Question:
An 80 year old man presents with Mild, crampy , bilateral lower quadrant pain, decreased appetite and low grade fever for 48 hours. Which of the following is most likely diagnosis?
A. Small bowel obstruction
B. Appendicitis
C. Constipation
D. Irritable bowel syndrome
E. Pancreatitis
Answer:
B
Advanced age can change the presentation and perception of abdominal pain. in fact studies estimate that there is 10%-20% reduction in the perceived intensity of the pain per decade after the age of 60. Only 22% of elderly patients with appendicitis present with classic symptoms, making the diagnosis more difficult. Therefore a high index of suspicion is necessary.
Small bowel obstruction and constipation may cause bilateral lower quadrant pain and decreased appetite, but fever indicates something different. IBS is chronic and generally not associated with fever. pancreatitis is associated with food intolerance but associated pain is usually in the epigastric region.
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