reduce the metabolic needs of the spinal nerves, thus often preventing cen-
tral nervous system cell death during the surgical procedure. Muscles
(answer a)and nerves (answer b)of the lower limb can survive reduced
blood flow for an hour. Microemboli would notselectively locate in the
motor cortex (answer d).Bleeding strokes in the motor cortex are unlikely
(answer e).
382.The answer is b.(Moore and Dalley, p 231.)Inferior epigastric artery.
The lateral umbilical folds are produced by the underlying inferior epigas-
tric 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)repre-
sents 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.
383.The answer is b.(Moore and Dalley, pp 191, 284.)The spleen is a
large blood filled organ with a relatively thin capsule that can rupture upon
sudden deceleration, causing bleeding into the peritoneal cavity. Appearing
pale, the positional hypotension and tachycardia would be consistent with
bleeding into the peritoneal cavity, which would lead to generalized
abdominal pain, and guarding (answer c).A ruptured gallbladder does not
fit with the blood loss symptoms. Neither diverticulitis (answer d)nor
hemorrhoids (answer e)would cause the set of symptoms listed. A lace-
rated kidney (answer a)wouldnotbring on the sudden onset of symptoms.
384.The answer is c.(Moore and Dalley, pp 239–241, 264.)The omental
bursa (lesser sac) is the remnant of the right coelomic cavity, which, owing
to rotation of the gut and differential growth of the liver, lies behind the
stomach. A posterior gastric perforation or an inflamed pancreas could lead
to abscess formation in the lesser sac. The right subhepatic space might
become secondarily involved via communication through the omental fora-
men (of Winslow). The pouch of Morison (answer b),which is the combined
Abdomen Answers 519