Sudden colic

Introduction Colic is a severe pain in the internal organs, like something is screwing. Sudden colic is seen in bile duct stones and cholangitis. Most patients have sudden angina under the xiphoid and can radiate to the right shoulder and back.

Cause

Causes of sudden colic:

The pathological changes caused by common bile duct stones mainly depend on the degree of obstruction caused by stones and the presence or absence of secondary infection. Bile duct obstruction caused by stones is generally incomplete and intermittent. The proximal bile duct of the obstruction may have different degrees of dilatation and thickening of the wall. Due to incomplete bile duct obstruction, liver tissue is generally less affected. The bile duct in the proximal side of the obstruction often has cholestasis, and it is easy to be infected with Gram-negative bacilli. Stones in the ampulla are more likely to cause complete obstruction of the bile duct. At this time, if a bile duct infection occurs, the condition can develop rapidly and produce bile duct hypertension. The pus and bacterial toxins in the bile duct can flow backwards, breaking through the hepatic capillary tube into the blood circulation, leading to so-called obstructive suppurative cholangitis. In severe cases, patients often die from toxic shock. Obstruction and infection can cause liver cell damage; hepatocyte necrosis, fibrous tissue hyperplasia around the bile duct, and finally biliary cirrhosis. When the common bile duct stone affects the pancreatic duct, it can be followed by acute pancreatitis, that is, gallstone pancreatitis.

an examination

Related inspection

EEG check balance radionuclide angiography (ERNA) blood test

Diagnosis of sudden colic:

The typical clinical manifestations of common bile duct stones are biliary colic, fever, chills, and jaundice, the Charcot triad. However, many patients lack complete triad performance. Most patients have sudden angina under the xiphoid, which can be radiated to the right shoulder and back. However, a few people can be completely painless, and only feel abdominal discomfort. About 2/3 of the patients developed chills and high fever after the onset of acute abdominal pain. Generally, jaundice begins to appear 12 to 24 hours after abdominal pain, and abdominal pain is often relieved. Astragalus is generally not very deep and has the characteristics of volatility. Sometimes jaundice can also be the only clinical manifestation of a small number of patients with choledocholithiasis. Astragalus often has dark urine, lighter stools, and itchy skin. During the physical examination, there is tenderness and muscle tension in the upper abdomen and upper right abdomen, and the gallbladder often cannot be affected. The liver texture is harder in patients with longer disease and swollen liver and spleen.

Differential diagnosis

Differential diagnosis of sudden colic:

Compression pain: Angina is a group of clinical syndromes in which chest compression pain caused by insufficient coronary blood supply lasts for several minutes. At the time of onset, ECG examination showed that in the lead-based lead, the ST segment was depressed, the T wave was flat or inverted (variant angina was associated with ST-segment elevation), and gradually recovered within a few minutes after the onset.

Persistent colic: It is the pain caused by the large intestine, which often makes the baby cry and keep on crying for 1-2 hours. Since the baby does not speak, for the discomfort of the body, only crying is the main body language. Infant colic is characterized by intermittent crying.

Abdominal cramps: Abdominal cramps are often caused by the strong peristaltic contraction of the muscles of the abdominal duct-like organs without the will of the person. Under normal circumstances, the pipe-like organs in the human body are constantly squirming. For example, the stomach is constantly moving and contracting to digest food, pushing the chyme into the small intestine, the small intestine is constantly squirming, absorbing nutrients and moisture, and allowing intestinal contents to the large intestine. Pushing, the large intestine is also constantly squirming while absorbing moisture and excreting waste; the gallbladder and bile duct are also creeping and contracting, storing and secreting bile according to the needs of the human body... The normal peristaltic contraction does not cause abdominal pain, but If you want to overcome the obstruction in the pipeline, it is necessary to strengthen the contraction, and the strong and severe contraction will cause abdominal cramps. Organs capable of producing abdominal cramps include the stomach and intestine (including the appendix), the cystic duct, the hepatic duct, the common bile duct, the pancreatic duct, the ureter, the uterus or the fallopian tube, and the kidney.

Paroxysmal colic: Colic is a pain caused by large intestine fistula, and patients with intestinal irritation syndrome often present with paroxysmal colic. The patient presented with paroxysmal colic. The onset and duration of abdominal pain are often irregular, usually more often after eating or after a cold drink, or relieved after defecation, venting or abdominal heat. Abdominal pain rarely occurs when you are asleep at night. The pain is mainly in the right lower abdomen, and a few are located in the umbilicus or other parts. When the colon is paralyzed, the intestinal propulsive peristalsis is weakened, causing constipation, accompanied by abdominal distension and frequent exhaustion.

Common bile duct stones: typical clinical manifestations of biliary colic, fever, chills and jaundice, namely Charcot triad. However, many patients lack complete triad performance. Most patients have sudden angina under the xiphoid, which can be radiated to the right shoulder and back. However, a few people can be completely painless, and only feel abdominal discomfort. About 2/3 of the patients developed chills and high fever after the onset of acute abdominal pain. Generally, jaundice begins to appear 12 to 24 hours after abdominal pain, and abdominal pain is often relieved. Astragalus is generally not very deep and has the characteristics of volatility. Sometimes jaundice can also be the only clinical manifestation of a small number of patients with choledocholithiasis. Astragalus often has dark urine, lighter stools, and itchy skin. During the physical examination, there is tenderness and muscle tension in the upper abdomen and upper right abdomen, and the gallbladder often cannot be affected. The liver texture is harder in patients with longer disease and swollen liver and spleen.

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