The major functions of the gastrointestinal tract are digestion of food, this is where food particle are broken-down and the other major function is absorption this is when food is transferred into the circulatory system to the cells for further use.
            The various parts of the gastrointestinal tract (GIT) includes:-

1.                  Mouth (oral cavity, tongue)
2.                  Teeth (inceision, molar and cuspids) 
3.                  Salivary (parotid, sublingual and submaxillary)
4.                  Pharynx (nasal, oral, langngeal)
5.                  Esophagus.
6.                  stomach (fundus, rugae, cardial sphincter, and pyloric sphincter)
7.                  small intestines (duo denum, jejunum, and deam)
8.                  Large intestines (cecum, ascencling colon tranverse desending colon, sigmoid, rectum and anus).
Functions of the parts of the (GIT) gastrointestinal tract     
1.                  The Mouth:- The mouth aids in chewing where the tongue contain the taste buds.
2.                  Salivary Glands:- Which moisten food, beginning the conversion of starches to sugars and lubricates the food as it travels through the Gastrointestinal tract (GIT).
3.                  Pharnyx:- aids in the travel of the food while
4.                  The Esophagus secrets mucus to aid the movement of food and serves in a passage way for food to enter the stomach.
5.                  The Stomach:- The stomach begins the digestion of protein, serves as a reservoir for food for 3-4 hours and also turns solid forms of food into a semi-liquid form called CHYME. in the stomach excretes to aid in digestion and absorption of needed nutrient and vitamins the stomach contain HCL acid (strong acid) that aids in the digestion of meats and protects us from foreign organisms, pepsin  for the digestion of proteins, intrinsic factor aids in the absorption of B12, mucin protects the stomach lining and water is a solvent that aid in digestion.
6.                  The small intestines are the longest part of the G.I tract and this is where 90% of digestion takes place. The wall of the duodenum secretes mucus to neutralize acids.
7.                  Large intestines:- The large intestine has two primary functions absorption and storage.
8.                  Anal canal:- aid in defecation which consist of unabsorbed food, bacteria and cell debris)

Disorders in the gastrointestinal tract and drug therapy for the disorder.
1.         Indigestion:- The sufferer of gastric discomfort must be certain that self-medication is appropriate, if so determined several therapeutic approaches can be used to alleviate the problem.

Non- medicinal approach (minimize acid rebound)  
            The stomach will pump out increased amounts of acid and juices following the consumption of all food and drinks (that includes bland foods and milk products). This causes increased gastric irritation 1-3 hours after eating or drinking, thus midnight snacks will result in early morning stomach discomfort because of the amount of acid rebound to avoid substance that stimulate gastric secretions.
            Avoid emotional situations that enhance gastric activities.
Medical Approach        
            The medication for the treatment of indigestion comes in a variety of forms depending on the cause of the gastric irritation the primary agents used for self- medication are classified as ANTACIDS these products may be promoted for an upset stomach caused by:-
a.         Heartburn
b.         Sour stomach
c.         acid indigestion
Note: That all antacids are relatively safe if used by healthy people but regular daily use can cause problem which can cause bowel irregularities (constipation or diarrhea)  
2.         Constipation:- laxatives are commonly used to accelerate the movement of food through the gastrointestinal tract. Laxatives the potential for loss of pharmacologic effect of poorly absort delayed acting and extended-release oral preparation by accelerating their transit through the intestine.
These drug can be classified into six but I will mention three(3).
a.         irritants and stimulants
i.          SENNA: This agent is a widely used stimulant laxative- its active ingredient is a group of sennosides, a natural complex of an thraquinone gloycoside. Taken orally, Senna causes evacuation of the bowels within 8 to 10 hours. In combination product with a docusate containing stool softener, it is useful in treating constipation mostly opioid- included constipation.
ii.         BISACODYL: Available as suppositories and enteric-coated tablets bisacodyl is a potent stimulant of colon. It acts directly on nerve fibers in the mucosa of the colon adverse effects include abdominal cramps and the potential for atonics colon with prolonged use. Avoid taking milk and drug like (antacids, ppls, and H2 – reception antagonists) at same time as the enteric-coated tablet in rmaturely of the enteric–coated tablet in the stomach resulting to stomach ach irritation and pain.
iii.       Castor oil:-This agents is broken down in the small intestine to ricinoleic acid, which is very irritating to the stomach and promptly increases peristalsis. Pregnant patients should avoid castor oil because it may stimulate uterine contractions.
b.         Bulk laxatives                   
            The bulk laxatives include hydrophilic colloids (from indigestible parts of fruits and vegetables). They form gels in the large intestine, causing water retention and intestinal distention thereby increasing peristaltic activity similar actions are produced by methylcellulose, psyillum seeds, and bran. They should be used cautiously in patients who are immobile because of their potential for causing intestinal obstruction.
c.         Lubricant Laxatives       
            Mineral oil and glycerin suppositories are considered to be lubricants and act by facilitating the passage of bard stools. Mineral oil should be taken orally in an upright position to avoid its aspiration and potential for lipid or lipoid pneumonia.
3.         DIARRHEA:- Anti-diarrheals increased motility of the gastrointestinal tract and decreased absorption of fluid are major factors in diarrhea. Anti diarrheal drugs used to treat diarrhea such as acute diarrhea include antimotility agents adsorbents and drugs that modify fluid and electrolyte transport.     
a.         Antimotility agents
            Two drugs that are widely used to control diarrhea are diphenoxylate and coperamide.
Both are analogs of meperidine and have opioid -like action on the gut, they activate presynaptic opioid receptors in the enteric nervous system to inhibit acetycholine release and decrease peristalsis. At the usual doses, they lack analgesic effects. Side effect includes drowsiness, abdominal cramps and dizziness because these drugs can contribute to toxic megacolon, they should not be used in young children or in patients with severe colitis.
b.         Adsorbents
            Adsorbent agents, such as aluminum hydroxide and methylcellulose are used to control diarrhea – presumably these agents act by adsorbing intestinal toxins or microorganisms and/or by coating or protecting the intestinal mucosa.
            They are much less effective than antimotility agents and they can interfere with the absorption of other drugs. 
c.         Agents that modify fluid /electrolyte transport
            Bismuth subsacicylate, used for traveler’s diarrhea, decrease fluid secretion in the bowel its action may be due to its salicylate component as well as its coating action. Adverse effect may include black tongue and black stools.
4.         LEAKY GUT SYNDROME: are clinical disorder associated with increased intestinal permeability. They include:-
a.         Inflammatory and infections bowel diseases
b.         Chronic inflammatory arthritides
c.         Cryptogenic skin condition like:-
i.          acne
ii.         Psoriasis
iii.       Dermatitis herpetiformis
iv.        Eczema
v.         Urticaria
vi.        Pancreatic carcinoma
vii.      Chronic Pancreatitis                  
Treatment of increased intestinal permeability (hyperpameability)
1.         Remove the cause: This includes the treatment of an intestinal infection avoidance of entero-toxic drugs (primarily NSAIDS and ethanol) and elimination of food allergens from the diet. Diagnostic methods for food allergy are controversial and a discussion of the merit and pitfalls of each method is beyond the scope of this chapter.
2.         Nourish the gut:- under normal condition, intestinal epithelium has the fastest rate of mitosis of any tissue in the body. The body (epithelium cell) requires protein, calories and essential fatty acid to repair old cell slough and generate a new epithelium, every three to six drugs so as to heal the damaged tissue or cell when they are not met hyperpermeability will exacerbates to maintain its integrity.
3.         Glutamine: among all the amino acids appear to have a special role in restoring normal small bowel permeability and immune function. Patients with intestinal mucosal injury secondary to chemotherapy or radiation benefit from glutamine supplementation with less villous atrophy. Increased mucosal healing and decreased passage of endotoxin thing of the gut wall.
4.         Ulcerative colitis: The treatment of patient with antibiotics followed by administration of non-pathogenes, standardized E-coli strains may induce and help to maintain remission, other probiotic therapies have not been tested in controlled trials although pouchitis (post inflammation of the heal pouch) has been shown to respond to respond to very high doses (450 billion C FUs/ day or more) of a mixture of lactic acid and bifidobacteria. Thus preparation is now being tested as an aid to maintenance of remission in patients with ulcerative colitis.

5.         Acid- peptic Disease                
            Hydrochloric acid produces much of the cellular damage and symptomatology of peptic ulcer diseases gastritis and gastroesopheigeal reflux disease, gas tropathy, atrophic gastritis and gastric lymhoms the treatment involves eradication of H. pylori with antibiotics and ppls has revolutionized conventional treatment of these conditions.
            Several natural products have been advanced as alternatives to antibiotics, but evidence to support the use is minimal. Example includes pastitia lentiscus resin or mastin gum which is used as food component in the mediterranean and as treatment of gastric disorders by the traditional healers. It kills H. pylori in vitro at concentrations equivalents to administration of 1000mg twice a day. These ppls: inhibitors of the H+ /k+ ATpase proton pump used in suppressing acid production and healing peptic-ulcers has made them, they preferred drugs for stress ulcer treatment and prophylaxis, treating erosive esophagitis and active duodenal ulcer and long term treatment of pathologic hypersecretroy conditions (for example, zollinga – Eclison syndrome in which a gastric –producing tumor causes hypersecretion of Hct) They are also appoved for the treatment of GERD and have gained favour over H2 antagonist. It reduces risk of bleeding from a ulcer, caused by aspirin and other NSAID.
            Finally it should be taken 30 to 60 minutes before breakfast or the largest meal of the day and if H2 – receptor antagonist is needed it should be taken well after the ppls for best effect because the H2 antagonist will reduce the activity of the proton pumps in adverse effect the ppls are generally well tolerated.
6.         Irritable bowel Syndrome (IBS)    
            Irritable bowel syndrome (also called spastic colon or nervous stomach) is a condition in which the colon muscle contracts more readily than in people without IBS. A number of factor can trigger IBS including certain foods, medicines and emotional stress symptoms of IBS includes abdominal pain and cramps, excess gas,  bloating, and a change in bowel habits such as harder, looser or more urgent stools than normal. Often people with IBS have alternating constipation and diarrhea.
Treatment of irritable bowel syndrome
Treatment includes avoiding caffeine, increasing fiber in the diet, monitoring which foods trigger IBS (and avoiding these foods) minimizing stress or learning different ways to cope with stress and sometimes taking medicines as prescribed by your health care provider.
7.         Anal disorder (Hemorrhoids)                               
            Hemorrhoids are swollen blood vessels that line the anal opening caused by chronic excess pressure from straining during a bowel movement, persistance diarrhea or pregnancy. These disorder is classified into two:-
1.                  Internal hemorrhoids
2.                  external hemorrhoids    

Interenal hemorrhoids:- are normal structures cushioning the lower rectum and protecting its from damage by stool. When they fall down into the anus as a result of straining, they become irritated and start to bleed ultimately, internal hemorrhoids can fall down enough to prolapsed (sink or protrude) out of the anus.
Treatment includes
Improving bowel habits (such as avoiding constipation, not straining during bowel movements and moving your bowels when you have the urge) using elastic bands to pull the internal hemorrhoids back into the rectum or removing them surgically. Surgery is needed only for a small number patients with very large painful and persistent hemorrhoids.
External Hemorrhoids       
External hemorrhoids are veins that lie just under the skin on the outside of the anus. Some times after straining, the external hemorrhoidal veins burst and a blood clot forms under the skin. This very painful condition is called a pile.
Treatment Includes
Removing the clot and vein under local anesthesia in the doctor’s office.
8. Dyspepsia: The sensation of difficulty in swallowing. it is a pain or discomfort located in the upper abdomen (stomach and upper small intestine)
Treatment of Dyspepsia 
It includes combination of :-
a.      diet
b.      eradication of H. pylori
c.      Acid-lowering medications
d.      Prokinetic and antiemetic agents
e.      centrally acting therapies
Acid lowering medications
·        H2 blockers such as:-
·        Ranitidine (zantac)
·        Cimetidine (tagamet)
·        Nizatidine (axid or
Famotidine (pepcid) are the initial agent used by many primary care providers and are marginally better than placebo at improving upper center abdominal (epigastric) pain, although they do not improve other dyspeptic symptoms. If the H2 blockers fail to improve symptoms most doctor then use a proton pump incubator (ppls) omeprazole
(prilosec) lansoprazole
(prevacid) rabeprazole
(aciphex)  pantoprazole
            The ppls (proton pump inhibitors) are approximately 10% better than placebo at improving dyspeptic symptoms.
Centrally Acting Therapies        
            Much of the control of digestive function and sensation is under central therapies that targets central control mechanisms, many have value in relieving symptoms. Tricyclic antidepressants, used in doses lower than required to treat depression may improve symptoms of dyspepsia in patients who have failed to benefit from treatment with H2 blockers or prokinetics. Hypnotherapy may improve dyspeptic symptoms in some patients, and a recent study found that hypnotherapy was better than medical therapy and supportive therapy at improving quality of life and symptom shores.
9.         Sphincter of oddi dysfunction
            A motility disorder characterized by severe steady pain with no structural abnormalities that explain the symptoms. It sometimes occurs following gall bladder removal, but also many occur with an intact gall bladder. It occur when the sphincter does not relax at the appropriate time (due to scarring or spasm).
Treatment of sphincter of odidi dysfunction               
            Treatment depends on what is found. It may often involve cutting the muscular sphincter (sphincterotomy) to remove any stones or to relieve any scarring or spasm of the sphincter.
10.       Dysphagia
            It is the sensation of solid and/or liquid foods sticking lodging or passing abnormally through the esophagus. It is diagnosed based on symptoms present for at least three months and not associated with anatomic abnormalities gastroesphageal reflux disease (GERD) or well recognized motility disorders such as adialaia (difficulty swallowing due to an absence of peristaltic contractions in the esophagus).
Treatment of Dysphagia         
            For mild symptoms avoidance or reduction of foods that worsen symptoms is recommended chewing food thoroughly during meals may also help.
12.       Globus  
            It is a sensation of a lump or ball in the throat typically felt in the throat at the level of the Adam’s apple. It is commonly experienced with an intense emotional experience, the disorder involves neck or throat pain, bleeding from the month or throat, weight loss, pain or difficulty in shadowing, muscle weakness. Heart burns commonly occur with globus.
Treatment of Globus  
            There is no specific treatment for glosus beyond the assurance that it isn’t the sign of a serious disease.
13.       Lactose Intolerance 
            Is the inability to digest these milk sugar symptoms are produced when lactose is not adequately absorbed in the digestive tract (malabsorption) symptoms may include watery stool or diarrhea, abdominal cramps, gas and/ or bloating experienced after eating drinking lactose –containing foods and beverages.
Treatment of lactose Intolerance       
            Individuals who experience symptoms of lactose intolerance from small amount of lactose- containing foods should look for words such as “whey”, “lactose”, “nonfat milk solids,” “butter milk”, “malted milk”, “margarine”, and “sweet” or sour cream” some breads dry cereals, cookies instant soups, breakfast drinks, and milk chocolate contain small amount of lactose also lactose is widely used as a filer or diluent (increases bulk) in tablets and capsules. Ask a pharmacist or if medications you take contain lactose.
14.       Narcotic Bowel Syndrome        
            The syndrome is characterized by chronic or periodic abdominal pain that gets worse when the effect of narcotic drug wear down in addition to pain which is the primary feature other symptoms may include: Nan sea, bloating- periodic vomiting, abdominal distention, and constipation.

Treatment of narcotic bowel syndrome    
            The UNC group has also developed a treatment approach. The  narcotic is with drawn and substituted with effective alternative medication to help manage the pain and bowel symptom until the narcoties are removed from the system. This requires the doctor and patients working closely together the treatment process usually takes  a week or two in the hospital but may take several weeks or months outside the hospital to implement it.
14.       Short Bowel Syndrome    
            Is a group of problems related to poor absorption of nutrients. It is sometimes known as short gut syndrome (or short gut) or intestinal failure. It typically occurs in people who have had half or more of that small intestine removed. Not enough bowel is left to absorb needed nutrition and fluid. The main cause of short bowel syndrome is surgical removal of half or more of the small intestine to treat intestinal disease, injuries, or defects present at birth.
Diarrhea is the main symptom of short bowel syndrome. Diarrhea can lead to dehydration, malnutrition, and weight loss.
Other symptoms may include: cramping, bloating, heartburn weakness and fatigue.  
Treatment of short bowel syndrome      
The main treatment for short bowel syndrome is nutritional support. Treatment may involve use of oral rehydration solutions parenteral nutrition, enteral nutrition and medications.
Long-term treatment and recovery depend in part on what sections of the small intestine were removed how much remains, and how well the remaining small intestine adoptions over time.
Intestinal transplantation may be an option for some patients for whom other treatment have failed and who have complication from long-term parenteral nutrition. These infection includes blood, infection, blood clots, and liver failure, which can lead to the need for liver transplantation and it take 2 year or more years for the intestinal adoption to occur.
15.       Volvulus      
            Is a condition in which the bowel twists on itself, causing obstruction to the flow of material through the bowel. It can also lead to obstruction of the blood supply to the intestine itself which can result in tissue death within the bowel volvulus is most commonly due to a birth defect called melioration, which is when the bowel becomes misaligned during fetal development. The bowel do not have a normal attachment to the abdominal wall, which make it possible for the bowels to shift out of their normal position or to rotate. Some children  with volvulus experience reducing episodes of vomiting with abdominal pain, which resolve without treatment. This may be due to a condition known as “intermittent volvulus”, which occurs when the bowel just happened to twist, then untwist on its own other symptoms which may occur include:-
a.                  Abdominal tenderness
b.                  Nauseas or vomiting
c.                  Vomiting gree bile looking material
d.                  Bloody or dark red stool
e.                  Constipation or difficulty expecting stools
f.                   Shock   
Treatment of Volvulus         
            Emergency surgery is necessary to repair a volvulus. An incision is made in the abdominal wall, and the bowels are untwisted and the blood supply restored. If a small segment of bowel to necrotic (dead from lack of blood flow) it is removed and the ends of the healthy bowel are sewn back together or used to form a colostomy or ileostomy (a tube to the outside through which bowel content can be removed. The term depend on where the tube is placed). If the entire bowel is necrotic, the outside look is poor and life threatening.
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