PAIN IN ACUTE AND CHRONIC DISEASES OF THE LIVER

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Abstract
Pain is an important symptom of liver disease, and, depending upon the primary cause, may be mild or marked. Present studies of the innervation of the liver indicate it is supplied by sympathetic fibers arising from T 7-10 bilaterally, the right and left vagus and, in some instances, branches of the right phrenic nerve. The sympathetic is the sole innervation of the blood vessels. The bile ducts are supplied by the sympathetic and parasympathetic as far peripherally as smooth muscle extends. Anatomical and clinical evidence of phrenic afferents within the liver substance, in parts of the liver capsule and in the wall of the gallbladder exists. The distr. of such phrenic afferents may explain shoulder pain experienced in some cases of liver disease. Liver pain is thought to be caused by stretching of the hepatic capsule or traction upon its ligaments. It may also occur as a result of lowering of the pain threshold of intrahepatic nerves by congestion or inflammation. The characteristic pain patterns of a variety of liver diseases are descr.