Anterior Abdominal Wall MCQs

The posterior vagus nerve gives rise to the criminal nerve of Grassi. This nerve supplies the cardia and fundus of the stomach. It is called a criminal nerve because it is often missed during a vagotomy procedure and can result in recurrent peptic ulcer disease. Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Abdomen, Page number - 158

Superficial epigastric and iliolumbar veins do not help to drain the blood in inferior vena cava (IVC) obstruction as they drain into the IVC itself. Iliolumbar veins drain directly into the IVC and superficial epigastric vein drains via the femoral vein. In IC obstruction, the collateral channels open up to drain the blood from the lower limb into the superior vena cava (SVC) and then to the heart. The main collateral channels are via azygous and hemizygous veins and vertebral venous plexuses. They communicate with the common iliac veins by the ascending lumbar veins and tributaries of the inferior vena cava. Additionally, blood is also drained by inferior epigastric veins > superior epigastric veins > internal thoracic veins > brachiocephalic veins > superior vena cava. Reference-Textbook of Gray's Anatomy for students, 3rd Edition, Thorax, Page number - 180

Ans. is 'c' i.e., Flank [Ref B.D.C. Vol II 6th/e p. 375; Clinical Anatomy - 912] Pain fibers from bladder pass through both parasympathetic and sympathetic pathway and enter T11- L2 and S2- S4 cord segments. Hence referred pain is felt in the lower part of anterior abdominal wall (hypogastrium), upper part of front of thighs, scrotum or labium majus, penis or clitoris, and perineum.

The round ligament of the uterus passes through the deep inguinal ring and runs through the inguinal canal. It is a derivative of the gubernaculum, a structure which pulled the gonads into place during embryonic development. In males, the scrotal ligament is what remains from the gubernaculum. Also keep in mind that, in males, the spermatic cord passes through the deep inguinal ring. Of the other answer choices, the ilioinguinal nerve is the only other one that courses through the inguinal canal. Remember--it leaves through the superficial ring and gives off the anterior labial or scrotal branch as a cutaneous continuation. However, the ilioinguinal nerve does not pass through the deep ring - it enters the inguinal canal on the side. Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Abdomen, Page number - 150

The medial umbilical fold is made by the medial umbilical ligament (the obliterated portion of the umbilical artery), while the lateral umbilical fold is a fold of peritoneum over the inferior epigastric vessels. The median umibilical fold is a midline structure made by the median umbilical ligament (obliterated urachus). The medial inguinal fossa is the space on the inner abdominal wall between the medial umbilical fold and the lateral umbilical fold. This is the place in the abdominal wall where there is an area of weak fascia called the inguinal triangle--direct inguinal hernias can break through this space. The lateral inguinal fossa is a space lateral to the lateral umbilical fold--indirect inguinal hernias push through the deep inguinal ring in this space Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Abdomen, Page number - 150

Explanation: The inguinal lymph nodes are of two types : Superficial inguinal lymph nodes : They are divided into three sets : Lower vertical group : drain the skin and fascia of lower limb Upper lateral group : drain of upper part of thigh, buttocks, flank and back below umbilicus Upper medial group : drain anterior abdominal wall below umbilicus, perineum including external genitalia except glans, the anal canal below pectinate line, vagina below hymen and the penile part of male urethra. Deep inguinal lymph nodes : They receives afferent from The superficial inguinal nodes The popliteal nodes Glans penis or clitoris Deep lymphatics of lower limb accompanying the femoral vessels Key Takeaways: The glans penis (or clitoris) drains primarily to the Deep inguinal lymph nodes , not the superficial inguinal lymph nodes. Level: Difficult

A i.e. Femoral branch of genitofemoral nerve; B i.e. Femoral vein ; C i.e. Psoas major

The ilioinguinal nerve enters the inguinal canal from the side (instead of passing through the deep inguinal ring). It leaves the inguinal canal by passing through the superficial inguinal ring to exit the canal, so it might be injured during inguinal hernia repair. The femoral branch of the genitofemoral nerve travels lateral to the superficial inguinal ring. The iliohypogastric nerve and the subcostal nerve travel superior to the inguinal canal and superficial inguinal ring. Finally, the obturator nerve is a branch of the lumbar plexus which innervates muscles in the thigh. To reach the thigh, this nerve travels deep to the inguinal canal, and it is not involved with this region. Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Abdomen, Page number - 142