medulla or cortex. There is nosomatic(answer e)innervation by the
adrenal medulla, by definition a visceral organ.
393.The answer is d.(Moore and Dalley, pp 316–318.) The venous
drainage from each adrenal gland tends to be through a single vein. The left
adrenal gland usually drains into the left renal vein superior [thus not
(answers a and b)] to the point where the gonadal vein enters the left renal
vein. The left adrenal vein usually anastomoses with the hemiazygos vein
and may provide an important route of collateral venous return. Left infe-
rior phrenic vein (answer c)and superior mesenteric vein (answer e)has
noconnections with adrenal veins. The right adrenal gland usually drains
directly into the inferior vena cava.
394.The answer is a.(Moore and Dalley, pp 213, 223–225.)A direct
inguinal hernia protrudes through a space bounded superolaterally by the
inferior epigastric vessels, medially by the rectus abdominus muscle, and
superior to the inguinal ligament (Hesselbach’s triangle). The other state-
ments(answers b, c, d, e)are true of an indirect inguinal hernia. A direct
hernia traverses only the most medial part of the inguinal canal and is not
covered by the most internal layers of spermatic cord fascia.
395.The answer is d.(Moore and Dalley, pp 321–324.)The diffuse cen-
tral abdominal pain in the patient presented is probably referred pain
from the loop of small bowel incarcerated within the herniated peritoneal
sac that then undergoes ischemic necrosis. Compression of the bowel
results in compromise of the blood supply and subsequent ischemic
necrosis [thus not (answer e)]. The visceral afferent fibers from the dis-
tal small bowel travel along the blood vessels to reach the superior
mesenteric plexus and lesser splanchnic nerves, which they follow to the
T10–T11 levels of the spinal cord. The pain, therefore, is referred to
(appears as if originating from) the T10–T11 dermatomes, which supply
the umbilical region. Because the gut develops as a midline structure,
visceral pain tends to be centrally located regardless of the adult location
of any particular region of the gut. As a result of dilation (answer c)of
the inguinal canal by the hernial sac, however, the patient also experi-
ences localized somatic pain mediated by the iliohypogastric, ilioinguinal
(answer b),and genitofemoral nerves (answer a),but this was notwhat
the question asked.
Abdomen Answers 523