Abdominal Pain

Abdominal Pain Pathways

2 innervations:
1. Somatic
(Peripheral nerves e.g. skin and parietal peritoneum lining
abdominal wall)
2. Visceral

If pain from abdominal organs travels with sympathetics

Visceral Pathway
Cell bodies are in the dorsal root ganglia
Pass through sympathetic paravertebral ganglia without
synapsing
Neurone decussates at this level & then ascends in the lateral
spinothalamic tract and on to the thalamus

If pain from thoracic and pelvic organs travel with

parasympathetics Visceral pathway

If pain from abdominal wall is via the peripheral cutaneous

nerves Somatic pathway
A initial shart pain (myelinated pain sensation travels
quickly)
C longer diffuse pain (unmyelinatedpain sensation travels
slowly)

Visceral vs Somatic
Painful stimuli are appropriate to the organs function

Basically, pain referred back to level of embryological

origin!

Embryological
Origin:

Structure:

Pain fibres
travel back w/:

Level Pain
Referred to:

All intestinal pain classified as

midline!
Everything elsepain localizes to
one side

Includes all gut structures from

lower oesophagus upper
anus
Also includes spleen, liver,

Pancreas
2nd-4th parts duodenum
Lower rectum
Aorta
Kidneys
Ureters

Oesophagus

Uterus
Ovaries
Fallopian tubes

Pattern

Visceral peritoneum
poorlylocalised
But when parietal peritoneum involved (i.e. somatic)
well localised
Classic example: appendicitis

Therefore pain usually begins as a general midline ache and as it progresses

localising pain occurs
This gives rise to classic clinical signs:

Peritonitis

Pain changes
fromcolic to
constant

Visceral peritoneum autonomic innervation

Parietal peritoneum somatic innervation

CHECK SHEET FOR PAIN PATTERNSLOOK @ LEARNING OBJECTIVES

AS THE LECTURER SAID WE DONT NEED TO KNOW CLINICAL STUFF!