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Flashcards in Acute Abdomen Deck (18):
1

THE CHALLENGE OF DIAGNOSIS for Acute Abdomen:
1. History confounded by what? 5

2. Why is the physical exam often unreliable? Examples 2

1. History confounded by
-stoicism
-alterations in pain perception
-memory deficits
-communication problems
-mental status changes

2. Physical exam unreliable
-80% will not have rigidity with peritonitis
-50% will be afebrile with acute cholecystitis

2

Less abdominal inflammatory response in the elderly leads to what? 3

1. less guarding/spasm,
2. lower leucocytes count and
3. lower and delayed temperature.

3

1. 60% of elderly requiring surgery will have a WBC of?

2. 40% with a perforated ulcer will not have what?

1. less than 10,000

2. free air on X-ray

4

1. Different anatomical factors, eg. such as what that are predisposing to perforation & gangrene?

2. Multiple abdominal diseases that the elderly are at greater risk for? 3

1. poor blood supply to a thinner appendix


2.
-gallstones,
-diverticulosis,
-atherosclerosis

5

What is the single most common cause of
abdominal operations in the elderly?

BILIARY TRACT DISEASE

6

1. 50% of >80 year olds will have what? (compared with 9% of 30-40 year olds)

2. “Biliary colic” is replaced by what?

3. In gallbladder perforation (occurring primarily in elderly), only a 1/3 of pts have a what?

4. What are found at the time of cholecystectomy in 10% of younger pts, but >50% of pts over age 70 years?

1. gallstones

2. vague abdominal complaints

3. history or prior symp. of gallstones.

4. Common bile duct stones

7

Diagnosis of acute cholecystitis usually straightforward BUT
1. 15% will have no what?
2. 5% will have?
3. 40% will have a normal _____?

4. 10% will be______ with all lab tests normal

5. What is diagnostic in 90%?

1. epigastric or RUQ pain

2. no pain at all (probably mental status changes)

3. WBC

4. afebrile

5. Ultrasound

8

What makes appendicitis dangerous in the elderly? 2

Elderly account for 5-10% of cases but >50% of deaths from appendicitis

1. 1/3 present late (>72 hours)
2. Misdiagnosed 50% on admission and 30% at time of surgery

9

ACUTE PANCREATITIS
1. What is the most common cause in the elderly?

2. Major symptom?
3. Nonspecific signs? 4

4. What to ask for in the history? 2

1. In the elderly - gallstones etiology is the most common.

2. abdominal pain

3. Non specific signs;
-tachycardia,
-hypotension,
-tachypnea,
-confusion.

4.
-alcohol
-high triglycerides

10

ACUTE DIVERTICULITIS: Diverticulitis may occur in an aggressive forms such as? 3



Many episodes subside, but the patient will present with what symptoms? 3

1. Phlegmonous inflammation,
2. Fistula to adjacent organs or skin,
3. Obstruction of the colon.

Many episodes subside, the patient has
1. left lower quadrant pain and tenderness,
2. moderate abdominal distension and
3. moderate temperature elevation.

11

PEPTIC ULCERS – IN THE ELDERLY
1. Describe how pain could present in the elderly with ulcers? 2

2. Presenting symptom may be what and related to what?

3. Whats going to make this ulcer much worse leading to death?

1.
-Pain is absent in one third of the cases.
-Pain can be vague and poorly localized.

2. Presenting symptoms may be systemic and related to blood loss and anemia (i.e. falls, syncope)\

3. Aspirin

12

ABDOMINAL AORTIC ANEURYSM
1. Typical presentation of rupture includes? 3

2. Key finding is what?

Misdiagnosed 30% of time DESPITE classic findings

1.
- Hypotension (70-96%)
-Abdominal pain (70-80%)
-Back pain (>50%)

2. an enlarged, tender aorta

13

ABDOMINAL AORTIC ANEURYSM
Late diagnosis increases mortality from 5% to 50-100%
Beware of what findings in the elderly that might be different in younger pts? 3

1. Renal colic symptoms in elderly
2. Labeling hypotension as vagal
3. Atypical location of abdominal pain

14

ABDOMINAL AORTIC ANEURYSM
Dx? 3

1. Supine flat plate superior to cross table lateral
2. Ultrasound 98% sensitive for leaking AAA
3. CT with contrast useful in stable patient

15

ISCHEMIC BOWEL
1. Characterized by?
2. Pain can be absent 25% of the time
Hard signs = TOO LATE!
What can lead = 90% survival?

3. What questions would we ask? 3

1. Severe, visceral pain out of proportion with physical exam in a patient with risk factors

2. Early angiography

3.
-postprandial
-warfarin/Afib
-Is it diffuse

16

ISCHEMIC BOWEL: Name 4 causes?

CAUSE
1. SMA embolus

2. SMA thrombosis

3. Venous thrombosis

4. Non-occlusive

17

ISCHEMIC BOWEL: Match the risk factors with the following causes:
CAUSE
1. SMA embolus? 2

2. SMA thrombosis? 2

3. Venous thrombosis? 1

4. Non-occlusive? 4

RISK FACTOR
1.
-A Fib,
-recent MI

2.
-CAD,
-low flow states

3. Hypercoaguable states

4. Low CO
-CHF,
-sepsis,
-digoxin,
-hypovolemia

18

MECHANICAL OBSTRUCTION
May result from what?
7

1. adhesions (scar tissue)
2. hernias (reducible, incarcerated, strangulated)
3. appendicitis,
4. malignancy,
5. volvulus,
6. diverticulitis or
7. AAA