Transcript Changes of the gastrointestinal tract, acute and chronic disorders

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-4.1.2-08/1/A-2009-0011
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-4.1.2-08/1/A-2009-0011
Erika Pétervári and Márta Balaskó
Molecular and Clinical Basics of Gerontology – Lecture
15
CHANGES OF THE
GASTROINTESTINAL
TRACT, ACUTE AND
CHRONIC DISORDERS
TÁMOP-4.1.2-08/1/A-2009-0011
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
Influence of aging on
gastrointestinal (GI)
disorders
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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 
Lifestyle changes in the
elderly – more severe
complications of GI disorders
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• 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).
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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
Dysphagia syndrome,
esophageal disorders
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• 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
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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)
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The most common gastric
disorders in elderly
GERD
Gastric
ulcer
Gastroparesis
Atrophic
gastritis
Gastric
carcinoma
Common causes of
constipation in the elderly
Nutrition
al causes
Functiona
l causes
Secondary
causes
(due to
other
diseases)
Drugs
• 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)
• Opiates
• Anticholinergics
• Cation-containing drugs (Al, Ca, Fe)
• Diuretics
etc.
* Many older people
incorrectly
believe that their bowel movements
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-
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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
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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.
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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 non-digested
food.
There is a decrease in the absorption of
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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.
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Disorders as consequences of
malabsorption
• osteoporosis (calcium)
• sarcopenia (proteins)
• infections (vitamins, proteins, trace
elements)
• pressure ulcers (proteins, fluids)
• anemia (Fe, B12)
• dementia (B12)
• GI tract disorders (fibers, fluids)
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Aging liver
Age-related changes are minimal,
significant only in late stage:
•  drug (alcohol) clearance
•  cholelithiasis, cholestasis
• appearance of abnormal proteins
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Major causes of
upper GI tract bleeding
CAUSE
%
Gastric ulcer
29
Duodenal ulcer
21
Gastritis
17
Esophagitis
14
Esophageal varices
12
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Major causes of
lower GI tract bleeding
CAUSE
%
Diverticulitis
Vascular ectasia of
right colon
Undetermined
43
Radiation proctitis
6
Colorectal carcinoma
5
Colonic polyps
4
Other
20
11
11
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Causes of lower intestinal
bleeding
Ischemi
c
colitis
Angiodysplasi
a
Colitis
(infections
, irritable
bowel
syndrome)
Polyp
s
Carcinom
a
Hemorrhoid
s
Diverticu
la