ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 276

CHAPTER 20
ACUTE ABDOMINAL PAIN
Ernest E. Moore, M.D.
Hunter B. Moore, B.A.
Ben Eiseman, M.D.
Principal Contributor s
Travelers to remote areas who consume food and water from questionable sources are fa-
miliar with the abdominal pain associated with acute diarrhea. These symptoms, although
painful for a few hours or days, are self-limited and gradually subside. Distinguishing such
relatively trivial conditions from serious diseases that are potentially life threatening can be
difficult. Inappropriate delay in evacuating an individual to a medical facility where surgic-
al intervention is available may seriously compromise the outcome, but unnecessary evacu-
ation can disrupt a carefully planned expedition. The key question is whether evacuation is
warranted.
A few questions are helpful in making a preliminary decision:
1. Do others in the party share identical complaints? The most common cause of abdominal
pain in wilderness conditions is infectious gastroenteritis (traveler's diarrhea), which is
discussed in Chapter 19: Gastrointestinal Disorders .
2. Has the individual had similar attacks of abdominal pain in the past? If so, symptoms are
likely to have the same cause and previously effective treatment should be repeated.
3. Does the person have a known medical disorder? What medications are being taken? In-
dividuals often fail to mention medications that they use routinely in their urban envir-
onment, such as aspirin, anticoagulants, antihypertensive agents, bronchodilators, anti-
histamines, diuretics, mood elevators or depressants, and even insulin. Such drugs may
produce unexpected symptoms and alter the course of a disease when taken in a harsh
outdoor environment.
4. Are the pain and tenderness localized to a single point in the abdomen? Such localization
often suggests an inflammatory process that requires operation.
5. Is the abdomen diffusely tender and rigid? A boardlike abdomen commonly signals gen-
eralized peritonitis that requires immediate evacuation and surgery.
6. Is the person seriously ill? Delirious? Febrile? Dehydrated? Thirsty? (These can be signs
of shock.) Does the individual feel warm?
7. Does the person seem likely to overreact to discomfort? A wilderness environment con-
stitutes a severe emotional stress for some inexperienced persons.