Reduce risks to elderly patients
Abdominal pain is often life-threatening for elderly patients, says Stephen Colucciello, MD, FACEP, clinical services director and trauma coordinator for the department of emergency medicine at Carolinas Medical Center in Charlotte, NC. "The mortality of abdominal pain in the elderly is as high or higher than that of chest pain," he explains.
The incidence of surgical disease is greater than 30%, says Colucciello. "Abdominal pain in patients over 55 is a high risk situation, so patients should be triaged to a high level of acuity," he emphasizes. (See page 164.)
Diagnosis presents unique challenges. "Elderly patients with bowel infarction may have significant pain but minimal tenderness. Bowel infarction is life-threatening," says Colucciello. "Bowel obstruction is also common in elderly patients, particularly in patients who have had prior abdominal surgery," he adds.
If there is persistent vomiting and abdominal pain, there should be a low threshold to order imaging studies in the elderly, advises Colucciello. "Abdominal films are usually not valuable unless belly is rigid and you suspect perforation or obstruction," says Colucciello. "That occurs with abdominal distention, abnormal bowel sounds, (high pitched or absent), and with many patients who have had abdominal surgery."
Another possibility with abdominal pain in the elderly is abdominal aortic aneurysm. "That is characterized by a tearing abdominal pain that radiates to the back or as severe back pain and may be accompanied by syncope," explains Colucciello. "Such patients may or may not have hematuria."
Abdominal aortic aneurysm can be mistaken for renal colic, says Colucciello. "The misdiagnosis of renal colic in elderly is dangerous," he notes. "Just as many patients have aneurysms as kidney stones, and the presentation is the same-with pain and hematuria."
In such patients, an ultrasound or CT of the abdomen is a better test than an IVP, says Colucciello. "Of course, if the patient is hypotensive, they need to be resuscitated, typed and crossed, and get a stat surgical consult," he adds.
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