Constipation is one of the most frequent GIT disorders encountered among older adults in clinical practice.
Up to 50% of elderly experiencing constipation at some point in their lives.
Elderly women are having 2–3 times more constipation than men.
Approximately, 30% of older adults are regular nonprescription laxative users, such as stimulant and bulking laxatives.
Constipation easy explanation -
Easy ppt for Student Nurses
Definition of Constipation
risk factors
Clinical manifestations of Constipation
Assessment & Diagnostic tests
Management of Constipation
Medical management of Constipation
Nursing Management of Constipation
Constipation easy explanation -
Easy ppt for Student Nurses
Definition of Constipation
risk factors
Clinical manifestations of Constipation
Assessment & Diagnostic tests
Management of Constipation
Medical management of Constipation
Nursing Management of Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Uirinary incontinence / Bladder Incontinence, and its management. Highly recommended for II B.Sc Nursing Students
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Uirinary incontinence / Bladder Incontinence, and its management. Highly recommended for II B.Sc Nursing Students
Chronic Constipation: Causes, Solutions, and When to Seek Medical Help- Dr. V...Dr. Kale's Gastro Clinic
Explore the causes, effective solutions, and signs indicating when to seek medical assistance for chronic constipation. Empower yourself with knowledge to manage this common condition effectively.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Gastroparesis is a condition in which a human stomach cannot empty itself of food in a normal manner. Gastroparesis disorder is also known as delayed gastric emptying.
Disease associated with gastrointestinal tract and its treatment.docxImtiajChowdhuryEham
Disease associated with gastrointestinal tract and its treatment
Imtiaj Hossain Chowdhury
B’Pharm (Jahangirnagar University), M’Pharm (Jahangirnagar University)
Master’s in Public Health (American International University Bangladesh)
Explore comprehensive insights on acute and chronic diarrhea with Dr. Vikrant Kale. Gain expert knowledge to manage symptoms and understand potential causes effectively. Get informed to promote digestive health today!
The Comprehensive Geriatric Assessment.pptxAhmed Mshari
Comprehensive Geriatric Assessment (CGA) is a process of care comprising a number of steps. Initially, a multidimensional holistic assessment of an older person considers health and wellbeing and leads to the formulation of a plan to address issues which are of concern to the older person (and their family and carers when relevant). Interventions are then arranged in support of the plan. Progress is reviewed and the original plan reassessed at appropriate intervals with the interventions reconsidered accordingly.
Helicobacter pylori (H. pylori) has so far infected more than half the global population. It is the most important and controllable risk factor for gastric cancer. The elderly, who are at a higher incidence of the infection, are also commonly found to develop antibiotic resistance. The symptoms, diagnosis, clinical features (of gastric or extra-digestive diseases), and treatment of H. pylori infection in the elderly, are different from that in the non-elderly. Health conditions, including comorbidities and combined medication have limited the use of regular therapies in elderly patients. However, they can still benefit from eradication therapy, thus preventing gastric mucosal lesions and gastric cancer. In addition, new approaches, such as dual therapy and complementary therapy, have the potential to treat older patients with H. pylori infection.
DYSLIPIDAEMIA Management the European approach.pptxAhmed Mshari
Atherosclerotic cardiovascular diseases are responsible for millions of deaths worldwide each year.
More patients are surviving their first CVD event and are at high-risk of recurrences.
The prevalence of some risk factors, notably diabetes and obesity, is increasing.
In recent years, a number of international and regional guidelines were developed to deal with this problem.
Frailty is a common clinical syndrome in older adults.
It is a risk factor for many health problems that older adults face.
Frailty is a major focus of geriatrics medicine.
This lecture will review the definition, epidemiology, etiologies, and consequences of frailty.
It will also discuss how to identify and manage frail older adults.
PHC represents a philosophical approach to health and health care.
This approach is characterized by a holistic understanding of health as well-being, rather than the absence of disease.
It integrates knowledge of the medical, biological, physical, social, psychological, and behavioral sciences.
PHC provides a comprehensive care including health promotion, illness prevention, treatment and care of the sick, and rehabilitation.
Polypharmacy and Rational Prescribing in Elderly Patients.pptxAhmed Mshari
Polypharmacy is typically defined as the prescription of five or more medications.
It also refers to the prescription of medications that do not have a specific current indication, that duplicate other medications, or that are known to be ineffective for the condition being treated.
In other words, polypharmacy is the use of multiple medications that are unnecessary and have the potential to do more harm than good.
Injurious falls is a true geriatric syndrome and serious clinical problems facing older adults.
Falls result in significant morbidity and mortality and an increased rate of nursing home placement.
هو نهج جديد يتم تطبيقه في بعض مراكز الرعاية الصحية الأولية، يهدف الى دعم وتحسين نظام الرعاية الصحية الأولية والمساهمة بتوفير حزمة الخدمات الصحية الأساسية بجودة عالية، وبتكلفة يسيرة، ومستندة الى الأدلة العلمية المحدثة.
Depression in elderly people, also known as late-life depression, is a clinical syndrome characterized by persistent feelings of sadness, loss of interest or pleasure in activities, and a range of emotional, cognitive, and physical symptoms that significantly impact the individual's functioning and quality of life.
Insulin has three characteristics:
Onset: is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.
Peak time: is the time during which insulin is at maximum strength in terms of lowering blood glucose.
Duration: is how long insulin continues to lower blood glucose.
Osteoporosis is a chronic, progressive skeletal disease characterized by low bone mass, microarchitecture deterioration of bone tissue, bone fragility, and a consequent increase in fracture risk.
In this overview, we draw inspiration from the article titled "Managing Hypertension in Primary Care“, published in the Canadian Family Physician journal (Vol 65: October 2019).
The article, edited by Khrystine Waked PharmD, Jeff Nagge PharmD, and Kelly Grindrod PharmD MSc,.
It provides valuable insights and evidence-based approaches to tackle Hypertension Management In Primary Care.
By incorporating the recommendations discussed in this article, we can enhance our ability to manage hypertension and ultimately improving patient outcomes and quality of life.
المداخلات المبسطة للتحرر من التبغ.pptxAhmed Mshari
التدخين هو عملية يتم فيها حرق مادة التبغ وإستنشاقه.
يعتبر التدخين واحداً من أسوأ الأختراعات التي عرفها التاريخ ومن أهم المشاكل التي تواجه مجتمعات العالم وخاصة النامية منها.
لوحظ تسارع إنتشار هذه الظاهرة بين الفئات العمرية كافة وخاصة فئة الشباب والمراهقين وبين أوساط النساء أيضاً.
إن ضرره يتعدى الجانب الصحي, فهو يساهم بحدوث أضرار بيئية وأجتماعية وأقتصادية كبيرة.
To the consultation, the patient brings ideas, concerns, expectations, feelings and emotions related to his health problem. These areas are often grouped together and called the “Patent’s Agenda”.
Some of these emotional concerns may be explicit “Open Agenda”, but a large part may never be expressed openly if doctors do not proactively elicit them.
In 1981, Barsky, an American psychiatrist, gave a name to this assortment of hidden concerns; he called it the “Hidden Agenda”.
An important objective of a medical consultation is to understand as much as possible these hidden emotions.
Unless the doctor is able to fathom these, the patient may only be left with therapy that will treat his most obvious symptoms but not resolve the underlying problems.
Referral Process in Family Practice.pptxAhmed Mshari
It the process that involve seeking the assistance of another specialist with a resource to guide in managing a specific problem and sharing responsibility in patient care.
Ideally, it would result in “a closed referral loop”, in which the referral appointment is completed and results are then shared with the patient’s referring physician.
Apart from consultants and hospitals, a referral might be considered to family physician colleagues with special interests or expertise, and other members of the primary health care team, such as physiotherapists, dietitians, and social workers.
Ethical Issues in Obtaining Informed Consent.pptxAhmed Mshari
Medical ethics is a set of moral principles, beliefs and values that guide decisions about patient care.
It is an integral part of good medical practice.
The health care professional uses knowledge, experience, and judgment and considers the ethical principles to make decisions on management recommendations.
Medical errors are a growing concern in health care organizations.
No matter how well trained or hard working, healthcare providers make mistakes, just like other professionals.
Some data suggest that medical errors occurs up to 80 times per 100,000 consultations.
Medical errors are the third leading cause of death in the United States.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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2. 1. Define constipation and describe its prevalence among
elderly populations.
2. Identify the risk factors associated with chronic
constipation in elderly people.
3. Recognize red flags that may indicate a serious
medical condition.
4. Discuss the diagnostic approach for chronic
constipation in elderly patients.
5. Explain the potential complications of chronic
constipation in elderly individuals.
6. Describe the different treatment strategies for chronic
constipation in elderly patients.
7. Discuss methods for preventing chronic constipation in
elderly populations.
3. It is one of the most frequent GIT disorders
encountered among older adults in clinical
practice.
Up to 50% of elderly experiencing
constipation at some point in their lives.
Elderly women are having 2–3 times more
constipation than men.
Approximately, 30% of older adults are
regular nonprescription laxative users, such
as stimulant and bulking laxatives.
4. Miss Layla is an 80-year-old woman who has been experiencing
chronic constipation for the past few months.
She reports having bowel movements once every 3-4 days, and
the bowel movement is often hard and difficult to pass. She also
reports feeling bloated and discomfort.
Miss Layla has a history of hypertension, osteoporosis, and a
previous stroke. She takes several medications, including a
diuretic, a calcium supplement.
As a geriatrician, what would be your approach to managing
Miss Layla's chronic constipation?
5. The definition of constipation in the elderly may involve
infrequent defecation, difficulty in passing stool, or
Sensation of incomplete evacuation of stool.
Often, there is a significant discrepancy between the
physician’s and the patient's definition of constipation.
Physicians tend to define constipation as fewer than 3
bowel movements per week.
For chronic constipation to be diagnosed, symptoms
should be present for at least 12 weeks.
The elder, on the other hand, often define constipation as
straining to defecate or sensation of incomplete
evacuation.
So, always ask the elder what he means by constipation.
6. The Rome IV criteria define chronic constipation as symptoms that have
persisted for the past 3 months with an onset at least 6 months prior to
diagnosis, with the following 3 criteria being met:
Must include 2 or more of the following:
Hard or lumpy stool in ≥25% of defecations.
Straining during ≥25% defecations.
Sensation of incomplete evacuation for at least 25% of defecations.
Sensation of anorectal obstruction or blockage for ≥25%of defecations.
Manual maneuvers to facilitate ≥25% of defecations.
Fewer than 3 defecations per week.
Loose stools are rarely present without use of laxatives.
Insufficient criteria for irritable bowel syndrome.
7. Aging factor, which may lead to slower colonic transit and pelvic floor dysfunction.
Poor diet (e.g., a diet low in fiber and fluids).
Lack of physical activity (e.g., sedentary lifestyle).
Medications (prescription and nonprescription drugs).
Neurologic disorders (e.g., Parkinson disease, MS, spinal cord injury, CVA, dementia,
diabetic autonomic neuropathy).
Endocrine disorders (e.g., hypothyroidism, hyperparathyroidism, DM).
Metabolic disorders (e.g., hypokalemia, hyperkalemia, hypercalcemia).
Structural disorders (e.g., colonic obstruction, colorectal cancer, rectal prolapse).
Psychiatric disorders (e.g., depression, anxiety, and cognitive impairment).
9. Blood in the stool.
Severe abdominal pain or
cramping.
Nausea and/or vomiting.
Family history of colon cancer or
inflammatory bowel disease.
Anemia.
Positive fecal occult blood test.
Unexplained weight loss (≥10
pounds).
Constipation that is refractory to
treatment.
10. 1. Medical history: A detailed history should be
obtained, including the duration and nature of the
constipation, associated symptoms, medication
history, diet, lifestyle, and past medical history.
2. Physical examination: to assess for any signs of
structural abnormalities, such as an abdominal mass,
rectal prolapse, hemorrhoids, or anal fissures.
Digital Rectal Examination to assess the tone
and strength of the anal sphincter, as well as to
detect any masses or fecal impaction.
11. 3. Laboratory tests: Blood and stool tests may
be done to evaluate for any underlying
conditions that may be contributing to the
constipation, such as CBC, ESR, TFT, S. Ca.
4. Imaging studies: Depending on the findings
of the physical examination and the laboratory
tests, imaging studies such as X-rays, CT scans,
or MRI scans may be recommended to assess for
any structural abnormalities in the colon or
rectum.
12. 5. Functional testing: These may be
recommended to evaluate for any
underlying problems with bowel motility,
such as colonic transit studies, anorectal
manometry, or defecography.
6. Colonoscopy: This may be
recommended in some cases, such as
rectal bleeding, weight loss, or a family
history of colon cancer.
13. Fecal impaction.
Anal fissures, Hemorrhoids, and
Rectal prolapse.
Diverticular disease.
Megacolon.
Volvulus, especially of the sigmoid
colon.
Fecal incontinence.
UTI and Urinary incontinence.
Malnutrition.
Decreased quality of life.
14. There are several treatment strategies for
management, including Pharmacologic and
Nonpharmacologic treatment and Surgical
interventions.
Management should be individualized based
on the patient’s presentation, severity of
symptoms, and comorbidities.
Treatment should also aim to improve quality
of life, prevent complications, and minimize
adverse effects from medications.
15. The treatment of constipation is
primarily non-pharmacologic.
It involves inducing the patient to
adopt a healthier lifestyle, such as
Dietary changes, Regular exercise,
and Bowel training.
It's important to note that these
non-pharmacologic treatments
may take time to have an effect.
16. Increasing fiber intake (20 to 25
g/day), and increase consumption
of liquids, particularly water (2
L/day.
Foods high in fiber include fruits,
vegetables, whole grains, and
beans.
Avoid foods that are low in fiber,
such as processed foods, meats,
and dairy products.
17. Exercise can help stimulate
bowel movements.
Even light activity such as
walking or stretching can be
beneficial.
Bedridden patients are at great
risk of constipation and often
respond poorly to treatment.
Establishing a regular time for
bowel movements can help
regulate bowel function and
reduce constipation.
This includes taking time to sit
on the toilet for a few minutes
each day, preferably after
meals.
18. It is strengthening the muscles of the pelvic
floor to improve bowel control and reduce
constipation.
Biofeedback is a mind-body technique that
involves using visual or auditory feedback to
gain control over involuntary bodily functions.
It involves using sensors to monitor muscle
activity in the pelvic floor and provide feedback
to help individuals learn how to relax and
contract these muscles.
20. Bulking agents are first-line agents for constipation,
and the safest laxatives.
These are fiber-containing preparations which absorbs
water and helps to increase the stool mass and soften
the stool consistency.
Adequate hydration with bulking agents is necessary
for the desired outcome and to avoid dehydration,
worsening of constipation, or impaction.
Bulking agents may Interfere with the absorption of
other drugs and should be taken 1 hour before or 2
hours after other medications.
Bulking agents should also be increased slowly over
weekly periods to avoid side effects, such as
abdominal bloating and discomfort.
These may include Methylcellulose (Citrucel), Psyllium
(Metamucil), and Polycarbophil (FiberCon).
21. Stool softeners work by increasing the amount of
water in bowel motion.
These are often used when bulking agents do
not work or are not preferred.
Stool softeners can also be used in combination
with bulking agents.
These include Mineral Oil and docusate salts,
such as docusate sodium (Colace) and docusate
calcium (Surfak).
Aspiration pneumonia is known risks of using
Mineral Oil in older adults.
Mineral Oil is generally not recommended
because safer, more effective agents are
available.
22. These work by drawing water into the
intestines by osmotic activity.
They include Magnesium hydroxide (Milk
of Magnesia), Polyethylene glycol
(Miralax), Lactulose (Duphalac), and
Sorbitol 70%.
Polyethylene glycol has the best evidence
of use and may be better than lactulose.
Osmotic laxatives are useful when first-
line bulking agents and/or stool
softeners are not effective.
23. Stimulants increase intestinal motility by
increasing peristaltic contractions.
They also decrease water absorption from
the lumen.
Examples include Senna (Senokot) and
Bisacodyl (Dulcolax).
They cause unfavorable side effects:
abdominal discomfort, cramping,
diarrhea, and electrolyte imbalance.
Chronic stimulant laxatives use has been
associated with Melanosis Coli.
24. These medications enhance GIT motility
by increasing intestinal contractions.
Examples include Metoclopramide
(Reglan), Tegaserod (Zelnorm), and
Prucalopride (Resolor).
These drugs are no longer used to treat
constipation in older adults.
The use of Tegaserod and Prucalopride
has cardiovascular adverse effects.
Metoclopramide should be avoided
because of the side-effect profile in
older adults.
25. These work by stimulating the bowel
movement.
Enemas can be uncomfortable and may cause
side effects such as abdominal cramping and
diarrhea.
Enemas can also be difficult to administer,
particularly for elderly individuals.
Enemas may recommended in certain
situations, such as when other treatments
have been ineffective or when constipation is
severe and causing fecal impaction.
Examples: Saline enemas, Mineral oil enemas,
and Phosphate enemas.
27. Surgical interventions are reserved
for refractory cases to restore
quality of life.
It should be considered only after
careful evaluation by a
gastroenterologist.
Examples: Colectomy and
Ileorectal anastomosis.
28. Monitoring is an essential
components of managing chronic
constipation in elderly patients.
In follow-up visits, we should inquire
about changes in bowel habits and
assess for any new or worsening
symptoms.
Follow-up is also important to assess
the effectiveness of the treatment
plan and adjust it as necessary.
We should also monitor for medication-
related adverse effects that may occur
with long-term use of certain laxatives.
Close monitoring is critical to identify
and manage complications promptly.
The frequency of follow-up visits will
depend on the severity of the
constipation and the patient's response
to treatment.
Patients should also be encouraged to
report any new symptoms or concerns
between follow-up visits.
29. We should focus on early identification of risk factors and
early intervention to prevent the onset of constipation.
Regular exercise, adequate fluid intake, and a high-fiber diet
are key components of prevention.
We should be aware of the medications that can cause
constipation and attempt to minimize their use.
Identify and treat underlying medical conditions that may
contribute to constipation.
30. Miss Layla is an 80-year-old woman who has been experiencing
chronic constipation for the past few months.
She reports having bowel movements once every 3-4 days, and
the bowel movement is often hard and difficult to pass. She also
reports feeling bloated and discomfort.
Miss Layla has a history of hypertension, osteoporosis, and a
previous stroke. She takes several medications, including a
diuretic, a calcium supplement.
As a geriatrician, what would be your approach to managing
Miss Layla's chronic constipation?
31. The first step in management would be to take a thorough
Medical History, including her diet and exercise habits,
medication use, and any previous bowel or digestive
issues. This would help identify any underlying medical
conditions that may be contributing to her constipation.
Then, we would perform a Physical Examination to assess
for any signs of structural abnormalities, such as an
abdominal mass, rectal prolapse, hemorrhoids, or anal
fissures.
Digital Rectal Exam must performed to detect any masses
or fecal impaction.
32. Based on medical history and physical exam, we
may recommend lifestyle changes.
Advise her to increase her intake of fiber-rich
foods.
She should also increase her fluid intake and
engage in regular exercise.
We would also advise her to establish a regular
bowel routine.
33. If lifestyle modifications do not improve the
condition, Then:
We may recommend bulk-forming laxative.
If a bulk-forming laxative is not effective, a stool
softener, then osmotic laxative can be used.
Stimulant laxatives and enema should be
reserved for severe cases and used only on a
short-term basis.
34. Given Miss Layla's age and medical history, it is
important to be followed up in 2-4 weeks to assess
the effectiveness of the management plan.
We would also advise her to report any new or
worsening symptoms, such as rectal bleeding or
severe abdominal pain.
If her symptoms persist, further evaluation with a
colonoscopy may be warranted.
35. Brandt LJ, Prather CM, Quigley EM, Schiller LR,
Schoenfeld P, Talley NJ. Systematic review on
the management of chronic constipation in
North America. Am J Gastroenterol. 2005;100
Suppl 1:S5-S21.
Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler
SM, Stoa JM. Chronic constipation in the elderly.
Am J Gastroenterol. 2012;107(1):18-25.
Higgins PDR, Johanson JF. Epidemiology of
constipation in North America: a systematic
review. Am J Gastroenterol. 2004;99(4):750-
759.
Lee-Robichaud H, Thomas K, Morgan J, Nelson
RL. Lactulose versus polyethylene glycol for
chronic constipation. Cochrane Database Syst
Rev. 2010;(7):CD007570.
Lembo A, Camilleri M. Chronic constipation. N
Engl J Med. 2003;349(14):1360-1368.
Leung L, Riutta T, Lotecha J, Rosser W.
Chronic constipation: an evidence-based
review. J Am Board Fam Med.
2011;24(4):436-451.
Longstreth GF, Thompson WG, Chey WD,
Houghton LA, Mearin F, Spiller RC.
Functional bowel disorders.
Gastroenterology. 2006;130(5):1480-1491.
Rao SS, Go JT. Update on the management of
constipation in the elderly: new treatment
options. Clin Interv Aging. 2010;5:163-171.
Wald A. Constipation in the primary care
setting: current concepts and
misconceptions. Am J Med.
2006;119(9):736-739.
36. Alsalimy N, Madi L, Awaisu A. Efficacy and
safety of laxatives for chronic constipation
in long-term care settings: a systematic
review. J Clin Pharm Ther. 2018;43:595–
605.
Mounsey A, Raleigh M, Wilson A.
Management of constipation in older
adults. Am Fam Physician. 2015;92(6):500–
504.
Reuben DB, Herr KA, Pacala JT, et al.
Constipation. In: Geriatrics at Your
Fingertips. 21st ed. American Geriatrics
Society; 2019:137–138.
37.
38. Question 1
What is the first-line pharmacologic treatment for
chronic constipation in the elderly population?
Bulk-forming
laxatives
Osmotic laxatives
Lubricant laxatives Stimulant laxatives
39. Question 1
What is the first-line pharmacologic treatment for
chronic constipation in the elderly population?
Bulk-forming
laxatives
Osmotic laxatives
Lubricant laxatives Stimulant laxatives
Bulk-forming
laxatives
40. Question 2
What is the gold standard for the diagnosis of
constipation in older adults?
Colonoscopy Rome IV criteria
Sigmoidoscopy
Anorectal
manometry
41. Question 2
What is the gold standard for the diagnosis of
constipation in older adults?
Colonoscopy Rome IV criteria
Sigmoidoscopy
Anorectal
manometry
Rome IV criteria
42. Question 3
Which of the following is an appropriate goal for the
management of constipation in older adults?
Complete resolution
of symptoms
Maintenance of regular
bowel movements
Reversal of
underlying causes
All of the above
43. Question 3
Which of the following is an appropriate goal for the
management of constipation in older adults?
Complete resolution
of symptoms
Maintenance of regular
bowel movements
Reversal of
underlying causes
All of the above
All of the above
44. Question 4
Which of the following is a red flag symptom that
warrants further evaluation in older adults with
constipation?
Abdominal bloating
Infrequent bowel
movements
Rectal bleeding
Difficulty passing
stools
45. Question 4
Which of the following is a red flag symptom that
warrants further evaluation in older adults with
constipation?
Abdominal bloating
Infrequent bowel
movements
Rectal bleeding
Difficulty passing
stools
Rectal bleeding
46. Question 5
Which of the following is NOT a potential
consequence of untreated chronic constipation in
older adults?
Fecal impaction
Increased risk of
colorectal cancer
Rectal prolapse Bowel obstruction
47. Question 5
Which of the following is NOT a potential
consequence of untreated chronic constipation in
older adults?
Fecal impaction
Increased risk of
colorectal cancer
Rectal prolapse Bowel obstruction
Increased risk of
colorectal cancer
48. Question 6
Which of the following medications may contribute
to constipation in elderly patients?
Tricyclic
antidepressants
CCBs
Oxybutynin All of the above
49. Question 6
Which of the following medications may contribute
to constipation in elderly patients?
CCBs
Oxybutynin All of the above
All of the above
Tricyclic
antidepressants
50. Question 7
Which of the following laxatives is NOT
recommended for long-term use in elderly patients?
Bulk-forming
laxatives
Stimulant laxatives
Osmotic laxatives Stool softeners
51. Question 7
Which of the following laxatives is NOT
recommended for long-term use in elderly patients?
Bulk-forming
laxatives
Stimulant laxatives
Osmotic laxatives Stool softeners
Stimulant laxatives
52. Question 8
Which of the following is NOT a common cause of
chronic constipation in the elderly?
Slow colonic transit
Pelvic floor
dysfunction
Hyperthyroidism Opioid use
53. Question 8
Which of the following is NOT a common cause of
chronic constipation in the elderly?
Slow colonic transit
Pelvic floor
dysfunction
Hyperthyroidism Opioid use
Hyperthyroidism
54. Question 9
What is the recommended daily fiber intake for
elderly individuals to prevent chronic constipation?
Less than 5 grams 5-10 grams
10-15 grams More than 15 grams
55. More than 15 grams
What is the recommended daily fiber intake for
elderly individuals to prevent chronic constipation?
Less than 5 grams 5-10 grams
10-15 grams More than 15 grams
Question 9
56. Question 10
Which of the following is a potential complication of
treatment with Stool Softeners?
Diarrhea Nausea
Abdominal cramps All of the above
57. Question 10
Which of the following is a potential complication of
treatment with Stool Softeners?
Diarrhea Nausea
Abdominal cramps All of the above
All of the above