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Presented byMrs. P.AKILA, M.Sc( N),Lecturer
Faculty of Nursing, SRUDate:25.07.2014
Department of Medical surgical nursing
13th CNE on:
Nurses role :
Junctional Disturbance of G.I System
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introduction
A sphincter is a set of strong muscles that
control opening and closing in the body; the
anus is the largest sphincter in the body.
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Junctions
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Definition
Gastroesophageal Reflux disease, occurs when stomach acid,and sometimes bile, refluxes or flows back into the esophagusand mouth.
Basically, there is a one way valve between your esophagusand stomach that allows food to enter the stomach butprevents it from refluxing back into the esophagus.
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Epidemiology
Developed countries
Epidemic proportions;present in 40% of healthypopulation
Male, over 40 yrs
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Risk factors and causes
spicy diet ,alochol uptake, carbonatedbeverages , stress ,coffee &teaconsumption
prolonged gastric emptying
obesity
pregnancy
hiatal hernia
trauma
transient LES relaxation
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Pathophysiology
Dysfunction of LESWhen LES becomesweak or does notclose properly, then
acid reflux can occur.
Barrier function:prevents reflux by
mutual contractionwith diaphragm&retains high pressureduring gastricdigestion
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8
Symptom- HEART BURN
Length & frequency of esophageal acid exposureTo HCl, Pepsin, bile acids & pancreatic enzymes
pH < 2.0 Diffusion potential@ surface epithelial
cells
Cellularpermeability
H+ penetrateintracellular space
H+ reach deepersensory nerveendings
Heartburn
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Symptoms
Retrosternal burning pain - may start inabdomen and extend up into the neck
Heartburn
Dysphagia
Dry cough , Hoarseness & sore throat.
Acid reflux
Lump in the throat
Bleeding Chest pain
Erosion of teeth and gums
Difficulty breathing
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Diagnosis1. pH analysis
2. Barium Swallow
3. Endoscopy
4. Ambulatory Acid Probe TestTest is to measure the acid level (or pH balance) in esophagus
5. Esophageal Motility TestingThis test measures the movement of the esophagus as well as esophageal
pressure.
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Complications
Chronic esophagitis erosivechanges
StricturesDYSPHAGIA
Barrets esopgagusDysplasia
Adenocarcinoma
.
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Medications
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Lifestyle modification
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Nursing management
Iodized Salt.
Insist the patient to sprinkle a little bit of salt on thoseveggies in your GERD diet.
Pineapple it contains Bromelain and papaya contains Papain,both substances known as proteases which are digestiveenzymes that help with the breakdown of protein alleviatethese symptoms.
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Very Hot Food and Liquid.
which can intensify the symptoms of acid reflux.
Mint and Chocolate.
Both peppermint and chocolate contain chemicals that can
stimulate the release of stomach acids & also relaxes thesmooth muscle sphincter between the stomach andesophagus.
Spicy diet.
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Cont
Ideal diet is eat low-fat, high-protein meals & eat smallermeals more frequently
Beverages
that commonly trigger heartburn or make it worse,include,
Coffee or tea & Carbonated beverages
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Foodsthat commonly trigger heartburn
Citrus fruits
Tomato sauce and salsa
Fatty or spicy foods, such as chili or curry Onions and garlic
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Pyloric stenosis
Pyloric stenosis is narrowing (stenosis) of the opening from the stomach to the firstpart of the small intestineknown as the duodenum
Due to enlargement (hypertrophy) of the muscle surrounding opening (the pylorus,meaning "gate"), which cause spasms when the stomach empties.
It causes severe projectile non-bilious vomiting.
It felt classically as an olive-shaped mass in the middle upperpart or right upperquadrantof the infant's abdomen.
http://en.wikipedia.org/wiki/Stenosishttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Hypertrophyhttp://en.wikipedia.org/wiki/Pylorushttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Epigastrichttp://en.wikipedia.org/wiki/Right_upper_quadrant_(abdomen)http://en.wikipedia.org/wiki/Right_upper_quadrant_(abdomen)http://en.wikipedia.org/wiki/Right_upper_quadrant_(abdomen)http://en.wikipedia.org/wiki/Right_upper_quadrant_(abdomen)http://en.wikipedia.org/wiki/Epigastrichttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Pylorushttp://en.wikipedia.org/wiki/Hypertrophyhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Stenosis8/11/2019 Akila Cne 2014 July99
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Epidemiology
1.Males are more commonly affected than females ,and males
babies affected about four times
2.genetic predisposition.
It is commonly associated with people of Scandinavian ancestry, and
has multifactorial inheritance patterns.
3. blood typeB or O are more likely than other types to be affected.
4.Infants exposed to erythromycinare at increased risk fordeveloping hypertrophic pyloric stenosis, especially when the drug is taken
around two weeks of life and possibly in late pregnancy life.
http://en.wikipedia.org/wiki/Genetic_predispositionhttp://en.wikipedia.org/wiki/Blood_typehttp://en.wikipedia.org/wiki/Erythromycinhttp://en.wikipedia.org/wiki/Erythromycinhttp://en.wikipedia.org/wiki/Blood_typehttp://en.wikipedia.org/wiki/Genetic_predisposition8/11/2019 Akila Cne 2014 July99
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causes Genetic and environmental factors may contribute to the
development of pyloric stenosis.
classificationPrimary type
Occurs without involvement of any apparent underlyingdisease or predisposing factors
Secondary typeoccurs as a consequence of a disease process. In some
cases, the narrowing of the pyloric region is not due tothickened muscle tissue but due to fibrous tissue.
It is often associated with:
Presence of gastric and duodenal ulcers,
Benign or malignant tumors of the stomach,
Bezoars (a ball of swallowed material that blocks the
passage of food from the stomach into the intestines).
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Common clinical symptoms
projectile vomiting, nausea, upper abdominal pain,
anorexia, weight loss and early satiety.
Common clinical symptoms of adult pyloric stenosisinclude:
Projectilevomiting
of nonbilious (no bile) partiallydigested food, soon after eating
History of frequent pain in the upper abdomen which is
temporarily relieved after vomiting
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Symptoms. Conditions that cause edema, spasm or inflammation might further
narrow the outlet and precipitate pylorus occlusion that hasalready occurred.
rohnsdisease
, which may cause inflammation and adhesions inthe pyloric region.
Persistent spasm of the pylorus, possibly due to overactivity of thevagal nerve that supplies the pyloric region.
Reduced bowel movements resulting in mildconstipation
Manifestation of biochemical and electrolyte changes that resultsin metabolic alkalosis
http://www.medindia.net/symptoms/ankle-edema.htmhttp://www.medindia.net/patients/patientinfo/crohns-disease.htmhttp://www.medindia.net/patients/patientinfo/crohns-disease.htmhttp://www.medindia.net/patients/calculators/constipation-calculator.asphttp://www.medindia.net/patients/calculators/constipation-calculator.asphttp://www.medindia.net/patients/patientinfo/crohns-disease.htmhttp://www.medindia.net/patients/patientinfo/crohns-disease.htmhttp://www.medindia.net/patients/patientinfo/crohns-disease.htmhttp://www.medindia.net/symptoms/ankle-edema.htm8/11/2019 Akila Cne 2014 July99
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Pathophysiologygastric outlet obstruction due to hypertrophic pylorus & that impairs emptying of gastriccontents into the duodenum.
All ingested food and gastric secretions can only exit via vomiting, which can be of aprojectile nature.
loss of gastric acid (hydrochloric acid).
hypochloremiawhich impairs the kidney's ability to excrete bicarbonate. This is thesignificant factor that prevents correction of the alkalosis.
Due to the hypovolemia. The high aldosteronelevels avidly retain Na+(to correct the
intravascular volume depletion), and excrete increased amounts of K+into the urine
The body's compensatory response to the metabolic alkalosis & hypoventilation resulting in anelevated arterial pCO2.
http://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Hydrochloric_acidhttp://en.wikipedia.org/wiki/Hypochloremiahttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Volume_depletionhttp://en.wikipedia.org/wiki/Volume_depletionhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Volume_depletionhttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Volume_depletionhttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypochloremiahttp://en.wikipedia.org/wiki/Hydrochloric_acidhttp://en.wikipedia.org/wiki/Duodenum8/11/2019 Akila Cne 2014 July99
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DIAGNOSIS
Blood tests will reveal low blood levels
of potassiumand chloridein association with an increased bloodpH and high blood bicarbonate leveldue to loss of stomachacid(which contains hydrochloric acid) from persistentvomiting.
There will be exchange of extracellular potassium withintracellular hydrogen ions in an attempt to correct the pHimbalance.
http://en.wikipedia.org/wiki/Hypokalemiahttp://en.wikipedia.org/wiki/Hypochloremiahttp://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Hydrochloric_acidhttp://en.wikipedia.org/wiki/Hydrochloric_acidhttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Hypochloremiahttp://en.wikipedia.org/wiki/Hypokalemia8/11/2019 Akila Cne 2014 July99
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Cont Imaging studies: Imaging studies that are useful in the diagnosis of
pyloric stenosis are:
1.Abdominal X-ray
2.Abdominal ultrasonography
3.Gastrointestinal barium swallow study (UGI series): The pyloric canal appears elongated and narrow. A mushroom-like
deformity may be noted in the pyloric region.
4.Abdominal CT scan: Reveals the thickening of pylorus muscle and helps to exclude
secondary type of pyloric stenosis.
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Cont
Gastrointestinal endoscopy - rule out other causes of gastricoutlet obstruction.
Biopsy -A biopsy make be taken during endoscopy todifferentiate between the gastric cancer and pyloric stenosis.
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Description of surgery
An incision is made in upper part of abdomen& pylorus will beexposed & cut through the pyloric muscle.
The sphincter is sewn back together in a way that makes the openingwider.
The abdominal muscles is sewn back together& skin is closed withstitches or staples.
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Surgery
Pyloromyotomy
splitting of overdeveloped muscles and widening of gastricoutlet.
Partial gastrectomy
This procedure may be preferred in some cases since
stomach cancer may be a complication of longstandingpyloric stenosis.
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ont
Endoscopic dilatation: Dilatation of pyloric end of thestomach
gastroenterostomy
pyloroplasty.
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Possible Complications
Bleeding
Infection
Damage to intestines Hernia
Chronic diarrhea
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Nursing Care
Prior to Procedure
Npo after midnight. IVF I&O Note vomiting color and character, VS, daily weight NG monitoring, General hygiene & skin care Give laxative To stop taking some medications up to one week before the
procedure, Anti-inflammatory drugs Blood thinners Antiplatelets
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ont
Wearing gloves or masks
Keeping your incisions covered
Washing your hands often and reminding
visitors and healthcare providers to do the same Not allowing others to touch your incision
Position with head elevated,
Wound management & sterile technique Observe the signs for infection
Encourage parental involvement
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Sphincter of Oddi dysfunction
Thesphincter of Oddi is the muscular valvesurrounding the exit of the bile ductand pancreaticductinto the duodenum, at the papilla of Vater.
physiology
The sphincter is normally closed, opening only inresponse to a meal so digestive juices can enter the
duodenum for digestion.
http://www.ddc.musc.edu/public/organs/gallbladder.cfmhttp://www.ddc.musc.edu/public/organs/pancreas.cfmhttp://www.ddc.musc.edu/public/organs/pancreas.cfmhttp://www.ddc.musc.edu/public/organs/stomach.cfmhttp://www.ddc.musc.edu/public/organs/pancreas.cfmhttp://www.ddc.musc.edu/public/organs/pancreas.cfmhttp://www.ddc.musc.edu/public/organs/pancreas.cfmhttp://www.ddc.musc.edu/public/organs/stomach.cfmhttp://www.ddc.musc.edu/public/organs/pancreas.cfmhttp://www.ddc.musc.edu/public/organs/pancreas.cfmhttp://www.ddc.musc.edu/public/organs/gallbladder.cfm8/11/2019 Akila Cne 2014 July99
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SOD
Sod allows chemicals-bile from the liver and pancreatic juice from thepancreas-flow into the small intestine to aid digestion.
The sphincter of Oddi also prevents the contents of the bowel frombacking up into the pancreas and bile ducts.
SO
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SOD The mechanism of SOD is not completely known the
sphincter goes into "spasm. causes temporary back-up of biliary and pancreatic
juices, resulting in attacks of abdominal pain. SOD refers to two conditions that can affect the
sphincter of Oddi ,
papillary stenosis and biliary dyskinesia.
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SOD cont
Biliary dyskinesiais a gallbladder dysfunction where the biliaryducts fail to contract properly emptying of the biliary tree
It might give signal for existence of other, digestive disorders suchas acute or chronic pancreatitis, chronic inflammationorgallbladder stones.
Pyloric stenosis is condition when sphincter mechanism isdisturbed when hole is too tight there is a backup of bile andpancreatic juices which can result in abdominalpainand/orjaundice.
Blockage to the pancreatic orifice can cause pancreatic pain orattacks of pancreatitis.
http://www.ddc.musc.edu/public/organs/biliaryTree.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/pancAcute.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/pancChronic.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/gallstones.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/symptoms/abdominalPain.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/symptoms/abdominalPain.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/symptoms/jaundice.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/pancAcute.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/pancAcute.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/symptoms/jaundice.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/symptoms/abdominalPain.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/symptoms/abdominalPain.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/symptoms/abdominalPain.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/gallstones.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/gallstones.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/gallstones.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/pancChronic.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/pancChronic.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/pancChronic.cfmhttp://www.ddc.musc.edu/public/symptomsDiseases/diseases/pancreas/pancAcute.cfmhttp://www.ddc.musc.edu/public/organs/biliaryTree.cfmhttp://www.ddc.musc.edu/public/organs/biliaryTree.cfmhttp://www.ddc.musc.edu/public/organs/biliaryTree.cfm8/11/2019 Akila Cne 2014 July99
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SYMPTOMS
Abdominal pain
located in mid- or right-upper abdomen might also be felt in the backand shoulders & can be a mild, dull throbbing pain
Jaundice :
Prolonged obstruction may result in bile leaking back into the blood
stream Abnormalities of liver function tests
Yellowish discoloration of the eyes and skin
Nausea Vomiting
Fever and chills
Diarrhea
Di i f SOD
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Diagnosis of SOD
Blood test to check on liverand pancreasfunction (particularly alkalinephosphatase, transaminases and amylase/lipase).
Ultrasound and CT scansto look for structural causes
Magnetic Resonance Cholangiopancreatography (MRCP)and Endoscopic Ultrasound (EUS)
.
ERCP, with or without measurement of the sphincter pressures, by Sphincterof Oddi Manometry (SOM)
T t t
http://www.ddc.musc.edu/public/organs/liver.cfmhttp://www.ddc.musc.edu/public/organs/pancres.cfmhttp://www.ddc.musc.edu/public/tests/scans/CTscans.cfmhttp://www.ddc.musc.edu/public/tests/scans/MRIscans.cfmhttp://www.ddc.musc.edu/public/procedures/EUS.cfmhttp://www.ddc.musc.edu/public/procedures/EUS.cfmhttp://www.ddc.musc.edu/public/tests/scans/MRIscans.cfmhttp://www.ddc.musc.edu/public/tests/scans/CTscans.cfmhttp://www.ddc.musc.edu/public/organs/pancres.cfmhttp://www.ddc.musc.edu/public/organs/liver.cfm8/11/2019 Akila Cne 2014 July99
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Treatment
Anti-spasm medicines.
Surgery:
When sphincter of Oddi manometry has
confirmed that the pressures are high,sphincterotomy gives good relief of patients.
A stent is usually placed for a period of up totwo weeks to keep the sphincter open. Then
the stent is removed.
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Surgery
Transduodenal sphincteroplasty
complications
Bleeding and perforation,
Risk of pancreatitis is as high as 20%.
Possibility of recurrent symptoms after months or
years due to scarring of the sphincterotomy.
Ileocecal Valve
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Ileocecal Valve
The ileocecal Valve is located between the ileum and the cecum . Between the small
intestine and the large intestine is a sphincter-type valve called the Ileocecal Valve(ICV).
The purpose of this valve is to prevent backflow from the Large Intestine, once anymaterial leaves the Small Intestine.
It sends its watery waste products into the large intestine & Closes again quickly toprevent any materials in the large intestine
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Symptoms of Your Ileocecal Valve
It is a great mimicker. Sudden, stabbing, sharp low back or leg pain that
feels just like a disc pain
Sharp, pinpoint headaches, especially on the left side, at the base of theskull
Migraine headaches wide response to the toxicity of the ICV
Loose bowels not quite diarrhea
Any of the colon syndromes such as Crohns Disease, spastic colon,
irritable bowel, Celiac Disease may develop IV problem
Burning leg pain Asthma-like symptoms
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Ileocecal Valve Syndrome
Management Nursing care
Chiropractic adjustments
Applied kinesiology
Temporary elimination diet (for 2 to 3 weeks avoid )
Diet
Roughage foods--such as:popcorn, nuts, potato chips, pretzels, seeds,whole grains
Raw fruits and vegetables--such as: celery, bell peppers, cucumbers,
cabbage, carrots, lettuce, tomatoes
Spicy foods--such as: chili powder, hot peppers, salsas, black and cayenne
pepper, paprika, cloves, cinnamon
Stimulants--such as: liquors, alcoholic drinks, cocoa, chocolate, caffeine
products
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Brain Management Ileocecal Valve
dysfunction
The Way You Chew Your Food
You must chew your food as thoroughly as possible. If you dont chew your food
to liquid form, you are sending boulder through the tube to the ileocecal valve.
How you eat (overeating, eating too frequently, eating too quickly, eatingfoods you are sensitive to, under-chewing your food)
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Cont
The Quality and Texture of Food You re EatingI
Ironically, health food can cause problems because it has a higher
content of roughage.
poor chewing is more likely to create irritation.
Eating a typical fast food meal, its relatively easy for body to processbecause the food is highly refined. Relatively speaking, not chewing it isBad.
Particularly heavy with tuberous vegetables (carrots, broccoli, or beans),
chewing becomes much more of an issue.
Cont
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Cont
The Condition and Toxicity of Your Large Intestine
Your large intestine may be so toxic that you need some type of aDigestive Repair Program to approximating normal.
Perhaps direct cleansing of the colon with colonics or enemas.
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The Nerve Going To Your Valve
The nerve can be partially blocked, as in a spinal fixation, to prevent hyper-mobile irritation of the nerve root
Emotional trauma, or a stressful work situation also have direct impact on theICV through shutting down the body in general.
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48
Anal and perianal
disorders makeup about
20 of all outpatient
Surgical referrals. These
conditions are extremely
distressing and embarrassing
patient often put up with
symptoms for long time,
before seeking
medical care.
I
N
TR
O
D
U
C
T
I
O
N
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Anal in continence
Anal fissure
49
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50
Normal anal continence
depends on an intact
spinal cord reflex acting
on an adequate sphincteric
mechanism under corticalinhibitory control.
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Fecal incontinence
It refers to involuntary loss of gas or liquid stool (called minorincontinence) or
It may be involuntary loss of solid stool (called major incontinence).
Surveys indicate that it affects between 2 and 7 percent of the generalpopulation
C f i ti
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Congenital malformations of the anus in which the
sphincter is partially or completely lacking.
Trauma,
Accidental injury,
Obstetrical tears or
Operative trauma
52
Causes of incontinence:-
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Anorectal disease such as,
Hemorrhoids
Rectal prolapsed
Chronic inflammatory bowel disease
Faecal impaction, Destruction as carcinoma of anus.
Medical conditions e.g.spinal cord lesions.
Neurological and physiological diseases
( eg). spina bifida, spinal tumours and trauma
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The following are the clinical types:
True incontinence
Partial incontinence
Overflow incontinence
54
Clinical Features:
Diagnosis
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Diagnosis
Direct examinationHelp identify inflammation, tumors, that cause fecal
incontinence Anorectal manometry Internal pressure useful in revealing tone of the anal
sphincters.
Ultrasound or MRI Identifying structural abnormalities
Stool tests
FECAL INCONTINENCE TREATMENT
Three types of treatment are commonly used for fecal incontinence: medical
therapy, biofeedback, and surgery. The specific treatment(s) recommended willdepend upon the underlying cause of fecal incontinence.
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MANAGEMENT
sphincter tone improved by daily exercises.
Sacral nerve stimulationElectrical stimulation can eliminate leakage in 40 to75 percent of people whose anal sphincter problem
Anal electrical stimulationElectrical stimulation involves using a mildelectrical current to stimulate the anal sphincter muscles to contract, which canstrengthen the muscles over time
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Injectable bulking agentThe gel is injected into the anal sphincter justbelow the lining that may help build tissue in the anal canal, therebynarrowing the opening of the anus and allowing the patient to bettercontrol their anal sphincter.
This device was approved the US Food and Drug Administration for
clinical use in 2011 in patients ages 18 and up.
SurgerySeveral different surgical procedures can help alleviate fecalincontinence.
Nursing care
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Nursing care Bulking substances Methylcellulose (a form of fiber) is one type of bulking substance
that is commonly used. The recommend daily intake of fiber is 25 to 30 grams
Medications that reduce stool frequency
Anticholinergic medications
Treatment of impaction
Defecation programsscheduled toileting program.
BiofeedbackBiofeedback is a safe and noninvasive way of retraining
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10 Tips for Better Digestive Health
Eat a high-fiber diet.
Limit foods that are high in fat.
Choose lean meats fatty cuts of meat can lead to uncomfortable digestion.When you eat meat, select lean cuts
Incorporate probiotics into your diet. Probiotics are the healthy bacterianaturally present in your digestive tract.probiotics can enhance nutrient
absorption, help break down lactose, strengthen your immune system,and possibly even help treat irritable bowel syndrome.
Cont
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Cont Eat on schedule. consuming meals and snackson a regular schedule can help
keep your digestive system in top shape.
Aim to sit down for breakfast, lunch, dinner, and snacks around the same timeeach day.
Stay hydrated. Water in your digestive system helps dissolve fats and solublefiber, allowing these substances to pass through more easily.
Skip the bad habits:Smoking and avoid excessive caffeine and alcohol.
Exercise regularly."Regular exercise helps keep foods moving through yourdigestive system, reducing constipation,".
Manage stress.Find stress-reducing activities that you enjoy and practice them ona regular basis.
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http://www.everydayhealth.com/health-report/healthy-eating/smarter-snacking.aspxhttp://www.everydayhealth.com/health-report/healthy-eating/smarter-snacking.aspx8/11/2019 Akila Cne 2014 July99
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Thank you
