A 20-year-old man presents with periumbilical pain of 12 hours duration that has now shifted to the right iliac fossa with localized tenderness at McBurney's point. The early periumbilical pain is explained by visceral afferent fibres from the appendix entering the spinal cord at which segment?

• A T8
• B L1
• C T12
• D T10 ✓

Explanation

Visceral afferents from the appendix travel with sympathetic fibres through the superior mesenteric plexus and enter the spinal cord at about T10, so inflammation of the appendix is initially perceived as vague periumbilical pain at the T10 dermatome. Once the parietal peritoneum overlying the appendix becomes inflamed, somatic afferents in the iliohypogastric and subcostal nerves localize the pain to the right iliac fossa. T12 and L1 correspond to inguinal and suprapubic regions, not the umbilicus.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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