Author Question: Alvita is a frail 89-year-old woman residing in a nursing home. She is able to move slowly around ... (Read 310 times)

itsmyluck · **on:** Jun 25, 2018

Alvita is a frail 89-year-old woman residing in a nursing home. She is able to move slowly around the residence with the use of a walker, but appreciates when her daughter is there to hold her arm and walk alongside her.

When one of the health care staff changes Alvita, her daughter helps. Alvita's incontinence has progressed, particularly over the last 6 years since she has resided in the nursing home. Alvita can smile at her lack of bladder control, however, and says that her incontinence really began when she was a young woman, just after the birth of her second daughter.

Alvita's mobility is limited. How does this affect continence in the elderly?

Shortly after the birth of her second daughter, Alvita experienced mild incontinence, particularly after laughing or coughing. What was she experiencing?

Question 2

Amy is a small, but active, 8-year-old. When Amy was approaching two, her mother took her to a pediatrician because Amy was failing to thrive.

She was small for her age and got tired easily. She was having difficulty with her meals, often developing colicky pain, abdominal distension, and diarrhea after eating. After a series of tests, Amy was diagnosed with celiac disease, a condition involving an abnormal immune response in the small intestine to foods containing the protein gluten. Her mother reminds Amy that in order for her to grow healthy and strong, it is important for her to eat her special food that is made at home, or has the words gluten free on the package.

What anatomical features of the small intestine lend it to the digestion and absorption of fats, carbohydrates, and proteins?

Sometimes individuals with celiac disease experience steatorrhea (fatty stools) after eating foods containing gluten. What are the chemical components that normally digest fats in the small intestine, and how are the fats absorbed?

Celiac disease involves an inflammatory response in the small intestine. How do inflammatory conditions affect small intestine motility?

amit · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Decreased mobility in the elderly has a significant effect on continence. Those who move slowly may not make it to the bathroom in time for urination. Arthritic individuals may find it difficult to move to the bathroom, manipulate door handles, or remove their clothes. If their vision is failing, it becomes a challenge to navigate to a bathroom, particularly in new surroundings or at night. Finally, stool impaction, a possibility with decreased mobility, leads to mechanical pressure on the bladder and subsequent incontinence.

What is the pathophysiology behind this type of incontinence?
Alvita began to experience stress incontinence after her second delivery. An intact pelvic floor maintains the position of the bladder in the pelvic cavity and the posterior urethrovesical angle between the bladder wall and urethra. When childbirth weakens the pelvic floor, the neck of the bladder descends and funnels into the lower pelvis. As it descends, the bladder also tilts posteriorly and widens the urethrovesical angle. These anatomical changes compromise continence so that relatively mild increases in intra-abdominal cause urinary leakage.

Answer to Question 2

The small intestine is anatomically specialized for the functions of digestion and absorption in many ways. It contains numerous circular folds that increase the surface area of the functional mucous membrane. Villi cover these folds and further contribute to increasing the surface area. Enterocytes are cells located at the upper portion of each villus and secrete brush border enzymes for the digestion of proteins and carbohydrates. The villi contain blood vessels and lacteals so that carbohydrates, proteins, and fats can all be absorbed and carried through the circulation.

The digestion of lipids occurs completely in the small intestine, particularly the upper jejunum. Lipases from the pancreas are secreted into the small intestine as a part of pancreatic juice and break down lipids to fatty acids. Bile salts, produced by the liver, enter the duodenum to combine with fatty acids to form micelles. The formation of these micelles facilitates the absorption of fatty acids at intestinal villi.

Inflammatory conditions increase motility and speed the transit time of foodstuffs through the gut. Parasympathetic activity, via the vagus nerve, is excitatory and increases gastrointestinal motility. Sympathetic innervation is through the celiac, superior mesenteric, and inferior mesenteric ganglia. Sympathetic activity acts to block excitatory neurotransmission at the intramural plexus and thereby inhibits gut activity.