8: Anatomy - pain and urinary continence Flashcards by Ross Wilson

What are the five types of nerve fibre?

Somatic sensory

Somatic motor

Visceral afferents / sensory

Sympathetic

Parasympathetic

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What are the two types of sensory nerve?

Somatic sensory

Visceral afferent

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What are the three types of motor nerve?

Somatic motor

Sympathetic

Parasympathetic

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Which type of nerve receives sensation from the body wall?

Somatic sensory

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Which type of nerve receives sensation from the internal organs?

Visceral afferent

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What type of nerve innervates skeletal muscle?

Somatic motor

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What types of nerves send motor impulses to the internal organs?

Sympathetic

Parasympathetic

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Which nerves control peristalsis of the ureters and contraction of the bladder?

Sympathetic

Parasympathetic

motor to internal organs

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Which nerves control the

a) internal urethral sphincter in males
b) external urethral sphincter and levator ani?

a) Sympathetic / parasympathetic (internal organs)

b) Somatic motor (as they’re in the perineum)

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Which nerves pick up sensation from the kidneys, ureters, bladder, testes and pelvic urethra?

Visceral afferents

The distal urethra, found in the perineum, has a somatic sensory innervation

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Which nerves are found in the lumbar and sacral plexuses?

Somatic sensory

Somatic motor

supplying perineum and lower limbs

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How many pairs of cranial nerves are there?

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At which levels do sympathetic nerves leave the spinal cord?

T1 - L2

THORACOLUMBAR OUTFLOW

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Where do sympathetic nerves leave the spinal cord?

Anterior horns

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Where do sympathetic nerves synapse after leaving the spinal cord from T1 - L2?

Sympathetic chain

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Where can post-synaptic sympathetic nerves travel?

Up and down the full length of the spinal cord

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Every spinal level has a ___ for post-synaptic sympathetic nerves.

What is the exception?

ganglion

Head and neck - superior, middle and inferior cervical ganglia

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How do post-synaptic sympathetic nerves travel to organs in the

a) head and neck
b) thorax
c) abdomen?

a) Periarterial plexuses

b) Cardiopulmonary splanchnic nerves

c) Abdominopelvic splanchnic nerves

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What are the two types of sympathetic splanchnic nerve?

a) Cardiopulmonary splanchnic nerve

b) Abdominopelvic splanchnic nerve

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How do post-synaptic sympathetic nerves reach the organs of the head and neck?

Hitch a ride on arteries

Periarterial plexuses

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Where does the spinal cord end?

Conus medullaris, then cauda equina to S1

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The sympathetic chains run along how much of the vertebral column?

The whole thing

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How do sympathetic nerve fibres get to the kidneys, ureters and bladder?

Abdominopelvic splanchnic nerves

synapsing at abdominal sympathetic ganglia on the way

then passing along periarterial plexuses

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Which cranial nerves do parasympathetic nerves come from?

Where else do they come from?

CN III, VII, IX and X

oculomotor, facial, glossopharyngeal and vagus nerves

Sacral spinal nerves

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Keeping in mind where **parasympathetic nerves** come from, what is their outflow called?

**Craniosacral outflow**

How do parasympathetic nerves reach the pelvic organs?

**Pelvic splanchnic nerves**

What is the difference between **pelvic** and **abdominopelvic splanchnic nerves**?

**Pelvic** - parasympathetic, come from sacral spinal nerves **Abdominopelvic** - sympathetic, come from all over the place

Which parasympathetic nerves supplies the a) **kidneys and ureters** b) **bladder**?

**a) Vagus nerve CN X** **b)** **S2 - 4**

What pelvic organs are supplied by the a) sacral spinal nerves b) vagus nerve?

**a) Bladder** **b) Kidneys and ureters**

Which spinal nerves supply the pudendal nerve?

**S2, 3, 4**

What organs do **somatic sensory** fibres supply?

**None** supply body wall only

What aspect of the skin is supplied by pelvic somatic sensory nerves?

**Perineum**

What renal structures are supplied by somatic sensory fibres?

**Distal urethra** **External urethral sphincter**

What fibres do **visceral afferents** run alongside?

**Sympathetic fibres** OR **Parasympathetic fibres** depending on where they are

What can happen when visceral afferents plug in to specific spinal nerves?

**Referred pain**

What is pain arising from the **kidneys** felt?

**Loin** Posterior flank on the affected side

What is pain arising from the **bladder** usually felt?

**Suprapubic region** in the midline

Where is pain felt when a **renal calculus** obstructs the ureter?

**Radiating pain from LOIN to GROIN** on affected side

Where is **urethral** pain felt?

**Perineum**

Which organs are affected if pain is felt in the a) **loin** b) **loin radiating to the groin** c) **suprapubic area** d) **perineum**?

a) **kidneys** b) **ureters** c) **bladder** d) **urethra**

Why is kidney pain felt in the loin?

**Travel alongside sympathetic fibres and plug into spine at T11 - L1 dermatomes** Which are posterior flanks

Why is ureter pain felt between the loin and groin?

**Visceral afferents travel alongside sympathetics and plug into spinal cord between T11 - L2** i.e posterior flanks and suprapubic

Visceral afferents supplying the **bladder** run alongside ___ nerves for the **inferior** aspect and ___ nerves for the **superior** aspect.

**run alongside _sympathetic_ nerves** **for superior aspect** ## Footnote **run alongside _parasympathetic_ nerves for inferior aspect**

Visceral afferents supplying the urethra run alongside ___ nerves to plug into the spinal cord.

**parasympathetic nerves** i.e sympathetic nerves until halfway down bladder, then parasympathetic nerves EXCEPT the testes, because they originate from the abdomen (sympathetic nerves)

Which nerve do **somatic sensory** nerves supplying the distal urethra travel in?

**Pudendal nerve** **S2,3,4**

The **visceral afferents** supplying the testes run alongside ___ fibres to reach the spinal cord.

**sympathetic**

Where can testicular pain be felt?

**Groin** **Scrotum** (if it's affected)

Which autonomic nerves do **visceral afferents** supplying the a) testes b) superior bladder c) proximal urethra d) ureters e) inferior bladder f) distal urethra run alongside to reach the spinal cord?

**a) Sympathetic** **b) Sympathetic** **c) Parasympathetic** **d) Sympathetic** **e) Parasympathetic** **f****) Distal urethra is supplied by somatic sensory, which plug into pudendal nerve**

How does a) visceral b) somatic pain feel?

**a) Dull, achey** **b) Sharp, stabbing**

What is **micturition**?

**Urination**

Which spinal nerves are vital in controlling **micturition**?

**S2, 3, 4**

Where do **visceral afferents** from the proximal urethra enter the spinal cord?

**S2,3,4**

Where does the **pudendal nerve** originate from? What type of nerve does it carry?

**S2,3,4** **Somatic motor** (to MOVE the levator ani, open external urethral / anal sphincters etc.)

Where do **pelvic splanchnic nerves** exit the spinal cord? What type of nerve do they contain?

**S2,3,4** **Parasympathetic nerves**

What types of nerve plug in to or leave **S2, 3 and 4**?

**Parasympathetic** via pelvic splanchnic nerves **Somatic sensory** from proximal urethra **Somatic motor** in pudendal nerve, supplying external urethral sphincter, levator ani

What are the important spinal levels for **micturition**?

**S2 - S4**

What is **urinary continence**?

**Ability to control flow of urine**

What is **potty training**?

**Ability to inhibit natural emptying of the bladder when it is stretched**

Which fibres detect **stretching** of the bladder?

**Visceral afferent fibres**

Which spinal levels do **visceral afferents** from the bladder plug into?

**S2 - S4**

Which muscle **constricts** to empty the bladder after an unopposed stretch reflex?

**Detrusor** **muscle**

Which autonomic fibres control the contraction of the detrusor muscle and the opening of the internal urethral sphincter in males?

**Parasympathetic**

Which fibres control the **opening of the external urethral sphincter** and **relaxation of the levator ani muscle**?

**Somatic motor** via the **pudendal nerve**

Which abdominal muscles contract to increase micturition? Which nerve fibres are involved?

**Anterolateral abdominal muscles** Somatic motor

What is formed by the tons of nerves which are found in the abdomen and pelvis?

Lumbar plexus Sacral plexus forming **Lumbosacral plexus**

Which spinal nerves are involved in the lumbosacral plexus?

**L1 - S4** Remember brachial plexus (C5 - T1)

What is the big thick nerve which arises from the sacral plexus at **L4 - S3**?

**Sciatic nerve**

The nerves of the sacral plexus have a close association with which muscle?

**Psoas major**

Which nerves of the lumbar plexus come from **L1**?

**Iliohypogastric nerve** (L1) **Ilioinguinal nerve** (L1)

Which nerve of the lumbar plexus arises from L2 - 3 and supplies the lateral skin of the thigh?

**Lateral cutaneous nerve of the thigh** (L2 - 3)

Which nerve of the lumbar plexus arises from **L1 - 2** and runs on the **surface** of **psoas major**?

**Genitofemoral nerve**

Which nerve of the lumbar plexus arises from **L2 - 4** and runs **lateral** to **psoas major**?

**Femoral nerve** (L2 - 4)

Which nerve of the lumbar plexus arises from the same levels as the **femoral nerve**, runs **medial** to **psoas major** and goes through its own foramen in the pelvis?

**Obturator nerve** (L2 - 4)

What are the **nerves of the lumbar plexus** and their spinal levels?

**Iliohypogastric nerve** (L1) **Ilioinguinal nerve** (L1) **Lateral cutaneous nerve of the thigh** (L2 - 3) **Genitofemoral nerve** (L1 - 2) - surface of psoas major **Femoral nerve** (L2 - 4) - lateral to psoas major **Obturator nerve** (L2 - 4) - medial to psoas major

Which compartment does the **femoral nerve** supply?

**Anterior compartment of thigh**

What compartment does the **obturator nerve** supply?

**Medial compartment of thigh**

What compartment does the **unbranched** sciatic nerve supply? What are its spinal levels?

**Posterior compartment of the thigh** L4 - S3

What compartments of the leg do the a) **tibial** b) **superficial fibular** c) **common fibular** branches of the sciatic nerve supply?

**a) Posterior** **b) Lateral** **c) Anterior**

Which nerve supplies the **plantar** surface of the foot?

**Tibial nerve**

Which nerve supplies the **medial aspect** of the leg and ankle and is a branch of the femoral nerve?

**Saphenous nerve**

Which nerve supplies the **dorsal** surface of the foot?

**Superficial fibular nerve**

Which nerve supplies the **lateral** aspect of the foot?

**Sural nerve**

Which nerve supplies the **1st web space** of the foot?

**Deep fibular nerve**

What aspects of the foot do the a) **tibial** b) **saphenous** c) **sural** d) **deep fibular** e) **superficial fibular** nerves supply?

**a) Plantar surface** **b) Medial aspect** **c) Lateral aspect** **d) 1st web space** **e) Dorsal surface**

When do **sympathetic fibres** close the internal urethral sphincter in males?

**Ejaculation** to prevent retrograde ejaculation into bladder

Which nerves a) **relax** the internal urethral sphincter b) **constrict** the external urethral sphincter?

**a) Parasympathetic** **b) Somatic motor**