Abdominal Pain Among Older Adults

M. Bachir Tazkarji, MD, CCFP

Disclosures

Geriatrics and Aging. 2008;11(7):410-415. 

In This Article

Physical Examination

General appearance is the first step in a physical examination, followed by overall volume status. The evaluation of vital signs is an important step, although vital signs may be normal despite serious intra-abdominal pathology. Table 2 outlines the changes in vitals signs that are essential to keep in mind when evaluating older adults.

The abdomen should be assessed fully, paying attention to note scars of previous surgeries, distension, organomegaly, ecchymosis, masses, or bruits. The abdominal musculature is often thin in older adults, leading to less guarding and rigidity, even in the presence of frank peritonitis. A detailed search for hernias should be conducted because they may be a cause of bowel obstruction and strangulation. The rectal examination may reveal the presence of gross or occult blood and may be the only way to discover prostatitis as a source of pain.

The physical examination should not be limited to the abdomen. Conjunctivae should be examined for pallor. The cardiopulmonary examination is crucial. It may suggest a diagnosis by showing signs of pneumonia, congestive heart failure, pericarditis, or pulmonary emboli. The presence of atrial fibrillation is of particular significance because this increases the risk for mesenteric ischemia. Examination of the extremities may reveal the presence of peripheral emboli or stigmata of vascular disease. Neurological findings of a previous cerebrovascular accident also may be a clue to underlying vascular disease.

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