Applied Clinical Anatomy - Visceral Anatomy

Cutaneous Source of Pain

• related to the skin

• localized

Somatic Source of Pain

• pain is generated from one or more somatic tissues: fascia, tendons, periosteum bone, muscles, ligaments

• can be superficial or deep; superficial rends to be more localized while descriptions of deep tends to be vague

• common causes of somatic pain are chemical, mechanical, or a combination of the two

• does not include nerve

Somatic Referred Source of Pain

• referred pain to pain perceived in a region topographically displaced from the region of the source of pain

• pain can be referred to abdominal region, limbs, head, neck, trunk, pelvic region, groin

Neuropathic Source of Pain

• results from damage or pathophysiologic changes to nerves to the peripheral or central nervous system

• this type of pain is not elicited by the stimulation of nociceptors but by malfunction of the nervous system itself

• description: sharp, shooting, burning, tingling shocking/electric

• radicular pain: defined as pain that radiates from a central source (nerve root) that is accompanied by numbness, reflex changes, and motor changes (does not have to be all-inclusive).

Primary Visceral Pain

• midline pain due to embryological development

Visceral Referred Pain

• sources are internal organs of the trunk and abdomen and the heart muscle

• description: poorly localized and diffuse

Visceral Referred Pain

1. is poorly localized with referral to somatic structures

2. produces nonspecific regional or whole-body motor responses

3. produces strong automatic responses

4. leads to sensation of somatic tissues

5. can produce strong effective responses

Thoracic Cavity

• space enclosed by thoracic wall

• three compartments

  • pulmonary cavities x 2

  • mediastinum

Abdomino-pelvic cavity

• boundaries

  • S: Diaphragm

  • A: abdominal wall

  • I: Pelvic Floor

  • P: Spine

Abdominal and Pelvic Cavity

• abdominal Cavity Boundaries: Abdominal wall, diaphragm, pelvis

• pelvic cavity boundaries: iliac crest, ilium(s), and pelvic floor

Diaphragm

• expands thoracic cavity, compresses abdominal cavity

• innervated by phrenic nerve C3, 4, 5

• can refer to pain shoulder, predminately left

• pain at tip of left shoulder - Kehr’s sign

  • classic sign of a ruptured spleen if on left side

right upper abdominal quadrant

• liver

• gallbladder

• superior aspect of right kidney

• portion of the pancreas

• portion of the stomach portion of ascending colon and transverse colon

left upper abdominal quadrent

• liver: portion of left lobe

• spleen

• stomach

• pancreas

• superior aspect of left kidney transverse colon and small portion to descending colon

• jejunum and proximal ileum

right lower abdominal quadrant

• ascending colon

• appendix

• right kidney and ureter

• small intestines

• right ovary and left fallopian tube

• right spermatic cord

• urinary bladder

left lower abdominal quadrant

• descending colon, sigmoid colon

• left kidney and ureter

• small intestines

• left ovary and fallopian tube

• left spermatic cord

• urinary bladder

system-based approach

• cardiovascular

• lymphatic

• pulmonary

• hepatic and biliary

• gastrointestinal

• immunological

• renal

• urologic

• reproductive

Cardiovascular system

• composted of the heart and blood vessels

mediastinum

• boundaries:

  • S = I: superior thoracic aperture to the diaphragm

  • A = = P: sternum and costal carriages to the bodies of the thoracic vertebrae

  • M = L: between the pulmonary cavities

• composed of loose connective tissue to accommodate movement

• contains: heart, great vessels, trachea, esophagus, thymus, lymph nodes/vessels, nerves, ligaments, and fats

Heart

• located in the middle of mediastinum, offset to the left

• composed of cardiac striated muscle - myocardium

• surrounded by pericardium

• two muscular pumps producing the pulmonary circulation and the systematic circulation

Blood Vessels

• three types of blood vessels: arteries, veins, capillaries

arteries

typically carries oxygenated blood away from the heart and distributes it to the body

veins

typically return poorly oxygenated blood to the heart for the heart to send to the pulmonary system

capillaries

connect the arterial and venous sides of the circulation

areas of cardiac referred pain

• left-sided chest pain

• left-sided shoulder pain

• left-sided jaw and neck pain

• inner aspects of the left arm radiating into the medial aspect of the forearm and hand (5th digit)

• left-sided mid-back pain (posterior)

• pattern less predictable in women

  • may only complain of shortness of breath and fatigue

lymphatics

• provides the drainage for any surplus of tissue fluid and leaked plasma proteins to the bloodstream

• important for removal of cellular debris and infection

Airway

• nasal cavity

• pharynx

• larynx

• trachea

• bronchi

• bronchioles

• alveoli

Lung Anatomy

• right lung (3 lobes)

• Left lung (two lobes)

• each lung is enclosed in a plural sac

  • visceral pleura: covers the lungs, adherent to lung surfaces

  • parietal pleural: lines the pulmonary cavities, adhering to the thoracic wall

  • pleural cavity - potential space between the visceral and the parietal layers, filled with pleural fluid

Pulmonary System Primary Functions

• inhalation/ exhalation

• external gas exchange

• internal gas exchange

Pulmonary System Secondary Functions

• phonation

• olfaction

• acid-based regulation

Liver

• general function: converts bilirubin into bile; filters the blood coming from the digestive tract; metabolizes and detoxifies; site for most medication metabolization

• common dysfunction: hepatitis, alcoholism, cancer

• Pain referral pattern: pain in right upper quadrant, right sided lower back pain, right shoulder and neck pain

Gall Bladder

• function: receive bile from the liver and then dump into the intestines to break down fatty foods

• dysfunctions: swollen, inflamed, gallstones —> blockage

  • choledystemotomy - removal of gallbladder

• pain referral pattern: pain primarily in the RUQ radiating posteriorly. can also reproduce pain in the back neck and shoulder region

GI system

esophagus and stomach

Esophagus

• extends pharynx to stomach carrying ingested matter

• passes through the esophageal hiatus if the diaphragm

Stomach

• food blender and reservoir

• chief function: acidic and mechanical digestion of ingested food

small intestine

• duodenum - continues to break down carbs and protein

• jejunum - nutrient absorption

• ileum - nutrient absorption

• extends from the stomach to the ileocecal junction

• reffered pain pattern: lower back, anterior abdomen, potentially right shoulder pain

large intestine

• cecum and appendix

• colon

  • ascending - water absorption

  • transverse - waste consolidation

  • descending - waste consolidation

  • sigmoid - S shape, links descending and rectum

• rectum and anal canal

• referred pain pattern: low back/ sacral region, anterior groin, lower abdomen

Pancreas

• general functions: accessory digestive glands; secretes digestive enzymes for carbs, proteins, fat; release insulin and glucagon into blood stream

• common dysfunction: problems can be caused by heavy alcohol composition, fatty floods, surgery goods

• location: RUQ

• Pain referral pain: pain in middle upper abdomen