Initially true visceral pain is felt during the first instance of the visceral sensation. Regardless of which viscera the pain originates from (esophagus, duodenum, gallbladder, heart, jejunum, pancreas, spleen, stomach), the location of presentation of the pain is constant (Fig. 24.1). The symptoms are poorly defined and usually described as deep, dull sensation. It can vary from slight to maximal intensity and is characteristically associated with marked autonomic phenomena, such as pallor, profuse sweating, nausea, vomiting, changes in blood pressure and heart rate, diarrhea, and changes in body temperature (Table 24.3).
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