Acute Abdomen Flashcards Preview

Geriatrics > Acute Abdomen > Flashcards

Flashcards in Acute Abdomen Deck (18):
1

Challenge of Diagnosis

History confounded by stoicism, alterations in pain perception, memory deficits, communication problems, or mental status changes
Physical exam unreliable: 80% no rigidity, 50% afebrile
Check potential hernia sites
Less abdominal inflammatory response
Ancillary testing unreliable
CT & US must be used liberally

2

Biliary Tract Disease

Most common cause of surgery in the elderly
"Biliary colic" replaced by vague abdominal complaints

3

Diagnosis of Biliary Tract Disease in the Elderly

15% no epigastric or RUQ pain
5% no pain at all
40% normal WBC
10% afebrile
90% ultrasound diagnostic

4

Appendicitis

Etiology: gallstones
Pain is usually absent
Pain when present is vague, PE unremarkable

5

Signs of Appendicitis

Non-specific
Tachycardia
Hypotension
Tachypnea
Confusion

6

Symptoms of Acute Diverticulitis

LLQ pain
Tenderness
Moderate abdominal distension
Moderate temperature elevation

7

Diagnosis of Acute Diverticulitis

CT scan

8

PUD

1/3 pain absent
Pain: vague, poorly localized
Symptoms: systemic & related to blood loss

9

Typical Presentation of AAA Rupture

Hypotension
Abdominal pain
Back pain

10

Key Finding of AAA

Enlarged, tender aorta

11

Beware of ______ in the Elderly

Renal colic symptoms
Labeling hypotension as vagal
Atypical location of abdominal pain

12

Diagnosis of AAA

Ultrasound
CT with contrast in stable patient

13

Ischemic Bowel Presentation

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

14

Treatment for Ischemic Bowel

Early angiography

15

Cause of Ischemic Bowel

SMA embolus
SMA thrombosis
Venous thrombosis
Non-occlusive

16

Risk Factors for Ischemic Bowel

A. fib
Recent MI
CAD
Low flow states
Hypercoaguable states
Low cardiac output (CHF, sepsis, digoxin, hypovolemia)

17

Causes of Mechanical Obstruction

Adhesions
Hernias
Appendicitis
Malignancy
Volvulus
Diverticulitis
AAA

18

Abdominal Pain in the Elderly

Difficult & dangerous disease
Investigate & manage aggressively
Maintain a high level of suspicion