Abdomen and pelvis: visceral pain pathway of the pancreas: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Abdomen and pelvis: visceral pain pathway of the pancreas

Sample item

A patient with an unresectable pancreatic carcinoma has severe constant epigastric pain radiating to the back. A neurolytic block is performed around the coeliac trunk behind the crura. Through which nerves do the pain afferents reach the spinal cord?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Greater and lesser splanchnic nerves

Visceral pain from the pancreas and other foregut organs passes through the coeliac plexus and then through the greater, lesser and least splanchnic sympathetic nerves to the lower thoracic cord (about T5 to T12). Splanchnic nerve or coeliac plexus neurolysis therefore relieves this pain.

Option by option

  • A. Pelvic splanchnic nerves

    Pelvic splanchnic nerves are parasympathetic fibres from S2 to S4 serving the hindgut and pelvic organs.

  • B. Vagus nerves

    The vagus carries parasympathetic and reflex afferents but is not the route for foregut pain.

  • C. Phrenic nerves

    The phrenic nerves supply the diaphragm and refer pain to the shoulder.

  • D. Greater and lesser splanchnic nerves (correct)

    Correct. The thoracic splanchnic nerves carry foregut pain afferents through the coeliac plexus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is D, Greater and lesser splanchnic nerves. Visceral pain from the pancreas and other foregut organs passes through the coeliac plexus and then through the greater, lesser and least splanchnic sympathetic nerves to the lower thoracic cord (about T5 to T12).

Why is "Pelvic splanchnic nerves" not the answer?

Pelvic splanchnic nerves are parasympathetic fibres from S2 to S4 serving the hindgut and pelvic organs.

Why is "Vagus nerves" not the answer?

The vagus carries parasympathetic and reflex afferents but is not the route for foregut pain.

Why is "Phrenic nerves" not the answer?

The phrenic nerves supply the diaphragm and refer pain to the shoulder.

What concept does this question test?

It tests Abdomen and pelvis: visceral pain pathway of the pancreas in Anatomy. Splanchnic nerve or coeliac plexus neurolysis therefore relieves this pain.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Abdomen and pelvis: visceral pain pathway of the pancreas?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.