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

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Wilderness and Rescue Medicine

Chapter 28 Review: Gastrointestinal Problems

• The GI system, including the stomach and intestines, is responsible for the maceration and digestion of food and excretion of waste. • A specific diagnosis for GI distress is rarely possible. Most of these problems are mild and self- limiting; serious ones present as a critical system problem or with the signs and symptoms of serious abdominal pain. • Diarrhea develops when the lining of the intestinal space is irritated by infection or toxins and fails to absorb fluid. The intestine can also leak more body fluid on its own, contributing to general fluid loss. • Mild diarrhea can be treated effectively with bismuth subsalicylate (Pepto-Bismol) or similar over- the-counter preparations or with opioid antispasmodic drugs. • The usual causes of constipation are dehydration and lack of opportunity. The patient reports full- ness, cramping, and intermittent pain in the lower abdomen and pelvis. • Hydration is the best initial treatment for constipation and often relieves the problem. The next step is the use of a stool softener and mild stimulant. • Constipation can be prevented in the backcountry by staying well-hydrated and adding fiber to the diet. • Vomiting can be the result of a problem with the GI system or a symptom of other problems such as motion sickness, toxic ingestion, head injury, or infection. Finding and treating the primary cause is ideal. • Replacement of fluid loss is a priority with a vomiting patient. Because nausea inhibits oral intake, IV or subcutaneous rehydration may be necessary. • Treating GI problems offers an easy opportunity to make things worse if you are not careful.