By Ranjit N. Ratnaike

This textbook offers a realistic and finished account of the administration of diarrhea and constipation within the aged. those universal problems will not be just a burden in themselves yet are frequently manifestations of a extra critical underlying disorder; therefore, powerful analysis and remedy are necessary to increase caliber of lifestyles. The chapters contain updates on pathogenesis, analysis and therapy, and spotlight the vulnerability of the aged to diarrhea and its issues. The etiology of diarrhea is defined, together with infections of the gastrointestinal tract, and systemic illnesses of which it's a symptom. The authors symbolize varied disciplines: immunology, body structure, microbiology, nutrients, and psychiatry. The ebook is aimed toward geriatricians, normal practitioners, gastroenterologists, and allied medical experts.

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54:143–61. , Hosokawa, T. & Aoike, A. (1990). Aging effect on the immune functions of murine gut-associated lymphoid tissues. Dev. Comp. Immunol. 14:465–73. V. H. (1991). Ageing and duodenal mucosal immunity. Age Aging 20:33–6. L. K. (1987). Immunodeficiency of the elderly. Rev. Infect. Dis. 9:1127–39. L. K. (1986). Aging, gastrointestinal infections, and mucosal immunity. J. Am. Geriatr. Soc. 34:377–84. K. L. (1992). Ageing compromises gastrointestinal mucosal immune response in the rhesus monkey.

New York: Elsevier. 4 History and physical examination Ranjit N. Ratnaike Introduction • • • • 31 A well taken history and careful physical examination provide substantial information to establish a working diagnosis. History taking from an elderly patient is more difficult as compared with younger adult patients. A thorough medical evaluation is complicated and time consuming in the elderly patient who has a longer history of illness and many associated medical problems. At the initial stage of the clinical interview there is much to be gained by establishing: the patient’s normal bowel habit what is meant by diarrhoea whether the problem is spurious (overflow) diarrhoea due to constipation whether there is faecal incontinence.

Decreased vitamin B12 concentrations suggest long standing disease and possible causes are: bacterial overgrowth Crohn’s disease coeliac disease tropical sprue ulcerative colitis ileal resection ileal bypass involving the terminal ileum. It is important that low vitamin B12 levels be further investigated by the Schilling test. The test, carried out with and without intrinsic factor, will exclude pernicious anaemia as a cause of vitamin B12 deficiency. In states of bacterial overgrowth bacteria compete with the host for luminal vitamin B12 and consume more than the host absorbs.

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