Book contents
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- 8 Pharmacology of Commonly Utilized Analgesic Agents
- 9 Patient Assessment: Pain Scales and Observation in Clinical Practice
- 10 Pathways and Protocols for the Triage Patient with Acute Pain
- 11 Patients with Acute Pain: Patient Expectations and Desired Outcomes
- 12 Analgesia for the Adult and Pediatric Multitrauma Patient
- 13 Analgesia for the Emergency Department Isolated Orthopedic Extremity Trauma Patient
- 14 Analgesia for Selected Emergency Eye and Ear Patients
- 15 Analgesia for the Emergency Headache Patient
- 16 Analgesia for the Emergency Chest Pain Patient
- 17 Analgesia for the Emergency Back Pain Patient
- 18 Analgesia for the Acute Abdomen Patient
- 19 Analgesia for the Renal Colic Patient
- 20 Analgesia for the Biliary Colic Patient
- 21 Analgesia for the Chronic Pain Patient
- 22 Outpatient Analgesia following Acute Musculoskeletal Injury
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
20 - Analgesia for the Biliary Colic Patient
from SECTION TWO - ANALGESIA FOR THE EMERGENCY PATIENT
Published online by Cambridge University Press: 03 December 2009
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- 8 Pharmacology of Commonly Utilized Analgesic Agents
- 9 Patient Assessment: Pain Scales and Observation in Clinical Practice
- 10 Pathways and Protocols for the Triage Patient with Acute Pain
- 11 Patients with Acute Pain: Patient Expectations and Desired Outcomes
- 12 Analgesia for the Adult and Pediatric Multitrauma Patient
- 13 Analgesia for the Emergency Department Isolated Orthopedic Extremity Trauma Patient
- 14 Analgesia for Selected Emergency Eye and Ear Patients
- 15 Analgesia for the Emergency Headache Patient
- 16 Analgesia for the Emergency Chest Pain Patient
- 17 Analgesia for the Emergency Back Pain Patient
- 18 Analgesia for the Acute Abdomen Patient
- 19 Analgesia for the Renal Colic Patient
- 20 Analgesia for the Biliary Colic Patient
- 21 Analgesia for the Chronic Pain Patient
- 22 Outpatient Analgesia following Acute Musculoskeletal Injury
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
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 - 134Publisher: Cambridge University PressPrint publication year: 2008