GI/GU in Geriatrics Flashcards
(37 cards)
Causes of GERD
- sliding hiatal hernia
- reduced LES sphincter
- reduced pinching action of Crus of diaphragm
What types of things aggravate GERD sx’s
- large meals
- fatty fooda
- caffeine
- ETOH/smoking
- obesity
- supine after ingestion of meals
Typical GERD sx’s? Atypical sx’s
Typical:
- substernal burning with radiation to mouth/throat
- sour tasting regurgitation
Atypical:
- chronic cough
- difficult to control asthma
- laryngitis/hoarseness
- recurrent chest pain
What is done in all patients with new-onset GERD
upper endoscopy
If you patient has atypical or extraintestinal manifestations of GERD how do you work them up
- 24 hour pH probe
- need to rule out other causes (ACS, dissection, pulmonary disease)
What do you do for patients with severe refractory GERD w/ complications
Nissen fundolication: upper part of the stomach is wrapped around the LES to strengthen the spincter
Diverticulum? Diverticulosis? Diverticulitis?
diverticulum: sac like outpouchings in the colonic wall
diverticulosis–> presence of out pouchings
diverticulitis–> inflammation of out pouchings
Presentation of diverticulitis
- constant LLQ abdominal
- N/V
- +/- tender mass, fever, peritoneal signs
Complications of diverticulitis
- abscess
- obstruction
- fistula (most common with bladder)
- perforation
Labs w/ diverticulitis
- +/- mild leukocytosis
- amylase and lipase elevation
- urinalysis–> sterile pyuria
CT scan findings with diverticulitis
- localized bowel wall thickening
- increase in soft tissue density withing pericolonic fat pad
- presence of diverticula
Treatment of mild diverticulitis
- IV abx (emperic for gram neg and anaerobes)
- admission to hospital
–> PO cipro plus flagyl or augmentin
Surgical indications for diverticulitis
- failed medical management
- recurrent episodes of acute diverticulitis
- peritonitis
- failed percutaneous drainage of abscess
- fistula formation
- bowel obstruction
Definition of constipation
infrequent or unsatisfactory defecation <3 times per week
Risk factors for constipation
- malignancy
- endocrine/metabolic disorders
- neurologic disorders
- rheumatologic disorders
- psych disorders
- anatomic dysfunction
Complaints with constipation
bloating, fullness and incomplete evacuation
“alarm symptoms” in a patient with constipation
- hematochezia
- family hx of colon cancer/IBD
- anemia
- (+) fecal blood
- unexplained weight loss
- refractory constipation
- new onset w/o evidence of primary cause
Diagnostics for constipation
- abdominal xray
- urgent CT if “alarm” sx’s
- colonoscopy
- marker studies or colonic transit studies
Treatment of constipation with normal colonic transport time
- fluids
- dietary fibers
- stimulant laxatives (bisacodyl, senna)
- stool softener (cloase)
Treatment of constipation with slow transit time
- osmotic laxatives (sorbitol, actulose, polyethylene glycol)
- probiotics
Causes of acute diarrhea
- medications
- C diff
- infectious cause
Causes of chronic diarrhea
- fecal impaction
- IBS
- IBD
- malabsorption syndromes
- chronic infections
- colon CA
Diagnostics for acute diarrhea
- stool cultures
- C diff toxin assay
Diagnostics for chronic diarrhea
- colonscopy
- breath hydrogen/ methane test
- stool fat testing
- TSH
