Persistent Right Lower Abdominal Pain in Seniors: Causes and Specialist Recommendations - Internal Medicine

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Persistent right lower abdominal pain in seniors can be a complex issue, especially in the context of a history of gastrointestinal problems like peptic ulcers. Given your grandmother's age and her recent hospitalization for a gastric ulcer, it's essential to consider several potential causes for her ongoing pain.

1. Appendicitis: Although less common in older adults, appendicitis can still occur. The pain typically starts around the belly button and then moves to the right lower abdomen. If there are any accompanying symptoms like fever, nausea, or changes in bowel habits, this should be evaluated immediately.

2. Diverticulitis: This condition involves inflammation of diverticula (small pouches that can form in the walls of the colon). It is more prevalent in older adults and can cause significant pain in the lower abdomen, often on the left side, but can also present on the right.

3. Ovarian Issues: In females, ovarian cysts or tumors can cause pain in the lower abdomen. Even if your grandmother has gone through menopause, it’s still possible for these conditions to arise.

4. Hernia: An inguinal or femoral hernia can cause localized pain in the lower abdomen, especially if there is a bulge present. This is more common in older adults due to weakened abdominal muscles.

5. Bowel Obstruction: This can occur due to adhesions from previous surgeries, tumors, or other gastrointestinal issues. Symptoms may include cramping abdominal pain, bloating, and changes in bowel habits.

6. Chronic Conditions: Conditions like irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) can also cause chronic abdominal pain. These conditions can be exacerbated by stress or dietary changes.

7. Musculoskeletal Pain: Sometimes, pain in the abdominal area can be referred from musculoskeletal issues, especially in older adults who may have degenerative changes in the spine or pelvis.

Given that your grandmother has already undergone endoscopic evaluations (gastroscopy and colonoscopy) that ruled out some immediate gastrointestinal concerns, it would be prudent to consider further diagnostic imaging, such as a CT scan of the abdomen, to get a clearer picture of what might be causing her pain.


Recommendations for Specialists:
1. Gastroenterologist: Since your grandmother has a history of gastrointestinal issues, a follow-up with a gastroenterologist is essential. They can evaluate her ongoing symptoms in the context of her previous conditions and may recommend further imaging or tests.

2. General Surgeon: If there is a suspicion of a hernia or if surgical intervention is needed for any gastrointestinal issues, a general surgeon would be the appropriate specialist to consult.

3. Gynecologist: If there are concerns about ovarian issues, a gynecologist can perform the necessary evaluations, even in post-menopausal women.

4. Pain Management Specialist: If the pain persists and is not easily explained by structural issues, a pain management specialist may help in managing her symptoms through various modalities.


Conclusion:
In summary, persistent right lower abdominal pain in seniors can arise from various causes, and it’s crucial to approach this systematically. Given your grandmother's age and medical history, a multidisciplinary approach involving gastroenterologists, surgeons, and possibly gynecologists will provide the best chance of identifying the underlying issue and managing her pain effectively. Always ensure that any new or worsening symptoms are promptly evaluated to rule out serious conditions.