Abdominopelvic Autonomics/Pain (Anatomy) Flashcards
Somatic Nervous System
voluntary, subconscious control; no ganglia; special senses input and motor output (acetylcholine)
+ axons are thick and myelinated for fast conductance
Autonomic Nervous System
involuntary/unconscious control with 2 major pathways; ganglia involved.
+ sensory input- general and visceral senses
+ motor input- cardiac muscle, smooth muscle, glands
*** acetylcholine/norepinephrine (axons are thin, slightly
myelinated)–> slower conduction rate
Sympathetics at Vertebral Levels
T1-T6= head, upper limb, thoracic viscera (lungs, heart, esophagus)
T7-T11= Body Wall, Abdominal Viscera (Stomach line, Gallbladder, Pancreas, Small Intestine)
T12-L3= Lower limb, Pelvic Viscera (rectum, bladder, uterus)
Function of the post synaptic sympathetic fibers that exit horizontally to synapse on to the body walls
Function: Sudomotion (release sweat), Pilomotion (hair movement), vasomotion (oscillation of the tone of blood vessel walls depending on cornoary or pulmonary vessels)
Horners Syndrome
Damage to the Brainstem at spinal cord levels above T1 affecting all those nerves going towards the face:
+ pupillary constriction (do to sympathetic loss of ciliary ganglion connection)
+ ptosis (drooping of the eyelids)
+ anhydrosis (lack of sweat production)
+ flushing (increase blood flow to the face)
Cardiopulmonary Sphlancnic Nerves
Sympathetic origins
Functions in the Lungs:
Bronchodilation, vasoconstriction of pulmonary vessels, inhibits alveolar gland secretions
Functions of the Heart:
increase HR, increase impulse conduction, increase force of contraction
Coronary Heart Functions:
Beta-2 receptors will help vasodilate by relaxing the smooth muscles and increase blood flow to coronary arteries
What are the abdominopelvic sphlancnic nerves (sympathetic origins)
Presynaptic neurons that go through the different tracts (greater, lesser, least sphlancnic nerves)
where do the abdominopelvic sphlancnic nerves synapse?
The abdominopelvic sphlancnic nerves synapse at the prevertebral ganglions of para-aortic plexus:
(Part 1) Greater Sphlancnic Nerves-> Celiac Ganglion-> Liver, Gallbladder, Pancreas
**(Part 2) Greater Sphlancnic Nerves-> Superior Mesenteric Ganglion–> Small intestines, ascending colon, transverse colon
(Part 1) Lesser Sphlancnic Nerves-> Aorticorenal Ganglion–> Suprarenal Gland, Kidney, Gonads
**(Part 2) Lesser Sphlancnic Nerves–> Superior Mesenteric Ganglion–> Small Intestine, Ascending Colon, Transverse Colon
Least Sphlancnic Nerves-> Aorticorenal Ganglion-> Kidney, Gonads
+ (DON’T FORGET THE EXCEPTION- ADRENAL
GLAND)
**Lumbar Sphlancnic Nerves–> Inferior Mesenteric Ganglion-> Descending Colon, Sigmoid Colon, Rectum
What is the special note to be made about the lesser sphlancnic nerve?
The lesser sphlancnic nerve goes directly presynaptically to the suprarenal gland to secretory cells of the suprarenal gland.
+ these secretory cells of the adrenal cortex act as post synaptic nuerons as they directly secrete NOREPINEPHERINE into the Bloodstream DIRECTLY!!!!!
Function of the parasympathetic ganglia of the head.
Constrict the pupil
Accomodation of the lenses
serous secretion of the lacrimal glands
serous secretion of the salivary glands
Cranial Nerves 3,7,9 have both parasympathetic and sympathetic innervations:
Synapse at: Ciliary Ganglion (CN 3), Pterygopalatine Ganglion (CN 7), Otic Ganglion (CN 9), submandibular Ganglion (CN 9)
What are the parasympathetic and sympathetic innervations of the left colic flexure, descending colon, sigmoid colon, rectum?
Sympathetic Nerves: Lumbar Sphlancnic Nerves
Parasympathetic Nerves: Pelvic Sphlancnic Nerves
What is the parasympathetic innervation of everything else above the left colic flexure?
This is the Vagus Nerve and its many branches
Abdominal Pain Criteria
x<3 days (Acute Pain)
3 days< x < 3 weeks (Subacute Pain)
x>3 weeks (Chronic Pain)
The Different Types of Pain
Visceral Pain-> diffuse and poorly localized pain that often is referred to a somatic region of the body; injury to organs
Somatic Pain-> well localized; caused by injury to the skin, muscles, bone, joints, connective tissues
Parietal Pain-> irritation of fibers to the parietal peritoneum
+ results in: guarding & tenderness
Visceral Pain Localization (diffuse & poorly localized)
Foregut Organs: will have diffuse epigastric pain
Midgut Organs: will have diffuse periumbilical pain
Hindgut Organs: will have diffuse hypogastric pain
What organs are referred to by foregut, midgut, and hindgut?
Hindgut Organs= most of colon + 1/2 of sigmoid colon
Midgut Organs= cecum, appendix, small intestine
Foregut Organs= stomach duodenum, biliary tract
Colicky Pain
“Colicky”: considered on-going that starts and stops abruptly-
*Due to muscular contractions of the hollow tubes in
an attempt to relieve an obstruction
(bowel obstruction, stone in ureter, stone in neck of
the gallbladder)
Gastric Ulcers
+ not wanting to eat/foregut visceral pain (stomach, duodenum, biliary tract, pancreas)
Perforated Gastric Ulcers
+ constant foregut visceral pain (biliary duct, stomach, pancreas, duodenum), diffuse pain ALL-OVER the abdomen, gives signs of GENERALIZED PERITONITIS
Acute Cholecystitis (N/V/ fever)
+ foregut visceral pain, somatic pain in RUQ, referred pain to right shoulder radiating from the RUQ; Obviously- POSITIVE MURPHY’S SIGN
+ Also: Nausea, Vomiting, Diarrhea
Acute Appendicitis (N/V/ fever)
+ midgut visceral pain (cecum, appendix, small intestine)
+pain & tenderness in RLQ
+Nausea & Vomiting
+ if appendix has ruptured the pt will have signs of LOCALIZED PERITONITIS in RLQ
Adhesive Small Bowel Obstruction
+ Midgut (cecum, appendix, small intestine)
+vomiting, no flatulance, bowel movements
+ VERY HIGH BOWEL SOUNDS
+Distended soft abdomen that is NOT TENDER
Passage of Kidney Stone
\+ Very severe colicky pain \+ In the loin to groin with SEVERE BACK PAIN \+ Dysuria= pain while urinating \+soft abdomen \+tender renal angle
Obstructing Cancer of the Descending Colon
\+ older patient \+ weight loss \+ hindgut (Left colic flexure, descending colon, sigmoid colon, rectum) cancer of the descending colon (obstruction due to cancer) \+ distended abdomen \+ possible mass in LLQ \+ VERY HIGH BOWEL SOUNDS
Ruptured Ectopic Pregnancy
+ women of childbearing age (12 y/o- 51 y/o)
+ missed her last menstrual cycle
+ onset of pain that is severe in hypogastrium
+ radiates from hypogastrium to the sacrum
+afebrile
+localized peritonitis in the hypogastric region
+tenderness in recto-uterine pouch with Digital Rectal Exam (DRE)
Leaking Aortic Aneurysm
+ when diagnosed with an Abdominal Aortic Aneurysm:
1.) history of atherosclerotic disease w/ hypertension or
cardiac disease
2. ) Sudden onset of SEVERE BACK PAIN
3. ) Elderly Patient
4.) tender epigastrium (although there is severe back
pain)
5.) palpable impulse from aneurysm in the epigastrium
for AAA
