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Geri - GI, GU, Endo

GI, urinary, endocrine aging

GI Aging: teeth & gums - Denture problems - Reduced chewing - Teeth lose masticating enameled area - Denture misfit, weak masticators
GI Aging: jaw atrophy teeth closer &/or farther apart
GI Aging: saliva - Dehydration →Reduced quantity - Swallowing difficulty - Dry mouth - Oral ms weakness: drool
GI aging: esophagus less mobile
GI aging: upper esophageal sphincter Takes longer to relax = feel full
GI aging: lower esophageal sphincter weaker - gastric reflux - heartburn - hiatal hernia
Intestinal aging - Malabsorption → malnutrition - Weaker peristalsis - Less lactase → more intestinal gas & diarrhea
Constipation - Insufficient fluid &/or fiber intake - Reduced blood supply → decr motility - Depression, confusion - Weakness - Inaccessible toilet
Constipation: colonic obstruction - fecal impaction - diverticulosis - tumor - radiation
Constipation: neurogenic - Parkinson’s - CVA - dementia
Constipation: endocrine - Hypothyroid - Hyperparathyroid
Constipation: drugs - Antidepressants - relaxants - Ca, iron - opiates - diuretics
Hepatic aging Decline/reduction: - Liver mass & blood perfusion - Protein binding - Drug metabolism
Aging renal anatomy: Decr... (4) - Kidney mass & wt - Nephrons: 30-40% fewer - Glomeruli # & size - Ms tone
Aging renal anatomy: Incr... (1) Arterial tortuosity (conn tissue condition, elongation & twisting of arteries)
Urinary aging: DIAPERS - Delirium - Infection - Atrophic urethritis/vaginitis - Pharmaceuticals - Psychosis - Excess urine output - Restricted mobility - Stool impaction
Aging renal physiology: Decline - Renal perfusion 50% - GFR - Renal tubules excretory & reabsorptive capacities - Metabolizing incr acids & bases
Aging renal physiology: Reduction - Blood filtered -> less blood in kidney: narrow vessels - Ability to reabsorb water & solutes from plasma - Ability to prevent water loss in dehydrated pt
Aging renal pathology - Too much/too little fluid - Too much/too little sodium - Too much potassium - Drug intoxication
Excessive K+: Young vs Old Young: - K exchanged for Na - K excreted, Na retained Old: Less K excreted -> More extracellular K -> Cardiac arrhythmia
Na/Water imbalance: Less able to excrete leads to (2) - Very dilute urine - Water
Na/Water imbalance: Diluted serum Na → (4) - Fatigue - Lethargy - Weakness - Confusion
Dehydration - Less able to conserve water - Loss of thirst mechanism - Mental changes
Dehydration: Na retention -> water retention More extracellular fluid: - CHF - Edema - HTN
Kidney changes: drugs - Lower clearance rate - Drugs retained longer - Younger adult dosage may be toxic
Bladder - Incr # of uninhibited contractions - Incr residual urine - Reduced capacity - Reduced ms tone - Reflux into ureters: risk infection
Incontinence: Urge - Need to empty, but insufficient time - Overactive bladder detrusor ms
Incontinence: Stress - Cough, strain, laugh, sneeze, sit-stand - Small void volume - Small post void residual volume
Incontinence: Overflow - Bladder distended: outlet obstruction, atony - Bladder pressure > urethral pressure - Weak sphincter - Small void volume - Large post void residual volume
Cholecystic aging Biliary stones more likely: Chol stabilization less efficient
Endocrine Aging: Incr (3) - Atrial Na peptide: diuretic -> nocturia - NE: BP by vasoconstriction - Parathormone: blood Ca & bone resorption - Insulin: need wt loss, exercise
Endocrine Aging: Decr (1) Corticotropin: stress response
Endocrine Aging: Women Incr: Testosterone Decr: Estrogen, progesterone
Endocrine Aging: Men Incr: Estrogen Decr: Testosterone
Thyroid: Thyroxin Controls: metabolism & temp Regulates: - protein, fat, carb catabolism - cardiac rate - force & output ms tone
Thyroid: Calcitonin - reduces serum Ca - inhibits bone resorption
Hypothyroidism: Signs & Symptoms - Dry skin - Jt pain - Lethargy - Confusion, depression - Wt gain - Edema - Cold intolerance
Thyroid: Circulating levels unchanged Decr production but decr degradation
Parathyroid - Stimulates Ca absorption from intestine & bone ***PTH incr with age Maintains Ca balance for: - nm irritability - blood clotting - cell membrane permeability
Pituitary - Incr resorption of water from kidney -> Incr BP Influences: - growth - thyroid - adrenocortex - melanocytes - vasopressin antidiuretic
Pituitary release stimulated by - Decr fluid volume - Incr osmolarity
Hypopituitary: 3 signs Lethargy, confusion, seizures
Insulin - Produced in pancreas, bc of incr blood glucose - Regulates metabolism of glucose, fat, carbs, proteins - Promotes entry of glucose into ms cells
Glucose intolerance ***Incr 25% by age 80
Diabetes Pathophysiology: Insulin - Healthy body adjusts glucose production by liver & uptake by mms - Tissue takes glucose from blood - suppresses hepatic glucose production - lowers plasma glucose
Diabetes Pathophysiology: Amylin - peptide co-secreted with insulin from pancreatic B cells - Modulates rate of nutrient delivery
Type 1 DM Autoimmune destruction of pancreatic B cells = deficient insulin
Type 2 DM - Liver produces excessive glucose - Insulin resistance in ms & adipose tissue Declined production of: - Pancreatic insulin - GI incretins (hormones)- facilitate response of pancreas & liver to plasma glucose fluctuations
Type 2 DM: Signs & Symptoms - Polyuria, polydipsia - Unexplained wt loss - Neuropathy - Nephropathy - Retinopathy - Accelerated atherosclerosis - Skin ulcers - Bacterial & fungal infections
Diabetes: Aggravating factors -Repetitive stress -Decr tactile sensation/proprio -Charcot neuropathic jts: Fragmentation & sublux -Autonomic neuropathy: decr sweating, dry skin -> fissures, callus -Infection -Deformities: weak intrinsic ms, pes planus -Plantar fat pad atrophy
Diabetes: Macrovascular disease - Stroke - MI: clots caused by platelet abnormalities - PAD: may have intermittent claudication - Lipid disorders - Thrombosis - HTN - Protein glycation: Glucose bonds to protein molecule
Diabetes: Microvascular disease - Abnormal vasoreactivity “ angiogenesis “ vasodilation & detoxification
Diabetes foot inspection & care: DO NOTs (8) - Smoke - Use chemical removers - Expose feet to high heat - Walk barefooted - Wear shoes without socks - Wear mended, holed, elastic top socks - Wear circular undies? - Wear thong sandals
Diabetes foot inspection & care: DOs (7) - Inspect feet daily, using mirror - Check b/w toes - Wash feet in warm water - Dry feet, esp b/w toes - Lubricate skin - Trim nails straight across - Check shoes for wrinkles, debris
Diabetic shoe - High, wide toe box - Resilient inner sole - High traction rocker outer sole
Created by: neej