ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 284

CONDITIONS REQUIRING EVACUATION
Appendicitis
Appendicitis is the most common acute abdominal condition requiring immediate evac-
uation from a remote region. Early surgery is needed to avoid rupture of the inflamed ap-
pendix and contamination of the entire peritoneal cavity, which can cause life-threatening
peritonitis. Acute appendicitis can occur at any age and in either sex. Only a previous ap-
pendectomy excludes the diagnosis. In the early stages this condition may resemble influ-
enza or similar infections. The first symptoms are vague and generalized abdominal dis-
tress, nausea, and vomiting. Rarely is persistent diarrhea present, which often is helpful in
differentiating appendicitis from gastroenteritis. In the early stages the abdomen may be
softwithsomegeneralizedlowerabdominaltendernessnotgreaterononesideortheother.
As the disease progresses, greater tenderness is found on the right side.
At this stage the individual should be kept under careful and frequent observation to de-
termine whether the pain and tenderness change location. Within six hours the abdominal
pain and tenderness usually shift from the midline to the right lower quadrant. Maximal
pain and tenderness usually are felt midway between the umbilicus and the bony protuber-
ance of the pelvic iliac crest (McBurney's point); pressure applied anywhere over the ab-
domen is referred to this site, which overlies the appendix, and pain is felt in that location
when the individual coughs or when pressure on the abdomen is suddenly released (re-
bound tenderness).
If the appendix ruptures, generalized peritonitis usually develops. This complication is
manifested by high fever, vomiting of any fluid or food taken by mouth, and rigidity of
theabdominalmuscles.Bythetimesuchadvancedsignsandsymptomsdevelop,theastute
examiner should have tried to obtain consultation by radio or telephone and should have
decided that evacuation is necessary. Delay invites rupture with its severe consequences.
As soon as the diagnosis of appendicitis is made, a broad-spectrum antibiotic should
be administered to minimize the spread of the infection. The individual should be allowed
only sips of water by mouth to relieve feelings of dryness. Any additional fluid taken by
mouth will not be absorbed and usually induces more vomiting.
Ruptured Ectopic Pregnancy
A ruptured ectopic pregnancy should be suspected in any sexually active woman exper-
iencing the sudden onset of severe lower abdominal pain who also has a history of miss-
ing one or more menstrual periods and who has evidence of blood loss such as weakness,
dizziness onstanding, increased pulserate, lowbloodpressure(“Shock” in Chapter 3:Life
Threatening Problems ) . Without definitive treatment, the signs of bleeding continue to the
pointofshock.TheonlydefinitivewaytostopthebleedingistosurgicallyremovetheFal-
lopian tube, which requires immediate evacuation to a hospital.