ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 280

Progressintelecommunication technology,particularlycellularandsatellitetelephones,
has simplified obtaining medical consultation in a wilderness environment. Those provid-
ingmedicalcareinsuchasituationshouldneverhesitatetoseekadvice.Beforeaconsulta-
tion, the care provider should prepare answers—preferably written—to all relevant ques-
tions (“Medical History” and “Physical Examination” in Chapter 1: Diagnosis ). The per-
son's name, address, age, and gender are also essential facts.
If a decision to observe the individual overnight is made, calls should be scheduled at
four- to six-hour intervals so that any deterioration in the person's condition can prompt
evacuation plans at first light ( Table 20-1 ).

CONDITIONS THAT DO NOT REQUIRE EVACUATION
Gastroenteritis
With acute gastroenteritis, others who have shared the same food or drink often have sim-
ilar signs and symptoms. The typical onset is gradually increasing abdominal distress that
soon changes to waves of cramping pain that may be severe and are often associated with
an overwhelming urge to defecate. The stools soon become watery and, in severe cases,
may contain flecks of blood. The acute pain characteristically subsides following each
diarrhealstool,andtheindividualmayberelativelyfreeofrightupperquadrantrightlower
quadrantleftupperquadrantleftlowerquadrantdiscomfortuntilanotherepisodeofcramps
begins. A feeling of weakness or malaise and a low-grade fever often appear with the
diarrhea, and the person may become dehydrated. Vomiting is usually not prominent.
Differentiating gastroenteritis from appendicitis may be difficult in the early hours of
thedisease.Diarrheaisseldomassociatedwithappendicitisbutistypicalofgastroenteritis.
The pain of appendicitis is steady and unrelenting, whereas discomfort with gastroenteritis
is usually intermittent and cramping in nature. The pain or discomfort from appendicitis
maystartnearthemidlinebutcharacteristically shiftstotherightlowerquadrantoftheab-
domen. In contrast, the pain and discomfort of gastroenteritis are typically generalized.

Table 20-1 Acute Abdominal Pain Features

GENDER PAIN LOCATION

CONDITIONS NOT REQUIRING EVACUATION

Gastroenteritis Equal Diffuse

Mittelschmerz Female Lower quadrant

CONDITIONS THAT MAY REQUIRE EVACUATION

Salpingitis Female Lower quadrant