Visceral Referral Patterns

Question 1

visceral referral pattern of the liver?

Answer 1

RUQ, R shoulder and scapula due to diaphragmatic irritation via the phrenic nerve

Question 2

visceral referral pattern of the gallbladder?

Answer 2

R upper abdomen, R shoulder and scapula due to diaphragmatic irritation via the phrenic nerve

Question 3

with the visceral referral pattern of the gallbladder, when is pain often felt in reference to meals?

Answer 3

after fatty meals

Question 4

what positive sign is associated with the gallbladder visceral referral pattern?

Answer 4

+ Murphy’s sign

Question 5

visceral referral pattern of the lungs (parietal pleura)?

Answer 5

chest wall, ipsilateral shoulder, upper back due to parietal irritation

Question 6

visceral referral pattern of the lungs (Pancoast tumor)?

Answer 6

shoulder, medial arm/forearm/hand

Question 7

what visceral referral pattern of the lungs results from compression of the brachial plexus (C8-T1) and often mimics thoracic outlet syndrome?

Answer 7

pancoast tumor

Question 8

visceral referral pattern of the central diaphragm?

Answer 8

ipsilateral upper trapezius and shoulder
irritation via organs supplied by phrenic nerve (liver and gallbladder)

Question 9

visceral referral pattern of the heart?

Answer 9

chest (substernal, L side)
L shoulder/arm
L upper back
neck/jaw

Question 10

visceral referral pattern of the heart often follows the __ nerve distribution in the shoulder and arm

Answer 10

ulnar

Question 11

describe the pain felt in the chest (substernal, L side) with the visceral referral pattern of the heart

Answer 11

pressure, heaviness, tightness (sharp, stabbing)

Question 12

visceral referral pattern of the stomach?

Answer 12

epigastric region
mid back/thoracic spine (T6-T10)
LUQ

Question 13

visceral referral pattern of the pancreas?

Answer 13

epigastric region
L shoulder
mid back (T10)
*often felt in midline, slightly left of midline

Question 14

visceral referral pattern of the small intestine?

Answer 14

periumbilical region
central abdominal pain that is diffuse and cramping in nature

Question 15

visceral referral pattern of the appendix (early stage)?

Answer 15

periumbilical region (T10)
pain is midline and vague

Question 16

visceral referral pattern of the appendix (late stage)?

Answer 16

localized pain in RUQ (T12)

Question 17

what positive sign is associated with the visceral pattern of the appendix (late stage)?

Answer 17

+McBurney’s sign/pain at McBurney’s point
rebound tenderness

Question 18

+McBurney’s sign and rebound tenderness is associated with what organ visceral referral pattern?

Answer 18

appendix (late stage)

Question 19

+ Murphy’s sign is associated with what organ visceral referral pattern?

Answer 19

gallbladder

Question 20

visceral referral pattern of the colon (large intestine)?

Answer 20

lower abdomen
sigmoid colon involvement causes referral to sacrum (pain)

Question 21

visceral referral pattern of the kidney?

Answer 21

costovertebral angle (low back)
ipsilateral flank
lateral abdomen
lower quadrants
groin

Question 22

visceral referral pattern of the bladder?

Answer 22

midline suprapubic area
lower abdomen
sacral region
perineum

Question 23

describe the pain associated with the visceral referral pattern of the bladder?

Answer 23

deep pressure
cramping