Abdominal Pain and Mass in an 86-Year-Old Patient - Gastroenterology and Hepatology

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When dealing with abdominal pain and a palpable mass in an elderly patient, especially one who is 86 years old, it is crucial to approach the situation with caution and thoroughness. The symptoms you describe—sudden, severe pain in the left upper abdomen, a noticeable mass, and pain that worsens with movement—could indicate several potential medical issues that need to be evaluated promptly.

Given the patient's age and the nature of the symptoms, there are a few possible causes for the abdominal pain and mass. These could include:
1. Hernia: An inguinal or abdominal hernia could present as a mass and cause pain, especially with movement. Hernias can become incarcerated or strangulated, leading to severe pain and potentially life-threatening complications.

2. Diverticulitis: This condition occurs when diverticula (small pouches that can form in the colon) become inflamed or infected. It can cause localized pain and may present with a palpable mass in the abdomen.

3. Tumors or Cysts: Both benign and malignant tumors can present as masses in the abdomen. In older adults, the risk of malignancy increases, and any new mass should be evaluated for potential cancer.

4. Splenic Issues: The spleen is located in the left upper quadrant of the abdomen. Conditions such as splenic enlargement (splenomegaly) or splenic rupture can cause pain and may present as a mass.

5. Gastrointestinal Obstruction: An obstruction in the intestines can lead to severe pain and a palpable mass, often accompanied by other symptoms such as nausea or vomiting.

6. Kidney Issues: Conditions affecting the kidneys, such as kidney stones or infections, can also cause referred pain to the abdomen and may present with a mass if there is swelling or an abscess.

Given that the patient has not been eating or drinking due to pain, it is essential to ensure they remain hydrated and to monitor for any signs of worsening condition, such as fever, vomiting, or changes in bowel habits.

In terms of seeking medical care, it is advisable to visit the Emergency Department (ED) as soon as possible, especially since the symptoms are acute and severe. The ED can provide immediate evaluation and management, including imaging studies (like an ultrasound or CT scan) to determine the cause of the pain and mass.
After the initial assessment, the patient may be referred to a specialist based on the findings. If the issue is related to the gastrointestinal tract, a gastroenterologist would be appropriate. If a hernia is suspected, a general surgeon may be needed. If there are concerns about malignancy, an oncologist may be involved in the management.

In summary, the combination of sudden severe pain, a palpable mass, and the patient's age necessitates prompt medical evaluation. Encourage the patient to seek care immediately, and ensure they are monitored for any changes in their condition. It is crucial to address these symptoms quickly to avoid potential complications.