Anatomy
Abdomen
A 29 year old man with HIV presents to ED with a painful blistering rash that has erupted on the skin around the umbilicus. You diagnose shingles. Which of the following spinal nerves supplies this dermatome:
Answer:
The T10 dermatome is located at the level of the umbilicus.Dermatomal Supply of Trunk
Anatomy / Abdomen / Anterior Abdominal Wall / Thorax / Thoracic Wall
Last Updated: 20th February 2019
Table: Dermatomal Supply of the Trunk
| Dermatome | Landmark |
|---|---|
| T1 | Medial antecubital fossa |
| T2 | Apex of axilla |
| T3 | Third intercostal space |
| T4 | Level of nipples (fourth intercostal space) |
| T5 | Fifth intercostal space |
| T6 | Level of xiphisternum |
| T7 | One-quarter distance between xiphisternum and umbilicus |
| T8 | One-half distance between xiphisternum and umbilicus |
| T9 | Three-quarter distance between xiphisternum and umbilicus |
| T10 | Level of umbilicus |
| T11 | Midway between umbilicus and inguinal ligament |
| T12 | Midpoint of inguinal ligament |
![By Grant, John Charles Boileau (An atlas of anatomy, / by regions 1962) [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2016/12/Dermatome-Body-Map-946x1024.png)
Dermatome Map. (Image by Grant, John Charles Boileau (An atlas of anatomy, / by regions 1962) [Public domain], via Wikimedia Commons)
The T3 dermatome is best tested at the midclavicular line and the third intercostal space.
The T4 dermatome is best tested at the midclavicular line and the fourth intercostal space, located at the level of the nipples.
The T5 dermatome is best tested at the midclavicular line and the fifth intercostal space, located midway between the level of the nipples and the level of the xiphisternum.
The T6 dermatome is best tested at the midclavicular line, located at the level of the xiphisternum.
The T7 dermatome is best tested at the midclavicular line, one quarter the distance between the level of the xiphisternum and the level of the umbilicus.
The T8 dermatome is best tested at the midclavicular line, one half the distance between the level of the xiphisternum and the level of the umbilicus.
The T9 dermatome is best tested at the midclavicular line, three quarters of the distance between the level of the xiphisternum and the level of the umbilicus.
The T10 dermatome is best tested at the midclavicular line, located at the level of the umbilicus.
The T11 dermatome is best tested at the midclavicular line, midway between the level of the umbilicus and the inguinal ligament.
The T12 dermatome is best tested at the midclavicular line, over the midpoint of the inguinal ligament.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
