Abdominal Pain and Vomiting in Elderly Patients - Gastroenterology and Hepatology

Lower abdominal pain and vomiting?

Hello doctor, my mother is 80 years old.
Last year, she experienced infrequent bowel movements, frequent lower abdominal pain, and dry mouth.
Drinking water would also cause her lower abdomen to hurt.
Therefore, I arranged for her to have a colonoscopy, gastroscopy, and abdominal ultrasound at Taipei Chung Hsing Hospital.
Only minor ulcers were found in her stomach, but she still has difficulty with bowel movements.
The doctor prescribed some liquid medication for her to take daily to help with bowel movements.
Recently, there have been new developments: not only is she having difficulty with bowel movements, but her stools are also infrequent and dry, and she has been experiencing vomiting.
She vomits the food she has eaten.
What further tests should we consider to identify the problem? Thank you.

Lin Zongli, 50~59 year old female. Ask Date: 2020/02/15

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, there are many reasons for constipation in the elderly, including gastrointestinal diseases, poor gastrointestinal function, neurological disorders, endocrine diseases, and medications (such as those for Parkinson's disease and hypertension) that may be related.
It is also associated with the activity level and diet of the elderly.
A gastrointestinal endoscopy has been performed, and treatment for peptic ulcers is recommended, along with appropriate physical activity, attention to diet, and adequate intake of fluids and fiber.
It is important to follow the prescribed medication regimen and have regular outpatient follow-ups.
Wishing you peace and health! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2020/02/15

More Info

Understanding abdominal pain and vomiting in elderly patients, especially those with a complex medical history, requires a comprehensive approach. In your mother's case, at 80 years old, she presents with several concerning symptoms: persistent abdominal pain, difficulty with bowel movements, dry mouth, and now vomiting. These symptoms can be indicative of various underlying issues, and it’s essential to consider both gastrointestinal and systemic factors.

Firstly, the history of abdominal pain and constipation suggests a possible gastrointestinal obstruction or motility disorder. Given that she has already undergone a colonoscopy and upper gastrointestinal endoscopy, which revealed only mild gastric ulcers, it is crucial to consider other potential causes. The fact that she experiences pain upon drinking water could indicate a sensitivity in the gastrointestinal tract, possibly due to irritation or inflammation.

The recent development of vomiting is particularly concerning. Vomiting in elderly patients can be caused by several factors, including:
1. Gastrointestinal Obstruction: This could be due to adhesions from previous surgeries, tumors, or severe constipation leading to a blockage. An abdominal ultrasound or CT scan may be warranted to visualize the intestines and check for any obstructions.

2. Gastroparesis: This condition, where the stomach cannot empty properly, can lead to nausea and vomiting. It is often seen in patients with diabetes or other metabolic disorders.

3. Medication Side Effects: Many elderly patients are on multiple medications, which can lead to gastrointestinal side effects, including nausea and vomiting. Reviewing her current medications with her healthcare provider may help identify any culprits.

4. Dehydration and Electrolyte Imbalance: Given her dry mouth and difficulty with bowel movements, dehydration could be a significant issue. This can exacerbate abdominal pain and lead to vomiting. Ensuring she is adequately hydrated and possibly receiving intravenous fluids may be necessary.

5. Infections: Conditions such as urinary tract infections or gastrointestinal infections can also present with abdominal pain and vomiting. A thorough evaluation, including urinalysis and possibly blood tests, may be needed to rule out infections.

6. Systemic Issues: Conditions such as heart failure or renal failure can lead to gastrointestinal symptoms in the elderly. Given her age and potential comorbidities, a comprehensive metabolic panel and possibly cardiac evaluation might be warranted.

Given these considerations, the next steps should include:
- Further Imaging: If not already done, a CT scan of the abdomen may provide more detailed information about her gastrointestinal tract and help identify any obstructions or other abnormalities.

- Laboratory Tests: Blood tests to check for electrolyte imbalances, kidney function, and signs of infection should be conducted.

- Medication Review: A thorough review of her medications with her healthcare provider to identify any that may be contributing to her symptoms.

- Consultation with Specialists: Depending on the findings, a referral to a gastroenterologist may be beneficial for further evaluation and management of her gastrointestinal symptoms.

In conclusion, your mother's symptoms are multifaceted and require a careful and thorough evaluation to determine the underlying cause. It is essential to maintain open communication with her healthcare team, ensuring that all her symptoms are addressed and that she receives the appropriate diagnostic tests and treatments. Early intervention can significantly improve her quality of life and address any potentially serious underlying conditions.

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