Dr B Ravinder Reddy

Consultant Gastrointestinal & General Surgeon

Chief – Division of Clinical Nutrition

Care Hospitals

Hyderabad

MBBS, MS, FRCS (Edinburgh), FRCS (Glasgow)

bravinderreddy@doctor.com

Greetings From Care Hospital, Hyderabadwww.carehospitals.com

Dept.of Surgical Gastroenterology & Division of Clinical Nutrition

Stress

Gastrointestinal Tract

What is stress?

Is a biological term

Any stimulus or fear of pain that disturbs the normal equilibrium

Stimulus can be…

Physical

Stimulus can be…

Mental

Stimulus can be…

Emotional

Any stimulus that triggers a stress response

Stressor

Stressors can be…

Internal

External Thoughts

Beliefs Attitudes

Loss Tragedy Change

Stressors can be…

Positive

Negative

Positive Stress

EustressThis occurs when the level of stress is high enough to motivate a person into action to get things accomplished

Eustress

• Performing in a competition (play / sports / dance / debate)

• Taking a test• Moving into a new place / home• Giving a presentation

Negative Stress

DistressOccurs when the level of stress causes the body and the mind to respond negatively

Distress

• Failing an examination or test• Loosing money on stock market• Fighting with friend or family

member• Dealing with separation or divorce• Being late

Distress

The commonest cause of distress amongst professionals is related to their respective work!

If work is …

FulfillingMeaningful Rewarding

But work can often be…

ChallengingUnpredictable Hard

Thankless

What happens when a person is stressed?

Body’s Responds In An Automatic Way

Body’s Response to Stress

• Heart rate increases• Muscles tighten• Sweating increases• Adrenaline increases• Pupils dilate• Hearing improves

Fight / Flight Response

What happens if the stress continues?

Body becomes extremely tired or fatigued!

Fatigue can be…

Physical

Physiological Simple Tiredness Extreme Tiredness Chronic Tiredness

Mental Fatigue Metabolic Fatigue Immunologic Fatigue

Why do these changes happen?

Hans Selye

Hans Selye

Hans Selye’s GAS Theory

Causes physiological & psychological response.

Stress

These in turn induces a kind of adjustment….

General Adaptation Syndrome

General Adaptation Syndrome

Stress

Adaptation

Resistance

General Adaptation Syndrome

Stress

Exhaustion

Resistance

Disease

Effects of Stress

Short Term Long Term

Short Term Effects

• Blood is diverted from less vital organs to more vital ones

• Heart rate increases to supply more blood quickly

• Blood pressure increases to supply blood efficiently

• Respiratory rate increases to get more oxygen from the atmosphere

Short Term Effects

• Glycogen in liver & muscles is converted to provide more glucose

• Even more glucose is formed from non- carbohydrate substances, like proteins

How does this acute stress manifest?

Acute Stress: Signs & Symptoms

• Cold skin + gooseflesh, flushing of skin and feeling of warmth

• Breathlessness & dry mouth

• Difficulty in speaking, swallowing

• Abdominal discomfort + stomach ulcers• Loose stools

Acute Stress: Signs & Symptoms

• Increased blood glucose levels• Reduced energy stores

• Headache, back ache & neck pain• Increase in diseases like eczema,

psoriasis, arthritis

• Difficulty in concentrating & memory disturbances

Acute Stress: Signs & Symptoms

• Sleeplessness• Loss of appetite

• Decreased sexual drive

• Anxiety & Depression• Outbursts of anger

Long Term Effects Persistent Stress

Secretion of Stress Hormones

Body Experiences Extra StressDue to High Levels of Hormones

Irreversible Physiological Damages

Chronic Stress – Signs & Symptoms

• Chronic head ache & mood swings• Anxiety & memory disturbances

• Increased heart attacks & strokes because of increased blood pressure, sugar & cholesterol

• Substance abuse• Sleeplessness

Chronic Stress – Signs & Symptoms

• Weight loss

• Increase in allergies including asthma

• Irritable bowel disease• Inflammatory bowel disease

• Decreased sexual drive

Brain & GIT are highly inter-related

Gastrointestinal symptoms are very common

Effect of Stress

Stress & Gastro Intestinal Tract

Stress & Gastrointestinal Tract

• Digestion is disturbed

• Stomach emptying is delayed

• Large intestine empties faster (IBS)

Stress & Gastrointestinal Tract

• Increased incidence of ulcers

• Increased incidence of constipation and associated fissures & hemorrhoids

• Increased incidence of various cancers

Management of Stress

PRAISES

Self Help

PRAISES

P: Physical exercise (Time spent meeting the basic physical needs and self care / health care activities)R: Recreational activities (Time spent in the pursuit of fun or relaxation)A: Artistic activities (Time engaging in creative pursuits, or enjoying the creativity of others (eg, listening to music, drawing, going to movies / plays)

PRAISES

I: Intellectual time spent expanding or

engaging the mind by means of direct or

indirect learning activities

S: Spiritual efforts made to connect with

anything larger than the individual or family

(eg, religion, community)

PRAISES

E: Employment time devoted to the pursuit of financial goals

S: Social time spent with others

(eg, parenting, friends, associations)

Positive Attitude Helps

Same Positive Attitude…

bravinderreddy@doctor.com

Many Many Thanks

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