{"id":420,"date":"2022-04-16T09:59:02","date_gmt":"2022-04-16T06:59:02","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=420"},"modified":"2022-04-16T09:59:02","modified_gmt":"2022-04-16T06:59:02","slug":"yasli-hastada-karin-agrisi-tuzaklarini-biliyor-muyuz","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/akademik-blog-yazisi\/yasli-hastada-karin-agrisi-tuzaklarini-biliyor-muyuz\/","title":{"rendered":"Ya\u015fl\u0131 Hastada Kar\u0131n A\u011fr\u0131s\u0131 Tuzaklar\u0131n\u0131 Biliyor Muyuz?"},"content":{"rendered":"<p style=\"font-weight: 400\"><strong>Giri\u015f <\/strong><\/p>\n<p style=\"font-weight: 400\">Geriyatrik ya\u015f grubu olarak kabul edilen 65 ya\u015f \u00fcst\u00fc n\u00fcfusun her ge\u00e7en g\u00fcn artmas\u0131yla birlikte kar\u0131n a\u011fr\u0131s\u0131 ile acil servise ba\u015fvuru oranlar\u0131 da art\u0131\u015f g\u00f6stermi\u015ftir. G\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 ve nefes darl\u0131\u011f\u0131ndan sonra 3. en s\u0131k acile ba\u015fvuru nedeni kar\u0131n a\u011fr\u0131s\u0131d\u0131r. Ya\u015fl\u0131 hastada temel \u015fik\u00e2yeti kar\u0131n a\u011fr\u0131s\u0131 olanlar\u0131n oran\u0131 %3-13, do\u011fru tan\u0131 oran\u0131 %40-82\u2019dir (1). G\u00f6rme ve i\u015fitme azl\u0131\u011f\u0131 gibi problemler, \u00e7oklu ila\u00e7 kullan\u0131m\u0131, komorbid hastal\u0131klar tan\u0131 koymay\u0131 ciddi anlamda g\u00fc\u00e7le\u015ftirir. Ayr\u0131ca ya\u015fl\u0131 grupta ba\u015fvuru semptomlar\u0131, fizik muayene bulgular\u0131 de\u011fi\u015fkendir. Kar\u0131n a\u011fr\u0131s\u0131 ile ba\u015fvuran ya\u015fl\u0131 hastalar\u0131n %50\u2019si yatm\u0131\u015f, %30-40\u2019\u0131na cerrahi gerekmi\u015ftir (2). Abdominal patolojik durumlara ba\u011fl\u0131 mortalite ve morbidite \u00f6nemli orandad\u0131r. Mortalite altta yatan patolojiye g\u00f6re de\u011fi\u015fmekle birlikte yakla\u015f\u0131k %10 civar\u0131ndad\u0131r (3). Gen\u00e7 hastalarla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda ya\u015fl\u0131 hastada mortalite oran\u0131 6-8 kat ve cerrahi gereksinim 2 kat daha y\u00fcksektir (1). Bu nedenle klinisyenler kar\u0131n a\u011fr\u0131s\u0131 ile ba\u015fvuran ya\u015fl\u0131 hastada olas\u0131 patolojilere kar\u015f\u0131 donan\u0131ml\u0131 olmal\u0131d\u0131r.<\/p>\n<p style=\"font-weight: 400\"><strong>Anamnez<\/strong><\/p>\n<p style=\"font-weight: 400\">Anamnez al\u0131rken ya\u015fl\u0131 hastan\u0131n ailesi ve bak\u0131c\u0131s\u0131 mutlaka sorgulanmal\u0131d\u0131r. A\u011fr\u0131 ba\u015flang\u0131c\u0131 ve s\u00fcreci, lokalizasyonu, \u015fiddeti, yay\u0131l\u0131m\u0131, art\u0131ran fakt\u00f6rler, benzer ataklar, gaz gayta \u00e7\u0131kar\u0131m\u0131, melena, d\u0131\u015fk\u0131da kan, ate\u015f, diz\u00fcri, dispne, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131, i\u015ftahs\u0131zl\u0131k ve kusma sorgulanmal\u0131d\u0131r. Ameliyat, kronik hastal\u0131klar, kulland\u0131\u011f\u0131 ila\u00e7lar, allerji, sigara ve alkol bilgileri unutulmamal\u0131d\u0131r.<\/p>\n<p style=\"font-weight: 400\"><strong>Fizik muayene <\/strong><\/p>\n<p style=\"font-weight: 400\">Fizik muayenede vital bulgular \u00f6nemlidir. Ancak vital bulgularda gen\u00e7 hastadan farkl\u0131 olarak dikkat edilmesi gereken baz\u0131 hususlar vard\u0131r. Geriatrik ya\u015f grubunda ate\u015f yan\u0131t\u0131 olmayabilir. Normotermi ve hipotermi g\u00f6r\u00fclebilir. Hipertansif bir hastada hipotansiyon beklenen durumda normotansiyon g\u00f6r\u00fclebilir. Ta\u015fikardi veya hipotansiyon r\u00fcpt\u00fcre abdominal aort anevrizmas\u0131 (AAA), septik \u015fok, gastrointestinal hemoraji ve hipovolemi bulgusu olabilir. Pn\u00f6moni de solunumsal bulgular olmaks\u0131z\u0131n kar\u0131n a\u011fr\u0131s\u0131 ile ba\u015fvurabilir. Epigastrik a\u011fr\u0131 ile gelen hastada akut miyokard infarkt\u00fcs\u00fc ak\u0131lda tutulmal\u0131d\u0131r. Tiz barsak sesleri, azalm\u0131\u015f barsak sesleri ve timpanik perk\u00fcsyon bulgular\u0131 barsak obstruksiyonu ile ili\u015fkili olabilir.<\/p>\n<p style=\"font-weight: 400\">Ya\u015fl\u0131 hastada kar\u0131n kaslar\u0131n\u0131n zay\u0131f olmas\u0131 nedeniyle defans ve rijidite g\u00f6r\u00fclmeyebilir. Rektal muayene ve ay\u0131r\u0131c\u0131 tan\u0131lar a\u00e7\u0131s\u0131ndan di\u011fer sistem muayeneleri mutlaka yap\u0131lmal\u0131d\u0131r. Umbikal, inguinal ve cerrahi skar etraf\u0131ndaki herniler g\u00f6zden ka\u00e7\u0131r\u0131lmamal\u0131d\u0131r.<\/p>\n<p style=\"font-weight: 400\"><strong>Laboratuvar <\/strong><\/p>\n<p style=\"font-weight: 400\">Laboratuvar bulgular\u0131 ya\u015fl\u0131 hastada cerrahi gerektiren durumlarda dahi normal olabilir. Kritik hastada kan grubu cross-match, hastan\u0131n klini\u011fi g\u00f6zetilerek tam kan say\u0131m\u0131, idrar, d\u0131\u015fk\u0131 \u00f6rne\u011fi, biyokimya ve ay\u0131r\u0131c\u0131 tan\u0131ya y\u00f6nelik ek tetkiklere ihtiya\u00e7 duyulabilir. Kan gaz\u0131nda asidoz ve anyon a\u00e7\u0131\u011f\u0131 ciddi kar\u0131n i\u00e7i patolojileri i\u015faret eder. Barsak iskemisi, ketoasidoz ve sepsis varl\u0131\u011f\u0131nda kan gaz\u0131 gereklidir. Gastrointestinal kanama d\u00fc\u015f\u00fcn\u00fclen hastalarda hematokrit de\u011ferini hemen g\u00f6rebilmek i\u00e7in kullan\u0131labilir. Serum amilaz ve lipaz pankreatit ay\u0131r\u0131c\u0131 tan\u0131s\u0131nda gereklidir. \u0130drar tetkikinde enfeksiyon ve hemat\u00fcri aranmal\u0131d\u0131r. Ya\u015fl\u0131 hastada hemat\u00fcri aort diseksiyonu bulgusu olabilir. Normal de\u011ferler hastal\u0131\u011f\u0131n ciddiyeti ile uyum sa\u011flamayabilir. Ya\u015fl\u0131 hastada l\u00f6kositoz ve l\u00f6kopeni g\u00f6r\u00fclmeyebilir. Karaci\u011fer fonksiyon testleri, biliyer sistem enfeksiyonlar\u0131nda dahi normal olabilir. Laboratuvar sonu\u00e7lar\u0131n\u0131 de\u011fil, hastay\u0131 tedavi etmek gerekti\u011fi unutulmamal\u0131d\u0131r.<\/p>\n<p style=\"font-weight: 400\">Ate\u015f, hipotermi ve sepsis \u015f\u00fcphesinde kan k\u00fclt\u00fcr\u00fc istenirken; aPTT ve PT, karaci\u011fer hastal\u0131klar\u0131, sepsis, gastrointestinal kanama ve cerrahi gereken hastalara istenmelidir.<\/p>\n<p style=\"font-weight: 400\">EKG, atriyal fibrilasyon ve miyokard infarkt\u00fcs\u00fcn\u00fc d\u0131\u015flamak a\u00e7\u0131s\u0131ndan \u00f6nemlidir. Atriyal fibrilasyon ve azalm\u0131\u015f kardiyak output, mezenter iskemi olas\u0131l\u0131\u011f\u0131n\u0131 art\u0131rabilir.<\/p>\n<p style=\"font-weight: 400\"><strong>G\u00f6r\u00fcnt\u00fcleme<\/strong><\/p>\n<p style=\"font-weight: 400\">Direk bat\u0131n ve akci\u011fer grafisi ileus, perforasyon, nefrolitiazis ve pnom\u00f6ni gibi durumlarda tan\u0131ya yard\u0131mc\u0131d\u0131r. Ultrasonografi (USG) acil hekimleri i\u00e7in steteskop niteli\u011finde, radyasyon riski olmayan, yatak ba\u015f\u0131, kolay ula\u015f\u0131labilir bir tetkik olmas\u0131 nedeniyle tan\u0131sal s\u00fcre\u00e7te \u00f6nemlidir. Abdominal aort anevrizmas\u0131nda yatak ba\u015f\u0131 yap\u0131lan USG h\u0131zl\u0131 tan\u0131da yard\u0131mc\u0131d\u0131r. Biliyer sistem hastal\u0131klar\u0131nda ilk tercih edilmesi gereken g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir.<\/p>\n<p style=\"font-weight: 400\">Bilgisayarl\u0131 tomografi (BT) klinisyenin son karar\u0131n\u0131 do\u011frudan etkileyen ve bir\u00e7ok akut durumda kesin tan\u0131ya g\u00f6t\u00fcren bir g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir. Perforasyon, abdominal aort anevrizmas\u0131, apandisit, akut mezenterik iskemi, pankreatit gibi bir\u00e7ok acil durumda gereklidir. Kontrasts\u0131z bat\u0131n BT nefrolitiazis, \u00fcrolitiazis olan hastada %95-100 sensitif iken, ya\u015fl\u0131larda damarsal kalsifikasyolar tan\u0131y\u0131 g\u00fc\u00e7le\u015ftirir. BT anjiografi mezenter iskemi tan\u0131s\u0131nda gereklidir.<\/p>\n<p style=\"font-weight: 400\"><strong>Tan\u0131<\/strong><\/p>\n<p style=\"font-weight: 400\">Ya\u015fl\u0131larda tan\u0131y\u0131 g\u00fc\u00e7le\u015ftiren ve komplikasyonlar\u0131 art\u0131ran bir\u00e7ok fakt\u00f6r vard\u0131r. \u0130leri ya\u015f, diyabet, malignite gibi e\u015flik eden hastal\u0131klarla birlikte imm\u00fcn fonksiyonlar azal\u0131r. Kardiyovask\u00fcler ve pulmoner hastal\u0131klar\u0131n fizyolojik rezervi azaltmas\u0131, abdominal aort anevrizmas\u0131 (AAA) ve mezenterik iskemi gibi hastal\u0131klara e\u011filimi art\u0131r\u0131r. Asemptomatik e\u015flik eden kolelithiazis, divertik\u00fcl ve AAA gibi durumlar olabilir. Ya\u015fl\u0131larda nonspesifik bulgularla ba\u015fvuru gen\u00e7lerden daha fazlad\u0131r. A\u011fr\u0131 alg\u0131s\u0131 bask\u0131lanm\u0131\u015f oldu\u011fundan patoloji daha ciddi bir hal alm\u0131\u015fken tan\u0131 konulabilmektedir. Ya\u015fl\u0131larda defans, rebound ve rijidite gibi klasik bulgularla ba\u015fvuruya daha az rastlan\u0131r. Ate\u015f, l\u00f6kositoz ve CRP y\u00fcksekli\u011fi g\u00f6r\u00fclmeyebilir. Bu fakt\u00f6rlerden dolay\u0131 ya\u015fl\u0131larda ciddi klinik durumlar ba\u015flang\u0131\u00e7ta gastroenterit ve konstipasyon gibi durumlarla kar\u0131\u015ft\u0131r\u0131labilir. Dikkatli hikaye, fizik muayene ve klinik \u015f\u00fcphe ile yanl\u0131\u015f tan\u0131 olas\u0131l\u0131\u011f\u0131 azalabilir.<\/p>\n<p style=\"font-weight: 400\">Ya\u015fl\u0131larda kar\u0131n a\u011fr\u0131s\u0131 ile ba\u015fvurularda ay\u0131r\u0131c\u0131 tan\u0131da \u00e7ok fazla hastal\u0131k olabilece\u011finden tan\u0131ya gitmek zordur. Ya\u015fl\u0131 hastalar\u0131n di\u011fer n\u00fcfusla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda kar\u0131n a\u011fr\u0131s\u0131 yerine halsizlik, bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131 ate\u015f, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 gibi semptomlarla ba\u015fvurusu daha s\u0131kt\u0131r.<\/p>\n<p style=\"font-weight: 400\"><strong>Ay\u0131r\u0131c\u0131 Tan\u0131<\/strong><\/p>\n<ul>\n<li>Biliyer sistem hastal\u0131klar\u0131<\/li>\n<li>Akut apandisit<\/li>\n<li>Pankreatit ve divertik\u00fclit<\/li>\n<li>Abdominal vask\u00fcler hastal\u0131klar (AAA ve mezenterik iskemi)<\/li>\n<li>Nonspesifik kar\u0131n a\u011fr\u0131s\u0131<\/li>\n<li>Malignite<\/li>\n<li>Barsak obstr\u00fcksiyonu<\/li>\n<li>Peptik \u00fclser<\/li>\n<li>\u0130nkarsere herni<\/li>\n<li>Pn\u00f6moni<\/li>\n<li>Miyokard \u0130nfarkt\u00fcs\u00fc<\/li>\n<\/ul>\n<p style=\"font-weight: 400\"><strong>Biliyer sistem hastal\u0131klar\u0131: <\/strong>Semptomatik kolesistit, kolelitiyazis, koledokolelitiazis, akalk\u00fcloz kolesistit ve kolanjiti kapsar. 65 ya\u015f \u00fcst\u00fc safra kesesinde ta\u015f oran\u0131 yakla\u015f\u0131k %30-50 oran\u0131ndad\u0131r. Baz\u0131 \u00e7al\u0131\u015fmalara g\u00f6re acile kar\u0131n a\u011fr\u0131s\u0131 ile ba\u015fvurular\u0131n en s\u0131k nedeni biliyer hastal\u0131klard\u0131r. Kolesistit tan\u0131s\u0131 alan ya\u015fl\u0131 hastalarda mortalite oran\u0131 %10 oran\u0131ndad\u0131r. Klasik olarak sa\u011f \u00fcst kadran a\u011fr\u0131s\u0131, ate\u015f ve l\u00f6kositoz olarak bulgu verir. Maalesef ya\u015fl\u0131lar\u0131n %25\u2019inde ciddi bir a\u011fr\u0131 g\u00f6r\u00fclmez, yar\u0131s\u0131ndan daha az\u0131nda ate\u015f l\u00f6kositoz ve kusma g\u00f6r\u00fcl\u00fcr (3). Bu nedenle tan\u0131 zor olabilece\u011finden y\u00fcksek klinik \u015f\u00fcphe gereklidir.<\/p>\n<p style=\"font-weight: 400\">Biliyer sistem hastal\u0131klar\u0131n\u0131n komplikasyonlar\u0131 safra kesesi perforasyonu, amfizemat\u00f6z kolesistit, asendan kolanjit, safra ta\u015f\u0131na ba\u011fl\u0131 ileustur. Ya\u015fl\u0131larda ince barsak obstr\u00fcksiyonlar\u0131 vakalar\u0131n %2\u2019sinden sorumludur (3).<\/p>\n<p style=\"font-weight: 400\"><strong>Apandisit: <\/strong>Gen\u00e7 ya\u015f grubu ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda apandisit ya\u015fl\u0131larda daha az s\u0131kl\u0131kta g\u00f6r\u00fcl\u00fcr. Fakat insidans giderek artmaktad\u0131r. Akut apandisit tan\u0131s\u0131 alanlar\u0131n %10\u2019u 60 ya\u015f \u00fcst\u00fcd\u00fcr, ancak apandisite ba\u011fl\u0131 \u00f6l\u00fcmlerin %50\u2019si bu gruptand\u0131r. Ya\u015fl\u0131larda perfore apandisit oran\u0131 gen\u00e7lerden 5 kat daha fazlad\u0131r ve %50 oran\u0131ndad\u0131r (3).<\/p>\n<p style=\"font-weight: 400\">Bu ya\u015f grubu hastalar\u0131n yar\u0131s\u0131nda ate\u015f ve l\u00f6kositoz g\u00f6r\u00fclmez. Hastalar\u0131n \u00fc\u00e7te birinde sa\u011f alt kadran a\u011fr\u0131s\u0131 yoktur. Hastalar\u0131n sadece %20\u2019sinde ate\u015f, i\u015ftahs\u0131zl\u0131k, l\u00f6kositoz ve sa\u011f alt kadran a\u011fr\u0131s\u0131 g\u00f6r\u00fcl\u00fcr. Ba\u015flang\u0131\u00e7 tan\u0131s\u0131 bu ya\u015f grubunda %40-50 oran\u0131nda yanl\u0131\u015ft\u0131r. T\u00fcm bu nedenlerle tan\u0131 gecikmekte ve mortalite artmaktad\u0131r. Yap\u0131lan 10 y\u0131ll\u0131k retrospektif \u00e7al\u0131\u015fmalara g\u00f6re tan\u0131 %35 hastada gecikmi\u015ftir. Y\u00fcksek klinik \u015f\u00fcphe hayat kurtar\u0131c\u0131d\u0131r.<\/p>\n<p style=\"font-weight: 400\"><strong>Divertik\u00fclit: <\/strong>Diyet ve ya\u015fa ba\u011fl\u0131 olarak geli\u015fen kolon divertik\u00fclleri 40 ya\u015f alt\u0131nda daha nadirken, Birle\u015fik Devletler&#8217;de 65 ya\u015f \u00fcst\u00fc hastalar\u0131n %50-80\u2019inde divertik\u00fcl mevcuttur. Divertik\u00fcl\u00fcn fekal materyalle t\u0131kanmas\u0131 sonucu divertik\u00fclit geli\u015fir ve bunun sonucu olarak lenfatik obstr\u00fcksiyon, inflamasyon ve kolon mikroperforasyonu ortaya \u00e7\u0131kabilir. Olgular\u0131n %85\u2019i sol kolonda ortaya \u00e7\u0131kar. Sa\u011f divertik\u00fcllerde tan\u0131 koymak daha zordur, ancak daha iyi huylu seyreder. Ya\u015fl\u0131 hastada divertik\u00fclit daha s\u0131kl\u0131kla afebril seyreder, olgular\u0131n yar\u0131s\u0131ndan az\u0131nda l\u00f6kositoz g\u00f6r\u00fcl\u00fcr. Hastalar\u0131n %25\u2019inde d\u0131\u015fk\u0131da kan pozitiftir.<\/p>\n<p style=\"font-weight: 400\"><strong>Mezenterik \u0130skemi: <\/strong>Her ne kadar kar\u0131n a\u011fr\u0131s\u0131 ile ba\u015fvuran olgular\u0131n %1\u2019inden az\u0131nda g\u00f6r\u00fclse de, ay\u0131r\u0131c\u0131 tan\u0131da mezenterik iskemiyi d\u00fc\u015f\u00fcnmek \u00f6nemlidir. Mortalite oran\u0131 %70-90\u2019d\u0131r. Tan\u0131 geciktik\u00e7e mortalite artmaktad\u0131r. Hastalarda ciddi a\u011fr\u0131ya ra\u011fmen, fizik muayenede hafif bir hassasiyet g\u00f6r\u00fcl\u00fcr. Kusma ve diyare s\u0131k g\u00f6r\u00fcl\u00fcr. Atriyal fibrilasyon, aterosklerotik kalp hastal\u0131\u011f\u0131 ve d\u00fc\u015f\u00fck ejeksiyon fraksiyonu mezenterik iskemi i\u00e7in risk fakt\u00f6r\u00fcd\u00fcr. Hastalar s\u0131kl\u0131kla postprandiyal rek\u00fcrren kar\u0131n a\u011fr\u0131s\u0131 ve bazen de sonlanm\u0131\u015f intestinal anjina ile ba\u015fvurur.<\/p>\n<p style=\"font-weight: 400\"><strong>Barsak Obstruksiyonu: <\/strong>Kar\u0131n a\u011fr\u0131s\u0131 ile ba\u015fvuranlar\u0131n %12\u2019sinde barsak obstr\u00fcksiyonu g\u00f6r\u00fcl\u00fcr. Obstr\u00fcksiyon kal\u0131n veya ince barsakta olabilir ve klinik olarak ay\u0131rt etmek zordur. \u00c7ekal volvulus relatif olarak nadirdir, tipik olarak klini\u011fi ince barsak obstr\u00fcksiyonu \u015feklindedir. Sigmoid volvulus daha s\u0131kt\u0131r, d\u00fcz grafide tan\u0131mlanabilir. 9 cm \u00fczerinde kolon distansiyonu perforasyona neden olabilir. Ya\u015fl\u0131larda s\u0131kl\u0131kla g\u00f6r\u00fclen barsak inaktivitesi ve laksatif kullan\u0131m\u0131 sigmoid volvulus i\u00e7in risk fakt\u00f6r\u00fcd\u00fcr. S\u0131kl\u0131kla ge\u00e7irilmi\u015f cerrahiye ba\u011fl\u0131 ortaya \u00e7\u0131kar. Ya\u015fl\u0131larda olgular\u0131n %30&#8217;u inkarsere herniye, %20&#8217;si safra ta\u015f\u0131 ileusuna ba\u011fl\u0131d\u0131r (3). Kal\u0131n barsak obstr\u00fcksiyonu ise daha \u00e7ok malignite ve volvulusa ba\u011fl\u0131 ortaya \u00e7\u0131kar.<\/p>\n<p style=\"font-weight: 400\"><strong>Abdominal Aort Anevrizmas\u0131 (AAA): <\/strong>AAA 3 cm&#8217;den b\u00fcy\u00fck aort \u00e7ap\u0131 olarak tan\u0131mlan\u0131r. Risk fakt\u00f6rleri ya\u015fl\u0131l\u0131k, erkek cinsiyet, sigara, pozitif aile \u00f6yk\u00fcs\u00fc, uzun boy, koroner arter hastal\u0131\u011f\u0131, hiperkolesterolemi, hipertansiyon ve aterosklerozu i\u00e7ermektedir (4). 65 ya\u015f \u00fczeri erkeklerin y\u00fczde 5\u2019inde AAA g\u00f6r\u00fcl\u00fcr. Erkek\/Kad\u0131n oran\u0131 7\/1\u2019dir. Hemodinamik olarak stabil r\u00fcpt\u00fcre AAA\u2019da mortalite %25\u2019tir. \u015eoktaki hastalarda mortalite y\u00fczde 80\u2019dir. Bir\u00e7ok hasta klinik olarak renal kolik ve kas iskelet sistemi a\u011fr\u0131s\u0131 klini\u011fi ile ba\u015fvurur. Klinik \u015f\u00fcphe \u00e7ok \u00f6nemlidir. Ortalama %30 hastada ilk tan\u0131da atlan\u0131r.<\/p>\n<p style=\"font-weight: 400\"><strong>Peptik \u00dclser: <\/strong>Peptik \u00fclser nonsteroid antiinflamatuvar ila\u00e7 (NSA\u0130\u0130) kullan\u0131m\u0131n\u0131n art\u0131\u015f\u0131yla birlikte 5-10 kat artmaktad\u0131r. Peptik \u00fclser hastal\u0131\u011f\u0131 mortalitesi ya\u015fl\u0131larda gen\u00e7lere oranla 100 kat daha fazlad\u0131r. Hastalar\u0131n %35\u2019inde a\u011fr\u0131 g\u00f6r\u00fclmez ve en s\u0131k semptom melenad\u0131r (3). Komplikasyonlar\u0131 hemoraji ve perforasyondur. Perforasyon ya\u015fl\u0131larda s\u0131kl\u0131kla a\u011fr\u0131s\u0131zd\u0131r ve hastalar\u0131n %60\u2019\u0131nda d\u00fcz grafide serbest hava g\u00f6r\u00fclmez.<\/p>\n<p style=\"font-weight: 400\"><strong>Malignite: <\/strong>Acil servisten nonspesifik kar\u0131n a\u011fr\u0131s\u0131 \u015fikayetiyle taburcu edilen hastalar\u0131n %10\u2019unda neden malignitedir. Akut patoloji d\u00fc\u015f\u00fcn\u00fclmeyen hastalar\u0131 ileri tetkik i\u00e7in y\u00f6nlendirmek gerekir.<\/p>\n<p style=\"font-weight: 400\"><strong>Gastroenterit: <\/strong>Kusma ve diyare \u015fik\u00e2yeti ile ba\u015fvuran hastalarda tan\u0131 gastroenterittir. Kusma ve ishal bir\u00e7ok hastal\u0131kta g\u00f6r\u00fclebilece\u011fi gibi, apandisit olanlar\u0131n %50\u2019sinde kusma ve ishal g\u00f6r\u00fcl\u00fcr. Di\u011fer \u00f6l\u00fcmc\u00fcl tan\u0131lar d\u0131\u015flansa bile, gastroenterite ba\u011fl\u0131 da ya\u015fl\u0131larda ciddi morbiditeler g\u00f6r\u00fclebilir. Gastroenterite ba\u011fl\u0131 \u00f6l\u00fcmlerin \u00fc\u00e7te ikisi 70 ya\u015f\u0131n \u00fczerindedir.<\/p>\n<p style=\"font-weight: 400\"><strong>\u0130drar Yolu Enfeksiyonu: <\/strong>\u0130drar yolu enfeksiyonu olan ya\u015fl\u0131 hastalarda gen\u00e7lerin aksine ba\u015fvuru \u015fikayeti olarak; diz\u00fcri, idrar s\u0131kl\u0131\u011f\u0131nda art\u0131\u015f ve urgency semptomlar\u0131 daha az g\u00f6r\u00fcl\u00fcr.<\/p>\n<p style=\"font-weight: 400\"><strong>Di\u011fer<\/strong>: Miyokard infarkt\u00fcs\u00fc ve pn\u00f6moni varl\u0131\u011f\u0131nda ya\u015fl\u0131lar m\u00fcphem kar\u0131n a\u011fr\u0131s\u0131 \u015fikayeti ile ba\u015fvurabilir.<\/p>\n<p style=\"font-weight: 400\"><strong>Yakla\u015f\u0131m<\/strong><\/p>\n<p style=\"font-weight: 400\">Ya\u015fl\u0131 hastan\u0131n kar\u0131n a\u011fr\u0131s\u0131 ile acile ba\u015fvurusunda hedef \u00f6nce hasta stabilizasyonu, sonra tan\u0131ya y\u00f6nelik i\u015flemler \u015feklinde olmal\u0131d\u0131r. Hastan\u0131n solunumu, bilin\u00e7 durumu ve vital bulgular\u0131 yak\u0131n takibe al\u0131nmal\u0131d\u0131r. Kar\u0131n a\u011fr\u0131s\u0131 ile ba\u015fvuran hastaya geni\u015f bir damar yolu a\u00e7mak, iv hidrasyon ba\u015flamak, monitorize etmek ve pulse oksimetre ile oksijen tedavisine ba\u015flamak gerekebilir. Hastan\u0131n klinik durumuna uygun hidrasyon ba\u015flan\u0131p, idrar \u00e7\u0131k\u0131\u015f\u0131 takibi yap\u0131lmal\u0131d\u0131r. Hipovolemi bulgular\u0131 olan hastaya, b\u00f6brek yetmezli\u011fi ve kalp yetmezli\u011fi olan hastalarda vol\u00fcm y\u00fcklenmesine dikkat ederek ringer laktat ve izotonik ile intraven\u00f6z yoldan hidrasyon ba\u015flan\u0131r. Foley kateter vol\u00fcm takibi a\u00e7\u0131s\u0131ndan kritik hastada gereklidir. \u0130nkontinans foley i\u00e7in bir neden olmamal\u0131d\u0131r. Acil cerrahi patolojiler d\u0131\u015flanana kadar hastan\u0131n oral al\u0131m\u0131 kapat\u0131lmal\u0131d\u0131r. Barsak obstr\u00fcksiyonu, ileus ve \u00fcst gastrointestinal kanama d\u0131\u015flanana kadar nazogastrik t\u00fcp tak\u0131lmal\u0131d\u0131r. Akut durumlarda erken cerrahi kons\u00fcltasyon istenmelidir.<\/p>\n<p style=\"font-weight: 400\">Hastan\u0131n analjezisi sa\u011flanmal\u0131 ve d\u00fc\u015f\u00fck doz opioidler NSA\u0130\u0130\u2019lardan daha \u00f6ncelikli tercih edilmelidir. Tan\u0131sal do\u011fruluk oran\u0131n\u0131 etkilemeden etkin ve g\u00fcvenli kullan\u0131labilece\u011fi bir\u00e7ok \u00e7al\u0131\u015fma ile g\u00f6sterilmi\u015ftir. Morfin 2-4 mg dozda etkin ve d\u00fc\u015f\u00fck maliyeti nedeniyle tercih edilebilir. Ancak morfin ve t\u00fcrevlerinin biliyer sistem hastal\u0131klar\u0131nda oddi sfinkter spazm\u0131na neden olabilece\u011fi unutulmamal\u0131d\u0131r. Fentanil k\u0131sa yar\u0131lanma \u00f6mr\u00fc olmas\u0131 ve dozlar aras\u0131 s\u0131k de\u011ferlendirme f\u0131rsat\u0131 tan\u0131mas\u0131, histamin sal\u0131n\u0131m\u0131na neden olmamas\u0131 ve kan bas\u0131nc\u0131na minimal etkisi nedeniyle avantajl\u0131d\u0131r. Analjezi uygulamadan \u00f6nce cerrahi patoloji d\u00fc\u015f\u00fcn\u00fclen hastada cerrah ile ileti\u015fim halinde olmak \u00f6nerilir.<\/p>\n<p style=\"font-weight: 400\">Sepsis, kolesistit, apandisit, divertik\u00fclit ve organ perforasyonu varl\u0131\u011f\u0131nda antibiyotik tedavisi erken d\u00f6nemde ba\u015flanmal\u0131d\u0131r. Hipotansiyon, azalm\u0131\u015f mental durum, persistan ta\u015fikardi veya \u00e7ok ciddi a\u011fr\u0131l\u0131 hastalar yo\u011funa bak\u0131m takibine al\u0131nmal\u0131d\u0131r. Yat\u0131r\u0131lan t\u00fcm hastalar seri muayeneye al\u0131nmal\u0131d\u0131r.<\/p>\n<p style=\"font-weight: 400\">Taburculuk a\u015famas\u0131nda ya\u015fl\u0131 hastada daha titiz davranmak gerekir. Kontrole \u00e7a\u011f\u0131rmak ve 12-24 saat sonras\u0131nda tekrar fizik muayene \u00f6nerilir. Yat\u0131\u015flarda hastan\u0131n sosyal durumu, yaln\u0131z ya\u015fay\u0131p ya\u015famad\u0131\u011f\u0131 g\u00f6z \u00f6n\u00fcnde bulundurulmal\u0131d\u0131r. R\u00fcpt\u00fcre AAA ve mezeneterik iskemi gibi acil durumlarda cerrahi konsultasyon geciktirilmemelidir.<\/p>\n<p style=\"font-weight: 400\"><strong>Kaynaklar<\/strong><\/p>\n<ol>\n<li style=\"font-weight: 400\">Samaras et al. Older Patients in Emergency department : A Review Annals of Emergency Medicine 2010; 56(3):261-69.<\/li>\n<li style=\"font-weight: 400\">Chang et al. Akut Abdominal Pain in Elderly. \u0130nternational Journal of Gerontology 2007: 1(2):77-82.<\/li>\n<li style=\"font-weight: 400\">Abdominal Pain in Elderly Persons, Updated: Jul 17, 2018 Author: E David Bryan, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP. <a href=\"https:\/\/emedicine.medscape.com\/article\/776663-overview\">https:\/\/emedicine.medscape.com\/article\/776663-overview<\/a>.<\/li>\n<li style=\"font-weight: 400\">Geriyatrik Acil T\u0131p. Christian Nickel, Abdelouahab Bellou, Simon Conroy. \u00c7eviri: Arzu Denizba\u015f\u0131 (\u00c7eviri Koordinat\u00f6r\u00fc). Murat , \u00d6zg\u00fcr Karc\u0131o\u011flu, Sinan Karacabey, Tanzer Korkmaz, \u00d6zlem K\u00f6ksal, Cem Oktay, Erkman Sanr\u0131 (\u00c7eviri Edit\u00f6rleri) Kongre Kitabevi 2021. Ya\u015fl\u0131 Hastalarda Kar\u0131n a\u011fr\u0131s\u0131, Nickel C, Bellou A, Conroy S. \u00c7eviri: Melih \u0130mamo\u011flu. 217-234.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Giri\u015f Geriyatrik ya\u015f grubu olarak kabul edilen 65 ya\u015f \u00fcst\u00fc n\u00fcfusun her ge\u00e7en g\u00fcn artmas\u0131yla birlikte kar\u0131n a\u011fr\u0131s\u0131 ile acil servise ba\u015fvuru&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":421,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10014],"tags":[10020,10018,10022],"class_list":["post-420","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","tag-acil-tip","tag-geriatri","tag-karin-agrisi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/420","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=420"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/420\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/421"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=420"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=420"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=420"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}