Anatomy

Physiology
Disorders

Digestive system
Presented By:
Mr. Kiran D. Baviskar,
Assist. Professor
Dept. of Pharmaceutics,
Smt. Sharadchandrika Suresh Patil College of Pharmacy, Chopda.
Life processes namely,

Nutrition
Respiration
Circulation
Excretion
Coordination
Reproduction

Which of these processes provide us energy to perform

different activities?

The processes which are responsible for providing energy are

nutrition and respiration.
What is nutrition?

Nutrition is the sum total of all processes through which

food is taken in,
Digested,
absorbed,
utilized and finally,
the undigested matter is eliminated outside the body.

Thus nutrition includes the processes like ingestion,

digestion, absorption, assimilation and egestion
(defaecation).
Ingestion: food is taken inside the body.
This ingested food is then digested.

Digestion: It is defined as the process during which the

complex, non-diffusible and non-absorbable food substances
are converted into simple, diffusible and absorbable
substances by enzymes.

Absorption: the simple substances get diffused into the blood.

The absorbed food is then carried to each and every cell of the
body where it is assimilated.
Assimilation: it is defined as the process by which protoplasm
is synthesized Into each cell of the body by utilizing simple
food because if it remains in the body, it becomes toxic to the
body.
Protoplasm is the
composed
living content
of a mixture
of a cell
of that
small
is molecules
surroundedsuch
by
a plasma
as ions, membrane.
amino acids,
It is colourless
monosaccharides
fluid and water, and
macromolecules such as nucleic acids, proteins, lipids and
polysaccharides.

In eukaryotes the protoplasm surrounding the cell nucleus is

known as the cytoplasm and that inside the nucleus as the
nucleoplasm.

In prokaryotes the material inside the plasma membrane is the

bacterial cytoplasm,
while in Gram-negative bacteria the region outside the plasma
membrane but inside the outer membrane is the periplasm.
Protoplasm was said to exist in two forms: a liquid-like sol
state or a jelly-like gel state.
Alimentary canal:
Alimentary canal is muscular tube of varying diameter, about
8-10 meters long and it consists of mouth, buccal cavity,
pharynx, oesophagus, stomach, small intestine, large intestine
and anus.

Histologically wall of alimentary canal shows four layers

which from outside inward are-
serosa,
muscularis,
sub-mucosa
and mucosa.
Alimentary canal:
Alimentary canal is muscular tube of varying diameter, about
8-10 meters long and it consists of mouth, buccal cavity,
pharynx, oesophagus, stomach, small intestine, large intestine
and anus.

Histologically wall of alimentary canal shows four layers

which from outside inward are-
serosa,
muscularis,
sub-mucosa
and mucosa.
Alimentary canal:
Alimentary canal is muscular tube of varying diameter, about
8-10 meters long and it consists of mouth, buccal cavity,
pharynx, oesophagus, stomach, small intestine, large intestine
and anus.
Awd
Histologically wall of alimentary canal shows four layers
which from outside inward are-
serosa,
muscularis,
sub-mucosa
and mucosa.
Mouth:
This is the uppermost transverse-slit-like Opening of the
alimentary canal.
It is bound by an upper lip and a lower lip.
It leads to a large cavity called buccal cavity or oral cavity.
Mouth is used to ingest the food.

Alimentary canal has two opening one for ingestion i.e.

mouth and other for egestion i.e. anus
Mouth cavity is divided into two parts
1. Vestibule: Outer small portion
2. Mouth cavity proper: an inner larger portion
Mouth cavity is divided into two parts
1. Vestibule: Outer small portion
2. It is narrow space bounded by externally lips and cheeks
and internally by gums and teeth.

3. Mouth cavity proper: an inner larger portion

Teeth:
The study of teeth with respect their number, arrangement,
and development is known as dentition.

In human beings, like other mammals, dentition is of the

heterodont type as there are four different types of teeth
 incisors (I)
 canines (C)
 premolars (PM)
 molars (M).

Animals whose teeth are all of the same type, such as most
non-mammalian vertebrates, are said to have homodont
Human dentition in adult can be represented in the form of a
formula called dental formula as follows
Human dentition in adult can be represented in the form of a
formula called dental formula as follows
As human being shows two sets of teeth in life, the dentition is
called diphyodont.
e.g. mammals are diphyodont
.to chew their food they need a strong, durable and complete set of teeth

While the dentition of animals with only one set of teeth

throughout life is monophyodont. e.g. beluga whale, aquatic
mammals (toothed whales-odontoceti), dolphin-order-cetaccea

The dentition of animals in which the teeth are continuously

discarded and replaced throughout life is
termed polyphyodont
e,.g.

1. toothed fishes, many reptiles such as,

shark, crocodiles, gecko(lizzard)
The teeth masticate the food into small particles and help to
mix food with saliva.

Teeth has 3 different parts:

Crown: outer visible portion, projects from gum
Root: Fixed in jaw bone inside gums
Neck: between crown and root surrounded by gums
1. Enamel:
It is outermost layer of teeth.
It covers the crown.
It is the hardest substance in body.

2. Dentine:
It is under the enamel
It forms main bulk of tooth.
It is calcified material

3.Gumline— where the tooth and the gums meet.

4.Cementum: is a specialized bone like substance covering

the root of a tooth.
It is approximately 45% inorganic material (mainly hydroxyapatite),
The principal role of cementum is to serve as a medium by
which the periodontal ligaments can attach to the tooth for
stability
5. Pulp:
The dental pulp is the central part of the tooth filled with soft
connective tissue

It consist of loose fibrous tissue containing blood vessels,

nerves and lymphatic's

Pulp fills up pulp cavity or root canal that begins at apical

foramen

Other cells in the pulp include fibroblasts, preodontoblasts,

macrophages and T lymphocytes.

The pulp is commonly called "the nerve" of the tooth.

6. Periodontal ligament:
The periodontal ligament is a specialized connective
tissue that attaches the cementum of a tooth to the alveolar
bone.

The functions of the periodontal ligaments include

attachment of the tooth to the bone, support for the tooth,
formation and resorption of bone during tooth movement,
sensation, and eruption.

gingiva :
The gingiva ("gums") is the mucosal tissue that overlays the
jaws
Types of Teeth
Deciduous:
The first set (called the "baby", "milk", "primary", or
"deciduous" set) normally starts to appear at about six months
of age

Natal teeth:
some babies are born with one or more visible teeth, known
as natal teeth.

Normal tooth eruption at about six months is known

as teething and can be painful
Pharynx:
The buccal cavity leads to pharynx which is the meeting point
of the digestive and respiratory systems.

The opening of the respiratory system in pharynx is called

glottis.

It is guarded by a cartilaginous flap called epiglottis which

prevents entry of food into the respiratory system.

It closes during the swallowing action.

Pharynx passes the food towards the esophagus.

The human pharynx is conventionally divided into three
sections:
Nasopharynx
The upper portion of the pharynx
It includes the space between the internal nares and the soft
palate and lies above the oral cavity.
Oropharynx
The oropharynx lies behind the oral cavity, extending from
the uvula to the level of the hyoid bone.
Laryngopharynx.
The laryngopharynx, also known as hypopharynx, it is the
part of the throat that connects to the esophagus.
It lies inferior to the epiglottis and adjacent to larynx
ItAtguides air and
that point, thefood into the respiratory
laryngopharynx (larynx)
is continuous andthe
with
digestive
esophagus(esophagus)
posteriorly pathways respectively
Parts of Pharynx
Oesophagus:
It is long, thin and narrow tube connecting pharynx to the
stomach.

It is about 25 cm long.
Opening in diaphragm-Esophageal hiatus

It passes through the thoracic cavity, pierces the diaphragm

and leads to the stomach.

The food moves through the oesophagus due to rhythmic

contraction of longitudinal and circular muscles.

This wave of contraction and relaxation is called peristalsis.

Mucous secreted by the epithelial cells in the inner lining

helps in the smooth passage of food.
Oesophagus is lined by mucosa; a moist pink tissue.

The oesophagus can be broken into two parts:

the upper oesophageal sphincter (UES) and
lower oesophageal sphincter (LES). (gastro-oesophageal)

The UES is a bundle of muscles at the top of the oesophagus

while the LES is a bundle of muscles at the low end of the
oesophagus.

The UES and LES muscles are made of a combination of

striated muscle,
smooth muscle and
connective tissue.
Stomach:
It is a sac-like, ‘ J’ shaped, 25-30 cm long organ.

It can be divided into three parts namely:

a) Cardiac
b) Fundus and
c) Pyloric stomach.

Cardiac stomach is the first part in which oesophagus opens.

The middle part is called fundus and the remaining part is the
pyloric stomach, which opens into the duodenum. (first part
of small intestine)
 A muscular sphincter (gastro-oesophageal)
Sphincters regulates the opening of oesophagus into the
stomach.
Sphincter are present at both the ends of stomach.

The anterior sphincter present at the opening of the

oesophagus into the stomach is called cardiac sphincter
while the posterior one present at the opening of the
stomach into the duodenum is ailed pyloric sphincter.

The cardiac sphincter prevents the regurgitation of food i.e.

the passage of food back into the buccal cavity.

The pyloric sphincter regulates the passage of food into the

duodenum of intestine.
The stomach stores the food and churns it.

The churning breaks up the food into smaller pieces and also
facilitates the mixing of the food with gastric juice secreted by
the inner wall of the stomach.

Initiates protein digestion.

Soft mass of food is formed called chyme.
Small intestine:-

It is about 6 meters long and 2.5 cm broad tube compactly

coiled within abdominal cavity.

The coils are held together by connective tissue membrane

called mesenteries supporting the blood vessels, lymph
vessels and nerves.
It is divided into three parts:-
 Duodenum
 Jejunum
 Ileum
Duodenum-
It is ‘U’ shaped and is about 25 cm. long.
The bile duct and the pancreatic duct open into the duodenum .

Jejunum-
It is about 2.5 meters long and narrower than the duodenum.

Ileum-
It is about 3.5 meters long.
It is a little bit broader than the jejunum.
Large Intestine:-
It is broader than the small intestine.
It is about 1.5 meters long.
It can divided into two parts:

1. Colon and
2. Rectum.

Colon:
It is the anterior region and is differentiated into three parts:
 the ascending colon,
 the transverse colon and the
 descending colon.
The colon is lined internally by mucosal cells secreting
mucous that makes the passage of undigested material easy.
Rectum:
It is the posterior region of large intestine.

Undigested material called faecal matter is stored in the

rectum temporarily before it is expelled through the anus.

At the junction of the ileum and colon there a blind pouch

called caecum.

An elongated worm like vermiform appendix arises from the

caecum.
It is a vestigial organ in human beings.

It is functional in herbivorous animals for the digestion of

cellulose.
Anus-
The rectum opens to the outside by the opening called anus
which is guarded by a sphincter.
It removes undigested matter outside by the process known as
defaecation or egestion.
Alimentary canal:
Alimentary canal is muscular tube of varying diameter, about
8-10 meters long and it consists of mouth, buccal cavity,
pharynx, oesophagus, stomach, small intestine, large intestine
and anus.

Histologically wall of alimentary canal shows four layers

which from outside inward are-
serosa,
muscularis,
sub-mucosa
and mucosa.
The wall of alimentary canal from oesophagus to rectum
possesses four layers (Figure 16.4) namely
serosa,
muscularis,
sub-mucosa and
mucosa.

Serosa is the outermost layer and is made up of a thin

mesothelium (epithelium of visceral organs) with some
connective tissues.

Muscularis is formed by smooth muscles usually arranged

into an inner circular and an outer longitudinal layer.

An oblique muscle layer may be present in some regions.

The submucosal layer is formed of loose connective.
An oblique muscle layer may be present in some regions.

The submucosal layer is formed of loose connective tissues

containing nerves, blood and lymph vessels.
In duodenum, glands are also present in sub-mucosa.

The innermost layer lining the lumen of the alimentary canal is

the mucosa.
This layer forms irregular folds (rugae) in the stomach and
small finger-like foldings called villi in the small intestine.

The cells lining the villi produce numerous microscopic

projections called microvilli giving a brush border
appearance.
These modifications increase the surface area enormously.
Villi are supplied with a network of capillaries and a large
lymph vessel called the lacteal.

Mucosal epithelium has goblet cells which secrete mucus

that help in lubrication.

Mucosa also forms glands in the stomach (gastric glands)

and crypts in between the bases of villi in the intestine
(crypts of Lieberkuhn).

All the four layers show modifications in different parts of the

alimentary canal.
Salivary glands-
These are multicellular glands which open into the buccal
cavity.

There are three pairs of salivary glands:

Parotid glands in front of the ear. (cheeks)
The sub-maxillary/ Sub- mandibular glands below lower jaw.
Sub-lingual glands below tongue,

These glands situated just outside the buccal cavity secrete

salivary juice into the buccal cavity

The salivary glands have two types of secretory cells:

 Serous cells and
 Mucous cells.
The serous cells produce a watery fluid which contains the
digestive enzyme salivary amylase or ptyalin.

The mucous cells produce mucous.

It binds the food and makes it slippery so that it can be easily

swallowed.
The secretion of the salivary glands is called saliva.
Liver-
It is the largest, heaviest gland of the body.
It is dark reddish brown in colour.
It weighs about 1.2- 1.5 kg. in an adult.
It is located on the right side, just below the diaphragm.
It is made up of two lobes. Separated by falciform ligament

The hepatic lobules are the structural and functional units

of liver containing hepatic cells arranged in the form of
cords.
Each lobule is covered by a thin connective tissue sheath
called the Glisson’s capsule. (dense irregular fibroelastic connective tissue)
The bile secreted by the hepatic cells passes through
the hepatic ducts and is stored and concentrated in a thin
muscular sac called the gall bladder
Function:
 Liver secretes bile which emulsifies fats and makes the
food alkaline.
 It stores excess of glucose in the form of glycogen which is
used during starvation.
 In liver, excess amino acids are converted into ammonia
by the process called deamination.
 It synthesizes vitamin A, D, K and B12.
 Blood proteins like prothrombin and fibrinogen are
formed in the liver.
 It produces red blood cells during early development thus
working as a haemopoietic organ.
 Kupffer cells of liver digest old R.B.Cs.
Pancreas-
It is a leaf-shaped gland lying in the gap between the
duodenum and stomach.

It is a mixed gland (compound gland) because some part of

it is exocrine in function i.e. its secretion is carried by ducts
while the other part is endocrine i.e. its secretion is poured
directly into the blood stream.
 Exocrine Endocrine
The exocrine part is made up of The endocrine part is made up of
pancreatic lobules called acini. groups of cells present in the
connective tissue between the acini.
They are flask-shaped and formed of These are called islets of Langerhans.
a single layer of large glandular
pyramid-shaped cells.
These cells secrete the alkaline They are made up of alpha (α) cells
pancreatic juice. that secrete glucagon and (β) cells
that secrete insulin.
Both these hormones together control
the blood sugar level.
In addition, the delta cells secrete
somatostatin hormone, which
inhibits glucagon and insulin
secretion.
The duct of gall bladder (cystic duct) along with the hepatic
duct from the liver forms the common bile duct.

The bile duct and the pancreatic duct open together into the
duodenum as the common hepato-pancreatic duct which
is guarded by a sphincter called the sphincter of Oddi.
 PHYSIOLOGY OF DIGESTION-
The food eaten is insoluble and it cannot become a part of our
body.
The food undergoes many physical and chemical changes so
that it is converted into the simple soluble absorbable form.
This is absorbed into the mucosa cells of the alimentary canal
and then diffused into the blood capillaries.
All the physical and chemical changes in the food are studied
under physiology of digestion.
The mechanical changes include breaking up of the food into
smaller finer particles due to mastication, churning and
peristaltic movements.
Chemical changes are brought about by the action of different
enzymes.
Digestion in the Buccal cavity:
The food is broken down into small particles by mechanical
activities like mastication, chewing etc.

During this process, the tongue mixes the food with saliva
secreted by the salivary glands.

As saliva is watery, it converts the food into a paste.

An enzyme salivary amylase or ptyalin, present in saliva acts

on starch .so as to convert it into maltose.
A round food ball called bolus is formed which is then pushed
into the oesophagus by the action of the tongue.

The tongue presses against the palate and pushes the bolus into
the pharynx, this is called swallowing or deglutition.

The saliva secreted into the oral cavity contains electrolytes (Na+,
K+,Cl+,HCO- ) and enzymes, salivary amylase and Lysozyme.

About 30 per cent of starch is hydrolysed here by this enzyme (optimum

pH 6.8) into a disaccharide – maltose.
Lysozyme present in saliva acts as an antibacterial agent that prevents
infections.
Buccal Cavity:

Salivary Amylase (Ptylin)

Starch (polysaccharides) Maltose (Disaccherides)
Peristalsis:
The rhythmic wave of contractions and relaxations in any
tubular organ is termed peristalsis.

The alimentary canal conducts the food from oesophagus to

anus is one of the examples of peristalsis.

The internal organs are lined by smooth muscles which bring

about this movement at a very slow pace.

Regurgitation or vomiting is due to reverse spasmodic

peristalsis.
Digestion in the stomach:
The gastric glands start producing gastric juice as soon as the
food enters the stomach.
The mucosa of stomach has gastric glands. Gastric glands
have three major types of cells namely - Exocrine gland cells
(i) mucus neck cells which secrete mucus;

(ii) peptic or chief cells (Zymogenic cells which secrete the

proenzyme pepsinogen; and prorenin (babies)

(iii) parietal or oxyntic cells which secrete HCl and intrinsic

factor (factor essential for absorption of vitamin B12).
Gastric glands include enteroendocrine cell G (gastrin) cells
(located in pyloric antrum) secrets harmone gastrin in
bloodstream

Argentaffin cells- serotonin and histamine

The stomach stores the food for 4-5 hours

Gastric juice contains
 dilute HCl,
 mucous and inactive protein digesting enzyme called
pepsinogen.

The stomach churns the food by strong peristaltic movements.

This is physical digestion. Food gets properly mixed with the
gastric juice produced in the stomach.

Rennin is a proteolytic enzyme found in gastric juice of

infants which helps in the digestion of milk proteins.
Small amounts of lipases are also secreted by gastric glands.
HCI performs the following functions-

a) Stop the action of salivary amylase.

b) Provides the acidic medium required to convert, inactive

pepsinogen into active pepsin. (pH=1.2)

c) Kills the germs that may entrapped along with the food.

d) Helps to soften the food.

e) Pepsin (Proteolytic enzyme) acts on proteins and converts

them into simpler forms like peptones and proteoses.
Mucous forms a protective layer on the mucosa of the
stomach to prevent the action of HCl.

Secretion of gastric juice is controlled by the sight, smell and

taste of food.

After digestion in the stomach, food gets converted into a

semisolid mass called chyme,
Acidic chyme travels into the duodenum through the pyloric
sphincter.
Stomach:

Gastric glands in stomach secrets Gastric Juice

 Dilute HCL
 Mucous
 Inactive Proteins digestive enzyme pepsinogens

HCL

Pepsinogens Pepsin(Active Enzyme)

Pepsin
Proteins Acidic Medium
Peptones+ Proteoses
Digestion in the small intestine:
In the duodenum, the secretions of the liver and pancreas are
poured.
Secretion of liver is bile and secretion of pancreas is
pancreatic juice.
Bile helps to neutralize the acidic chyme.
Small Intestine :

Crypts of Liberkuhn (tubular glands between villi)

It has two types of cells

Paneth cells- found in Argentaffin cells

the bottom and rich in (enterochromatin
zinc. cells)-serotonin
Secrets Lysozyme (peristalsis)
(antibacterial)

Brunners Glands- submucosa of duodenum

Small Intestine :

Bile Juice:
Yellowish Green Liquid
It carries Neutralization of Acidic Chyme
 Water
 Cholesterol
 Bile Salts
 Bile Pigments
 No any Enzyme
 phospholipids

It carries emulsification of fats.

Bile pigments
Bilirubin & Biliverdin (breakdown of haemoglobin)
Small Intestine :

Pancreatic Juice:
Yellowish Green Liquid
It carries Neutralization of Acidic Chyme
 Water
 Sodium Salts
Many Enzyme
Amylase
Lipase
Trypsinogen
Chymotrypsinogens
procarboxypeptidases,
and nucleases
Small Intestine :

Pancreatic Amylase

Starch (polysaccharides) Maltose (Disaccherides)

Alkaline Medium

Pancreatic Lipase

Lipids Fatty Acids+ Glycerols

Alkaline Medium

Enterokinase (intestinal
juice)
Trypsinogen (inactive) Trypsin (Active)
P. Juice Alkaline Medium
Small Intestine : From inactive Trypsinogen

Trypsin

Proteins+Peptones+ Proteoses Polypeptides

From inactive Trypsinogen

Trypsin
Chymotrypsinogen(Inactive) Chymotrypsin (Active)
P. Juice

Chymotrypsin

Polypeptide Dipeptide
 Nucleases P. Juice

Nucleic Acids Nucleotides

Nucleotidases

Nucleotides Nucleosides

Nucleosidases

Nucleosides Sugar + Base

Small Intestine :

Intestinal Juice or Succus Entericus:

It is secreted by intestinal glands.
It contains many enzymes
Maltase
Enterokinase
Sucrase
Lactase
Dipeptidase
 Maltase Int. Juice

Maltose Glucose
Disaccharides Monosaccharide's

Sucrase Int. Juice

Sucrose Glucose+ Fructose

Disaccharides Monosaccharide's

Lactase Int. Juice

Lactose Glucose+ Galactose

Disaccharides Monosaccharide's
 Dipeptidase Int. Juice

Dipeptides Amino Acids

Lipase P. Juice

Emulsified Fats Fatty Acids+ Glycerols

Carbohydrates Glucose+Fructose+Galactose

Fats Fatty Acids+ Glycerols

Proteins Amino Acids

Brush border enzyme:
1.Enterokinase

2. Lactase- only in children's below age 4

(inactive in adults)
Lactose in tolerance- diarrhea, gas, cramps

Yogurt is better tolerated than milk.

It contains lactase produced by Yogurt bacteria
Endocrine Cells in different parts of alimentary tract secrets four different hormones

Gastric Glands Gastrin HCL & Pepsinogens

Water & Bicarbonate

Exocrine Pancreas Secretin ions to form
Pancreatic Juice

Pancreas & Gall Pancreatic Enzyme &

Cholecystokinin
Bladder Bile Juice

Inhibits Gastric
Gastric Inhibitory Peptide Secretion & Motility
ABSORPTION AND ASSIMILATION:
The digested forms of food diffuse in the inner lining of the
digestive tract. This is called absorption.
Water, inorganic salts and some glucose is absorbed by the
inner wall of the stomach.
Rest of the absorption is done by the small intestine.
The villi increase the area of absorption.

Glucose and fructose are absorbed into the blood vessels.

They are absorbed by osmosis, diffusion and active
absorption.

Amino acids are absorbed by the blood vessels,.

Fatty acids and glycerol get absorbed into lymph capillaries
or lacteals.
Fatty acids are first incorporated into small droplets called
micelles which move into intestinal mucosa.

They are reformed into very small protein coated fat

globules called chylomicrons which are transported into
lacteals they are absorbed into lymph.
Lacteals open into blood vessels.

Assimilation-
The absorbed food material becomes a part of the protoplasm.
This is called assimilation.
The mitochondrion oxidize food to liberate energy in the form
of ATP.
Egestion-
After the process of digestion in the small intestine its soluble
and useful part is absorbed, while the undigested, unwanted
residue is sent to the large intestine.

Water is reabsorbed in the large intestine and a semisolid

waste called faeces is thrown out of the body through the anus.
CALORIFIC VALUE OF NUTRIENTS:
The amount of heat liberated by complete combustion of 1 g.
food in a bomb calorimeter is termed as gross calorific
(gross energy) value.

In animals, the energy content of food is expressed in terms of

heat energy.

The actual energy produced by 1 g. of food is its

physiological value.
NUTRITIONAL DISORDERS:
The deficiency diseases are caused by inadequate proteins,
vitamins and minerals in the diet.

Protein energy malnutrition (PEM) is generally reported in

the children of growing age.

This causes two types of diseases :

Kwashiorkor:
It is a protein deficiency disease.
It is the most widely spread kind of malnutrition.
It commonly affects infants and children between 1 to 3 years
of age.
The common symptoms of kwashiorkor are
underweight,
stunted growth,
poor brain development,
loss loss of appetite,
anaemia,
protruding belly,
Slender Legs and bulging eyes.

Oedema of lower legs and face and change in skin and hair
colour may also occur in kwashiorkor.
The basic causes of the disease are protein deficient or
inadequate diet due to ignorance and poverty and
infectious diseases, such as diarrhea, measles, respiratory
infections, intestinal worms, which weaken the child.
There are some contributory factors for the disease.
These are ill spacing of children,
large family,
poor maternal health,
early termination of pregnancy,
breast feeding,
late introduction of suppiemelitary diet and
adverse practices of child rearing such as the use of over
diluted cow’s milk.
The proteins are building foods, and are essential for growth
and repair of tissue and also for body defence.

Therefore, adequate amount of proteins must be present in the

diet.

For normal health, daily diet should contain one gram of

proteins per kg. body weight in case of adults, and
Two grams of proteins per kg. body weight in case of
growing children.

The sources of proteins are cereals, pulses, fish, milk, cheese,

leafy vegetables, groundnut, peas and beans.
Marasmus:
it is a form of prolonged protein energy malnutrition.
it affects infants under one year of age.

Marasmus is caused by simultaneous deficiency of proteins

and total food caloric value, that is deficiency of all nutrients

It affects the infant if mother’s milk is replaced too early with

foods having low protein content and caloric value.

This often happens when the mother conceives before her

infant is ready for weaning.

Due to protein deficient diet, stored fats and tissue proteins are
used as sources of energy.
It impairs physical growth and retards mental development.

Subcutaneous fat disappears, ribs become very prominent,

limbs become thin and skin becomes dry, thin and wrinkled.

There is emaciation (extreme leanness) and loss of weight.

Digestion and absorption of food stop due to atrophy of

digestive glands and intestinal mucosa.

This leads to diarrhea There is no oedema, which is a

characteristic of kwashiorkor.
Diet with adequate proteins and proper calorific value should
be given to the infants.

Severe malnutrition impairs immune system and makes the

victim very susceptible to respirator and gastrointestinal
infection.

Malnutrition with immunodeficiency and infections is the

worlds leading cause of infant and child deaths.
Indigestion:
It is a nonspecific term that includes a variety of upper
abdominal complaints including heart burn, regurgitation,
dyspepsia (upper abdominal discomfort or pain)

These symptoms are esophageal reflux disease.

It occurs as a consequence of acid reflux into the esophagus

from the stomach.

This may occur due to a large meal or acid hypersecretion.

Some other factors include physical position such as lying

down, bending over, increased pressure on the stomach (tight
clothes, obesity) and loss of lower esophageal sphincter tone.
Indigestion can be improved with avoidance of large meals,
smoking, alcohol, fatty food and weight reduction and taking
antacids.
Constipation:
It is defined as decrease in the frequency of stools to less than
one per week or difficulty in defecation which may result in
abdominal pain, distortion and a rarely perforation.

Some contributory factors may include inactivity, low fiber

diet etc.

Specific causes of constipation may include affected colonic

mobility due to neurological dysfunction e.g. diabetes
mellitus, spinal cord injury etc.

Constipation may be improved with increased dietary fibres,

increased fluid intake and exercises.
Jaundice:
This is not a disease in itself, but is a sign of abnormal
bilirubin metabolism and excretion.
Jaundice develops when there is an abnormality at some stage
in the metabolic sequence caused by
excess haemolysis of red blood cells with the production of
more bilirubin than the liver can deal with, obstruction to
the flow of bile from the liver to the duodenum and
abnormal liver function

Bilirubin. produced from the breakdown of haemoglobin is

usually conjugated.
The bilirubin is water soluble and can be excreted.
(Conjugation is a process of adding certain groups to bilirubin
to make it water soluble)
Unconjugated bilirubin is fat soluble and has a toxic effect on
the brain cells.

Serum bilirubin may rise to 40 to 50 umol/1 before the yellow

coloration of skin and conjunctiva is seen (Normal value is 3
to 13 umol/1)

Effects of raised bilirubin include pruritis (itching) caused by

the irritating effects of bile salts on the skin, pale face, dark
urine and whitish stool.

There is no specific drug to prevent jaundice.

Mainly, the treatment involves supportive care, rest and
treatment of cause.
Vomiting:
It is a reverse peristaltic movement due to which the stomach
contents are thrown out of the mouth.
It is controlled by non-vital vomiting centre of medulla.
It is typically associated with nauseatic feeling.

Diarrhoea:
Diarrhoea is loose, watery stools.
Having diarrhoea means passing loose stools three or more
times a day.

Diarrhoea lasting more than 2 days may be a sign of a more

serious problem.
Diarrhoea of any duration may cause dehydration, which
means the body lacks enough fluid and electrolytes (chemicals
in salts, including sodium, potassium and chloride) to function
properly.

Loose stools contain more fluid and electrolytes and weigh

more than solid stools.
People of all ages can get diarrhoea.

In the United States, adults have an average of one episode of

acute diarrhoea each year, while young children have an
average of two.

Acute diarrhoea is usually caused by a bacterial, viral, or

parasitic infection.
Chronic diarrhoea is usually related to a functional disorder
such as irritable bowel syndrome or some intestinal disease.