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位置: eLearning Site of APLCGG > e-Learning > Oct 22-28, 2012,Geriatrics Fellowship Teaching Schedule > Complex case presentations

Slide 1 (1:24:43)

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1. Orthogeriatrics - managing complex cases Antony JohansenConsultant in Trauma Medicine, University Hospital of WalesHon. Senior Lecturer in Public Health, University of Swansea

2. James Spencer (born 1919)

3. Slide 4

4. Slide 5

5. Slide 4

6. Slide 5

7. Paget’s disease of the bone

8. Slide 4

9. Paget’s disease of the bone

10. Epidemiology250,000 people in UKPrevalence 2% in over 55 year oldsSeveral times higher in oldest peopleFalling prevalence over recent yearsAetiology Viral (measles) mRNA in osteoclastsPositive family history in 5 –25% of patients7-fold increase among first degree relatives? Genetic factors: RANK, Osteoprotegerin

11. Clinical manifestations

12. Diagnosis

13. Treatment

14. Paget’s diseaseHip fracture secondary to Paget’s increases risk of complications.Calcitonin 100iu bd. sub-cut. even just for a day or two pre-op. will reduce bone vascularity and peri-op. blood loss.Ensure a pre-op. Hb >11g/dl, and cross match 4 units of blood.Admission Ca2+ and ALP levels will indicate the extent of disease activity – helping to guide fluid rehydration and/or calcitonin therapy to avoid the risk of hypercalcaemia in patients on bed-rest.

15. James Spencer (born 1919)

16. Medical historyHypertension, CKD3Extensive Paget’s diseaseRight sided vitreous detachment MarchAdmission with chest pain - Troponin normalAugust Urology admission with haematuria- prostatism, ultrasound normal- awaits cystoscopy

17. InvestigationsHb 10MCV 89Platelets 404WBC 10.7 CRP 5 Ca2+ 2.32 ALP 221Na+ 121 K + 4.6 Urea 11.1 Creat.84

18. Why did he fall?

19. InvestigationsHb 10MCV 89Platelets 404WBC 10.7 CRP 5 Ca2+ 2.32 ALP 221Na+ 121 K + 4.6 Urea 11.1 Creat.84

20. Why did he fall?

21. Successful hip fixationPost-operative deliriumPoor oral intakeHaematologyHb 9.6WCC 15BiochemistryCRP 300MicrobiologyMSU, MRSA screen, blood cultures all negative

22. Constance Davies (born 1925)87 year old womanLiving alone, independent PMHhypertension airways disease

23. 6th AugustAssaultHit about head and bodyKnocked to floor

24. Slide 21

25. Slide 22

26. 10th AugustShort of breathTender over front of right side of chestNo focal signsFever and high WCC

27. Slide 22

28. Slide 21

29. 6th AugustAssaultHit about head and bodyKnocked to floor

30. Slide 21

31. 10th AugustShort of breathTender over front of right side of chestNo focal signsFever and high WCC

32. Slide 24

33. Slide 25

34. Post-operative courseImproved Anxiety and insomniaRemained short of breath

35. Slide 27

36. 1st SeptemberMoved to trauma rehabilitation wardSome progress in physiotherapyFrail, frightened, and poor appetiteCare home placement increasingly likely

37. 1st October DeteriorationLeg swelling Increased shortness of breathAgain septic, with productive cough

38. Slide 30

39. Progressive deteriorationIncreasing shortness of breath"Given up"DiarrhoeaDied - 27th October

40. Why did she die? What view of causation should we take?

41. Why did she die? What view of causation should we take? pathological

42. Slide 34

43. Why did she die? What view of causation should we take? pathological

44. Why did she die? What view of causation should we take? pathological medical

45. Cause of death I aPseudomembraneous colitisI bChest infectionI cCOPDIIIHD and old age

46. Why did she die? What view of causation should we take? pathological medical legal

47. Cause of death I aPseudomembraneous colitisI bChest infectionI cCOPDIIIHD and old age

48. Why did she die? What view of causation should we take? pathological medical legal

49. Man denies OAP murder charge Constance Davies was "sprightly and perky"A 28-year-old man has appeared in court chargedwith the murder of a pensioner, who was left badly battered in her own home

50. Why did she die? What view of causation should we take? pathological medical legal general public

51. Quality of life related to fear of falling and hip fracture in older women: a time trade-off studySalkeld et al. BMJ 2000; 320: 341-4580% of over 75 year old women would prefer to die than lose their independence as a result of a “bad hip fracture” that requires their placement in a nursing home

52. Why did she die? What view of causation should we take? pathological medical legal general public

53. Why did she die? What view of causation should we take? pathological medical legal general public dietician

54. Nutritional intake - % of recommended

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