11 Lumbar Plexus and Pain

Question 1

What levels innervate the stomach, liver, GB, and pancreas

Answer 1

T6-9

Question 2

What levels innervate the small bowel

Answer 2

T7-10

Question 3

What levels innervate the colon and appendix

Answer 3

T10-11

Question 4

What levels innervate the suprarenal gland

Answer 4

T6-L2

Question 5

What levels innervate the kidney

Answer 5

T10-L1

Question 6

What levels innervate the rectum bladder and uterus

Answer 6

T12-L2(3)

Question 7

Cell bodies of sympathetic presynaptic neurons are only found in

Answer 7

The intermediolateral cell column

Question 8

How do sympathetic nerves exit the spine

Answer 8

White rami ocmmunicans to the sympathetic trunk

Question 9

Where are parasympathetic fibers from

Answer 9

Cranial and S2-4

Question 10

Gastric ulcers show what pattern

Answer 10

Foregut visceral pain

Worse on eating and patient avoids meals

Question 11

Perforated gastric ulcers follow what pattern

Answer 11

Foregut chronic visceral pain and sudden severe pain spreading all over abdomen and signs of generalized peritonitis

Question 12

What is the pattern of acute cholecystitis

Answer 12

Foregut visceral pain, somatic pain in RUQ, referred pain to right shoulder, nausea, vomitting, fever, tender RUQ, positive murphys sign

Question 13

What is the pattern of acute appendicitis

Answer 13

Midgut visceral pain, somatic pain in RLQ, nausea, vomitting, fever, tender RLQ, and if ruptured they will show peritonitis in RLQ

Question 14

What is the pattern for adhesive small bowel obstruction

Answer 14

History of previous abdominal surgery, midgut visceral colicky pain, vomitting, no flatus or bowel action, possible dehydration, distended soft abdomen, non-tender, increased bowel sounds

Question 15

What is the pattern for passage of a kidney stone

Answer 15

Sudden onset of very severe colicky pain from loin to groin, severe back pain, patient writing with pain and pacing about, possible hematuria, afebrile, soft abdomen, tender renal angle

Question 16

What is the pattern for obstructing cancer of descending colon

Answer 16

Older age patient, weight loss, hindgut visceral colicky pain, no flatus or feces, distended abdomen, possible mass in LLQ, increased bowel sounds

Question 17

What is the pattern for an ectopic pregnancy

Answer 17

Women of childbearing age, missed her last menstrual period, sudden onset of severe pain in hypogastrium radiation to sacral area, afebrile, localized peritonitis in suprapubic area, tenderness in rectouterine pouch or vaginal exam

Question 18

What is the pattern for leaking aortic aneurysm

Answer 18

Elderly mail with history of atherosclerotic disease such as HTN or cardiac disease, sudden onset of severe back pain, pale and shocked, hypotensive, tender epigastrium, palpable pulsation