Skip to main content

Abdominal Pain

  • Reference work entry
  • First Online:
Geriatric Gastroenterology
  • 171 Accesses

Abstract

Abdominal pain is a common problem in the geriatric population. Assessment is challenging in this age group because of the difficulty in obtaining a satisfactory history due to the presence of comorbid processes including impaired cognition, delirium, physical or other disabilities. It is generally more likely that the older patient with abdominal pain may have a serious underlying disorder. Older patients presenting to the emergency department (ED) with abdominal pain have a greater likelihood of requiring hospitalization and perhaps surgery. The importance of rapid assessment, use of appropriate tests, and early surgical consultation where indicated may be instrumental in improving outcomes. A focused physical examination is important. A combination of approaches in pain management based on current guidelines will help address pain. The geriatric patient has unique and differing pharmacokinetics and dynamics with regard to use of medications, including analgesics, and is thereby prone to adverse drug effects. Older adults are additionally subject to polypharmacy and consequent drug–drug or drug–disease interactions. The traditional indicators of disease in the younger individual may be lacking in the older adult, making it pivotal to consider a wide differential diagnosis during evaluation. A multidisciplinary approach may be helpful in tackling abdominal pain in the geriatric patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • AGS Clinical Practice Committee. Management of cancer pain in older patients. J Am Geriatr Soc. 1997;45:1273.

    Article  Google Scholar 

  • AGS Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57:1331–46.

    Article  Google Scholar 

  • Andrade DC, Faria JW, Caramelli P, et al. The assessment and management of pain in the demented and non-demented elderly patient. Arq Neuropsiquiatr. 2011;69(2-B):387–94.

    Article  PubMed  Google Scholar 

  • Barat M, Paisant A, Calame P, et al. Unenhanced CT for clinical triage of elderly patients presenting to the emergency department with acute abdominal pain. Diagn Interv Imaging. 2019;110:pii. S2211-5684(19)30115-9. (ahead of print).

    Google Scholar 

  • Bardhan KD, Berghofer P. Look-but also listen! ReQuest: an essay on a new validated scale to assess the outcomes of GERD treatment. Digestion. 2007; 75(Suppl 1):87–100.

    Article  PubMed  Google Scholar 

  • Barie PS, Eachempati SR. Acute acalculous cholecystitis. Gastroenterol Clin N Am. 2010;39:343–57.

    Article  Google Scholar 

  • Birnbaum BA, Jeffrey RB Jr. CT and sonographic evaluation of acute right lower quadrant abdominal pain. Am J Roentgenol. 1998;170:361–71.

    Article  CAS  Google Scholar 

  • Bjoro K, Herr K. Assessment of pain in the nonverbal or cognitively impaired older adult. Clin Geriatr Med. 2008;24:237–62.

    Article  PubMed  Google Scholar 

  • Brewer BJ, Goldern GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976;131:457–78.

    Article  Google Scholar 

  • Bruckenthal P. Assessment of pain in the elderly adult. Clin Geriatr Med. 2008;24:213–6.

    Article  PubMed  Google Scholar 

  • Bugliosi TF, Meloy TD, Vukov LF. Acute abdominal pain in the elderly. Ann Emerg Med. 1990;19:1383–6.

    Article  CAS  PubMed  Google Scholar 

  • Burg M, Francis L. Acute abdominal pain in the elderly. Emerg Med. 2005;37:8–12.

    Google Scholar 

  • Cangemi JR, Picco MF. Intestinal ischemia in the elderly. Gastroenterol Clin N Am. 2009;38:527–40.

    Article  Google Scholar 

  • Carlino E, Benedetti F, Rainero I, et al. Pain perception and tolerance in patients with frontotemporal dementia. Pain. 2010;151(3):783–9.

    Article  PubMed  Google Scholar 

  • Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008;77:971–8.

    PubMed  Google Scholar 

  • Cervo FA, Bruckenthal P, Chen JJ, et al. Pain assessment in nursing home residents with dementia: psychometric properties and clinical utility of the CAN pain assessment tool. J Am Med Dir Assoc. 2009;10:505–10.

    Article  PubMed  Google Scholar 

  • Chang C, Wang S. Acute abdominal pain in the elderly. Int J Gerontol. 2007;1:77–82.

    Article  Google Scholar 

  • Costamagna D, Pipitone Federico NS, Erra S, et al. Acute abdomen in the elderly. A peripheral general hospital experience. G Chir. 2009;30(6–7):315–22.

    CAS  PubMed  Google Scholar 

  • Cotton D, Taichman D, Williams S. In the clinic: herpes zoster. Ann Intern Med. 2011;154:ITC-1–14.

    Article  Google Scholar 

  • Crane SJ, Talley NJ. Chronic gastrointestinal symptoms in the elderly. Clin Geriatr Med. 2007;23:721–34.

    Article  PubMed  Google Scholar 

  • Dang C, Aguilera P, Dang A, Salem L. Acute abdominal pain. Geriatrics. 2002;57:30–42.

    PubMed  Google Scholar 

  • de Dombal FT. Acute abdominal pain in the elderly. J Clin Gastroenterol. 1994;19:331–5.

    Article  PubMed  Google Scholar 

  • Dempsey DT. Chapter 26: Stomach. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE, editors. Schwartz’s principles of surgery. 9th ed. New York: McGraw-Hill; 2010. http://www.accessmedicine.com/content.aspx?aID=503024.

  • Fenyo G. Acute abdominal disease in the elderly: experience from two series in Stockholm. Am J Surg. 1982;143:751–4.

    Article  CAS  PubMed  Google Scholar 

  • Frauenfelder T, Wildermuth S, Marineck B, Boehm T. Nontraumatic emergent abdominal vascular conditions: advantages of multi-detector row CT and three-dimensional imaging. Radiographics. 2000;24: 481–96.

    Article  Google Scholar 

  • Gardner RL, Almeida R, Maselli JH, Auerbach A. Does gender influence emergency department management and outcomes in geriatric abdominal pain? J Emerg Med. 2010;39(3):275–81.

    Article  PubMed  Google Scholar 

  • Glasgow RE, Mulvihill SJ. Acute abdominal pain. In: Fledman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s gastrointestinal and liver disease. 8th ed. Philadelphia: Saunders Elsevier; 2010. p. 87–98.

    Google Scholar 

  • Glenister KM, Corke CF. Infarcted intestine: a diagnostic void. ANZ J Surg. 2004;74:260–5.

    Article  PubMed  Google Scholar 

  • Guirguis-Blake JM, Beil TL, Senger CA, Whitlock EP. Ultrasonography screening for abdominal aortic aneurysms: a systemic evidence review for the U.S. Prev Serv Task Force. 2014;160:321–9.

    Google Scholar 

  • Gupta H, Dupuy DE. Advances in imaging of the acute abdomen. Surg Clin North Am. 1997;77:1245–63.

    Article  CAS  PubMed  Google Scholar 

  • Hanlon JT, Perers S, Sevick MA, et al. Pain and its treatment in older nursing home hospice/palliative care residents. J Am Med Dir Assoc. 2010;11:579–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Herr KA, Garand L. Assessment and measurement of pain in older adults. Clin Geriatr Med. 2001;17:457–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Husebo BS, Ballard C, Aarsland D. Pain treatment of agitation in patients with dementia: a systematic review. Int J Geriatr Psychiatry. 2011;26(10):1012–8.

    Article  CAS  PubMed  Google Scholar 

  • Kizer KW, Vassar MJ. Emergency department diagnosis of abdominal disorders in the elderly. Am J Emerg Med. 1998;16:357–62.

    Article  CAS  PubMed  Google Scholar 

  • Leuthauser A, McVane B. Abdominal pain in the geriatric patient. Emerg Med Clin North Am. 2016;34(2): 363–75.

    Article  PubMed  Google Scholar 

  • Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician. 2006;74:1537–44.

    PubMed  Google Scholar 

  • Makhana GK. Understanding and treating abdominal pain and spasms in organic gastrointestinal diseases: inflammatory bowel diseases and biliary diseases. J Clin Gastroenterol. 2011;45:S89–93. (Proceedings from the Pan-European conference on irritable bowel syndrome, 10 Dec 2010, Vienna).

    Article  Google Scholar 

  • Manias E, Gibson SJ, Finch S. Testing an educational nursing intervention for pain assessment and management of older people. Pain Med. 2011;12(8):1199–215.

    Article  PubMed  Google Scholar 

  • Marston WA, Ahlquist R, Johnson G Jr, et al. Misdiagnosis of ruptured abdominal aortic aneurysms. J Vasc Surg. 1992;16:859–68.

    Article  Google Scholar 

  • Martinez JP, Mattu A. Abdominal pain in the elderly. Emerg Med Clin North Am. 2006;74:371–88.

    Article  Google Scholar 

  • McCleane G. Pain perception in the elderly patient. Clin Geriatr Med. 2008;24:203–11.

    Article  PubMed  Google Scholar 

  • McNamara RM. Acute abdominal pain. In: Sanders AB, editor. Emergency care of the elder person. St. Louis: Beverly Cracom Publications; 1996. p. 219–43.

    Google Scholar 

  • Meyer T, Klein P, Schweiger H, et al. How can the prognosis of acute mesenteric artery ischemia be improved? Results of a retrospective analysis [German]. Zentralbl Chir. 1998;123:230–4.

    CAS  PubMed  Google Scholar 

  • Mills AM, Edwards JM, Shofer FS, et al. Analgesia for older adults with abdominal pain or back pain in the emergency department. West J Emerg Med. 2011;12(1):43–50.

    PubMed  PubMed Central  Google Scholar 

  • Morley JE. Constipation and irritable bowel syndrome in the elderly. Clin Geriatr Med. 2007;23:823–32.

    Article  PubMed  Google Scholar 

  • Morrow DJ, Thompson J, Wilson SE. Acute cholecystitis in the elderly. Arch Surg. 1978;113:1149–52.

    Article  CAS  PubMed  Google Scholar 

  • Nelson BP, Senecal EL, Prak T, et al. Opioid analgesia in the elderly: is the diagnosis of gallbladder pathology hindered. Ann Emerg Med. 2004;44(S4):S89.

    Article  Google Scholar 

  • Ozden N, Gurses B. Mesenteric ischemia in the elderly. Clin Geriatr Med. 2007;23:871–87.

    Article  PubMed  Google Scholar 

  • Scher C, Meador L, Van Cleabe JH. Moving beyond pain as the fifth vital sign and patient satisfaction scores to improve pain care in the 21st century. Pain Manage Nurs. 2018;19:125–9.

    Google Scholar 

  • Ragsdale L, Southerland L. Acute abdominal pain in the older adult. Emerg Med Clin North Am. 2011;29(2): 429–48.

    Article  PubMed  Google Scholar 

  • Rossato M, Paccagnella M, Burei M, et al. Splenic infarction: a rare cause of acute abdominal pain presenting in an older patient with primary antiphospholipid antibodies syndrome. Intern Emerg Med. 2009;4(6):531–3.

    Article  PubMed  Google Scholar 

  • Rothrock SG, Greenfield RH. Acute abdominal pain in the elderly: clue to identify serious illness. Part 2: diagnosis and management of common disorder. Emerg Med Rep. 1992;13:185–92.

    Google Scholar 

  • Salkin MS. Abdominal aortic aneurysm: avoiding failure to diagnose. ED Leg Lett. 1997;8:67–78.

    Google Scholar 

  • Sanson TG, O’Keefe KP. Evaluation of abdominal pain in the elderly. Emerg Med Clin North Am. 1996;14:615–27.

    Article  CAS  PubMed  Google Scholar 

  • Shuman WP. Low sensitivity of sonography and cholescintigraphy in acalculous cholecystitis. Am J Roentgenol. 1984;143(3):531–4.

    Article  Google Scholar 

  • Storm-Dickerson TL, Horratas MC. What have we learned over the past 20 years about appendicitis in the elderly? Am J Surg. 2003;185:198–201.

    Article  PubMed  Google Scholar 

  • Sweetser S. Abdominal wall pain: a common clinical problem. Mayo Clin Proc. 2019;94(2):347–55.

    Article  PubMed  Google Scholar 

  • Telfer S, Fenyo G, Holt PR, de Dombal FT. Acute abdominal pain in patients over 50 years of age. Scand J Gastroenterol Suppl. 1998;144:47–50.

    Google Scholar 

  • Touzios JG, Dozois EJ. Diverticulosis and acute diverticulitis. Gastroenterol Clin N Am. 2009;38:513–25.

    Article  Google Scholar 

  • van de Langenberg R, Scheltinga MR, Streukens SA, et al. Elderly women with abdominal pain due to an incarcerated “femoral hernia”. Ned Tijdschr Geneeskd. 2008;152(29):1597–601.

    PubMed  Google Scholar 

  • Yeh E, McNamara RM. Abdominal pain. Clin Geriatr Med. 2007;23:255–70.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C. S. Pitchumoni .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Pitchumoni, C.S., Dharmarajan, T.S. (2021). Abdominal Pain. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-030-30192-7_43

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-30192-7_43

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-30191-0

  • Online ISBN: 978-3-030-30192-7

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics