The efficacy of intravenous lidocaine and its side effects in comparison with intravenous morphine sulfate in patients admitted to the ED with right upper abdominal pain suspected of biliary colic

Acute or recurrent pain in the right upper part of the abdomen is a common cause for visits to physicians. Not less than two thirds of episodes of pain in this area are conditioned by biliary colic and acute cholecystitis. Other most common causes include diseases of the liver, pancreas, prepyloric and pyloric parts of the stomach and the beginning portion of the small intestine, the right kidney, and also subhepatic appendicitis. Some cases of developing pain are associated with the right lung affection and involvement of the diaphragmatic pleura, with heart diseases, involvement of the locomotor system and nerves. Taking into account a high prevalence of cholelithiasis in Russia – around 10–12% – we can conclude that episodes of biliary colic develop every year in 1 of 500–1000 individuals. In Russia, approximately half a million cholecystectomies are performed annually. The prevalence of gall stones among the paediatric population amounts to 2%. As distinct from adults, who in 80% of cases have an asymptomatic course of disease, pain episodes in children manifest themselves in 60–67% of cases. The diiagnosis of acute cholecystitis might meet with considerable difficulties; a scale for assessment of the likelihood of acute cholecystitis has been developed. Unlike in adults, in children a significantly large proportion of cases occur due to acalculous cholecystitis. Differentiating the causes of pain might be difficult, therefore, its character and concomitant symptoms should be thoroughly analysed, and the findings of additional examinations should also be taken into consideration (at the first step – assessment of haematological and biochemical parameters, urinalysis, electrocardiogram and abdominal ultrasonography). Key words: right upper abdominal pain, biliary colic, biliary dyskinesia, cholelithiasis

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Triclabendazole and fascioliasis: a new drug to combat an age-old disease

Eastern Mediterranean Health Journal ◽

10.26719/1998.4.2.385 ◽

1998 ◽

Vol 4 (2) ◽

pp. 385-387

Author(s):

Keyword(s):

Abdominal Pain ◽

Side Effects ◽

Chronic Phase ◽

Biliary System ◽

Cure Rate ◽

Split Dose ◽

Human Fascioliasis ◽

Human Use ◽

Upper Abdominal ◽

Mild Fever

The tolerance and efficacy of triclabendazole CGP 23030, specially prepared for human use, were assessed in 50 patients in the chronic phase of fascioliasis. After clinical examination, investigation and ultrasonography of the liver and biliary system, triclabendazole 10 mg/kg, either as a single or split dose, was administered. The clinical picture was studied daily for six days and the investigations were repeated 6, 30 and 60 days after treatment. The drug was tolerated. Its side-effects, which included upper abdominal pain, mild fever and limited derangement of liver function, were considered negligible. The cure rate at 2 months was 94% when assessed by the disappearance of eggs in stools and 88% when assessed by both the absence of eggs in stools and of worms in the biliary system. The use of triclabendazole for the treatment of human fascioliasis was found to be justified

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Triclabendazole in the treatment of established human fascioliasis

Eastern Mediterranean Health Journal ◽

10.26719/1998.4.2.244 ◽

1998 ◽

Vol 4 (2) ◽

pp. 244-251

Author(s):

H. F. Farag ◽

T. A. El Khoby ◽

A. I. Salem ◽

M. Abou El Hoda ◽

G. A. Amin

Keyword(s):

Abdominal Pain ◽

Side Effects ◽

Chronic Phase ◽

Biliary System ◽

Cure Rate ◽

Split Dose ◽

Human Fascioliasis ◽

Human Use ◽

Upper Abdominal ◽

Mild Fever

The tolerance and efficacy of triclabendazole CGP 23030, specially prepared for human use, were assessed in 50 patients in the chronic phase of fascioliasis. After clinical examination, investigation and ultrasonography of the liver and biliary system, triclabendazole 10 mg/kg, either as a single or split dose, was administered. The clinical picture was studied daily for six days and the investigations were repeated 6, 30 and 60 days after treatment. The drug was tolerated. Its side-effects, which included upper abdominal pain, mild fever and limited derangement of liver function, were considered negligible. The cure rate at 2 months was 94% when assessed by the disappearance of eggs in stools and 88% when assessed by both the absence of eggs in stools and of worms in the biliary system. The use of triclabendazole for the treatment of human fascioliasis was found to be justified

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Role of Cholecystectomy in Symptomatic Hyperkinetic Gallbladder Patients

Case Reports in Surgery ◽

10.1155/2021/5569850 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Jai P. Singh

Keyword(s):

Abdominal Pain ◽

Complete Resolution ◽

Biliary Colic ◽

Quadrant Pain ◽

Gallbladder Ejection Fraction ◽

Hida Scan ◽

Upper Abdominal ◽

The Right ◽

Upper Abdomen

Introduction. Biliary dyskinesia is defined by a gallbladder ejection fraction (EF) of less than 35% on HIDA scan, and these patients have shown a good response to cholecystectomy. Management of patients with biliary colic symptoms who have a hyperkinetic gallbladder ( EF > 80 % ) is not clearly defined. Herein, I report three cases of the symptomatic hyperkinetic gallbladder that were successfully managed with cholecystectomy. Case Report. Patient 1was a 56-year-old female presented with pain in the right upper abdomen for one month. Her workup was unremarkable except for the gallbladder EF of 86%. Patient 2 was a 33-year-old female with similar symptoms and workup with gallbladder EF of 97%. Patient 3 was a 20-year-old female with right upper abdominal pain and gallbladder EF of 91%. Patients 1 and 3 had the normal US, normal CT scan, and normal EGD. Patient 2 had normal US and CT but did not undergo EGD. All three patients underwent laparoscopic cholecystectomy and had complete resolution of their symptoms. Conclusion. The hyperkinetic gallbladder is a rare phenomenon, which can cause debilitating right upper quadrant pain. All three patients had an excellent response to cholecystectomy. Therefore, it is concluded that the patients with biliary colic and gallbladder EF of 80% or higher should be strongly considered for surgery.

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Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain

Seminars in Interventional Radiology ◽

10.1055/s-0037-1608861 ◽

2017 ◽

Vol 34 (04) ◽

pp. 376-386 ◽

Cited By ~ 18

Author(s):

Joshua Cornman-Homonoff ◽

Daniel Holzwanger ◽

Kyungmouk Lee ◽

David Madoff ◽

David Li

Keyword(s):

Quality Of Life ◽

Abdominal Pain ◽

Side Effects ◽

Celiac Trunk ◽

Celiac Plexus ◽

Opiate Dependence ◽

Celiac Plexus Block ◽

Upper Abdominal ◽

Plexus Block

AbstractChronic upper abdominal pain occurs as a complication of various malignant and benign diseases including pancreatic cancer and chronic pancreatitis, and when present may contribute to lower quality of life and higher mortality. Though various pain management strategies are available as part of a multimodal approach, they are often incompletely effective and accompanied by side effects. Pain originating in upper abdominal viscera is transmitted through the celiac plexus, which is an autonomic plexus located in the retroperitoneum at the root of the celiac trunk. Direct intervention at the level of the plexus, referred to as celiac plexus block or neurolysis depending on the injectate, is a minimally invasive therapeutic strategy which has been demonstrated to decrease pain, improve function, and reduce opiate dependence. Various percutaneous techniques have been reported, but, with appropriate preprocedural planning, use of image guidance (usually computed tomography), and postprocedural care, the frequency and severity of complications is low and the success rate high regardless of approach. The main benefit of the intervention may be in reduced opiate dependence and opiate-associated side effects, which in turn improves quality of life. Celiac plexus block and neurolysis are safe and effective treatments for chronic upper abdominal pain and should be considered early in patients experiencing such symptoms.

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Efficacy of a Combination of Ketamine and Morphine for Intravenous Patient Controlled-Analgesia in Upper Abdominal Surgery: A Prospective, Double-blind, Randomized Controlled Trial

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.09.12996 ◽

2021 ◽

Vol 104 (9) ◽

pp. 1528-1534

Keyword(s):

Abdominal Pain ◽

Side Effects ◽

Abdominal Surgery ◽

Rating Scale ◽

Morphine Consumption ◽

Patient Controlled Analgesia ◽

Double Blind ◽

Upper Abdominal Surgery ◽

Upper Abdominal ◽

Postoperative Morphine

Background: Most postoperative upper abdominal pain is severe, and various methods can be employed to control it. Presently, morphine is the main drug used for anesthesia, but it may contribute to the occurrence of many uncomfortable side effects. Ketamine is an analgesic drug that inhibits NMDA receptors, making it a synergistic effect of morphine. Objective: To investigate the efficacy of a combination of ketamine and morphine in controlling postoperative upper abdominal pain. Materials and Methods: Informed consents were obtained from patients enrolled into the present double-blind randomized study that divided into two groups, (i) the M group, which received 1 mg/mL of morphine, and (ii) the MK group, which received 1 mg of ketamine plus 1 mg/mL of morphine as intravenous patient-controlled analgesia (IV-PCA) post-operation. All patients were assessed based on postoperative morphine consumption, a numeric rating scale (NRS) used to rate pain, and the presence of side effects. Results: Sixty-seven patients completed the study including 34 patients in the MK group and 33 patients in the M group. Cumulative postoperative morphine consumption at 24 and 48 hours was significantly lower in the MK group at 27.91±11.11 and 46.44±15.21 mg compared to the M group at 43.24±15.32 and 71.33±19.67 mg, respectively (p<0.001). NRS were similar between the two groups and no observable differences regarding to side effects. Conclusion: A combination of ketamine and morphine via IV PCA is effective in controlling postoperative upper abdominal pain. Keywords: Ketamine; Morphine; Upper abdominal surgery; Intravenous patient-controlled analgesia

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The Efficacy, Applicability and Side-Effects of Postoperative Intravenous Patient-Controlled Morphine Analgesia: An Audit of 1233 Chinese Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x9602400604 ◽

1996 ◽

Vol 24 (6) ◽

pp. 658-664 ◽

Cited By ~ 39

Author(s):

S. L. Tsui ◽

W. N. Tong ◽

M. Irwin ◽

K. F. J. Ng ◽

J. R. Lo ◽

...

Keyword(s):

Side Effects ◽

Pain Relief ◽

Rating Scales ◽

Adverse Outcomes ◽

Self Control ◽

Chinese Patients ◽

Major Surgery ◽

Analgesic Regimen ◽

Intravenous Morphine ◽

Upper Abdominal

We analyzed data from 1233 Chinese patients of a wide age range who received patient-controlled analgesia (PCA) intravenous morphine for postoperative pain relief during the period from January 1992 to May 1995. The analgesic regimen was standardized as follows: PCA bolus 1 to 1.5 mg; lock-out interval 5 minutes; one-hour maximum dose 0.075 to 0.1 mg.kg–1 and background infusion 0 or 0.5 mg.h–1. Most patients underwent major surgery that was broadly subclassified according to the anatomical area involved. The median verbal numerical rating scales of pain (0 to 10) at rest and while coughing for the first, second and third 24 hours were 3.0/5.0, 1.5/4.0 and 0/3.0 respectively and the corresponding demand to delivery ratios were 2.8±2.9, 2.6±2.4 and 2.4±2.6. The overall morphine consumptions in 1004 of these Chinese patients were 27.5±16.8, 178±16.1 and 18.1±21.0 μg.kg-1.h–1 during the first 16, 17 to 41 and 42 to 66 postoperative hours respectively. These figures were the same as for Caucasian patients man-aged in the same institution. Morphine consumption was significantly higher following thoracic, upper abdominal and spinal surgery. Also it was higher in patients younger than 65 years, males, cigarette smokers and those with ASA physical status I or II. The commonest side-effects were nausea (34.5%) and vomiting (18.2%). Bradypnoea and oxygen desaturation occurred in 0.5% and 1.6% respectively. All cases were promptly detected and managed with no adverse outcomes. Most patients were satisfied (76.7% ranked “good”) with their postoperative analgesia. The commonest reasons for dissatisfaction were inadequate pain relief, nausea and reluctance to self-control analgesic administration. It is concluded that PCA with intravenous morphine is effective and safe as a routine postoperative technique for Chinese surgical patients.

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The Comparative Study of the Effectiveness of Cimetidine, Ranitidine, Famotidine, and Omeprazole in Treatment of Children with Dyspepsia

ISRN Pediatrics ◽

10.5402/2011/219287 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Seyed Mohsen Dehghani ◽

Mohammad Hadi Imanieh ◽

Roya Oboodi ◽

Mahmood Haghighat

Keyword(s):

Clinical Trial ◽

Abdominal Pain ◽

Side Effects ◽

Comparative Study ◽

Functional Dyspepsia ◽

Medical Therapy ◽

Visceral Hypersensitivity ◽

Chronic Disorder ◽

Upper Abdominal ◽

The Comparative Study

Background. Functional dyspepsia is a common chronic disorder with non specific upper abdominal pain or discomfort. Different approaches with anti-secretory, spasmolytic, prokinetic and anti-inflammatory effects and most preferably reduction of visceral hypersensitivity seem logical. In this study, we compared the effectiveness of the four most drugs used for treatment of dyspepsia in children. Methods. 169 patients between 2 to 16 years old that 47.3% was male and 52.7% was female were enrolled in this clinical trial study by the diagnosis of functional dyspepsia. Then for each patient one of the drugs; Omeprazole, Famotidine, Ranitidine or Cimetidine was administered, for a period of 4 weeks. Patients were followed after 2 and 6 weeks from the beginning of the treatment. Results. The distribution of drugs between these patients were including; 21.9% with Cimetidine, 21.3% with Famotidine, 30.8% with Omeperazole and 26% with Ranitidine that the proportion of patients with all symptoms relief were: 21.6% for Cimetidine, 44.4% for Famotidine, 53.8% for Omeprazole and 43.2% for Cimetidine (). In followups within 2 and 6 weeks after beginning medical therapy, no side effects due to drugs were seen. Conclusion. If a cure is defined as all symptoms relief after a period of 4 weeks treatment, our findings showed that Omeperazole are superior to Ranitidine, Famotidine, and Cimetidine for management of functional dyspepsia.

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Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

Journal of Case Reports in Medicine ◽

10.25149/jcrm.v8i2.178 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Peter Wang

Keyword(s):

Abdominal Pain ◽

Digestive Enzymes ◽

Gallbladder Disease ◽

Hepatobiliary Scintigraphy ◽

Hepatobiliary Imaging ◽

Upper Gi ◽

Gi Symptoms ◽

Upper Abdominal ◽

Enterogastric Reflux

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

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Foreign Body in abdomen

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v14i2.22775 ◽

2015 ◽

Vol 14 (2) ◽

pp. 210-212

Author(s):

Md Zakirul Alam ◽

Mohibul Aziz

Keyword(s):

Abdominal Pain ◽

Foreign Body ◽

Medical Science ◽

X Ray ◽

Diagnostic Center ◽

History Of ◽

Upper Abdominal ◽

Married Female

A 19 years old married female presented with severe upper abdominal pain, repeated vomiting having history of swallowing a knife 7 months ago was admitted in Mordern Clinic and Diagnostic center, Joypurhat, Bangladesh. USG abdomen & X-ray (fig-1) abdomen were done when presence of a large foreign body (knife fig-3) in abdomen was made which latter on confirmed by Endoscopy of upper GIT (fig-2). Surprisingly the patient kept it in her abdomen for 7 months without any symptoms until the symptoms got worse and compelled her to seek medical help. The knife was removed by laparotomy, gastrotomy with uneventful recovery.Bangladesh Journal of Medical Science Vol.14(2) 2015 p.210-212

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