Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Chapter 26: Abdominal Pain

The differential diagnosis of abdominal pain is extensive. Making a specific diagnosis can be a challenge for experienced clinicians, even when using laboratory data and sophisticated imag- ing equipment. The wilderness medical practi- tioner must usually be satisfied with the generic assessment; serious or not serious? Because the treatment of a serious intra-abdominal problem requires hospital and surgical care anyway, the specific diagnosis can usually wait.

major components: hollow organs, solid organs, the peritoneal lining, and the muscular abdomi- nal wall. Hollow structures such as the stomach, intestines, and gall bladder are muscular organs that excrete and move fluids and food through the digestive system using rhythmic muscle contrac- tions called peristalsis. The ureters and urinary bladder are of similar structure and function to contain and excrete urine. Solid organs within the abdomen have a vari- ety of functions and associated diseases, but we worry most about their potential for rupture in abdominal trauma. The liver, spleen, pancreas, and kidneys are part of the body core, are richly supplied with blood, and can fracture and bleed on impact. The abdomen offers a large enough space into which blood can be lost to cause life- threatening volume shock. The peritoneum is the membrane that lines all the abdominal organs and the abdominal wall. It is easily irritated by bacteria, blood, and digestive fluids that have leaked into the abdominal cav- ity. Because the peritoneum represents a surface area greater than that of your patient’s skin, it can lose a large volume of fluid in a short period of time when it becomes inflamed. Much like a large surface area burn, extensive peritonitis will result in volume shock.

Abdominal Pain

General Principles

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Gastroenteritis Ectopic pregnancy Appendicitis Cholecystitis Diverticulitis Perforating ulcer Pancreatitis Internal Bleeding…

Serious or Not Serious?

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Practical Abdominal Anatomy

For field purposes, we can consider the contents and structure of the abdomen to consist of four