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Renal > 1.9: Anatomy of Renal Pain and Urinary Incontinence > Flashcards

1.9: Anatomy of Renal Pain and Urinary Incontinence Flashcards

1
Q

What are the functions of the motor nerves in the renal system?

A
  • Ureter Peristalsis
  • Contraction of the detrusor muscle
  • Urethral Sphincter Control
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2
Q

*WAIT FOR DR CUNNIGHAMS REPLY BEFORE FINALISING THIS CARD

Describe the urethral sphincters in males and females?

A

Males have an internal urethral sphincter and an external urethral sphincter

Females just have an external urethral sphincter

The males internal urethral sphincter is to prevent retrograde ejaculation (sperm entering bladder)

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3
Q

What is the function of the sensory nerves in the renal system?

A

These transmit pain from the:

  • Kidneys
  • Bladder
  • Ureters
  • Urethra
  • Testis (not technically in renal system)
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4
Q

What is the function of the motor and sensory nerves in urinary continence?

A

The motor and sensory nerves allow for the voluntary control of elimination of urine from the bladder

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5
Q

What is the function of the lumbar and sacral plexus in the renal system?

A

This is the motor and sensory nerve supply to the perineum and the lower limb

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6
Q

Nerve fibres can be split into two broad categories. Name these?

They can be further split into 5 categories. Name these?

A

Sensory nerves

Motor Nerves

Somatic Sensory

Visceral Afferent Nerve Fibres

Somatic Motor

Parasympathetic

Sympathetic

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7
Q

Describe somatic sensory nerve fibres?

A

This conveys information from the body wall (soma) about our external environment to the CNS

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8
Q

Describe visceral afferent nerve fibres?

A

These convey information from our organs (Our internal environment) to the CNS

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9
Q

Describe somatic motor nerve fibres?

A

Motor responses to our body wall (soma) are conveyed from the CNS by somatic motor nerve fibres

They stimulate skeletal muscle (voluntary) to contract

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10
Q

Describe sympathetic nerve fibres?

A

Motor responses to our organs (the internal environment) are conveyed from CNS via the sympathetic nerve fibres

This stimulates smooth muscle (involuntary), cardiac muscle and glands

Sympathetic - Fight or flight

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11
Q

Describe parasympathetic nerve fibres?

A

Motor responses to our organs (internal environment) is conveyed from the CNS by parasympathetic nerve fibres

Stimulates smooth muscle (involuntary), cardiac muscle and glands

Parasympathetic = Feed and Breed

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12
Q

Which type of nerve fibres control ureteric peristalsis?

Which type of nerve fibres control detrusor muscle contraction?

Which type of nerve fibres control urethral control?

(Internal urethral sphincter, external sphincter and levator ani)

A

Sympathetic/Parasympathetic (motor) - autonomic

Sympathetic/Parasympathetic (motor) - autonomomic

Internal Urethral Sphincter = Sympathetic/Parasympathetic - autonomic

External Sphincter and Levator Ani (Voluntary) = Somatic Motor

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13
Q

Which type of nerve fibres carry pain sensations from the:

  • Kidney
  • Ureter
  • Bladder
  • Urethra
  • Testis
A

Kidney = Visceral Afferent (Sensory)

Ureter = Visceral Afferent (Sensory)

Bladder = Visceral Afferent (Sensory)

Urethra = Visceral Afferent (Sensory) AND Somatic Sensory (when in perineum)

Testis = Mainly visceral afferent but some somatic sensory

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14
Q

Describe the nerve fibres invovled in urinary continence?

A

Sympathetic/Parasympathetic (Autonomic)

Visceral Afferent

Somatic Motor (Voluntary)

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15
Q

Match the type of nerve fibres to the type of muscles:

  • Parasympathetic/Sympathetic
  • Somatic Motor
    1. Involuntary
    2. Voluntary
A

Parasympathetic/sympathetic are part of the autonomic nervous system and they innervate involuntary (smooth) muscle

Somatic motor innervates voluntary skeletal muscle

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16
Q

Describe the nerve fibres of the lumbar and sacral plexus?

A

Somatic Motor

Somatic Sensory

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17
Q

How many pairs of cranial nerves are there?

How many pairs of spinal nerves are there?

A

12 cranial nerves

31 spinal nerves

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18
Q

The nerve fibres can only communicate with the CNS by travelling in the cranial nerves.

True or False?

A

False.

The nerve fibres can only communicate with the CNS by travelling in the cranial nerves OR the spinal nerves

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19
Q

The nerve fibres travel in the cranial nerves or the spinal nerves to communicate with the CNS.

For how long are the somatic motor and somatic sensory carried?

For how long are the autonomic and visceral afferent nerves carried?

A

Somatic Motor and Somatic sensory are carried the entire length (from origin to destination) in these nerves

Autonomic (Parasympathetic and Sympathetic) and visceral afferent are carried for just a short time

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20
Q

Where do the sympathetic nerve fibres leave the CNS?

A

Within the spinal nerve fibres of T1-L2

(Thoracolumbar outflow)

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21
Q

Where does the sympathethic chain run from?

A

Runs the entire length of the vertebral column, from cervical to sacral

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22
Q

Describe how sympathetic nerve fibres get from the CNS to the smooth muscle and glands BODY WALL?

A

Exit the CNS in the spinal nerve fibres

Enter the sympathetic chain via rami communicans

The nerve fibres leave the sympathetic chain via one of the 31 pairs of spinal nerves

Follows spinal nerve to the body wall

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23
Q

Describe how sympathetic nerve fibres get from the CNS to the smooth muscle/glands of the BODY (not including body wall)?

A

Leave CNS in the spinal nerves

Enter sympathetic chain via rami communicans

Leave sympathetic chain in splanchnic nerves (either cardiopulmonary or adominopelvis)

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24
Q

Describe how sympathetic nerve fibres get from the CNS to the smooth muscle and glands of the HEAD?

A

Exit CNS in spinal nerves

Enter sympathetic chain

Exit sympathetic chain

Follow arteries that supply head (hitch a ride)

Eg: Internal Carotid Plexus

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25
Q

How do the sympathetic nerve fibres get from the CNS to the:

  • BODY WALL?
  • BODY?
  • HEAD?
A

Body Wall = In spinal nerves

Body = Splanchnic Nerves

Head = Follow arteries (hitch a ride)

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26
Q

What is containd in the spinal nerves?

A
  • Somatic Motor
  • Somatic Sensory
  • Sympathetic fibres (that innervate the smooth muscle and the glands of the body wall)
27
Q

Describe, in detail, how the sympathetic nerves get from the CNS to the kidneys, ureters and bladder?

A

Leave the CNS at T12-L2

Enter the sympathetic chain (do not synapse)

Leave the sympathetic chain in the abdominopelvic splanchnic nerves (Still presynaptic fibres)

Synapse at the abdominal sympathetic ganglia around the abdominal aorta

Postsynaptic sympathetic nerve fibres pass onto the surface of arteries that supply these organs (Called a peri-arterial plexus)

Eg: Renal Artery

28
Q

Describe the difference between the cardiopulmonary splanchnic nerves and abdominopelvic splanchnic nerves?

(Sympathetic)

A

Cardiopulmonary splanchic nerves carry postsynpatic nerve fibres (they synapse in the sympathetic chain)

Abdominopelvic splanchinc nerves carry pre-synaptic nerve fibres (Don’t synapse in sympathetic chain, they synapse at the abdominal sympathetic ganglia

29
Q

How many sympathetic chains are there?

Where are the sympathetic chains?

What are the communicating branches between spinal nerves and sympathetic chains called?

A

There are two sympathetic chains - left and right

They are found on either side of the vertebral column from cervical to sacral region

These connections between spinal nerves and the sympathetic chains are called the Rami Communicans

30
Q

Describe the peri-arterial plexus that supplies the kidneys, ureter, bladder etc.? (SYMPATHETIC)

A

Presynaptic sympathetic nerve fibres carried to abdominal ganglia by abdominopelvic splanchnic nerves

Synapse at abdominal sympathetic ganglia

Post-synaptic sympathetic nerve fibres pass onto the surface of the arteries that supply these organs (Eg: Renal artery)

Form a peri-arterial plexus

Yellow = Abdominal sympathetic ganglia

Green = Peri-arterial plexus

31
Q

How do parasympathetic nerve fibres leave the CNS?

A

They leave within 4 cranial nerves:

  • 3 (Oculomotor)
  • 7 (Facial)
  • 9 (Glossopharyngeal)
  • 10 (Vagus)

and at the sacral spinal nerves (S2, S3, S4)

So it is called CRANIO-SACRAL OUTPUT

32
Q

How do parasympathetic nerve fibres reach the smooth muscle/glands/organs of the body and the head?

A

Via the cranial nerves and the sacrospinal nerves

33
Q

How do parasympathetic nerve fibres reach the smooth muscles, glands and organs of the pelvis and hindgut?

A

Via the pelvic splanchnic nerves from the sacrospinal nerves

They are carried very briefly within the sacrospinal nerves

34
Q

Match the splanchnic nerve to the type of nerve?

  • Pelvic
  • Abdominal

A) Parasympathetic

B) Sympathetic

A

Pelvic = Parasympathetic

Abdominal (Abdominopelvic) = Sympathetic

35
Q

What is the cranial nerve for parasympathetic supply to the renal system?

Which supplies:

  • Kidneys?
  • Ureter?
  • Bladder?
A

Vagus

Sacrospinal nerves important too

Kidney = Vagus

Ureter = Vagus

Bladder = Sacrospinal (Pelvic Splanchnic Nerve)

36
Q

How do somatic motor nerve fibres get from the CNS to the kidneys, bladder and ureters?

A

Kidney, bladder and ureters are all visceral organs so don’t recieve supply from somatic motor nerve fibres

The only part to recieve this supply is the distal part of the urethra and the perineum

37
Q

Describe the nerve supply to the external urethral sphincter?

A

Somatic Motor Nerve Supply

S2, S3 and S4 converge to form the Pundendal Nerve

38
Q

What is the only part of the renal system supplied by the somatic motor nerves?

A

The perineum

  • Distal Urethra
  • External Urethral sphincter
  • Levator ani
39
Q

What nerve fibres cause bladder contraction?

A

Parasympathetic fibres (From S2, S3, S4 pelvic splanchnic nerve) stimulate the detrusor muscle

40
Q

What nerve fibres cause internal urethral sphincter contraction (in males)?

What nerve fibres cause internal urethral sphincter relaxation (in males)?

A

Sympathetic fibres stimulate the internal urethral sphincter to contract

Parasympathetic fibres cause internal urethral sphincter relaxation

41
Q

What nerve fibres cause exteranl urethral sphincter contraction?

What nerve fibres cause levator ani contraction?

A

Somatic motor nerves within the Pudendal nerve (From S2, S3, S4) stimulate the external urethral sphincter to contract

Somatic motor nerves within the nerve to the levator ani muscle (S3, S4) stimulate the levator ani to contract

42
Q

Where is kidney pain felt?
Where is ureter pain felt?

Where is bladder pain felt?

Where is urethral pain felt?

A

Kidney Pain = ‘Loin’ (Posterior aspect of flank) - BACK

Ureter Pain = ‘Loin to groin’ (Back to front)

Bladder pain = Suprapubic region

Urethral = Localised in perineum

43
Q

How do visceral afferent nerve fibres get from the kidney to the CNS?

Describe why kidney pain is felt at a certain location?

A

Visceral affernet leaving the kidneys run alongside sympathetic nerve fibres

Enter the spinal cord at T11 - L1

Patient feels pain in these dermatomes (Eg; The loin)

44
Q

How do visceral afferent fibres get from the ureters to the CNS?

A

Visceral afferent fibres from ureters run alongside sympathetic fibres back to the CNS

Enter betwee T11 and L2

45
Q

How do visceral afferent fibres get from the:

  • Superior
  • Rest

of the bladder back to the CNS?

A

Visceral afferent fibres from the superior part of the bladder run alongside sympathetic fibres

Enter spinal cord at T11-L2

Pain is suprapubic

Visceral afferent nerve fibres from the rest of the bladdder run alongside parasympathetic fibres
Enter CNS at S2, S3, S4

46
Q

Describe the route of visceral afferent fibres to the CNS from:

  • Kidneys
  • Ureters
  • Bladder (Superior and Inferior)
  • Proximal Urethra
A

Kidneys: Follows sympathetic, T11-L1

Ureters: Follow sympathetic, T11-L2

Superior Bladder: Follow sympathetic, T11-L2

Inferior Bladder: Follow parasympathetic, S2, S3, S4

Proximal Urethra: Follow parasympathetic S2, S3, S4

47
Q

How do visceral afferent fibres get from the proximal urethra to the CNS?

How do somatic sensory fibres get from the distal urethra to the CNS?

A

Visceral Afferent: Follow parasympathetic, S2, S3, S4

Somatic Sensory: Carried in pudendal nerve to S2, S3, S4

48
Q

What part of the renal system has visceral afferent supply for pain?

Which part of the renal system has somatic sensory for pain?

A

Visceral Afferent = Kidneys, Ureter, Bladder, Proximal Urethral

Somatic Sensory = Distal Urethra

49
Q

How do pain fibres get from the testis to the CNS?

A

Visceral afferents run alongside the spinal cords

Enters at T10-T11

Due to embryological origins

50
Q

What part of the renal system is the pain coming from:

  • Dull, achy pain in loin?
  • Loin to groin pain?
  • Dull, achy, suprapubic pain?
  • Localised, sharp pain in perineum?
  • Scrotum pain/groin pain/lower abdominal pain?
A

Dull achy pain in loin = Kidney

Loin to groin pain = Ureter

Dull, achy, suprapubinc pain = Bladder

Localised sharp pain in perinuem = Distal Urethra

Scrotumm pain/groin pain/lower abdo pain = Testis

51
Q

What are the important nerves in controlling urine flow?

A

S2, S3, S4

52
Q

What nerves sense the stretch in the bladder (from filling)?

Where do these enter the CNS?

A

Visceral afferent nerves detect stretch in the bladder

They enter the CNS at S2, S3, S4

53
Q

Describe the control of urine flow (When it is appropriate to urinate)

A

Parasympathetic innervation causes detrusor muscle contraction

Parasympathetic innervation causes internal urethral sphincter relaxation

Somatic motor nerves causes external urethral sphincter relaxation

54
Q

What is the pudendal nerve composed from?

Which plexus do these nerves come from?

A

S2, S3, S4 (spinal nerves)

From the lumbo-sacral plexus

55
Q

What is contained within the lumbo-sacral plexus?

A

Somatic Motor

Somatic Sensory

Sympathetic Nerve fibres to lower limb

56
Q

Which nerve can be described as the ‘nerve of the perineum’?

A

The Pudendal Nerve

57
Q

What does the pundendal nerve carry?

What region does the pundendal nerve supply?

A

Carries somatic motor, somatic sensory and sympathetic to the arterioles/hair follicles/glands

Supplies the perineum

58
Q

The sacrolumbar plexus gives rise to a number of named nerves that supply the lower limb.

Name the three main ones that supply the thigh?

A

Femoral

Obturator

Sciatic

59
Q

Where does the femoral nerve come from?

Where does it supply?

A

Comes from L2, L3, L4

Supplies anterior compartment of thigh

60
Q

Where does the obturator nerve come from?

What does it supply?

A

L2, L3, L4

Supplies medial compartment of thigh

61
Q

Where does the sciatic nerve come from?

Where does it supply?

A

L4 - S3

Posterior Compartment of the thigh

62
Q

What supplies the lateral skin of the thigh?

A

Lateral Cutaneous Nerve of the thigh

63
Q

Label this diagram (A–F)?

A

A = Lateral Cutaneous Nerve of the Thigh

B = Obturator

C = Femoral

D = Sciatic

E = Posterior Cutaneous Nerve of Thigh

F = Sciatic

64
Q

What are the branches of the sciatic nerve?

A

Tibial

Common Fibular

Renal (34 decks)

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