Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Class Summary

Believed to work centrally by suppressing conduction in the vestibular cerebellar pathways. They may have an inhibitory effect on the parasympathetic nervous system.

Dicyclomine (Bentyl)

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Smooth muscle relaxant. Fairly effective in relieving pain from biliary tract disease. May be administered PO/IM. Cannot be administered IV.

Glycopyrrolate (Robinul)

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Acts in smooth muscle, the CNS, and secretory glands where it blocks action of acetylcholine at parasympathetic sites. Similar to dicyclomine in effects. May be administered IV.

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or have sustained injuries.

Morphine sulfate (Duramorph, Astramorph, MS Contin)

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Generally safe in low-to-moderate doses in abdominal pain. Not recommended for biliary tract disease because of potential for sphincter of Oddi spasm.

Meperidine (Demerol)

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Generally safe in low-to-moderate doses in abdominal pain. Causes less sphincter of Oddi spasm than morphine but has potential to cause CNS adverse effects.

Fentanyl citrate (Sublimaze)

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Potent narcotic analgesic with much shorter half-life than morphine sulfate. Potential advantages in management of abdominal pain include short duration of action and lack of histamine release. Potential disadvantage is potential for sphincter of Oddi spasm.

Questions

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Media Gallery

Inflammatory mass in the right lower quadrant of an 84-year-old woman with mild abdominal pain of 2 days' duration. A ruptured appendix was found at surgery.
CT scan of a 76-year-old woman with severe abdominal pain of 3 hours' duration. Note the ringlike enhancement of bowel wall in the posterior abdomen. Ischemic small bowel was resected at surgery.
Radiograph of a 90-year-old man with abdominal pain of 4 days' duration. Plain films reveal large bowel dilatation. Sigmoid volvulus with ischemic colon was diagnosed at surgery.
Radiograph of a 79-year-old woman with several hours of diffuse abdominal pain. Initial examination of the plain films suggests bowel obstruction.
Radiograph of a 79-year-old woman with several hours of diffuse abdominal pain. Initial examination of the plain films suggests bowel obstruction. Close-up view reveals pneumatosis intestinalis, indicating mesenteric ischemia.
CT scan of a 64-year-old woman with vague abdominal pain of 2 days' duration. Physical examination revealed a tender palpable mass in the left lower quadrant. CT scan reveals an incarcerated ventral hernia.
CT scan of a 62-year-old man who reported 2 weeks of left lower quadrant abdominal pain. CT scan reveals fat stranding and multiple diverticula around the descending colon. A phlegmon containing bowel and inflammatory tissue has eroded into the left psoas muscle.
A lower CT scan slice from a 62-year-old man who reported 2 weeks of left lower quadrant abdominal pain. Multiple diverticula are observed with an inflammatory mass overlying the left ilium.

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Sections Abdominal Pain in Elderly Persons
Overview
Presentation
DDx
Workup
Treatment
Medication
Questions & Answers
Media Gallery
References

Abdominal Pain in Elderly Persons Medication

Medication Summary

Antispasmodics