Ageing 6: Digestive

Question 1

Describe age-associated enteric nerve changes

Answer 1

• Loss of enteric neurons, particularly in colon/oesophagus
• Loss in both myenteric (motor) and submucosal (secretion/absorption) nerve plexuses
• Reduced afferent activity (distension sensitivity; why might this matter?)

Question 2

Recall the categorisation of dysphagia

Answer 2

• Oropharnygeal (can’t get into oesophagus; stroke, neurodegenerative etc)
• Oesophageal (can be mechanical [solids] like cancer or stricture, or motilty [liquids] like achalasia [WIT?])

Question 3

GORD is more common in older people. Why might this be?

Answer 3

• Reduced saliva (?anticholinergics)
• Reduced secondary peristalsis (this happens w/ age)
• Increased prevalence of hiatius hernia (Pop)

Question 4

List drugs that can cause pill oesophagitis

Answer 4

• Aspiring
• NSAIDs
• Iron sulfate
• Alendronate (WIT?)

Question 5

Changes to stomach and small intestine w/ age

Answer 5

• Reduced acid secretion
• Impaired capacity to heal

Question 6

What causes anorexia of aging?

Answer 6

• Slowing of gastric empyting
• Raising level/increased sensitivity to hormones like CCK (satiation) and GLP-1
• Chronic disease may also influence

Question 7

Postprandial hypotension is more common with age. What is this condition, and what causes it?

Answer 7

• Hypotension following meal
• Associated with inability to compensate for redistribution of blood to splanchnic vasculature

Question 8

Causes of constipation in the elderly

Answer 8

• Bowel cancer (?bleeds, weight loss, anaemia, FHx)
• Mechanical (stricture, volvulus)
• NMSK dysfunction (stroke, dementia, Parkinson’s)
• Hormonal (hypothyroid, hypercalcaemia, diabetes [how?])

Question 9

Constipation mgmt

Answer 9

Laxatives (bulk forming, osmotic, stimulants) and/or enemas

Question 10

Causes of fecal incontinence in old age

Answer 10

• Reduced muscular strength to hold it back
• Less sensitisation (is it a fart or a shit?)
• Obstetric injury in women
• Neurological disease (spina bifida, diabetes)
• Impaired mobility (shit yourself in the chair)
• Overflow incontinence from constipation

Question 11

Faecal incontinence Ix

Answer 11

• Rectal manometry
• Response to rectal distention/sensitivity test
• Endoanal ultrasound

Question 12

Faecal incontinence mgmt

Answer 12

• Fibre intake (e.g. bran) to form solid stools
• Osmotic laxative if too hard
• Loperamide to slow intestinal motility