Colic biliary

Superior mesenteric artery syndrome Enteric infections Inflammatory bowel diseases Pancreatitis Appendicitis Cholecystitis Biliary colic Gastroparesis Postvagotomy syndrome Intestinal pseudo-obstruction Functional dyspepsia Gastroesophageal reflux Peptic ulcer disease Hepatitis Peritonitis Gastric malignancy Liver failure... 

Spasmolytics. N-Butylscopolamine (p. 104) is used for the relief of painful spasms of the biliary or ureteral ducts. Its poor absorption (N.B. quaternary N absorption rate <10%) necessitates parenteral administration. Because the therapeutic effect is usually weak, a potent analgesic is given concurrently, e.g., the opioid meperidine. Note that some spasms of intestinal musculature can be effectively relieved by organic nitrates (in biliary colic) or by nifedipine (esophageal hypertension and achalasia). 

Xanthines (usually caffeine) are frequently combined with aspirin in the treatment of headaches. In combination with an ergot derivative, methylxanthines have been used to treat migraine. These effects are likely due to their ability to produce vasoconstriction of cerebral blood vessels. Aminophylline is useful in the rehef of pain due to acute biliary colic. 

Visceral pain e.g. myocardial infraction, pleurisy, vascular occlusion, renal and biliary colic. 

The opioids contract biliary smooth muscle, which can result in biliary colic. The sphincter of Oddi may constrict, resulting in reflux of biliary and pancreatic secretions and elevated plasma amylase and lipase levels. 

The acute, severe pain of renal and biliary colic often requires a strong agonist opioid for adequate relief. However, the drug-induced increase in smooth muscle tone may cause a paradoxical increase in pain secondary to increased spasm. An increase in the dose of opioid is usually successful in providing adequate analgesia. 

N.A. Croton oil.105 Oil is carcinogenic, can be fatal. For constipation, dysentery, biliary colic, intestinal obstructions, food poisoning, malaria, mastitis. Externally for warts, dermatitis, abscesses, boils. 

Analgesic efficacy and clinical use Pethidine (Clark et al.,1995 Latta et al., 2002) is used for the treatment of moderate to severe pain including labor pain. It is also used as preoperative medication and as an adjunct to anesthesia. Due to its anti-muscarinic properties, it has a weaker muscle stimulant activity than other opioids and does not increase biliary pressure, which makes it suitable for the treatment of pain associated with pancreatitis or biliary colic. 

For the relief of pain arising from spasm of smooth muscle, as in renal or biliary colic, morphine is frequently employed. Other measures including antispasmodics such as atropine, atropine substitutes, theophylline, nitrites, and heat may be employed first however, if they are ineffective, meperidine, methadone, or opiates must be used. Morphine relieves pain only by a central action and may aggravate the condition producing the pain by exaggerating the smooth muscle spasm. Morphine may also be indispensable for the relief of pain due to acute vascular occlusion, whether this be peripheral, pulmonary, or coronary in origin. In painful acute pericarditis, pleurisy, and spontaneous pneumothorax, morphine is likewise indicated. Carefully chosen and properly spaced doses of codeine or morphine may occasionally be necessary in pneumonia to control pain, dyspnea, and restlessness. Traumatic pain arising from fractures, bums, etc., frequently requires morphine. In shock, whether due to trauma, poisons, or other causes, morphine may be required to relieve severe pain. 

Papaverine, because of its general depressant effect on smooth muscle, has been used in doses of 30 to 60 mg, subcutaneously and intravenously, in peripheral thrombosis and embolism, acute myocardial infarction, angina pectoris, bronchial asthma, renal and biliary colic, and other conditions in which relaxation of smooth muscle is desired. However, the therapeutic effectiveness of papaverine is questionable, and there is no established indication for its use. 

Meperidine has replaced morphine to a large extent in medical practice because of the physician s reluctance to use an opiate and the belief that meperidine manifests less undesirable side effects than does morphine. However, both of these assumptions are ill founded. Addiction to meperidine is much less amenable to treatment than is addiction to morphine. Meperidine, similar to morphine and codeine, causes spasm of the upper gastrointestinal tract and typical attacks of biliary colic in biliary tract disease. Meperidine, in doses giving an equal analgesic effect, induces as much respiratory depression as does morphine. Similar to morphine, it also crosses the placental barrier and must therefore be used cautiously in the latter stages of labor. 

In the unanesthetized dog, reserpine selectively depresses the sympathetic centers and induces facilitation of the parasympathetic centers in the diencephalon. The latter effect accounts for the bradycardia, miosis, aggravation of bronchial asthma, renal and biliary colic, and ulcerative colitis observed in some patients receiving the drug. 

Hydromorphone is also indicated for use during surgical procedures, and pain associated with trauma to bone and tissue, biliary colic, myocardial infarction, severe burns, and renal colic. 

The opioids constrict biliary smooth muscle, which may result in biliary colic. The sphincter of... 

The opiates cause constipation by inducing spasm of the stomach and intestines, presumably by the stimulation of opioid receptors in the myenteric plexus and reducing the release of acetylcholine. This property can be used therapeutically for the symptomatic relief of diarrhoea. Biliary colic and severe epigastric pain can occur because of the contraction of the sphincter of Oddi and the resulting increase in pressure in the biliary ducts. 

In certain liver disorders NSAIDs may actually be of benefit. For example, in biliary colic there is no impairment of liver synthetic function and thus NSAIDs may be safe to use. Prostaglandins are thought to increase pressure, secretions and contractions of the gallbladder, and thus there is a theoretical basis for pain improvement with NSAIDs. Studies with diclofenac have also demonstrated a reduced occurrence of cholecystitis, a frequent complication of biliary colic [2, 4, 44]. 

Morphine can reduce biliary secretions, and patients with biliary colic may experience an exacerbation of pain after morphine. Similarly, opioids such as morphine can cause bile duct spasm [27]. Opioid-induced spasm of the sphincter of Oddi and increased intrabiliary pressure may result in a secondary increase in LFTs [55]. 

Akriviadis EA, Hatzigavriel M, Kapnias D, et al. (1997) Treatment of biliary colic with diclofenac a randomized, double-blind, placebo-controlled study. Gastroenterology 113 225-231. 

Intrabiliaiy pressure may rise substantially after morphine (as much as 10 times in 10 minutes), due to spasm of the sphincter of Oddi. Sometimes biliary colic is made worse by morphine, presumably in a patient in whom the dose happens to be adequate to increase intrabiliary pressvue, but insufficient to produce more than slight analgesia. In patients who have had a cholecystectomy this can produce a syndrome sufficiently like a myocardial infarction to cause diagnostic confusion. Naloxone may give dramatic symptomatic relief, as may glyceryl trinitrate. Another result of this action of morphine is to dam back the pancreatic juice and so cause a rise in the serum amylase concentration. Morphine is therefore best avoided in pancreatitis but buprenorphine has less of this effect. 

Phenazocine is a high-efficacy agonist used particularly in biliary colic for it has less capacity than other opioids to cause spasm of the sphincter of Oddi. It may be administered sublingually if the patient is vomiting. 

Contraindications The following contraindications should be observed acute cholecystitis, acute cholangitis, obstruction of the cystic duct and common bile duct as well as frequent biliary colic. 

Therapeutic doses of opioids constrict the sphincter of Oddi, and biliary tract pressure rises ten-fold. Patients with biliary colic can have exacerbation of pain after morphine. Likewise, opioids such as fentanyl, morphine, and dextropropoxjrphene can cause bile duct spasm (SEDA-21, 85). 

For drugs that have poor oral bioavailability, rectal administration of prodrugs can increase their absorption. For example, nalbuphine is an analgesic with potency approximately 0.5-0.9 that of morphine. It is used for the relief of moderate to severe pain from a variety of causes, e.g., surgery, trauma, cancer, kidney, or biliary colic pain. Oral bioavailability of nalbuphine was poor, e.g., around 6% in experimental dogs. Rectal administration of nalbuphine-3-acetylsalicylate in the same animals enhanced the bioavailability 4- to 5-fold to around 28%. In addition, the plasma half-life of nalbuphine after rectal administration of the prodrug was prolonged. 

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