This is a painful spasmodic contraction of the muscular layer of the
intestines.
=Osteopathic Etiology.=—Lesions of the splanchnics derange the
intestinal nervous mechanism, with a consequent upsetting of
circulatory equalization and chemical function of the intestines.
Thus irritations and obstructions of the reflex arc predispose to
lowered resistance, congestions, and disturbed chemism. Indigestible
food, flatulency and impaction of feces oftentimes produce intestinal
colic. Exposure to cold and emotional upsets may be factors. Foreign
bodies, intestinal worms, abnormal amounts of bile discharged into
the intestines, and reflex causes from diseases, as from the ovaries,
uterus, liver, kidneys, etc., will produce the disorder; also lead
poisoning, syphilis, rheumatism, locomotor ataxia, chronic malaria and
hysteria.
Kerley says: “Children who take too much milk, too strong milk, or who
take milk too frequently are the usual subjects of colic. Probably the
most frequent cause of colic is indigestion of the proteid of the milk;
either the proteid is in excess or the child has poor proteid capacity.
Not a few cases of colic are due secondarily to defective bowel action.”
=Symptoms.=—Severe paroxysms of pain, centering around the navel and
diffused throughout the entire abdomen. The pain is of a piercing,
cutting and twisting nature, relieved upon pressure. The abdomen
is distended and the patient restless and continually changing his
position. The attacks alternate with periods of complete quietude.
In severe attacks the features may be pinched and the surface cold,
with feeble pulse, vomiting and tense abdominal walls, all indicating
incipient collapse. The duration of the attack is from a few minutes to
several hours, eased at intervals and usually ending by a discharge of
flatus.
=Differential Diagnosis.=—In =lead colic= the history, the
slate-colored skin, blue line on the gums, sweetish metallic taste,
constipation, slow pulse, retracted abdominal walls, and lead in the
urine will designate this disease. =Biliary colic= presents pain in
the hepatic region, radiating to the back and right shoulder; also
jaundice, calculi in the stools and bile in the urine. Tenderness
over the gall bladder is important. =Nephritic colic= is accompanied
by pain radiating down one or both ureters to the inner side of the
thigh, with retraction of testicle of side affected, or the labia, and
blood, mucus, pus or calculi in the urine. In =uterine colic= there
is dysmenorrhea and pain in the pelvis. In =ovarian colic= there is
extreme pain upon pressure over the ovaries, and hysteria. =Abdominal
aneurism= presents tumor, pulsation, bruit. In =inflammatory= and
=ulcerative= disorders of the abdomen there is tenderness upon
pressure, and fever. The pain of acute appendicitis is at first
general, centering in the right iliac fossa in about 24 hours. The
X-ray may be of definite aid in renal and biliary conditions and
various disorders, such as intestinal adhesions, angulations, etc.
=Treatment.=—Relief of pain is the first indication and is best
accomplished by strong inhibition in the splanchnic region, which
relaxes the spasm of the intestinal muscles, by normalizing the
reflex arc. If disorders of the spinal column are located, it is of
primary importance that they be corrected. In cases of irritation of
the intestinal mucous membrane, a contraction of muscles of the spine
will be found according to the area of the intestines involved, e. g.,
irritation of the mucous coat of the jejunum causes contraction of
the muscles at the tenth and eleventh dorsals. It is a viscero-motor,
viscerosensory or viscerotrophic reflex sign. On the other hand, a
lesion at the tenth and eleventh dorsals may produce colic or other
disorders of the jejunum. The portion of the bowel affected, therefore,
can be often told by noticing the places of muscular contraction along
the spinal column. Generally the jejunum and ileum are the portions
of the bowel affected in intestinal colic. The pain can frequently
be controlled if in the jejunum, at the tenth and eleventh dorsals;
if in the ileum, at the twelfth dorsal; if in the ileo-cecal region,
including the vermiform appendix, at first to third lumbar; if in the
colon, at the third to the fifth lumbar; and if in the rectum, over
the sacral and coccygeal nerves. Occasionally the duodenum and jejunum
are reached by nerves as high as the fifth dorsal (usually vasomotor
nerves, not sensory), and the other portions of the bowel lower,
according to their respective positions. The relief is given by way
of the splanchnics and sympathetics to the mucous (sensory) coat of
the intestines, although inhibition relaxes intestinal muscles (motor
nerves) and dilates blood-vessels (vasomotor nerves). Though precisely
localized inhibition is of decided value, still if normal alignment,
through adjustment, can be secured results are usually quicker and more
satisfactory.
Anterior treatment to the abdomen helps to relieve the contracted
fascia of the mesentery, with a consequent freeing of the circulation.
It aids peristalsis of the intestines and expulsion of the irritating
material. This probably produces considerable effect by way of the
axone reflex. Direct treatment to the abdomen for the peristalsis
relieves also constipation, impactions and the enteralgia, the latter
principally by firm pressure. Peristalsis is also increased by
stimulation of the vagi and inhibition of the splanchnics. The latter
treatment, of course, is not given to relieve pain directly, but to
facilitate the removal of irritating substances if such are the source
of trouble. If this does not produce a movement of the bowels promptly,
a warm enema will assist greatly. The cecum and sigmoid should not be
overlooked.
=Flatulency= can be relieved by direct pressure upon the solar plexus,
which apparently removes obstructions to the abdominal nervous system
(particularly the nerves of the digestive glands, as fermentation and
flatulency are due to a disproportionate secretion of digestive juices)
and thus the gaseous formations are absorbed. Additional treatment to
the lower dorsal vertebræ and lower ribs to relieve nerve lesions and
increasing both thoracic and abdominal circulation may be indicated.
As stated in the etiology of intestinal colic, the splanchnic nerves
contain not only sensitive fibers, but motor and vasomotor fibers
as well. The same is true of the vagi nerves; they exert upon the
intestines not alone a motor influence, but also a blood control;
consequently, our work in a certain region can be for more than one
purpose. Hot applications to the abdomen may be of benefit. And hot
fomentations to the spine for 20 or 30 minutes (affecting reciprocal
innervation) is often of great benefit. The diet should always be
regulated for a few days at least.