ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 282

partners, and have tenderness right above the pubic bone, a mild fever, and occasionally
some vaginal discharge. The characteristic symptom is the gradual onset of pelvic and
suprapubic discomfort. Women with this condition seldom appear acutely ill or toxic, and
some have had previous attacks. The treatment consists of antibiotics ( Chapter 22: Infec-
tions ), and evacuation is usually not necessary. However, occasionally salpingitis results in
an abscess that can rupture and produce generalized peritonitis, and when located on the
right side it may be confused with acute appendicitis; in either of these situations, the con-
dition requires prompt evacuation.
Kidney (Renal) Stone
When minerals in the urine precipitate to form a stone, it may remain in the kidney or
may pass through the narrow tube (ureter) that connects each kidney to the bladder. The
resulting pain typically is quite severe. Renal stones are considered by some to be the most
painful condition people encounter. The pain usually is sudden in onset and cramping in
nature. The pain is usually associated with nausea, and may be accompanied by vomiting.
The pain may be localized to one of the flanks or back but often radiates down to the groin
and into the scrotum or labia. The diagnosis is confirmed by identifying blood in urine col-
lected in a clear glass container or passed into snow. However, the pain of a kidney stone
can be confused with that of an incarcerated (irreducible) inguinal hernia or appendicitis.
If the stone does not pass through the ureter into the bladder, pain persists, although it may
gradually diminish to a dull ache in the side. Fever, chills, and generalized malaise may
accompany the pain with a stone that obstructs the ureter. In extreme cases, the urine may
contain pus if a kidney infection supervenes ( Chapter 21: Genitourinary Disorders ).
Treatment consists of antibiotics and consumption of large volumes of water by mouth
to increase urine volume and help wash the stone into the bladder. If the stone passes into
thebladder,thepainquicklysubsidesandtheemergencyisover.Oncethestonehaspassed,
an early recurrence of another stone is rare, but the individual should consult a urologist
upon completion of the trip. On the other hand, in the rare case of prolonged retention of
the kidney stone in the ureter with secondary infection, evacuation is warranted.
Peptic Ulcer
Peptic ulcer is described in greater detail in Chapter 19: Gastrointestinal Disorders . Ul-
cers characteristically produce discomfort in the upper part of the abdomen, usually some
hoursfollowingameal,whenthestomachisempty,andthepainisoftenrelievedbyeating
bland food or milk. Duodenal or gastric ulcer usually is a chronic disease. The individual
may have previously been diagnosed with a peptic ulcer and may have been taking medic-
ations such as antacids or proton pump inhibitors.
If the discomfort is localized and not significantly different from previous ulcer pain,
treatment with antacids or proton pump inhibitors is usually all that is necessary. However,