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Hannah GI 2 > abdominopelvic autonomics and pain > Flashcards

abdominopelvic autonomics and pain Flashcards

1
Q

what are the two ANS divisions

A
  1. Sympathetic
    - Thoracolumbar
  2. Parasympathetic
    - Craniosacral
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2
Q

what is the location of the pre-ganglionic cell bodies of the sympathetic (thoarcolumbar) nervous system

A

Intermediolateral cell column (IMC)
T1-L2
**derviced from lateral horn of spinal cord

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3
Q

what is the location of the post-ganglionic cell bodies of the sympathetic (thoarcolumbar) nervous system

A
  • (3) superior cervical ganglion
  • sympathetic chain ganglion (paravertebral ganglion)
  • preverterbral ganglion (celiac, sup. inf. mesenteric, aorticorenal)
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4
Q

what are the divisions of the SNS based on the divisions of the vertebral column and the organs it innervates

A

viscera T1-T6; head upper limb and thoracic

Viscera T7-T11; body wall, abdominal

viscera T12- L2l lower limb, pelvic viscera

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5
Q

what makes up the sympathetic trunk

A

paravertebral ganglia + interganglionic connections

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6
Q

how does the SNS enter the paravertebral ganglion

A

through white rami communicans

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7
Q

what are the options for the presynaptic fibers of the SNS entering the sympathetic trunk for locations of synapsing

A
  1. ascend to synapse
  2. descende to synapse
  3. remain at level of entry for synapse
  4. pass the trunk without synapsing to become apart of abdominopelvic splanchnic n. and synapse in prevertebral ganglion
  5. innervate the suprarenal glands via special pathway
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8
Q

what level do postsynaptic fibers of the sympathetic trunk exit, thought what structure

A

level of the cell body (no ascend or descend) trough gray communicans

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9
Q

are presynaptic or postsynaptic SNS fibers myelinated?

A

SNS fibers
pre-short, myelinated (white)
post-long, unmyelinated (gray)

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10
Q

what are the functions of the SNS that is delivered to body wall and limbs

A

vasomotion
sudomotion (sweat glands)
pilomotoin

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11
Q

describe path of SNS innervation of lower limb

A
  1. from IML (T12-L2) presynaptic fibers take the descend option
  2. enter white communicans and synapse at lower lumbar and sacral portion of sympathetic trunk (paravertebral ganglion)
  3. exit gray communicans to adjacent L2-S3 anterior rami
  4. postsynaptic fibers run in roots of lumbosacral plexus
    or periarterial plexus on vessels

*upper limb (T1-T6) is similar but ascends and synapses in middle and inferior cervical ganglion to exit at C5-T1 and run in brachial plexus or periarterial plexus

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12
Q

describe the location of the superior, middle, and inferior cervical ganglion. and what a stellate ganglion is

A

superior- near bifurcation of common carotid into internal and external carotids
middle- near thyroid gland
inferior- above clavicle
stellate = fusion of inferior + T1 ganglion

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13
Q

describe path of SNS innervation of head

A
  1. leave T1-T4
  2. ascend to synapse in superior cervical ganglion
  3. postsynaptic fibers run to periarterial plexus of internal carotid A. or external carotid A.
  4. Internal - blood vessels and mucus glands of nasal and oral cavity, dilates eye, keeps eyelid open; External- salivary gland, mucus gland, sweat gland, blood vessels
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14
Q

what is Horner syndrome

A

a lesion of sympathetic trunk at the superior cervical ganglion region

  • causes: pupillary constriction, ptosis, anhydrosis (no sweat), and flushing
  • inhibits SNS innervation to head
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15
Q

what are the 2 types of parietal branches of sympathetic trunk

A
  • *arise laterally off trunk
    1. gray rami communicans - to all 31 spinal nerves; carry postsynaptic fivers to body wall and limbs
  1. cephalic arterial rami- arise from cerival ganglia to periarterial plexus of carotid A.s and postsympatic fibers to head
    * VASOMOTION, SUDOMOTION, PILOMOTION
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16
Q

describe the SNS innervation of abdominal viscera

A

presynaptic fibers pass through paraverterbral ganglion to synapse in prevertebral ganglion entering as abdominopelvic splanchnic nerves. greater lesser least and lumbar then leave and pass through associated plexus with ganglion (i.e. celiac ganglion to celiac plexus) then they innervate the viscera of the abdominal cavity

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17
Q

what are the names of the prevertebral (pre-aortic) ganglion of abdominal viscera

A
  1. celiac ganglion (mainly supplied by greater)
  2. superior mesenteric ganglion (lesser and least)
  3. inferior mesenteric ganglion (lumbar)
  4. aorticorenal ganglion (mixed of all)
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18
Q

T/F

most of the plexus are mixed with presynaptic PNS fibers and postsynaptic SNS fibers

A

TRUE

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19
Q

what are the levels of greater, lesser, least, lumbar splanchnic

A 
greater- T6-T9
lesser - T10 -T11
least - T12 
Lumbar- L1-L2 (3) 
**greater, lesser, least pierce the diaphragm
20
Q

name the only plexus that is purely postsynaptic SNS fibers

A

inferior mesenteric ganglion–> SUPERIOR HYPOGASTRIC PLEXUS–> hypogasric n.

21
Q

what are the 2 types of visceral branches of sympathetic trunk

A
  • *arise medial off trunk
  • splanchnic nerves
    1. cardiopulmonary splanchnic nerves
  • postynaptic fibers to thoracic viscera; synapse in PARAvertebral ganglion of sympathetic trunk
  1. abdominopelvic splanchnic nerves
    - presynaptic fibers to innervate the abdominal and pelvic viscera; synapse in PREverterbral ganglia of para-aortic plexus
22
Q

explain the suprarenal gland exception of the SNS

A
  • pass paravertebral and prevertebral ganglia without synapsing and synapse directly on secretory cells of the medulla
  • stimulated by presynaptic neurons
  • neural crest cells of suprarenal medulla act as postsynaptic neurons
  • cause release of EPE in blood for widespread response
23
Q

what is the location of the pre-ganglionic cell bodies of the parasympathetic (cranial-sacral) nervous system

A

cranial nerves 3, 7, 9, 10
and pelvic splanchnic n. (S2-S4)

*cranial nerve 10 = vagus

24
Q

what is the location of the post-ganglionic cell bodies of the parasympathetic (cranial-sacral) nervous system

A

Cranial nerves 3, 7, 9 [in head]
-cilary ganglion, pterygopalatine ganglion, submandibular ganglion, otic ganglion

vagus and pelvic splanchnic [ in trunk]
-wall of organ (intrinsic ganglia)

25
Q

what cranial nerves go with what cranial ganglia

A

cilary ganglion, - 3 (eye)
pterygopalatine ganglion, -7 (nasal and palate)
submandibular ganglion, -7 (sublingual and submandibular salivary glands )
otic ganglion-9 (parotid salivary gland)

26
Q

functions of PNS cranial nerves 3,7, 9,

A

pupil constriction
accommodation
serous secretion from lacrimal glands (tears) and salivary (water in saliva)

27
Q

T/F

except for S2-S4 PNSs are never components of spinal nerves of their peripheral branches

A

TRUE

*also do not go to body wall or limbs, except for erectile tissue of genitalia

28
Q

where is the PNS split between cranial and sacral outflow

A

left colic flexure

29
Q

which branch is most active in controlling vision, stimulating GI tract, and active in elimination of feces and urine

A

PNS

30
Q

what are the 2 components of splanchnic nerves both in PNS and SNS. **these two things make up a splanchnic nerve

A
  1. visceral afferents (sensory)
    - pain and reflexes
    - pain afferent usually SNS
    - reflex afferent usually PNS
  2. visceral efferents (motor)
    - smooth muscle, glands, cardiac muscle
31
Q

what percent of vagus nerve is visceral afferent? splanchnic nerves?

A

vagus- 80%

splanchnic - 20%

32
Q

physiologic receptors (homeostasis) for reflexes travels with ___; pain normally travels with ____

A

PNS (vagus or pelvic splanchnic)

SNS *except below pelvic pain line

33
Q

what is the pelvic pain line in terms of the colon and what innervates above and below? what about in terms of peritoneum? thoracic pain line

A

middle of the sigmoid colon is the boundary

  • above- pain runs with SNS
  • below- pain runs with PNS

plane of lower extent of peritoneum (above pelvic pain line if in contact with peritoneum)

plane of the sternal angle (T4 - 5)

  • above is PNS
  • below is SNS
34
Q

definitions of acute, subacute, and chronic abdominal pain

A

acute- < 3 days
subacute- 3 days - 3 weeks
chronic > 3 weeks

35
Q

what type of pain is it if the organ starts to irritate the parietal peritoneum

A
  • parietal pain
  • somatic pain like
  • well localized to corresponding dermatome
  • caused by injury to parietal peritoneum
36
Q

where do foregut, midgut, and hindgut organs produce pain

A

foregut ( stomach, duodenum, biliary tract, liver, spleen, pancreas)
-pain in epigastric region (T6 - T9)

midgut ( most small bowel, appendix, cecum, ascending colon, 2/3 transverse colon)
-pain in periumbilical region (T8 - T11)

hindgut ( 1/3 transverse colon, descending colon, sigmoid, to anal canal, and intrapertional genitourinary tract)
-suprapubic or hypogastric area pain (T12- S4)

37
Q

where is kidney or ureter pain felt

A

right or left flank or lumbar pain

38
Q

where is gallstones, hepatitis (galll bladder and liver) pain felt

A

Right hypochondriac

39
Q

esophagitis, peptic ulcer pancreatitis pain

A

epigastric

40
Q

spleen abscess, rupture, splenomegaly pain

A

left hypchondriac

41
Q

early appendicitis, meckels diverticulum, lymphomas pain

A

peri-umbilical

42
Q

late appendicitis, crohns, cecum obstruction, ovarian cyst, ectopic pregnancy, hernias pain

A

right inguinal

43
Q

tresticular torsion, urinary retention, cystitis (UTI), placental abruption pain

A

suprapubic (hypogastric)

44
Q

diverticulitis, UC, constipation, ovarian cyst, hernias

A

left inguinal

45
Q

where is retroperitoneal organs referred pain

A

back pain

46
Q

which organs can cause right shoulder (anterior and posterior) referred pain be=c of irritation of the diaphragm

A

liver, gallbladder, and duodenum

47
Q

intermittent cramp-like pain caused by obstruction of hollow muscular viscus (bowel obstruction, stone in ureter, gallstone obstruction)

A

colicky pain

Hannah GI 2 (11 decks)

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