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Geri - GI, GU, Endo
GI, urinary, endocrine aging
| Question | Answer |
|---|---|
| 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
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