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3.what causes right upper abdominal pain in the scenario?

a. Understanding Pain

Pain as a subjective sensory and emotional experience not fun that is related to tissue damage
acute nature that is felt in the events where it occurs damage. Pain is a sensory pain and
emotional experience that is not fun related to actual and networkdamage potential.

Acute pain is pain that occurs after acute injury, disease, or surgical intervention and has a
fast process with intensity which varies (mild to severe). Acute pain is short duration
(approximately 6 months) and will disappear without treatment after the damaged area has
Chronic pain is a constant, intermittent pain that persists over a period of time, this pain
lasts long with the intensity varies and usually last smore than 6 months.

Pathomechanism Nociceptive Pain

Transduction. Is a change in pain stimulation (noxious stimuli) into electrical

activity in sensory nerve endings. Algesic substances such as prostaglandin, serotonin,
bradykinin, leukotriene, substance P, potassium, histamine, lactic acid and pain receptors.
Pain receptors are woven edges free afferent fibers A-delta and C. These receptors are
often found in the skin tissue, periosteum, in the dental pulp and tissues another body.
Afferent nerve fibers A-delta and C are nerve fibers sensory function has the function of
continuing sensory pain from peripheral to central to the central nervous system.
Interaction between algesic substances and receptors pain causes the formation of pain
impulses. Transduction is the process of pain stimulation is configured in forms that can
be accessed by brain. The transduction process starts when the nociceptor is the receptor
function to receive activated pain stimuli. Activation of this receptor (nociceptors) is a
form of response to a stimulus come like network damage. Transmission / Transmission.
Transmission is a series of neural events that carry electrical impulses through the
nervous system to the area of the brain. The transmission process involves afferent nerves
formed from small to medium-diameter nerve fibers and large-diameter ones. Afferent
nerves will accuse the dorsal horn in the spinal cord. Furthermore this transmission is
continued through the contralateral spinalthalamic system through the lateral ventral of
the thalamus to the cerebralcortex..Modulation / Modulation. The modulation process
refers to neural activity in an effort to control the nociceptor transmission line. The
modulation process involves a complex neural system. When pain impulses reach the
nerve center, the transmission of pain impulses will be controlled by the central nervous
system and transmit these pain impulses to other parts of the nervous system such as
cortex section. Furthermore this pain impulse will be transmitted through descend nerves
to the spine to modulate effectors.
Perception / Perception. Perception is a subjective process. This perception process is not
only related to physiological processes or anatomical processes, but also includes
cognition and memory. Therefore, psychological, emotional, and berhavioral (behavioral)
factors also appears as a response in perceiving the experience of the pain. This process
of perception is also what makes the pain a phenomenon which involves

The splanchnic and the cerebrospinal are the two neural pathways available for
transmission of abdominal pain. Pacinian corpuscles and free nerve endings in the walls
of the viscera are the splanchnic afferent nerve receptors. They are sensitive only to
stretch and spasm. By contrast, receptors of the cerebrospinal nerves are sensitive to
pressure, friction, cutting, burning, and any other stimulus that can be appreciated by
skin. In the dorsal root ganglia the splanchnic and cerebrospinal cell bodies are side by
side. Their proximal fibers also terminate in close proximity within the spinal cord. The
close relationship of these anatomic pathways may account for the fact that severe
visceral pain, such as rapid distention of a viscus, may "spill over" into somatic segments
(viscerosensory and visceromotor reflexes) in the absence of somatic nerve irritation.
Understanding of "spillover" pain is essential for accurate diagnosis of abdominal
pain.Since the embryonic gut and its appendages arise as midline organs, their splanchnic
innervation is bilateral, and accordingly, visceral pain is perceived in the midline.
Cerebrospinal nerves to the parietal peritoneum (T6 through T12) have the same
segmental arrangement as the lower thoracic dermatomes. There are no nerve fibers in
the visceral peritoneum.Upper abdominal organs have anatomic features that make pain
patterns emanating from them far more complex than those of the appendix. Painful
lesions of the gastroesophageal junction, the fundus and lesser curvature of the stomach,
the biliary tract, and proximal portions of the duodenum commonly produce pain in the
interscapular zone corresponding to the sixth thoracic segment, since the somatic
innervation of the lesser omentum is supplied by that thoracic nerve. Pancreatic pain is
often perceived in the same location one segment lower.The stomach is so situated that
portions of its surface are in contact with the diaphragm, the gastrohepatic ligament, the
lesser sac, the pancreas, the parietal peritoneum, the splenic hilus, the gastrocolic
ligament, the transverse mesocolon, and the transverse colon. Inflammatory or neoplastic
lesions of the stomach that involve any of these surfaces may irritate somatic nerves from
several different spinal segments. Accordingly, pain may be

Referensi : - [price,sylvia Anderson.2015.patofisiologi.jakarta:egc].

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