Acute Abdomen Flashcards

1
Q

Acute abdomen dx in elderly is challenging, why?

A

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)

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2
Q

Biliary tract disease
-most common cause of what
-sx in elderly
-

A

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
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3
Q

Acute Appendicitis

  • presentation
  • dx
A

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

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4
Q

Acute Pancreatitis

  • MC cause
  • major sx
  • other sx
A

MC cause

  • gallstones
  • might expect a history or alcohol use or really high triglycerides

Major sx
-abd pain

Other sx
-tachycardia, hypotension, tachypnea, confusion

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5
Q

Acute Diverticulitis

  • sx
  • dx
A

Sx

  • LLQ pain
  • tenderness
  • moderate abd distension
  • moderate temp elevation

Dx
-CT

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6
Q

Peptic Ulcers

  • elderly pts have a higher risk to develop these due to what?
  • sx
A

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)
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7
Q

Abdominal Aortic Aneurysm

  • typical presentation
  • beware of… (3)
  • dx
A

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
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8
Q

Ischemic bowel

  • sx
  • dx
  • risk factors for each of the following causes
  • -SMA embolus
  • -SMA thrombus
  • -Venous thrombosis
  • -Non-occlusive
A

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)
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9
Q

Causes of mechanical obstruction of the bowel

A

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

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10
Q

Test question: Do NOT use what drug in old people

A

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

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