Term
| Physiologic changes with aging |
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Definition
Olfactory, taste losses
Histologic changes
Manometric change
NOT decrease in saliva secretions |
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Term
| Oropharyngeal dysphagia (Cricopharyngeal discoordination) |
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Definition
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 |
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Term
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Definition
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 |
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Term
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Definition
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
Endoscopy:
Path examination reveals a defect in the myenteric plexus. |
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Term
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Definition
"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 |
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Term
GERD
(I only include stuff that's additional for geri - this is NOT all-inclusive GERD info) |
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Definition
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 |
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Term
| Gastric secretory & motor function in older adults |
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Definition
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
*NSAIDS*
- depletion of mucosal prostaglandins
- Decreased reparation
- Increased risk of gastric/duodenal ulceration and bleeding |
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Term
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Definition
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
Uncomplicated:
- Often an incidental finding on screening exams
- Some patients complain of:
Nonspecific abdominal cramping
Bloating
Flatulence
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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