ROSH Gastrointestinal Practice Exam

Which statement is true regarding elderly patients presenting with abdominal pain?

1. More likely to need an emergent surgical procedure

2. More likely to present with elevated white blood cell count

3. More likely to present with fever

4. More likely to present with peritoneal signs

The correct answer is: More likely to need an emergent surgical procedure

Elderly patients presenting with abdominal pain often have a higher incidence of serious underlying conditions requiring surgical intervention. This is due to several factors, including physiological changes that occur with aging, which may lead to a decreased ability to cope with acute abdominal pathology. Conditions such as appendicitis, cholecystitis, or bowel obstruction are more challenging to diagnose in this population, often resulting in more severe presentations by the time they seek care. Thus, when addressing abdominal pain in elderly individuals, clinicians maintain a higher index of suspicion for the need for emergent surgical procedures to address these potentially serious and life-threatening conditions. In contrast, while elevated white blood cell count, fever, and peritoneal signs can indeed present in elderly patients with abdominal pain, these symptoms are not as definitive indicators of the need for surgical intervention. Elderly patients may not always exhibit classic signs of infection or inflammation due to altered immune responses and comorbid conditions, making the absence of these findings more common in this demographic. Therefore, while option A highlights the significant need for prompt surgical assessment, the other statements do not necessarily convey the same urgency or likelihood of requiring surgery as a direct outcome of presenting symptoms.