Chapter 4 Visceral Pain Flashcards
The Peritoneum is made up of these three parts.
1) Parietal peritoneum
2) Mesentery
3) Visceral peritoneum
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What nerve innervates the parietal peritoneum?
Intercostal nerve
Intercostal nerve- part of the somatic nervous system. The parietal peritoneum has somatic innervation.
What nerve provides somatic sensation for the diaphramatic portion of the parietal peritoneum?
Phrenic nerve
Diaphragmatic phrenic nerve- C3, C4, C5 ‘keep the diaphragm alive.’
What innervates the visceral peritoneum?
Visceral afferent neurons.
How would you describe visceral pain?
Vague
Diffuse
Hard to localize
The liver is encassed by a loose connective tissue called ____ capsule. **Visceral **peritoneum overlies this capsule. Pain from HEPATIC STRETCH causes ____ pain initially, but then local inflammation causes a shift to _____ pain.
- Glisson’s capsule
- Epigastric pain
- RUQ pain
What descriptor words are used for visceral pain?
Deep
pressure
squeezing
cramping
constant
dull
steady
bloating
sickening
Visceral pain also involves the autonomic nervous system. What symptoms can accompany the pain?
malaise
pallor
profuse sweating
nausea
tachycardia
hypotension
Emotional reactions from the sympatehtic nervous system are common and the patient may be anxious or even may have a sense of impending doom.
Patients experiencing somatic pain (parietal pain) will often describe their pain being better when they are doing what?
laying still
Pain is well localized and made worse by movement
What words often describe parietal pain?
Sharp
Knife-like
aching
throbbing
spasm
pulling
hurts
twisting
tense
hard
irritating
gnawing
stiff
sore
What is referred pain?
Rreferred pain is visceral pain perceived as somatic pain located by dermatomes of the skin.
Referred pain is sharper, better localized, and less likely to be accompanied by autonomic or emotional signs.
What are the 7 ‘P’s’ of TOTAL PAIN
1) physical
2) emotional
3) intellectual
4) interpersonal
5) spiritual
6) financial
7) bureaucratic
What features on clinical assessment would make you suspicious of an acute abdomen? (peritonitis)
Lying rigidly or very restless
guarding
rigidity
sharp pain on palpation
Rebound tenderness
Quiet or absent bowel sounds
