Acute Abdomen Flashcards
Acute abdomen dx in elderly is challenging, why?
history is confounded by
- stocicism
- alterations in pain perception
- memory deficits
- communication problems
- mental status changes
physical exam is unreliable
- 80% will not have rigidity with peritonitis
- 50% will be afebrile with acute cholecystitis
lower leukocyte count and lower/delayed temp
Ancillary testing is unreliable, other imaging techniques (CT/US)must be used liberally
different anatomical factors (poor blood flow to a thinner appendix predisposing to perforation and gangrene)
Biliary tract disease
-most common cause of what
-sx in elderly
-
Most common cuase of abd operations in the elderly
Sx
-“biliary colic” is replaced by vague abd complaints
Dx
- may or may not have epigastric/RUQ pain, no pain at all, normal WBCs
- murphys sign
- US is diagnostic
Acute Appendicitis
- presentation
- dx
Presentation
- 1/3 present late (more than 72 hours)
- 50% misdiagnosed on admission
- only 20% presented with classic: n/a, fever, RLQ pain, elevated WBC
Dx
-CT
Acute Pancreatitis
- MC cause
- major sx
- other sx
MC cause
- gallstones
- might expect a history or alcohol use or really high triglycerides
Major sx
-abd pain
Other sx
-tachycardia, hypotension, tachypnea, confusion
Acute Diverticulitis
- sx
- dx
Sx
- LLQ pain
- tenderness
- moderate abd distension
- moderate temp elevation
Dx
-CT
Peptic Ulcers
- elderly pts have a higher risk to develop these due to what?
- sx
Elderly pts have a significantly higher risk to develop peptic ulcers and complications from NSAIDs
Sx
- pain is absent in 1/3 pts
- pain can be vague and poorly localized
- presenting sx may be systemic and related to blood loss and anemia (falls, syncope)
Abdominal Aortic Aneurysm
- typical presentation
- beware of… (3)
- dx
Presentation
- hypotension
- abd pain
- back pain
*key finding is an enlarged, tender aorta
Beware of
- renal colic sx in elderly
- labeling hypotension as vagal
- atypical location of adb pain
Dx
- supine flat plate superior to cross table lateral
- US
- CT with contrast in stable pt
Ischemic bowel
- sx
- dx
- risk factors for each of the following causes
- -SMA embolus
- -SMA thrombus
- -Venous thrombosis
- -Non-occlusive
Sx
- severe, visceral pain out of proportion with physical exam in a pt with risk factors
- pain can be absent 25% of the time
Dx
-early angiography
- risk factors for each of the following causes
- -SMA embolus: A fib, recent MI
- -SMA thrombus: CAD, low flow states
- -Venous thrombosis: Hypercoaguable states
- -Non-occlusive: Low CO (CHF, sepsis, digoxin, hypovolemia)
Causes of mechanical obstruction of the bowel
adhesions, hernias, appendicitis, malignancy, volvulus, diverticulitis, AAA
Test question: Do NOT use what drug in old people
Do NOT use opioids in old people! they cause constipation and other bad things!
