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Flashcards in Acute Abdomen Deck (10)
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1

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)

2

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

3

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

4

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

5

Acute Diverticulitis
-sx
-dx

Sx
-LLQ pain
-tenderness
-moderate abd distension
-moderate temp elevation

Dx
-CT

6

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)

7

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

8

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)

9

Causes of mechanical obstruction of the bowel

adhesions, hernias, appendicitis, malignancy, volvulus, diverticulitis, AAA

10

Test question: Do NOT use what drug in old people

Do NOT use opioids in old people! they cause constipation and other bad things!