nerve T 6–8 (answer a)would cause a loss of sensation on the upper ante-
rior abdominal wall, but would not cover all the area to which pain is
referred. This would be the second best answer. The lateral epigastric folds
(answer c)are inferior and only house inferior epigastric blood vessels, not
nerves. The coronary ligament (answer d)holds the liver to the undersur-
face of the diaphragm. The lateral arcuate ligaments (answer e)are con-
nective tissue structures on the posterior abdominal wall that allow the
psoas muscles to pass inferiorly. The whipple procedure (performed in this
case) removes the head of the pancreas and much of the duodenum and
attaches the gallbladder to the descending portion of the duodenum to
relieve the back-up of bile.
380.The answer is b.(Moore and Dalley, pp 440–442.)The hematoma
was contained by superficial perineal space. This is a typical “straddle”
injury to the perineum. The blood is collecting in the superficial perineal
space, which houses the erectile tissue and is created by the superficial
membranous fascia (see Moore & Dalley, p 440),which is called Scarpa’s on
the anterior abdominal wall (where it is attached half way up to the rectus
abdominis muscle sheath) and is called Colles’ fascia in the perineum. The
membranous fascia attaches (deep) to the perineal membrane posteriorly
and to the fascia lata of thigh and inguinal ligament. In males the membra-
nous fascia has three names: Scarpa’s (anterior abdominal wall); Dartos on
penis and scrotum and Colles’ on perineum. Following straddle injuries
blood does notenter the inguinal canal (answer e),femoral sheath (answer
d)and ischioanal fossa (answer a).The deep perineal space (answer c)is
deep to the perineal membrane.
381.The answer is c.(Moore and Dalley, pp 528–530.)The lower thoracic
and upper lumbar portion of the spinal cord tend to receive a single major
radicular artery (of Adamkiewicz), which supplies blood to the anterior
longitudinally running spinal artery. The anterior spinal artery mainly sup-
plies the anterior two-thirds of the spinal cord in this region, which
includes motor neurons that control the lower limbs. Because the meta-
bolic needs of the spinal cord nerves are so great, the lack of blood during
the surgery can lead to nerve cell death and thus paraplegia. Both muscle
and peripheral nerves generally can survive the temporary disruption in
blood flow. A process of cooling the spinal cord, by perfusing ice cold saline
into the extradural space (called epidural cooling), is often performed to
518 Anatomy, Histology, and Cell Biology