Question

Gastrointestinal

A college student complained of pain, nausea with vomiting, and tenderness in the right lower quadrant. The pain was first vague and diffuse and then became more severe in the midepigastric region before localizing in the right lower quadrant. The pain was accentuated by movement, deep respiratory movements, coughing, or sneezing. A mild fever of 102.2ºF and a moderate leukocytosis (11,500 cu mm) were present. A marked tenderness was noted over the right lower quadrant at McBurney’s point (one-third the distance between the anterior superior iliac spine and the umbilicus). The psoas sign (pain on passive hyperextension of the thigh) was also present.

5. What is “referred” pain? Does it exist in this case and are there other diseases where it might be more common?

Answer 1

ANSWER: Referred pain is the pain received at a location other than the site of location of painful stimulus/ orgin. The initial pain represents a referred pain resulting in from the visceral innervation of midgut and the localised pain is due to pareital peritoneum involvement after the progression of inflammatory process. Palpating the remote area of the abdomen from the site of pain may elicit tensderness in fhe right lower quadrant. This sign is called Rovsing sign or referred pain in appendicitis.

Other examples of referred pain are injured spleen, liver cyst, heart attack may cause referred pain over the shoulder an neck. Injury to pancreas may have its referred pain in the back.