Abdominal pain (geriatrics)

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

60% are surgical
Acute onset associated with catastrophe
Med list is important
Abdominal exam generally unhelpful/difficult to localize pain
Misc 25%
- MI, dissection, mesenteric ischemia
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%
- NSAIDs
Diverticular - 10%
Appendicitis - 5%
- 60% perforation in OR, lacking rebound/guarding
Renal colic - 4%