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Differential diagnosis in the elderly

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Appendicitis is a grave concern in the elderly patient. Poorer localisation of infection and diminished blood supply to the appendix result in a relatively greater incidence of gangrene and perforation at operation than in other groups.

The differential diagnosis is wider than younger individuals and includes:

  • intrabdominally:
    • perforated peptic ulcer
    • acute cholecystitis
    • acute intestinal obstruction
    • gastroenteritis
    • acute diverticulitis
    • acute regional ileitis

  • urinary tract:
    • renal colic
    • pyelonephritis

  • chest:
    • basal pneumonia
    • pleurisy
    • rarely, myocardial infarction

  • miscellaneous:
    • abdominal pain before a paroxysm of herpes zoster
    • diabetes

Elderly individuals may be more stoical and less willing to report symptoms; this inevitably delays treatment.


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