Gallstones Presenting as Mental and Physical Debility in the Elderly

Cobden, I; Venables, C W; Lendrum, R; James, Ofw

doi:10.1016/s0140-6736(84)91462-4

Cited by 37 publications

(19 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ACS may be the only symptom of an underlying disease and causes difficult diagnostic problems [2][3][4][5][6]. Unobvious stroke is a cause of ACS [7], and ACS has been reported to be the commonest and sometimes the only symptom of a subdural hematoma [8],…”

Section: Introductionmentioning

confidence: 99%

Acute Confusional States (Delirium) in Stroke Patients

Gustafson¹,

Olsson

Eriksson³

et al. 1991

Cerebrovasc Dis

117

135

View full text Add to dashboard Cite

Acute confusional states (ACS) were studied in 155 consecutive representative patients (mean age 73 years) with acute cerebrovascular disorders. Testing for ACS could be done in 94% of the patients. Sixty-nine of the 145 testable patients (48%) were acutely confused on admission or developed ACS within 7 days of admission. The mean age for the patients who developed ACS was 76 years compared with 69 years for patients without ACS (p < 0.001). Fifty-six of 113 patients (50%) with cerebral infarction, 6 of 21 patients (29%) with transitory ischemic attack and 7 out of 8 patients (88%) with intracerebral hemorrhage developed ACS. ACS were more common in patients with left-sided brain lesions (38/65; 58%) than in patients with right-sided brain lesions (18/47; 38%, p < 0.05). Multivariate analysis showed that extensive extremity paresis, previous ACS, left-sided brain lesions, old age and treatment with drugs with anticholinergic effects were independent predictors for ACS. ACS were associated with poststroke complications such as myocardial infarction, pulmonary embolism, pneumonia, deep vein thrombosis, urinary retention or urinary tract infection. Extensive paresis and ACS were the main independent predictors for discharge to geriatric rehabilitation.

show abstract

Section: Introductionmentioning

confidence: 99%

Acute Confusional States (Delirium) in Stroke Patients

Gustafson¹,

Olsson

Eriksson³

et al. 1991

Cerebrovasc Dis

117

135

View full text Add to dashboard Cite

show abstract

“…Pancreatobiliary disease is not uncommon in the elderly and may present atypically [1], Endoscopic retrograde cholangiopancreatog-tients who are ill. Ultrasound is often, there fore, the only imaging modality used to inves tigate pancreatobiliary disease.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Retrograde Cholangiopancreatography in the Elderly: A Single Unit Audit

MacMahon

Walsh²,

Brennan

et al. 1993

Gerontology

View full text Add to dashboard Cite

Endoscopic retrograde cholangiopancreatography (ERCP) has an established role in the management of pancreatobiliary disease, but its role in elderly patients has not been evaluated. A prospective study was carried out in 50 elderly patients, aged between 65 and 94 years, to compare the sensitivity and specificity of ERCP in this age group with ultrasound and liver blood tests, and to examine its safety and therapeutic effectiveness. ERCP was successful in 46 of 50 (92%) procedures. Thirty-four patients had abnormal findings, and 18 sphincte-rotomies were performed. No complications were recorded. There was a poor correlation between ultrasound and ERCP with agreement in only 45% of cases; sensitivity 35% and specificity 75%. Liver blood tests, alkaline phosphatase and γ-glutamyl transferase were elevated in all 30 cases with obstructed ducts on ERCP. Ultrasound revealed obstruction in only 10 (33%) of these. Thus, liver biochemistry proved a more reliable indicator of biliary obstruction than ultrasound. In 22 cases endoscopic stone clearance or demonstration of inoperable lesions obviated surgery while in 9 cases surgery was indicated, because of multiple large stones not cleared at ERCP, or for bypass of a malignant stricture. ERCP is therefore safe and effective with a high diagnostic and therapeutic yield even in the poor risk elderly.

show abstract

“…"Functional" presenting symptoms were defined as falls, urinary tract or fecal incontinence, and confusion (2,3). Confusion was judged as present when there was documentation of a worsened mental state, regardless of the presence or absence of preexisting dementia (2,3).…”

Section: Methodsmentioning

confidence: 99%

“…Confusion was judged as present when there was documentation of a worsened mental state, regardless of the presence or absence of preexisting dementia (2,3). Patients were classified as "elderly" or "younger" according to an agecut off of 75 years.…”

Section: Methodsmentioning

confidence: 99%

Clinical Presentation and Delayed Treatment of Cholangitis in Older People

Rahman

Larvin

McMahon³

et al. 2005

Dig Dis Sci

View full text Add to dashboard Cite

Acute cholangitis is more common in older people, and increasing age is a determinant of morbidity and mortality, as is early biliary decompression by ERCP. This study aims to identify factors that may contribute to delays in the diagnosis and treatment of older people with acute cholangitis. Case notes of 122 patients (45 aged < 75 years, 77 > 75 years) with a final diagnosis of acute cholangitis who underwent ERCP were reviewed for presenting clinical features (pain, jaundice, rigors, fever, falls, incontinence, confusion), liver function tests, blood count, and the interval from admission to diagnosis, ultrasonography, and ERCP. The most common symptom at presentation was abdominal pain (81%), followed by jaundice (55%). These symptoms were no less common in older patients. Charcot's triad was present in only 15.6% of young and 18.8% of older patients. Jaundice was not detected in 16% of significantly hyperbilirubinemic older patients, but only the presence of functional symptoms was associated with significant diagnostic delay (median, 1 day [range: 0-11] vs. 9.5 days [3-25]; P< 0.001) and delay in performing ERCP (median: 4 days [0-24] vs. 16.5 days [2-29], P< 0.001). Overall mortality was 10%, and the incidence of septic shock was similar in both groups. Charcot's classical triad is infrequent in patients suffering from acute cholangitis. Given the greater difficulty assessing jaundice in older people and the confounding effect of falls, incontinence, and confusion, a routine policy of liver function tests, with further investigation of abnormal results in such presentations, may reduce delays in diagnosing and treating acute cholangitis.

show abstract

Gallstones Presenting as Mental and Physical Debility in the Elderly

Cited by 37 publications

References 5 publications

Acute Confusional States (Delirium) in Stroke Patients

Acute Confusional States (Delirium) in Stroke Patients

Endoscopic Retrograde Cholangiopancreatography in the Elderly: A Single Unit Audit

Clinical Presentation and Delayed Treatment of Cholangitis in Older People

Contact Info

Product

Resources

About