1 / 28

Acute Abdominal Pain in a Geriatric: An Emergency Medicine Perspective

Acute Abdominal Pain in a Geriatric: An Emergency Medicine Perspective. Ali R. Rahimi,MD. Geriatrics as an increasing segment of the population. 1 in 8 is >64yo in 1994 1 in 5 projected to be >64yo in 2030. The Geriatric Functional Continuum. Geriatric with CC of abdominal pain in ED.

richelle
Download Presentation

Acute Abdominal Pain in a Geriatric: An Emergency Medicine Perspective

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Acute Abdominal Pain in a Geriatric: An Emergency Medicine Perspective Ali R. Rahimi,MD

  2. Geriatrics as an increasing segment of the population • 1 in 8 is >64yo in 1994 • 1 in 5 projected to be >64yo in 2030

  3. The Geriatric Functional Continuum

  4. Geriatric with CC of abdominal pain in ED • 50% will be admitted • 10% Overall Mortality • Around 1 in 4 patients seen for abdominal pain are discharged with a diagnosis of “undifferentiated abdominal pain

  5. Difficulties in making the Dx • Sometimes Jerry is a poor historian (present with altered mental status) • Lack of consistent physiological responces (ie. may not be febrile or tachycardic) • They often have little reserve capacity

  6. You Make the Call! • All he follow case presentations refer to a 82 year old white female • Triage Note- • “CC: belly pain. – 82 yo WF, demented, conversing with wall, dropped off by friend, no additional history, in obvious pain”

  7. RULES: YOU MUST GIVE A DIFFERENTIAL DX BEFORE YOU CT SCAN OR ELSE

  8. Actual ER Physicians

  9. CASE UNO! • Belly pain, green vomit x 3, distended belly, painful throughout, “tinkly” bowel sounds • Upright Abd film 

  10. Most common risk factor – prior abd. Surgery Look for dilated loops of bowel on imaging Needs surgical intervention (LOA) Bowel Obstruction

  11. CASE DOS! • Back or Belly pain, Low BP and pulsatile abdominal mass • Get crackin’! • Bedside U/S then CTA (if Vital signs stable)

  12. Ruptured AAA • The survival rate of patients who experience a ruptured abdominal aortic aneurysm is less than 50 percent. • The symptoms of a ruptured or leaking aneurysm may mimic other acute conditions such as renal colic, diverticulitis, pancreatitis, inferior wall coronary ischemia, mesenteric ischemia, or biliary tract disease. In addition, elderly patients who present with hypotension from a leaking abdominal aortic aneurysm may have electrocardiographic changes consistent with coronary ischemia.

  13. CASE TRES! • Intense belly pain, N/V/D, pain out of proportion to exam • Oh snap! • Think CTA (if Vital signs stable- ‘cause you don’t want to run a code in CT) Geriatric Hippies – A High Risk Population

  14. Mesenteric Ischemia • High mortality – 45-90% • Occlusion in SMA most common • Big Risk factor = A-fib • Get vascular surgery pronto

  15. CASE CUATRO! • Severe epigastric pain, rigid abd with guarding, found some Prilosec in her handbag • Peritonitis! Yeehaw!

  16. Perforated Bowel • Free Air! 40% of upright abd xrays will miss the free air • Most common cause = peptic ulcers • Poorer outcome in >70yo w/o surgical intervention

  17. CASE CINCO! • Belly pain, boring to the back, N/V, feels very sick, ecchymosed on flanks • Vitals are muy loco

  18. Acute Pancreatitis • Gallstones the cause in ~ 70% of pts >80yo • Frequently present in shock • Amylase/Lipase and CT

  19. CASE SEIS! • Colicky RUQ pain, no N/V, no fever • Bedside ultrasound available and shows -->

  20. Acute cholecystitis • Nonoperative mgmt can result in ~17% mortality • Use HIDA scan if high suspicion and neg U/S • Look for atypical presentations in elderly

  21. CASE SIETE! • Belly Pain all over, TTP over RLQ, no fever or leukocytosis • Told she had a “stomach bug” at walk-in clinic

  22. Appendicitis • 5% of all surgical abdomens in geriatric • > Half of geriatric appy’s are misdiagnosed on initial presentation • Watch for perfs!

  23. CASE OCHO! • Belly & pelvic pain, vag bleeding, tachy, low BP

  24. Ruptured Ectopic • Yeah. • Right. • Think endomertrial CA, you doofus

  25. Conclusions • Geriatric Emergencies demand attention and diligence • Often present atypically • Remember to ROWC it! (Rule Out Worst Case) • ‘Cause Jerry goes down fast! Tele Medicine – Scary!

  26. References • Bugliosi, TF, Meloy, TD, Vukov, LF. Acute abdominal pain in the elderly. Ann Emerg Med 1990; 19:1383. • Kamin, RA, Nowicki, TA, Courtney, DS, Powers, RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am 2003; 21:61. • Kizer, KW, Vassar, MJ. Emergency department diagnosis of abdominal disorders in the elderly. Am J Emerg Med 1998; 16:357. • Hustey, FM, Meldon, SW, Banet, GA, et al. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med 2005; 23:259. • Yamamoto, W, Kono, H, Maekawa, M, Fukui, T. The relationship between abdominal pain regions and specific diseases: an epidemiologic approach to clinical practice. J Epidemiol 1997; 7:27. • Yeh, E, McNamara, R.Abdominal Pain. Clin Geriatr Med 23 (2007) 255-270.

More Related