Exam 2 Flashcards
1
Q
effect of aging on hepatic and biliary perfusion
A
decreased by 30-40%
2
Q
effect of aging on caffeine clearance
A
decreased
3
Q
effect of aging on bile flow
A
decreased by 50%
4
Q
effect of aging on hepatic function
A
hepatic function remains intact
5
Q
effect of aging on liver regeneration capacity
A
reduced
6
Q
effect of aging on antiviral therapy for hepatitis
A
elderly may not respond
7
Q
effect of aging on risk of colelithiasis
A
elevated risk
8
Q
why elevated risk of cholelithiasis in elderly
A
increased cholesterol synthesis with decreased bile acid secretion
9
Q
why is gallbladder function impaired with age
A
impaired contractility, increased volume, decreased CCK receptors
10
Q
“classic” signs of cholelithiasis that are absent in 50% of cases in elderly
A
fever, N/V
11
Q
why are women more prone to cholelithiasis
A
estrogen’s effects on cholesterol synthesis
12
Q
effects of aging on exocrine pancreas
A
pancreatic juice steadily decreases after the age of 50, limited ability to increase lipase and amylase, but there is adequate reserve to maintain normal digestive capacity. Increased production of autoimmune antibodies
13
Q
what % of cases of pancreatitis are due to alcohol abuse
A
70%
14
Q
when does alcoholic pancreatitis classically present
A
middle age
15
Q
what etiology of pancreatitis increases in older people
A
gallstones
16
Q
what to watch out for if underling pancreatitis is not due to ETOH or gallstones
A
adenocarcinoma
17
Q
acute pancreatitis labs
A
amylase/lipase 3x upper limit
18
Q
acute pancreatitis tx
A
bowel rest, IV fluids, pain control, ERCP if gallstones, IV abx if necrosis on CT scan, gastric decompression
19
Q
when to use abx for acute pancreatitis
A
if necrosis on CT scan
20
Q
how long does lipase remain elevated
A
5-7 days
21
Q
which elevates first, amylase or lipase
A
amylase
22
Q
when does amylase return to normal
A
48 hours
23
Q
when does lipase elevate
A
24-48 hours
24
Q
when does oral intake resume in acute pancreatitis
A
when pain free
25
what pain med to use in acute pancreatitis
meperidine
26
chronic pancreatitis usual etiology
alcoholism
27
most common location/type for pancreatic cancer
70% is adenocarcinoma of pancreas
28
what % of NASH progresses to cirrhosis and what % dies
4%, 2%
29
NASH ssx
asymptomatic or vague RUQ discomfort
30
risk factors for NAFLD/NASH
BMI>40, male, DM, metabolic syndrome, "hispanic"
31
what drugs can precipitate NAFLD
tamoxifen, methotrexate, amiodarone, prednisone
32
first step and gold standard for NAFLD diagnosis
abdominal US, biopsy
33
what intervention can lower ALT/AST and insulin level in NAFLD
10% weight loss
34
risk factors for HCC
hepatitis (of any cause), cirrhosis, hemochromatosis, alpha-1 antitrypsin, Wilson's, NAFLD
35
screening for HCC
AFP followed by US
36
ssx of HCC
jaundice, anorexia, fatigue, weight loss, upper abdominal pain, ascites, LFT changes
37
what imaging to obtain after HCC diagnosis
chest x-ray to look for mets
38
gallbladder cancer is usually what kind
adenocarcinoma
39
CEA/CA 19-9 in gallbladder cancer
not specific
40
cholangiocarcinoma is usually what kind
adenocarcinoma (90%)
41
what % of acute cholelithiasis are geriatric
50-70%
42
test of choice for cholelithiasis/cholecystitis
US/HIDA
43
benefit of ERCP in cholelithiasis/cholecystitis
can be diagnostic and therapeutic
44
tx of choice for cholelithiasis/cholecystitis
laparoscopic removal
45
pancreatic exocrine deficiency in elderly
rare without underlying pathology
46
bicarbonate in the elderly
decreases steadily after 4th decade
47
what scale is used to assess severity of acute pancreatitis
Ranson criteria
48
amylase/lipase in chronic pancreatitis
mildly elevated
49
imaging findings in chronic pancreatitis
calcifications
50
what may be needed to make diagnosis of chronic pancreatitis
ERCP, MRCP, EUS
51
chronic pancreatitis treatment
pancreatic enzyme replacement
52
what % of pancreatic cancer pts are >55
87%
53
5-year survival of pancreatic cancer
5%
54
effect of aging on liver volume
40% decrease
55
effect of aging on coags/LFTs
unaffected
56
NAFLD pathophys
insulin resistance enhances triglyceride lipolysis and increases serum free fatty acids which are taken up by the liver
57
conditions associated with NAFLD
hyperlipidemia, insulin resistance/DM, metabolic syndrome, hep C, rapid weight loss, TPN, Wilson's disease, diverticulosis, PCOS, OSA
58
risk factors for NAFLD
insulin resistance, metabolic syndrome, jejunoileal bypass, age, genetics, some drugs
59
HCC screening for patients at risk
AFP (alpha-fetoprotein) and US q 6-12 months
60
what to do if screening AFPs are rising
order imaging to see if there is a mass
61
what to do if no mass is confirmed after AFP is elevated
follow up q 3 months with AFP, liver imaging
62
which ethnic group has lowest incidence of NAFLD
African Americans
63
Claire is 69 and has had non-alcoholic fatty liver for about five years. Recently, she was diagnosed with atherosclerosis in her coronary arteries. The most likely mechanism that links these two disorders is
endothelial dysfunction
64
aging effect on gastric acid
decreased due to fewer cells and use of acid suppressing meds
65
implications of decreased gastric acid in elderly
decreased B12, iron, folic acid, altered gut flora leading to diminished immune response
66
effect of aging on GI motility and why
decreased, loss of neurons and atrophy of muscle layer
67
implications of decreased GI motility in elderly
atrophy of muscle layer leads to diverticula
68
effect of aging on splanchnic bloodflow and implications
reduced, results in decreased nutrient absorption
69
implications of SIBO in elderly
bacteria take up nutrients, bacterial proliferation damages epithelium brush border leading to malabsorption
70
causes of SIBO in elderly
impaired motility, abx disrupting balance, undigested carbs feed bacteria
71
SIBO diagnosis
breath tests or biopsy
72
abx associated colitis prognosis
usually mild and self-limited, resolves after discontinuation of abx
73
cautions with vancomycin
ototoxic, nephrotoxic
74
tx for mild/moderate c diff
metronidazole
75
tx for severe c diff
vanc
76
tx for very severe c diff
both metronidazole and vancomycin possible colectomy
77
gold standard for c diff diagnosis
stool culture
78
when will they test formed stool for c diff
only if you suspect ileus/obstruction
79
considerations with metronidazole for c diff
don[t use it after the first occurrence or for long-term treatment due to neurotoxicity
80
considerations for c diff testing
don't test asymptomatic or test for cure
81
how many have c diff relapse within 1-2 weeks after abx
20%
82
infection control measures for c diff
decon with bleach, glove/gown upon entry to pt room
83
treatment for diverticulitis
cipro plus metronidazole (or bactrim plus metronidazole) 10-14 days and clear liquid diet
84
what to do if initial diverticulitis treatment doesn't help
get imaging, must r/o malignancy
85
when to get colonoscopy with diverticulitis
after resolution of attack, usually at least 6 weeks after discharge
86
risk of colonoscopy during diverticulitis attack
converting sealed perforation into free perforation
87
differences in how appendicitis may present in elderly
fewer have fever, may have diffuse pain, delayed left shift
88
colon cancer screening after age 75
if no previous diagnosis of colon cancer, colonoscopy risk is greater that colon cancer risk
89
reasons for increased polyp formation with age
NSAID use, calcium supplementation
90
ulcerative colitis in the elderly
symptoms are similar as in younger people but milder
91
which type of laxative does she think we should avoid
osmotic/magnesium
92
which laxative does she think is safe for long term use
senna +/- stool softener
93
how long does it generally take for diverticulitis ssx to resolve
48-72 hours
94
diverticulitis complications
perforations, abscess
95
which colon cancer annual test is recommended by USPTF
Cologuard instead of FOBT
96
which IBD is more common in elderly
Crohns
97
most prevalent neoplastic polyps
adenomatous
98
risk of developing cancer in high-grade adenomatous polyps
25%
99
what makes adenomatous polyps more risky
quantity, large size (at least 1 cm)
100
what triggers colon cancer screening q 3 years
large number of polyps, high-grade adenomatous, large size of polyps
101
screening frequency for 1-2 tubular adenomas
q 5 years
102
mainstays of treatment in IBD in elderly
sulfasalazine, mesalamine, corticosteroids
103
when does colon cancer risk increase with IBD
after 8-10 years of the disease
104
"most common complaint in elderly"
constipation
105
what to assess in elderly pt complaining of constipation
DRE, assess pelvic floor/rectal prolapse in females
106
constipation diagnostic criteria
2 or more: straining, hard stools, incomplete evacuation, feeling of anorectal obstruction, manual maneuvers in 25% or more of defecations. LEss than 3 bowel movements/week
107
most common cause of constipation
dehydration, low fiber diet
108
initial treatment of constipation
drink 2x current amount of water (up to half body weight in ounces), fiber supplementation, increase physical activity
109
"safest laxative option"
senna-based
110
diverticulosis tx
increase fiber, prevent constipation, decrease fat, avoid seeds
111
"class" diverticulitis ssx commonly absent in elderly
fever, rebound tenderness
112
treatment of mild diverticulitis can be
empiric
113
moderate-severe diverticulitis needs
CT +/- hospitalization
114
tx for recurrent c diff
vancomycin taper x 1 month
115
indications for fecal transplant with c diff
recurrent c diff not responding to vancomycin taper, 2 or more c diff episodes causing hospitalization, refractory moderate c diff infection, severe c diff not responding to tx within 48 hours
116
when to consider SIBO diagnosis
weight loss, diarrhea, abd pain, macrocytic anemia, protein malnutrition
117
gold standard SIBO diagnosis
aspirate and culture of proximal jejunal secretion
118
SIBO tx
1-2 week broad spectrum abx with low fodmap diet
