To seek in the site
      Index       |      Forum     |    Gold Book      |     Newsletter      |      Contact    |                                                                                                            Send by email  |   Print

Courses of Geriatrics

An infection at the old person is always potentially serious.


Senescences of the various functions:

Determined by the loss of the cells.

Reduction of the weight of the bodies: atrophy.

Even mode for all.

But different speed for each individual.

Differential speed for each body.

Start as from the 2nd decade of the life for the kidney. The liver is the only body which does not age: it pushes back.

A out-of-date organization is a precarious organization, as well in terms of capacity as in terms of resistance.


Ageing causes a functional renal insufficiency.

The kidney is one of the two principal sites of infection at the old subject, with the lung.

a) Reduction in the functional clusters:

• Reduction in the number of clusters

• Reduction in the function of the remaining clusters

• A Number of increased abnormal clusters

b) Potential dehydration:

• Reduction in the feeling of thirst

• Incontinence

One passes to the organic renal insufficiency.

Lead quickly to the anurie.

Effects in return on the clusters.

c) Fall of the blood flow:

Ageing of the renal vascular system.

Effects on the renal blood flow.

That reinforces the anurie.

Worsen degradations of the renal function.

The blood flow decreases in return: effect swell of snow.

Glomerular filtration passes from 350 to 250 ml/min.


Degradation with the age of the pulmonary function.

The vital capacity decreases.

In the event of bronchopulmonary infection, increased risk of:

• Morbidity

• Mortality

The ventilatory function decreases as from 20 years.

• Reduction in the functionality of the cells

• Reduction in the movements of thoracic certified copy: osseous ageing; reduction in the elasticity of the costal cartilages

The more one ages, the more one develops a latent respiratory insufficiency. Men:

• 25 years: 5 L

• 75 years: 3,75 L Women:

• 25 years: 3,25 L

• 75 years: 1,75 L

Involve a disturbance of the gaseous exchange.


• An increase in the respiratory frequency

• An increase in the heart rate

The principal complication is a cardiac decompensation.

The patients die of cardiorespiratory complications.


Reduction in the number of the myocardic cells.

Involve an atrophy of the cardiac muscle.

Reduction in the weight of the myocardium.

Masked by lipidic invasion: deposit of athéromes.

The total weight of the heart increases paradoxically.

Ageing involves a latent cardiac insufficiency.

Dependent on an ageing of the vascular system.

Loss of the elasticity of the vascular walls.

Replaced by rigid fibres: in particular collagen.

Involve an aortic atrophy inter alia.

Deterioration of the blood flow:

• Lipidic Deposits

• Calcic Deposits

Involve a general fall of the blood flow; in particular:

• Renal

• Pulmonary

Reduction in the vascular light.

Involve an arterial hypertension.

At the pulmonary level: risk OAP.

The bronchopulmonary infection of the old person often has a cardiac component.


At the old person, the infection kills more than cancer.

In any event, it leaves after-effects.

First cause of death in institution.

Into ambulatory, cardiovascular causes, but often related to a pneumopathy.

Prevalence of the infections in institution: 15%.

Physiopathological elements:

a) Denutrition:

The nutritional phenomena are a worsening factor of the loss of immunizing defenses.

b) Deterioration of the quality of the cutaneous and/or mucous barrier:

• Bronchial

• Digestive

• Urinaire Represents as many entrance doors.

c) Reduction in cellular immunizing protection:

Immunizing defenses decrease during the senescence.

At the old person, they are very decreased when there is polypathology.

The cells immunocompétentes keep their effectiveness.

But their number falls.

Immunizing protection:

• Humorale: lymphocytes B (preserved)

• Cellular: lymphocytes T (decreased)

The intra-dermo reaction will be negative, even in the event of primary infection tubercular patient.

Associated factors:

They are generally causes some in the reduction in the elements of immunizing defense.

It is thus necessary to detect them.

a) Denutrition:

Reduction in the contributions in protids.

b) Cancer:

To seek in the event of repeating infection.

Urinary infections with repetition: to seek a renal cancer.

c) inflammatory Syndrome:

Sedimentation test increased: one tolerates a rise with 30 at the old person.

Alpha-2-globulines increased.

Can involve:

• Hyperthermia

• Hypothermia

Chronic deterioration of immunizing defenses.

Disturbance in the sector of immunoglobulins.

The infectious phenomenon and the inflammatory phenomenon are different things.

• Infectious Syndrome: clinical demonstrations

• Inflammatory Syndrome: biological demonstrations

d) Polypathology:


e) Depression:

Syndrome of slip.

Modification of behaviour on the mode of:

• Fall of tonicity

• Fall of the activity

• Modification of mood

MIME a depressive state.

But a depressive state can inaugurate an infectious or inflammatory syndrome.

f) Iatrogenic pathology:

Very invasive gesture:

• Probes

• Catheters


Prolonged Décubitus and consequent pathologies.

g) Hospitalization:

• Infections nosocomiales

• Community Infections

Private clinic:

a) Traditional:


Not obvious.

b) Goes away:


Systematic discovery at the time of an other infection.

c) Misleading:

• Deterioration of the state general: asthenia, anorexia, loss of appetite, denutrition

• Dehydration

• Hoop nets neuro-encephalic: modification of mood and vigilance, confusion

• Malayan, repeated falls, modifications of the diagram of walk: repercussion of the infection on the muscular system

• Cardiorespiratory Décompensation

• Urinary Incontinence


One should not be satisfied to observe but always reason.

Risk diagnostic wander.

• The gravity of the infection will be raised

• Forecast functional, even vital, brought into play

Systematic introduction of a antibiotiqueadapté treatment:

• Posology

• Sufficient Duration

It is a antibiothérapie probabilist and empirical:

• It is rare that the germ is known

• Doubts about the localization

It is necessary to take account of various elements:

• Senescence of the bodies

• Pharmacokinetic of antibiotics after 79 years

The adverse effects increase with the age.

Half-amounts are used.

The feverish state:


It is a clinical and therapeutic urgency.

Startup of an irreversible phenomenon of dehydration.

Importance of the precocity of the diagnosis.

To make an assessment general quickly.

It is essential to have quickly diagnostic orientations.

Never not to await the result of hémocultures to give the treatment.

Repercussion hemodynamic.

The patient will put himself in acidosis: the antibiotic treatments will not be effective any more.


• Shivers

• Productive Cough

• Vomiting (origin)

• Digestive Signs: distort roads

• To eliminate a surgical pathology (ex: appendicitis is not painful)


• Heart rate: acceleration of the pulse

• State neuropsychic: disorders of vigilance

• State of hydration


• Respiratory

• Cutaneous

• Neurological

• Cardiovascular

• ORL: nonpainful otitises

• Vascular

• Abdominal, modifications of the voice (polyps on the level of the vocal cords)


a) Hémoculture:

b) ECBU:

c) blood Assessment:


• VS

• Ionogramme blood

d) Hepatic assessment:

e) Radiograph thorax:

f) ASP:

• Digestive

• Renal

g) ECG


a) Renal pathologies:

Very frequent.

Important mortality.

Three weeks of treatment.

Renal echography can be negative.

b) Low urinary pathologies:

c) hépato-biliary Pathologies:

Attention with the misleading pulmonary signs (ex: vomiting because of a lithiasis)

Not inevitably of ictère nor of fever.

Sometimes simply of the vomiting.

d) Pathologies ORL:

e) Neurological pathologies:

f) Pleuro-pulmonary pathologies:

• Infectious

• Tumoral

• Vascular

g) Cutaneous pathologies:

- > Escarres

- > therapeutic Erysipelas Urgency.

Streptococcic cutaneous infection.

In relation to the vessels.

Risk septicaemia.

Therapeutic urgency:

• Antibiotic: penicillins

• Anticoagulants

Often lead to a thrombophlébite.

Pulmonary embolism of infectious type.

h) Thromboembolic pathologies:

• Dyspnea

• Right cardiac Insufficiency

• Thoracic Pain

• Essential Gazométrie Cough arterial.


One announces a hyperthermia more easily than a hypothermia.

It is however a sign much more pejorative for the vital forecast.

Hyperthermia is a sign of defense of the organization.

Hypothermia is the sign of nona defense of the organization by the immune system. The germ diffuses at any speed.

Major sign of gravity of the infection: 99% of death.

  Send by mail Envoyer cette page à un ami  Print Imprimer cette page

Posting of page 262

Medix in French

© Copyright Medix course in medicine 2003/2007 - All rights reserved.