Referred Pain

[Miracoli]

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A 40 yrs old bakery worker is admitted to the ED in acute distress. She has experienced severe abdominal pain, nausea, and vomiting for two days. The pain, which is sharp and constant, began in the epigastric region and radiated bilaterally around the chest to just below the scapulas. Subsequently, the pain became localized in the right hypochondrium. The patient, who has a history of similar attacks after hearty meals over the past five years, is moderately overweight and the mother of four. Palpation reveals marked tenderness in the right hypochondriac region and some rigidity of the abdominal musculature. An x-ray without contrast medium shows numerous calcified stones in the region of the gallbladder. The patient shows no sign of icterus (jaundice).
Diffuse pain referred to the epigastric region and radiating circumferentially around the chest is the result of afferent fibers that travel via which of the following nerves?
A.Greater splanchnic
B.Intercostal
C.Phrenic
D.Vagus

 

[thehundredthone]

Is there a doubt about some part of the question? It says afferent fibres, and those would be the visceral phrenic splanchnic nerve fibres.

 

[Miracoli]

Is there was a doubt about some part of the question? .

What do you mean?

 

[dyspareunia]

B

 

[Fatalis]

C

 

[Miracoli]

Is this pain visceral or from parietal peritoneum?

 

[thehundredthone]

What do you mean?

Sorry, I mistyped that sentence. I meant to ask whether you just wanted the answer or you had some other questions regarding it.

Is this pain visceral or from parietal peritoneum?

Visceral. The parietal peritoneum inflammation will cause pain in the region overlying the gallbladder i.e. the right hypogastrium.

 

[giants25]

The answer is A. Visceral sensory fibers run with the greater splanchnic nerves from the gallbladder. This visceral pain is sensed as diffuse around the epigastric region.
Parietal pain would be localized to the right hypochondriac region (below the ribs where the gallbladder is located) by intercostals and can also be referred to the right shoulder via the phrenic nerve.

 

[thehundredthone]

The answer is A. Visceral sensory fibers run with the greater splanchnic nerves from the gallbladder. This visceral pain is sensed as diffuse around the epigastric region.
Parietal pain would be localized to the right hypochondriac region (below the ribs where the gallbladder is located) by intercostals and can also be referred to the right shoulder via the phrenic nerve.

Seems I had a brain fart while typing visceral and phrenic in the same sentence. This is correct, the afferents are visceral like I mentioned before but the nerve fibres are from the splanchnic nerves. All foregut structures have the visceral pain component localised to the epigastrium.

 

[Miracoli]

Great.
The correct answer is A.Greater splanchnic
Thanks for participating.

 

[acciddropping]

it's a visceral pain from GB at the cord level around T8/T9 - and greater splanic covers T5 to T10.