Podcast
Questions and Answers
What is the primary mechanism behind viscero-visceral referral?
What is the primary mechanism behind viscero-visceral referral?
In patients with IHD and gall bladder disease, what can reduce the number of angina attacks?
In patients with IHD and gall bladder disease, what can reduce the number of angina attacks?
What is a characteristic of somatic referred pain?
What is a characteristic of somatic referred pain?
What is an example of pain syndromes with viscero-somatic referral?
What is an example of pain syndromes with viscero-somatic referral?
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What is a potential consequence of somatic referred pain?
What is a potential consequence of somatic referred pain?
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What is the primary mechanism behind somatic-viscero referral?
What is the primary mechanism behind somatic-viscero referral?
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What can reproduce visceral pain in people with profound muscle hyperalgesia?
What can reproduce visceral pain in people with profound muscle hyperalgesia?
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What is the significance of thorough history, examination, and investigations in patients with pain?
What is the significance of thorough history, examination, and investigations in patients with pain?
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Study Notes
Viscero-Visceral Referral
- One sensitized organ can cause sensitization of another organ when they share a common sensory afferent nerve or have afferent 'cross-talk' in the dorsal horn (DH).
- Causes of viscero-visceral referral:
- The heart and gallbladder share overlapping (T5) afferent pathways, leading to reduced angina attacks and coronary revascularization when gallbladder calculi are treated.
- The renal system and uterus share overlapping afferent nerve pathways (T10-L1 afferents), resulting in reduced renal colics when hormonal therapy is used for dysmenorrhoea.
Viscero-Somatic Referral
- Visceral pain causes referred somatic pain, requiring thorough history, examination, and investigations to determine its origin.
- Characteristics of somatic referred pain:
- Better localized
- Sharper
- Less likely to be associated with emotional and neurovegetative signs
- Somatic referred pain can be associated with:
- Hyperalgesia, resulting in increased sensitivity in muscles, skin, and subcutaneous (SC) tissue innervated by the somatic spinal nerve.
- Examples of pain syndromes with viscero-somatic referral:
- Renal colic: hypersensitive lumbar muscles (quadratus lumborum, obliques) and pain in the flank and groin, even after calculi have been passed.
- Acute myocardial ischaemia: pain in the chest radiating down the arm (C8-T1 dermatomes).
Somatic-Viscero Referral
- Similar mechanisms to those of viscero-somatic referral.
- Characteristics of somatic-viscero referral:
- Deep palpation of muscle can reproduce visceral pain in people with profound muscle hyperalgesia.
- Examples of somatic-viscero referral:
- Deep palpation in the flank and groin can elicit visceral pain from the genitourinary system, even after a renal calculi has been passed.
- Treatment of somatic referred pain can improve visceral pain.
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Description
This quiz covers the concept of viscero-visceral referral, where one sensitized organ affects another organ due to shared sensory afferent nerves or 'cross-talk' in the dorsal horn. It also explores the relationship between the heart and gall bladder in this context.
