It is the most common 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 hepatic colic. Its appearance, according to the corresponding medical statistics, is observed with a certain periodicity in every tenth patient with cholelithiasis , mainly in male patients.
Women suffer from liver colic much less frequently, appearing with about half the frequency of registered cases.
There is the appearance of hepatic colic due to the fact that the stones present in the gallbladder create an obstacle to the processes of normal outflow of bile.
This pathological phenomenon in the human body is accompanied by sharp pains that arise in the area where the gallbladder is located, that is, 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, receding pain under the right clavicle is sometimes noted.
The pain in hepatic colic is an acute burning character, and can be triggered as high intensity physical activity and act as a consequence of strong emotional tension.
Due to great physical exertion or an agitated psycho-emotional state, the content of the hormone adrenaline increases in the blood, excess of this leads to spasms in muscle tissues, as well as vascular spasms.
This causes stagnant bile processes in the hepatic ducts, which in turn causes pain characteristic of hepatic colic.
Causes of hepatic colic
An attack of hepatic colic can be caused by inaccurate diet or physical exertion, however, in many patients it is not possible to identify the provoking factors, and the pain can begin during a night’s sleep. The mechanism of hepatic colic is complex and not fully understood.
Most often, the appearance of colic is caused by:
- A failure of the bile outflow from the gallbladder (spasm of bladder eruption, blockage with a stone, mucous mucus).
- A failure of bile flow along the common bile duct (OZHP) (spasm of the sphincter of Oddi, blockage with a stone, a mucus mucus, ACL stepping stone).
Different areas of the gallbladder and bile ducts are characterized by a different pain response to the finding of the stone.
Generally, three zones are distinguished:
- The lower part and the body of the gallbladder: “dumb” zone (the presence of a stone does not cause 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 towards this zone, the stone causes a failure of the outflow of bile, the reduction of the RA is accompanied by moderate pain).
- Acute pain zone (a duct zone) – the presence of concretions in the ducts causes a concomitant spasm accompanied by ischemia of the wall, a violation of the outflow of bile, a dilation of the overlying sections of the duct, hyperperstastitis, which causes sharp pain and increased spasm.
This becomes a vicious cycle that continues until the stone, the mucus from the clot, or the introduction of antispasmodics.
It is not recommended to administer true opioid receptor agonists (morphine, fentant, promedol, etc.), which can improve pain syndrome (sphincter spasms may be present).
For hepatic colic, the following clinical symptoms are typical:
An attack comes on suddenly, it can last for hours, rarely more than a day.
The pains are acute, paroxysmal, indistinctly located in the right hypochondrium and epigastrium – visceral pain (occurs with spasms, stretching, swelling of the organs).
Radiation of pain in the back or shoulder blade is caused by irritation of the ends of the branches of the spinal nerves that are involved in the innervation of the hepatic-duodenal ligament along the bile ducts.
The conspicuous symptoms may be associated with the presence of choledocholithiasis, cholangitis, ductal hypertension, the so-called choledochal colliculus.
The attack may be accompanied by reflex vomiting, which does not bring relief. Pulse can be increased, blood pressure does not change significantly.
Temperature rises, chills, and leukocytosis is 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 nearly constant for 1 to 6 hours.
Later there is a gradual loss of pain, but it is possible and the sudden termination of pain. An attack of pain, lasting more than 6 hours, may indicate the possible development of acute cholecystitis.
Between attacks of hepatic colic, the patient feels quite satisfied. 30% of patients do not have repeated attacks. lasting more than 6 hours, it may indicate the possible development of acute cholecystitis.
Between attacks of hepatic colic, the patient feels quite satisfied. 30% of patients do not have repeated attacks. lasting more than 6 hours, it may indicate the possible development of acute cholecystitis. Between attacks of hepatic colic, the patient feels quite satisfied. 30% of patients do not have repeated attacks.
Acute liver colic
Acute hepatic colic occurs mainly against the background of the fact that gallstone disease occurs.
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 greatly, which causes the gallbladder to stretch in the part that is above the obstacle that creates the inability of the free exit of this organ.
Lead in acute hepatic colic can be the use of excessively large amounts of food, especially if it is too fatty, the excessive use of sharp spices, spices and intemperance in alcoholic beverages.
Also, the appearance of such pain symptoms is possible as a result of too intense physical stress on the body.
Characteristics for acute hepatic colic are the following symptoms:
Before it may be the appearance of nausea, a feeling of heaviness in the pit of the stomach or in the right upper quadrant.
In these areas of the body there is a sudden onset of sharp pain. Painful sensations can also occur 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.
The pain in acute hepatic colic is very severe and can be permanent. The duration of an attack can be several minutes or hours and continue for a time that exceeds the whole day.
In acute hepatic colic, patients, as a rule, reach a state of extreme excitement, pale, sweaty and very restless when trying to find the position of the body in which it can be relieved.
Acute hepatic colic requires the need to take appropriate medical measures to help the patient cope with a critical condition.
Hepatic colic attack
The attack of hepatic colic occurs in the context of cholelithiasis and also has the name of bilious or cholelithic colic.
Attacks of hepatic colic are mainly observed at that stage of the disease with the formation of gallstones, in which the undeniable clinical manifestations of this disease become clearly pronounced.
The two previous stages are predominantly asymptomatic and have no pain syndrome.
For cholelithiasis, when it reaches its third stage in the development process of pathological progress, the alternation of rather long periods in which the disease practically does not manifest itself is characteristic, with episodic attacks of hepatic colic.
For a long time, all symptoms can be reduced to nothing more than a feeling of heaviness in the right upper quadrant, slight discomfort after eating, and the appearance of a bitter taste in the mouth. And sometimes even such manifestations may not be observed.
But such a pause in the course of the disease, only for the moment, and sooner or later, one way or another, an attack of hepatic colic should be expected.
Due to the fact that with the course of the pathological process of gallbladder stone formation, stagnation phenomena become more pronounced, pain symptoms are characterized by 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 considerably narrowed due to spasm.
This leads to an excessive accumulation of bile within the gallbladder, which increases in size, stretches, and this process is accompanied by pain. Hepatic colic attacks can also occur when stones move into the bile duct.
The attack of hepatic colic from the first moment just appears indicates that cholelithiasis, if it was still present in humans asymptomatically and not manifested in any way, its presence was not established, but now it is absolutely clear and with complete certainty. makes you feel.
It is with an attack of hepatic colic that the development of all kinds of complications of this disease begins.
Hepatic colic during pregnancy
Hepatic colic during pregnancy may be due to the fact that the woman could have a chronic disease or impaired functioning of internal organs associated with the processes of bile outflow before pregnancy.
Among the causes of hepatic colic in this regard can be called, in particular cholelithiasis and dyskinesia bile ducts. Hepatic colic in this case occurs as a consequence of the exacerbation of such diseases during pregnancy.
To provoke the appearance of hepatic colic during pregnancy an unplanned and ill-conceived approach to the organization of the diet of a woman preparing to become a mother is also possible.
In this case, you should consult a doctor to optimize the diet. Avoid eating foods and foods that can negatively affect the normal functioning of the liver. It is desirable to refrain from all canned, fried, and to exclude from the menu all smoked meat.
When a woman suffers from hepatic colic during pregnancy, it is often difficult for her to find a body position in which it is possible to reduce the intensity of pain.
Hepatic colic pain during pregnancy is a very acute pain and can be accompanied by an increase in body temperature, nausea, and the urge to vomit.
In order to cope with liver colic during pregnancy, taking any drug anesthetic is not recommended because its use will not benefit liver functions.
The best way to beat hepatic colic during pregnancy is probably to walk barefoot, which stimulates the feet, which in turn has beneficial effects in relaxing the muscles of the gallbladder and bile ducts.
For the elimination of spasms, the administration of antispasmodic agents is also justified.
Where it hurts?
- Pain in the liver
- Gallbladder pain
- Pain in the right hypochondrium.
- Pain in the right side.
What is necessary to examine?
How to examine?
The procedures to examine are:
- Ultrasound of the liver.
- X-ray of the liver and biliary tract.
- Diagnosis of the liver and gallbladder.
- Ultrasound of the gallbladder and biliary tract.
Who to contact?
Emergency care for hepatic colic
Emergency care for hepatic colic involves, on the one hand, the use of resources to help reduce the severity of the pain syndrome and, on the other hand, restore the patency of the bile duct by relieving tension on your 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 a tablet or a solution in the amount of 2 drops. Sometimes this measure is not enough. In this case, it is required to introduce the platyillin subcutaneously in a 0.2% solution of 2 ml or 2 to 3 ml of papaverine solution at a concentration of 2%.
An alternative may be a subcutaneous injection of a 0.1% atropine solution of 1 milliliter. This medicine can be used in combination with each of the two above.
Good results are obtained in terms of spasm removal using arpenal, which should be administered under the skin in a dose of 1 ml of a 2% solution.
To relieve pain, an injection of 1.0 aspirin or analgin is given in a similar dose. Repeated use of these drugs with an interval of 4 hours 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 water bath for 10-15 minutes.
If the hepatic colic is accompanied by the onset of fever in the patient, the patient is shivering, and the fever persists for more than a day, antimicrobial agents are prescribed, for example, 500,000 administration of streptomycin twice daily. Alternatively, 1.0 sulfadimezine with a 4 hour interval can also be considered.
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 prolonged 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 surgery. That is, it becomes such that the control of a person’s condition, diagnosis and treatment must be entrusted to the surgeon.
Since often the only effective treatment method can be only a surgical intervention. Therefore, if the hepatic colic does not disappear for a long time, such a patient should be hospitalized.
As for how it is possible to contribute to the relief of suffering in an attack, there are a number of practical recommendations on what type of first aid should be provided for hepatic colic.
The minimal program in this case assumes first that said patient needs to provide bed rest. Next, you are invited to take analgesic tablets (1-2), a couple of papaverine tablets under the tongue.
It should be noted that the use of a heating pad is not always justified. It is advisable only in this situation, if one can definitively and unambiguously be sure that there is hepatic biliary colic, while there is no acute cholecystitis. The competent in this matter is only a doctor.
So having done the above, you should definitely make a call for medical emergencies.
Especially if the attack happened for the first time. All these first aid for hepatic colic are exhausted, and the question of further treatment should be transferred to the doctors.
Nutrition for hepatic colic
In the diet, when there is hepatic colic, you need to enter a sufficient amount of fully digestible protein.
It is necessary to include in it a greater 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 exceed the amount regulated by the physiological norm. If the patient is overweight, carbohydrates may be present in the diet in a reduced amount.
The normalization of bile output is also due to the content in the diet of products whose composition is rich in dietary fiber. Due to this, the composition of the feces strongly excludes cholesterol.
Nutrition in hepatic colic, as it is clearly the main objective of promoting normalization and leading to an optimal state of functioning of the gastrointestinal tract, liver, gallbladder and bile ducts. As a result, the likelihood of characteristic attacks of acute pain decreases.
Diet with liver colic
Diseases of the liver and bile ducts, if we exclude congenital defects of heredity, the consequences of acute infections, metabolic disorders with the formation of gallstones, arise and continue in a chronic form often against the background of excessive drinking alcoholic and in an inappropriate manner.
Diet in hepatic colic after successfully eliminated pain symptoms should be based on the principle that as soon as possible to reduce the possibility of such attacks in the future. For the first few weeks after liver colic, you should stop eating meat and animal fats, in addition to eggs.
A suitable substitute for these products is the state of cooked fish, vegetable oil. You can diversify the menu by adding more boiled vegetables to it.
In the future, by persistently adhering to certain dietary prescriptions, it is possible to minimize the likelihood of liver colic.