Sunday, February 19, 2017

Abdominal Pain in the Geriatric Patient

EM Resident Magazine
EM Resident - By Carpenter C, Nagurney J and Tyler K - 02/02/2017
"Geriatric patients, generally defined as persons age 65 and older, comprise a specific, vulnerable, and ever-growing population within the emergency department. Frequently, care of these patients requires modification of existing diagnostic and treatment paradigms.
In particular, older patients presenting with abdominal pain can be challenging for a few reasons. First, the physical exam may be falsely reassuring. For example, older patients with infections do not necessarily have fevers
Even in the face of a serious intra-abdominal pathology, they are equally as likely to be normothermic or hypothermic as hyperthermic.
Second, medications such as beta-blockers or calcium channel blockers may mask tachycardia.
Third, peritoneal symptoms are much less common, possibly because aging changes the way elderly patients experience pain.3 In one study of older patients, 80% of geriatric patients with perforated peptic ulcers did not have peritonitis.
Finally, older patients often have multiple comorbidities, which can complicate diagnostic processes..."