Obstetrician/Gynecologists frequently encounter older patients complaining of acute abdominal pain. Because of physiologic changes, medication use, and preexisting conditions, the elderly patient often does not manifest overt signs of disease. Also, while appendicitis is the most common cause of abdominal pain in the general population, biliary disease, small bowel obstruction and perforated viscus constitute the leading etiologies in the geriatric population. The older patient's physical findings often do not correlate with the severity of disease; however, mental status changes, hypothermia, bandemia, and metabolic acidosis are helpful indicators of significant derangement. Emergent abdominal pain, defined as hemodynamic instability such as that caused by massive hemorrhage, requires immediate surgery. Otherwise, the most effective work-up includes a detailed history and physical examination, and selective screening laboratory tests. When the diagnosis is still unclear, repeat physical examination, in-patient observation, and consultation should be considered. The decision of whether to perform diagnostic laparoscopy or laparotomy should be individualized after assessing the patient's entire clinical presentation and progress. Acute abdominal pain in the older patient is associated with low diagnostic accuracy, but high mortality. Therefore, as a primary care physician, the obstetrician/gynecologist must be proficient in the evaluation of acute abdominal pain in the elderly patient.
ASJC Scopus subject areas
- Obstetrics and Gynecology