The list presented above is certainly not comprehensive for abdominal pain in the elderly. Aortic dissection is common in this age group and may cause abdominal pain directly or by causing ischemia of intraabdominal organs, including the bowel. The diagnosis of pancreatitis in this age group is generally straightforward. Tumors can serve as lead points for intussusception in elderly patients. Acute gastric volvulus should be considered in the older patient with sudden epigastric pain, repetitive nonproductive retching, and inability to pass a nasogastric tube. Older patients with underlying vascular disease may develop ischemic colitis, which can be difficult to distinguish from other forms of colitis.
The list of other conditions that can cause abdominal pain in the older patient is extensive, highlighting the need for the comprehensive evaluation of such patients. The most important disease to suspect is acute myocardial ischemia. Some 1 to 2 percent of elderly patients with abdominal pain will be having a myocardial infarction.10 Virtually all other "chest" diseases can cause abdominal pain, including pneumonia, pulmonary embolism, empyema, tuberculosis, congestive heart failure, esophageal rupture, and endocarditis. Genitourinary disease including renal colic, pyelonephritis, epididymitis, and testicular torsion is a possible cause of abdominal pain in the elderly. Diabetic ketoacidosis, herpes zoster, hypercalcemia, addisonian crisis, hemochromatosis, and retroperitoneal or rectus sheath hematomas secondary to anticoagulant therapy are examples of "medical" causes of abdominal pain in the elderly.
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