Answer to Strong but Wrong!
Correct answer is D. The indicated level is approximately where the umbilicus is located. This represents dermatome level T10, but it projects posteriorly to vertebral level L4. Language is important always, and especially so in medicine. Referred pain in the T10 dermatome is consistent with appendicitis, and/or other derivatives of the mid-gut. Hence, it is one of the important dermatomes to recall correctly when students enter a general surgery rotation. The location of the xiphoid process, clearly identifiable above the liver, is approximately at vertebral T9-T10 levels. Referred pain in this region could be indicative of issues with the duodenum or head of the pancreas. Diagnostic tests and treatment approaches would be markedly different based on the discomfort felt by the patient in these two distinct regions.
= Epigastric region
= Transpyloric plane
= Intertubercular plane
= Dermatome T10, but Vertebral level L4
= Hypogastric region
Answer to this question is based on material presented in lectures 7 of the Abdomen Lecture Series.
