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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
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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.

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

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References

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  • 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
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  • 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
×