One task we are allfamiliar 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.

Our DigestiveSystem

4

Parts of Our Digestive System

Nose

How Do We DigestThe Food We Eat??

The digestive system startsfrom the mouth and noseand ends at the anus fromwhere we pass stools (orshit).

Once the food has goneinto the mouth, the teeththere chew it.

Saliva from the salivaryglands around themouth mixes with thefood here so that thetongue can push it intothe back of the throatand the food slips downinto the food pipe.

From the food pipe, itgets into a large sac likeorgan called the stomach.After staying in thestomach for a few hoursand mixing with juices,the food goes into thesmall intestine.

Mouth

Throat

Largeintestine

Small intestine

Stomach

Food Pipe

Appendix

Liver &gall bladder

Pancreas

Anus

4-1

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.

Parts of our Digestive Sytem

NoseAlthough 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.

MouthStarting at thelips, the mouthhas a set of teethbesides atongue.

There are different types ofteeth that help us in biting,chewing, tearing or grindingthe food we eat.

Holes in YourTeeth

Small food particles can get stuck in the small-est of pits on the surface of the teeth. If not,brushed or rinsed out, millions of small bacte-ria/germs that normally stay in the mouth willact on this food and make it acid. This acid willcut holes into your teeth giving you cavities ordental caries. Mouth must be properly rinsedor the teeth well brushed. Brushing teeth in thenight before sleeping is MORE important thanbrushing in the morning.

Keep Your Mouth & Teeth CleanMouth: Rinsing the mouth after every meal, tea or snack helps keep the teeth clean and avoidsbad breath. Betel nut, paan and tobacco can harm the inner skin of the mouth – they are thereason 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 helpsremove any food particle stuck next to the teeth and is useful if carried out after meals, notbefore. Most people brush wrongly and cause more damage than help – the upper teeth must becleaned by strokes of the brush from top to bottom, while brush strokes from below upwardsare required for teeth of the lower jaw. Any cavity in the teeth must be filled up at the earliest toavoid widening of the cavity.

4-2

How Many TeethCan We Have?

Adults have thirty two teeth - sixteen each in theupper and lower jaws. Children below five yearshave a total of twenty milk teeth.

A child starts getting milk teeth around six monthstill a year and a half years. By the time they are 6years old, their milk teeth gradually start to fall offone by one. Permanent teeth replaces milk teeth.

Holes in theteeth can bevery painfuland will needto be filled.

Children Must Drink Milk for Calcium

Many children get their first teeth late. Teethmay come later for those children who drinkless milk or did not have food with morecalcium. Advise mothers to give their smallchildren milk or food with calcium, like daal,beans, leafy vegetables and fish.

Salivary Glands :What happens when the smellof our favourite food reachesour nose? Or when food isplaced in the mouth? Ourmouth waters. This is calledsaliva. Saliva has some types ofsubstances that breaks downour food into small particleseven before they reach ourstomach.

Two sets of salivary (se-laee-va-ree) glands around the mouthgive out saliva. One set is foundunder the lower jaw on eitherside while another is found onboth sides of the face just in frontof the ear lobes.

What Are MUMPS?

Mumps is a common diseaseof the salivary glands underthe lower jaws. It spreadsamongst children playing orstaying together through germs breathed out bya patient.

The patient gets severe pain in opening themouth, first on one side and later on the other.One can easily see the swelling on the side ofthe lower jaw that is painful to touch. Mumpsgets well by itself in a week or two.

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.

food pipe

4-3

What are Tonsils?The inside of the mouth ends behind in folds ofreddish inner-skin (mucous membrane). These haveone tonsil amongst them on each side. These tonsilsstand like guards to the throat. Whenever germsstart attacking either the breathing organs or thedigestive organs, the tonsils swell up and becomepainful. This warns us of an infection.

Ask your friend to open her/his mouth and shine atorch to look at the tonsils. It is not rare to see themswollen and causing pain, especially in children.

Tonsils SwellingSwelling of the tonsils again andagain can cause repeated illnessand disturb routine of children.Also, the infection may cause

some problems in the heart in some youngchildren. Hence such children should beeither on medicines regularly or else, thetonsils can be removed by a rather simpleoperation.

ThroatThe throat or pharynx is connected to thenose and the mouth in the front.

It ends below into two pipes. The pipebehind food pipe leads to the stomachinside the abdomen after crossing thechest.

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 whatis commonly called pharyngitis (fay-rin-jaee-tis).

Remember the “- itis”The suffix ‘-itis’ is added behind the name of an organ to tell us that the organs isinflamed. This means that some germs or some injury has harmed the organ and it isfighting 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 thetonsils, arthr-itis of the joints (also arthros), appendic-itis of the appendix and sinus–itisof the sinuses are some examples.

food pipe

wind pipe

lungs

diaphram (seperates abdomenfrom chest)

stomach

throat

4-4

STOMACHThe stomach starts where the food pipefinishes.

It lies in the upper part of the abdomen.The stomach is a big sac like organ thatcan store food for about two to fourhours. The stomach produces verystrong acid and a substance calledpepsin. The two things work togetherto break down the protein present in

food like meat, lentils (pulses or daals) and milk, so that thebody can use them later.

Food PoisoningAny strong infection, infected food (as in food poisoning), liquoror chillies can cause serious irritation in the lining of thestomach. This leads to hiccupping and also to vomiting. Theperson may also feel pain and burning sensation in the ‘pit’ ofthe stomach (the upper part of abdomen just where it meetsthe centre of the chest). This is what doctors call gastritis (gas-traee-tis). If this irritation persists for a long time, a woundmay develop in the lining of the stomach - usually in the lowerpart of the stomach and in the early part of the small intestine– that is called Peptic Ulcer or commonly just Ulcer.

When Does the Stomach Empty?The stomach gets empty two to four hoursafter eating a meal. Hence, when a doctortells you not to take a pill on an emptystomach, she means that it is to be takenWITHIN two hours of taking a meal.

stomach

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Did you know that the acidproduced in your stomach isso strong that it can dissolvean iron nail. Luckily for usin normal times the lining ofthe stomach does not getharmed by the acid. Unlessthe lining has been alreadyweakened by infection ormedicines, the acid in thestomach cannot harm it.

Lemon Juice is Good for “Gas-tric”.Many of us call vomiting and pain inthe upper stomach as ‘gas’ or ‘gastric’.A large spoon of lemon juice with somesugar is effective to deal with theirritation 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.

4-5

SMALL 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 breakdownmany parts of the food; especially thosethat are greasy and oily like butter, oilsand meat.

Not only the liver but the pancreas alsoempties its juices into the upper part ofthe small intestine. These substances arealso very strong and can break downalmost all types of food into very tinypieces.

The small intestine itself produces juiceswith strong digestive power. They arein charge of acting on small food parti-cles of all types and breaking them downto the tiniest pieces. These particles haveto be small enough to be absorbed bydifferent parts of the small intestine.From here they are sent to the blood forbeing used by the body.

smallintestine

largeintestine

anus

appendix

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 !

600 times longer?!

The inner wall of thesmall intestine hascountless folds thatlook like tiny fingers.These folds increasethe amount of surfaceavailable forabsorbing then u t r i t i o n a lsubstances.

Without these folds our small intestine wouldhave to be 600 times longer than it is now!

4-6

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.

About four feet long when a person is alive, thelarge intestine is so called because of being muchwider than the small intestine before it. Also calledthe colon (kow-lun), it goes up on the right side,hangs down while going from right to left side, thencomes down the left side to end in a big loop beforefinishing in a straight stretch behind (see diagram)called the rectum (rek-tum).

The rectum ends below into the anus, the openingfrom which we pass stools or shit.

The contents move much slowly in the largeintestine. Almost all of the last two litres of waterthat is still present in the contents coming from thesmall intestine is absorbed here. What is left behindfrom the contents that came from the small intestineis what forms the stools or shit.

LARGE INTESTINE

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.

large intestine

rectum

anus

Worms Live in Your IntestineThe large intestine, as also the lower parts of the small intestine alsohouse most of the worms that we see in the stools of children andadults. These worms can lead to serious nutritional problems as theyeat away many of the food products that are necessary for us.

Eggs or babies of these worms keep passing out in the shit and cansurvive 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 eatthat has been dropped, or we eat vegetables without washing, these eggs can enter ourintestines again. Some of the worms like hook worms can enter through the skin if wewalk bare feet! DO NOT WALK barefoot and do not allow children to walk bare-foot.

4-7

The large intestine starts where the smallintestine ends into it on the right lower sideof the abdomen.

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 hencevery important.

What the Liver Does?a. Makes Building Blocks for the Body: Tiny food nutrients getinto the blood from the small intestine and reach the liver. Theliver changes them into forms that can be used. The make build-

ing blocks for various for different or-gans, tissues and cells. The body needshelp of the liver to provide it matterfor building and repairing differentorgans in the body.

b. The liver also makes antibodies thatcan fight against germs.

c. It also changes waste items made inthe body into such forms that can bethrown out of the body with urine orwith stools.

liver

gall bladder

LIVER

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.

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 StonesIf some germs enter the biletube or the bile gets very thick,we can get gall stones. Theseare found in ten to twentypercent people in the country.If these stones cause repeatedpain or they block the bile,operation may be necessary.

Why do we get jaundice?If too much bilirubin - matter from liver - collects in theblood, then our skin, eyes and the lining of the mouth turnyellow. This is called jaundice and can happen because ofmany reasons.

If the liver has some disease (Hepatitis) because of whichit cannot change the form of bilirubin to throw it out withthe bile, again jaundice may result. Lastly, if the bile tubehas been blocked because of cancer or stones, once againbilirubin collects in the blood to give jaundice.

4-8

PANCREAS

Another solid organ that looks like ayellow but soft carrot, the pancreas ispresent in the curve of the upper partof the small intestine.

What the Pancreas Does?a. It produces pancreatic juice thathelps to break down many of the foodparticles already broken by otherjuices into yet finer particles.

The substances in the pancreatic juice that help to digest the foodare very powerful and can digest almost everything. If ever theoutlet of the pancreas is blocked due to infection or stones from

the 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 anglewhere the small intestine meets the large intestine, the appendixis not known to be if any use. However, if worms, bacteria or otherthings block its hollow, it may swell up, cause great pain –appendicitis (app-end-i-caee-tis) - and can burst to kill unlessoperated fast.

Important Signs of AppendicitisAnyone having :1. pain in the right side of the lower abdomen2. a little fever and3. some vomitingshould be suspected to be having appendicitis and rushedto hospital to save her life.

appendix

4-9

Our Digestive System

4-10

Know the Answers

1. 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 likedaal, 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 _________________________________.

My Notes4-11

DISEASES OF THE DIGESTIVESYSTEM

What we will learn in this ChapterPage Number

1. General principles of keeping thedigestive system fit 4-13

2. Problems of the Mouth, especiallytoothache & what to do in toothache 4-14 to 4-15

3. Problems of the Stomacha. Gastric & Ulcers 4-16 to 4-17

b. Constipation & Piles 4-18c. Diarrhoea / ORS 4-19 to 4-21e. Making a Gourd Baby 4-22 to 4-23d. Dysentery 4-24e. Giardiasis 4-25f. 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

4-124-12

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 fruitsand vegetables must be taken daily so that the bowels functionsmoothly and there is no constipation.

Loose motions make us lose a lot of water as well as salt. To make upfor this, we must take extra salt and water in our diet whenever we have loose motions. Sugars helpthe 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 begiven 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 inLOMOFEN).

Lemon juice is considered very beneficial for the digestive system. So arecurds and yoghurt. In all cases of loose motions – except in those whocannot tolerate any milk products – give plenty of curds.

Drinking clean potable water is one of the most important ways tomaintain a good digestive system. Not eating foods cooked the previous day, preventingflies 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.

DISEASES OF THE DIGESTIVE SYSTEMThe digestive system on most occasions can look after itself. However, thereare 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 getconstipated. Germs or their poisonous secretions may cause severe dysentery, whileworms can simply stay there and share our nutrition. The abdomen also has greatpotential 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 curethem and to save ourselves from them.

4-13

Mouth 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.

ToothacheWhich 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 usedto sweet things if you want their teeth andgums to be healthy. Cold drinks with sodacan wear out the teeth very fast while thesugar in them helps make cavities (holes).Avoid them.

Brush after meals. If you have time only for brushing only once aday, this must be done after dinner. Food left behind between teeth and between teeth andgums breeds bacteria which produce acid that cause cavities (or holes) to be formed in theteeth.

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.

Problems of the Mouth

4-14

PYORHHOEA (Py-ria)Pyorrhoea is also very common amongst our populations. It oc-curs because:

We do not clean our teeth well enough andoften enough, andWe 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 orsnack.

2. Massage some salt with mustard oil on the gums and leave for a few minutes. Rinse themouth. Repeat three times a day for at least a month.

3. Give Capsules DOXYCYCLINE or Tablets COTRIMOXAZOLE for seven days also.

What to do when we have a tooth ache?If there is a cavity already, clean it carefully with a sharpened twig and try toget it filled by a dentist at the earliest. Rinse the mouthwell with warm salt water.

For pain, chew some cloves. Or get clove oil and use afew drops in the cavity. You may give PARACETAMOLalso.

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.

Rub a twig of Neem or Babool orapply salt on the gums – this sucksaway the water and makes the gumstick firmly to the roots of the teeth.This prevents food from getting in-side and causing cavities. Rinse themouth after using the salt.

Toothpastes and tooth powdershave little or no role to play in clean-ing teeth. Mix salt and baking soda(soda bicarb) to make your owntooth powder.

Eat a healthy diet which has things like aamlakhi (amla), lemon, oranges or guavas. Milk alsohelps to build up Calcium in one’s diet and strengthen the teeth.

4-15

Problems of the Stomach

GASTRITIS (acid indigestion, heartburn, alsocalled 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 takenwithout 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 Ulcers

Blood – 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.

4-16

Taking care of your gastritis1. 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 weekshelps in returning the stomach back to normal.

2. Tablets ANTACID to be chewed whenever there is pain or one and three hours aftermeals 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 milkis 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.

4-17

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.

4-18

Dealing withPiles & Fissures

1. Eat Food with Fibres (vegetables /carrots / radish / fruits etc.)

2. Drink plenty of Fluids

3. If pain is too much and stoolscannot be passed, applyBETAMETHASONE ointment.

What To DoIf Constipated?• Drink more waterand eat foods with fibre.• Do not take laxativesall the time for constipa-tion.• Instead, eat fruits,green vegetables, foodswith natural fibre like tapi-oca (cassava), rye (mustard), s u n f l o w e rseeds, raisins, nuts and wheat bran.• Vegetables such as carrots, pumpkin,

turnips are good forconstipation.• One must haveenough exercise foreasy bowel move-ment.• Adding a bit of

vegetable oil to food each day also helps.

Piles & FissuresA common problem faced by people is pain whilepassing stools (shitting) and also passing of bloodalong with shit.

1. PILESIn piles, one can feel some fleshy things (veins cov-ered with flesh) coming out of the anus (shit hole).Also, blood in good quantities is thrown out (like aninjection) when the person strains while shitting. Toprevent piles and also for relief, one should away fromconstipation. If the pain and bleeding is regular, theperson should be referred to a surgeon. By giving aninjection on the fleshy part, it can be shrunk. Else,the fleshy part can be cut off by a small operation.

2. FISSURESIn fissures too, there is pain while shitting. However,this pain is due to the anus getting torn during stariningto throw out (hard) stools. The blood is usuallysmeared on the stool and nevere bleed smore than adrop at a time. It helps to keep the stools soft by go-ing to the toilet regularly and not allowing stools toharden. An operation can heal fissures permanently.

To Lessen Pain from Piles

DIARRHOEADiarrhoea 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 duringthe daytime and when in some kind of tension, like during examinations, interviewsetc. 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 forsometime 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.

4-19

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.

Viruses cause mostdiarrhoeas of children.Passing of loose stoolsvery often may drain outthe person of water andsalt. As a result the personfeels tired and listless.Even death may occur.

All that one needs to do in diarrhoeas caused byviruses is to replace the fluids at the earliest. Ricewater 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.

Diarrhoeas in Children

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 twofull days, tablet COTRIMOXAZOLE twice a day for threeto five days should be given.

OR else, tablet FURAZOLIDONE four times a day for threedays may be given.

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DEHYDRATION from Diarrhoea

Diarrhoea 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.

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 !

Signs of Dehydration

a sagging “softspot” in the baby

dry mouth

when pinched, skindoes not spring back

sudden loss in weight

urine yellow in colourlittle or no urine

sunken eyes /tearless eyes

Give Salt - Sugar Solution !

ORSThe 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 came as a magic wand.

Well, 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.

ORS packets as a magicwand against diarrhoea

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!

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THE GOURD BABY

The gourd baby is so named because the double bell gourd ispainted up as a baby to be used as a tool for teaching dehydra-tion.

1. Get a doublebell gourd (onewhich has twobells).

4. Drill small holes (apen tip can go through)in both the eyes, themouth and at the tip ofthe penis (or top of thevulva) and in the anus.Make stoppers to coverthese holes. Your gourdbaby is ready for use.

Making a gourd baby

3. Use perma-nent markers tomake a face onone of the bellsand mark legs,belly, andgenitals andanus on theother bell.

2. Cut off the topdry it. After thatclean the outsidesurface with soapand water andthen wipe dry.

urineopening

anus

eyes

mouth

Fill us with water and yourgourd baby is really for use !

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1. 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 theanus intermittently (keep a vessel belowto catch the water). Explain that it is likediarrhoea. Keep showing the water levelto the trainees. Demonstrate how thewater level goes down faster if each stoolis large (keep open the anus stopper fora longer time) or if the diarrhoea is morefrequent (open and close the anus stoppermore frequently).

3. Refill the gourd baby. Open all the holesexcept the anus stopper to show that tears areflowing, the tongue is moist and that urine ispassing. Now, open and close the anus stop-per repeatedly. As the water level keeps fall-ing, you will be able to show that first the tearsstop flowing, later the tongue becomes dryand as the water level goes down even fur-ther, even the urine stops.

Demonstrating dehydration in a gourdbaby

After making the gourdbaby, one can also discuss :• how people can make

out the stages ofdehydration.

• mild moderate andsevere dehydration.

water level

to show howwater which is

lost in diarrhoeaneeds to bereplaced

a larger hole can bemade in the mouth

and one can actuallypractice giving of SSS

to the baby

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DYSENTERYDiarrhoea with Blood and Pus is called Dysentery. Dysentery canbe caused by both bacteria as well as other germs like amoeba and Giardia.

Amoebic (a-mi-bic) dysentery (‘A’ Dysentery)Small germs that are neither viruses nor bacteria may alsocause dysentery. But in amoebic dysentery, there is no fe-ver to be seen. Also, the shit is smelly, comes out in largequantities – “explosive’’ stools – and there are only two tofive stools in a full day. Rarely, there may be blood in largeamounts. On pressing the sides of the abdomen, the personmay complain of pain.

What to do in amoebicdysentery?

1. Curds and enough fluids aslearnt before may be given.

2. Tablet METRONIDAZOLE400 mg three times a day for fivedays should be given

SignA (Amoe bic)D yse nte ry

B (B acte rial)D ys e nte ry

How ofte n? Usually less than five times aday

Usually more than seventimes per day

How big? Big large stools, explosive Usually small and watery

Fe ve r and othe rbody s igns ?

Usually no feverFever common, sometimes

high.

Pain abdome n? Usually on pressing sides ofabdomen

C ramps in abdomencommon.

B lood and mucus Some mucus - if blood,more amount

At times, all stool is mucusalone. Some blood also

Tre atme ntTab M ETRO N IDAZO LE

400 mg three times a day for5 days

Tab C O TRIM O XAZO LEtwice a day O RTab

FURAZO LIDO N E fourtimes a dayfor three days

may be needed.

How to differentiate Amoebic & Bacterial Dysentery

Bacterial Dysentery (‘B’ Dysentery)Bacteria cause diarrhoea as well as dysentery (which is diar-rhoea with pus and blood). Very frequent watery stools (nor-mally 7 to 10 times but could go up to even 40 times) that arevery small in quantity and often with pus and blood are sig-nals of bacterial dysentery. Very often, mild or high feverwith stomach cramps will also be seen with bacterialdiarrhoeas.

What to Do In BacterialDysentery?

1. Curds and enough fluids to be given.2. Tablet COTRIMOXAZOLE orFURAZOLIDONE can be given totackle the germs.

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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 timesa 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 leastuntil 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.

Bury the stools of cholerapatients carefully beneathat least 2 inches of soil.

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’sLactate – may be required.

• Also give DOXYCYCLINE or COTRIMOXAZOLE forthree days.

• It is very important in Cholera to be taught how to safelydispose their stools.

• Drink cool water from a good source of water.

• If there is testing facility ( one just needs a microscope)then the stools can be tested for Cholera germs.

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.

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eating unwashed vegetables growing in areas where people shit inthe open; eating food without washing hands carefullyafter passing shit; eating food/ toffees/biscuits that fallon the ground without washing. (Round worms/ Whipworms)

scratching the anus and then eating anything withoutwashing hands. (Pin worms, Tape worm’s cyst in brain/lung/liver, etc.)

eating improperly cooked meat of pigs or cows that mayeat shit or grass with eggs on them. (Tape worm)

eating improperly cooked fish/ snails/ crabs that have fed on eggsfrom shit washed into the water . (Broad tape worm, Oriental lungfluke)

handling of dogs that have worms (Dog tape worm).

walking bare feet in wet soil where baby worms from the eggs may enterthe 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 notgain weight. They feel hungry and tend to eat sugar, bananas, etc (hence thewrong belief that eating sugar or bananas leads to worms).

Pain in the abdomen especially with cramps is very common. Many becomepotbellied (round worms) as the load increases. In hookworms, the person maylose 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 prolongeddry cough — sometimes so severe that even blood may be coughed out.

Those worms that pass their way up through the skin (hookworms) may causeredness and scratching at the place of entry of the baby worms.

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

Pin worms

Whip Worms

Round Worms

Tape Worms

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Can 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 twohours.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 thingsone can try.

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 wellbefore 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.

Try this for getting rid of wormsRemove the outer layer of a handful of pumpkinseeds, crush and put into a glass of boiling waterand keep covered for 20 minutes. On an emptystomach – preferably after a day’s fast — drink sucha glass three to four times. Take castor oil the nextday if one had suspected tapeworms.

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DISEASES OF THE LIVER

HEPATITISAn 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.

Hepatitis spread by food & water takes four tosix weeks for the germs to take effect, while theblood borne hepatitis may take a few months todevelop the disease in the body.

The person gets nausea and vomiting to startwith. The urine turns a deep yellow and otherpeople may notice that the white of the eye hasturned yellow. In some people this may worsenand the person may have to be admitted.

Every Jaundice is NOT Hepati-tis. Jaundice just means eyesturning yellow. Many diseases –from malaria to gall stones tocancer of pancreas can causeJaundice. It is not necessarilyonly a liver problem.

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 andoils 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 personfrom eating oils. We may decrease the person’s already low nutrition on account ofpoor appetite. Unlike popular belief, oils and butter etc. should be stopped onlywhen 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 medicinescan 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 wouldhave come down.

In rare cases, hepatitis gets worse and can cause death also. If the person doesn’t look betterwithin a week or the jaundice is getting worse, the person should be taken to a hospital.

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APPENDICITISThis is a well-known emergency. One of thereasons may be worms, but otherwise, we do notknow what may cause the infection or inflamma-tion of the appendix. There are three classicalsignals of an infected appendix:

Mild fever

Vomiting

Pain in the right lower abdomen – midwaybetween the naval and the hip bone on the side.A pain here that becomes worse if someone triesto 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 whereoperation facilities are available.

¨ The person should not be given anything else to eat or drink because emptystomach is required for performing the operation.

¨ At best, a painkiller like Paracetamol may be given till the person reaches thehospital.

How to stop others from getting Hepatitis?Dispose the shit properly

Do not share needle with anyone. One person, oneneedle !

Do not give or take blood unless it has been tested forAustralia Antigen (for Hepatitis B).

Clean hands before eating

Do not let flies sit on your food.

Cover Fod Well

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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.

Acute Abdomen

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refer immediately !

Know the AnswersDiseases Of the Digestive System

1. 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 ________________________________________

________________________________________________________________________________.

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Please 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.

Know the AnswersDiseases Of the Digestive System

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My Notes4-33