TAILIEUCHUNG - Chapter 014. Abdominal Pain (Part 2)

Some Mechanisms of Pain Originating in the Abdomen Inflammation of the Parietal Peritoneum The pain of parietal peritoneal inflammation is steady and aching in character and is located directly over the inflamed area, its exact reference being possible because it is transmitted by somatic nerves supplying the parietal peritoneum. The intensity of the pain is dependent on the type and amount of material to which the peritoneal surfaces are exposed in a given time period. For example, the sudden release into the peritoneal cavity of a small quantity of sterile acid gastric juice causes much more pain than the same. | Chapter 014. Abdominal Pain Part 2 Some Mechanisms of Pain Originating in the Abdomen Inflammation of the Parietal Peritoneum The pain of parietal peritoneal inflammation is steady and aching in character and is located directly over the inflamed area its exact reference being possible because it is transmitted by somatic nerves supplying the parietal peritoneum. The intensity of the pain is dependent on the type and amount of material to which the peritoneal surfaces are exposed in a given time period. For example the sudden release into the peritoneal cavity of a small quantity of sterile acid gastric juice causes much more pain than the same amount of grossly contaminated neutral feces. Enzymatically active pancreatic juice incites more pain and inflammation than does the same amount of sterile bile containing no potent enzymes. Blood and urine are often so bland as to go undetected if their contact with the peritoneum has not been sudden and massive. In the case of bacterial contamination such as in pelvic inflammatory disease the pain is frequently of low intensity early in the illness until bacterial multiplication has caused the elaboration of irritating rate at which the irritating material is applied to the peritoneum is important. Perforated peptic ulcer may be associated with entirely different clinical pictures dependent only on the rapidity with which the gastric juice enters the peritoneal cavity. The pain of peritoneal inflammation is invariably accentuated by pressure or changes in tension of the peritoneum whether produced by palpation or by movement as in coughing or sneezing. The patient with peritonitis lies quietly in bed preferring to avoid motion in contrast to the patient with colic who may writhe characteristic feature of peritoneal irritation is tonic reflex spasm of the abdominal musculature localized to the involved body segment. The intensity of the tonic muscle spasm accompanying peritoneal .

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