Emergency Department Evaluation of Geriatric Patients with Acute Cholecystitis

Parker, Lee; Vukov, Larry F.; Wollan, Peter C.

doi:10.1111/j.1553-2712.1997.tb03643.x

Cited by 76 publications

(52 citation statements)

References 6 publications

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“…Increasing age is accompanied by an increased occurrence of concurrent diseases [1][2][3][4] and has also been considered to be associated with less-specific symptoms in cases of abdominal pain caused by surgical diseases [5][6][7] . In addition, older patients undergoing emergency surgery have shown a higher morbidity and mortality than younger ones [1,2,8,9] .…”

Section: Introductionmentioning

confidence: 99%

Acute Abdominal Pain among Elderly Patients

2006

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Background: Diagnosis of acute abdominal pain in older persons is a challenge, with the age-related increase in concurrent diseases. In most western countries the number of elderly people is constantly rising, which means that an increasing proportion of patients admitted for abdominal pain at the emergency department are elderly. Objective: To characterize differences in clinical presentation and diagnostic accuracy between younger and more elderly patients with acute abdominal pain. Methods: Patients admitted to Mora Hospital with abdominal pain of up to seven days’ duration were registered according to a detailed schedule. From 1st February 1997 to 1st June 2000, 557 patients aged 65–79 years and 274 patients aged ≧80 years were registered. Patients aged 20–64 years (n = 1,458) served as a control group. Results: A specific diagnosis, i.e. other than ‘nonspecific abdominal pain’, was established in 76 and 78% of the patients aged 65–79 and ≧80 years respectively, and in 64% of those aged 20–64 (p < 0.001). Pain duration before admission increased with age (p < 0.003), as did frequency and duration of hospitalization (p < 0.0001). Hospital stay increased from 170 days per 100 emergency admissions in the control group to 320 and 458 days in the younger and older study groups, respectively. At the emergency department, older patients were more often misdiagnosed than control patients (52 vs. 45%; p = 0.002). At discharge the diagnosis was more accurate in the control group (86 vs. 77%; p < 0.0001). Hospital mortality was higher among older patients (23/831 vs. 2/1,458; p < 0.001). The admission-to-surgery interval was increased (1.8 vs. 0.9 days, p < 0.0001) in patients ≧65 years. Rebound tenderness (p < 0.0001), local rigidity (p = 0.003) and rectal tenderness (p = 0.004) were less common in the older than in the control patients with peritonitis. In patients ≧65 years, C-reactive protein did not differ between patients operated on and those not, contrary to the finding in patients <65 years (p < 0.0001). Conclusion: Both the preliminary diagnosis at the emergency department and the discharge diagnosis were less reliable in elderly than in younger patients. Elderly patients more often had specific organic disease and arrived at the emergency department after a longer history of abdominal pain compared to younger patients.

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Section: Introductionmentioning

confidence: 99%

Acute Abdominal Pain among Elderly Patients

2006

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“…Additionally, the most frequent symptom was reported to be nausea (19). The most frequent symptom accompanying epigastric pain in our study was determined as nausea as well.…”

Section: Discussionmentioning

confidence: 84%

“…Although patients whose complaints are relieved by symptomatic upper gastrointestinal treatment are mostly thought to have non-BTD pathologies, various studies proved that neither symptomatic relief nor symptoms or laboratory tests have good predictive value in terms of presence or absence of cholelithiasis, especially in elderly patients (14)(15)(16)(17)(18)(19).…”

mentioning

confidence: 99%

The importance of routine bedside biliary ultrasonography in the management of patients admitted to the emergency department with isolated acute epigastric pain

Değerli¹,

Korkmaz²,

Mollamehmetoğlu³

et al. 2017

Turk J Med Sci

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IntroductionAcute abdominal pain is one of the most common complaints of patients presenting to emergency departments (EDs) and it constitutes approximately 5%-10% of ED admissions. Biliary tract disease (BTD) has a significant proportion among patients admitted with acute abdominal pain and is found in approximately 3%-10% of patients hospitalized for acute abdominal pain (1-3). Patients with BTD may present with epigastric pain as often as right upper quadrant pain. Nausea, vomiting, abdominal distention, belching, chills, shivering, and acid regurgitation may accompany it (1,4).Since upper gastrointestinal diseases (GIDs) (i.e. reflux esophagitis, gastritis, peptic ulcer disease, and pancreatitis) may present with symptoms similar to cholelithiasis, the differential diagnosis of BTD may be challenging for emergency physicians. Infectious diseases such as acute appendicitis, pyelonephritis, hepatitis, and pneumonia may be confused with acute cholecystitis (1). Furthermore, myocardial ischemia, renal diseases, and some disorders of Background/aim: The aim of our study was to emphasize the importance of routine bedside biliary ultrasonography (USG) for the differential diagnosis of biliary tract disorders in patients admitted with acute isolated epigastric pain. Materials and methods:Adult patients who were admitted to the emergency department with acute isolated epigastric pain were included in the study. Emergency residents (ERs) were asked whether they planned to perform biliary USG during the initial evaluation and following diagnosis/treatment (secondary evaluation) of these patients. Bedside biliary USG examinations were performed by a sonologist and a radiologist evaluated the video recordings.Results: A total of 103 patients were enrolled, 29 of whom were diagnosed with biliary tract disease (BTD). In the 29 patients diagnosed with BTD, 27 had gallstones (biliary colic, 18; acute cholecystitis, 7; acute pancreatitis, 2) and two had biliary sludge. USG was not ordered by the ERs for 44.8% of the 29 patients with a final diagnosis of BTD, 58.8% of 17 patients with normal liver function tests and BTD, and 35.3% of the 17 hospitalized patients. Conclusion:Emergency physicians should routinely use biliary USG along with clinical judgement and laboratory studies in order to rule out BTD in patients with acute isolated epigastric pain.

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“…Çoğu hastada ağrı intermitan karakterdedir ve sağ üst kadran ile epigastrik bölgede görülür. Ayrıca hastaların 1/3'ünde ağrı sırt ve omuza yayılır (21,40). Silik olarak ortaya çıkan karın ağrısı ve minimal periton irritasyonu bulguları hastaların yaklaşık üçte birinde görülürken, bu tablo hastalığın klinik şiddeti ile ilişkili değildir (41).…”

Section: Safra Yolları Sorunlarıunclassified

“…Ayrıca bu hastaların çoğunda klasik semptomlar görülmeyebilir, hatta safra kesesi ampiyemi, gangreni veya belirgin perforasyon olsa dahi bu hasta grubundaki kişilerin 1/3'ünde ateş hiç görülmeyebilir (43). 168 olgunun geriye dönük olarak incelendiği bir olgu serisinde, 65 yaş ve üzerindeki kolesistit tanısı almış hastalarda %60 hastanın sırt ya da yan ağrısı olmadığı, hatta %5 hastada hiç ağrı olmadığı gösterilmiştir (40).…”

Section: Safra Yolları Sorunlarıunclassified

Geriatrik hastada akut karın ağrısına yaklaşım

Ersel¹

2014

Ege Tıp Dergisi

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Dünya nüfusunun hızla yaşlanması sonucu acil servislere karın ağrısı ile başvuran geriatrik yaş grubu hasta sayısı da hızla artmaktadır. Değişen fizyoloji, komorbid hastalıklar, iletişim güçlükleri, çoklu ilaç kullanımı, yaşlı hastalarda akut karın tablosunda tanı koymayı güçleştirmektedir. Bu güçlüklere karşın bir çok hastanın organ spesifik tanısı acil serviste konmaktadır. Geriatrik yaş grubundaki hastalarda karın ağrısı tablosunda altta yatan bir cerrahi patoloji olma olasılığı yüksektir. Bu nedenle geriatrik hastaların karın ağrılarında tetkik ve konsültasyon istemleri diğer hasta gruplarına oranla daha hızlandırılmış ve öncelikli olarak yapılmalı, tanı güçlüğü çekilen hastalarda yatış ile gözlem ön plana alınmalıdır.Anahtar Sözcükler: Acil servis, acil yaklaşım, akut batın, geriatrik hasta. Summary As a result of rapidly aging of the world's population, the number of patients admits with complaint of acute abdominal pain to the emergency deparments in the geriatric age group is increasing. Changing physiology, comorbid disorders, barriers to communication and polypharmacy makes it difficult to make diagnosis in elderly patients

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Emergency Department Evaluation of Geriatric Patients with Acute Cholecystitis

Cited by 76 publications

References 6 publications

Acute Abdominal Pain among Elderly Patients

Acute Abdominal Pain among Elderly Patients

The importance of routine bedside biliary ultrasonography in the management of patients admitted to the emergency department with isolated acute epigastric pain

Geriatrik hastada akut karın ağrısına yaklaşım

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