Instant Natural Colic Relief
Hyoscine hydrobromide effectively reduces respiratory secretions and is sedative (but occasionally causes paradoxical agitation) it is given in a subcutaneous infusion dose of 1.2-2.4 mg 24 hours. Hyoscine butylbromide is used for bowel colic and for excessive respiratory secretions, and is less sedative than hyoscine hydrobromide. Hyoscine butylbromide is given in a subcutaneous infusion dose of 60-300mg 24hours for bowel colic and 20-120mg 24hours for excessive respiratory secretions (important these doses of hyoscine butylbromide must not be confused with the much lower dose of hyoscine hydrobromide, above).
Snake bites Envenoming from snake bite is uncommon in the UK. Many exotic snakes are kept, some illegally, but the only indigenous venomous snake is the adder (Vipera berus). The bite may cause local and systemic effects. Local effects include pain, swelling, bruising, and tender enlargement of regional lymph nodes. Systemic effects include early anaphylactic symptoms (transient hypotension with syncope, angio-edema, urticaria, abdominal colic, diarrhoea, and vomiting), with later persistent or recurrent hypotension, ECG abnormalities, spontaneous systemic bleeding, coagulopathy, adult respiratory distress syndrome, and acute renal failure. Fatal envenoming is rare but the potential for severe envenoming must not be underestimated.
Indications symptomatic relief of gastro-intestinal or genito-urinary disorders characterised by smooth muscle spasm bowel colic and excessive respiratory secretions (see Prescribing in Palliative Care, p. 23) Cautions see notes above Contra-indications see notes above Pregnancy manufacturer advises use only if potential
BILIARY TRACT After the subcutaneous injection of 10 mg morphine sulfate, the sphincter of Oddi constricts, and the pressure in the common bile duct may rise more than tenfold within 15 minutes this effect may persist for 2 hours or more. Fluid pressure also may increase in the gallbladder, producing symptoms that vary from epigastric distress to typical biliary colic. All opioids can cause biliary spasm. Atropine only partially prevents morphine-induced biliary spasm, but opioid antagonists prevent or relieve it. Nitroglycerin (0.6-1.2 mg) administered sublingually also decreases the elevated intrabiliary pressure.
One in four patients who undergo cholecystectomy for uncomplicated gallstone disease or acute cholecystitis continues to have persistent abdominal pain 5 years after their surgery 46 . This postcholecystec-tomy syndrome consists of pain which is typically in the right upper quadrant of the abdomen and is similar to that of cholecystitis. It is exacerbated by eating, may be associated with nausea, and is often described as dull and colicky. An appropriate work-up can rule out a definable pathology such as a retained bile duct stone or secondary pancreatitis. Endoscopic retrograde cholangiopancreatography manometry may identify abnormal pressures or motility within the biliary duct and if observed, elevated sphincter of Oddi pressures suggest sphincter dysfunction as the cause of the syndrome 47 . Treatments include sphincterotomy or stenting when elevated pressures are noted. Nifedipine has been reported to help with sphincter dysfunction, but there is no high-level evidence for any...
The exclusive use of IVM on horse farms has not been effective for controlling the entire spectrum of equine parasites because the MLs have no efficacy against cestodes, such as Anoplocephala perfoliata, and the proposed significance of this parasite in the induction of colic recently has gained support (Proudman and Trees, 1999). The use of higher dosages of
Antimony compounds have been known for their much lower toxicity in humans compared with arsenic. Generally, SbIII is more toxic than its penta-valent analogue (SbV),49 with 50 of a lethal dose (LD50) ranging from 172 to 4000 mg kg- in mice and rats (for SbIII), in contrast to the highly toxic arsenic compound (e.g. Me2AsCl 5mgkg-1).15 Nevertheless, side-effects of SbIn such as nausea, vomiting, weakness and myalgia, abdominal colic, diarrhea and skin rashes, together with the most important cardiotoxicity, have been observed.50
Occasionally jaundice when obstructive. However, even after surgical resection of the gallbladder, pain may continue which is termed postcholecystectomy syndrome. In a follow-up study, Vetrhus et al.129 found that 27 percent of patients who underwent cholecystectomy for uncomplicated gallstone disease or acute cholecystitis continued to have persistent abdominal pain five years after their surgery. Typically in the right upper quadrant of the abdomen, its symptomatology is similar to that of cholecystitis in that it may be exacerbated by eating, may be associated with nausea, and is described as continuous during the day, dull and frequently colicky. Appropriate workup will rule out definable pathology such as a retained bile duct stone or secondary pancreatitis. It is a correlate to chronic pancreatitis in that there may be abnormal pressures or motility within the biliary duct. Endoscopic demonstration of elevated sphincter of Oddi pressures suggest sphincter dysfunction as the...
Stones located within the urinary system (renal pelvis calices, ureters, bladder, urethra) can produce severe pain (renal colic) and if sufficiently obstructive to urine flow can destroy kidney function. It occurs in 15 percent of white men and 6 percent of all women in industrialized countries.132 Recurrent in stone-formers, it may produce continuous pain when numerous or large renal pelvic (staghorn) calculi are present. Diagnosis is based on history of stone formation and or imaging studies (intravenous pyelogram or computed tomography). The definitive treatment is the removal of the stone by spontaneous passage which may be assisted by fragmentation using lithotripsy or surgical removal. Drugs producing a relaxation effect in the ureters include NSAIDs, nifedipine, and tamsulosin. Pain treatments employed for renal colic are intended to be temporizing until stone removal occurs. As such, narcotics and NSAIDs are the mainstay of treatment. There may be particular benefit to the use...
They may exaggerate or feign medical problems, for example, complain of renal colic and prick a finger to add blood to the urine specimen, so you might believe a renal stone was not visible on x-ray. Their complaints may be hard to determine objectively, such as a migraine, tic, or toothache.
Diverticular disease is treated with a high-fibre diet, bran supplements, and bulk-forming drugs (section 1.6.1). Antispasmodics may provide symptomatic relief when colic is aproblem (section 1.2). Antibacterials are used only when the diverticula in the intestinal wall become infected. Antimotility drugs which slow intestinal motility, e.g. codeine, diphenoxylate, and loperamide could possibly exacerbate the symptoms of diverticular disease and are contra-indicated.
Lemon balm is a delicious lemony-tasting botanical that is widely used for colic, restlessness, teething, and fever in children. It is also used as a mood elevator, antidepressant, and relaxing diaphoretic in adults, among many other uses. In Europe, a balm made from the essential oil-rich leaves is also used topically as an antiviral for the treatment of oral herpes. Although the leaves of lemon balm are not readily subject to adulteration, whole-plant lemon balm may also be traded. This material would include fragments of stem and flowers.
Species of Illicium are used for the treatment of colic in infants and children. The primary species used is Chinese star anise, I. verum. However, shikimi fruits, also known as Japanese star anise, have adulterated the I. verum market since at least 1881 and have been associated with causing seizures in children. With standard light microscopy, the anatomy of shikimi fruit is extremely similar to that of star anise except for differences in the palisade cells of the endocarp, astrosclereids of the columella, and macroscle-reids of the testa. Electron microscopy can pick up more specific and detailed differences between the species but still may not provide a definitive differentiation.
Mushrooms are a rich source of toxins mushroom poisoning has increased as the result of the popularity of hunting wild mushrooms. High concentrations of muscarine are present in various species of Inocybe and Clitocybe. The symptoms of muscarine intoxication (salivation, lacrima-tion, nausea, vomiting, headache, visual disturbances, abdominal colic, diarrhea, bronchospasm, bradycardia, hypotension, shock) develop within 30-60 minutes of ingestion. Treatment with atropine ( -2 mg intramuscularly every 30 minutes) effectively blocks these effects.
Star anise fruits are used in herbal teas in different parts of the world for the treatment of colic and appear to be relatively safe. However, I. verum is sometimes adulterated with a Japanese species of Illicium I. anisatum that is also known as Japanese star anise or shikimi. I. anisatum has been associated with seizures in infants to whom the tea was given. This adulteration has occurred at least since 1881.
CaNa2EDTA is initiated at a dose of30-50 mg kg day in 2 divided doses either by deep intramuscular injection or slow intravenous infusion for up to 5 consecutive days. The first dose of CaNa-EDTA should be delayed until 4 hours after the first dose of dimercaprol. An additional course of CaNa2EDTA may be given after an interruption of 2 days. Each course of therapy with CaNa-EDTA should not exceed a total dose of 500 mg kg. Urine output must be monitored because the chelator-lead complex is believed to be nephrotoxic. Treatment with CaNa2EDTA can alleviate symptoms quickly. Colic may disappear within 2 hours paresthesia and tremor cease
German chamomile is one of the most popular herbal teas worldwide. It is used as a mild sleep aid and painkiller a digestive bitter to settle an upset stomach for colic, fever, restlessness, and teething in infants and topically as an antimicrobial, to name only a few of its primary uses. German chamomile may be mixed or substituted with Roman chamomile, Chamaemelum nobile. The two flowers can be readily distinguished from each other (see Chamaemelum nobile).
Within seconds of the intravenous injection of a histamine liberator, human subjects experience a burning, itching sensation. This effect, most marked in the palms of the hand and in the face, scalp, and ears, is soon followed by a feeling of intense warmth. The skin reddens, and the color rapidly spreads over the trunk. Blood pressure falls, the heart rate accelerates, and the subject usually complains of headache. After a few minutes, blood pressure recovers, and crops of hives usually appear on the skin. Colic, nausea, hypersecretion of acid, and moderate bron-chospasm also occur frequently.
There is no compelling evidence that one opioid is better than another, but there is good evidence that pethidine has a specific disadvantage25 and no specific advantage. Given in multiple doses, the metabolite norpethidine can accumulate and act as a central nervous system irritant, ultimately causing convulsions, especially in renal dysfunction. Pethidine should not be used when multiple injections are needed. The old idea that pethidine is better than other opioids at dealing with colicky pain is no longer tenable.26
Renal colic is also seen more commonly in patients taking the protease inhibitor indinavir as drug crystals can obstruct the renal tract if insufficient fluids are taken. Tumors of the small and large bowel causing abdominal pain include Kaposi's sarcoma and non-Hodgkin's lymphoma (NHL). NHL can occur even when patients have relatively well-preserved immunity and in HIV can present in unusual sites such as the mouth or anus.57 Abdominal colic can accompany infections such as HIV or CMV colitis, cryptosporidium, or Mycobacterium avium complex. Patients are likely to be relatively immunocompromised, experiencing severe diarrhea and anorexia. An acute presentation of colic may be caused by intussusception as a result of enlarged mesenteric lymph nodes.
Pennyroyal has been used historically as a tea for headache, teething, restlessness, colic, and fevers in children. It is rich in essential oils and has stimulating diaphoretic activity. The highly concentrated essential oil has also been used as an abortifacient sometimes with fatal outcomes thus bringing the safety of the general use of pennyroyal into question. The diluted oil is popular for external use as an insect repellant against mosquitoes and fleas.
(IAP) which is associated with colicky abdominal pain that is intermittent, may be associated with environmental exposures, and which can last for days to months. Since it is transmitted as an autosomal dominant disorder with incomplete penetrance, family history may or may not be helpful in the diagnosis. Certain drugs such as barbiturates, benzodiazepines, alcohol, phenytoin, ketamine, etomidate, mep-robamate, and corticosteroids have been implicated as triggers of a crisis, so are generally avoided. Other gastrointestinal signs and symptoms such as vomiting, constipation, and abdominal distension are common and may complicate the initial diagnosis. Neural demyelination can occur, resulting in various neurologic and psychiatric symptoms. The urine and blood tests which are useful for the diagnosis of porphyria may only be valid during crises, though increased urinary porphobilinogen secretion confirms the diagnosis. Genetic testing of asymptomatic members in IAP families is now...
The classic presentation of pancreatic cancer4 located at the head of the pancreas (70 percent of these tumors) is the triad of abdominal pain, weight loss, and jaundice due to obstruction of the biliary system. Epigastric tenderness and a palpable gallbladder or abdominal mass may be present, but in general there are no definitive findings on physical exam. Cancer in the body or tail of the pancreas may be associated with venous obstruction, portal hypertension, and or bleeding. The abdominal pain is described as persistent and typically located in the middle of the upper abdomen and may have radiation through to the back. It can be dull and achy, gnawing, or have a cramping, colicky sensation. Pain is moderate to severe in 20-30 percent of patients at the time of presentation and is severe in 80 percent with advanced disease.6 Weight loss may be profound and malabsorption is frequently noted. Due to its location and the typically asymptomatic nature of this cancer, tumors are often...
In factitious disorder, patients consciously fabricate symptoms and may even physically injure themselves in order to produce symptoms and signs that are typical of an organic illness. The motivation for exhibiting such symptoms in factitious disorder is to obtain medical care. Abdominal pain, often suspected to be due to renal or biliary colic, is the most frequent presentation of a painful factitious disorder. Most people encountered in clinical practice with this disorder are healthcare professionals with a considerable female preponderance.77 They are often found to have a number of different diagnoses at different times. Their families are closely involved and are convinced of an organic etiology. Frequent attendance at emergency departments, coupled with negative investigations, raises suspicions that this disorder may be present.
Diverticuli, sacs or pouch openings off the main lumen of the gut, occur most commonly in the colon but can also occur at any other GI tract site. They typically arise at the site of penetrating blood vessels which represent weak sites in the colon wall. Colonic diverticuli are generally pain free but severe abdominal pain and infection may result if their mouth (opening to the lumen) becomes inflamed and or obstructed. The disorder is then termed diver-ticulitis and is associated with pain, altered bowel habits, abscess formation, obstruction, colonic distension, and bleeding. In the absence of infection or inflammatory changes, diverticuli may present with recurrent, episodic left lower quadrant colicky pain and the disorder is termed diverticulosis.
The CCK A antagonist loxiglumide has been examined in patients with biliary colic and compared to conventional treatment with the anticholin-ergic hyoscine. It has been shown that the loxiglumide was significantly more effective at reducing biliary colic pain than the hyoscine.
Irritative effects of stones moving within the urinary system (renal pelvis calices, ureters, bladder, urethra) can lead to severe pain (renal colic) and if sufficiently obstructive to urine flow, can destroy kidney function. It may be recurrent in stone-formers and may be continuous when numerous or large renal pelvic (staghorn) calculi are present. It occurs in 15 of white men and 6 of all women in industrialized countries 48 . Diagnosis is based on history of stone formation and or imaging studies (intravenous pyelogram or CT). The primary treatment for the disorder is the removal of the stone by spontaneous passage, which may be assisted by fragmentation using lithot-ripsy, or it may require surgical removal. Drugs which relax the ureters include nonsteroidal anti-inflammatory drugs (NSAIDs), nifedipine, and tamsulosin, all of which have been demonstrated to facilitate stone passage. Otherwise, pain treatments employed are intended to be temporizing with the goal of relieving pain...
Serious toxic reactions to carbonic anhydrase inhibitors are infrequent however, these drugs are sulfonamide derivatives and, like other sulfonamides, may cause bone marrow depression, skin toxicity, sulfonamide-like renal lesions, and allergic reactions (see Chapter 43). With large doses, many patients exhibit drowsiness and paresthesias. Most adverse effects, contraindications, and drug interactions are secondary to urinary alkalinization or metabolic acidosis, including (1) diversion of ammonia of renal origin from urine into the systemic circulation, a process that may induce or worsen hepatic encephalopathy (the drugs are contraindicated in patients with hepatic cirrhosis) (2) calculus formation and ureteral colic owing to precipitation of calcium phosphate salts in an alkaline urine (3) worsened metabolic or respiratory acidosis (the drugs are contraindicated in patients with hyperchloremic acidosis or severe chronic obstructive pulmonary disease) and (4) reduced urinary...
Complete or partial responses after 24 (12-40) sessions of HBO in 7 of 17 cases rectal bleeding, 2 of 4 pain syndromes, 3 of 4 cases of fecal incontinence, and 4 of 8 diarrheal syndromes.54 These experiences are broadly repeated in other studies, including a cohort of 14 patients, 11 of whom presented with rectal bleeding, 5 with diarrhea, and 5 with tenesmus or colic.55 After 40 (20-72) HBO sessions, 9 patients were completely healed, 3 patients improved substantially, and 2 were non-responders.
Somatic pain is localized around the site of injury visceral pain is poorly localized, cramp-like, or colicky in nature and could be associated with nausea and vomiting diaphragmatic pain is characterized by its location and radiation to the shoulder. The pain from laparoscopic tubal ligation is usually of moderate intensity and Anita responds to further doses of opioid and ketorolac. She is discharged 2 days later. Three months after her surgery Anita is back to see you in the pain clinic. She has been referred to you by her primary care physician for the evaluation of a tender scar above the belly button. She tells you that the scar sometimes burns . She mentions that ever since the laparoscopic her surgery, she has been suffering from severe and unbearable colicky pelvic pain radiating to her lower back. The pain comes during her mid-menstrual cycle. Anita is convinced that it is related to her ovulation. Her primary care physician has tried various analgesics and antidepressants...
Everything You Need To Know About Baby Sleeping. Your baby is going to be sleeping a lot. During the first few months, your baby will sleep for most of theday. You may not get any real interaction, or reactions other than sleep and crying.