Page 131 - BSAVA Guide to Pain Management in Small Animal Practice

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Abdominal pain

Caroline Kisielewicz

Pain of viscera in the abdominal or pelvic cavities Multiple physiological mechanisms are
results from the activation of nociceptors within involved with the development of referred pain,
the organs. Stimuli that can result in visceral pain which are beyond the scope of this chapter.
include distension of hollow organs, traction on There are several abdominal conditions, such
the mesentery, ischaemia and endogenous as pancreatitis and peritonitis, which cause
in ammatory mediators. As a result of the various abdominal pain in dogs and cats. This
stimuli that can be involved in inducing visceral assessment is based on extrapolation from
pain, it is possible that this pain can occur humans, where it is recognized that these
without signi cant visceral in ury or obvious conditions are painful, as well as clinical
pathology. There is also a poor correlation assessment of the a ected animal. Abdominal
between the degree of visceral pathology and pain is under diagnosed in animals for a number
the intensity of pain in some cases; for example, of reasons including di culties in communication
intestinal ulceration or perforation can occur with with the patient, not recognizing clinical signs
minimal or no pain. Certain viscera, such as the associated with pain, variation in individual
liver and kidneys, appear relatively insensitive to tolerances to pain, and severity of the disease.
stimulation; however, their capsules do have Inadequate management of pain can have a
nociceptors that are sensitive to in ammatory ma or negative impact on the recovery of
mediators and distension. animals and their welfare. It is recognized in
Visceral pain is typically di use and poorly humans that abdominal pain can result from any
locali ed, partly due to sparse visceral a erent of over conditions. Abdominal visceral pain
innervation relative to somatic innervation. can result from neoplastic in ltration, infection,
Visceral pain can be referred and perceived in a in ammation, rupture or perforation, obstruction,
somatic area. Clinically, abdominal pain can be torsion and ischaemia or infarction of any of the
confused with spinal or back pain and vice abdominal or pelvic organs as well as metabolic
versa, likely as a result of referred pain. or endocrine disease.
Referred pain occurs particularly when the Abdominal visceral pain is associated with
process in the viscus inducing the pain is strong emotional and autonomic responses and
intense and long-lasting or recurs frequently. so can occur in con unction with other clinical

126 BSAVA Guide to Pain Management in Small Animal Practice. Edited by Ian Self. ©BSAVA 2019

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