Geri Chapter 24 gastrointestinal function

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Age related changes in the oral cavity and pharynx
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Age related changes in the oral cavity and pharynx
- Loss of teeth, one for the adults were 65 or older are edentulous (without teeth). Periodontal gum disease is the cause.
- Taste buds: decrease in number and atrophy beginning at age 60, resulting in decreased ability discriminate a little salty and sweet followed by bitter and sour
- Xerostomia: (dry mouth) medications such as diuretics, anti-cholinergics, certain antidepressants, and antipsychotics reduce saliva production
- Healthy people 2020 set the goal to improve access to preventive oral care
Age-related changes in the esophagus
Decrease in strength of esophageal contractions and lower esophageal sphincter weakness, leading to decreased food transit time. They're more prone to reflux of acid from the stomach, or gastroesophageal reflux. EGD (upper endoscopy) every six months
Age-related changes in the stomach
- Decreased production of gastric acid, pepsin, bicarbonate, prostaglandins, and mucus. By 60, the gastric secretions decreased to 70% to 80% of the average adult.
- Decreased Pepsin: - hinder protein digestion
- Decreased Hydrochloric Acid and Intrinsic factor:malabsorption of Iron, Vitamin D B12, calcium, and folic acid
- Increased pernicious anemia, peptic ulcer disease (PUD), and stomach cancer
- Diabetics are affected
Age-related changes in the small intestine
- Atrophy and broadening of the villi leading to a decrease and absorptive surface, results in a decrease in the absorption of lipids.
- Decreased production of lactase, resulting in intolerance to dairy products
- Increase in the overpopulation of certain intestinal bacteria leading to bloating, pain, and weight loss
- Decrease in the absorption of calcium, folic acid, and iron because of the increase in intestinal bacteria
Age-related changes in the large intestine
- Atrophy of the muscle layers and mucosa
- Decrease contraction of the muscle wall when the rectum is filled with feces, resulting in constipation
- Higher incidence of diverticuli (small outpouchings of the colon)
Age-related changes in the gallbladder
- The gallbladder and bottled dogs are unaffected by aging
- Incidence of gallstones does increase with age
- These predispositions for stone development, along with a tendency for dehydration in older adults, explained increased incidence of cholelithiasis and cholecystitis in older adults
Age-related changes in the pancreas
• Atrophy of the pancreas • fibrosis • fatty acid deposits
- Volume of the pancreatic secretions decline with age
- Decrease in enzyme activity affects the digestion of fat and may account for vague intolerance of fatty foods in older adults
- Increased Incidence of pancreatic cancer and pancreatitis
Age-related changes in the liver
- Liver size decreases after 50
- A decline in cardiac output associated with aging contributes to a decrease in hepatic blood flow
- As hepatic blood flow slows, drug metabolism is reduced, which leaves the aging liver more susceptible to drugs and toxins
- 24 creatinine clearance is the lab
Prevention measures for colon Cancer for men and women aged 50 or older
- Fecal occult blood (FOBT) test every five years
- Flexible sigmoidoscopy every five years
- Colonoscopy every 10 years
- Double contrast. enema every five years
Common gastrointestinal symptoms (nausea and vomiting)
-Patient may state "I feel sick"
-It is important to obtain information about the amount and characteristics of the emesis and whether the vomitus contain food particles, vial or blood
Common gastrointestinal symptoms (anorexia)- "lack of appetite" - Weight loss, nausea, vomiting, abdominal pain, diarrhea, and constipation - Psychosocial factors such as stress, grief, pain, and concomitant illnesses.Common gastrointestinal symptoms (abdominal pain)- Visceral pathways: develop from stretching or distending the abdominal wall or from inflammation DIFFUSED, POORLY LOCALIZED, GNAWING, BURNING OR CRAMPING QUALITY - Somatic or parietal pathway: activated by receptors in the parietal peritoneum and other supporting tissues SHARP, MORE INTENSE, CONSTANT AND BETTER LOCALIZED - Referral pathways: pain felt at a different site than the source of the pain but sharing the same dermatome. SHARP AND WELL LOCALIZEDCommon gastrointestinal symptoms (GAS)- Belching, bloating, fullness, and flatus. - Nitrogen, oxygen, hydrogen, carbon dioxide, and methane - A frequency of 7 to 20 expulsions of gas a day is considered normal - Foods that cause gas include beans, cabbage, Legumes, raisins, and artificial sweeteners. - Patient for lactose intolerant may produce more gasCommon gastrointestinal symptoms (diarrhea)- Usually caused by C diff - Increased thirst, weakness, dizziness, palpitations, and fatigue - Diarrhea can account for up to 5 to 10 L of water loss dailyCommon gastrointestinal symptoms (constipation)- Hard, dry stools that are difficult to pass. - Bowel movements less than three times a week are often associated with constipation - Often caused by decreased fiber intake, mechanical abstraction, medication side effects, multiple comorbidities, and mobility and functional issues - it is treated through dietary measures such as increasing fluid intake and increasing fiber, Combined with light exerciseCommon gastrointestinal symptoms (fecal incontinence)- It is devastating and may significantly alter their quality-of-life - Maybe a result of colorectal lesions, Neurologic problems, laxative abuse, unrecognized lactose intolerance, diabetic neuropathy, poor dietary habits, and immobilityGingivitis- Inflammation of the gums surrounding the teeth, may result in pain and bleeding; email lead to periodontitis - Promotion of regular oral hygiene, regular preventive dental care, and maintenance of nutritional status - Professional care every 6 monthsPeriodontitis- A spreading of the inflammation to the underlying tissues, bone, or roots of teeth - Promotion of regular oral hygiene, regular preventive dental care, and maintenance of nutritional status - Professional care every 6 monthsThrushIt is an infection causing white lesions on the oral mucosa Prevent by rinsing mouth after medicineDysphagia- Difficulty swallowing - Weakened esophageal smooth muscle and incompetent sphincter function - It may compromise the nutritional status in the older adult, increase the risk of aspiration pneumonia, and lead to a decreased quality-of-life - Nursing care is aimed at ensuring the patient receive adequate evaluation, nutrition, hydration, and safe positioning doing meals to prevent aspirationGERD- It is a prevalent condition found in 20 to 25% of the older adult population - Causes are lower esophageal sphincter dysfunction, delayed gastric emptying, hiatal hernia, and increased intra-abdominal pressure - Older adults also take medications that increase the symptoms of Gerd like NSAIDs - Heartburn, retrosternal discomfort, and the regurgitation of sour, bitter materialGERD interventionsMaintenance of adequate nutrition, prevention of aspiration, and instruction to patients and their families about the disease process and treatment approach Avoid foods that increase symptoms, maintenance of health, and smoking cessation Support is key to successHiatal hernia (diaphragmatic or esophageal hernia)- It is a major cause of reflux and esophagitis, part of the stomach pertrudes through an opening of the diaphragm - Either part or all of the stomach and even the intestines may herniate, causing dyspepsia, severe pain, and often gastric ulcerationAtypical symptoms of hiatal herniaIndigestion or heartburn rather than pain Hoarseness Chest pain Postpandreal fullness Respiratory symptoms BelchingVitamin B12 deficiency (intrinsic factor deficiency)CAUSES -Malabsorption causes the majority of cases -Pernicious anemia -Gastritis, alcoholism, gastric surgery, inflammatory bowel disease, auto immune disorders, and long-term use of proton pump inhibitors (PPIs) -The decrease in production of the intrinsic factor, results in reduced absorption of vitamin B12 -Vitamin B12 deficiency impairs the production of red blood cellsGastritis (acute)-Causes transient inflammation, hemorrhages, and erosion into the gastric mucosal lining -It is frequently associated with a alcoholism, Aspirin or NSAIDs ingestion, smoking, and severely stressful conditions such as burns, trauma, CNS damage, chemotherapy, and radiotherapy -Abdominal painGastritis (chronic)-Involves inflammation of the stomach lining that may occur repeatedly or continue over a period of time. -Possible causes are ulcers, hiatal hernias, vitamin deficiencies, Chronic alcohol use, gastric mucosal atrophy, and peptic alteration -Abdominal painStressed induced gastritis- May occur in critically ill patients such as those with burns, sepsis, Multi organ failure, major surgery, or head injury - Two mechanisms are thought to produce stress ulcers 1) mucosal ischemia resulting from a lack of blood supply to the gastric mucosa during the post stress period 2) decrease in mucosal bicarbonate concentration leading to an increased sensitivity of the gastric mucosa to Hydrochloric acid and pepsin - Major manifestation is painless gastric bleeding INTERVENTIONS: * Acid suppressant medications, small, frequent, easily digested meals. Maintenance of calm environment, *Monitoring of fluid and electrolyte status, And teaching the older patient about precipitating and contributory factors *limiting or eliminating alcohol and tobacco use * avoid using aspirin and other NSAIDs G.I. bleed is a possible complication of gastritisPeptic ulcer diseaseHelicobacter pylori infection plays a central role in the development of peptic ulcer diseaseGastric ulcers (causes)The level of HCl secretion is usually normal or reduced. The problem lies in the increased rate of diffusion of gastric acid back into the tissue.Gastric ulcers (common signs and symptoms)The most common symptom with gastric ulcers is gnawing or burning pain in the epigastric region that comes and goes; EATING MAY LEAD TO PAIN RELIEF. Pain may be worse with an empty stomach, If the ulcer has eroded through the mucosa, food aggravate symptoms, rather than alleviating them Nausea, vomiting, and weight loss Hemorrhage and peritonitis if there's perforationDuodenal ulcersCAUSE: Increased rate of gastric acid secretion Increased emptying rate of acid from the stomach to the duodenum which leads to irritation of the duodenal mucosa COMMON S/S - Typically, the symptoms of DUs are pattern by periods of exacerbation and remission follow up pain- food- relief pattern. - The pain begins 2 to 4 hours after meals and his immediately relieved by food or antacid. - pain is in the midepigastrium, and it is described as burning or cramp like - It may manifest as back pain - Heartburn and regurgitation of sour acid juice into the back of the throatNursing interventions and patient education for duodenal ulcers- Lifestyle changes: smoking cessation, alcohol cessation, And avoidance of other irritants such as aspirin containing products and NSAIDs - Dietary modifications: avoiding foods that irritate the mucosa of the stomach, For example caffeine and foods that can cause pain - Medications: medications to reduce or prevent acid production (H2 receptor antagonist and PPI's) should be taken exactly as ordered. - Stress reduction techniques: exercise, relaxation training, biofeedback - If surgeries performed more dietary modifications may be necessary because of a reduction in the size of the stomach. A response known as dumping syndrome is comimon after gastric resection; it is manifested by dizziness, nausea, and diaphoresis after mealsEnteritis (pathophysiology)Inflammatory process of the stomach or small intestine. Bacterial enteritis, commonly known as food poisoning, is often caused by ingestion of food contaminated with bacteria, for example Staphylococcus aureus, salmonella, in Clostridium botulinum. CAUSES Bacteria, viruses, medications, radiation, ingestion of foods that irritate the gastric mucosa, or allergic reactions may cause it S/S Abdominal cramping, Profuse diarrhea, and electrolytes maybe lost, Which leads to dehydration and electrolyte imbalances of hyponatremia and hypokalemia OLDER ADULTS ARE AT HIGHER RISK FOR DEHYDRATIONMechanical Intestinal obstructionIt is the most common and are primarily caused by tumors, adhesions, or hernias. Another cause is volvulus or the twisting of the parts of the intestine It is more common in older adults because the mesenteric ligaments weaken overtimeParalytic ileusInvolves decreased or absent peristalsis resulting from neurologic or vascular disorders. Common after abdominal surgery S/S - Abdominal pain is a major symptom - Atherosclerosis ischemia may create angina like cramping abdominal pain that becomes worse after meal and then dissipates - Colonic ischemia is left lower quadrant pain - Hyperactive bowel sounds above the site of the obstruction and absent below itDescribe symptoms of mesenteric ischemia, atherosclerotic ischemia, colonic ischemia-- Mesenteric Ischemia: vascular disorders may cause intestinal or mesenteric ischemia resulting in obstruction. Prolonged ischemia results and death of surface of the villi and epithelial cells, which in turn, impairs the absorption of nutrients. Mucosal layer becomes necrotic, and peristalsis diminishes -- Atherosclerotic Ischemia: Plaques made up mostly of cholesterol build up on your artery walls and restrict blood flow. -- Colonic Ischemia: Colonic ischemia is the most frequent form of intestinal ischemia, most often affecting older adults. Colonic ischemia may be more prevalent in women. Colonic ischemia should be suspected in patients with lower abdominal pain and bloody diarrhea or hematochezia; however, these symptoms are nonspecific. --- Whatever the cause of intestinal obstruction, after the blockage occurs, the bottle becomes distended buy gas an air proximal to the area of blockage.---Complications of intestinal abstractionPerforation of the bowel Chemical or bacterial peritonitis Hypovolemic shock Septic shockDiverticula-- Sacklike protrusions of the mucosa along the G.I. tract -- These small sacks are formed by herniation of the mucus membrane outward through a separation in circular muscle fibers of the intestine where blood vessels penetrate the muscle layer -- Diverticulosis is the presence of multiple diverticula that are not inflamed -- Diverticulitis is an inflammation of or around diverticular sack that is usually caused by the retention of undigested food, stool, and bacteria -- prevent and eliminate constipation -- eat high fiber foods, which include beans, whole grains, Brown rice, fruits (apples, bananas, and pears) and vegetables (broccoli, carrots, corn, and squash). -- And older patient with diverticulitis needs pain management - Bowel rest: intravenous fluids if given NPO status