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Keywords:

  • acute cholecystitis;
  • geriatrics;
  • abdominal pain;
  • jaundice;
  • acute abdomen

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. REFERENCES

Objective: To estimate the frequency of abnormal clinical symptoms, laboratory tests, and diagnostic imaging studies in the ED assessment of elderly (≥65 yr) patients with acute cholecystitis, and to compare these factors in the young-old (65–74 yr), middle-old (75–84 yr), and old-old (≥85 yr) population groups.

Methods: A retrospective, cross-sectional study was performed by review of ED records, hospital charts, and surgical operative reports of consecutive elderly ED patients determined at surgery to have acute cholecystitis. Records were reviewed between April 1990 and April 1995 at a large Midwestern tertiary care facility with 65,000 annual ED patient visits. Clinical signs and symptoms were compared in the young-old, middle-old, and old-old population groups.

Results: Of the 168 patients reviewed, 141 (84%) had either epigastric or right upper quadrant abdominal pain, and 8 (5%) had no pain whatsoever. Only 61 patients (36%) had back or flank pain radiation. Ninety-six (57%) experienced nausea, 64 (38%) had emesis, and 13 (8%) had visible jaundice. Ninety-four (56%) patients were afebrile and 69 (41%) had no increase of white blood cell count. Twenty-two (13%) patients had no fever and all tests were normal. No statistical difference was noted in any symptom or laboratory factor for the 3 age groups, except jaundice was more common among the patients aged ≥85 years. Ultra-sonography was diagnostic for 91%, and CT was beneficial for only 1 patient. Eight patients had normal results on their ultrasonographic and CT studies.

Conclusion: Classic symptoms and abnormal blood test results are frequently not present in geriatric patients with acute cholecystitis. Increasing age does not appear to affect the clinical and test markers used by clinicians to diagnose this illness. A high degree of awareness is essential for correct diagnosis of acute cholecystitis in geriatric patients.

REFERENCES

  1. Top of page
  2. ABSTRACT
  3. REFERENCES
  • 1
    Parker JS, Vukov LF, Wollan PC. Abdominal pain in the elderly. Use of temperature and laboratory testing to screen for surgical disease. Fam Med. 1996; 28: 1915.
  • 2
    Bugliosi TF, Meloy TD, Vukov LF. Acute abdominal pain in the elderly. Ann Emerg Med. 1990; 19: 13836.
  • 3
    Schick FL, Schick R. Statistical Handbook on Aging Americans. Phoenix, AZ: Oryx Press, 1994, p 8.
  • 4
    Hafif A., Gutman M., Kaplan O., Winkler E., Rozin RR, Skomick Y. The management of acute cholecystitis in elderly patients. Am Surg. 1991; 57: 64852.
  • 5
    Crawford JM. The liver and the biliary tract. In: CotranRS, KumarV., RobbinsSL (eds). Robbins Pathologic Basis of Disease, 5th ed. Philadelphia: W. B. Saunders, 1994, p 888.
  • 6
    Roslyn JJ, Zinner MJ. Gallbladder and extrahepatic biliary system. In: SchwartzSI, ShiresGT, SpencerFC (eds). Principles of Surgery, 6th ed. New York: McGraw-Hill, 1994, pp 13789.
  • 7
    Jolly BT, Love JN. Emphysematous cholecystitis in an elderly woman: case report and review of the literature. J Emerg Med. 1993; 11: 5937.
  • 8
    Girard RM, Morin M. Open cholecystectomy: its morbidity and mortality as a reference standard. Can J Surg. 1993; 36: 7580.
  • 9
    Kauvar DR. The geriatric acute abdomen. Clin Geriatr Med. 1993; 9: 54758.
  • 10
    Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain: an analysis of 1,000 consecutive cases in a university hospital emergency room. Am J Surg. 1976; 131: 21923.
  • 11
    Castle SC, Norman DC, Yeh M., Miller D., Yoshikawa TT. Fever response in elderly nursing home residents: are the older truly colder J Am Geriatr Soc. 1991; 39: 8537.
  • 12
    Patrick GL, Stewart RJ, Isbister WH. Patients with acute abdominal pain: white cell and neutrophil counts as predictors of the surgical acute abdomen. N Z J Med. 1985; 98: 3246.
  • 13
    de Manzoni G., Furlan F., Guglielmi A., et al. Acute cholecystitis: ultrasonographic staging and percutaneous cholecystostomy. Eur J Ra-diol. 1992; 15: 1759.
  • 14
    Schwartz SI. Appendix. In: SchwartzSI, ShiresGT, SpencerFC (eds). Principles of Surgery, 6th ed. New York: McGraw-Hill, 1994, p 1313.