Here - American Geriatrics Society

P OSTER
A BSTRACTS
Achalasia is a rare, elusive, and progressive disease that is usually
diagnosed only once it has reached advance stages. Described is a
case of an older adult who after four years of extensive testing received
therapeutic treatment for symptoms of episodic hypersalivation,
vomiting, and weight loss.
Case description:
A 79 yo female with a history of Alzheimer’s Disease, atrial fibrillation,
and osteoporosis was first seen in the office in 2006 with the
complaint of episodic hypersalivation, vomiting, and weight loss. Initial
EGD was significant for H.pylori, pre-pyloric edema and ulcer,
gastric antrum thickening, and antral erosion. Laboratory tests, CT of
the abdomen, and ultrasound of the abdomen were negative. Her
symptoms persisted, however, after eradication of the H. pylori and
PPI therapy. Further investigations in 2009 involved obtaining a
colonoscopy and a non-air contrast barium enema; both revealed diverticulosis.
Transglutaminase and small bowel biopsy were subsequently
negative for celiac disease. In April 2010 she was diagnosed
with lymphoma and was started on Rituxan therapy; she completed 4
treatments. She then underwent psychiatric evaluation and was
treated for apparent paranoia.
In 2010 she again presented to the office with similar complaints.
She now stated that she regurgitated what she ate after approximately
15 minutes. She was given a trial of applesauce to verify
her statement and after 10 minutes she regurgitated the applesauce.
She was immediately admitted to the hospital for a barium swallow
study that resulted in retained barium confirming the diagnosis of
achalasia. The diagnosis of achalasia came with great relief to the patient.
Today, her symptoms have resolved with the use of botulinum
toxin injections.
diagnosis which often times diverts clinicians from less common and
treatable causes. This is a case of failure to thrive with chronic abdominal
pain suggestive of an underlying malignancy but found to
have a benign cause.
The patient is a 78 year old female, cognitively intact with no
past medical or surgical history, from Senegal, presented with a progressive
2- year history of intermittent, mild, lower abdominal pain
with normal soft bowel movements and 30-lb weight loss. Symptoms
worsened for the past 2 months. She reports bright red blood per rectum
but denies diarrhea, constipation, hematemesis,vaginal bleeding
or fever.
On physical examination, her abdomen was soft, non-distended
with mild bilateral lower quadrant tenderness, without guarding or
rebound. Rectal exam showed no hemorrhoids or masses with brown,
Guiac positive stools. CT scan of the abdomen revealed significant
circumferential thickening at the lower anus and rectum suspicious
for malignancy.
Colonoscopy failed to show any discrete mass but found irregularity
and bogginess of anal mucosa along with severe diverticulosis
of entire colonic mucosa. Biopsies were sent and were negative for
malignancy. Ova and parasite screen revealed Ascaris lumbricoides.
Patient was started on mebendazole. A three-week follow-up
was significant for improved appetite with relief of abdominal pain
and diarrhea.
Discussion:
Dealing with immigrants, parasitic causes of failure to thrive
should be considered. Most of the literature describes Ascariasis in
tropical and subtropical areas affecting mostly children without mentioning
any case in the Geriatric population. Adults with ascariasis
are more likely to present with biliary complications. However, significant
nutritional deficiencies can be seen due to malabsorption, as in
this case. Hence in an immigrant with failure to thrive, parasitic
causes should be entertained.
Barium Swallow
A8 Encore Presentation
Worming Through a Case of Failure to Thrive.
M. A. Rashad, 1 J. Angeles, 1 H. Arabelo, 1 B. Matti-Orozco. 1,2 1.
Geriatric medicine, St Lukes Roosevelt Hospital, New York, NY; 2.
Medicine, Columbia Univeristy College of Physicians and Surgeon,
New york, NY.
Failure to thrive is a common diagnosis in the elderly consisting
of physical frailty, cognitive impairment and functional disability.
Weight loss more than 5% within 1 year is considered as the key component
and usually attributed to poor oral intake, medications, depression,
stroke and dementia. Malignancy is also a major differential
A9
Arteriovenous malformations in End Stage Renal disease.
N. Maheshwari, 1 R. Varma, 1 S. Kulkarni, 1 D. Kumari, 2 E. Ong, 1
E. Roffe, 2 S. Chaudhari. 2 1. Internal Medicine, New York Medical
College Metropolitan Hospital Centre, Manhattan, New York, NY; 2.
Geriatrics, New York Medical College Metropolitan Hospital Center,
New York, NY.
Introduction: Angiodysplasias can cause upper and lower gastrointestinal
(GI) bleeding in small percentage of patients with an increased
prevalence in patients like ESRD. We present a case of a
ESRD patient with recurrent GI bleeding secondary to AVM that ultimately
required a life saving surgical intervention.
Case presentation: A 68 year old African American male patient
with ESRD on maintenance hemodialysis was referred from Dialysis
Center for evaluation of severe anemia with hemoglobin (Hb) of
5.1gm/dl. He was managed in the medical intensive care unit and stabilized
with multiple blood transfusions. EGD, colonoscopy and capsule
endoscopy were inconclusive except an AVM in the proximal jejunum
which was photocoagulated. Patient was discharged but
presented again after a repeat fall in Hb from 8.7 to 4.3 gm/dl and was
readmitted to MICU. A small bowel endoscopy did not demonstrate
any lesion this time, tagged RBC scan showed abnormal activity from
hepatic flexure till the sigmoid colon. Colonoscopy showed multiple
erythematous mucosal lesions in the cecum, ascending colon and a
solitary lesion in the left colon resembling AVM which was photocoagulated.
Patient continued to drop his Hb despite repeated blood
transfusion. A repeat colonoscopy showed fresh red blood throughout
the colon up till the cecum and no clear bleeding site identified.
Angiography of the celiac axis and superior mesenteric artery failed
to identify clear focus of bleeding. Finally patient underwent Right
hemicolectomy and distal ileal resection as a life saving procedure.
Patient remained stable postoperatively and made an uneventful recovery.
AGS 2012 ANNUAL MEETING
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