Contemporary Geriatric Medicine: Volume 3

ISBN-13: 9781468454291 / Angielski / Miękka / 2012 / 502 str.

Steven R. Gambert; Steven R. Gambert

Opis

This volume is the third in the Contemporary Geriatric Medicine series. As in previous volumes, information is presented in the form of easy-to read essays to bring the reader up to date on state-of-the-art develop ments in the area of geriatric medicine. Once again, a system approach is utilized. In addition, several new topics-including alcoholism, throm boembolic disease, and decubitus ulcer management-have been intro duced to enhance this volume's usefulness to the busy clinician and student. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues currently receiving a great deal of attention. Our goal continues to be to create an exciting approach to contemporary issues in geriatric medicine. The editors are once again appreciative for having been given the opportunity to develop this series. Appreciation is also expressed to our professional colleagues, families, and administrative assistants, who have enabled this volume to reach fruition. As in the past, we thank, most of all, our elderly patients for providing the inspiration and impetus to improve our knowledge and understanding of the health care needs of the elderly. Steven R. Gambert, M.D. V alhalla, New York ix Contents Chapter 1 Geriatric Cardiology and Blood Pressure 1 Edmund H. Duthie, Jr., and Michael H. Keelan, Jr."

Spis treści

1 Geriatric Cardiology and Blood Pressure.- 1.1. Cardiovascular Morbidity-Mortality.- 1.2. Cardiovascular Anatomy and Physiology.- 1.2.1. Anatomic Changes.- 1.2.2. Intrinsic Cardiac Function.- 1.2.3. Autonomic Reflexes.- 1.2.4. Pulse Wave Characteristics.- 1.3. Clinical Evaluation.- 1.4. Laboratory Investigations.- 1.4.1. Electrocardiogram.- 1.4.2. Exercise Electrocardiography.- 1.4.3. Nuclear Cardiology.- 1.4.4. Echocardiography.- 1.4.5. Ambulatory Electrocardiography.- 1.4.6. Computerized Tomography.- 1.4.7. Invasive Procedures.- 1.4.7.1. Catheterization and Angiography.- 1.4.7.2. Electrophysiology.- 1.5. Coronary Artery Disease.- 1.5.1. Presentation and Diagnosis.- 1.5.2. Therapy.- 1.5.2.1. Nitrates.- 1.5.2.2. Beta Blockers.- 1.5.2.3. Calcium Channel Blockers.- 1.5.2.4. Antiplatelet Agents.- 1.5.3. Unstable Angina.- 1.5.4. Myocardial Infarction.- 1.5.5. Angioplasty.- 1.5.6. Coronary Artery Surgery.- 1.6. Congestive Heart Failure.- 1.6.1. Amyloidosis.- 1.6.2. Hypertrophic Cardiomyopathy.- 1.6.3. Thyroid Disease.- 1.7. Dissection of the Aorta.- 1.7.1. Diagnosis.- 1.7.2. Therapy.- 1.8. Valvular Heart Disease.- 1.8.1. Aortic Valve Disease.- 1.8.2. Mitral Valve Disease.- 1.8.3. Endocarditis.- 1.8.4. Valve Surgery.- 1.9. Atrial Septal Defect.- 1.10. Syncope.- 1.10.1. Heart Block.- 1.10.2. Sick Sinus Syndrome.- 1.10.3. Arrhythmias.- 1.10.4. Diagnosis and Treatment of Problem Cases.- 1.11. Cardiovascular Pharmacology.- 1.11.1. Digitalis.- 1.11.2. Antiarrhythmics.- 1.11.3. Vasodilators.- 1.12. Preoperative Evaluation.- 1.13. Blood Pressure and Aging.- 1.13.1. Blood Pressure: Determinant and Effects of Age.- 1.13.1.1. Cardiac Influences.- 1.13.1.2. Neurohumoral Influences.- 1.13.2. Population Studies.- 1.13.3. Hypertension: Definition.- 1.13.4. Approach to the Patient.- 1.13.4.1. History.- 1.13.4.2. Physical Examination.- 1.13.4.3. Laboratory Evaluation.- 1.13.5. Essential Hypertension in the Aged.- 1.13.6. Therapeutic Decision Making.- 1.13.6.1. Systolic Hypertension.- 1.13.6.2. Combined Systolic-Diastolic Hypertension.- 1.13.7. Treatment.- 1.13.7.1. Nonmedical Treatment.- 1.13.7.2. Medical Therapy.- References.- 2 The Gastrointestinal System and the Elderly.- 2.1. Introduction.- 2.1.1. Pathophysiologic Changes.- 2.1.2. Achlorhydria.- 2.2. Esophagus.- 2.2.1. Dysphagia.- 2.2.2. Preesophageal Dysphagia.- 2.2.2.1. Dysfunction of the Cricopharyngeus Muscle.- 2.2.2.2. Diagnosis and Complications.- 2.2.2.3. Treatment.- 2.2.3. Esophageal Dysphagia.- 2.2.3.1. Achalasia of the Lower Esophagus.- 2.2.3.2. Clinical Findings.- 2.2.3.3. Diagnosis.- 2.2.3.4. Treatment.- 2.2.4. Diffuse Esophageal Spasm.- 2.2.4.1. Diagnosis.- 2.2.4.2. Treatment of Diffuse Esophageal Spasm.- 2.2.5. Esophagitis.- 2.2.5.1. Reflux Esophagitis-Pathogenesis.- 2.2.5.2. Clinical Findings.- 2.2.5.3. Diagnosis.- 2.2.5.4. Treatment.- 2.3. Stomach.- 2.3.1. Upper Gastrointestinal Bleeding.- 2.3.1.1. Endoscopy.- 2.3.1.2. Therapeutic Endoscopy.- 2.3.2. Peptic Ulcer Disease.- 2.3.2.1. Incidence.- 2.3.2.2. Etiology.- 2.3.2.3. Diagnosis.- 2.3.2.4. Clinical Course.- 2.3.2.5. Treatment of Ulcer Disease.- 2.3.2.6. Long-Term Therapy with Cimetidine and Ranitidine.- 2.3.2.7. Side Effects.- 2.3.2.8. Complications.- 2.3.2.9. Surgery.- 2.3.3. Gastritis.- 2.3.3.1. Etiology.- 2.3.3.2. Clinical Findings.- 2.3.3.3. Diagnosis.- 2.3.3.4. Treatment.- 2.4. Hepatobiliary Disease.- 2.4.1. Viral Hepatitis.- 2.4.2. Chronic Active Hepatitis.- 2.4.2.1. Etiology.- 2.4.2.2. Clinical Findings.- 2.4.2.3. Treatment.- 2.4.3. Cholelithiasis.- 2.4.3.1. Incidence.- 2.4.3.2. Etiology.- 2.4.3.3. Prognosis.- 2.4.3.4. Treatment.- 2.4.3.5. Gallstone Dissolution.- 2.4.4. Acute Cholecystitis.- 2.4.4.1. Etiology.- 2.4.4.2. Clinical Findings.- 2.4.4.3. Diagnosis.- 2.4.4.4. Treatment of Acute Cholecystitis.- 2.4.5. Choledocholithiasis.- 2.5. Acute Pancreatitis.- 2.5.1. Incidence.- 2.5.2. Alcoholic Pancreatitis.- 2.5.3. Gallstone Pancreatitis.- 2.5.4. Diagnosis.- 2.5.5. Prognosis.- 2.5.6. Treatment-Medical.- 2.5.7. Treatment-Surgical.- 2.5.8. Complications.- 2.6. Appendicitis.- 2.7. Colon.- 2.7.1. Diverticulosis.- 2.7.1.1. Incidence.- 2.7.1.2. Etiology.- 2.7.1.3. Clinical Findings.- 2.7.1.4. Prognosis.- 2.7.2. Diverticulitis.- 2.7.2.1. Etiology.- 2.7.2.2. Clinical Findings.- 2.7.2.3. Treatment.- 2.7.2.4. Complications.- 2.7.3. Polyposis.- 2.7.3.1. Incidence.- 2.7.3.2. Etiology.- 2.7.3.3. Clinical Findings.- 2.7.3.4. Treatment.- 2.7.4. Superior Mesenteric Artery Occlusion.- 2.7.4.1. Incidence.- 2.7.4.2. Etiology.- 2.7.4.3. “Nonocclusive” Disease.- 2.7.4.4. Clinical Findings.- 2.7.4.5. Prognosis.- 2.7.4.6. Treatment.- 2.7.5. Ischemic.- 2.7.5.1. Etiology.- 2.7.5.2. Acute Transitory Colitis.- 2.7.5.3. Acute Nongangrenous (Strictural) Colitis.- 2.7.5.4. Gangrenous Colitis.- 2.7.5.5. Diagnosis.- 2.7.5.6. Treatment.- 2.7.6. Constipation.- 2.7.6.1. Primary Constipation.- 2.7.6.2. Secondary Constipation.- 2.7.6.3. Diagnosis.- 2.7.6.4. Treatment.- 2.7.6.5. Fecal Impaction.- 2.7.6.6. Fecal Incontinence.- 2.7.6.7. Diagnosis.- 2.7.6.8. Treatment.- 2.7.7. Diarrhea.- 2.7.7.1. Bowel Fluid and Electrolyte Absorption and Secretion with Diarrhea.- 2.7.7.2. Etiology.- 2.7.7.3. Pathogenesis of Diarrhea.- 2.7.7.4. Diagnosis.- 2.7.7.5. Treatment.- 2.7.8. Flatus.- 2.7.8.1. Etiology.- 2.7.8.2. Diagnosis.- 2.7.8.3. Treatment.- 2.7.9. Irritable Bowel Syndrome.- 2.7.9.1. Etiology.- 2.7.9.2. Clinical Findings.- 2.7.9.3. Diagnosis.- 2.7.9.4. Treatment.- 2.8. Lower Gastrointestinal Bleeding.- 2.8.1. Etiology.- 2.8.2. Vascular Ectasias (Angiodysplasias).- 2.8.3. Diverticulosis.- 2.8.4. Cancer.- 2.8.5. Diagnosis.- 2.8.6. Treatment.- 2.9. Cancer.- 2.9.1. Cancer of the Esophagus.- 2.9.1.1. Etiology.- 2.9.1.2. Clinical Findings.- 2.9.1.3. Treatment.- 2.9.2. Cancer of the Stomach.- 2.9.2.1. Etiology.- 2.9.2.2. Clinical Findings.- 2.9.2.3. Treatment.- 2.9.3. Colorectal Cancer.- 2.9.3.1. Etiology.- 2.9.3.2. Diagnosis.- 2.9.3.3. Treatment.- 2.9.4. Cancer of the Pancreas.- 2.9.4.1. Clinical Findings.- 2.9.4.2. Diagnosis.- 2.9.4.3. Treatment.- 2.9.5. Hepatoma.- 2.9.5.1. Etiology.- 2.9.5.2. Clinical Findings.- 2.9.5.3. Treatment.- 2.9.6. Cancer of the Gallbladder.- 2.9.6.1. Clinical Findings.- 2.9.6.2. Treatment.- 2.9.7. Summary.- References.- 3 Rheumatologic Disorders in the Elderly.- 3.1. Introduction.- 3.2. Septic Arthritis.- 3.2.1. Epidemiology.- 3.2.2. Pathogenesis.- 3.2.3. Clinical Presentation.- 3.2.4. Microbiology.- 3.2.5. Treatment.- 3.2.6. Outcome.- 3.2.7. Prosthetic Joint Infection.- 3.2.8. Summary.- 3.3. Crystal-Mediated Disorders.- 3.3.1. Introduction.- 3.3.2. Effect of Aging on Connective Tissue.- 3.3.3. Osteoarthritis.- 3.3.4. Gout.- 3.3.5. Calcium Pyrophosphate Dihydrate Deposition Disease.- 3.3.6. Apatite Arthropathy.- 3.3.7. Miscellaneous.- 3.4. Rheumatoid Arthritis.- 3.4.1. Introduction.- 3.4.2. Etiology.- 3.4.3. Clinical Features.- 3.4.4. Laboratory Studies.- 3.4.5. Diagnosis and Differential Diagnosis.- 3.4.6. Prognosis.- 3.4.7. Management.- 3.4.8. Summary.- 3.5. Systemic Lupus Erythematosus.- 3.5.1. Idiopathic Systemic Lupus Erythematosus.- 3.5.2. Drug-Induced Systemic Lupus Erythematosus.- References.- 4 Genitourinary Problems in the Elderly.- 4.1. Introduction.- 4.2. The Normal Lower Urinary Tract.- 4.2.1. Bladder Anatomy.- 4.2.2. Urethral Anatomy.- 4.2.3. Sphincters.- 4.2.4. Neuroanatomy.- 4.2.5. Normal Voiding.- 4.3. Incontinence.- 4.3.1. Scope of the Problem.- 4.3.2. Types and Etiologies of Incontinence.- 4.3.2.1. Urge Incontinence.- 4.3.2.2. Stress Incontinence.- 4.3.2.3. Mixed Urge and Stress Incontinence.- 4.3.2.4. Total Incontinence.- 4.3.2.5. Overflow Incontinence.- 4.3.2.6. Other Types of Problems.- 4.4. Evaluation of Incontinence.- 4.4.1. History.- 4.4.1.1. Voiding History.- 4.4.1.2. Past Medical and Surgical History.- 4.4.1.3. Neurologic History.- 4.4.1.4. Pharmacologic History.- 4.4.1.5. Behavioral and Psychosocial History.- 4.4.2. Physical Examination.- 4.4.3. Laboratory Data.- 4.4.4. X-Ray Evaluation.- 4.4.5. Cystoscopy/Urethral Calibration.- 4.4.6. Urodynamic Evaluations.- 4.4.6.1. Cystometry.- 4.4.6.2. Intraabdominal Pressure.- 4.4.6.3. Sphincter Electromyography.- 4.4.6.4. Urethral Pressure Profile.- 4.4.6.5. Uroflow.- 4.4.6.6. Fluoroscopic Voiding Cystourethrogram.- 4.4.6.7. Combined Studies.- 4.5. Evaluation of Specific Types of Incontinence.- 4.5.1. Urge Incontinence.- 4.5.2. Stress Incontinence.- 4.5.3. Mixed Incontinence.- 4.5.4. Overflow Incontinence.- 4.5.5. Total Incontinence.- 4.6. Treatment of Incontinence.- 4.6.1. Treatment of Urge Incontinence.- 4.6.1.1. Intermittent Self-Catheterization.- 4.6.1.2. Surgical Treatment.- 4.6.1.3. Indwelling Catheters.- 4.6.1.4. Other Treatments.- 4.6.2. Treatment of Stress Urinary Incontinence.- 4.6.2.1. Pharmacologic Therapy.- 4.6.2.2. Mechanical Devices.- 4.6.2.3. Surgery.- 4.6.2.4. Other Treatment Options.- 4.6.3. Treatment of Mixed Incontinence.- 4.6.4. Treatment of Total Incontinence.- 4.6.5. Treatment of Functional and Behavioral Causes.- 4.7. Urinary Retention in the Elderly.- 4.7.1. Introduction.- 4.7.2. Symptoms of Urinary Retention.- 4.7.3. Etiologies of Urinary Retention.- 4.7.3.1. Obstructive Uropathy.- 4.7.3.2. Sensory Dysfunction.- 4.7.3.3. Motor Dysfuncflon.- 4.7.3.4. Psychologic Dysfunction.- 4.7.4. Diagnosis of Urinary Retention.- 4.7.5. Urodynamic Evaluation.- 4.8. Treatment of Urinary Retention.- 4.8.1. Treatment of Acute Urinary Retention.- 4.8.2. Treatment of Chronic Urinary Retention.- 4.8.2.1. Increasing Intravesical Pressure.- 4.8.2.2. Decrease Bladder Outlet Resistance.- 4.8.2.3. Circumventing the Dysfunction.- References.- 5 Neuropsychiatric Problems in the Elderly.- 5.1. Introduction.- 5.2. Psychiatric Diseases.- 5.2.1. Thought Disorders.- 5.2.1.1. Schizophrenia of Late Onset.- 5.2.1.2. Paraphrenia.- 5.2.1.3. Late-Occurring Paranoia.- 5.2.1.4. Thought Disorders Secondary to an Organic Mental Disorder.- 5.2.2. Affective Disorders.- 5.2.2.1. Depression.- 5.2.2.2. Mania.- 5.2.3. Neurotic Disorders.- 5.2.3.1. Anxiety Neurosis.- 5.2.3.2. Compulsive Neurosis.- 5.2.3.3. Hysterical Neurosis.- 5.2.3.4. Chronic Fatigue.- 5.2.3.5. Hypochondriasis.- 5.2.4. Special Problems.- 5.2.4.1. Sleep Disturbances.- 5.2.4.2. Stress.- 5.2.4.3. Relationship between Functional Disorder and Physical Illness.- 5.2.4.4. Suicide.- 5.3. Drugs of Abuse.- 5.3.1. Introduction.- 5.3.2. Comparison of Drugs of Abuse-Young versus Aged.- 5.3.3. The Elderly Abuser.- 5.3.4. Causation of Alcohol Abuse in the Elderly.- 5.4. Organic Mental Disorders.- 5.4.1. Introduction.- 5.4.2. Causes of Dementia.- 5.4.3. Dementia as a Biopsychosociocultural Problem.- 5.4.4. Differential Diagnosis.- 5.4.5. Specifics regarding Diagnosis of Dementia.- 5.4.6. Alzheimer’s Disease.- 5.4.6.1. Epidemiology.- 5.4.6.2. Theories of Etiology/Risk Factors.- 5.4.6.3. Pathologic Correlations.- 5.4.6.4. Pick’s Disease-The Clinicopathologic Comparison with Alzheimer’s Disease.- 5.4.6.5. Treatment.- 5.5. Neurologic Diseases.- 5.5.1. Huntington’s Disease.- 5.5.2. Parkinson’s Disease.- 5.6. Conclusion.- References.- 6 Enteral and Parenteral Nutrition In the Elderly Patient.- 6.1. Statement of Purpose.- 6.2. Introduction.- 6.3. Enteral Nutritional Support of the Elderly.- 6.3.1. Introduction.- 6.3.2. Methods of Nutrient Delivery.- 6.3.3. Enteral Supplements.- 6.3.4. Complications during Enteral Nutrition.- 6.4. Parenteral Nutritional Support of the Elderly.- 6.4.1. Introduction.- 6.4.2. Techniques of Nutrient Delivery.- 6.4.3. Composition of Parenteral Formulas.- 6.4.4. Complications of Total Parenteral Nutrition.- 6.5. Conclusion.- References.- 7 Contemporary Issues In Geriatric Medicine.- 7.1 Decubitus Ulcers.- 7.1.1. Introduction.- 7.1.2. Etiology.- 7.1.3. Clinical Considerations.- 7.1.4. Complications.- 7.1.5. Prevention.- 7.1.6. Treatment.- 7.1.6.1. Statements of General Agreement.- 7.1.6.2. Relief of Pressure.- 7.1.6.3. Debridement.- 7.1.6.4. Local Agents.- 7.1.6.5. Dressings.- 7.1.6.6. Systemic Treatments.- 7.1.7. Overview.- References.- 7.2 Risk Factors for Coronary Artery Disease and Atherothrombotic Brain Infarction in the Elderly.- 7.2.1. Introduction.- 7.2.2. Coronary Artery Disease.- 7.2.2.1. Cigarette Smoking.- 7.2.2.2. Hyperlipidemia.- 7.2.2.3. Hypertension.- 7.2.2.4. Diabetes Mellitus.- 7.2.2.5. Obesity.- 7.2.2.6. Physical Inactivity.- 7.2.2.7. Age and Sex.- 7.2.3. Atherothrombotic Brain Infarction.- 7.2.3.1. Cigarette Smoking.- 7.2.3.2. Hyperlipidemia.- 7.2.3.3. Hypertension.- 7.2.3.4. Diabetes Mellitus.- 7.2.3.5. Obesity.- 7.2.3.6. Age and Sex.- References.- 7.3 Alcoholism in the Elderly.- 7.3.1. Introduction.- 7.3.2. Acute Effects of Alcohol.- 7.3.2.1. Vascular Problems.- 7.3.2.2. Gastrointestinal Problems.- 7.3.2.3. Ketoacidosis.- 7.3.2.4. Hypoglycemia.- 7.3.2.5. Gout.- 7.3.2.6. Metabolic Bone Disease.- 7.3.2.7. Renal Problems.- 7.3.2.8. Neurologic Impairment.- 7.3.3. Chronic Alcohol Use.- 7.3.3.1. Introduction.- 7.3.3.2. Hepatic and Hormonal Dysfunctions.- 7.3.3.3. Lipid Abnormalities.- 7.3.3.4. Cardiovascular Effects.- 7.3.3.5. Gastrointestinal Effects.- 7.3.3.6. Hematologic Consequences.- 7.3.3.7. Drug Interferences.- 7.3.4. Conclusion.- References.- 7.4 Preoperative Assessment of the High-Risk Elderly.- 7.4.1. Introduction.- 7.4.2. Assessment.- 7.4.3. Classification of Risk.- 7.4.4. Experiences from a Pre-operative Assessment Unit.- References.- 7.5 Hypercalcemia and Calcium Metabolism In the Elderly.- 7.5.1. General Considerations.- 7.5.2. Hyperparathyroidism.- 7.5.2.1. Epidemiology.- 7.5.2.2. Clinical Considerations.- 7.5.2.3. Laboratory Investigations.- 7.5.2.4. Treatment.- 7.5.3. Hypercalcemia in Malignancy.- 7.5.4. Miscellaneous Causes of Hypercalcemia.- 7.5.4.1. Vitamin D Intoxication.- 7.5.4.2. Sarcoidosis.- 7.5.4.3. Vitamin A Intoxicosis.- 7.5.4.4. Addison’s Disease.- 7.5.4.5. Thyrotoxicosis.- 7.5.4.6. Milk-Alkali Syndrome.- 7.5.4.7. Immobilization.- 7.5.4.8. Thiazide Diuretics.- 7.5.4.9. Familial Hypocalciuric Hypercalcemia.- 7.5.5. Treatment of Hypercalcemia.- References.