Failure to Thrive; Acute Abdomen in Elderly; UTI, Urosepsis, Incontinence Flashcards
Failure to Thrive
Multi-syndrome reduction in reserve to the extent that a number of physiological systems are close to/past the threshold of symptomatic clinical failure
Impaired homeostatic reserve impairs ability to withstand stress
Near irreversible end of fragility
Sarcopenia
Loss of 0.5-1% muscle mass with age
Starts at 25 years old
Diminished acute physiological stress response, decreased immune competence
Signs of frailty
Weakness, fatigue, anorexia, inactivity
Weight loss/malnutrition, decreased muscle and bone mass, anemia
Disability is an independent risk factor for mortality, hospitalization, and need for long-term care
Factors that contribute to FTT
Women are more at risk - tend to be on more drugs
>14 prescriptions per year
ETOH use could exacerbate effects
Medication administration timing and order
Biliary tract disease
Single most common cause abdominal surgery in elderly
Gallstones are common, biliary colic with vague abdominal complaints
Perforation occurs primarily in elderly, cholecystitis often presents w/ no pain, Murphy’s sign negative
Diagnose with ultrasound
Appendicitis
5-10% all cases in elderly, but >50% deaths
Present abnormal in elderly - only 20% have N/V, fever, RUQ pain with abnormal wbc
70% has already perforated, 30% have abscess formation
Acute Pancreatitis
Gallstone etiology most common
Pain may be absent/vague with unremarkable PE
Nonspecific sc: tachycardia, HOTN, tachypnea, confusion
Always screen for in alcoholics
Acute Diverticulitis
Phlegmonous inflammation, fistula formation, colon obstruction
LLQ pain, tenderness, moderate distention and fever
Can be less specific in geriatric abdomen
Get a CT scan
Peptic Ulcers
Elderly have higher risk, H. pylori common
NSAIDs/ASA worsen
Pain absent, poorly localized with systemic presenting sx related to blood loss and anemia
Abdominal Aortic Aneurysm
Presents with HOTN, abdominal pain, back pain
Key: enlarged, tender aorta - beware renal colic sx, atypical location, HOTN - don’t write off as vagal
US will show 98%, CT w/ contrast if stable
Ischemic bowel
Severe visceral pain out of proportion to PE - post prandial pain
Risk: Coumadin, previous clots
Hard signs = too late
Early angiography - 90% survival
Ischemic Bowel causes and risk factors
SMA embolus - a-fib, recent MI
SMA thrombosis - CAD, low flow states
Venous thrombosis - hypercoagulable state
Non-occlusive - low CO -> CHF, sepsis, digoxin, hypovolemia
Mechanical Obstruction
Adhesions - biggest thing
Hernia
Appendicitis
Malignancy
Volvulus
Diverticulitis
AAA
Uncomplicated UTI in elderly
Screen for pyuria and colon counts to ensure actual UTI and not just asx bacteriuria
Wait for culture before administering antibiotics
25-50% of the time, >65 yo women w/ UTI sx will resolve in a week w/o treatment
Never rely on UA dipstick - may have nitrites and leukocyte esterase w/o UTI
Complicated UTI
With fever, CVA tenderness, toxic signs - treat immediately
UTI in older men is frequently concomitant with prostate dx
-Get full rectal, urine cultures, different drugs
