based on the patients hx or physical, how can u tell if it's visceral pain or parietal?

thanks

based on the patients hx or physical, how can u tell if it's visceral pain or parietal?

thanks

I'd ask over in the surgery forum too.

But for me, I generally take into consideration all of those seven basic factors. What's the pain like? Visceral pain tends to localize and is much more "crampy" in nature, while parietal pain tends to be more global, and sharp in nature. The patient with visceral pain will often be "doubled up" on the gurney, on their side in a fetal type of position. The patient with parietal pain lays flat and still on their back, as movement will irritate parietal pain. And since many time parietal pain has an association with perf, look at their vitals. Everyone with pain will probably be tachy with an increase SBP given severe enough pain, but fever and HYPOtension will point you in the direction of parietal pain.

At the end of the day, you'll have to run some tests to confirm your dx, because that's just what we do.

I'd ask over in the surgery forum too.

But for me, I generally take into consideration all of those seven basic factors. What's the pain like? Visceral pain tends to localize and is much more "crampy" in nature, while parietal pain tends to be more global, and sharp in nature. The patient with visceral pain will often be "doubled up" on the gurney, on their side in a fetal type of position. The patient with parietal pain lays flat and still on their back, as movement will irritate parietal pain. And since many time parietal pain has an association with perf, look at their vitals. Everyone with pain will probably be tachy with an increase SBP given severe enough pain, but fever and HYPOtension will point you in the direction of parietal pain.

At the end of the day, you'll have to run some tests to confirm your dx, because that's just what we do.
This all rings true except the one highlighted statement - visceral pain usually is poorly localized and parietal pain tends to be more localized. Hollow organs don't have nociceptive neurons, so they cause referred pain - anything in the midgut will hurt vaguely around the umbilicus, e.g. Inflamed peritoneum hurts where it is actually inflamed, and will also result in the traditional s/sx of peritonitis like rebound tenderness and involuntary guarding.

The archetypal model of appendicitis says it all: early in the course, before peritoneal inflammation has occurred, pain is experienced as vague, crampy, periumbilical discomfort. As peritoneal inflammation progresses, pain localizes to the RLQ, with pain in the RLQ even when other areas are palpated or manipulated. :thumbup:

This all rings true except the one highlighted statement - visceral pain usually is poorly localized and parietal pain tends to be more localized. Hollow organs don't have nociceptive neurons, so they cause referred pain - anything in the midgut will hurt vaguely around the umbilicus, e.g. Inflamed peritoneum hurts where it is actually inflamed, and will also result in the traditional s/sx of peritonitis like rebound tenderness and involuntary guarding.

The archetypal model of appendicitis says it all: early in the course, before peritoneal inflammation has occurred, pain is experienced as vague, crampy, periumbilical discomfort. As peritoneal inflammation progresses, pain localizes to the RLQ, with pain in the RLQ even when other areas are palpated or manipulated. :thumbup:

Bah! I wrote that backwards. That's what I get for not proof-reading.

Bah! I wrote that backwards. That's what I get for not proof-reading.
Heh, I figured it was one of those, "Listen to what I mean, not to what I say" type moments... :p