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GI Final > Abdominopelvic Autonomics/Pain > Flashcards

Abdominopelvic Autonomics/Pain Flashcards

1
Q

Gastric Ulcer pain

A
  • Foregut visceral pain

- Worse w/ eating

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2
Q

Perforated gastric ulcer pain

A
  • Foregut chronic visceral pain
  • Sudden severe pain spreading throughout abdomen
  • Generalized peritonitis
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3
Q

Acute cholecystitis pain

A
  • Foregut visceral pain
  • Somatic pain in RUQ
  • Referred pain to R. shoulder
  • n/v
    • Murphy’s sign
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4
Q

Acute appendicitis pain

A
  • Midgut visceral pain (umbilical region)
  • Somatic pain in RLQ
  • n/v
  • Localized peritonitis w/ rupture (RLQ)
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5
Q

Adhesive small bowel obstruction pain

A
  • Hx of previous abdominal surgery
  • Midgut visceral colicky pain
  • No bowel action
  • Distended soft abdomen (non-tender)
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6
Q

Passage of kidney stone pain

A
  • Sudden onset of severe colicky pain (loin to groin)
  • Severe back pain
  • Possible hematuria
  • Soft abdomen
  • Tender renal angle
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7
Q

Obstructing cancer of descending colon pain

A
  • Hindgut visceral colicky pain
  • Distended abdomen w/ possible LLQ mass
  • Increased bowel sounds
  • Weight loss
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8
Q

Ruptured ectopic pregnancy pain

A
  • Sudden onset of pain in hypogastrium radiating to sacral area
  • Localized peritonitis in suprapubic region
  • Tenderness in rectouterine pouch on DRE
  • Missed LMP
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9
Q

Leaking abdominal aortic aneurysm pain

A
  • Sudden onset of severe back pain
  • Pale/shocked/hypotensive
  • Tender epigastrium
  • Palpable impulse from aneurysm in epigastrium
  • Elderly male w/ hx of atherosclerotic disease
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10
Q

Sensory nervous system

A
  • Afferent

- Somatic and visceral

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11
Q

Motor nervous system

A
  • Efferent
  • Somatic (voluntary)
  • Visceral (autonomic)
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12
Q

Autonomic nervous system

A
  • Motor
  • Thoracolumbar (sympathetic)
  • Craniosacral (parasympathetic)
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13
Q

Characteristics of Somatic nervous system

A
  • Voluntary single neuron pathway
  • No ganglia
  • Sensory input from general and special senses
  • Motor output to skeletal muscle
  • Ach only
  • Axons are thick and myelinated
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14
Q

Characteristics of Autonomic nervous system

A
  • Involuntary two neuron pathway
  • Ganglia involved
  • Sensory input from general and visceral senses motor output to cardiac, smooth mm, and glands
  • Uses Ach and NE
  • Some axons thin/myelinated others not
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15
Q

Which autonomic axons are myelinated?

A

Preganglionic

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16
Q

Location of parasympathetic preganglionic cell bodies

A

CN III, VII, IX

CN X, S2-S4

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17
Q

Location of parasympathetic postganglionic cell bodies

A

CN III, VII, IX go to ciliary, pterygopalatine, submandibular and otic ganglia
CN X and S2-S4 go to terminal wall of organ they innervate

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18
Q

Parasympathetic transmitters

A

Ach (pre and post) on nAChR and mAChR

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19
Q

Location of sympathetic preganglionic cell bodies

A

Interomediolateral cell column (IMC) from T1-L2

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20
Q

Location of sympathetic postganglionic cell bodies

A
  • Superior cervical ganglion
  • Sympathetic chain ganglion
  • Prevertebral ganglion (celiac, SM, IM, aorticorenal)
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21
Q

Sympathetic transmitters

A
  • Pre = ACh
  • Post = NE
  • on alpha and beta receptors
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22
Q

Another term for interomediolateral cell columns

A

Lateral horns

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23
Q

Spinal levels for head, upper limb, thoracic

A

T1-T6

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24
Q

Spinal levels for body wall, abdomonal viscera

A

T7-T11

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25
Q

Spinal levels for lower limb and pelvic viscera

A

T12- L2/3

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26
Q

Stomach, liver, GB, pancreas

A

T6-T9

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27
Q

Appendix/colon

A

T10-T11

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28
Q

Small Bowel

A

T7-T10

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29
Q

Kidney

A

T10-L1

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30
Q

Suprarenal gland

A

T6-L2

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31
Q

Rectum, bladder, uterus

A

T12-L2/3

32
Q

Path of sympathetic presynaptic neurons

A
  1. Cell body of presynaptic neuron in IML
  2. Ant. (motor) root of spinal nerve
  3. Mixed spinal nerve
  4. Ant. ramus of spinal nerve
  5. White ramus communicans
  6. Autonomic (paravertebral) ganglion
33
Q

What makes up the sympathetic trunks?

A

Paravertebral ganglia + Interganglionic connections

34
Q

4 Options for entering sympathetic trunks

A
  1. Ascend to a higher level to synapse
  2. Descend to a lower level to synapse
  3. Synapse at level of entry
  4. Traverse the trunk w/o synapsing to become part of abdominopelvic splanchnic nerve (will synapse in prevertebral ganglia) or to innervate suprarenal glands
35
Q

Where do postsynaptic fibers of sympathetic trunks exit?

A

Laterally @ level of cell body via grey rami communicans

36
Q

Path of sympathetic postsynaptic neurons

A
  1. Cell body of post-synaptic neuron
  2. Grey rami communicans
  3. (if headed for back) Posterior ramus of spinal n.
  4. (if headed to rest of body) Anterior ramus of spinal n.
37
Q

Functions of sympathetic neurons

A
  • Vasomotion (specifically vasoconstriction)
  • Pilomotion (goosebumps)
  • Sudomotion (sweat glands)
38
Q

Sympathetic innervation of lower limb

A
  • Presynaptic fibers DESCEND
  • T12-L2
  • Synapse @ lower lumbar/sacral portions of sym. trunk
39
Q

Sympathetic innervation of upper limb

A
  • Presynaptic fibers ASCEND
  • T1-T6
  • Middle/inferior cervical ganglia
40
Q

Parietal branches of sympathetic trunks

A
  1. Grey rami communicans to all 31 spinal nerves (post-synaptic)
  2. Cephalic arterial rami to periarterial plexuses of carotids
    - Vasomotion, Sudomotion, Pilomotion
41
Q

What are the prevertebral ganglia?

A
  • Preaortic
  • Celiac ganglion
  • Superior mesenteric ganglion
  • Inferior mesenteric ganglion
  • Aorticorenal ganglion
42
Q

Path for sympathetic innervation of abdominal viscera

A
  1. IML
  2. Paravertebral ganglia (sympathetic trunk)
  3. Abdominopelvic splanchnic n.
  4. Prevertebral ganglion
  5. Periarterial plexus
  6. Celiac plexus, inferior hypogastric plexues, etc.
43
Q

Visceral branches of sympathetic trunks

A
  • Splanchnic nerves arise as medial branches of trunks
  • Cardiopulmonary splanchnic nn. (post-syn fibers)
  • Abdominopelvic splanchnic nn. (post-syn fibers)
44
Q

Cardiopulmonary splanchnic nn. synapse location?

A

PARAvertebral ganglia

45
Q

Abdominopelvic splanchnic nn. synapse location?

A

PREvertebral ganglia

46
Q

Where are sympathetic postsynaptic fibers found?

A
  1. Paravertebral ganglia of sym trunks (everywhere except abdominopelvic viscera)
  2. Prevertebral ganglia of paraaortic plexus
47
Q

Suprarenal gland innervation

A
  • Presynaptic fibers enter suprarenals w/o synapsing
  • Synapse occurs on secretory cells of medulla
  • D/t NEURAL CREST embryology
48
Q

Relative lengths of parasympathetic nerves

A
  • Preganglionic is very long/myelinated

- Postganglionic is very short and synapses on wall of organ

49
Q

Relative lengths of sympathetic nerves

A
  • Preganglionic is short/myelinated

- Postganglionic is longer/unmyelinated

50
Q

Transition from CN X to pelvic splanchnic nerves

A

Left Colic (Splenic) flexure of gut

51
Q

Characteristics of parasympathetic postsynaptic neurons in trunk

A
  • Widely scattered/irregularly spaced
  • Microscopic (could be single cell body)
  • In or on effector organ (intrinsic/enteric ganglia)
52
Q

Parasympathetic functions in head

A
  • Pupil constriction
  • Accomodation
  • Serous secretions from lacrimal gland
  • Serous secretions from salivary glands
53
Q

Location of parotid gland

A

Infratemporal fossa

54
Q

Where do parasympathetic nerves travel to

A
  • Only internal organs/glands of head/body cavities
  • Does NOT enter body wall (except erectile tissue of genitalia)
  • Never components of spinal nerves (except pelvic splanchnics, from S2-S4)
55
Q

General functions of sympathetics NS

A
  • Pupil dilation
  • Bronchodilation
  • Increased HR and contractility of myocardium
  • Vasoconstriction in skin and GI
  • Decreased peristalsis (sphincters constricted)
  • Stimulates suprarenal glands
  • Ejaculation/remission of erection
56
Q

General functions of parasympathetic NS

A
  • Pupil constriction
  • Accomodation
  • Bronchoconstriction
  • Decreased HR and contractility
  • Stimulates peristalsis (relaxes sphincters)
  • Produces erection
57
Q

Do splanchnic nerves have afferent or efferent fibers?

A

BOTH

  • Visceral afferent = sensory (receptors for pain/reflexes)
  • Visceral efferent = motor (smooth mm, cardiac mm. glands)
58
Q

Visceral afferents

A
  • Travel w/ both sympathetics and parasympathetics
  • 80% in CN X are afferents
  • 20% in splanchnics are afferents
59
Q

Where do physiologic receptors travel?

A

Parasympathetics (CN X or pelvic splanchnics)

60
Q

Where does pain travel?

A

Sympathetics (except below pelvic pain line AKA middle of sigmoid colon)

61
Q

Duration of acute abdomen pain

A

< 3 days

62
Q

Duration of chronic abdominal pain

A

> 3 weeks

63
Q

Duration of subacute abdominal pain

A

3 days to 3 weeks

64
Q

Visceral pain characteristics

A
  • Diffuse and poorly localized
  • Can refer to somatic regions
  • Injury to internal organs
65
Q

Somatic pain characteristics

A
  • Well localized

- Injury to skin, muscles, bone, joint and CT

66
Q

Parietal pain

A
  • Caused by irritation of fibers innervating parietal peritoneum
  • Can be localized to dermatomes
  • Visceral pain can give rise to parietal pain
67
Q

Visceral pain (foregut)

A
  • T6-T9

- Epigastric

68
Q

Visceral pain (midgut)

A
  • T8-T10

- Periumbilical

69
Q

Visceral pain (hindgut)

A
  • T12-S4

- Suprapubic/hypogastric

70
Q

Location of referred pain for liver, GB, duodenum

A

Right shoulder d/t irriation of diaphragm

71
Q

Stomach referred pain

A

Middle of upper back

72
Q

Liver referred pain

A

Right shoulder and right superior to iliac crest on back

73
Q

Kidney/ureter referred pain

A

Flank

74
Q

Retroperitoneal pain

A

Back pain

75
Q

Colicky pain

A
  • Intermittent, cramp-like pain

- Caused by obstructions of hollow muscular viscus

GI Final (13 decks)

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