BALDADO, YVONNE

IBMS BERATO, RUGENE

CABRERA, B LESSY
ESTRADA, HANNA

Group 5
LANTAYA, OPHELIA
PASCUA, MISH
STA ANA, RAFAELLA
 Are you ready?

Let's Start!
 8 years old, Female

Single, Student

Purok 5, Brgy. Langub, Davao

Patient
Filipino, Bisaya
"EM"
Ht. 122cm, Wt 22.5kg

BMI: 15.1, Underweight

100% reliability, from

mother
 Patient came into the
hospital to consult about
abdominal pain and
loose bowel movement
CHIEF COMPL
AINT
History of Present Illness
Past Medical History Personal and Social History: EM is 4th
child among 6 siblings.
4th grade student at Magtuod Elementary
Childhood Illness: Patient had
School.
occasional cough and colds but
She loves to play outside.
was only give home remedies.
Economic Status: Patient's mother is a
Immunization: Complete EPI
housewife and her father is a
immunization done at Brgy.
carpenter
Health Center
Living Environment: She lives with her
Allergies: No known drug and
parents and brothers in a rural area with
food allergies
water source coming from a deep well in
Maternal and Birth History: their neighbourhood.
Delivered by NSVD assisted by
Family Health History: Elder brother had
traditional birth attendant. No
episodes of loose bowel a week ago. No
noted complicati ons after
consultati on was done.
delivery.
No family history of Diabetes Mellitus,
Review of Syste m s
Neck: Supple neck, Trachea is in
midline, No noted lumps and
tenderness
Breasts: Symmetric, No mass
Respiratory: (+) tacti le fremitus,
equal chest expansion, no retrations,
resonant lung fields, vesicular
breath sounds, no wheezing
Cardiovascular: Regular rhythm, PMI
on 5th ICS mid clavicular line, no
murmurs
Hematology: ( - ) anemia
Abdomen: Flat, Hyperacti ve bowel
sound, (+) tenderness on deep
palpati on on both lower quadrants,
( - ) hepatosplenomegaly
Urinary: No dysuria or flank pain
Genetalia: No lesions and infecti on
Musculoskeletal: Underweight, No
myalgia, Normal bilateral extremiti es
Neurologic: No history of seizures, No
motor and sensory loss.
Endocrine: Unremarkable
Physical Examinati on
Skin:
(+) dry skin 90/60
(+) poor skin turgor
( - ) skin discolorati
110onbpm
( - ) rashes and
lumps 22 bpm
HEENT:
37 c Head: No history of head
injury, Normocephalic
Eyes: (+) sunken eyeballs, Anicteric sclera,
22.5 kg
No contact lenses or glasses, (+) PERLA
Ears: ( - ) ear deformity, Intact tympanic
membrane
122 cm Nose: Occasional colds, Alar flaring
Throat: (+) dry lips, (+) dry buccal mucosa,
No oral lesions
BMI: 15.1
Salient Features Dry buccal mucosa and tongue

Diarrhea: 3 x a d a y ( 1 0 0 -
Sunken eyeballs
200cc/episode)
Abdominal pain in both lower quadrants
Stool characteristics:
- yellowish Hyperacti ve bowel sounds
- foul odor
- watery Tympanic upon percussion
- no mucus
- no blood Tenderness on lower abdominal
Fever: 37.9̊ C quadrants upon palpati on
Vomited, 2 x a d a y ( 2 0 0 m l )
Poor s kin turgor, d r y skin
Tenesmus Irritability,
Dr y lips weakness Polydipsia
BP: 90/60
Underweight
 PROVISIONAL DIAGNOSIS

MODERATE DEHYDRATION
POINT TO SUPPORT:
• DIARRHEA
• VOMIT
• NAUSEA
• INCREASE HEART RATE
• IRRITABILITY
 Management:
MILD -
MODERATE
DEHYDRATION
Reduced osmolarity oral rehydration
solution (ORS) –
To replace ongoing losses.

Administration of OR via nasogastric tube

-
If oral rehydration is not feasible.
Management:
ABDOMINAL
PAIN

During abdominal pain, o r a l o r i n t r a v e n o u s

f l u i d can also be advised to make up for
fluid loss and rest the bowel.
But it still depends on what is may be the
cause if the patient’s abdominal pain
because some abdominal pain might require
medicine or other medical approach.
Importance of hydration in the circulatory system
loss and cell swells
 WATER
7
ABS O RPTIO N
VITAMIN About 9 liters of fluid enter the small intestine.
6 About 2.3 liters are ingested in foods and
ABS O RPTIO N beverages, and the rest is from GI secreti ons.
About 9 0 % of this water is absorbed in the small
The small intesti ne absorbs the vitamins that
intestine. Water absorpti on is driven by the
occur naturally in food and supplements.
concentrati on gradient of the water.
Fat-soluble vitamins are absorbed along with
The concentrati on of water is higher in chyme
dietary lipids in micelles via simple diffusion. Most
than it is in epithelial cells.
water-soluble vitamins also are absorbed b y
water moves down its concentrati on gradient
simple diffusion.
from the chyme into cells.
An excepti on is vitamin B12, which is a very
large molecule.
Intrinsic factor secreted in the stomach binds to
vitamin B12, preventi ng its digesti on and creati ng
a complex that binds to mucosal receptors in
the terminal ileum, where it is taken up b y
endocytosis.
Anatomy of Gastrointesti nal Tract

1 Oral C av i t y

2 Pha ry nx

3 E s op hag us

4 S tom ac h

5 Intesti nes to r e c t u m and an us

GI Tract is a
muscular tube
lined b y an
Epithelium.
Layers of Epithelium

1 M u co s a

2 Submucosa

3 Mascularis Externa

4 Serosa/Mesentery
 Components of GI Syste m
1 Oral C av i t y

2 Salivary Glands
Parotids
S ubmandibula
r Sublingual

3 Es o pha gus

4 S to m a c h
Components of GI Syste m
5 Small Intesti ne
Duod enum
Jejunum 7 Liver
Ileum

8 Gallbladder
6 Large Intesti ne
9 Pancrea s
C ae c um
Colon
Rectum
GI Physiology
Fo o d Ingesti on
Mastication (chewing)
Swallowing (deglutition)
Voluntary stage
Pharyngeal stage
Esophageal stage
Digesti on
Stomach

Absorpti on
Small Intestine
Large Intestine

Excreti on
Rectum
HISTOLOGY OF THE

G AS TRO INTES TINAL

T R AC T
A visual representati on of
Gastrointesti nal Tract Tissues
 MUC O S A SUBMUCOSA

Epithelium
Submucosal plexus
Lamina Propria
"Plexus of
Muscularis
Mucosae Meissner"

MUSCULARIS
A DV ENT IT IA /S ERO S A

Circular Layer
Myenteric plexus
 GENERAL HISTORY O F GIT
LAYE RS LO CAT IO N
MUCOSA INNERMOST

Epithelium: In Contact with

Nonkeratinized Stratified Lumen
Squamous to Simple
Columnar Epithelium
Lamina Propia: Deep to Epithelium
Loose Connective
Tissue to Diffuse Lymphoid
Tissue Outermost Layer of
Muscularis Mucosa Mucosa
Smooth Muscles
 GENERAL HISTORY O F GIT
LAYERS LO C ATI O N
SUBMUCOSA BETWEEN MU COSA AND
MUSCULARIS PROPIA
Mostly Dense Irregular
Connective Tissue

Meissner's Plexus
Delivers Parasympathetic
Innervations
 GENERAL HISTORY O F GIT
LAYE RS LO CAT IO N
MUSCULARIS PROPIA BETWEEN SUBMUCOSA
ANS S E RO SA
Thicker Smooth Muscle
Inner layer of Muscularis
Layers
Mucosa
Circular Layer

Between Circular and

Myenteric Plexus
Longitudinal layers f
Muscularis Mucosa
Longitudinal Layer
Outer layer of
Muscualris Mucosa
 GENERAL HISTORY O F GIT
LAYE RS LO CATI O N
SEROSA/ADVENTITIA OUTERMOST

Mesothelium Outermost layer of GIT

Simple Squamous
Epithelium
Subserosa Between Mesothelium
Loose to and Muscularis
Adipose Connective Propia
Tissue
Longitudinal Layer
Connective Tissue Outermost layer of:
without Mesothelium Esophagus, Duodenum,
Ascending & Descending
Colon, and Rectum
 HISTOLOGY O F MUCOSA
ORGAN EPITHELIUM

ES O P H AG U S No n- kerati nized
Strati fi ed S q u a m o u s

S T O MA C H Simple C o lum nar

S M A L L INTESTINE Simple C o lum nar

L A R G E INTESTINE Simple C o lum nar

ESO
PHA
GU
S
 A C H
STO M
 A C H
STO M
 S MA
LL
INTE
S T IN
E
 S MA
LL
INTE
S T IN
E
 R G E
L A
T I N E
N T E S
I
Biochemistry of Digestive
System
DIGESTED J U I C ES & ENZYMES SU BSTANCE DIGESTED PRODUCT FORMED

Saliva
Starc Maltose
Amylas
h
e

Gastric Juice
Protease (Pepsin) Protein Partly digested protein
Hydrochloric acide s

Pancreatic Juice
Proteins Peptides and Amino acids
Proteases (Trypsin)
Fats emulsified Fatty acids and Glycerol
Lipases
Starch Maltose
Amylase
Biochemistry of Digesti ve Syste m
DIGESTED J U I C ES & ENZYMES SU BSTANCE DIGESTED PRODUCT FORMED

Intestinal Enzymes
Peptides Amino acids
Peptidases
Sucrose (sugar) Glucose and Fructose
Sucras
Lactose (milk sugar) Glucose and Galactose
e
Maltose Glucose
Lactase

Maltas
e the Liver
Bile from
Fat globules Fat droplets
Bile Salts
 Carbohydrate
Digesti on
All the food that you eat
goes through your
digesti ve system so it can
be broken down and be
used by the body.
The journey of
carbohydrates starts with
the intake through the
mouth and ends with
elimination from the colon.
 C ARBO HY DRATE'S
JOURNEY
MOUTH

S TO MAC H
Digestion begins in the mouth.
Saliva secreted moistens the W h e n f o o d is s wa ll o w
e d , it
food when chewed. t r a v e ls t h e e s o p h a g u
s to
Amylase is released by the saliva the sto m ach.
for the breakdown of sugars in A t t h is s t a g e , f o o d is
now
the carbohydrates. re fe r re d t o a s c h y m e .
The st o m a c h creates
an
a c i d t o kill t h e b a c t e r
ia in
c hy m e .
C ARBO HY DRATE'S
C OLON
JOURNEY
Everything that is left
S M AL L INT ES TIN E, after the digesti ve
P AN CR EA S, LIV ER process goes to the
colon.
Chyme from the stomach goes to It is broken down by
the duodenum of the intestine, the intestinal bacteria.
causing the pancreas to release
pancreati c amylase, an enzyme that
breaks down the chyme into
dextrin and maltose.
Once this sugars are absorbed it will
be stored to the liver as glycogen.
 PROTEIN
DIG ES TIO N

Dietary Proteins huge complex

molecules that cannot be absorbed
by the intestine.
It can only be digested to small
simple molecules (Amino Acid) that
are absorbed from the intestine.
 Digesti on in Protein digesti on begins in the stomach by

the Stomach gastric juice.

1 2 4
3
ROLE OF GASTRIC PEPSIN RENNIN G EL ATINAS E
HCL
Milk clotting enzyme
Causes to denature An endopeptidase An enzyme that
Present in stomach of
proteins. acting on central liquefies gelatin
infants and young
Converts protein to peptide bond which is The end product of
animals.
metaproteins, which an aromatic amino protein digestion
Optimum pH: 4
are easily digested. acid. in stomach are:
Acts on
Activates pepsinogen Secreted as Proteoses, Peptones,
casein,
to pepsin. pepsinogen. and Large
converted to
Makes pH of the Optimum pH: 1.5-2.2 Polypeptides.
paracasein, binds with
stomach suitable for Activated by HCl and
calcium ions to form
pepsin action. by auto activation.
insoluble calcium
paracaseinate
 Digesti on in
the Small
1
Intesti ne
2 3 4

TRYPS IN CHYMOTRYPSIN EL AS TAS E CARBOXYPEPTIDAS

E
An endopeptidase
An endopeptidase that An endopeptidase that An exopeptidase that
acting on peptide
hydrolyzes central hydrolyzes central acts on terminal
bonds formed by
peptide, its carboxyl peptide, its carboxyl peptide at amino
glycine, alanin, and
group belongs to basic group belongs to terminus of the
serine.
amino acid. aromatic amino acid. polypeptide chain
Secreted as
Secreted as Trypsinogen Secreted as Releases a single
Proelatase
Optimum pH: 8 Chymotrypsinogen amino acid
Activated by Trypsin
It is activated by Optimum pH: 8
Digest Elastin and
enterokinase enzyme Activated by Trypsin
Collagen
and autoactivation
Optimum pH: 8
 LIPID
DIG ES TIO N

Lipids are non water-soluble large molecules. Lipids

are broken into small components for absorption.
Triacylglycerols and phospolipids are digested
1
as they encounter saliva in the mouth.

Chewing enables digesti ve enzymes to do their

2
tasks.
Lingual lipase along with the emulsifier
3 phospholipid initiates the process of digestion.
Breakdown of triacylglycerols into diglycerides
4 and fatt y acids happens in the stomach by
Gastric Lipase
Going to the Bloodsteam
As the stomach contents enter the small intestine,
the digesti ve system sets out to manage a small
hurdle to combine fats with water fluid. Bile is the
solution for this hurdle.
Bile contains bile salts, lecithin, and cholesterol
1
substances that acts as a own watery fluid.

Elmusifi cation increases the surface area of lipids

2 over a thousand-fold, making them more
accessible to the digesti ve enzymes.
Fat-breaking enzymes work on the
3 triaclyglycerols and diglycerides to sever fatt y Micelles allows effi cient transportation to the
acids from their glycerol foundation. 5
intestinal microvillus.
As pancreati c lipase enters the small intestine, it
Fats can travel through the watery environment
4 breaks down the fats into free fatt y acids and 6 of the body due to the process of emulsion.
monoglycerides to form micelles.
 NUCLEIC
ACID
DIG ES TIO N

Nucleic acids DNA and RNA are

found in most of the foods you eat.
Two types of nuclease are
responsible for their digestion:
Nucleoti des produced are further broken down by
two interstinal brush border enzymes: Nucleosidase
Deoxyribonuclease and
and Phosphatase into Pentoses, Phosphates, and Ribonuclease.
Nitrogenous bases.
 ABSORPTION
The goal of mechanical and digesti ve proc esses
is to convert food into molecules small enough to
be absorbed.
The absorpti ve capacity of the alimentary canal
is almost endless.
Almost all ingested food, 8 0 % of electrocytes,
and 9 0 % of water are absorbed in small
intestine. Most absorpti on of carbohydrates and
proteins occurs in the jejunum.

1 Acti ve Transport

2 Passive Diff usion

3 Facilitated Diff usion

4 Co-transport, secondary acti ve transport

5 Endocytosis
ABSORPTION IN THE ALIMENTARY C A N A L
ABSORPTION IN THE ALIMENTARY C A N A L
 PROTEIN
2
ABS O RPTIO N
Acti ve transport mechanism absorb most
C A R B O HYDRATE protein as their breakdown products.
1
ABSORPTION 9 5 - 9 8 % of protein is digested and absorbed
in the small intestine.
All carbohydrates are absorbed in form of The type of carrier that transport amino
monosaccharides. acids varies.
All normally digested dietary carbohydrates Dipepti des and Tripepti des are acti vely
are absorbed; indigesti ble fi bers are transported.
eliminated through feces.
The monosaccharides glucose and galactose
are transported into the epithelial cells.
Monosaccharides leave these cells via
facilitated diffusion and enter the capillaries
through intercellular clefts.
3 LIPID ABSORPTION
About 95% of lipids are absorbed in the
small intestine.
Short-chained fatt y acids are relatively water
soluble and can enter the enterocytes directly.
The large and hydrophobic long-chain fatt y
acids and monoacylglycerides are not so
easily suspended in the watery intestinal
chyme.
The core also includes cholesterol and fat-
soluble vitamins. Without micelles, lipids would
sit on the surface of chyme and never come
in contact with the absorpti ve surfaces of the
epithelial cells.
The free fatt y acids and monoacylglycerides
that enter the epithelial cells are reincorporated
into triglycerides.Triglycerides are mixed with
phospholipids and cholesterol, and surrounded
with a protein coat called Chylomicrons.
Liver cells combine the remaining chylomicron
remnants with proteins, forming lipoproteins
that transport cholesterol in the blood.

5
4 N UC L E IC ACID
ABSORPTION
Products of nucleic acid
absorption: Pentose sugars,
Nitrogenous bases, and
Phosphate ions.
Transported by carrier across
the villus epithelium via
acti ve transport.
MINERAL
ABS O RPTIO N
The electrolytes absorbed by the small
intesti ne are from both GI secreti ons and
ingested foods.
During absorpti on, co-transport mechanisms
result in the accumulati on of sodium ions
inside the cells, whereas anti -port
mechanisms reduce the potassium ion
concentrati on inside the cells.
All minerals that enter the intesti ne are
absorbed, whether you need them or not.
Iron and calcium are excepti ons; they are
absorbed in the duodenum in amounts that
meet the body ’s current requirements.
 DIFFERENTIAL DIAGNOSIS

RULED IN

BUT VOMITING
NOT ASSOCIATED WITH DIARRHEA
AND ABDOMINAL PAIN
 DIFFERENTIAL DIAGNOSIS

RULED IN

VOMIT
VOMITOUS WAS NOT BILE AND AND
STAINED DIARRHEA
NO BLOOD STAINED NOTED IN
THE STOOL
 DIFFERENTIAL DIAGNOSIS

RULED IN

LOWER ABDOMINAL PAIN

NO EVIDENT OF CLOUDY AND FOUL SMELLING AND BLOODY URINE
DIFFERENTIAL DIAGNOSIS

RULED IN

NAUSEA AND VOMITTING

DID NOT VOMITS, BLOOD
LOSS OF WEIGHT
 DIFFERENTIAL DIAGNOSIS

CANNOT RULE
RULED IN OUT

SEVERE VOMITING AND DIARRHEA, NAUSEA, DIFFUSE

ABDOMINAL PAIN, FEVER AND WEAKNESS
 ACUTE GASTROENTERITIS

• DIARRHEAL DISEASE OF RAPID ONSET WITH OR WITHOUT

ACCOMPANYING SYMPTOMS, SIGNS, SUCH AS NAUSEA, VOMITING, FEVER
AND ABDOMINAL PAIN

• DIARRHEA:
• THE FREQUENT PASSAGE OF UNFORMED LIQUID STOOLS (3 OR MORE
LOOSE, WATERY STOOLS PER DAY)
 AGE (EPIDEMIOLOGY)
REMAINS A MAJOR CAUSE OF MORBIDITY AND MORTALITY
WORLDWIDE:
- AFFECTING CHILDREN

IMPACT ON THE INCIDENCE:

- poor living condition
- insignificant improvement in water
- sanitation
- Personal hygiene
- lack of information
ACUTE GASTROENTERITIS
BACTERIAL AGENTS:
ACUTE GASTROENTERITIS
VIRAL AGENTS
ACUTE GASTROENTERITIS
PARASITIC AGENTS
Significance of the Case to the
Public Health
Gastroenteriti s in the pediatric populati on is one of
the m o s t d i s e a s e a n d that co u l d b e lethal.

Around the globe, it a c c o u n t s for around 10% of pediatric d e at h s

esti mati ng 7 0 millions d e ath per year a n d s e c o n d c a u s e of
d e at h worldwide.
Gastrointesti nal infecti on is a t y p e of d i s e a s e of the GI t rac t
c a u s e d b y the establishment a n d multi plicati on of microo rgan isms
in the GI tract.
A c u t e gastroenteriti s is ch a ra cte r i ze d b y diarrhea a n d in s o m e
ca s e s , vomiti ng that m a y result to fl uid a n d electrolyte losses,
leading to dehydrati on a n d electrolyte imbalances.
 Transmission
of Pathogens c a n b e
prevented by:

1 Hand Hygiene

2 Water Safety Interventions

3 Proper Food Handling

4 Safe Stool Disposal

5 Vaccine

6 Supplements
 Partner Insti tuti ons
The management and implementation of the FWBD-PCP are shared responsibility among the
following offices:

Infecti ous Dise ase Offi ce (IDO) - Health Promoti on and Communicati on
Dise ase Preventi on and Control Bureau Services (HPCS)
( D P C PB )
Re se a rch Insti tute for Tropical Medicine
(RITM) and Nati onal Reference
Environmental Health and
Laboratories (Parasitology, Bacterial
Sanitati on
Enterics and Viral Enterics)

Epidemiology Bureau (EB) Food and Drug Administrati on (FDA)

Health Em e rge n cy Management Bureau

Local Government Units ( LG U s )
(HEMB)
 FINAL DIAGNOSIS

ACUTE GASTROENTERITIS
SECONDARY TO MODERATE DEHYDRATION