Abdominal pain (geriatrics): Difference between revisions
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*Elderly patients | *Elderly patients | ||
**Surgical emergencies are more common in elderly than in any other patient population | **Surgical emergencies are more common in elderly than in any other patient population | ||
**Viral gastroenteritis is uncommon | **[[Viral gastroenteritis]] is ''uncommon'' | ||
**Conservative admission strategy is strongly advocated | **Conservative admission strategy is strongly advocated | ||
*Patients with immunosuppression often have delayed or atypical presentations | *Patients with immunosuppression often have delayed or atypical presentations | ||
*Fever is not a reliable marker for surgical disease | *[[Fever]] is not a reliable marker for surgical disease | ||
==Elderly== | ==Elderly== | ||
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*Acute onset associated with catastrophe | *Acute onset associated with catastrophe | ||
*Med list is important | *Med list is important | ||
* | *Abdominal exam generally unhelpful/difficult to localize pain | ||
*Misc 25% | *Misc 25% | ||
**MI, dissection, mesenteric ischemia | **[[MI]], [[aortic dissection|dissection]], [[mesenteric ischemia]] | ||
*Biliary | *[[Biliary disease]] - 21% | ||
*Unknown - 20% | *Unknown - 20% | ||
*Obstruction - 12% | *[[SBO|Obstruction]] - 12% | ||
**previous surgery adhesions, internal/external hernia, malignancy | **previous surgery adhesions, internal/external [[hernia]], malignancy | ||
**sigmoid/cecal | **sigmoid/cecal [[volvulus]] - persistent pain, can be subacute, [[nausea and vomiting]], may not have fever | ||
*Perforated | *Perforated viscus - 7% | ||
** | **[[NSAIDs]] | ||
*Diverticular - 10% | *[[diverticulitis|Diverticular]] - 10% | ||
*Appendicitis - 5% | *[[Appendicitis]] - 5% | ||
**60% perforation in OR, lacking rebound/guarding | **60% perforation in OR, lacking rebound/guarding | ||
*Renal | *[[Renal colic]] - 4% | ||
Revision as of 18:13, 29 September 2019
Background
- Elderly patients
- Surgical emergencies are more common in elderly than in any other patient population
- Viral gastroenteritis is uncommon
- Conservative admission strategy is strongly advocated
- Patients with immunosuppression often have delayed or atypical presentations
- Fever is not a reliable marker for surgical disease
Elderly
- 60% are surgical
- Acute onset associated with catastrophe
- Med list is important
- Abdominal exam generally unhelpful/difficult to localize pain
- Misc 25%
- Biliary disease - 21%
- Unknown - 20%
- Obstruction - 12%
- previous surgery adhesions, internal/external hernia, malignancy
- sigmoid/cecal volvulus - persistent pain, can be subacute, nausea and vomiting, may not have fever
- Perforated viscus - 7%
- Diverticular - 10%
- Appendicitis - 5%
- 60% perforation in OR, lacking rebound/guarding
- Renal colic - 4%