Guest lecture ageing gut
20 important questions on Guest lecture ageing gut
What is important for the gastrointestinal motility?
- longitudinal layer
- circular layer
- smooth muscle
- circular layer contracts to propel the chyme forward
- longitudinal layer contracts, shortens the small intestine
- circular layer contracts
What are the top 5 elderly dental problems?
- Tooth decay
- Gum disease
- Receding gums
- Dry mouth
- Tooth loss
What are the result of the study done on periodontal disease (and the role of fiber intake)?![]()
- significant association with Good fiber sources (>2.5 gr per serving) in progression of:
- ABL: HR=0.86 per serving
- PPD: HR=0.95 per serving
- Tooth loss: HR=0.88 per serving
<65 yrs
- no significant associations were seen in
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What is the oesophageal (cardiac) sphincter?
function: separation acid environment of the stomach
Which disease does this man have? And what will be done as a treatment?
endoscopy and treatment
- management of GERD
- avoid symptom causing foods or medication
- medical (proton pump inhibitors)
- surgery (nissen fundoplasty)
What are the signs for dysphagia & odynophagia?
- Dysphagia (difficulty with swallowing)
- signs
- pocketing of food in cheeks
- speech abnormalities with slurring of words
- orofacial changes
- facial weakness
- abnormal tongue movement
- foods becoming such if swallowed
- Odynophagia (pain upon swallowing)
- heartburn
- may be caused by GERD (gastroesophageal reflux disease)
- beware red flags: weightless, obstruction
- prevent Barrett's oesophagus (increased cancer risk)
What are the signs for dysphagia & odynophagia?
- Dysphagia (difficulty with swallowing)
- signs
- pocketing of food in cheeks
- speech abnormalities with slurring of words
- orofacial changes
- facial weakness
- abnormal tongue movement
- foods becoming such if swallowed
- Odynophagia (pain upon swallowing)
- heartburn
- may be caused by GERD (gastroesophageal reflux disease)
- beware red flags: weightless, obstruction
- prevent Barrett's oesophagus (increased cancer risk)
What is the treatment advise for dysphagia?
- Targeting the cause (when possible)
- consult with a speech therapist
- foods should be pureed, thickened or homogenous
- no raw foods except bananas
- have someone eat with the older adult
- cut tender meat to 1cm or less
- avoid nuts; raw, crispy food, stringy foods
prevent aspiration (abnormal entry of food or fluid into the airway)
What are the functions of the stomach?
functions
- to acidify and hydrolyse protein to a mixture (chyme = gastric juice + food particles)
- to control for bacterial growth
- moves food into small intestine
Why is someone nausea and vomiting ![]()
- Gastroparesis (delayed stomach emptying)
- symptoms include nausea, early satiety, vomiting, pain and possibly heartburn from reflux
- common causes: diabetes, idiopathic, psychological and post surgical
- occurs in 30% of those with type 2 diabetes
- occurs in 27% to 58% of those with type 1
- main concern is dehydration and weight loss
- if seriously ill, hospitalisation and IV rehydration
- medication to stop nausea and vomiting
- dietary recommendations
- liquids, salt and minerals to prevent dehydration
- eating small amounts through the day
Why is someone nausea and vomiting ![]()
- Gastroparesis (delayed stomach emptying)
- symptoms include nausea, early satiety, vomiting, pain and possibly heartburn from reflux
- common causes: diabetes, idiopathic, psychological and post surgical
- occurs in 30% of those with type 2 diabetes
- occurs in 27% to 58% of those with type 1
- main concern is dehydration and weight loss
- if seriously ill, hospitalisation and IV rehydration
- medication to stop nausea and vomiting
- dietary recommendations
- liquids, salt and minerals to prevent dehydration
- eating small amounts through the day
What are the functions of the small intestine?
- Receiving secretions from pancreas and liver
- complete digestion of nutrients
- absorbs products of digestion
- transport of remaining residues to large intestine
- defence against antigen entry
When/how does malabsorption happen when ageing?
- Defect that occurs during digestion and absorption of food nutrients
- compensation of organ function
- can occur at any of the three phases of digestion
- luminal phases - dietary fats, protein and carbohydrates are hydrolysed and solubilised
- mucosal phase - brush-border membrane of intestinal epithelial cells transport digested nutrients from the lumen into cells
- postabsorptive phase - lipid and other nutrients are transported form epithelial cells via the lymphatic system and portal circulation to other parts of the body
- signs: weight loss, steatorrhoea, deficiencies, osteoporosis
- treatment dependent on the cause
What are the functions of the large intestine?
- Reabsorption and recycling of water and electrolytes
- Secretion of mucus
- Bacteria (microbiota): digestion of dietary fibre to short chain fatty acids and synthesis/absorption of vitamin B1, B2 and K
- Formation and storage of faeces (undigested/unabsorbed materials, water, electrolytes, mucus and bacteria)
What does the women have? What is the treatment?
- Mrs Slotenmaker is now 76 years old
- sudden attacks of severe pain in the left lower abdomen
- fever and rectal blood loss once
- at physical examination a painful swelling in the left lower abdomen
- elevated ESR, leucocytosis
- CT-scan: Peridiverticular inflammtion
treatment:
- conservative (antibiotics)
- surgery
What are the functions of the gallbladder?
function of gallbladder:
- storage of bile between meals
- concentrates bile by reabsorbing water
- releases bile into duodenum (simulated by cholecystokinin)
function of bile acids:
- aid digestive enzymes
- enhances absorption of fatty acids and fat-soluble vitamins
What is the related to uncontrolled fecal losses [incontinentio alvi]
symptoms:
- anal itching, pain and irritated skin around the anus
- inintentionally letting winds or shit your pants without feeling it
- soiling
- loss of small amounts of mucus form the anus
- feelings of shame due to bad smells and fear of accidents --> social isolation
- combination with bladder control problems
treatment
- lifestyle
- reassurance
- mediation
- inlay bandage
- physiotherapy of pelvic floor and sphincter
- myofeedback
- electrostimulation
- balloon training
- rectal irrigation
- surgery
- sfincterrepair
- neurostimulation
- gracilis plasty
- abdominal stoma
What is the related to uncontrolled fecal losses [incontinentio alvi]
symptoms:
- anal itching, pain and irritated skin around the anus
- inintentionally letting winds or shit your pants without feeling it
- soiling
- loss of small amounts of mucus form the anus
- feelings of shame due to bad smells and fear of accidents --> social isolation
- combination with bladder control problems
treatment
- lifestyle
- reassurance
- mediation
- inlay bandage
- physiotherapy of pelvic floor and sphincter
- myofeedback
- electrostimulation
- balloon training
- rectal irrigation
- surgery
- sfincterrepair
- neurostimulation
- gracilis plasty
- abdominal stoma
How can we influence gut microbiota and health?
- Lifestyle
- diet
- hygiene
- antibiotics
- chronic inflammation
- metabolic dysfunction
18.7% variation by external factors
What is the bowel function in aging?
- Food digestion and nutrient absorption
- Barrier against toxic substances and pathogens
- Dependent on peristalsis, microbiota and gut integrity
absorption and barrier need to be in balance
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