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

Chapter 28: Gastrointestinal Problems

The gastrointestinal (GI) system, including the stomach and intestines, is responsible for the maceration and digestion of food and the excre- tion of waste. The process involves digestive acids and enzymes secreted by your stomach, liver, and pancreas and the action of what has been called your microbiologic organ: the billions of bacteria inhabiting your gut. The digestive process can be disturbed by a vari- ety of mechanisms, such as changes in diet, the introduction of foreign bacteria, or the elimina- tion of normal and necessary bacteria as a side effect of antibiotic use. Problems with the diges- tive organs can result in inadequate or excessive secretion of digestive enzymes. Digestive organs are also subject to inflammation and obstruction. The patient experiences diarrhea, constipation, gas, vomiting, cramps, or other nonspecific pain. A specific diagnosis for GI distress is rarely pos- sible. Fortunately, most of these problems are mild and self-limiting. The worrisome ones present as a critical system problem or with the signs and symptoms of serious abdominal or chest pain. Diarrhea One of the functions of the large intestine is to absorb fluid from feces just before excretion. This serves to conserve the body’s fluid balance

and to allow some degree of control over when and where excretion occurs. Diarrhea develops when capillaries dilate and leak in the inner lining of the intestine. The usual cause is irritation by infection or toxins, but local or systemic allergy and even altitude illness can have the same effect. Like abdominal pain, we’re usually leftmaking the generic assessment; serious or not serious. Assessment of Diarrhea Diarrhea that is a softer version of normal stool and relatively infrequent in an otherwise healthy individual is not considered serious if fluid losses can be replaced by oral intake. Pain is limited to cramping that is relieved by a bout of flatulence or diarrhea. Fever, if present, is low grade and intermittent. Diarrhea can be a symptom of more serious problems when accompanied by the signs and symptoms of serious abdominal pain. Diarrhea itself becomes a critical system problemwhen flu- id loss occurs so rapidly that it cannot be replaced. For example, the cause of death in cholera is vol- ume shock from diarrhea.