Which nerve irritated by an inlammed appendix? - USMLE Forums
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Old 08-05-2012
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Default Which nerve irritated by an inlammed appendix?

An 11-year-old boy is brought to the emergency room because of a 3-day history of severe abdominal pain that began in the area around the umbilicus and has localized in the lower right quadrant of the abdomen. There is tenderness and guarding, with some rebound tenderness. During examination, he is noted to have elevation of the right testis. Which of the following nerves is most likely being irritated by an inflamed appendix and causing the elevation of the testis?

a) Anterior scrotal
b) Femoral
c) Genitofemoral
d) Ilioinguinal
e) Obturator
f) Perineal
g) Pudendal
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  #2  
Old 08-05-2012
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C. Genito femoral??

I dont remember testing this component of appendicular pain! will there be time to do such tests I wonder..
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Old 08-05-2012
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i thnk its corrrect ans would b option d
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Default genitofemoral

right testicle elevation seems like a cremaster reflex but as i remember its not involved with appendicitis.
If appendix big enough to irritate cremaster reflex nerves then it can be either sensory fibers of genitofemoral nerve or ilioinguinal nerve.
So my answer would be genitofemoral nerve as its more lateral.
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Ilioinguinal nerve more involved with cremasteric reflex ... option d.
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its genitofemoral.... elevation of testis is due to contraction of dartos muscle innervated by genitofemoral...
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d) Ilioinguinal
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Default correct answer

The answer is c) Genitofemoral

Irritation of the genitofemoral nerve, a complication of appendicitis, might stimulate contraction of the cremaster muscle, with resultant elevation of the testis. The genital branch of the genitofemoral nerve enters the spermatic cord and supplies the skin of the anterior scrotum (or labia majora) and the cremaster muscle, which arises from the internal abdominal oblique muscle and extends along the spermatic cord as part of the cremasteric fascia. The cremaster muscle surrounds the testis and acts to raise and lower the testis in response to changes in temperature or injury. The genitofemoral nerve, a branch of the lumbar plexus, receives contributions from L1 and L2 ventral primary rami. The nerve passes through the substance of the psoas major to course on its anterior surface, leaves the abdomen, and enters the thigh. On the surface of the psoas major, the nerve is susceptible to irritation by the inflamed appendix.
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