Acute abdominal pain. Four classifications can guide assessment and management

Abdominal pain is a common occurrence in older persons and a frequent catalyst for office and emergency room visits. Complaints must be investigated thoroughly because they often indicate serious underlying pathology such as Infection, mechanical obstruction, malignancy, biliary disease, cardiac problems, and GI ischemia. One means of overcoming a sprawling differential diagnosis is to determine whether the problem falls into one of four general categories: peritonitis, bowel obstruction, vascular catastrophe, or nonspecific abdominal pain. A comprehensive history, careful physical examination, and use of abdominal imaging studies facilitate effective assessment. As atypical presentations are frequently encountered in older persons, liberal use of ultrasound and contrast CT and early surgical consultation are recommended.