Anil Kantiwal ( OM Nursing Academy )

Introduction :-

Human digestive system, इस System म� Human Digestive Organs एवं Digestion( पाचन ) स�ब�ंधत त�य� का अ�ययन करते ह� ।

Digestive System को Gastrointestinal Tract एवं Alimentary Canal के नाम से भी जानते ह�

Alimentary Canal यह 8-10 मीटर ( 30 Feet ) ल�बी tube like structure ह� जो Mouth सेAnus तक फैली रहती ह� ।

Anatomy of Digestive System :-

Digestive System यह Primary Digestive Organs एवं Accessory Digestive Organs से�मलकर बना होता ह� ।

Digestive System GIT Short Review

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Anil Kantiwal

Anil Kantiwal ( OM Nursing Academy )

Mouth :- Mouth को Oral Cavity और Buccal Cavity के नाम से भी जानते ह� ।

1. Teeth :-

Enamel, Teeth पर एक Outer Covering पायी जाती ह� �ज�से Enamel के नाम से जानते ह� जोHuman Body का सबसे Toughest और Hardest Element ह� जो 96% Minerals से बना होताह� ।

Temporary Teeth / Desiduous Teeth 6 Month क� Age म� उगना शु� हो जाते ह�

सबसे पहला दाँत - Lower Central Incisor ( 6 Month पर )

�सरा दाँत - Upper Central Incisor ( 7 Month पर )

2. Salivary Glands :-

Human Body म� 3 Pairs Salivary Glands पायी जाती ह� ( Parotid Gland, Sub Mandibularएवं Sublingual Gland ).

Parotid Gland यह Largest SalivaryGland ह� जो अपने Secretion को StensenDuct के �ारा Oral Cavity म� छोड़ती ह�

o Volume of Saliva :- 1000-1500 ml/day

o pH of Saliva :- 6.35-6.85 Slightly Acidic

Enzyme in Saliva :- Amylase ( Ptyline )यह Cooked और Boiled food एवं Starchको Dextrin & Maltose म� बदल देता ह� ।

IgA found in Saliva.

Oesophagus :- Length - 25 cm.

Upper Oesophageal Sphincter - Cricopharyngeal

Lower Oesophageal Sphincter - Cardia

Anil Kantiwal ( OM Nursing Academy )

Stomach :-

Stomach यह एक J Shape का Muscular organ ह�

Parts - Cardiac Region, Fundus, Body or Corpus एवं Pylorus Region.

Glands of Stomach :-

1. Fundic Gland - यह Fundus Part म� पाई जाती ह�

A. Parietal Cells or Oxyntic cells :- ये Cells HCLHydroChloric Acid एवं Instrinsic factor को secretकरती ह� । AIIMS JDPR 2016

B. Chief Cells :- ये Pepsinogen, Rennin और Lipase काsecreation करती ह� AIIMS BBSR 2018

C. Mucus Neck Cells :- ये Mucin का Secreation करती ह� ।

2. Pyloric Glands :- ये Pylorus Part म� पाई जाती ह� ।

A. G - Cells :- यह Gastrin hormone का secreation करती ह� जो gastric glands कोStimulate करके Gastric Juice Secreation म� help करता ह� ।

Gastrin यह Pancreas को भी Stimulate करता ह� �जससे Pancreatic Juice काsecreation हो सके ।

Gastric Juice :-

Volume - 1200-1500 ml/Day

pH - Highly Acidic 1.5 to 3.5 Due to Presence of HCL

Food Stay in Stomach :-

Carbohydrate meal :- 2 to 3 hour

Protein Meal :- 3 to 3.5 hour

Fat Meal :- 3.5 to 4 hour

Mixed Diet :- 2.5 to 3 hour.

Enzymes in Gastric Juice :-

Pepsinogen :- Pepsinogen यह HCL क� presence म� Pepsin म� convert हो जाता ह�,Pepsin यह एक Proteolytic enzyme ह� जो Protein को Proteases, Peptones एवंPolypeptides म� convert कर देता ह� ।

Gastric Lipase :- यह एक Weak Lipolytic enzyme ह�

Anil Kantiwal ( OM Nursing Academy )

Pancreas :- Pancreas दो Organ �क तरह काय� करता ह�।

1. Endocrine function - Production of Hormones

2. Exocrine Function - Secreate Digestive Juice

Pancreas यह Acini cells से �मलकर बना होता ह�

Carcinoma Pancreas के Head म� common ह� ।

Icelets of Langerhans सबसे �यादा Pancreas के Tail पाट� म� पायी जाती ह� । AIIMS BBSR

Pancreas म� 99% Exocrine Part और 1% Endocrine Part होता ह�

Pancreas का Weight - 60gm

Pancreatic Juice Volume - 500-800ml/day इसक� pH 8-8.3 होती ह� Highly Alkalinedue to Bicarbonate.

Enzyme in Pancreatic Juice :-

1. Proteolytic Enzyme - Trypsinogen ( Trypsin ) & chymotripsinogen

2. Lipolytic Enzyme - Lipase ( Powerful lipolytic Enzyme. )

Liver :-

Liver is the Largest Gland of the Body. ( Exocrine Gland )

यह Secretory एवं Excretory Organs क� तरह काम करती ह�, एक Normal Adult म� इसकाWeight 1.5 kg के लगभग होता ह� ।

यह Bile Produce करता ह� जो Digestion म� सहायक ह�

Main Metabolic Organs of the Body.

Maximum Heat is Produced in Liver.

Liver secret Anticogulant is Heparin.

Liver म� कुछ Special Macrophases cells ( Kupffer Cells ) पायी जाती ह� जोPhagocytosis का काम करती ह� ।

Liver को सबसे �यादा Blood supply 1500 ml/�मनट होती ह� । ( 20% of Total CardiacOutput).

Common location of Liver Abscess is - Right Lobe of Liver

Anil Kantiwal ( OM Nursing Academy )

Gall Bladder :- Reservoir of Bile.

Bile �लवर से secret होता ह� ले�कन Store Gall Bladder म� होता ह� ।

Storage of Bile :- 30-60 ml

Bile Volume - 800-1200 ml/Day ( pH of Bile - 8-8.6 )

Bile Salt :- Bile Salts are

Sodium/Potassium Taurocholate.

Sodium/Potassium Glycholate

Bile यह Lipid Emulsification म� सहायक ह� ।

Small Intestine :- Length - 5 meter

Small Intestine म� Villi एवंMicro Villi पायी जाती ह� जो Mucous membrane के surfacearea को बढ़ा देती ह� �जससे Food के बहेतर Absorption म� सहायता �मलती ह� ।

Brunner Glands - यह Mucous एवं Enzyme secret करती ह�

Parts of Small Intestine :-

1. Duodenum :- यह Small intestine का first Part ह� जो लगभग 25 cm length का होता ह� ।

Duodenum यह Cholecystokinin ( Pancreozyme ) नामक हाम�न को secret करती ह� ।

2. Jejunum :- Middle Section of Small intestine, Length - 2 meters

3. Ileum :- Terminal Section , Length - 3 meter

Ileum म� Payer's Patches ( lymphoid follicles ) देखने को �मलते ह� , Typhoid fever म�Payer Patches Inflammed & Ulcerated हो जाते ह� �ज�ह� Oval Ulcer कहते ह� ।

Succus Entericus :- Secreated by Small intestine ( Volume - 1500 ml/day )

लगभग 90-95% Nutrients का absorption Small intestine म� होता ह� बाक� 5-10%Stomach एवं Large Intestine म� ।

Large Intestine :- Length - 1.5 meters

यह Ileocaecal Valve से लेकर Anus तक फैली रहती ह� ।

Parts :- Caecam , Appendix, Ascending Colon, Transverse Colon, Descending colon,Sigmoid Colon, Rectum & Anus.

Transverse Colon यह Large Intestine का सबसे लंबा part ह� ( 45 cm ).

Anil Kantiwal ( OM Nursing Academy )

GERD :- Gastro Esophageal Reflux Disease

Back flow of Gastric content into Esophagus.

Clinical feature - Pyrosis ( Chest Burn ) , Indigestion & Epigastric Pain.

Position in GERD - Reverse Trendelenburg Position

Gastritis :- Inflammation of Stomach or Gastric mucosa.

Peptic Ulcer :-

Breakdown or Ulceration in the Mucosal wall of the Stomach, Duodenum andEsophagus.

Causes - Excess Secreation of HCL

Helicobacter Pylori ( H. Pylori )

Urea Breath Test - यह H. Pylori के detection के �लए करते ह� ।

Dumping Syndrome :-

Gastric Resection के कारण Gastric contents का Small intestine म� खाली हो जाना ।

Management - High Fat , High Protein or Low Carbohydrate

Dumping Syndrome यह Subtotal Gastrectomy का Complication ह� ।

Intestinal Obstruction :-

Most common Obstruction Occurs in Small Intestine ( 85 % ) Specially in theIleum.

Large bowel म� Obstruction के chance 15% और यह Mostly Sigmoid colon म� देखते ह� ।

Note :- Intestinal Obstruction के case म� Barium meal एवं Barium Enema नह� देनीचा�हय,े �य��क यह Constipation करती ह� �जससे Colon wall inflammed होकर Perforate होसकती ह� ।

Appendicitis :-

Inflammation of Appendix.

यह Emergency Abdominal Surgery का सबसे common Reason ह� ।

Clinical features -

Pain at McBurney Point ( Right Lower Quadrant of Abdomen ).

Anil Kantiwal ( OM Nursing Academy )

Rovsing Sign :- left lower quadrant को Palpate करने पर Right lower Quadrant म� दद�होना ।

Psos Sign :- Patient के लेटाने के बाद Mc Burney Point पर जसेै ही Pressure डालते ह� तोPatient Pain क� complain करता ह� ।

कभी भी Appendicitis म� Hot Application का use ना कर�, �य��क Hot Application applyकरने से Appendix Rupture हो सकती ह� व Peritonitis को Cause कर सकती ह� ।

Appendicitis म� Enema का use भी नही करना चा�हये ।

Gridiron Incision Appendectomy के case म� लगाते ह� ।

Hernia :-

Most common Hernia in Males - Inguinal Hernia

Most common Hernia in females - Femoral Hernia

Most Common Hernia in Children - Umbilical Hernia & Inguinal hernia

Strangulated Hernia :- Hernia ring के Pressure के कारण Herniated Bowel segmentक� Blood supply म� अवरोध आना ।

Management of Hernia - Hernioplasty

Position in Hiatus Hernia during eating - Elevated of head or Semi fowler Position.

Position in Inguinal Hernia - Squating Position

Pancreatitis :-

Acute or Chronic Inflammation of the Pancreas.

Clinical Features :-

1. Severe Abdominal Pain :- Pain occurs at left Upper Quadrant of Abdomen andRadiate to Back and Increase with fatty meal.

2. Cullen's Sign - Discoloration of the Abdomen and Periumbilical area

3. Turner's Sign - Bluish discoloration of the Flanks area.

Diagnostic Findings :-

Pancreatitis म� Serum Amylase or Serum Lipase का Level बढ़ा �आ �मलता ह� ।

Stool Examination :- Steatorrhea

Pain Management in Pancreatitis :- Meperidine

Anil Kantiwal ( OM Nursing Academy )

Cholelithiasis :- Stone in Gallbladder

Cholecystitis :- inflammation of gall bladder.

Murphy Sign :- यह Sign Cholecystitis के Patient म� देखा जाता ह� ( इसम� ExaminerHepatic margine के नीचे क� तरफ Fingers Press करता ह� तब तजे दद� के कारण Patient को�वांस लेने म� तकलीफ होती ह� )

Other Important Points

Sequence of Abdominal Examination :-

Inspection ---> Auscultation ----> Percussion ----> Palpation

Most Common cause of Liver Cirrhosis is Alcohol.

Sulfasalazine यह Ulcerative Colitis क� Drug of Choice ह� ।

Enamel यह Body का Hardest और Strongest part ह� जो कै��शयम काब�नटे एवं कै��शयमस�फेट का बना होता ह�, Enamel यह Teeth क� Outer covering का �नमा�ण करता ह� ।

Hirschprung disease (Aganglionic Megacolon) म� Ribbon like Stool देखने को �मलता है

Intusucception Disease ( Telescoping of Bowel ) म� Current Red Jelly Stool देखने को�मलता ह� ।

Wisdom teeth - Third Molar teeth को कहते ह� ।

Tenesmus - Ineffectual straining at Stool.

Deglutition center found in Medulla Oblongata.

Motilin Hormone - Motilin Hormone यह 22 �कर के Amino acids से �मलकर बना होता ह�जो Stomach एवं Intestine म� MO Cells से secreate होता ह�

Motilin hormone यह Peristaltic Movement के �लए Responsible ह� ।

Stool म� Pungent Smell यह Indole एवं Skatole के कारण होती ह� ।

Rennin ( Chymosin ) यह Milk Cogulation म� सहायक ह� ।

Most commom complication of Peptic Ulcer is Hemorrhage.

Celiac disease is due to Gluten Protein.

Rota Virus is main cause of Diarrhoea in Young and Children.

Orlistat ( Statins ) Drug, Obesity को Treat करने के �लए काम मे लेते ह� ।

Anil Kantiwal ( OM Nursing Academy )

Most common Position of Vermiform Appendix is Retrocaecal.

Satiated - feeling of fullness, discomfort, nausea and Anorexia.

Sjogren syndrome :- यह salivary gland एवं tear gland क� एक Auto immune diseaseह� �जसम� Mouth और Eyes म� Dryness देखने को �मलती ह� ।

Sialadentitis :- inflammation of salivary gland.

Esophageal Verices - Dilated and tortuous vein of esophagus caused by PortalHypertension.

A Child with Lactose intolerance can be develop calcium and Vitamin Ddeficiency.

Projectile Vomiting is Hallmark of Pyloric Stenosis.

Hemetemesis also indicates Portal Hypertension.

Hernia that is more prone to Strangulated is Femoral Hernia.

Carcinoma of Acinic cells is associated with Salivary Gland.

Curling Ulcer यह Burn का complication ह� जो Duodenal Ulcer का type ह� ।

Paralytic Ileus - inability of intestine to conduct the Peristalsis which leads toObstruction. ( GIT Surgery का यह एक मु�य complication ह� । ).

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