A 19-year-old man presents with periumbilical pain that later localizes to the right lower quadrant, accompanied by nausea and low-grade fever. Vital signs show temperature 38.2°C, heart rate 92/min, blood pressure 118/76 mmHg, and respiratory rate 16/min. Physical examination reveals tenderness at McBurney point without rebound rigidity. Laboratory studies show WBC 11,200/μL with left shift. Abdominal imaging demonstrates appendiceal wall thickening. Which of the following best explains the initial periumbilical location of this patient's pain?
- A)Visceral afferent fibers from the midgut enter at T10GABARITO
- B)Inflammation of the pudendal nerve
- C)Compression of the ilioinguinal nerve
- D)Somatic innervation from the obturator nerve
- E)Irritation of the phrenic nerve
Explicação
Early appendicitis causes poorly localized periumbilical visceral pain because the appendix is a midgut structure and visceral afferents travel with sympathetic fibers to the T10 spinal level. As the parietal peritoneum becomes inflamed, pain localizes to the ... Ver explicação completa e trilha adaptativa →