GeriQBank · Topic
Luminal GI disease, constipation, liver disease.
Set 3 or more times
Management of constipation in the elderly (including pharmacological management and complications) Constipation is defined by Rome IV criteria — straining, hard or lumpy stools, sensation of incomplete evacuation, anorectal blockage,…
Constipation is defined by difficult, infrequent or incomplete defecation. Rome IV criteria require two or more of straining, hard or lumpy stools, sensation of incomplete evacuation, sensation of anorectal blockage, manual manoeuvres,…
Set twice
Etiopathogenesis, clinical manifestations, diagnostic algorithm and management of malabsorption Malabsorption means defective passage of digested nutrients into the blood and lymph. It may be global (all nutrients) or selective (one…
Gastro-oesophageal reflux disease in the elderly GORD is the reflux of gastric contents into the oesophagus causing troublesome symptoms or mucosal complications. Pathy's records that GORD is the sixth most common disorder among elderly…
Approach to upper gastrointestinal bleeding in the elderly Upper GI bleeding (UGIB) is bleeding proximal to the ligament of Treitz, presenting as haematemesis, coffee-ground vomiting, melaena, or occasionally haematochezia when brisk.…
Haematemesis Haematemesis is vomiting of frank blood or coffee-ground material, indicating bleeding proximal to the ligament of Treitz. It is an alarm symptom mandating prompt endoscopy at any age, and Pathy's specifically lists it…
Set once
Gastrointestinal motility disorders in the elderly The core teaching point of Pathy's chapter is that gastrointestinal motor function is relatively well preserved with healthy ageing, but there is a general decline in visceral…
The uploaded textbook covers hepatitis C only briefly — it states that chronic HCV is prevalent in the elderly, that up to 85% of patients are asymptomatic with at least half having normal liver function tests, that screening should be…
The uploaded textbook covers hepatitis B briefly — it notes that around 257 million people worldwide are HBsAg positive, lists the high-risk groups to be screened, states that the screening tests are surface antigen and antibody, that…
Liver transplantation is often the best treatment for advanced cirrhosis, acute hepatic failure, and some liver cancers. It is the only definitive therapy for end-stage liver disease. Types are deceased-donor transplantation (whole or…
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Definition and mechanism. GORD exists when reflux of gastric contents causes troublesome symptoms or complications. Mechanisms include transient lower oesophageal sphincter relaxations (the dominant mechanism), a hypotensive LOS, hiatus…
Definition. H. pylori is a Gram-negative, spiral, urease-producing bacterium that colonises the gastric mucus layer. It is a WHO Class I carcinogen. Why it matters in the elderly. Prevalence rises with age (over 60–70% in Indian…
Definition. Bleeding from a source proximal to the ligament of Treitz, presenting with haematemesis, coffee-ground vomiting or melaena. Mortality in the elderly is 10–15%. Causes in the elderly. Peptic ulcer is the commonest, followed…
Definitions. Maldigestion is impaired breakdown of nutrients within the lumen or at the brush border; malabsorption is impaired mucosal uptake and transport of digested nutrients. Both produce the clinical malabsorption syndrome, and…
Definition (Rome IV). Two or more of — straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction, need for manual manoeuvres, and fewer than three spontaneous bowel movements per week —…
The Bristol Stool Form Scale — purpose and diagram. A validated seven-point pictorial scale developed at Bristol Royal Infirmary that classifies stool by form, which correlates with whole-gut transit time. It gives an objective,…
Epidemiology and risk factors. Median age at diagnosis is about 70 years. Risk factors are age, adenomatous polyps, inflammatory bowel disease, family history, Lynch syndrome and FAP, red meat, obesity, smoking and diabetes. India shows…
Definition and context. Mechanical or functional obstruction distal to the ligament of Treitz in a patient with known intra-abdominal or pelvic malignancy. It is commonest in ovarian and colorectal cancer (10–28% of colorectal cancers),…
Definition and framework. Jaundice is yellow discoloration of skin and sclerae when serum bilirubin exceeds about 2.5–3 mg/dL. Classify as pre-hepatic, hepatocellular or post-hepatic (obstructive). In older adults, obstructive and…
Definition and importance. Drug-induced liver injury (DILI) is liver damage caused by drugs, herbs or supplements. It is the commonest cause of acute liver failure in the West and an important cause of jaundice in the elderly because of…
Definition and modern terminology. Chronic hepatitis is hepatic necroinflammation persisting for more than 6 months. The old histological labels "chronic active hepatitis" (interface hepatitis/piecemeal necrosis extending beyond the…
Definition. An acute clinical syndrome of rapid onset or worsening of jaundice in a patient with sustained heavy alcohol use, with underlying histological steatohepatitis. Severe disease may progress to acute-on-chronic liver failure…
Confirm and characterise the infection. Repeat HBsAg at 6 months to confirm chronicity; check HBeAg/anti-HBe, quantitative HBV DNA, ALT, and screen for anti-HDV, anti-HCV and HIV. Assess fibrosis with APRI, FIB-4 and transient…
Definition. Cirrhosis is diffuse hepatic fibrosis with regenerative nodules. Decompensation is defined by the appearance of ascites, variceal bleeding, hepatic encephalopathy or jaundice (Baveno VII). Median survival is more than 12…
Definition and classification. Brain dysfunction caused by liver failure and/or portosystemic shunting, ranging from subclinical impairment to coma. Type A — acute liver failure; Type B — portosystemic bypass without intrinsic liver…
Causes and initial assessment. Cirrhosis with portal hypertension accounts for about 80%; other causes are malignancy (peritoneal carcinomatosis), heart failure, tuberculosis, nephrotic syndrome and pancreatitis. Perform a diagnostic…
Definition and mechanism. A functional, potentially reversible renal failure occurring in advanced cirrhosis with ascites, caused by intense renal vasoconstriction secondary to splanchnic arterial vasodilatation and effective arterial…