Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-84b7d79bbc-fnpn6 Total loading time: 0 Render date: 2024-07-25T14:18:09.102Z Has data issue: false hasContentIssue false

20 - Analgesia for the Biliary Colic Patient

from SECTION TWO - ANALGESIA FOR THE EMERGENCY PATIENT

Published online by Cambridge University Press:  03 December 2009

John H. Burton  and
James Miner
By
Allan B. Wolfson  and
David H. Newman
John H. Burton
Affiliation:
Albany Medical College, New York
James Miner
Affiliation:
University of Minnesota
Allan B. Wolfson
Affiliation:
Professor of Emergency Medicine, 230 McKee Place Suite 500, Pittsburgh, PA 15213, Email: wolfsonab@upmc.edu
David H. Newman
Affiliation:
Director of Clinical Research, Asst Professor of Clinical Medicine, Dept of Emergency Medicine, St Luke's/Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, Email: dnewman@chpnet.org
Get access

Summary

SCOPE OF THE PROBLEM

Painful biliary tract dysfunction is common. It is estimated that more than 20 million people in the United States have been treated for gall bladder disease, including 9 million who have undergone cholecystectomy. The overwhelming majority of these procedures (98%) are related to cholelithiasis, a condition that has also been reported to be present in 15% of asymptomatic adults.

CLINICAL ASSESSMENT

Biliary colic, a term used to refer to noninflammatory, noninfectious gall bladder pain, is believed to arise from outflow tract obstruction leading to increased prostacyclin and prostaglandin elaboration. This process may result in muscular spasm of the gall bladder wall, causing both viscerally and somatically mediated pain.

Typically, biliary pain is experienced in the epigastric and right upper quadrant regions of the abdomen and may radiate to the back. In contrast to classic descriptions of colic in which minutes-long spasms of pain are considered characteristic, biliary “colic” frequently remains constant and severe for 2–3 hr or more.

Pain in biliary tract disease also often arises in association with prandial stimulation and may be associated with nausea, emesis, chest pain, and diaphoresis. Biliary colic pain due to obstruction alone is not generally associated with abdominal tenderness.

PAIN CONSIDERATIONS

As with most abdominal processes that are evaluated and treated in the emergency department (ED), the diagnosis of biliary tract disease is often unclear on initial presentation.

Type
Chapter
Information
Emergency Sedation and Pain Management , pp. 131 - 134
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Everhart, JE. Khare, M, Hill, M. et al. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 117(3):632–639.CrossRef
Ko, CW. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc 2002;56:S165–S169.CrossRefGoogle Scholar
Ranji, SR, Goldman, , Simel, DL, et al. Do opiates affect the clinical evaluation of patients with acute abdominal pain?J Am Med Assoc. 2006;296(14):1764–1774.CrossRefGoogle ScholarPubMed
Tanaka, M, Ikeda, S, Matsumoto, S, et al. Manometric diagnosis of sphincter of Oddi spasm as a cause of postcholecystectomy pain and the treatment by endoscopic sphincterotomy. Ann Surg 1985;202:712–719.CrossRefGoogle ScholarPubMed
Murphy, P, Solomon, J, Roseman, DL. Narcotic analgesic drugs: Their effect on biliary dynamics. Arch Surg 1980;115:710–711.CrossRefGoogle ScholarPubMed
Lang, DW, Pilon, RN. Naloxone reversal of morphine-induced biliary colic. Anesth Analg 1980;59:619–620.CrossRefGoogle ScholarPubMed
Butler, KC, Selden, B, Pollack, CV Jr. Relief by naloxone of morphine-induced spasm of the sphincter of Oddi in a post-cholecystectomy patient. J Emerg Med 2001;21(2):129–131.CrossRefGoogle Scholar
Akriviadis, EA, Hatzigavriel, M, Kapnias, D, et al. Treatment of biliary colic with diclofenac: A randomized, double-blind, placebo-controlled study. Gastroenterology 1997;113(1):225–231.CrossRefGoogle ScholarPubMed
Kumar, A, Deed, JS, Bhasin, B, et al. Comparison of the effect of diclofenac with hyoscine-N-butylbromide in the symptomatic treatment of acute biliary colic. ANZ J Surg 2004;74(7):573–576.CrossRefGoogle ScholarPubMed
Svanvik, J, Thornell, E, Jansson, R. Indomethacin in the treatment of patients with biliary pain. A controlled clinical study. Scand J Urol Nephrol Suppl 1983;75: 55–57.Google Scholar
Dula, DJ, Anderson, R, Wood, GC. A prospective study comparing IM ketorolac with i.m. meperidine in the treatment of acute biliary colic. J Emerg Med 2001;20(2):121–124.CrossRefGoogle Scholar
Henderson, SO, Swadron, S, Newton, E, et al. Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic. J Emerg Med 2002;23(3):237–241.CrossRefGoogle ScholarPubMed
Al-Waili, N, Saloom, KY. The analgesic effect of intravenous tenoxicam in symptomatic treatment of biliary colic: A comparison with hyoscine N-butylbromide. Eur J Med Res 1998;3(10):475–479.Google ScholarPubMed
Antevil, JL, Buckley, RG, Johnson, AS, Thoman, DS, Riffenburgh, RH. Treatment of suspected symptomatic cholelithiasis with glycopyrrolate: A prospective, randomized clinical trial. Ann Emerg Med 2005;45(2):172–176.CrossRefGoogle ScholarPubMed
Rothrock, SG, Green, SM, Gorton, E. Atropine for the treatment of biliary tract pain: A double-blind, placebo-controlled trial. Ann Emerg Med 1993;22(8):1324–1327.CrossRefGoogle ScholarPubMed
los Santos, AR, Marti, ML, Di Girolamo, G, et al. Propinox in biliary colic: A multicenter, randomized, prospective and parallel double-blind study of three doses of propinox versus placebo in acute biliary colic pain. Int J Tissue React 1999;21(1):13–18.Google Scholar
Stower, MJ, Foster, GE, Hardcastle, JD. A trial of glucagon in the treatment of painful biliary tract disease. Br J Surg 1982;69(10):591–592.CrossRefGoogle ScholarPubMed
Lishner, M, Lang, R, Jutrin, I, et al. Analgesic effect of ceruletide compared with pentazocine in biliary and renal colic: A prospective, controlled, double-blind study. Drug Intell Clin Phar 1985;6:433–436.CrossRefGoogle Scholar
Basso, N, Bagarani, M, Materia, A, et al. Effect of caerulein in patients with biliary colic pain. Gastroenterology 1985;89(3):605–609.CrossRefGoogle ScholarPubMed
Malesci, A, Pezzilli, R, D′Amato, M, et al. CCK-1 receptor blockade for treatment of biliary colic: A pilot study. Pharmacol Ther 2003;18(3):333–337.Google ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Analgesia for the Biliary Colic Patient
    • By Allan B. Wolfson, Professor of Emergency Medicine, 230 McKee Place Suite 500, Pittsburgh, PA 15213, Email: wolfsonab@upmc.edu, David H. Newman, Director of Clinical Research, Asst Professor of Clinical Medicine, Dept of Emergency Medicine, St Luke's/Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, Email: dnewman@chpnet.org
  • John H. Burton, Albany Medical College, New York, James Miner, University of Minnesota
  • Book: Emergency Sedation and Pain Management
  • Online publication: 03 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547225.020
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Analgesia for the Biliary Colic Patient
    • By Allan B. Wolfson, Professor of Emergency Medicine, 230 McKee Place Suite 500, Pittsburgh, PA 15213, Email: wolfsonab@upmc.edu, David H. Newman, Director of Clinical Research, Asst Professor of Clinical Medicine, Dept of Emergency Medicine, St Luke's/Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, Email: dnewman@chpnet.org
  • John H. Burton, Albany Medical College, New York, James Miner, University of Minnesota
  • Book: Emergency Sedation and Pain Management
  • Online publication: 03 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547225.020
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Analgesia for the Biliary Colic Patient
    • By Allan B. Wolfson, Professor of Emergency Medicine, 230 McKee Place Suite 500, Pittsburgh, PA 15213, Email: wolfsonab@upmc.edu, David H. Newman, Director of Clinical Research, Asst Professor of Clinical Medicine, Dept of Emergency Medicine, St Luke's/Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, Email: dnewman@chpnet.org
  • John H. Burton, Albany Medical College, New York, James Miner, University of Minnesota
  • Book: Emergency Sedation and Pain Management
  • Online publication: 03 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547225.020
Available formats
×