ANSWER:
Advanced age may blunt the manifestations of acute abdominal disease.

Pain may be less severe; fever often is less pronounced: and signs of peritoneal inflammation, such as muscular guarding and rebound tenderness, may be diminished or absent.

Elevation of the white blood cell (WBC) count is less sensitive in the elderly: In patients older than age 65 [...]

ANSWER:

Anorexia
Nausea
Vomiting

are directly proportional to the severity and extent of peritoneal irritation. The presence of appetite does not rule out a surgically significant inflammatory process, such as appendicitis• A retrocecal appendicitis with limited peritoneal irritation may be associated with minimal gastrointestinal upset, and 1/3 of all patients with acute appendicitis do not report anorexia on initial [...]

Answer:
Generally, pain preceding vomiting is suggestive of a surgical process, whereas vomiting before onset of pain is more typical of a nonsurgical condition. Epigastric pain that is relieved by vomiting suggests intragastric pathology or gastric outlet obstruction.

Answer:
Rebound tenderness is the traditional physical examination finding for peritonitis• In a patient with likely generalized peritonitis (obvious distress, an excruciating pain every time the ambulance hits a bump), the standard tests for rebound tenderness are unnecessarily harsh. Asking the patient to cough generally supplies adequate peritoneal motion to give a positive test. When in [...]

Answer:
As the peritoneum adjacent to a diseased organ becomes inflamed, palpation or any abdominal movement causes stretching of the sensitized peritoneum and, consequently, pain localized at that site (localized peritonitis). If irritating material (pus, blood, gastric contents) spills into the peritoneal cavity, the entire peritoneal surface may become sensitive to stretch or motion, and any [...]

Answer:
Evolving patterns of pain frequently reveal the source and give an idea of the extent to which the process has advanced. Early, the patient may describe a deep-seated, dull pain, which may be crampy (visceral pain) emanating from inflammation, ischemia, chemical irritation, or stretching of the smooth muscle of hollow viscera or the capsule of [...]

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