Abdominal Autonomics and Pain Flashcards
1
Q
What NS has axons that are thick and myelinated?
A
somatic nervous system
2
Q
What utilizes sensory input from general and special senses–>motor output to skeletal muscle?
A
somatic NS
3
Q
What NS doesn’t involve ganglia?
A
somatic NS
4
Q
What NS is under voluntary/subconscious control of single neuron pathway?
A
somatic NS
5
Q
What only uses ACh for excitation?
A
somatic NS
6
Q
What NS is under involuntary control via 2 neuron pathway?
A
ANS
7
Q
What NS has sensory input from general and visceral senses–>motor output to cardiac, SM and glands?
A
ANS
8
Q
What NS has thin axons with some myelination?
A
ANS
9
Q
What do many visceral effects have in terms of innervation?
A
dual innervation that oppose each other
10
Q
Where does the PNS not innervate?
A
adrenal glands semnal vesicles vas deferens uterus splene liver pancreas
11
Q
What do autonomic plexuses contain?
A
- POSTganglionic sympathetic axons
- PREganglionic parasympathetic axons
- visceral sensory axons
12
Q
Where do sympathetic axons in automonic plexuses come from?
A
spinal cord via sympathetic trunk
13
Q
Where do parasympathetic axons in autonomic plexuses come from?
A
cranial and caudal repositories
14
Q
Do plexuses close together interact or synapse with each other?
A
no
15
Q
What is contained in the abdominal aortic plexus?
A
celiac plexus
superior mesenteric plexus
inferior mesenteric plexus
–>autonomic control of digestion
16
Q
What is contained in the hypogastric plexuses?
A
superior and inferior plexuses
–>innervate pelvic viscera for autonomic control of urinary and reproductive fxn
17
Q
Describe typical parasympathetic pathway
A
Cranial or caudal repositories–>pregang–> ganglion (releases ACh)–> postgang–> releases ACh at target organ
18
Q
What NS is mass activaton part of ?
A
ANS
—>sympathetic
19
Q
Define mass activation?
A
large # ganglionic neurons may activate effector organs
–>heightened sense of alterness d/t + reticular activation system
20
Q
Describe general sympathetic pathway
A
CNS–>pregang–>ACh @ gang–>postgang–>NE
21
Q
Where do sympathetic preganlgionic neuron cell bodes originate?
A
T1-L2 lateral horns
22
Q
Preganglionic symp axons travel with ___________ to exit spinal cord and first enter anterior roots, then _________
A
somatic motor neuron axons, T1-L2 spinal nerves
23
Q
Where are the L and R sympathetic trunks?
A
lateral to VC, anterior to spinal nerves
24
Q
What is another name for the sympathetic paravertebral ganglia?
A
sympathetic trunks
25
Every spinal nerve has a sympathetic trunk ganglion EXCEPT?
cervical portion
| -->superior, middle and inferior cervical ganglia instead of 8
26
What are white rami?
myelinated preganglionic axons that carry pregang symp axons from T1-L2 spinal nerves to the sympathetic trunk
27
What spinal nerves are the white rami associated with?
T1-L2
28
What is similar to entrance ramps on a highway?
white rami
29
Why is similar to exit ramps on a highway?
gray rami
30
What rami are myelinated vs unmyelinated?
White vs gray rami
31
What connects to all spinal nerves so info can start out in thoracolumbar and disperse to all parts of body?
Gray rami
32
What connect postgang symp axons from symp trunk to the spinal nerve?
gray rami
33
What are examples of sympathetic pathways?
spinal nerve
postgang symp
splanchnic
adrenal medulla
34
Describe a typical symp spinal nerve pathway
Ventral root from cell body-->spinal nerve-->white rami-->symp trunk and synapse-->gray rami--> same spinal nerve to destination
OR
same up until white rami-->symp trunk and synapse-->asc/desc level-->gray rami-->destination
35
What are examples of destinations of spinal nerves?
arrector pili, dilate BV in skin, activate sweat glands
36
What is the difference between the postgang symp pathway and spinal nerve pathway?
instead of going back to spinal nerve via gray rami, it becomes one long gray rami and hops onto vessels-->target organ
37
What are examples of destinations of postgang symp N?
heart, lung, salivary gland
38
Describe the adrenal medulla pathway
NO SYNAPSING d/t direct + of adrenal medulla via splanchnic N
axon via cell body lateral horn-->ventral root-->spinal nerve-->white rami-->symp trunk--> continues out without synapsing in trunk as thoracic splanchnic N--> directly synapses on cells in medulla
39
Describe the splanchnic nerve pathway
cb from lateral horn-->ventral root-->spinal N-->white rami-->symp trunk NO SYNAPSE--> out as splanchnic N-->synapse in prevertebral ganglia--> into plexus-->abd organs
40
Where are prevertebral ganglia located?
ONLY IN ABDOMINOPELVIC CAVITY
-->single structures clustered around major arteries (same name)
41
What are examples of prevertebral ganglia?
- celiac ganglia
- superior mesenteric ganglia
- inferior mesenteric ganglia
42
What axons compose "thoracic" splanchnic nerves?
pregang symp axons
43
What splanchnic nerves are not classified in the "thoracic" splanchnic N pathway?
- cardiopulmonary splanchnic N (postgang symp)
| - pelvic splanchnic N (parasymp)
44
What are examples of sympathetic pregang splanchnic N?
Greater thoracic (celiac gang)
Lesser thoracic (sup mes)
Least thoracic (sup mes)
Lumbar (sup mes)
Sacral (inf mes)
45
What splanchnic N supplies the foregut?
greater thoracic splanchnic N
46
What splanchnic Ns supply midgut?
lesser, least, lumbar splanchnic N
47
What splanchnic N supplies the hindgut?
sacral splanchnic N
48
What ganglia are anterior to VC on the anterolateral wall of the abd aorta?
prevertebral ganglia
49
What NS is most active during times when body must process nutrients and conserve energy?
PNS
50
What aspect of PNS prevents mass activation?
lack of extensive divergence in pregang axons
51
What NS has discrete and localized effects?
PNS
52
What is special about PNS in terms of turning on organs?
can turn one on without turning on all other organs
53
Craniosacral division AKA
PNS
54
What CN are associated with parasympathetic system?
3, 7, 9, 10
```
Oculomotor
Facial
Glossopharyngeal
-->all to head
Vagus
-->thoracic and abd organs
```
55
What parasym innervates distal gut tube and pelvic viscera?
pelvic splanchnic N (S2-4)
| -->to sup and inf hypogastric plexus
56
Pain travels with _____ except for below pelvic pain line
sympathetics
57
What is the boundary of the pelvic pain line?
middle of sigmoid colon
58
What percent of vagus fivers are afferents?
80%
59
What percent of thoracic splanchnic nerves are afferents?
20%
60
Innocuous (not pain) input will travel with?
parasympathetics
61
Where is the thoracic pain line?
sternal angle (T4-5)
62
What carries pain input above thoracic pain line?
Parasymp
63
What carries pain input between thoracic and pelvic pain lines?
sympathetic
64
What carries pain input below pelvic pain line (lower peritoneum and perineum)?
parasymp
65
What duration consitutes acute abd pain?
less than 3 days
66
What duration consitutes chronic abd pain?
more than 3 weeks
67
What duration consitutes subacute abd pain?
3 days to 3 weeks
68
What pathologies can cause pain?
```
inflammation
ischemia
stretching
obstruction
trauma
fxnl disease
```
69
What is visceral pain?
- diffuse, poorly localized
- referred to somatic regions
- injury to internal organs and tissues that support them
70
What is somatic pain?
- well localized
| - caused by injury to skin, muscles, bone, joint and CT
71
What is parietal pain?
- caused by irritation of fibers that innervate parietal peritoneum
- localized to dermatome
- can stem from visceral pain-->tenderness and guarding
72
What is the progression of visceral to parietal pain in abd?
visceral to parietal causes tenderness and guarding
localized peritonitis develops rigidity and rebound
73
Visceral pain can be localized to______
embryologic origin of organ
-->foregut produces pain in epigastric
-->midgut produces periumbilical pain
-->hindgut produces suprapubic or hypogastric pain
74
What can cause umbilical pain?
- early appendicitis
- mesenteric adenitis
- Meckel's diverticulum
- lymphomas
75
What causes flank or lumbar pain?
ureteric colic
| pyelonephritis
76
What causes epigastric pain?
- esophagitis
- peptic ulcer
- perforated ulcer
- pancreatitis
77
What causes R inguinal pain?
```
late appendicitis
Crohn's disease
cecum obstruction
ovarian cyst
ectopic pregnancy
hernia
```
78
What causes hypogastric/suprapubic pain?
testicular torsion
urinary retention
cystitis
placental abruption
79
What causes L inguinal pain?
```
diverticulitis
ulcerative colitis
constipation
ovarian cyst
hernia
```
80
What causes L hypochondriac pain?
spleen abscess
acute splenomegaly
spleen rupture
81
What causes R hypochondriac pain?
gallstones
cholangitis
hepatitis
liver abscess
82
What causes referred pain?
results of network of interconnecting sensory nerves that supply different tissues
-->converge at same level of SC
83
What causes retroperitoneal pain?
pancreas
kidney
aorta
-->back pain
84
What causes colicky pain?
intermittent, cramp-like
d/t obstruction of hollow muscular viscus
--> SBO, stones
Down middle of abd
85
What causes pain from loin to groin?
urinary tract obstruction
86
What causes foregut visceral pain that is worse with eating?
gastric ulcer
87
What produces foregut chronic visceral pain with sudden severe pain that spreads over abd?
perforated gastric ulcer
-->signs of generalized peritonitis
88
What would acute cholecystitis cause?
- foregut visceral pain
- somatic pain RUQ
- referred pain R shoulder
- N, V
- F
- tender RUQ
- positive Murphy's sign
89
What would acute appendicitis cause?
- midgut visceral pain
- somatic pain RLQ
- N, V, F
- tenderness RLQ
- localized peritonitis RLQ if ruptured
90
What would an adhesive SBO cause?
- hx prev abd surg
- midgut visceral colicky pain
- vomiting
- no gas, bowel action
- possible dehydration
- distended soft abd, nontender
- increased bowel sounds
91
What would passage of kidney stone cause?
- sudden onet severe colicky pain from loin to groin
- sever back pain
- pt writing in pain, pacing
- possible hematuria
- afebrile
- soft abd
- tender renal angle
92
What would obstructing cancer of descending colon cause?
- older age patient
- weight loss
- hindgut visceral colicky pain
- no flautus or feces
- distended abd
- possible mass felt LLQ
- increased bowel sounds
93
What would rupture of ectopic pregnancy cause?
- woman childbearing age
- missed LMP
- sudden onset severe pain hypogastrium radiating to sacral area
- afebrile
- localized peritonitis in hypgastric area
- tenderness on DRE or vaginal examination
94
What would a leaking aortic aneurysm cause?
- elderly male with hx HTN or CAD
- sudden onset severe back pain
- pale, shocked, hypotensive
- tender epigastrium
- palpable impulse epigastrium
95
Where would gallbladder refer pain to?
R side below ribs, around to upper mid back
96
Where would liver refer pain to?
R side around back to mid lower flank
97
Where would stomach refer pain to?
upper mid back, mid abdomen
98
Where would kidney/ureter refer pain to?
lower groin around to mid/lower flank
99
Where would liver, gallbladder, duodenum refer pain to?
R shoulder
