Travel Reference
In-Depth Information
DIAGNOSIS
A definitive diagnosis may be impossible during the early phases of a disease, but a tentat-
ive or working diagnosis, with the understanding that it may be altered as signs and symp-
toms change, is appropriate because it provides guidance for the next step. Once the ab-
dominalpainandotherevidenceofdiseasearewelldeveloped,anastuteexaminercanusu-
ally match the signs and symptoms with the pattern of a known disorder.
History
Important information to be obtained for the history includes the following:
When did pain begin?
Whatisthenatureofthepain(suddenversusgradualonset,sharpversusdull,persist-
ent versus intermittent)?
Where is the pain (right or left of the midline, above or below the umbilicus)?
How have the pain and tenderness progressed since onset? (Is the pain increasing or
decreasing? Hasitshiftedfromonepartoftheabdomentoanother?Hasthenatureof
the pain changed? For example, has generalized discomfort become localized sharp
pain?)
Is nausea, vomiting, or diarrhea present?
Are chills, fever, or other signs of infection present?
Does the urine contain blood?
Does the individual have a history of any of the following?
Similar episodes
Pain relieved by food or milk
Indigestion caused by fried or fatty food
Previous abdominal surgery
A missed menstrual period
Physical Examination
An unhurried examination should be performed in the quietest place available, with the
personascomfortable andassecureaspossible.However,inthewilderness medical emer-
gencies frequently arise at night, and a frightened individual must be examined inside a
cramped tent with a headlamp as the only light source.
The entire abdomen from crotch to nipple line should be bared and examined visually
first. Abdominal surgical scars suggest intestinal obstruction caused by postoperative ad-
hesions. Abdominal distention is indicative of intestinal obstruction, either mechanical ob-
struction or paralysis of the intestinal muscles (ileus) by inflammation. A mass or hernia
should be specifically sought. The abdomen should be watched to determine whether at-
tacks of cramping pain are accompanied by abdominal muscular spasm.
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