In an 81-year-old female with a two-day history of bilateral lower abdominal pain, chills, normal urination and no diarrhea or constipation, what laboratory and imaging studies should be ordered?

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Last updated: October 10, 2026 • View editorial policy

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Diagnostic Workup for 81-Year-Old Female with Bilateral Lower Abdominal Pain and Chills

Order CT abdomen and pelvis with IV contrast as your primary imaging study, along with CBC, CRP, urinalysis, and basic metabolic panel. 1

Initial Laboratory Testing

Start with these essential labs:

  • Complete blood count (CBC) - to assess for leukocytosis suggesting infection or inflammatory process
  • C-reactive protein (CRP) - elevated inflammatory markers are critical in elderly patients who may not mount typical responses 1
  • Urinalysis - despite no dysuria, UTI remains common in elderly women and can present atypically
  • Basic metabolic panel - assess electrolytes, renal function, and glucose
  • Lipase - if any epigastric component to pain

2

Critical Pitfall in Elderly Patients

In elderly patients with acute abdominal pain and fever/chills, laboratory tests may be normal despite serious infection. 1 This makes imaging even more essential - you cannot rely on labs alone to rule out serious pathology in an 81-year-old.

Primary Imaging: CT Abdomen/Pelvis with IV Contrast

CT with IV contrast is the gold standard for bilateral lower abdominal pain with systemic symptoms (chills) in elderly patients. 1

Why CT is Superior Here:

  • Broad differential coverage: In a prospective study, CT changed the leading diagnosis in 49% of patients with nontraumatic abdominal complaints, changed admission status in 24%, and altered surgical plans in 25% 1

  • Fever/chills workup: CT dramatically improves diagnostic accuracy for infectious etiologies - diagnosis of cholecystitis/cholangitis increased by 100% and pelvic inflammatory disease by 280% following CT in patients with fever 1

  • Age-appropriate: Diverticulitis is the most likely diagnosis given bilateral lower abdominal pain in an 81-year-old, and CT has 81% sensitivity versus only 61% for ultrasound 1

  • Other critical diagnoses: Can detect abscess (88-93% specificity), colitis including C. difficile (88% sensitivity), bowel obstruction, appendicitis, and malignancy 1

IV Contrast is Essential

Use IV contrast unless contraindicated by renal dysfunction or allergy. IV contrast increases detection of subtle bowel wall abnormalities, abscesses, and inflammatory processes that would be missed on non-contrast studies. 1, 3

Alternative Imaging (If CT Contraindicated)

If CT is unavailable or contraindicated (severe renal dysfunction, contrast allergy), obtain MRI abdomen/pelvis. 3

MRI has shown 99% overall accuracy for acute abdominal pathology and can detect diverticulitis, pelvic inflammatory disease, pyelonephritis, abscesses, and colitis. 1 However, availability and acquisition time make this less practical in most acute settings.

Why NOT Ultrasound First

While ultrasound is appropriate for right upper quadrant pain (cholecystitis), it is inferior to CT for bilateral lower abdominal pain: 1

  • Only 75% sensitive for intra-abdominal abscess (vs 88% for CT)
  • Only 61% sensitive for diverticulitis (vs 81% for CT)
  • Limited by body habitus, bowel gas, and operator dependence

Why NOT Plain Radiographs

Abdominal X-rays have minimal utility here - low sensitivity (49%) for bowel obstruction and essentially no value for detecting inflammatory processes, diverticulitis, or abscesses. 1 Skip this outdated test.

Most Likely Diagnoses to Consider

Given bilateral lower abdominal pain with chills in an 81-year-old:

  1. Diverticulitis (most likely) - can be bilateral if sigmoid involvement
  2. Intra-abdominal abscess - chills suggest infectious process
  3. Colitis (infectious, ischemic, or inflammatory)
  4. Complicated UTI/pyelonephritis - can present with lower abdominal pain
  5. Gynecologic pathology - less likely at age 81 but consider tubo-ovarian abscess
  6. Malignancy - lymphoma or metastases can present with pain and fever

Immediate Management Considerations

While awaiting imaging:

  • Ensure hemodynamic stability
  • Consider empiric antibiotics if patient appears septic (don't wait for imaging if unstable)
  • NPO status if surgical pathology suspected
  • IV access and fluid resuscitation if needed

The combination of age, bilateral pain, and systemic symptoms (chills) creates high risk for serious pathology requiring prompt diagnosis and potential intervention. CT with IV contrast provides the most comprehensive evaluation in a single study.

References

1
Guideline

acr appropriateness criteria<sup>®</sup> acute nonlocalized abdominal pain.

Journal of the American College of Radiology, 2018

2
Research

Acute Abdominal Pain in Adults: Evaluation and Diagnosis.

American family physician, 2023

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.