A50yrs old male,with inguinal hernia,presented with dull aching pain around the umbilicus that later descended to the inguinal region.he was diagnosed as a case of strangulated hernia.A.what can be the cause of his initial pain?B.what type of innervation can cause the initial pain (somatic/autonomic)?C.why does the pain shifted to the inguinal region?
A.pain fibers traverse the sup mesenteric sympathetic plexus and pass to the spinal cord via the splanchnic nerves .Referred pain from this segment of GIT is felt in the dermatomes supplied by the 9th 10th ana11th thoracic nerves strangulation of a coil of SI in an inguinal hernia first gives rise to pain in the region of the umbilicus
C. Later when the parietal peritoneum of the hernial sac becomes inflamed does the pain become more intense and localized to inguinal region
