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 Visceral Pain
Arising from ischemia, inflammation, or other
injury to the viscera in the body cavities
Poorly localized (the patient can only indicate
a general area or areas of the pain, often
described as deep or inside)
Aching, pressing, or squeezing in quality
Often accompanied by autonomic symptoms
such as nausea, vomiting, diaphoresis, and
intestinal ileus
 Visceral Pain
Jadi
Usus yang terjerat pada kasus hernia
strangulata dan peritonitis termasuk dalam
visceral pain
 Somatic Pain
Arising from:
Skin
Skeletal muscles
Bones
Ligaments
Tendons
Soft tissues
Usually described as sharp or stabbing and is well
localized (the patient can point with one finger to
the site of maximal pain)
 Neuropathic Pain
Arises from damage to the nerve cells
themselves, rather than to other tissues
Usually described as a burning or hot pain in
the distribution of the affected nerve or nerves
 Colicky Pain
Pain that comes and goes, which starts and
stops abruptly
Occur due to muscular contraction of a hollow
tube (e.g. intestine, colon, ureter, bile duct) in
attempt to relieve the obstruction by forcing
content out
 Abdominal Pain with Percussion
Pathophysiology:
Percussion sends a wave of movement through
the free wall of the abdomen and peritoneal
surface
Pain induced by percussion, especially when
referred to areas remote from the point of
percussion suggests peritoneal inflammation
 Rebound Tenderness
(Blumberg Sign)
Pathophysiology:
The inflamed peritoneum is painful when
disturbed by direct pressure or movement,
especially when two inflamed peritoneal surfaces
slide over one another
Because the peritoneum has somatic sensory
afferents, the site of pain is well localized
 Direct Tenderness
Pathophysiology:
Tenderness may be caused by inflammation of the
abdominal wall, the peritoneum, or a viscus
A solid organ may be tender when its capsule is
distended
 Resistance to Palpation
Involuntary Rigidity of Muscle
Pathophysiology:
Reflex muscle spasm is caused by peritoneal
irritation
Persistence of rigidity despite relaxing maneuvers
suggest it to be involuntary
Thank You