Visceral Pain

Question 1

Visceral pain is pain that results from

Answer 1

Stretching, inflammation, ischeamia

Question 2

Features of visceral pain

Answer 2

Diffuse/poorly defined, often midline
Nausea, vomiting, sweating often accompanies

Common presentation- difficult to diagnosse

Question 3

Sympathetic outflow is from

Answer 3

T5-L2 (preganglionic)

Pass through paravertebral sympathetic trunk without synapsing (preganglionic)

Form abdominopelvic presynaptic splanchnic nerves (preganglionic)

Question 4

Presynaptic splanchnic nerves

Answer 4

Greater T5-T9
Lesser T10-11
Least T12

Question 5

Splanchnic nerves synapse with

Answer 5

Prevertebral ganglia- coeliac, renal, superior mesenteric, inferior mesenteric and others

Question 6

Sympathetic outflow post ganglionic

Answer 6

Extend from prevertebral ganglia to viscera (post ganglionic)
Mainly innervate blood vessels

Question 7

Greater T5-T9 innervation

Answer 7

Top of GI (liver , stomach, lower oesophagus) foregut

Question 8

Where is foregut pain felt

Answer 8

Think dermatome

Epigastric region

Question 9

Lesser T10-11 innervation

Answer 9

Midgut- pain felt in umbilical region

Question 10

Least T12 innervation

Answer 10

Hindgut- suprapubic region

Question 11

What is caecal volvulus

Answer 11

Distended small bowel

Question 12

Pain in Caecal volvulus

Answer 12

General visceral afferents activated

Question 13

Pathway of general visceral afferents activated

Answer 13

• Afferent impulse goes back to superior mesenteric ganglia (prevertebral)
• Continues back along lesser splanchnic nerve
• Passes back through sympathetic chain (paravertebral)
• Into dorsal horn of spine
• Converge with somatic afferents at that spinal level T9 and T10
• Brain interprets visceral afferent to be coming from T9 and T10 dermatome
• Peri-umbilical pain