Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master’s Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP /1/A

CHANGES OF THE GASTROINTESTINAL TRACT, ACUTE AND CHRONIC DISORDERS Erika Pétervári and Márta Balaskó Molecular and Clinical Basics of Gerontology – Lecture 15 Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master’s Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP /1/A

TÁMOP /1/A delicate balance among the organ systems functional loss in the most vulnerable system, unrelated to the locus of illness masked, not typical symptoms (e.g. no pain in appendicitis) interaction with other systemspolymorbidity (interaction with other systems) altered drug disposition/clearance Characteristics of geriatric patients

TÁMOP /1/A Interaction with other systems:  ability to raise the cardiac output + maldistribution of circulation   GI motility and/or absorption capacity (hypoxia in the apical part of the villi); postprandial: insufficient rise of GI-perfusion (abdominal angina) or hypoperfusion in other organs (fainting, AMI) diabetes, neurologic and vascular changes   esophageal motility, gastric atonia, constipation, or even paralytic ileus  stress (mental and physical limitations and isolation)  atypical GI symptoms Influence of aging on gastrointestinal (GI) disorders

TÁMOP /1/A Lifestyle changes in the elderly – more severe complications of GI disorders decrease in fluid intake; decrease in protein intake (social and psychological causes); caloric malnutrition (weight loss); insufficient intake of trace elements, vitamins sedentary lifestyle (lack of exercise, obesity).

TÁMOP /1/A Upper GI tract disorders -Dysphagia syndromes, disorders of the esophagus -Disorders of the stomach and the duodenum Disorders of the lower bowel -Constipation -Fecal incontinence -Fecal incontinence (pressure ulcers!) -Diverticular disease -Diarrhea (malabsorption, chronic pancreatitis) -Aging liver Cancers in the GI tract (e.g. esophagus, gastric cancer, colorectal carcinoma) Special emergency situations: GI bleedings Common GI disorders in the elderly

TÁMOP /1/A malnutrition, aspirationdental, oral disorders (stomatitis, denture), xerostomia + dysphagia (caused by drugs, cerebrovascular or neuromuscular disorders)  malnutrition, aspiration progressive dysphagia, weight lossesophageal carcinoma  progressive dysphagia, weight loss non-cardiac chest pain: 50% of cases have esophageal cause e.g.gastro-esophageal reflux nutcracker esophagus (manometric syndrome, high-amplitude peristaltic contractions confined to the distal esophagus) Dysphagia syndrome, esophageal disorders

TÁMOP /1/A  acid output   incidence of duodenal ulcer  intake of NSAIDs   incidence of gastric ulcer  stress +  defensive factors  gastritis, stress ulcer ulcers may lead to serious bleeding, perforation, penetration  incidence of autoimmune gastric atrophy with achlorhydria and IF deficiency (pernicious anemia) Disorders of the stomach and the duodenum

TÁMOP /1/A The most common gastric disorders in elderlyGastriccarcinoma GERD Gastriculcer Atrophicgastritis Gastro-paresis

* Many older people incorrectly believe that their bowel movements are abnormal. Common causes of constipation in the elderly

Common causes of fecal incontinence in the elderly Anorectal incontinence Anorectal incontinence (disorders of the anal sphincter and puborectal muscles) descending perineum (idiopathic) trauma anal surgery spinal cord injuries diabetic and other autonomic neuropathies Symptomatic incontinence colorectal disease with diarrhea Overflow incontinence impaired terminal reservoir capacity (aging, ischemia, cancer, resection) fecal impactation Neurogenic incontinence Neurogenic incontinence (sensory- cognitive factors) dementia confusion

TÁMOP /1/A Diverticular disease low-fiber diet asymptomatic colonic diverticula (sac-like projection of the mucosa and submucosa) bleeding diverticulitis (infection of the diverticula) peritonitis, paralytic ileus

TÁMOP /1/A Precipitating factors: -dehydration -hemorrhage -low-output heart failure -polycythemia -diabetes mellitus -digitalis The ischemic colitis is rare (many anastomoses), but its mortality rate is high. Ischemic colitis

TÁMOP /1/A Aging and enteral absorption The small intestine has a large reserve capacity, aging has only subtle influences on the digestive and absorptive processes: Reduced intestinal blood flow. Decrease in the absorbing surface (30%), atrophied villi. Decreased activity of disaccharidases and aminopeptidases can lead to osmotic diarrhea (thin, watery), due to the bacterial breakdown of non-digested food. There is a decrease in the absorption of vitamin D, folic acid, vitamin B 12, Ca, Cu, Zn, Fe and cholesterol. Replacement is necessary.

TÁMOP /1/A Major causes: infections drug side-effects (long-term and inappropriate use of antibiotics) chronic pancreatitis lactose intolerance Consequences are more severe Consequences are more severe (dehydration, hypovolemia, malnutrition) Cave! Alternating diarrhea vs. constipation Cave! Alternating diarrhea vs. constipation (colon tumors!) Diarrhea and malabsorption in the elderly

TÁMOP /1/A Disorders as consequences of malabsorption osteoporosis (calcium) sarcopenia (proteins) infections (vitamins, proteins, trace elements) pressure ulcers (proteins, fluids) anemia (Fe, B 12 ) dementia (B 12 ) GI tract disorders (fibers, fluids)

TÁMOP /1/A Age-related changes are minimal, significant only in late stage:  drug (alcohol) clearance  cholelithiasis, cholestasis appearance of abnormal proteins Aging liver

TÁMOP /1/A Major causes of upper GI tract bleeding

TÁMOP /1/A Major causes of lower GI tract bleeding

TÁMOP /1/A Carcinom a Colitis (infections, irritable bowel syndrome) Angio- dysplasi a Ischemi c colitis Polyp s Hemorrhoid s Diverticu la Causes of lower intestinal bleeding