Lets get healthy Dr Sanjiv Haribhakti, MS, DNB, MCh (GI Surgery) Kaizen hospital, 132 ft ring road, Nr helmet circle, Memnagar, Ahmedabad-380052
The digestive system
Effect of aging on digestive system Esophagus
• With age, the strength of esophageal contractions and the tension in the upper esophageal sphincter decrease, but the movement of food is not impaired by these changes • However, many older adults are likely to be affected by diseases that interfere with esophageal contractions
Effect of aging on digestive system Stomach
• Stomach lining's capacity to resist damage decreases, which in turn may increase the risk of peptic ulcer disease, especially in people who use aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) • Stomach cannot accommodate as much food (because of decreased elasticity), and the rate at which the stomach empties food into the small intestine decreases • Aging has little effect on the secretion of stomach juices such as acid and pepsin, but conditions that decrease acid secretion, such as atrophic gastritis, become more common
Effect of aging on digestive system Small Intestine
• Aging has only minor effects on the structure of the small intestine, so movement of contents through the small intestine and absorption of most nutrients do not change much • However, lactase levels decrease, leading to intolerance of dairy products by many older adults (lactose intolerance) • Excessive growth of certain bacteria becomes more common with age and can lead to pain, bloating, and weight loss • Bacterial overgrowth may also lead to decreased absorption of certain nutrients, such as folic acid, iron, and calcium
Effect of aging on digestive system Pancreas and Gallbladder
• Pancreas decreases in overall weight, and some tissue is replaced by scarring (fibrosis) • However, these changes do not decrease the ability of the pancreas to produce digestive enzymes and sodium bicarbonate • As the gallbladder age, a number of structural and microscopic changes occur
Effect of aging on digestive system Liver
• The color of the liver changes from lighter to darker brown. Its size and blood flow decrease. However, liver function test results generally remain normal • The ability of the liver to metabolize many substances decreases with aging. Thus, some drugs are not inactivated as quickly in older people as they are in younger people • the liver's ability to withstand stress decreases. Thus, substances that are toxic to the liver can cause more damage in older people than in younger people • Repair of damaged liver cells is also slower in older people. • The production and flow of bile decrease with aging. As a result, gallstones are more likely to form
Effect of aging on digestive system Large Intestine & Rectum
• The large intestine does not undergo much change with age • The rectum does enlarge somewhat
• Constipation becomes more common. This may be due partly to a slight slowing in the movement of contents through the large intestine and a modest decrease in the contractions of the rectum when filled with stool
What is Acidity ? • The stomach normally secretes acid that is essential in the digestive process. This acid helps in breaking down the food during digestion • When there is excess production of acid by the gastric glands of the stomach, it results in the condition known as acidity
How to avoid Acidity ? • A suitable diet must be strictly followed avoiding spicy, salty and acidic foods • Smoking and alcohol consumption must be stopped • Those with highly nervous and emotional disposition and those involved in high-stress jobs must be encouraged to take lifestyle modifying measures
How is GERD treated ? Lifestyle changes • Altering eating and sleeping pattern • Eliminate smoking and alcohol consumption • Weight reduction Drug therapy • Antacids - neutralize stomach acid • PPI - reduce stomach acid production Surgery • Nissen fundoplication
Helicobacter pylori infection • H pylori is a type of bacteria that normally infect the stomach • It can lead to problems such as ulcers developing in the stomach or duodenum • It is also associated with stomach cancer and an inflammation inside your stomach known as gastritis
Symptoms of H pylori infection • Abdominal pain • Excessive burping • Feeling bloated • Feeling sick or vomiting • Losing your appetite • Losing weight
How to prevent H Pylori infection ? • Work in ventilated area - allow for fresh air flow • Wash your hands frequently and properly • Only drink clean water from a reputable source • Broccoli sprouts has shown to inhibit H Pylori * • Eating cranberries, red grapes, and blueberries make H Pylori grow much more slowly and changes the shape of the bacterium into a coccoid form, so that it is no longer a helicobacter # * http://www.ncbi.nlm.nih.gov/pubmed/19349290 # http://www.ncbi.nlm.nih.gov/pubmed/19120894
What is constipation ? • Constipation occurs when bowel movements become difficult or less frequent • You are considered constipated if you have two or more of the following for at least 3 months: Straining during a bowel movement > 25% of the time Hard stools > 25% of the time Incomplete evacuation > 25% of the time Two or fewer bowel movements in a week
Constipation - when to consult doctor ? Call your doctor if: • Constipation is a new problem for you • You have blood in your stool • You are losing weight even without dieting • You have severe pain with bowel movements • Your constipation has lasted more than two weeks
How to prevent constipation ? • Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain bread and cereal (especially bran) • Drink 12 glasses of water everyday • Fiber and water help the colon pass stool • Exercise regularly
Treatment of UC Lifestyle changes • Limit dairy products • Eat more fibers - vegetables, fruits, bran • Take plenty of liquid • Avoid stress Drug therapy • Anti inflammatory - sulfasalazine, mesalamine • Immune suppressor - azathioprine, cyclosporin Surgery • Proctocolectomy
What is hernia ? • A hernia occurs when there is a weakness or hole in the muscular wall that usually keeps abdominal organs in place - the peritoneum. This defect allows organs and tissues to push through, or herniate, producing a bulge
• Hernias are caused by a combination of muscle weakness and strain • A hernia can develop quickly or over a long period of time, depending on its cause
Treatment of hernia • If the hernia is growing larger or causing pain, doctor may decide that it’s best to operate • Doctor may repair the hernia by patching the hole with surgical mesh • Hernias can be repaired with either open or laparoscopic surgery • Laparoscopic surgery uses a tiny camera and miniaturized surgical equipment to repair the hernia using only a few small incisions • Laparoscopic surgery is less damaging to the surrounding tissue
What are piles ? • Piles are swollen blood vessels in or around the anus and rectum • The haemorrhoidal veins are located in the lowest part of the rectum and the anus • Sometimes they swell so that the vein walls become stretched, thin, and irritated by passing bowel movements
Why do piles occur ? • The blood vessels around the anus and in the rectum will stretch under pressure and may swell or bulge • Inflamed veins (hemorrhoids) can develop when pressure increases in the lower rectum. This may be due to: • • • • •
Chronic constipation Chronic diarrhea Lifting heavy weights Pregnancy Straining when passing a stool
How to prevent piles ? • A change in diet can help keep the stools regular and soft. This involves eating more fiber, such as fruit and vegetables, or switching your cereal breakfast to bran • losing weight may help reduce the incidence and severity of hemorrhoids • Try not to strain when you go to the toilet • Avoid laxatives • Exercise
Surgery to cure piles • Used for particularly large piles, or grades 3 or 4 hemorrhoids • Hemorrhoidectomy - the excess tissue that is causing the bleeding is surgically removed. It is the most effective in completely removing piles, but there is a risk of complications, such as difficulties passing stools, as well as UTI • Hemorrhoid stapling - blood flow is blocked to the tissue of the hemorrhoid. It is usually less painful. However, there is a greater risk of hemorrhoid recurrence and rectal prolapse (part of the rectum pushes out of the anus)
What is cancer ? • Normal cells multiply when the body needs them, and die when the body doesn't • Cancer appears to occur when the growth of cells in the body is out of control and cells divide too rapidly • It can also occur when cells “forget” how to die • There are many different kinds of cancers
Most common cancers in India 35 30
25 20
28
15 10 5 0
Prostate cancer
30 17
13
Breast cancer Lung cancer
12 12 Colorectal cancer
Men
Women
7 Bladder cancer
6 Uterus cancer
4
Ovary cancer
Most common GI cancers
Colorectal cancer
Pancreatic cancer Esophageal cancer
Stomach cancer
Liver cancer
Risk factors of cancer ? There are multiple risk factors of cancers, including: • • • • • •
Radiation UV light Tobacco Certain viruses Benzene Genetic / Hereditery
Early detection of cancer • Early detection of cancer greatly increases the chances for successful treatment • There are two major components of early detection of cancer: • Education to promote early diagnosis • Screening
Education to promote early diagnosis of cancer • Recognizing possible warning signs of cancer and taking prompt action leads to early diagnosis • Increased awareness of possible warning signs of cancer can have a great impact on the disease • Some early signs of cancer include: • • • • • •
lumps sores that fail to heal abnormal bleeding per rectum persistent indigestion chronic hoarseness Difficulty in swallowing
Screening to promote early diagnosis of cancer • Screening refers to the use of simple tests across a healthy population in order to identify individuals who have disease, but do not yet have symptoms • breast cancer screening using mammography • cervical cancer screening using cytology screening methods including Pap smears • Colorectal cancer screening using colonoscopy • UGI cancer screening using UGI endoscopy
Lifestyle diseases
• Lifestyle Diseases are diseases that are caused partly by unhealthy behaviors and partly by other factors
Today's lifestyle
Abundance of fats & sugar
Change in work culture
Lack of Physical Exercise
Emotional Distrubances
Most common lifestyle diseases • CVDs • Diabetes Mellitus • COPD
Top 4 Lifestyle Diseases in India
• Cancer • Asthma • Disease of Digestive System (Peptic Ulcers, GERD) • Genitourinary Conditions (Nephritis, CKD) • Neuro-Psychiatric Disorders (Depression, Anxiety, Stress)
Obesity has reached alarming figures • More than 25% of Indians are overweight • More than 3% are Obese (3 crores Indians) • > 5% of urban adults are obese • > 15% of urban children are overweight
Complications of obesity
Surgery for morbid obesity
Gastric Bypass
Gastric Sleeve
Gastric Band
Planning a meal • Proportions and timings are important • Portions at each meal should be balanced and proportionate • Eat at regular intervals
08:00 AM
10:30 AM
01:00 PM
04:00 PM
Size of circle indicates size of meal
08:00 PM
09:30 PM
Health benefits of yoga & exercise • Yoga has been practiced for more than 5000 years • Speeds up a Sluggish Digestion by massaging surrounding muscles • Increases Muscle Flexibility, Strength & Endurance • Relieves Stress & Anxiety • Boost positive Energy and Mood • Help normalize Blood Pressure • Increases feelings of Calm & Wellbeing
Health benefits of meditation • It can reverse the Stress Response, thereby provides a shield against the effects of Chronic Stress • Heart Rate and Breathing slows down, Blood Pressure normalizes • Oxygen can be used more efficiently • Adrenal glands produce less Cortisol • Mind ages at a slower rate • Improves Immune Function
Stay physically active Gardening & Leisurely activities Use Stairs more often Self clean the house at least weekly
Stay physically active
Clean the Car by hand
Play with children everyday
Take optimum sleep of 8 hours
too much sleep can also cause fatigue
stay happy stay healthy