Ab pain Flashcards
Most organs in ab
do not have pain fibers in parenchyma
Visceral peritoneum
pain mediated by
Predominantly
Feeling
visceral afferents of ANS
unmyelinated C fibers- slow conduction/density
Dull, crampy, achy, poorly localized
Visceral pain receptors
activated via
Visceral pain is perceived along
Stomach vs kidney/ureter/liver/GB pain
all serosal surfaces of ab, mesentery, hollow organs
chemical/mechanical stimuli
Spinal segments where VAN enter- usually midline (bilateral)
Stomach- anterior low chest/ab on midline
Organs- lateralized, unilateral innervation
Pain perceived in distal location
transmitted via
Reffered- VAN and somatic cutaneous afferens synapse on same dorsal horn nuclei
Spinothalamic pathway to brain
C3-C5 reffered to R
Referred to L
T5-T8
T6-T9
T7-T9
T6-T10
Visceral origin and referred location
Diaphragmatic irritation- R shoulder
Diaphragmatic irritation- L shoulder
Stomach/duodenum- Left lower chest/mid back
GB/Biliary tree- right scapula
Pancreas- mid/left midback
SI- periumbilical pain
T10-T12
T10- L2
L1
L1-L2
S2-S4
Visceral origin and referred location
Kidney/ureter- flank/groin
Colon- hypogastric/low back
Ovaries/tests- uni hypogastric
Uterus- mid hypogastric
Rectum- parasacral
Parietal peritoneum innvervated by
Pain signals carried by
More irritating
Somatic nerves also innervate
somatic nerves- well localized
A fibers- constant/sharp
More intense
ab wall- pain to palpation reflex spasm (guarding)
Peritoneal pain accentuated by
Indicative signs
Change in tension- moving/coughing
Rebound tenderness
lie motionless
Ab wall pain
Obstructed hollow viscera
Mechanism and feel
Muscle spasm/pressure
Constant, achy, worse with movement/standing
Visceral mediated
SBO- IM, poorly localized
RUQ pain
Vasc disturbances
Parietal peritoneal inflamm
Mech
Feeling
Ischemia releases chemical mediators of visceral pain
Mild to severe, out of proprotion to exam
Mesenteric thrombosis- constant, IM, general ab pain
Steady/achy localized
Worse with pressure changes
Associated with spasm
Surgical abdomen dz consider:
Intestinal obstruction
Peritonitis
IO- pain/anorexia/bloating/NV
High pitched/absent bowel sounds
Dx with radiographs lying/upright (CT better)
severe pain, signs of sepsis
movement exacerbates, guarding, TTP, rebound tenderness
absent bowel sounds
Gastroenteritis
Acute mesenteric ischemia
chronic
SBO
Intussception
Generalized ab pain
Acute/subacute, mild/mod
NV/diarrhea
Acute/severe/persistent
Hx of a fib
Intestinal angina (pain after eating) Wl, eating smaller meals
Acute/severe/persistent
severe N/V
Acute/IM/Severe- 15/30 min intervals
Anorexia,NV
SBP
DKA
Ruptured aortic aneurysm
IBS
Constipation
Generalized ab pain
Acute/sub, mod/severe
hx/rf cirrhosis
Pain/TTP that shifts
DM or hypergly
Ab/back pain
HypoTN, pusling ab mass
Chronic, mild/mod, worse w eating/stress
Diarrhea/constipation
Chronic/ IM mild to mod
Dec stool freq
PUD
GERD
Gastritis
Gastroparesis
Epigastric pain
Subacute/chronic, mild/mod
perf with severe pain/guarding
chronic/ mild to mod, worse with eating/lying down
Regurg/HB
Acute/chronic, mild mod
NSAIDS/aspirin/alcohol
Chronic/fullness
Vomiting/wl
Acute pancreatitis
MI
Epigastric pain
Acute, severe pain radiating to back
NV, anorexia
Mod/severe pain w exertion
Dyspnea
