ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 283

if the pain develops suddenly, is unusually severe, or is associated with signs of peritonitis,
free perforation of the ulcer into the abdomen is likely and evacuation is mandatory.
Acute Cholecystitis
Thegallbladderisathinwalledsacthatliesbeneaththeliverintherightupperquadrant
oftheabdomenandstoresbilesecretedbytheliver.Whenfoodcontainingfatemptiesfrom
the stomach into the intestine, the gallbladder contracts, forcing bile through the common
bile duct into the intestine where it mixes with the food to assist digestion. Bile salts in the
bile can precipitate and form stones, which may remain in the gallbladder or pass through
the bile duct into the intestine. Most individuals with gallstones are middle aged, usually
obese, and may have a history of intolerance for fried or fatty foods.
Individuals with acute cholecystitis usually have had uncomplicated gallstones (chole-
lithiasis)foranumberofyears.Acutecholecystitisdevelopswhenoneofthegallstonesob-
structs the duct emptying the gallbladder. The typical manifestations are the sudden onset
of acute right upper quadrant stabbing pain associated with nausea and vomiting and ab-
dominal tenderness that is maximal in the right upper quadrant.
Analgesics should be administered to relieve pain; severe pain may require an opiate
suchasmorphine.Antibioticsareneededifsymptomsareprolonged,ortheattackdoesnot
resolve spontaneously. As soon as vomiting stops, the individual can start drinking small
amounts of water and eating a gradually increasing fat-free diet. If symptoms persist for
more than forty-eight hours, evacuation is warranted.
Acute Pancreatitis
Acute pancreatitis is an uncommon but dramatic cause of acute abdominal pain. As the
nameimplies,itisinflammation(notinfection)ofthepancreas,whichliesacrosstheupper
part of the abdomen. The condition characteristically involves middle-aged persons who
have a history of alcohol abuse, but gallstones can also be a cause. This disorder typically
is heralded by the sudden appearance of severe upper abdominal pain that is associated
with nausea and vomiting. It frequently follows an episode of alcohol overindulgence. The
individual is usually immobilized by the severity of the pain. Individuals with acute pan-
creatitis may be frighteningly ill and in severe pain.
Treatment consists of analgesics to minimize pain and encouraging fluid intake. For the
individualwhoseconditionfailstoimprove,evacuationisnecessarytoprovideintravenous
fluids for hydration.