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WEEK 3:
Referred pain:
| Question | Answer |
|---|---|
| referred pain | perception of visceral pain some way away from organ involved (does not accurately represent where problem is) |
| diaphragm | C3-C5 |
| appendicitis | peri-umbilicus - visc afferents enter T10 and later Rt lower quadrant |
| pain resulting from shoulder region is referred to | irritation of diaphragmatic pleura/ diaphragmatic peritoneum (C3-C5) |
| segments of dermatomes contribute to | anterior rami to phrenic nerves |
| irritation of peripheral regions of diaphragm are invervated by | inferior intercostal nerves (more localised being referred to skin over costal margins of anterolateral abdominal wall) |
| most viscera are innervated only by | autonomic nerves |
| visceral pain is conducted along | afferent autonomic nerves (visceral afferent) |
| autonomic afferent fibres are able to enter CNS only where | sympathetic or parasympathetic motor fibres leave it |
| sensory information from viscera may be involved with | reflex or may elicit pain |
| how does visceral pain differ from somatic pain | quality, localisation and referred (eg coughing, vomiting, swallowing etc) |
| somatic pain | epitomised by pain arising from skin |
| modalities of somatic pain | many modalities - experienced and described in various ways eg superficial and deep somatic, mechanism and inflammatory) |
| type of pain experienced in somatic pain | sensitive, well localised and often sharp |
| sensory receptors in somatic pain | many sensory receptors |
| perception of pain is dominated by what type of pain | somatic pain (cutaneous sensation in particular) |
| visceral pain | fewer sensory endings in viscera |
| where is visceral pain found | often in smooth muscle and may be referred |
| type of pain experienced in visceral pain | poorly localised, dull, heavy or gripping |
| difference in type of pain experienced in somatic and visceral pain | somatic has sensitive well localised often sharp pain but visceral experiences poorly localised dull heavy or gripping pain |
| examples of pain from internal organs | mild discomfort of indigestion, agony of a renal colic, many forms of visceral pain associated with reproductive life (women) |
| viscera are insensitive to (3) | crushing, cutting, and burning |
| what can cause visceral pain | excessive stretching/ contraction of heir walls or certain pathological conditions (eg ischaemia or chemical irritation) |
| how do visceral (autonomic) afferent fibres differ from visceral efferent | visceral (autonomic) afferent fibres do not have a peripheral synapse but visceral efferent do |
| how do visceral (autonomic) afferent fibres communicate from organ to CNS | via single neuron pathways from organ to CNS |
| where does the single neuron pathway of visceral (autonomic) afferent fibres go | join spinal/ cranial nerve to enter CNS along dorsal nerve route (or CN equivalent) |
| how do GVA fibes create referred pain | by activating general somatic afferent fibres where the two meet in posterior grey column |
| where is the cell body of visceral (autonomic) afferent fibres found | dorsal root ganglion |
| T1-L2 | sympathetic motor outflow |
| S2,3 &4 | sacral parasympathetic outflow |
| visceral (autonomic) afferent fibres return with what | cranial nerves IX and X |
| nociceptors from several locations converge where | on a single ascending tract in spinal cord |
| most common pain signals | from skin |
| brain associates activation of pathway with | pain in skin |
| when does referred pain occur | when fibres from regions of high sensory input (eg skin) and nerve fibres from regions of normally low sensory input (eg internal organs) converge on same levels of spinal cord |
| during a MI where can pain be felt | base of neck, jaw, shoulder and arm |
| nerves from damaged heart tissue convey pain signals to where | spinal cord levels T1-T4 on the left side (which also recieve sensation from left chest and left arm BUT brain not used to feeling pain from heart so interprets it as pain from chest and arm) |
| epigastrium pain refers to what structure | unpaired foregut structures (below diaphragm) |
| umbilicus pain refers to what structure | midgut |
| hypogastrium (sigmoid and rectum S2-S4) pain refers to what structure | hindgut |
| T10-L1 pain refers to what structure/ posterior costovertebral angle radiating forward around flank | kidneys |
| L1/2 pain refers to what structure | ureters |
| S2-S4, T12-L2 pain refers to what structure | bladder/ upper urethra |
| T12-L1 pain refers to what structure/ costovertebral angle radiating to lower abdomen, testicles and inner thigh | uterus |
| S2-S4 pain refers to what structure | cervix |
| right lower quadrant/ umbilicus pain refers to what structure | appendix |
| lower abdomen and upper thighs pain refers to what structure | bladder |
| shoulder pain refers to what structure | diaphragm |
| along sternum, left upper thorax pain refers to what structure | oesophagus |
| base of neck, left jaw, left shoulder and arm pain refers to what structure | heart |
| back (headache or sharp pain in back), umbilicus pain refers to what structure | intestines |
| right shoulder pain refers to what structure | liver |
| directly behind pancreas, upper left quadrant, umbilicus pain refers to what structure | pancreas |
| left shoulder and upper third of arm pain refers to what structure | spleen |
Created by:
22tango
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