malignancy
(cancerous growth) of colon

30. Symptoms
 General malaise: vague feeling of
bodily discomfort as in beginning of an
illness
 Headache
 Coated tongue
 Foul breath
 Lack of appetite

31. Poor personal hygiene
Irregular intake of meals
Inadequate intake of fluids / insufficient
bulk
Emotional disturbances like tension,
depression, anxiety or excitement
Causes

32. Lack of exercise
Painful fissures or hemorrhoids
Diseases like colon cancer or obstruction
in intestine

33. Etiology
Atonic constipation mainly occurs in
elderly people, pregnant women & people
leading sedentary life
Spastic constipation can occur in people
suffering from diseases related to colon &
intestine

34. Treatment
Aim of treatment is to:
 Develop regularity of habits of evacuation
 Follow regular meal pattern
 Consume high fibre diet
 Ensure adequate intake of fluids
 Increase exercise & activity

35. Dietary Management

36. Fiber
 Intake of fiber should be increased
 High fiber foods like whole cereals, whole
pulses, GLV, other fibrous vegetable & fruits
to be eaten in large amounts
 Fibre retains water, increases bulk & softens
stool
 If still constipation is not relieved extra
wheat bran can added to chapattis or bread

37. Fats: Stimulate flow of bile & also lubricate
bowel. Butter, ghee & cooking oils are
beneficial for lean patients. Still fried
foods should be avoided
Fluids: Liberal amount of fluids is advised to
soften stool. Intake of 8-10 glasses of
water / fluids per day is desirable. Warm
water with lemon juice early in morning
also helps to ease constipation

38. Foods to be taken
Bread or chappaties of whole wheat
flour
Breakfast cereals preferably high bran
cereals like cracked wheat or oats
porridge
Vegetables preferable with skin

39. Salads
Rice, preferable brown rice
Whole pulses, husked pulses
Fluids, 8-10 glasses a day
Fruits, fresh preferable with skin

41. Foods to be Restricted
Fried foods like samosa, kachori, etc.
Carbonated beverages
Refined products such as noodles,
burger, white breads, maida (refined
flour)

43. What is constipation?
What are the three types of constipation?
 Constipation is ____ (organic / functional)
type GI disorder.
 Name 5 foods recommended & 5
restricted during constipation.
 Pregnant women suffer with ______
constipation.
To sum up

44.  Explain the three types of constipation.
 What are the causes of constipation?
 What is the aim of treatment of
constipation?
 Mention the nutrients requirements of
which are altered in constipation. Why?
[
 What is the role of fluid & fiber in
relieving constipation?
Home assignment