A substantial reduction in renal function accompanies normal aging, although the senescent kidney ordinarily functions sufficiently to remove wastes and adequately regulate the volume and composition of extracellular fluid. Nevertheless, changes in renal function reduce the older person’s capacity to respond to a variety of physiologic and pathologic stresses, with important clinical implications. Renal Anatomy [...]
Surgery is limited in the treatment of splenic disorders. Operative measures include splenectomy, repair of injuries by methods other than splenectomy, and drainage of abscesses. The main indications for splenectomy are trauma (either blunt, penetrating, or iatrogenic), disease of adjacent organs (such as the stomach, pancreas, or colon), idiopathic thrombocytopenic purpura, and advanced splenomegaly. Rarely [...]
In older patients, the major disorders of the pancreas are injuries from blunt trauma, gallstone pancreatitis, and cancer. Exocrine and endocrine neoplasms of the pancreas are discussed in Ch. 60. Traumatic Injury Diagnosing and treating penetrating wounds present no problems. However, diagnosing an injury from blunt trauma is often difficult, and the treatment is controversial. [...]
