Differential diagnosis in the elderly
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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