Identification number: TÁMOP /1/A

Transcription

1 Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master s Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP /1/A

2 Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master s Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP /1/A Erika Pétervári and Márta Balaskó Molecular and Clinical Basics of Gerontology Lecture 15 CHANGES OF THE GASTROINTESTINAL TRACT, ACUTE AND CHRONIC DISORDERS

3 Characteristics of geriatric patients delicate balance among the organ systems functional loss in the most vulnerable system, unrelated to the locus of illness masked, not typical symptoms (e.g. no pain in appendicitis) polymorbidity (interaction with other systems) altered drug disposition/clearance

4 Influence of aging on gastrointestinal (GI) disorders Interaction with other systems: ability to raise the cardiac output + maldistribution of circulation GI motility and/or absorption capacity (hypoxia in the apical part of the villi); postprandial: insufficient rise of GI-perfusion (abdominal angina) or hypoperfusion in other organs (fainting, AMI) diabetes, neurologic and vascular changes esophageal motility, gastric atonia, constipation, or even paralytic ileus stress (mental and physical limitations and isolation) atypical GI symptoms

5 Lifestyle changes in the elderly more severe complications of GI disorders decrease in fluid intake; decrease in protein intake (social and psychological causes); caloric malnutrition (weight loss); insufficient intake of trace elements, vitamins sedentary lifestyle (lack of exercise, obesity).

6 Common GI disorders in the elderly Upper GI tract disorders - Dysphagia syndromes, disorders of the esophagus - Disorders of the stomach and the duodenum Disorders of the lower bowel - Constipation - Fecal incontinence (pressure ulcers!) - Diverticular disease - Diarrhea (malabsorption, chronic pancreatitis) - Aging liver Cancers in the GI tract (e.g. esophagus, gastric cancer, colorectal carcinoma)

7 Dysphagia syndrome, esophageal disorders dental, oral disorders (stomatitis, denture), xerostomia + dysphagia (caused by drugs, cerebrovascular or neuromuscular disorders) malnutrition, aspiration esophageal carcinoma progressive dysphagia, weight loss non-cardiac chest pain: 50% of cases have esophageal cause e.g. gastro-esophageal reflux nutcracker esophagus (manometric syndrome, high-amplitude peristaltic contractions confined to the distal esophagus)

8 Disorders of the stomach and the duodenum acid output incidence of duodenal ulcer intake of NSAIDs incidence of gastric ulcer stress + defensive factors gastritis, stress ulcer ulcers may lead to serious bleeding, perforation, penetration incidence of autoimmune gastric atrophy with achlorhydria and IF deficiency (pernicious anemia)

9 The most common gastric disorders in elderly GERD Gastric ulcer Atrophic gastritis Gastroparesis Gastric carcinoma

10 Common causes of constipation in the elderly Nutritional causes Functional causes Secondary causes (due to other diseases) Low dietary fiber Inadequate fluid and caloric intake Immobilization (terminal reservoir syndrome) Depression Confusion Neurological disorders (Parkinson s disease, cerebrovascular accidents, dementia) Endocrine disorders (hypothyroidism, hyperparathyroidism, diabetes) Colonic obstruction (ischemia, diverticular disease, neoplasms, irradiation) Drugs Opiates Anticholinergics Cation-containing drugs (Al, Ca, Fe) Diuretics etc. Others Incorrect interpretation of symptoms* * Many older people incorrectly believe that their bowel movements are abnormal.

11 Common causes of fecal incontinence in the elderly Anorectal incontinence (disorders of the anal sphincter and puborectal muscles) descending perineum (idiopathic) trauma anal surgery spinal cord injuries diabetic and other autonomic neuropathies Symptomatic incontinence colorectal disease with diarrhea Overflow incontinence impaired terminal reservoir capacity (aging, ischemia, cancer, resection) fecal impactation Neurogenic incontinence (sensory-cognitive factors) dementia confusion

12 Diverticular disease low-fiber diet asymptomatic colonic diverticula (sac-like projection of the mucosa and submucosa) bleeding diverticulitis (infection of the diverticula) peritonitis, paralytic ileus

13 Ischemic colitis Precipitating factors: - dehydration - hemorrhage - low-output heart failure - polycythemia - diabetes mellitus - digitalis The ischemic colitis is rare (many anastomoses), but its mortality rate is high.

14 There is a decrease in the absorption of vitamin D, folic acid, vitamin B, Ca, Cu, Zn, Fe and cholesterol. TÁMOP /1/A Aging and enteral absorption The small intestine has a large reserve capacity, aging has only subtle influences on the digestive and absorptive processes: Reduced intestinal blood flow. Decrease in the absorbing surface (30%), atrophied villi. Decreased activity of disaccharidases and aminopeptidases can lead to osmotic diarrhea (thin, watery), due to the bacterial breakdown of nondigested food.

15 Diarrhea and malabsorption in the elderly Major causes: infections drug side-effects (long-term and inappropriate use of antibiotics) chronic pancreatitis lactose intolerance Consequences are more severe (dehydration, hypovolemia, malnutrition) Cave! Alternating diarrhea vs. constipation (colon tumors!)

16 Disorders as consequences of malabsorption osteoporosis (calcium) sarcopenia (proteins) infections (vitamins, proteins, trace elements) pressure ulcers (proteins, fluids) anemia (Fe, B 12 ) dementia (B 12 ) GI tract disorders (fibers, fluids)

17 Aging liver Age-related changes are minimal, significant only in late stage: drug (alcohol) clearance cholelithiasis, cholestasis appearance of abnormal proteins

18 Major causes of upper GI tract bleeding TÁMOP /1/A CAUSE % Gastric ulcer 29 Duodenal ulcer 21 Gastritis 17 Esophagitis 14 Esophageal varices 12

19 Major causes of lower GI tract bleeding TÁMOP /1/A CAUSE % Diverticulitis 43 Vascular ectasia of right colon 20 Undetermined 11 Radiation proctitis 6 Colorectal carcinoma 5 Colonic polyps 4 Other 11

20 Causes of lower intestinal bleeding Ischemic colitis Colitis (infections, irritable bowel syndrome) Angiodysplasia Polyps Carcinoma Hemorrhoids Diverticula