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WEEK 7 SEM 4 > The ageing skin and GI tract > Flashcards

The ageing skin and GI tract Flashcards

1
Q

What are the functions of the skin?

A 
Protect
Barrier
Thermoregulation
Perception (touch, vibration, temperature, pain)
Vitamin D production
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2
Q

What happens to old age skin?

A

epidermal and dermal layer atrophy
less blood vessels in dermis
loss of collagen fibres

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3
Q

How does the old age skin affect the function of the skin acting as a barrier?

A

decreased sebum production

epidermal thinning

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4
Q

How does the old age skin affect the function of the skin acting as a thermoregulator?

A

dermal thinning
less moisture retention
less ability to vasodilate= so heat retention

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5
Q

How does the old age skin affect the function of the skin acting as a protector?

A

UV damages skin
loss of telomere ends (which removes damaged DNA)
reduce nail growth by 50%

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6
Q

How does the old age skin affect the function of the skin acting as a pain receptor?

A

dermal thinning- less nerve endings

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7
Q

How does the old age skin affect the function of the skin acting as an endocrine?

A

less ability to synthesise vit D

less ability to synthesise melanin ➔ prone to skin cancers (in addition to photodamage done in previous years)

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8
Q

What is xerosis/xerdoderma?

A

dryness of the skin or cracking

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9
Q

What does dry skin affect?

A

the barrier of the skin

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10
Q

In old age, there is flattening of the junction between what and what does this cause?

A

between dermis and epidermis (no rete ridges and dermal papillae)
causes
1. less nutrient transfer to epidermis bc smaller surface area
2. protective lipids not transferred into stratum corneum of epidermis

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11
Q

What happens to the number of sweat glands in the ageing skin?

A

reduces

causes dry skin

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12
Q

What related to immunity is reduced in the epidermis of the ageing skin?

A

langerhan cells so there is less protction

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13
Q

What is pruritis?

A

chronic itching of the skin- can be caused by dry skin

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14
Q

What causes wrinkling of the skin?

A

epidermis thins
decline in elastin synthesis (after 40 years)
decrease in subdermal fat skin

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15
Q

What factors lead to increased susceptibility to trauma?

A

dermis and epidermis junction is weaker
so more likely to get tears here
and more bleeding comes into this gap

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16
Q

What leads to delayed wound healing?

A

dermis thins because of less vascularity and less collagen and elastin synthesis
longer transit time for keratinocytes to reach upper stratum corneum

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17
Q

What are external factors that lead to pressure ulcers?

A
  • excessive pressure on a part of the skin
  • friction and shear forces
  • impact injury
  • heat
  • moisture
  • posture
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18
Q

What are the internal factors that lead to pressure ulcers?

A
  • immobility (lack of movement)
  • sensory loss (so the patient will not be able to sense pain)
  • age
  • diseases such as diabetes
  • body type
  • poor nutrition
  • infection
  • incontinence
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19
Q

How many grades are pressure ulcers classified into?

A

4
1= calm
4= worst

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20
Q

Why is thermal regulation impaired in ageing skin?

A

loss of dermal capillaries
less subdermal fat (less insulation)
less sweat glands produced

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21
Q

Why is there impaired sensory perception in ageing skin?

A

Less meissner’s corpuscles= LIGHT TOUCH

Less pacinian corpuscles= LOW FREQUECY VIBRATION

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22
Q

Why can’t ageing skin produce Vitamin D as effectively?

A

UV converts 7 dehydrocholestrol to pre vitamin D3 in the epidermis
in older skin, 7 dehydrocholestrol levels are less= so less vitamin D production

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23
Q

What can prolonged vitamin D deficiency lead to?

A
  • less Ca and phorphorus absorption in intestines
  • hypocalcaemia= can lead to secondary hyperparathyroidism
    = that leads to phosphate secretion in urine, demineralization of bones etc
    = leads to osteopenia (less mineral in bones) and osteomalacia (softening of the bones)
    = can lead to fractures, muscle weakness, and bone pain
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24
Q

What is photoageing?

A

sun exposure affects the skin

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25
Q

What does photoageing lead to?

A

cellular dysplasia (wrong cells in wrong place)
atypical (abnormal) cells
epidermis disorganized
less collagen content

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26
Q

What is achromotrichia?

A

greying of hair in the elderly

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27
Q

Why does achromotrichia take place?

A

less melanocytes in epidermis and hair

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28
Q

What is the order of achromotrichia (greying of hair in the elderly)?

A

nose hair, hair on head, beard, body, eyebrows

29
Q

What is campbell de morgan spots?

A

Abnormal growth of blood vessels in the elderly

30
Q

What are the risk factors if the barrier of the skin is affected?

A

infection

31
Q

What are risk factors if thermoregulation of the skin is affected?

A

dehydration
dysregulation of osmolality
hypothermia risk

32
Q

What symptom can neuropathic pain medications have?

A

deliriogenic effects

33
Q

What is a flipflow valve?

A

If someone is cognitively switched on you can use a flipflow valve- you put this at the end of a catheter- you open it to go to the toilet and then switch it off again so they don’t have the bag which goes around their leg so the flipflow gives them the drive to walk to the toilet. With the bag by their leg they don’t want to walk bc they can just pee on their bed.

34
Q

What is a pressure ulcer?

A

Pressure ulcers usually occur over a bony prominence, such as the sacrum, ischial tuberosity and heels.
However, they can appear anywhere that tissue becomes compressed, such as under a plaster cast, splint, arm sling, crutches – or under glasses / nasal cannulae.
This occurs when the soft tissue of the body is compressed between a bony prominence and a hard surface. This occludes the blood supply, leading to ischaemia and tissue death.

35
Q

What is a moisture lesion?

A

caused by moisture e.g. pee
not normally over a bone- can be in cracks e.g. buttocks
you might not just see 1 wound but many different wounds
it normally stays superficial (unless infected)
no necrosis

36
Q

What do pressure injuries and moisture lesions indicate about patient?

A

they are immobile
poor nutrition
care needs are not being met at right time

37
Q

What is vasculitis?

A

inflamed blood vessels

38
Q

What are the functins of the GI tract?

A

Digestion•Absorbing nutrients and water•Electrolyte balance•Immune barrier•Expelling waste

39
Q

What in the ageing GI leads to risk of malnutrition?

A

epithelial lining of oral mucosa thins
gums recede= teeth more prone to decay
acinar cells in salivary gland decrease in number

40
Q

Why do receding gums increase risk of decay, root infection and incomplete mastication?

A

because exposes the tooth cementum

41
Q

What happens to the oropharynx function as we age?

A

it declines

42
Q

Why do elderly people often have dry mouths?

A

because of anticholinergic medications

43
Q

What is aspiration?

A

food entering the respiratory tract through the larynx

44
Q

What can cause aspiration?

A

loss of oesophageal muscle compliance

less effecive mastication

45
Q

What is aspiration pneumonia?

A

a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs

46
Q

With ageing, why is there increased exposure of gastric acid to the oesophagus?

A

hypertrophy of skeletal muscle around oesophagus- makes swallowing harder (upper third of oesophagus)
less myenteric ganglion cells (control peristalsis)
less oesophageal contractions

47
Q

What happens to the stomach with age?

A

there is increased risk of infection and ulceration

48
Q

Why is there increased risk of infection and ulceration in the stomach with age?

A

− more H. pylori in the stomach of an elderly
− decreased prostaglandin synthesis
− decreased Hcl secretion
− decreased pepsin secretion
− delayed emptying of the stomach into the duodenum

49
Q

What happens to the small intestine with age?

A

less villous
inside walls get rough
less efficient calcium absorption from gut lumen
less sensory and myenteric neurones of the gut mean that ulcers are more likely to be painless, so you may be bleeding or getting reflux but not notice

50
Q

How does the large intestine decline in function when ageing?

A

mucosal atrophy
less muscle wall strength
less bowel wall compliance
more intraabdominal pressure

51
Q

What does the decline in function of the large intestine cause in elderly?

A

constipation

increased water reabsorption and harder stools

52
Q

What is fecal loading?

A

lots of stool in the rectum

can lead to overload diarrhoea

53
Q

What is diverticular disease?

A

sac formation in the sigmoid colon bc of slow bowel movement in the large intestine

54
Q

Are liver function tests affected with age?

A

no

55
Q

What happens to metabolism of cholestrol LDL with age?

A

decreases

56
Q

What does the flattening of the dermoepidermal junction decrease?

A

the surface area for nutrient transfer and so the nutrient transfer is less.

57
Q

What does osteomalacia put a person at risk of?

A

fracture, proximal muscle weakness and bone pain

58
Q

What does too much exposure to sun cause for the skin?

A

wrinkled, lax, yellowed and rough skin.

There is also telangiectasias (swollen blood vessels e.g. spider naevi) and patchy hyper/hypo pigmentation.

59
Q

What is xerostomia?

A

dry mouth

60
Q

Which of these can be a consequence of constipation in older adults?

a) Urinary incontinence
b) Diverticular disease
c) Delirium
d) Aspiration pneumonia
e) Diarrhoea

A

A (pressure from rectum), B (pressure in bowel pushes against wall causing outpouches),C,E (E because liquid faeces gets around the side)

61
Q

Which of these factors associated with ageing decrease vitamin D levels?

a) Increased levels of 7-dehydrocholesterol in the epidermis
b) Decreased pepsin secretion
c) Decreased vitamin D receptors in the gut
d) Large bowel mucosal atrophy
e) Slower large bowel transit

A

C

62
Q

Which of these statements are correct with regards to the ageing skin

a) There is flattening of the dermoepidermal junction
b) There is an increase in the number of sweat glands
c) There is a decrease in melanocytes
d) There are increased Pacinian corpuslces
e) There is a decrease in subdermal fat

A

A,C,E

63
Q

What is pemphigus?

A

autoimmune disease

64
Q

What is cellulitis?

A

skin infection with infection/sepsis

65
Q

What is cellulitis caused by?

A

pathogen on skin gaining entry beneath
look for skin breaks including insect bites and fungal infections
Check between the toes
Ensure good foot care and maintaining good skin care including adequate moisture barrier maintained to prevent further infections.

66
Q

How do you treat cellulitis?

A

antibiotics

67
Q

What is Lipodermatosclerosis?

A

Inflammatory condition of the lower legs usually due to venous insufficiency.
usually deep red

68
Q

What happens in fecal continence?

A

Rectum Mechanical changes (i.e. muscle) in the rectum cause most of the problems older people suffer in evacuating as well as the increasing prevalence of faecal incontinence with increasing age.
less rectal wall elasticity
An age dependent increase in rectal pressure needed to produce an initial sensation of rectal filling has been found
Maximum resting anal pressure and maximum squeeze pressure have been shown to decline with age, particularly in postmenopausal women.

WEEK 7 SEM 4 (7 decks)

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