Types of pain in acute abdomen

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Pain is the most common and most important symptom in all types of acute abdomen . There are three types of pain in NPB:

  1. Visceral pain
  2. Visceral pain with radiation
  3. Somatic pain

Visceral pain[edit | edit source]

It is caused by irritation of the intra-abdominal organs; the organs have more superficial irritation, and the process has not yet reached the peritoneum.

The stimulus is the contraction or expansion of the organ, in the case of parenchymal organs, increased tension of the capsule. Cutting and stabbing do not cause visceral pain - therefore it is possible to perform a biopsy (e.g. of the stomach) without anaesthesia.

  • Pathway of visceral pain: irritation of sensitive receptors in the organ - vegetative nn. splanchnics (sympathetic) – spinal cordthalamus – g. praecentralis, where exact organ localization is missing.
  • Clinically: dull pain without precise localization, mostly in the midline, lack of a relief position (the patient is looking for it, cannot find it, is restless), lack of muscular defence

Visceral pain with radiation[edit | edit source]

Projection and radiation of pain in appendicitis

It occurs when organs are more deeply irritated than visceral pain.

  • Clinically: more permanent pain with radiation in a typical direction (appendicitis – from the navel to the right iliac fossa, cholecystitis – right hypochondrium, right shoulder, right shoulder blade, pancreatitis – from the navel to the inside of the abdomen)

Somatic pain[edit | edit source]

It is caused by irritation of the peritoneum during deep organ damage.

The stimulus is toxic substances, substances with a different pH and osmotic pressure than in the abdominal cavity (contents of the GIT after perforation, blood, pus, urine), mechanical distention.

  • Pathway: sensitive receptors on the skin, lower and upper limbs, peritoneum, pleura - somatic intercostal nerves - spinal cord - thalamus - gyrus praecentralis according to the homunculus, it can therefore be precisely localised.
  • Clinically: sharp, precisely localized pain, there is a relief position (the patient takes it, he does not like to leave it, he is not restless as in visceral pain), there is a muscular defense .
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