1. Based on the article, Abdominal Pain (listed below), list the three types of visceral
pain and briefly describe the differences between each type of pain.
Ischemic Pain:
The identification of ischemic pain patterns is of utmost importance in order to mitigate
severe and even life-threatening consequences. Fortunately, the sensation of ischemia discomfort
seems to manifest similarly as it would in any other anatomical region. According to Saccomano
and Ferrara (2013), the onset of the phenomenon is abrupt, characterized by high intensity,
prolonged duration, and progressive deterioration. A further diagnostic indicator is the lack of
relief with analgesic medications, in contrast to other forms of gastric discomfort (Miller &
Alpert, 2006). Obstruction-related strangulation of the colon is the primary etiology for ischemic
abdominal pain in the majority of cases. When encountering ischemic pain, it is imperative to
evaluate the possibility of mesenteric artery infarction as an additional etiology for abdominal
ischemic discomfort.
Tension Pain:
Tension discomfort, also called colic, is commonly attributed to an elevation in the
intensity of peristaltic contractions. This discomfort typically arises when the colon attempts to
expel a substance that elicits irritation (Miller & Alpert, 2006). The above substances encompass
pungent edibles, lactose, and pathogens like bacteria, viruses, or parasites. Individuals may
inadvertently or intentionally ingest non-edible items, leading to gastrointestinal pain as the
stomach attempts to eliminate the foreign material.
Inflammatory Pain:
Inflammatory pain initially manifests as a profound and inadequately localized sensation
of discomfort. In contrast to tension discomfort, visceral peritoneal inflammation typically

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represents the primary etiology. The initial perception of pain caused by the innervation of the
visceral peritoneum by type C fibers is characterized by its deep, indistinct, and challenging to
localize nature. In some instances, the pain may even be experienced in a distant location, a
phenomenon known as referred pain (Miller & Alpert, 2006). Nevertheless, without appropriate
medical intervention, the inflammatory response will escalate, leading to detrimental effects on
the parietal peritoneum. The localization of pain to the appropriate anatomical location occurs
due to the innervation of the parietal peritoneum by type A delta fibers. Appendicitis pain
represents a prevalent manifestation of inflammatory abdominal pain.

2. List and briefly describe the two additional physical exam techniques that can be
performed to assess for ascites. (Ball, 2023). (This is a book) see the ball zip file.
Shifting Dullness: In this approach, the patient is placed supine. The examination begins with
auscultation and percussion of the abdomen. When the patient is lying on the side, which is close
to the bed, and has ascites, there will be dullness because of free accumulating fluid. In
particular, on the upper side (away from the bed), resonating will be detected (Ball et al., 2023).
The dullness and resonance shift when the patient is turned to the opposite side is evidence of
ascites.
Fluid thrill: This approach involves asking an assistant to place the corner of his/her hand or
fingers against the midline on the patient's supine position. Next, the examiner taps the other side
of the patient's abdomen as he or she palpates the other side. Free fluid in the abdomen will result
in a fluid wave; it will be transmitted through the abdominal wall, and it can be palpated on the
opposite side, confirming that ascites are present.

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3. Genetic information can be used to diagnose conditions and identify asymptomatic
family members so that necessary screening can be implemented. For GI conditions
such as APC syndrome, HNPCC, and hereditary hemochromatosis, are commercial
tests available, and are they recommended for screening? (Roath & Palma, 2012).
APC syndrome genetic testing is commercially available. The assays focus on the APC
gene, which is linked to FAP. Genetic testing is advised for persons with a family history of FAP
or relevant clinical symptoms. Commercial testing identifies APC gene mutations quickly,
enabling diagnosis. Early detection allows for appropriate surveillance and preventive measures
(Roath & Palma, 2012). Management of at-risk patients and family members is crucial.
Lynch Syndrome, also known as Hereditary Nonpolyposis Colorectal Cancer (HNPCC),
increases the risk of getting colon cancer. Comme