Quiz Over Symptoms Of Gallbladder

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  • 1/30 Questions

    A 58-y/o man is admitted to a hospital with severe abdominal pain, nausea, and vomiting resulting in dehydration. Emergency computed tomography (CT) scan reveals a tumor located between the celiac trunk and the superior mesenteric artery. Which of the following structures is likely compressed by this tumor?

    • Fundus of the stomach
    • Neck of the pancreas
    • Transverse colon
    • Hepatopancreatic ampulla
    • Duodenojejunal junction
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Gallbladder Quizzes & Trivia
About This Quiz

This quiz assesses knowledge on gallbladder symptoms, focusing on clinical scenarios involving abdominal pain, gallstones, and related anatomical features. It enhances diagnostic skills, pertinent to medical professionals and students.

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  • 2. 

    During a cholecystectomy (removal of the gall bladder), the surgical resident accidentally jabbed a sharp instrument into the area immediately posterior to the epiploic foramen (its posterior boundary). He was horrified to see the surgical field immediately fill with blood, the source which he knew was the:

    • Aorta

    • Inferior vena cava

    • Portal vein

    • Right renal artery

    • Superior mesenteric vein

    Correct Answer
    A. Inferior vena cava
    Explanation
    The epiploic foramen, also called the omental foramen, is the passageway between the greater and lesser peritoneal sacs. The inferior vena cava lies immediately posterior to this foramen, so this is the vessel that was probably cut. The aorta lies next the inferior vena cava, but it is a little more to the left and a little deeper--it does not lie immediately posterior to the epiploic foramen. The hepatic portal vein is anterior to the epiploic foramen. The right renal artery is a branch off of the aorta. Like the aorta, it is too deep to be a vessel immediately behind the foramen. Finally the superior mesentric vein is anterior to the foramen. Remember, this is one of the two vessels that makes the hepatic portal vein, so if the hepatic portal vein is anterior to the foramen, the SMV should be too. (See Netter's 256 for some relevant pictures)

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  • 3. 

    The boundaries of the inguinal triangle include all except:

    • Arcuate line

    • Inferior epigastric vessels

    • Inguinal ligament

    • Lateral border of rectus abdominus muscle

    Correct Answer
    A. Arcuate line
    Explanation
    The inguinal triangle is the site for direct inguinal hernias. It is defined medially by the lateral border of rectus abdominus, inferiorly by the inguinal ligament, and superiorly by the inferior epigastric artery.

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  • 4. 

    Which is not a boundary of the epiploic (omental) foramen?

    • Aorta

    • Caudate lobe of the liver

    • First part of the duodenum

    • Hepatoduodenal ligament

    Correct Answer
    A. Aorta
    Explanation
    The epiploic (omental) foramen is a passageway between the greater peritoneal sac and the lesser peritoneal sac. It is located posterior to the hepatoduodenal ligament and the first part of the duodenum. The caudate lobe of the liver forms the posterior wall of the epiploic foramen. The aorta is retroperiteoneal, and it does not form a boundary of this foramen

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  • 5. 

    A 41-year-old woman is brought to the ER by her family because of acute onset of right upper quadrant pain, nausea, and vomiting. For this case, it important to remember that the bile duct:

    • Drains bile into the second part of the duodenum

    • Can be blocked by cancer in the body of the pancreas

    • Joins the main pancreatic duct, which carries hormones

    • Is formed by union of the right and left hepatic duct

    • Lies posterior to the portal vein in the right free edge of the lesser omentum

    Correct Answer
    A. Drains bile into the second part of the duodenum
    Explanation
    The bile duct is formed by union of the common hepatic and cystic ducts, lies lateral to the proper hepatic artery and anterior to the portal vein in the right free margin of the lesser omentum, traverses the head of the pancreas, and drains bile into the second part of the duodenum at the greater papilla. The endocrine part of the pancreas secretes the hormones insulin and glucagon, which are transported through the bloodstream. The main pancreatic duct carries pancreatic juice containing enzymes secreted from the exocrine part of the pancreas.

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  • 6. 

    A 43-year-old woman is admitted to a hospital because of deep abdominal pain in her epigastric region. On examination, it is observed that a retroperitoneal infection erodes an artery that runs along the superior border of the pancreas. Which of the following arteries is likely injured?

    • Right gastric artery

    • Left gastroepiploic artery

    • Splenic artery

    • Gastroduodcnal artery

    • Dorsal pancreatic artery

    Correct Answer
    A. Splenic artery
    Explanation
    http://upload.wikimedia.org/wikipedia/commons/3/3b/Gray533.pngThe splenic artery arises from the celiac trunk, runs along the superior border of the pancreas, and enters the spleen through the lienorenal ligament and the hilus of the spleen.
    The right gastric artery runs along the lesser curvature of the stomach, and
    The left gastroepiploic artery runs along the greater curvature of the stomach.
    The gastroduodenal artery runs behind the first part of the duodenum.
    The dorsal pancreatic artery descends behind the neck of the pancreas and divides into right and left branches to supply the pancreas.

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  • 7. 

    A 60-year-old woman arrived at the emergency room complaining of acute abdominal pain. She was diagnosed with ischemic bowel resulting from an obstruction of one or more branches of the inferior mesenteric artery. Which of the following is most likely NOT to be seriously affected by the ischemia?

    • Cecum

    • Descending colon

    • Rectum

    • Sigmoid colon

    • Splenic flexure

    Correct Answer
    A. Cecum
    Explanation
    The inferior mesenteric artery supplies blood to the end of the transverse colon and all distal structures in the GI tract. This means that the splenic flexure, descending colon, sigmoid colon, and rectum would all be deprived of blood if the inferior mesenteric artery was occluded. The cecum receives blood from the superior mesenteric artery, so it would not be affected by the obstruction

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  • 8. 

    Portal hypertension is defined by a hepatic venous pressure gradient (HVPG) greater than 5 mmHg. It is usually caused by an increase in resistance in the portal-hepatic vascular bed due to obstruction to flow, which is related to cirrhosis in the vast majority of patients. Which of the following veins would contribute for by passing this obstruction?

    • Right gastric and esophageal veins

    • Left gastric and esophageal veins

    • Middle rectal and inferior rectal veins

    • Superior rectal and sigmoidal veins

    • Left gastromental and Splenic vein

    Correct Answer
    A. Left gastric and esophageal veins
    Explanation
    The left gastric and esophageal veins would contribute to bypassing the obstruction in portal hypertension. These veins form collateral pathways that allow blood to flow around the obstructed area and relieve the increased pressure in the portal-hepatic vascular bed. This collateral circulation helps to maintain blood flow to the liver and prevent further complications of portal hypertension.

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  • 9. 

    Mucosal necrosis of the rectum usually will not result from occlusion of the inferior mesenteric artery for which of the following reasons?

    • Arterial supply to the rectum is from anastomotic connections from the superior mesenteric artery

    • Arterial supply to the rectum is from the left colic artery with anastomoses to branches of the internal iliac artery

    • The inferior mesenteric artery does not supply the rectum

    • A principal branch of the external iliac artery is a major supplier to the rectum

    • The middle rectal artery, a branch of the internal iliac artery, supplies the rectum

    Correct Answer
    A. The middle rectal artery, a branch of the internal iliac artery, supplies the rectum
    Explanation
    (Moore and Dalley, p 430.) The rectum receives blood from the superior rectal (hemorrhoidal) artery and from the paired middle and inferior rectal arteries. The superior rectal artery is a direct continuation of the inferior mesenteric artery, but the middle and inferior rectal arteries are branches of the internal iliac artery and continue to supply the distal rectum despite occlusion of the inferior mesenteric artery. It should be noted that Sudeck’s point, between the last sigmoidal artery and the rectosigmoid artery, is an area of potentially weak arterial anastomoses, but that is further cranial. The superior mesenteric artery (answer a) distributes arteries to the small intestine right and middle colic arteries, that supply blood as far distal as the splenic flexure of the transverse colon. The left colic artery (answer b) anastomoses with the sigmoidal arteries. The inferior mesenteric artery supplies the superior rectal artery, so answer c is not correct. The principal branch of the external iliac artery is the femoral
    artery (answer e).

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  • 10. 

    Mac, the surgeon, and PC, the anatomist, are fighting about which 1/2 of the liver the caudate and quadrate lobes belong to. What would Mac argue?

    • Right because they’re right of the falciform ligament

    • Right because they’re right of the IVC

    • Left because they’re left of the falciform ligament

    • Left because they’re left of the IVC

    Correct Answer
    A. Left because they’re left of the IVC
    Explanation
    http://upload.wikimedia.org/wikipedia/commons/a/a3/Gray1087-liver.pngSurgeons follow the branchings of the portal triad or hepatic veins to divide the liver into 8 segments. Instead of using the falciform ligament, surgeons draw an imaginary line between the IVC and gallbladder as the division between right and left halves.

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  • 11. 

    A woman presents with gallstones and no jaundice. She is prepared for exploratory surgery. The lesser omentum is incised close to its free edge, and the biliary tree is identified and freed by blunt dissection. The liquid contents of the gallbladder are aspirated with a syringe, the fundus incised, and the stones are removed. The entire duct system is carefully probed for stones, one of which is found to be obstructing a duct. In view of her symptoms, where is the most probable location of the obstruction?

    • The bile duct

    • The common hepatic duct

    • The cystic duct

    • Within the duodenal papilla proximal to the juncture with the pancreatic duct

    • Within the duodenal papilla distal to the juncture with the pancreatic duct

    Correct Answer
    A. The cystic duct
    Explanation
    (Moore and Dalley, p 304.) Obstruction of any portion of the biliary tree will produce symptoms of gallbladder obstruction. If the common hepatic duct (answer b) or bile duct (answer a) is occluded by stone or tumor, biliary stasis with accompanying jaundice occurs. In addition, blockage of the duodenal papilla (of Vater), distal to the juncture of the bile duct with the pancreatic duct (answer e), can lead to complicating pancreatitis. If only the cystic duct is obstructed, jaundice will not occur because bile
    may flow freely from the liver to the duodenum. Bile duct obstruction also may arise as a result of pressure exerted on the duct by an external mass, such as a tumor in the head of the pancreas. Answser d is not anatomically correct.

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  • 12. 

    The presence of which feature (also obvious on a radiograph with barium contrast) distinguishes small from large bowel?

    • Circular folds of the mucosa

    • Circular smooth muscle layer in the wall

    • Mucosal glands

    • Longitudinal smooth muscle layer in the wall

    • Serosa

    Correct Answer
    A. Circular folds of the mucosa
    Explanation
    The small intestine features circular folds of tissue that are covered with villi - these folds are very obvious on a radiograph with barium contrast. The colon does not have similar folds in the mucosa. Some other things that distinguish the small intestine from the large intestine are: 1) The large intestine has 3 strips of longitudinal muscle, called tenia coli, instead of a continuous longitudinal muscle layer the whole way around. 2) The tenia coli are shorter than the colon, so the colon forms bulges, called haustra. 3) The surface of the colon is covered with fatty omental appendages.
    The colon and small intestine share similar circular smooth muscle layers and a serosa. Although the gland structure is different in the colon versus the small intestine, this would not be visible on a radiograph. The same goes for the longitudinal muscle layer - there are differences between the two organs, but not ones that you would see on a barium contrast radiograph.

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  • 13. 

    In order to avoid ischemia induced necrosis of the sigmoid colon in a colonectomy procedure, the surgeon had to understand the circulation around the critical point of Sudek. Which two arteries provide the weak anastomosis around this area?

    • Left Colic and Marginal artery (of Drummond)

    • Marginal artery of Drummond and Inferior mesenteric

    • Sigmoid and superior rectal arteries

    • Inferior rectal and internal pudendal

    • Internal pudendal and Superior mesenteric

    Correct Answer
    A. Sigmoid and superior rectal arteries
    Explanation
    The correct answer is Sigmoid and superior rectal arteries. These two arteries provide a weak anastomosis around the critical point of Sudek, which is important in avoiding ischemia induced necrosis of the sigmoid colon during a colonectomy procedure.

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  • 14. 

    When the sphincter of the bile duct contracts:

    • Bile is propelled into the duodenum

    • Bile is forced into the gallbladder for concentration and storage.

    • Pancreatic juices are prevented from entering the duodenum

    • Bile flow in the common hepatic duct is occluded.

    • Bile flow in the cystic duct is occluded

    Correct Answer
    A. Bile is forced into the gallbladder for concentration and storage.
    Explanation
    When the sphincter of the bile duct contracts, it prevents the flow of bile into the duodenum. Instead, the bile is forced into the gallbladder where it is concentrated and stored for later use. This contraction of the sphincter allows the gallbladder to fill up with bile, which can then be released when needed to aid in the digestion and absorption of fats in the small intestine.

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  • 15. 

    Which of the following is incorrect pertaining to the gall bladder?

    • Some venous drainage is directly into the visceral surface of the liver

    • Cholecystitis can result from an impacted gallstone

    • A gallstone lodged in the cystic duct causes intense spasmodic pain

    • During cholecystectomy surgeons typically ligate the left hepatic artery.

    • The infundibulum of the gall bladder is a pouch that appears between the neck and the cystic duct in diseased states.

    Correct Answer
    A. During cholecystectomy surgeons typically ligate the left hepatic artery.
    Explanation
    The incorrect statement pertaining to the gall bladder is that during cholecystectomy surgeons typically ligate the left hepatic artery. Cholecystectomy is the surgical removal of the gall bladder, and ligating the left hepatic artery during this procedure would not be a standard practice. The left hepatic artery supplies blood to the left lobe of the liver, and ligating it could lead to complications such as liver ischemia.

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  • 16. 

    An oncologist is reviewing a computed tomography (CT) scan of a 74-year-old man with newly diagnosed hepatocellular carcinoma. He locates the affected quadrate lobe of the liver that:

    • Lies between the inferior vena cava and ligamentum venosum

    • Receives blood from the right hepatic artery

    • Drains bile into the left hepatic duct

    • Is a medial superior segment

    • Is functionally a part of the right lobe

    Correct Answer
    A. Drains bile into the left hepatic duct
    Explanation
    http://upload.wikimedia.org/wikipedia/commons/a/a3/Gray1087-liver.pngThe quadrate lobe of the liver drains bile into the left hepatic duct and receives blood from the left hepatic artery. It lies between the gallbladder fossa and the ligamentum teres hepatic, is a medial inferior segment, and is a part of the left lobe.

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  • 17. 

    Volvulus is most likely to occur within segments of the GI tract that are intraperitoneal, not retroperitoneal. Which segments of the GI tract are susceptible to volvulus, and to where does the referred pain of volvulus tend to occur for that segment?

    • Duodenum; epigastric region

    • Jejunum; epigastric region

    • Ascending colon; umbilical region

    • Descending colon; umbilical region

    • Sigmoid colon; suprapubic region

    Correct Answer
    A. Sigmoid colon; suprapubic region
    Explanation
    (Moore and Dalley, pp 277, 257–258.) Volvulus (twisting of the GI tract on itself) which limits movement of material within the lumen and may compromise blood flow occurs most frequently with the jejunum and ileum and the sigmoid colon. These are intraperitoneal segments of the GI tract. The jejunum and ileum are both midgut derivatives and thus refer pain to the periumbilical region [thus not (answer b)]. The sigmoid colon is the most mobile portion of the large bowel and is derived from the hindgut and tends to refer pain to the suprapubic region (especially on the left side) [thus not answers c and d)]. The duodenum (answer a) is retroperitoneal and generally does not undergo volvulus.

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  • 18. 

    In order to approach the area posterior to the stomach, a surgeon decided to go through the lesser omentum. Before incising the mesentery she was careful to find and preserve a nerve lying in the upper portion of the hepatogastric ligament, i.e., the

    • Celiac branch of the anterior vagal trunk

    • Celiac branch of the posterior vagal trunk

    • Greater splanchnic branch to the right suprarenal gland

    • Hepatic branch of the anterior vagal trunk

    • Hepatic branch of the posterior vagal trunk

    Correct Answer
    A. Hepatic branch of the anterior vagal trunk
    Explanation
    The hepatic branch of the anterior vagal trunk travels in the upper portion of the hepatogastric ligament. The posterior vagal trunk supplies a celiac branch deep to the hepatogastric ligament. The greater thoracic splanchnic branches to the suprarenal glands come off the greater thoracic splanchnic nerves as they pass through the diaphragm. Then, the greater thoracic splanchnic nerves continue on to synapse in the celiac ganglia.

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  • 19. 

    Regarding the diaphragm, which, is paired INCORRECTLY?

    • Vertebrocostal trigone - lateral arcuate ligament

    • Esophageal hiatus - right crus

    • Medial arcuate ligament - psoas muscle

    • Central tendon - aortic hiatus

    • Vena caval foramen - right phrenic nerve

    Correct Answer
    A. Central tendon - aortic hiatus
    Explanation
    The aortic hiatus is not in the central tendon of the diaphragm--the caval opening, for the inferior vena cava, is found in the central tendon of the diaphragm. The aortic hiatus is formed by the median arcuate ligament, which unites the two crura of the diaphragm. The vertebrocostal trigone is an area of the diaphragm superior to the lateral arcuate ligament. Here, the diaphragmatic muscle is deficient and the trigone is closed primarily by the inferior and superior fascia of the diaphragm. It is a significant area for hernias. The esophageal hiatus is formed entirely by the fibers of the right crus. The psoas major muscle passes behind the medial arcuate ligament. Finally, the right phrenic nerve passes through the central tendon of the diaphragm, near the vena caval foramen. See Netter Plate 181 for a picture of all these structures and their relationships.

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  • 20. 

    A 19-year-old male suffers a tear to the psoas major muscle during the course of a football game. A scar, which formed on the medial part of the belly of the muscle, involved an adjacent nerve, immediately medial to the muscle. The nerve is called the:

    • Femoral

    • Genitofemoral

    • Iliohypogastric

    • Ilioguinal

    • Obturator

    Correct Answer
    A. Obturator
    Explanation
    The obturator nerve runs along the medial border of the psoas major muscle, eventually passing through the obturator canal to innervate muscles of the medial thigh. So, it might be damaged by an injury to the medial portion of psoas major. The femoral nerve runs along the lateral border of psoas major, where psoas major contacts iliacus. The genitofemoral nerve pierces through psoas major at the level of L3 or L4. The iliohypogastric and ilioinguinal nerves run under psoas major, emerging at the lateral border of psoas major to run over quadratus lumborum. The way to distinguish between these two nerves is to remember that the iliohypogastric is superior to the ilioinguinal nerve.

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  • 21. 

    If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall?

    • Camper's and Scarpa's fascias

    • External abdominal oblique and internal abdominal oblique muscles

    • Internal abdominal oblique and transversus abdominis muscles

    • Skin and deep fascia of the abdominal wall

    • Tranversus abdominis muscle and peritoneum

    Correct Answer
    A. Tranversus abdominis muscle and peritoneum
    Explanation
    The inferior epigastric vessels lay on the inner surface of the transversus abdominis and are covered by parietal peritoneum. Remember, the peritoneum lies over the inferior epigastric vessels to make the lateral umbilical fold. Camper's fascia and Scarpa's fascia are two layers of the superficial fascia - Camper's is the fatty layer and Scarpa's is the membranous layer.

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  • 22. 

    The hepatorenal recess (Morison pouch):

    • Is part of the omental bursa.

    • Is in the subphrenic recess

    • Receives infected fluids draining from the omental bursa in the supine position.

    • Is a potential space in the hepatorenal ligament.

    • Is extraperitoneal

    Correct Answer
    A. Receives infected fluids draining from the omental bursa in the supine position.
    Explanation
    The hepatorenal recess, also known as Morison pouch, is a potential space located between the liver and the right kidney. It is in the subphrenic recess, which is an area beneath the diaphragm. This recess can receive infected fluids draining from the omental bursa when a person is in a supine (lying flat on their back) position. This can occur in conditions such as peritonitis or abscess formation in the abdominal cavity.

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  • 23. 

    The lateral umbilical fold serves as the demarcation for whether an inguinal hernia is direct or indirect. The lateral umbilical fold on each side  of the inner surface of the anterior abdominal wall is created by which of the following underlying structures?

    • Falx inguinalis

    • Inferior epigastric artery

    • Lateral border of the rectus sheath

    • Obliterated umbilical artery

    • Urachus

    Correct Answer
    A. Inferior epigastric artery
    Explanation
    (Moore and Dalley, p 231.) Inferior epigastric artery. The lateral umbilical folds are produced by the underlying inferior epigastric arteries as they course from the external iliac artery in the inguinal region toward the rectus sheath. A direct inguinal hernia starts medial to the lateral ambilical fold and an indirect inguinal hernia starts lateral to the same fold. The medial umbilical folds are peritoneal elevations produced by the obliterated umbilical arteries (answer d). In the midline, the median umbilical ligament is formed by the underlying urachus (answer e), a remnant of the embryonic allantois. The Falx inguinalis (answer a) represents inferomedial attachment of transversus abdominis with some fibers of internal abdominal oblique, also known as: conjoint tendon. The lateral border of the rectus sheath (answer c) forms the medial edge of the inguinal triangle.

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  • 24. 

    You are observing a laparoscopic cholecystectomy. The surgeon states that he is next going to expose the cystic artery in order to staple across it. He asks you where he should look for it. You reply, "In the triangle of Calot." What stuctures form this triangle and are the keys to finding the artery?

    • Common hepatic duct, liver and cystic duct

    • Cystic duct, right hepatic artery and right hepatic duct

    • Gall bladder, liver and common bile duct

    • Left hepatic duct, liver and cystic duct

    • Right branch of portal vein, liver and common bile duct

    Correct Answer
    A. Common hepatic duct, liver and cystic duct
    Explanation
    The triangle of Calot is formed by the cystic duct laterally, the liver superiorly, and the common hepatic duct medially. It is an important landmark in this region, because the cystic artery can be found in the triangle of Calot. During a cholecystectomy, the cystic artery needs to be ligated. Although the cystic artery usually branches from the right hepatic artery, there is some variation. However, if you locate the triangle of Calot, you can find the cystic artery in that triangle, trace it back to its origin, and then ligate it there.

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  • 25. 

    Which of the following is least likely pertaining to an ileal diverticulum (of Merkel)?

    • It occurs near the junction between the jejunum and the ileum.

    • It occurs on the antimesenteric border of the ileum.

    • It may have a cordlike attachment to the umbilicus.

    • If inflamed, it may produce symptoms that mimic those of appendicitis.

    • It may be present in both infants and adults.

    Correct Answer
    A. It occurs near the junction between the jejunum and the ileum.
    Explanation
    The correct answer is "It occurs near the junction between the jejunum and the ileum." This is least likely pertaining to an ileal diverticulum because ileal diverticula are typically found in the ileum, not near the junction between the jejunum and the ileum. The other statements are more likely pertaining to an ileal diverticulum, such as occurring on the antimesenteric border of the ileum, having a cordlike attachment to the umbilicus, potentially causing symptoms similar to appendicitis, and being present in both infants and adults.

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  • 26. 

    A loop of bowel protrudes through the abdominal wall to form a direct inguinal hernia; viewed from the abdominal side, the hernial sac would be found in which region?

    • Deep inguinal ring

    • Lateral inguinal fossa

    • Medial inguinal fossa

    • Superficial inguinal ring

    • Supravesical fossa

    Correct Answer
    A. Medial inguinal fossa
    Explanation
    A direct inguinal hernia passes through the weak fascia in the medial inguinal fossa. This is the area between the medial and lateral umbilical folds (made of the obliterated umbilical artery and inferior epigastric vessels, respectively). A direct inguinal hernia does not pass through the deep inguinal ring or the lateral inguinal fossa--that's what an indirect hernia does. Although it's much more common for an indirect hernia to pass through the superficial inguinal ring, direct hernias could go through this ring too. However, the question is asking you to identify which region the hernia enters on the abdominal side, so superficial inguinal ring is not the correct answer. The supravesicular fossa is between the median and medial umbilical folds--it is formed where the peritoneum reflects from the anterior abdominal wall onto the bladder. Potentially, a very rare external supravesicular hernia could form here.

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  • 27. 

    The part of the male reproductive tract which carries only semen within the prostate gland is the:

    • Prostatic urethra

    • Membranous urethra

    • Seminal vesicle

    • Ductus deferens

    • Ejaculatory duct

    Correct Answer
    A. Ejaculatory duct
    Explanation
    The ejaculatory duct is a duct which courses through the prostate gland and contains only semen. Remember, semen is the combination of sperm from the ductus deferens, seminal fluid from the seminal vesicle, and secretions of the prostate gland. The ejaculatory duct is formed by the union of the duct of the seminal vesicle and the ampulla of the ductus deferens, and it is the site where sperm and seminal fluid mix. The prostatic urethra is also contained in the prostate gland, and it carries semen, but it also carries urine out of the bladder. The membranous urethra is the continuation of the prostatic urethra outside of the prostate gland, and it carries both semen and urine as well. The seminal vesicle is a structure on the posterior surface of the bladder that produces seminal fluid. The ductus deferens is a passageway that carries sperm from the epididymis to the ejaculatory duct.

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  • 28. 

    The nerve supply to the muscles of the anterior abdominal wall:

    • Pierces the peritoneum immediately prior to entering the deep surface of the muscle.

    • Is derived from the sympathetic trunk

    • Travels between the internal oblique and transverses abdominis muscles.

    • Also innervates the diaphragm

    • Is derived from sacral ventral rami

    Correct Answer
    A. Travels between the internal oblique and transverses abdominis muscles.
    Explanation
    The nerve supply to the muscles of the anterior abdominal wall travels between the internal oblique and transversus abdominis muscles.

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  • 29. 

    A 46-year-old bakery worker is admitted to a hospital in acute distress. She has experienced severe abdominal pain, nausea, and vomiting for 2 days. The pain, which is sharp and constant, began in the epigastric region and radiated bilaterally around the chest to just below the scapulas. Subsequently, the pain became localized in the right hypochondrium. The patient, who has a history of similar but milder attacks after hearty meals over the past 5 years, is moderately overweight and the mother of four. Palpation reveals marked tenderness in the right hypochondriac region and some rigidity of the abdominal musculature. An x-ray without contrast medium shows numerous calcified stones in the region of the gallbladder. The patient shows no sign of jaundice (icterus). Diffuse pain referred to the epigastric region and radiating circumferentially around the chest is the result of afferent fibers that travel via which of the following nerves?

    • Greater splanchnic

    • Intercostal

    • Phrenic

    • Vagus

    • Pelvic splanchnics

    Correct Answer
    A. Greater splanchnic
    Explanation
    Moore and Dalley, pp 257–258, 322–323.) Visceral afferent pain fibers from the gallbladder travel through the celiac plexus, thence along the greater splanchnic nerves to levels T5–T9 of the spinal cord. Thus, pain originating from the gallbladder will be referred to (appear as if coming from) the dermatomes served by T5–T9, which include a band from the infrascapular region to the epigastrium. If the gallbladder enlarges sufficiently, then pain could be carried by the phrenic nerve (answer c), but this would refer pain to the neck. Intercostal nerves (answer b) would course above the diaphragm and thus are not involved. The vagus (answer d) generally does not transmit pain information. Pelvic splanchinics (answers e) receive pain information from pelvic organs and thus are not involved.

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  • 30. 

    What is true about the Greater Splanchnic Nerve?

    • Provides sympathetic innervation to the adrenal cortex

    • Receives contributions from spinal levels T4-T9

    • Fibers synapse in the celiac ganglia and contribute to the celiac plexus

    • Modulates the enteric nervous system of the midgut

    Correct Answer
    A. Fibers synapse in the celiac ganglia and contribute to the celiac plexus
    Explanation
    The greater splanchnic nerve provides sympathetic innervation to the adrenal MEDULLA, and receives contributions from spinal levels T5-T9, and modulates the enteric nervous system of the foregut.

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  • Mar 22, 2023
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  • Apr 15, 2012
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    Chachelly

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