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Chapter 21. The Acute Abdomen

Of the following causes of abdominal pain, which occurs more frequently in patients less than 50 years old compared with older patients?

A. Bowel obstruction

B. Cholecystitis

C. Appendicitis

D. Diverticulitis

E. Mesenteric Ischemia

C. Appendicitis. Both the patient’s age and gender play an important role in forming the differential diagnosis. As patients age there is a distinct shift in causes of abdominal pain and an increase in surgically treatable etiologies. This has been best documented in the OMGE’s (World Organization of Gastroenterology) survey of worldwide causes of abdominal pain. This survey gathered data on more than 10,000 patients in 17 countries presenting with acute abdominal pain. When the data is segregated by age comparing those less than 50 years of age to those older than 50 years of age there are clear differences. Appendicitis is by far the most common etiology of a surgical abdomen in patients younger than 50. In the older population group cholecystitis is the most common cause with good representation from bowel obstruction, appendicitis, pancreatitis and diverticulitis. In older patients hernias are a more common problem, with up to a third of bowel obstructions being related to hernias. Cancer, vascular disease, and mesenteric ischemia are also more common as we age. While it is more common for a patient in their twenties to present with abdominal pain, a large proportion will have the diagnosis of nonspecific abdominal pain. Patients older than 50 years of age have both a higher likelihood of an operative etiology for their acute abdomen as well as an increased mortality related to their presentation. This mortality is higher still for patients older than 70 years of age.

Which of the following is correct regarding the role of the abdominal plain films in evaluation of the acute abdomen?

A. They can exclude serious disease.

B. They are most useful when intestinal obstruction is part of the differential diagnosis.

C. They are an important part of the work up in patients presenting to the emergency department with abdominal pain.

D. They are the most sensitive test for a perforated viscus.

E. They have a high sensitivity in detecting disease including appendicitis, cholecystitis, renal stones and GI bleeding.

B. They are most useful when intestinal obstruction is part of the differential diagnosis. Before the advent of the CT scan the acute abdominal series played an important role in the diagnosis of ...

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