Hepatic colic

Hepatic colic is the most frequent clinical form of cholelithiasis (75% of patients). It manifests itself in sudden and usually recurring intense painful attacks.

Among the most characteristic basic manifestations that occur in connection with the formation of stones in the gallbladder, belongs to the hepatic colic. Its occurrence, according to the corresponding medical statistics, is noted with a certain periodicity in every tenth patient with cholelithiasis, mainly in male patients. Women suffer from hepatic colic much less often, they appear with about half the frequency of recorded cases.

There is the occurrence of hepatic colic due to the fact that the stones present in the gall bladder create an obstacle to the processes of normal outflow of bile. This pathological phenomenon in the human body is accompanied by acute pains arising in the area where the gallbladder is located, namely, on the right side under the costal arch. In the localization of the pain syndrome in hepatic colic, the right scapula is also involved, and in addition, the recoil of pain under the right collarbone can sometimes be noted. Pain in hepatic colic is acute burning character, and can be triggered as physical activity of high intensity, and act as a consequence of a strong emotional tension. Due to heavy physical exertion or an agitated psycho-emotional state, the content of the hormone adrenaline rises in the blood, the excess of which leads to spasms in the muscle tissues, as well as to vascular spasms. This provokes stagnant processes of bile in the hepatic ducts, which in turn causes pain peculiar to hepatic colic.

[1], [2],

Causes of hepatic colic

An attack of hepatic colic can be provoked by inaccuracy in diet or physical exertion, however in many patients it is not possible to identify provoking factors, and pain can begin during a night's sleep. The mechanism of hepatic colic is complex and not fully understood. Most often, the onset of colic is caused by a violation of the outflow of bile from the gall bladder (spasm of bladder rash, obturation with a stone, a mucus of mucus), or a violation of bile flow along the common bile duct (OZHP) (spasm of the sphincter of Oddi, obturation with a stone, a mucus of mucus, passage stone on the LCA).

The different zones of the gallbladder and bile ducts are characterized by a different pain response to the finding of the calculus. Usually, three zones are distinguished:

• the bottom and the body of the gallbladder - "mute" zone (the presence of a stone in it does not give pain in the absence of inflammation of the mucosa);
• zone of moderate sensitivity - the funnel, the neck of the HP and the adjacent part of the body of the HP (moving into this zone, the stone causes a violation of the outflow of bile, reduction of the RA is accompanied by moderate pains);
• a zone of sharp soreness (a zone of ducts) - the presence of concrements in the ducts causes concomitant spasm accompanied by ischemia of the wall, a violation of the outflow of bile, a dilatation of the overlying sections of the duct, hyperperstastitis, which causes sharp pain and increased spasm (vicious circle) continuing until the concrement of the calculus, clot mucus or the introduction of antispasmodics. It is not recommended to administer true opiate receptor agonists (morphine, fentant, promedol, etc.), which can enhance pain syndrome (spasm of sphincters is possible).

[3], [4], [5], [6]

Symptoms of hepatic colic

For hepatic colic, the following clinical symptoms are typical: an attack occurs suddenly, can last for hours, rarely more than a day. The pains are acute, paroxysmal, indistinctly localized in the right hypochondrium and epigastrium - visceral pain (occurs with spasm, stretching, swelling of the organs). Irradiation of pain in the back or shoulder blade is caused by irritation of the ends of the branches of the spinal nerves that take part in the innervation of the hepatic-duodenal ligament along the bile ducts. The noted symptoms can be associated with the presence of choledocholithiasis, cholangitis, ductal hypertension - the so-called choledochial colic. The attack can be accompanied by reflex vomit, which does not bring relief. Pulse can be increased, blood pressure does not change significantly. Increases in temperature, chills, and leukocytosis are not observed, since there is no inflammatory process (in contrast to an attack of acute cholecystitis). The pain usually builds up for 15-60 minutes, and then remains almost constant from 1 to 6 hours. Later there is a gradual loss of pain, but it is possible and sudden termination of pain. An attack of pain, lasting more than 6 hours, may indicate the possible development of acute cholecystitis. Between the attacks of hepatic colic the patient feels quite satisfactory. 30% of patients have no repeated attacks.

Acute hepatic colic

Acute hepatic colic occurs mainly on the background of the fact that gallstone disease takes place. To a somewhat lesser degree, it is capable of dyskinesia of the biliary tract. The fundamental factor in the development of the prerequisites for the appearance of acute hepatic colic is the blockage of the outflow of bile from the gallbladder by the stones formed in it. Due to this, the amount of bile increases to a considerable extent, causing the gallbladder to stretch in the part that is above the obstacle that creates the inability of free outflow from this organ.

Lead to acute hepatic colic can be the use of excessively large amounts of food, especially if it is too fatty, excessive use of acute spices, spices, intemperance in alcoholic drinks. In addition, the appearance of pain symptoms of this kind are capable of as a result of too intense physical stress of the body.

Characteristic for acute hepatic colic are the following symptoms. Preceding it may be the appearance of nausea, a feeling of heaviness in the pit of the stomach or in the right hypochondrium. In these areas of the body there is a sudden appearance of pain that is acute. Painful sensations can also take place in the right shoulder and shoulder blade, and spread to the neck. In some cases, the localization of the pain syndrome, extending from the hypochondrium, completely covers the abdomen.

Pain in acute hepatic colic is very intense, it can be permanent or it can manifest itself in the form of fights.

The duration of an attack can be equal to several minutes or hours, and continue for a time exceeding the whole day. In acute hepatic colic, patients, as a rule, come to a state of extreme excitement, pale, become sweaty and are very restless trying to find the position of the body in which relief may come.

Acute hepatic colic calls for the need to immediately take appropriate medical measures to help the patient cope with such a critical condition.

[7], [8], [9], [10], [11]

Attack of hepatic colic

The attack of hepatic colic occurs against the background of cholelithiasis and has the name also - bilious or cholelithic colic. Attacks of hepatic colic are mainly noted at that stage of the disease with the formation of gallstones, on which the undeniable clinical manifestations of this disease become clearly pronounced. The previous two stages are predominantly asymptomatic and have no pain syndrome. For cholelithiasis, when it reaches its third stage in the process of development of pathological progress, the alternation of rather long periods in which the disease practically does not manifest itself, with episodic attacks of hepatic colic, is characteristic. For a long time, all the symptoms can be reduced to nothing more than a sense of heaviness in the right hypochondrium, slight discomfort after eating and the appearance in the mouth of a bitter taste. And sometimes even such manifestations may not be observed. But such a lull in the course of the disease - only for the time being, and sooner or later one way or another one should expect an attack of hepatic colic.

Due to the fact that with the course of the pathological process of formation of stones in the gallbladder, stagnant phenomena become more pronounced, pain symptoms are characterized by ever-increasing intensity. They appear against the background of the fact that the lumen of the common duct turns out to be a clogged stone or is narrowed considerably due to spasm. This leads to excessive accumulation of bile within the gallbladder, which increases in size, stretches and this process is accompanied by pain. Attacks of hepatic colic can occur also when the stones move in the bile duct.

The attack of hepatic colic from the very first moment as soon as it appears signals that the cholelithiasis, if it was still present in humans asymptomatically and did not manifest itself in any way, its presence was not established, but now it is absolutely clear and with all certainty makes itself felt. It is with an attack of hepatic colic that the development of all kinds of complications of this disease begins.

[12], [13], [14], [15]

Hepatic colic during pregnancy

Hepatic colic during pregnancy can be due to the fact that a woman in the situation before she began to bear any chronic diseases or impaired functioning of the internal organs associated with the processes of outflow of bile. Among the causes of hepatic colic in this regard can be called in particular cholelithiasis and dyskinesia bile ducts. Hepatic colic in this case occur as a consequence of exacerbation of such diseases during pregnancy.

To lead to the appearance of hepatic colic during pregnancy is also capable of an unplanned and ill-conceived approach to the organization of the diet of a woman preparing to become a mother. In this case, you need to consult a doctor to optimize the diet. Avoid eating foods and foods that can adversely affect the normal functioning of the liver. It is desirable to refrain from all sharp, fried, to exclude from the menu all smoked meat.

When a woman suffers from hepatic colic during pregnancy, she often finds it difficult to find a position of the body in which it becomes possible to reduce the intensity of pain. The pain of hepatic colic during pregnancy is very acute aching and may be accompanied by a rise in body temperature, nausea and the urge to vomit. In order to cope with hepatic colic during pregnancy, it is not recommended to take any pharmacological anesthetic because their use will not benefit the liver functions.

The best way to defeat hepatic colic during pregnancy is probably walking barefoot, which stimulates the feet, which in turn has beneficial effects for relaxing the muscles of the gallbladder and bile ducts. For the removal of spasms, the administration of antispasmodic agents is also justified.

Emergency care for hepatic colic

Emergency care for hepatic colic involves, on the one hand, the use of funds to help reduce the severity of the pain syndrome, and on the other hand, to restore the patency of the bile duct by relieving the tension of his muscles.

A high degree of effectiveness as an antispasmodic drug shows the use of nitroglycerin in alcohol solution or in the form of tablets. The patient should take either one tablet or a solution in the amount of 2 drops. Sometimes this measure is not enough. In this case, it is required to enter subcutaneously platifillin in a 0.2% solution of 2 ml or from 2 to 3 ml of papaverine solution at a concentration of 2%. An alternative may be a subcutaneous injection of a 0.1% solution of atropine 1 milliliter. This drug can be used in combination with each of the two above. Good results in terms of removal of spasm are achieved using arpenal, which must be administered under the skin in a 1-ml dose of a solution of 2%.

To relieve the pain, an injection of 1.0 aspirin or analgin in a similar dose is done. Repeated use of these drugs with a 4-hour interval is allowed.

In the area where the gallbladder is located, it is recommended to keep the heating pad. It should be filled with not too much water, so as not to expose the peritoneal wall to significant pressure. When there is such a possibility for a patient with hepatic colic, it is possible to place a sufficiently high temperature in a bath with water for 10-15 minutes.

If hepatic colic is accompanied by the appearance of fever in the patient, he is shivering and the fever persists for more than one day, antimicrobial agents are prescribed, for example, 500 000 streptomycin administration twice a day. Alternatively, 1.0 sulfadimezine with a 4-hour interval can also be considered.

As you can see, emergency care for hepatic colic has two main vectors of the therapeutic effects. The essence of medical measures in connection with it is to eliminate the spasm in the bile duct, preventing the normal outflow of bile, as well as to reduce the intensity of pain symptoms associated with excessive content in the gallbladder.

[16], [17]

First aid for hepatic colic

Before taking any independent measures to help with hepatic colic, it is necessary to take into account that if the pains are protracted and do not stop after 5 to 6 hours, this requires an immediate request to the medical specialist. This situation means that the disease automatically goes into the category of surgical. That is, it becomes such that the monitoring of a person's condition, diagnosis and treatment should be entrusted to the surgeon. Since often the only effective treatment method can be only surgical intervention. Thus, if the hepatic colic does not go away for a long time, such a patient needs to be hospitalized.

As to how it is possible to contribute to the alleviation of suffering in an attack, there are a number of practical recommendations on what kind of first aid should be provided for hepatic colic.

The minimum program in this case assumes first of all that such a patient needs to provide bed rest. Next, he is invited to drink painkillers tablets (1-2), a couple of papaverine tablets or no-shpah, under the tongue - validol.

It should be noted that the use of a heating pad is not always justified. It is expedient only in this situation, if one can definitely and unambiguously be sure that there is hepatic, biliary colic, while there is no acute cholecystitis. A competent in this matter is only a doctor.

So, having done the above, you should definitely make a call for medical emergency. Especially if the attack happened for the first time. This all first aid for liver colic is exhausted, and the matter of further treatment should be transferred to doctors.

[18], [19],

Than to remove a hepatic colic?

When there is an attack of acute pain in the region of the liver and gall bladder, the question becomes especially topical, what is necessary in this case to take and how to remove the hepatic colic? Since this phenomenon is most directly caused by the appearance of stagnant processes, in order to alleviate the condition of the patient with hepatic colic, a number of actions aimed at ensuring free outflow of bile in the hepatic ducts and the gall bladder are a primary measure.

To achieve this it is possible with the use of pharmacological preparations having antispasmodic properties. In particular, the use of drotaverine, no-shpy, papaverine, platyphilin is justified. In especially severe cases, it may be necessary to administer them intramuscularly, as well as intravenously.

Among the activities that are useful for hepatic colic is the use of a heating pad, which is applied to the right side. Here, however, it is necessary to take into account the fact that resort to such a measure is allowed only if there is complete certainty that this is not an acute attack of appendicitis.

Another way that can help normalize the processes of bile outflow is complete abstinence from eating during that time period until all the food in the body is fully digested.

Useful, when there is hepatic colic, can be the drinking of mineral water, from which all gases have been previously released.

Help to cope with hepatic colic in addition are also capable of allochol tablets in an amount of 2 to 3 pieces.

Thus, although there is a sufficient number of possible means and methods to relieve the hepatic colic, nevertheless, if due to their use it is not possible to promote pain relief for more than half an hour after the onset of an attack, this requires immediate medical attention. But even in case of successful self-removal of hepatic colic, it is not necessary to postpone visiting a medical specialist who can outline the range of possible causes leading to its appearance and subsequently establish an accurate diagnosis.

Anesthetic for hepatic colic

So, what means can help cope with sudden acute burning pain in the liver and what can be used as an effective analgesic for hepatic colic?

In case of an attack of a very serious severity, the use of anesthetics and antispasmodics is carried out through injections, as well as by intravenous injection. And the appointment and conduct of such manipulations can be performed only by a medical specialist. As for what should be done until the ambulance arrives, there are a number of specific recommendations that follow, which can help alleviate the patient's suffering.

Successfully reduce the severity of the pain syndrome in hepatic colic is often possible with nitroglycerin, the tablet of which must be placed under the tongue. As an alternative method of taking this drug, several drops of it (2-3) can be applied on a slice of sugar-refined sugar.

If there have been previous attacks of hepatic colic and a patient on this occasion has previously applied for medical help, it makes sense to use those specific pain medication to take pain relief, which is one of the prescriptions of the doctor.

Without prescription, accessible to the use of pain relievers are rectal suppositories with papaverine, as well as containing belladonna extract. However, it should be noted that resort to their assistance should not be earlier than having consulted a doctor. Since they, in particular, are contraindicated in cases of glaucoma.

If the pains differ not too strongly pronounced character is shown taking atropine solution 0.1% from 5 to 10 drops per 1 tablespoon of cold water. Atropine belongs to the list of prescription drugs.

Among the permissible measures, the possibility of applying a warming compress or a non-heated hot water bottle in the area of the upper abdomen is also not excluded. But, putting the heating pad you need to consider, if after a 5-10-minute period of time from the heat of improvement does not come it must be removed.

An anesthetic for hepatic colic can bring some relief to the patient's condition, but it should not be forgotten that such pain is a symptom associated with a dysfunction of the gallbladder and a violation of the processes of bile flow in the hepatic duct. And this calls for the need to treat primarily the underlying disease.

[20], [21], [22], [23], [24]

Nutrition for hepatic colic

Hepatic colic is closely related to diseases of the liver and biliary tract. Nutrition for hepatic colic should be organized in this way, based on general recommendations regarding the principles on which to establish a diet and select a menu for these diseases.

In the diet, when there is hepatic colic, must enter into a sufficient amount of fully digestible protein. The basic factor on the basis of which the necessary content and quality of fats is calculated is the general condition of the patient in each specific case. With the view that the diet has acquired properties that promote the activation of cholagogue processes, when there is such a need, it is necessary to include in it an increased amount of vegetable fats.

In relation to the extent to which carbohydrates should be included in the diet, there is a rule according to which they should not be in excess of the amount regulated by the physiological norm. If the patient has excess body weight, then carbohydrates can be present in the diet in a reduced amount.

Not the least role in terms of how you can achieve the greatest shudder of the digestive tract is played by the method of cooking. In this regard, the optimal is the cooking process by digestion, the food in a grinded or chopped form. Better digestion of digestion is greatly facilitated by eating in small amounts at short intervals. This principle of fractional nutrition provides improvement of intestinal motility, and besides it produces a remarkable choleretic effect.

Normalization of outflow of bile is also due to the content in the diet of products whose composition is rich in dietary fiber. Due to this, the composition of stools intensively excludes cholesterol.

Nutrition in hepatic colic, as is clearly the main purpose of promoting normalization and lead to an optimal state of functioning of the gastrointestinal tract, liver, gallbladder and bile ducts. As a result, the likelihood of characteristic acute attacks of pain decreases.

Diet with hepatic colic

Diseases of the liver and bile ducts, if we exclude congenital heredity defects, the consequences of acute infections, metabolic disorders with the formation of gallstones, arise and go on in a chronic form often against the backdrop of excessive consumption of alcoholic beverages and an inappropriately organized diet. To provoke violations of the functioning of the liver and gallbladder in a state of regular irregular intake of food, an unbalanced menu in which there are not enough proteins and necessary vitamins.

Diet in hepatic colic after successfully removed pain symptoms should be based on the principle that as soon as possible to reduce the possibility of such attacks in the future. During the first few weeks after hepatic colic, you must stop eating meat and animal fats, as well as eggs. A suitable substitute for these products is the state of being cooked fish, vegetable oil, cottage cheese. You can diversify the menu by adding to it an increased number of boiled vegetables.

In the future, persistently adhering to certain dietary prescriptions, it becomes possible to minimize the likelihood that there will be hepatic colic.

As a rule, for diseases of the liver and bile ducts, diet no. 5 is taken, as a rule. In accordance with it, the energy value of the dishes should be calculated on the basis of physiological norms, it is recommended to avoid overeating. The physiological norm of proteins is 1 gram to one kilogram of body weight, which is optimal. And about half of their total number should be represented by proteins of animal origin: meat, poultry, fish, dairy products, eggs.

The diet is made in the ratio of two-thirds of the animal fats to one-third of the plant's total daily rate of 70-80 grams.

Adhering to a diet for hepatic colic, one should not abuse fatty and spicy dishes, refrain from smoked foods and pickles, and exclude products with a high content of cholesterol. A sensible approach to the use of alcoholic beverages is also important.

Diet for hepatic colic is selected on the basis of medical recommendations and prescriptions, taking into account the stage to which the main disease came in its course and based on the general condition of the patient.

Hepatic colic, thus, has its prerequisites for the presence of certain factors of a pathogenic property, and its occurrence occurs solely on their basis. In the absence of health disorders and the normal functioning of the liver and gall bladder, it does not appear.

[25], [26], [27]