aortic aneurysms have been known to rupture with straining, such as dur-
ing defecation. None of the other conditions, a hiatal hernia (answer a),
splenomegaly(answer b),cirrhosis of the liver (answer c),nora horse-
shoe kidney (answer d)would normally pulsate.
411.The answer is c.(Moore and Dalley, pp 223–225.)Most indirect
inguinal hernias are congenital [present at birth; thus not (answers d and e)].
Indirect inguinal hernias recapitulate the passage of the testis through the
abdominal wall, and as such, originate lateral to the inferior epigastric ves-
sels and reopen the process vaginalis if it had ever separated from the peri-
toneal cavity. Large indirect inguinal hernias need to be repaired to prevent
intestinal organs from being strangulated within the inguinal canal and the
process vaginalis needs to be closed to prevent abdominal peritoneal fluid
from accumulating in the scrotum, causing swelling upon increased intra-
abdominal pressure. Only about 1 in 20 inguinal hernias occur in females
[thus not (answers a and b)]; 95% are within males.
412.The answer is d.(Moore and Dalley, pp 276, 279–281.)The major
artery that is going to be reconnected is the marginal artery and the supe-
rior and inferior mesenteric lymph nodes will be collected. About a foot
long section of the splenic flexure along with the marginal artery (of
Drummond) and vein, paracolic lymph nodes and adjacent mesentery
would all be surgically removed. The splenic flexure receives blood from
the marginal artery. Blood from the splenic flexure portion of the marginal
artery comes from both the middle colic artery, which is a branch off the
superior mesenteric artery and from the left colic, which is a branch of the
inferior mesenteric artery. Thus, it is essential to collect lymph nodes from
the base of both the superior mesenteric and inferior mesenteric arteries.
Neither the splenic artery (answers b and c)noraorta(answer a)would
be sectioned. The sigmoid artery (answer e)serves the sigmoid colon and
would remain intact.
413.The answer is b.(Moore and Dalley, pp 212, 298, 300.)The findings
are consistent with hepatomegaly. There are two pieces of physical evi-
dence that point towards an enlarged liver as being the likely cause of the
physical findings. While the liver lies in the upper right quadrant of the
abdomen it is generally fairly well covered by the costal margin. Enlarge-
ment of the liver can be caused by chronic alcohol consumption. In addition,
Abdomen Answers 529