Diagnosis and Management of Abdominal Colic

Roseous.com - Diagnosis and Management of Abdominal Colic. What is colic abdomen? Abdominal colic is a disturbance in the normal flow of intestinal contents along the intestinal tract. Obstruction occurs when there is a disturbance that causes obstruction of the intestinal contents flow forward but the peristaltic is normal.

Many experts also define abdominal colic as a condition characterized by severe cramps or colicky pain that may be accompanied by nausea and vomiting.

Etiology of Abdominal Colic

1. Mechanical

Adhesion / postoperative adhesion (90% of mechanical obstruction)

• Carcinoma.
• Volvulus.
• Intussusception.
• Obstipation.
• Polyp.
• Strictures.

2. Functional (non mechanical)

• Paralytic Ileus.
• Spinal cord lesions.
• Regional enteritis.
• Electrolyte imbalances.
• Uremia.

Colon Abdominal Manifestations

1. Simple mechanics - upper intestine

Colic (cramps) in the mid- to upper abdomen, distension, early bile vomiting, increased bowel sounds (high-pitched rattling sounds at short intervals), minimal diffuse tenderness.

2. Simple mechanics - lower intestine

Significant midabdominal colic (cramp), severe distension, vomiting - little or no - then has dregs, bowel sounds and hush sounds increased, minimal diffuse tenderness.

3. Simple mechanics - colon

Cramps (middle to bottom abdomen), distention that last appears, then vomiting (feculence), increased bowel sounds, difus tenderness minimal.

4. Partial mechanical obstruction

May occur with intestinal granulomatousitis in Crohn's disease. Symptoms of abdominal pain cramps, mild distension and diarrhea.

5. Strangulation

Symptoms develop rapidly; severe pain, continuous and localized; moderate distension; persistent vomiting; usually bowel sounds decrease and localized tenderness is great. Feces or vomitus become dark or bleeding or contain faint blood.

Examination

• Tension, pulse, breathing, and temperature.
• Abdominal examination: the location of the pain, is there any tenderness / pain relief? Is there an enlarged heart, is it a palpable mass?
• Rectal examination: the location of pain at what time, is there feces, is there blood?
• Laboratory: Leukocytes and Hb

Supporting investigation

1.     X-ray abdomen shows gas or fluid in the intestine.

2.     Barium enema shows a distended colon, containing air or enclosed sigmoid folds.

3.     Decreased serum sodium, potassium and chloride levels due to vomiting; an increase in SDP count with necrosis, strangulation or peritonitis and elevated serum amylase levels due to pancreatic irritation by intestinal folds.

4.     Blood gas arteries may indicate acidosis or metabolic alkalosis.

Medical Management

• Correction of fluid and electrolyte imbalances.
• Na +, K + therapy, blood components.
• Ringer lactate to correct interstitial fluid deficiency.
• Dextrose and water to correct the deficiency of intracellular fluid.
• Decompression of long nasoenteral tubes from the proximal bowel to the blockage area; The hose can be inserted more effectively with the patient lying on his side to the right.
• Implement treatment for shock and peritonitis.
• Hyperalimentation to correct protein deficiency due to chronic obstruction, paralytic ileus or infection.
• Resection of the intestine with anastomosis from end to end.
• Double-barreled ostomy if end-to-end anastomosis is too risky.
• Colostomy of the circle to divert the flow of feces and decompress the intestine with bowel resection performed as a second procedure.

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Action

Here are the recommended abdominal colic medications to relieve this stomach disorder, among others:

• RL infusion; if anuria -> infusion RL: D5 = 1: 1.
• When severe dehydration -> infusions are washed down, a catheter dauwer is installed.
• Give mild analgesics (xylomidon), Spasmolitik: Baralgin, Sulfas Aliopin (inj); if it hurts -> give petidin 1 amp im, do not give antibiotics if the cause is not clear
• If anxious person is restless, give Diazepam 10 mg iv, can be repeated every 30 minutes
• When hot, give: antipyretic (Paracetamol).
• If general condition is bad, give Vitamin / Alinamin F (inj), Cortison inj 3 cc or Dexamethasone 2 amp.
• If the above effort does not improve, immediately take it to the nearest hospital.