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GI I Exam I Geriatrics
3 questions
Health Care

Additional Health Care Flashcards




Physiologic changes with aging
Olfactory, taste losses
Histologic changes
Manometric change
NOT decrease in saliva secretions
Oropharyngeal dysphagia (Cricopharyngeal discoordination)
difficultly initiating swallowing, transferring food from oropharynx to upper esophagus
high risk of aspiration pneumonia
may develop a Zenker's diverticulum
Causes: stroke, Parkinson's, m gravis, myositis, lesion in medulla
Zenker's diverticulum
an outpouching through gaps in the muscles of the pharyngeal wall, immediately above the UES. These sacs collect food that becomes caught above the uncoordinated sphincter, slowly enlarging over time. They may enlarge enough to become a visible mass in the neck.
Patients with Zenker’s complain of coughing, gurgling in the neck, postprandial regurgitation and aspiration.
Diverticulectomy will reduce the danger of aspiration. Upper esophageal myotomy is done in some centers to improve the ease of swallowing
Achalasia - sx & dx
Long history, with insidious onset, of intermittent dysphagia to liquids and solids
Regurgitation of of undigested foods or aspiration
An esophageal motility disorder

widened mediastinum (massive dilation & tortuosity of esophagus)
*Barium swallow – “bird beak” narrowing*
Manometry is key diagnostic test:
Nonperistaltic contractions (Aperistalsis of the esophageal body)
Elevated esophageal pressure
Poor relaxation of LES
Very high pressure in LES
Path examination reveals a defect in the myenteric plexus.
Schatzski ring
"steakhouse syndrome" - pt swallows a bolus of food larger than their Schatzski ring

A ring found in the esophagus that can cause difficulty swallowing, especially solid foods.

- The A ring: A muscular asymmetric band of muscle that forms the upper border of the esophageal vestibule and is located approximately 2 cm above the gastroesophageal junction.

- The B ring: A diaphragm-like thin mucosal ring usually located at the squamocolumnar junction; it may be symptomatic or asymptomatic, depending on the luminal diameter.

Mechanical cause of dysphagia in older adults
(I only include stuff that's additional for geri - this is NOT all-inclusive GERD info)
30% prevalence in the elderly, i/c with increasing age

Dx - pH monitoring of esophagus, barium swallow, gastroesophageal endoscopy

Tx - in addition to what we've learned elsewhere - metaclopramide, H2 blockers, PPIs, surgical intervention
- criteria for surgery does NOT change with age
Gastric secretory & motor function in older adults
gastric acid secretions are reduced
- ? reduction in parietal cell mass
delay in liquid emptying (unchanged for solids)
*H. pylori*
- ↑ carriage with age
- 50% of adults by age 60 yrs are seropositive
- H. Pylori induced gastritis is a pivotal event in development of PUD

- depletion of mucosal prostaglandins
- Decreased reparation
- Increased risk of gastric/duodenal ulceration and bleeding
Diverticular disease
Prevalence is age-dependent
30% by age 60
65% by age 85
Most patients remain asymptomatic:
20% develop diverticulitis
10% develop diverticular bleeding
The mere presence of diverticulosis does not require specific therapy

- Often an incidental finding on screening exams
- Some patients complain of:
Nonspecific abdominal cramping
Irregular bowel habits
- Diverticular bleeding is usually painless and self-limiting, and rarely coexists with acute diverticulitis

Acute diverticulitis
- Usually presents with left lower quadrant pain
- Other potential symptoms—nausea, vomiting, constipation, diarrhea, dysuria, urinary frequency
- Physical exam usually reveals left lower quadrant tenderness, a tender mass, and abdominal distention
- CT scanning is the optimal imaging method in acute diverticulitis

Tx: fluids, antibiotics

All patients with complicated diverticulitis require surgery
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