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Medical Management of Colic
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Differential Diagnosis and Prognosis.
There a multitude of causes of colic. Table 1 lists the diagnoses made in 925 cases of colic included in the BEVA EBM study on colic.
In that study, 83% (95% CI 80.6-85.4%) survived. The clinical features that were significantly associated with survival included mild degree of pain, normal findings on transrectal palpation, normal or increased gastrointestinal sounds, normal mucous membranes, absence of strangulation, treatment with a single drug rather than combinations and lack of recurrence of colic signs after initial analgesic treatment.
Analgesia as part of first-line management of colic.
Initial physical examination should allow the clinician to identify whether there are any immediate signs of conditions requiring surgical exploration such as abnormal findings on transrectal palpation or large volumes of nasogastric reflux, but the response to an analgesic drug can be seen as part of the diagnostic work-up.
Desirable properties for analgesics for use in first-line management of colic are:
- Predictable duration of analgesia of short to medium term
- Predictable level of analgesia of mild to moderate degree
- Minimal direct depression of gastrointestinal (GI) motility
Additional properties that may be helpful in specific cases include:
- Anti-endotoxic effects
- Sedative effects
- Suitability for human consumption
Four main categories of drugs are relevant in the first-line treatment of colic
- Non-steroidal anti-inflammatory drugs
- α2 Adrenergic agonists
- Opiates
- Anticholinergics. [...]
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