Abdominopelvic Autonomics/Pain (Anatomy)

Question 1

Somatic Nervous System

Answer 1

voluntary, subconscious control; no ganglia; special senses input and motor output (acetylcholine)
+ axons are thick and myelinated for fast conductance

Question 2

Autonomic Nervous System

Answer 2

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

Question 3

Sympathetics at Vertebral Levels

Answer 3

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)

Question 4

Function of the post synaptic sympathetic fibers that exit horizontally to synapse on to the body walls

Answer 4

Function: Sudomotion (release sweat), Pilomotion (hair movement), vasomotion (oscillation of the tone of blood vessel walls depending on cornoary or pulmonary vessels)

Question 5

Horners Syndrome

Answer 5

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)

Question 6

Cardiopulmonary Sphlancnic Nerves

Sympathetic origins

Answer 6

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

Question 7

What are the abdominopelvic sphlancnic nerves (sympathetic origins)

Answer 7

Presynaptic neurons that go through the different tracts (greater, lesser, least sphlancnic nerves)

Question 8

where do the abdominopelvic sphlancnic nerves synapse?

Answer 8

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

Question 9

What is the special note to be made about the lesser sphlancnic nerve?

Answer 9

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!!!!!

Question 10

Function of the parasympathetic ganglia of the head.

Answer 10

Constrict the pupil
Accomodation of the lenses
serous secretion of the lacrimal glands
serous secretion of the salivary glands

Question 11

Cranial Nerves 3,7,9 have both parasympathetic and sympathetic innervations:

Answer 11

Synapse at: Ciliary Ganglion (CN 3), Pterygopalatine Ganglion (CN 7), Otic Ganglion (CN 9), submandibular Ganglion (CN 9)

Question 12

What are the parasympathetic and sympathetic innervations of the left colic flexure, descending colon, sigmoid colon, rectum?

Answer 12

Sympathetic Nerves: Lumbar Sphlancnic Nerves

Parasympathetic Nerves: Pelvic Sphlancnic Nerves

Question 13

What is the parasympathetic innervation of everything else above the left colic flexure?

Answer 13

This is the Vagus Nerve and its many branches

Question 14

Abdominal Pain Criteria

Answer 14

x<3 days (Acute Pain)
3 days< x < 3 weeks (Subacute Pain)
x>3 weeks (Chronic Pain)

Question 15

The Different Types of Pain

Answer 15

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

Question 16

Visceral Pain Localization (diffuse & poorly localized)

Answer 16

Foregut Organs: will have diffuse epigastric pain

Midgut Organs: will have diffuse periumbilical pain

Hindgut Organs: will have diffuse hypogastric pain

Question 17

What organs are referred to by foregut, midgut, and hindgut?

Answer 17

Hindgut Organs= most of colon + 1/2 of sigmoid colon

Midgut Organs= cecum, appendix, small intestine

Foregut Organs= stomach duodenum, biliary tract

Question 18

Colicky Pain

Answer 18

“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)

Question 19

Gastric Ulcers

Answer 19

+ not wanting to eat/foregut visceral pain (stomach, duodenum, biliary tract, pancreas)

Question 20

Perforated Gastric Ulcers

Answer 20

+ constant foregut visceral pain (biliary duct, stomach, pancreas, duodenum), diffuse pain ALL-OVER the abdomen, gives signs of GENERALIZED PERITONITIS

Question 21

Acute Cholecystitis (N/V/ fever)

Answer 21

+ 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

Question 22

Acute Appendicitis (N/V/ fever)

Answer 22

+ 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

Question 23

Adhesive Small Bowel Obstruction

Answer 23

+ Midgut (cecum, appendix, small intestine)
+vomiting, no flatulance, bowel movements
+ VERY HIGH BOWEL SOUNDS
+Distended soft abdomen that is NOT TENDER

Question 24

Passage of Kidney Stone

Answer 24

\+ Very severe colicky pain 
\+ In the loin to groin with SEVERE BACK PAIN
\+ Dysuria= pain while urinating
\+soft abdomen
\+tender renal angle

Question 25

Obstructing Cancer of the Descending Colon

Answer 25

\+ 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

Question 26

Ruptured Ectopic Pregnancy

Answer 26

+ 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)

Question 27

Leaking Aortic Aneurysm

Answer 27

+ 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