Autoimmune Theory of Aging
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Abdominal pain is a common problem for people in all age groups, and leads to frequent visits to physicians’ offices, emergency rooms, and hospitals. Causes of abdominal pain are manifold, and can range from trivial to acutely life‐threatening. Evaluation of acute abdominal pain is one of the most challenging tasks a physician can face. In the elderly, diagnosis can be even more difficult because the causes, signs, and symptoms of abdominal pain are often different than in young and middle‐aged patients. Abdominal pain may have many anatomic causes, from skin (herpes zoster or ‘‘shingles’’), muscle (abdominal muscle strains), inflammation of the lining of the abdominal cavity (peritonitis), diseased internal organs in the abdomen (gastritis, peptic ulcer disease, pancreatitis, appendicitis, diverticulitis, cholecystitis), to the blood vessels that pass through the abdomen or supply the abdominal organs (abdominal aortic dissection and mesenteric artery thrombosis). Rarely, abdominal pain can be caused by metabolic diseases such as diabetic ketoacidosis. Pain from many of these conditions may be referred to other areas such as the back, neck, scapula, flank, or groin, and the pattern of radiation can be an important diagnostic clue. Gall bladder colic, for instance, causes right upper abdominal pain that typically radiates to a point just below the right scapula. The upper abdominal pain of pancreatitis often radiates to the midback. In early appendicitis, the pain is usually mid‐abdominal and then migrates over time to the right lower abdomen. In addition, the quality of abdominal pain (e.g., sharp, dull, colicky, or constant) and the accompanying symptoms (e.g., nausea, vomiting, fever, diarrhea, constipation, and blood in the stool) must be considered. Patients should also be asked what makes the pain better or worse; for instance, antacids will often give prompt but temporary relief of pain from peptic ulcer disease, esophagitis, or gastroesophageal reflux. Patients with peritonitis, or generalized abdominal pain due to perforation, feel better when they lie completely still; those with pancreatitis usually prefer to sit upright. Abdominal colic (or ‘‘colicky’’ pain) is important to recognize because many of its causes are serious and can require surgical treatment. This pain is caused by stretching or distention of a hollow tube due to #
Springer-Verlag Berlin Heidelberg 2008
obstruction, and worsens as the involuntary bowel contractions increase to overcome the obstruction. Examples include obstruction of the bile ducts or the neck of the gallbladder by gallstones, blockage of the ureters by kidney stones, and obstruction of the intestines by tumor or adhesions from previous surgery. Colicky pain is acute, agonizing, and builds to spasms of unbearable intensity before gradually easing. Patients with abdominal colic are usually doubled up, writhing in pain, and unable to find a comfortable position, and may have nausea and vomiting. Although the abdominal muscles may be rigid during paroxysms of pain, the abd
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