Health Questions and Answers

QUESTION: What are the pitfalls in evaluating elderly patients with acute abdominal pain?

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 requiring immediate surgery, 39% have a WBC count greater than 10,000 compared with 71% of patients younger than 65.

Nevertheless, the overall incidence of surgical pathology among patients older than 65 admitted for abdominal pain is high (from 33% to 39%) compared with patients younger than 65 (16%). Cholecystitis, intestinal obstruction, and appendicitis are the most common causes for acute surgical abdomen in the elderly. Of all elderly patients with peptic ulcer disease. 50% present with an acute surgical abdomen as their initial manifestation of this condition. Because of atypical clinical presentations, additional screening tests, such as amylase, liver function studies, and alkaline phosphatase, and the liberal use of ultrasound or CT scan may be useful in this age group.

Leave a Reply