ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 281

Kidney stone Equal Flank/back

Peptic ulcer Equal Upper middle

Acute cholecystitis Female > Male Right upper quadrant

Acute pancreatitis Equal Upper middle

CONDITIONS REQUIRING EVACUATION

Appendicitis Equal Right lower quadrant

Ruptured ectopic pregnancy Female Lower quadrant

Intestinal obstruction Equal Diffuse

Incarcerated hernia Male > Female Groin

Diverticulitis Equal Left lower quadrant

Differentiating the two conditions is important because appendicitis must be treated by
early operation, whereas gastroenteritis is usually self-limited and rarely requires evacu-
ation.Asdetailedin Chapter19:GastrointestinalDisorders ,hydrationisnecessaryforgast-
roenteritis, but oral intake of any kind is difficult for a nauseated individual with appendi-
citis and should be avoided unless evacuation is expected to require more than twenty-four
hours.

Mittelschmerz
Midway between menstrual periods, some women encounter discomfort from the slight
amount of bleeding associated with normal ovulation. The pain is located on either side
of the lower abdomen, where the involved ovary is located. The discomfort is sometimes
significant. While some women recognize the cause of such discomfort, younger women
unfamiliar with this symptom may under the stress of a wilderness environment confuse
this process with appendicitis, particularly when ovulation is from the right ovary.
The differential diagnosis is usually easy; the timing of the discomfort halfway between
menstrual periods is invariable. Physical signs of inflammation are minimal, and the disor-
der usually disappears without treatment within twenty-four hours.

CONDITIONS THAT MAY REQUIRE EVACUATION
Salpingitis
This gynecologic infection, also known as pelvic inflammatory disease, occurs in sexu-
ally active women of any age. Most infections affect one of the Fallopian tubes, through
which eggs move from the ovaries to the uterus. The organism is usually either Chlamydia
or Gonococcus . The tipoff is that the women are sexually active, typically with multiple