Abdominal Pelvic Autonomics/ Pain Flashcards
Abdomen, pelvis, perineum innervation
ANS
- both sympathetic and parasympathetic
Sympathetic fiber components
thoracic, lumbar, sacral splanchnic nerves
Parasympathetic fiber components
anterior and posterior vagal trunk
pelvic splanchnic nerves
Thoracic splanchnic nerve
- describe
- vertebral level
- parts
pre-ganglionic sympathetic
T5-T12
- greater splanchnic nerve
- lesser splanchnic nerve
- least splanchnic nerve
Greater splanchnic nerve
- vertebral level
- location
- organs
T5-T9 SYMpathetic ganglia
descend in posterior mediastinum to synapse with celiac ganglion
- esophagus, stomach, spleen, pancreas, liver, biliary tree, duodenum, greater omentum
Lesser Splanchnic Nerve
- vertebral level
- location
- organs
T10-T11 SYMpathetic ganglia
descend in abdomen to synapse with superior mesenteric ganglion
- branches of SMA to jejunum, ileum, cecum, ascending and transverse colon
Least Splanchnic Nerve
- vertebral level
- location
- organs
T12 SYMpathetic ganglia
descends into abdomen to synapse with aorticorenal ganglion
- renal arteries to kidneys
Lumbar Splanchnic Nerves
- vertebral levels
- parts
preganglion sympathetic nerve
L1- L5
FOUR lumbar splanchnic nerves
first and second lumbar splanchnic nerves
- vertebral level
- location
- organs
L1 and L2 Sympathetic
terminate in intermesenteric plexus on anterior surface of abdominal aorta, btw SMA and IMA
- IMA to descending colon, sigmoid colon, proximal rectum
third and fourth lumbar splanchnic nerve
- vertebral level
- location
- organs
- L3
- L4 and L5
enter superior hypogastric plexus on anterior surface of distal abdominal aorta
post: superior hypogastric plexus
Pre: hypogastric nerves to inferior hypogastric plexus on anterior surface of sacrum
- internal iliac artery to organs of pelvic cavity and perineum
Sacral Splanchnic Nerves
- vertebral level
- location
- organs
preganglionic sympathetic nerves in inferior hypogastric plexus
S1-5 sympathetic
postganglionic: pudendal nerve and branches of internal iliac artery
organs of pelvic cavity and perineum
Vagus Nerve
- vertebral level
- location
- organs
preganglionic parasympathetic nerve:
brain stem (dorsal motor nucleus), enter abdomen via anterior and posterior vagal trunk to terminate in intrinsic (enteric) plexus
stomach, liver, pancreas, SI, cecum, ascending and transverse colon
Postganglionic fibers
- short
- smooth muscle and glands –stomach, liver, pancreas, SI, cecum, ascending and transverse colon
Pelvic splanchnic nerves
- vertebral level
- location
- organs
Preganglionic parasympathetic:
- S2-S4
- synapse in intrinsic (enteric) plexus
descending colon, sigmoid colon, rectum, anal canal, urogenital organ of pelvic cavity, structures in urogenital triangle of perineum
Enteric Nervous System
- nickname
- function
- plexus
aka second brain
regulating most of the physiological activity in distal esophagus, stomach, intestine, pancreas, and biliary system
- myenteric and submucosal plexus
Myenteric Plexus
regulates motility, vasomotion of muscle layers, and secretion of gastric glands
Submucosal Plexus
- organ
- function
SI
- exocrine/endocrine secretion
- vasomotion ( blow flow to regulate water and electrolyte movement)
- micromotility
- immune activity
Sensory function within ENS
detect hunger, satiety, nausea, and pain
ANS
- controlled by
- innervates what organs
- division
controlled by hypothalamus
innervates SM, cardiac muscle and glands
- parasympathetics and sympathetics
Preganglion neuron
- origin
- synapse
originates in CNS
synapses on ganglion in peripheral nervous system
Postganglionic neuron
travels to target orga
Types of Visceral Autonomics
Sympathetics
Parasympathetics
Sympathetics characteristics
- short presynaptic fiber
- long postsynaptic fiber
vasoconstriction, reduce bowel motility and secretions
Parasympathetic characteristics
- long presynaptic fibers
- short postsynaptic fibers
increase bowel motility, secretion, blood flow (vasodilation)
Visceral Sympathetics
- pre and post synaptics
- nerve
Presynaptic cell bodies: gray matter of Spinal cord T5- L2
Post Synaptic Cell bodies: in prevertebral ganglia to abdominal viscera via periarterial plexuses
Splanchnic nerves: post synpatic fibers run from prevertebral fanflia to abdominal viscera via periarterial plexuses
Greater Splanchnic N
- vertebral level
- ganglion
T5-T9
celiac ganglion
Lesser splanchnic N
- vertebral level
- ganglion
T10-T11
superior mesenteric ganglion
Least splanchnic N
- vertebral level
- ganglion
T12
aorticorenal ganglion
Lumbar Splanchnic nerves
- vertebral level
L1-L3
Sacral Splanchnic nerves
S1-S5
Visceral Parasympathetics
- nerves
- anterior and posterior vagal trunks ( from left and right vagus nerves respectively)
- conveys presynaptic parasympathetic fibers and visceral affernts
- innervates smooth muscle and glands of gut up to left colic flexure in GI tract - Pelvic splanchnic nerves (anterior rami of S2-S4)
- converys presynaptic parasympathetic innervation to inferior hypogastric plexus
- innervates from left colic flecure to above the pectinate line in the anal canal
Extrinsic Autonomic Plexuses
- parts (6)
1) Celiac Plexus and ganglia
2) Superior mesenteric plexus and ganglia
3) inferior mesenteric plexus and ganglia
4) intermesenteric plexus
5) superior hypogastric plexus
6) inferior hypogastric plexus
Celiac plexus and ganglia
- sympathetic root from greater and lesser splanchnic nerves
- parasympathetic root from posterior vagal trunk
Superior mesenteric plexus and ganglia
- median root from branch of celiac plexus
- lateral roots arise from lesser and least splanchnic nerves
Inferior mesenteric plexus and ganglia
- medial roots from intermesenteric plexus
- lateral roots from lumbar sympathetic trunk
Inter mesenteric Plexus
- part of aortic plexus between SMA and IMA
- gives rise to testicular, ovarian, ureteric, and renal plexuses
Superior Hypogastric plexus
- receives only sympathetic fibers
- anterior to abdominal aortic bifurcation (L4)
- continuous with intermesenteric and inferior mesenteric plexuses
- give rise to ureteric, testicular, and common iliac plexuses
Inferior Hypogastric plexus
- joined to superior hypogastric plexus via bilateral hypogastric ns
- receives from superior sacral sympathetic ganglia and pelvic splanchnic ns
- give rise to plexuses on walls of pelvic viscera (rectal and vesical plexuses)
Intrinsic Enteric NS
- nickname
- plexus
aka second brain
- myenteric (auerbach) plexus
- Submucosal (meissner) plexus
- intrinsic sensory neuron
Myenteric (Auerbach) Plexus
- location
- function
- in muscular layers of gut wall
- regulates motility, vasomotion of muscle layers and secretion of gastric glands
Submucosal (Meissner) Plexus
- location
- function
- in submucosa- most prominent in SI
- regulate exocrine/endocrine secretion vasomotion, micromotility, and immune activity
Intrinsic sensory neurons
- function
locally monitor mechanical and chemical conditions of gut for short reflex response
Visceral Sensory Afferents
- Pain afferents
2. Reflex afferents
Pain afferents
- d/t distention, inflammation, ischemia
- impulses pass retrograde into posterior root to sensory ganglia
- foregut to midpoint of sigmoid colon -> sympathetic fiber (T5-L2)
- after midpoint of sigmoid colon-> parasympathetic fibers (S2-S4)
Reflex afferents
- unconscious
- info from chemoreceptors, osmoreceptors, and mechanoreceptors
- via parasympathetics only ( vagal S2-S4)
Types of Pain
- Organic pain
2. Parietal peritoneum
Organ pain
- poorly localized, dull
- radiates to dermatome level-> visceral referred pain
Parietal peritoneum
- localized, acute or severe
- supplied by somatic sensory fibers via thoracic nerves (T7-T12)
- extremely sensitive to stretching-> rebound tenderness
Somatic Nervous System
- control
- ganglia
- sensory input
- hormone
- conduction
- axon
- voluntary or subconscious control single neuron pathway
- no ganglia involved in pathway
- sensory input from general and special senses, motor output to skeletal muscle
- excites using acetylcholine
- axons are thick and myelinated= fast condition
Autonomic nervous system
- control
- ganglia
- sensory input
- hormone
- conduction
- axon
involuntary unconscious control two neuron pathway
ganglia involved in pathway
sensory input from general and visceral senses motor output to cardiac, smooth muscle, an glands
can excite or inhibit function using Ach or NE
axons are thin, some are myelinated, slower conduction
Sympathetic Presynaptic Neurons
cell bodies found only ONE place
- intermediolateral cell column of spinal cord gray matter
- somatotopically- arranged from T1- L2
fibers exit CNS via anterior roots of spinal nerves T1-L2 and enter mixed nerve
FIber exit spinal nerves to pass via white rami communicans to sympathetic trunk
Pathways of presynaptic sympathetic fibers through sympathetic trunks
- ascend and then synapse
- synapse at level of entry
- descend and then synapse
- pass through trunk without synapsing to enter abdomino pelvic splanchnic nerve
Parietal branches of Sympathetic Trunks
1) Gray rami communicans
- to all 31 spinal nerves
- arise as lateral branches
- carry postsynaptic fibers to body wall and limbs for distribution via spinal nerves
2) cephalic arterial rami
- to periartieral plexus of carotid arteries
- arise from cervical ganglia
- postsynaptic fibers to head for distribution via periarterial plexuses
- produce: vasomotion, sudomotion, pilomotion
