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Acute gingivitis:

vitamin C deficiency

Periodontal disease:

malnutrition/zinc deficiency


pain on swallowing


Pain on swallowing: Mechanical causes-affect large solids
Motility disorders-intermittant, liquids

Changes in small intestine w aging

Decreased clearing of debris from small intestine to colon:
-Gastric hypochlorhydria (low gastric acid) /jejunal diverticula with small intestinal bacterial overgrowth
-Decreased vitamin D and Calcium absorption

with elderly, Colonic transit time is

normal, rectosigmoid transit is delayed, and Rectal contents are expelled more slowly

Dieulafoy's lesions

rupture of exposed submucosal artery that bleeds

This is more likely to be only colonic and to perforate...

Crohn's dz.

Fatigue, shortness of breath, angina are common elder symptoms in

-colon cancer
-Adenomatous polyps become cancerous over 5-10 years

epigastric/back pain
weight loss
painless jaundice
glucose intolerance
may be signs of

Pancreatic Cancer (CA 19-9 may aid in dx)

diseases with higher energy requirements like....

cancer, infections, COPD, wounds, burns, fractures

Elderly Screening (must have symptoms)


Elderly Screening-no symptoms needed

-Dementia (mini-mental)
-Social (able to get food, do ADL's, IADL's, help if disabled, church, family nearby)
-Osteoporosis, pap smear, etc.


Greatest effect of aging is on cell mediated immunity-- everything decreases (including response to vaccines), except auto antibody production INCREASES

These 3 factors make respiratory infection more likely:

-Less forceful cough reflex
-Lower ability to eliminate bacteria from tracheobronchial tree thru cilaiary action
-Physiologic changes in chest wall, bronchi, etc.

There is a 2-4 fold increase in plasma/serum levels of....

Cytokines and other inflammatory mediators
-increased fat
-decreased sex steroids
-subclinical infections
-chronic diseases
Aging may be associated with dysregulated cytokine response following stimulation

This occurs in 1/3 of pesons >60 increases absorption mightily of Penicillin G

achlorhydria (absent production of gastric acid)

Izoniacid in those over 50=

hepatotoxicity 2.3%

Fatalities are higher in elderly with this dz that presents as sudden onset of flu like/ fever transmitted between birds/ mosquitoes. CNS dz is rare

West Nile. Can also cause flaccid paralysis.

Ramsey-Hunt syndrome:

(of the geniculate ganglion) pain/vesicles external auditory meatus, loss of taste, ipsilateral facial paralysis

Maxillary/mandibular trigeminal nerve involvement= intraoral lesions

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