Abdominal pain in the elderly

The elderly can suffer from a wide spectrum of disorders. Ischaemic events, emboli, cancer (in particular) and diverticulae of the colon are more common in old age; duodenal ulcer is less so. Those causes of abdominal pain that occur with more frequency include:

• vascular catastrophies o ruptured abdominal aortic aneurysm o mesenteric artery occlusion

• perforated peptic ulcer

• biliary disorders: bilary pain and acute cholecystitis

diverticulitis

• sigmoid volvulus

• strangulated hernia

• intestinal obstruction

• carcinoma, especially of the large bowel

herpes zoster, causing unilateral root pain

constipation and faecal impaction

Problems arise with management because the pain threshold is raised (colic in particular is less severe) and there is an attenuated response to infection so that fever and leucocytosis can be absent. Non-specific signs such as confusion, anorexia and tachycardia might be the only systemic evidence of infection.

Specific causes of acute abdominal pain

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