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Types of Pain
1. Visceral – your serosa is the visceral peritoneum in other
words visceral peritoneum comes from the abdominal
viscera/organs (as in cholecystitis, appendicitis, intestinal
obstruction, etc.)
innervated by autonomic nerve fibers Visceral afferent fibers stimulated by irritation (A) synapse with second
mainly due to sensation of distention and muscular order neuron in the spinal cord (B) as well as somatic fibers (C) arising
contraction from the left shoulder area (Cervical roots 3 to 5 and the brain
vague interprets the pain to be somatic in origin and localizes it to the
nauseating – because of distention and reflex ileus caused shoulder)
by the inflammation in the abdomen; px feels full and E.g. Kehr’s sign shoulder pain in a patient with subphrenic hematoma
sometimes vomits or splenic rupture
poorly localized
perceived in areas corresponding to embryonic origin Reminder: Palpation should be performed LAST in a patient with
of affected structure abdominal pain. Go first with the history like:
Pain in periumbilical area – involves the medial structures type of pain
(jejunum, ileum, appendix, proximal colon, up to the proximal Is it sharp or constricting?
transverse colon – supplied by the superior mesenteric artery) If it is constricting, it is a spastic pain in the body’s
Lower abdomen/hindgut structures – distal transverse colon up attempt to pass something through an obstruction
to the anus; also includes the genitourinary tract (that’s why a (colicky – sudden and severe).
renal colic is usually felt in the lower abdomen) An example is a biliary colic (patient takes in a fatty
2. Somatic – comes from the parietal peritoneum meal → stimulates gallbladder to contract →
Felt when an inflamed abdominal structure comes in contact gallbladder contracts against the biliary tree which is
with the anterior abdominal wall which is innervated by obstructed by stone → pain)
somatic nerves of parietal peritoneum.
The dermatomal levels come into play. The innervations of
parietal peritoneum follow the dermatomal level.
E.g., the dermatomal level of umbilicus is T10.