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Sunday, January 06, 2008

Referred pain may be felt along the inner side of right thigh

018. Referred pain from all of the following conditions may be felt along the inner side of right thigh, except:

1. Inflamed pelvic appendix

2. Inflamed ovaries

3. Stone in pelvic Ureter

4. Pelvic abscess

Answer

4. Pelvic abscess

Reference

Gray 38th Edition Pages 1307, 1866

Das, A manual of clinical Surgery 4th Edition Page 326

Das, A Concise text book of surgery 3rd edition Page 997

Bailey and Love 24th Edition Page 1207

Sabiston 15th Edition Chapter 44

Quality

Confusa

Status

New

QTDF

??

Discussion

Pain felt in one area of the body does not accurately represent where the problem is, because the pain is referred there from another area. Pain can be referred because signals from several areas of the body often travel through the same nerve pathways going to the spinal cord and brain. For example, pain from a heart attack may be felt in the neck, jaws, arms, or abdomen. Pain from a gallbladder attack may be felt in the back of the shoulder.

Explanation

Ä Pelvic Abscess may follow acute pelvic infection, pelvic surgery, septicemia, puerperal endometritis, appendicitis, or peritonitis of any cause. It may be localized in the cul-de-sac or between the leaves of the broad ligament, or it may be tubo-ovarian. If gonorrhea is the primary cause, the purulent exudate usually does not contain the organism, because it is short-lived in such conditions. Secondary organisms such as colon bacilli and anaerobic organisms such as Bacteroides, streptococci, and staphylococci may be present in large quantities. The signs and symptoms of pelvic abscess are elevation of temperature and pulse, pelvic or lower abdominal pain, and leukocytosis. (Sabiston)

Ä Patient will complain of pain in the lower abdomen and run temperature (A manual of clinical Surgery)

Ä The patient may complain of a poorly localized dull abdominal pain. (A Concise text book of surgery)

Ä The most characteristic symptoms of a pelvic abscess are diarrhea and the passage of mucus in the stools.

Comments

All textbooks talk of Ureteric pain being referred to the Inner side of right thigh. However there is little mention about the other two choices given

Tips

Read the topic “pain and Nociception” from Gray (38th Edition Page 1005)

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