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2nd Year - Renal > Anatomy 6 - Urinary Continence and Renal System Pain > Flashcards

Anatomy 6 - Urinary Continence and Renal System Pain Flashcards

1
Q

Which sex has an internal urethral sphincter?

A

Only males (females only have an external urethral sphincter; males have both an internal and external sphincter)

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2
Q

What are the 5 types (modalities) of nerve fibres?

A

Sensory -> somatic sensory or visceral afferent

Motor -> somatic motor, parasympathetic or sympathetic

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3
Q

What type of muscle is supplied by somatic motor nerve fibres?

A

Skeletal (voluntary) muscle

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4
Q

Type of nerve fibres for ureteric peristalsis?

A

Sympathetic and parasympathetic

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5
Q

Type of nerve fibres for bladder contraction?

A

Sympathetic and parasypathetic

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6
Q

Type of nerve supply for urethral sphincter control?

A 
Sympathetic/ parasympathetic (internal in male)
Somatic motor (external and levator ani)
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7
Q

Type of nerve supply for kidney, ureteric and bladder pain?

A

visceral afferent

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8
Q

Type of nerve supply for urethral pain?

A 
Visceral afferent (in pelvis)
Somatic sensory (in perineum)
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9
Q

Type of nerve supply for testicular pain?

A

Visceral afferent (also get somatic prevention as the testicle is in close proximity to the scrotum and there can therefore be a mix up between the nerve supplies)

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10
Q

Type of nerve supply for urinary continance?

A

Visceral afferent
Sympathetic and parasympathetic
Somatic motor

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11
Q

Type of nerve supply for perineum and lower limbs?

A 
somatic senosry
Somatic motor (+ some sympathetics)
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12
Q

How many pairs of cranial nerves are there?

A

12 pairs

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13
Q

How many pairs of spinal nerves are there?

A

31 pairs

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14
Q

Why are cranial and spinal nerves so important?

A

it is the only means by which any type of nerve fibre can communicate with the CNS

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15
Q

At what level does the spinal cord end?

A

L1/L2 intervertebral disc level

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16
Q

What type of nerves are carried from their origin to insertion (entire length) within the cranial/ spinal nerves?

A

Somatic motor and sensory nerves

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17
Q

How do sympathetic, parasympathetic and visceral afferents use the cranial and spinal nerves?

A

For limited portions to get into and out of the CNS

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18
Q

What spinal cord levels do sympathetic fibres leave the CNS within spinal nerves?
What is the name for this?

A

T1 - L2

Thoracolumbar outflow

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19
Q

How do sympathetic fibres reach the smooth muscle/ glands of the body wall (other than the head)?

A

Within the spinal nerves

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20
Q

Where does the presynaptic sympathetic fibres from the thoracolumbar outflow pass to?

A

The sympathetic chain

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21
Q

What is the sympathetic chain?

A

A chain of paravertebral ganglia -> all sympathetic fibres travel here and then hitch a ride with one of the 31 pairs of spinal nerves to supply the smooth muscle and glands of the body wall structures or pass into a splanchnic nerve to supply the organs

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22
Q

What are the 2 types of sympathetic splanchnic nerves?

A

Cardiopulmonary or abdominopelvic

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23
Q

How does the sympathetic fibres reach the smooth muscle/ glands of the head?

A

Mainly by hitching a ride with the arteries which supply the same structures (usually internal external carotid arteries)

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24
Q

Where does the sympathetic fibres that are passing into each of the 31 pairs of spinal nerves to supply the body wall synapse?

A

In the paravertebral ganglia of the sympathetic chain

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25
Q

Where do the sympathetic fibres that are passing into the cardiopulmonary splanchnic nerves synapse?

A

In the paravertebral ganglia

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26
Q

Where do the sympathetic fibres that are passing into the abdominopelvic splanchnic nerves synapse?

A

In the abdominal sympathetic ganglia which are located around the abdominal aorta

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27
Q

What connects the sympathetic chain and spinal nerves?

A

Rami communicans

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28
Q

Name of the sympathetic chain ganglia located in the cervical region?

A

superior, middle and inferior cervical sympathetic ganglia

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29
Q

Nerves from what spinal cord levels contribute sympathetic nerve fibres to the kidneys, ureters and bladder?
Where do these pass?

A

T10 and L2
Enter the sympathetic chains and then leave (without synapsing) in the abdominopelvic splanchnic nerves -> synapse at the abdominal sympathetic ganglia

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30
Q

How do the sympathetic nerve fibres from the postsynpatic nerve fibres from the abdominoplevic splanchnic nerves get to the nerves that they are innervating?

A

They pass from the ganglia onto the surface of the arteries which are heading towards the organs they need to innervate

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31
Q

What is the collection of nerve fibres found on the outside of the arteries called?

A

A periarterial plexus

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32
Q

What nerve fibre types take part in the periarterial plexus?

A

Sympathetic
Parasympathetic
Visceral afferent
(all coming from/ going to the same organs)

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33
Q

Where do parasympathetic nerve fibres leave the CNS?

What is this called?

A

Within 4 cranial nerves and the sacral spinal nerves

Craniosacral outflow

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34
Q

Do parasympathetic fibres innervate the smooth muscle/ glands of the body wall?

A

No

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35
Q

How do parasympathetic fibres reach the smooth muscle/ glands of the head, lungs, heart and parts of the GI tract (part from the hindgut), kidneys and ureter?

A

Cranial nerves III, VII, IX and X

36
Q

How do parasympathetic fibres reach the smooth muscle/ glands of the hindgut and pelvic organs?

A

Via the pelvic splanchnic nerves

37
Q

What spinal nerves transmit parasympathetic fibres?

A

S2, S3 and S4 (fibres travel in these sacral spinal nerves for only a very short period of time before they enter the pelvic splanchnic nerves make up craniosacral)

38
Q

Where do presynaptic parasympathetic fibres synpase?

A

On the organs

39
Q

What nerve are parasympathetic fibres which innervate the kidneys and ureter carried within?

A

the vagus nerve (CN X)

40
Q

What nerve are parasympathetic nerves which innervate the bladder carried within?

A

Pelvic splanchnic nerves

41
Q

Where do the vagus nerve fibres pass onto to get to the kidneys and ureter?

A

Periarterial plexus

42
Q

What are the only parts of the renal system that somatic fibres go to?

A

Those within the perineum e.g. urethra (distal to the pelvic floor), external urethral sphincter and levator ani

43
Q

What nerve supplies the somatic motor innervation to the structures of the perineum e.g. urethra, external urethral sphincter and elevator ani?
What are the spinal nerve roots for this?

A

Pudendal nerve

S2, S3, S4 spinal nerves

44
Q

Where is pain from kidney usually felt?

A

Loin area (posterior aspect of the flank)

45
Q

Where is pain from the bladder usually felt?

A

Suprapubic region (midline)

46
Q

Where can pain calculus obstructing the ureter be felt?

A

Radiating from “loin to groin” on the affected side

47
Q

Where can pain from the perineal part of the urethra usually be felt?

A

Usually felt quite localised in the perineum

48
Q

How do visceral afferent nerve fibres from the kidneys get back to the spinal cord?
At what levels do they enter the spinal cord approx. between?

A

They run alongside sympathetic fibres

T11 and L1 (patients therefore feel pain from kidney in these dermatomes posteriorly)

49
Q

How do visceral afferent nerve fibres get from the ureters to the CNS?

A

They run alongside the sympathetic fibres

Enter the spinal cord between levels T11 and L2 (pain tends to be perceived from patient anywhere along this path)

50
Q

How do visceral afferent nerve fibres from the bladder get back to the CNS?
What spinal cord level do they enter?

A

Nerves from the part of the bladder touching the peritoneum (superior part) run alongside sympathetic fibres back to spinal cord innervated)
T11 to L2
Visceral afferent from rest of bladder run alongside parasympathetic nerve fibres
S2, S3, S4

51
Q

How do visceral afferent nerve fibres from proximal urethra get to the CNS?
What spinal cord levels do they join at?

A

Run alongside parasympathetic fibres

S2, S3, S4

52
Q

How do somatic sensory nerve fibres from the distal urethra get back to the CNS?
what spinal cord levels do they join at?

A

Carried within the pudendal nerve

S2, S3, S4

53
Q

What type of nerve fibres supply pain innervation to the testis?

A

Visceral afferents

54
Q

How do visceral afferents from the testes get to the CNS?

What spinal cord levels do they join at?

A

Run alongside sympathetic fibres (due to embryological descent)
T10 - T11

55
Q

Apart from T10-T11 dermatome, where can pain from testis often be felt?

A

Localised to the scrotum and/ or groin (L1) - due to close relationship between testis and scrotal wall

56
Q

At what spinal cord level are the nerve fibres entering and leaving key in the control of micturition?

A

S2- S4 -> pelvic splanchnic nerves (parasympathetic firbes), visceral afferent fibres, and pudendal nerve (somatic motor) all leave at S2-S4

57
Q

What senses the bladder filling?

A

Stretch receptors at the end of visceral afferent nerve fibres (info relayed to CNS via S2-S4)

58
Q

What does stimulation of the stretch receptors on visceral afferent nerve fibres cause?

A

A reflex to empty the bladder by stimulation of the detrusor muscle and inhibition of the internal sphincter muscle (males)

59
Q

What happens to the reflex to empty the bladder stimulated by the visceral afferent nerves (as the bladder fills)?

A

The brain overrides it (if toilet trained)
Action potentials within inhibitory nerve fibres from the cortex pass inferiorly and inhibit this reflex
We can also voluntarily contract the external sphincter and elevator ani muscles

60
Q

What happens once it is appropriate to micturate?

A

The cerebral inhibition of the reflex is listed and the detrusor muscle contracts (parasympathetic), internal urethral sphincter (parasympathetic), external urethral sphincter and elevator ani muscles relax (somatic motor control)
Anterolateral abdominal wall muscles contract to increase intra-abdominal pressure and force urine out of the external urethral orifice (somatic motor nerve fibres)

61
Q

What forms the lumbrosacral plexus?

A

Anterior rami of spinal nerves

62
Q

In general, what emerges from the lumbrosacral plexus?

A

Named spinal nerves (vast majority contain somatic sensory, somatic motor and sympathetic nerve fibres going to/ from the body wall structures)

63
Q

What plexus does the pudendal nerve arise from?

A

The sacral plexus

64
Q

Which plexus does the sciatic nerve arise from?

Nerve roots?

A

Sacral plexus

L4-S3

65
Q

From superior to inferior (from body wall) what are the names of the 6 nerves arising from the lumbar plexus?

A 
Iliohypogastric
Ilioinguinal
Lateral cutaneous nerve of the thigh
Genitofemoral
Femoral
Obturator
66
Q

Nerve root of iliohypogastric?

A

L1

67
Q

Nerve root of ilioinguinal?

A

L1

68
Q

Nerve root of lateral cutaneous nerve of thigh?

A

L2, L3

69
Q

Nerve root of genitofemoral nerve?

A

L1, L2

70
Q

Nerve root of femoral nerve?

A

L2 - L4

71
Q

What nerve supplies the lateral gluteal region above the pubis, internal oblique and transverses?

A

Iliohypogastric

72
Q

What nerve supplies the root of the penis and upper scrotum, mons and lab. maj..?

A

Ilioinguinal

73
Q

Which nerve supplies the skin over the lateral thigh?

A

Lateral cutaneous nerve of the thigh

74
Q

Which nerve supplies the upper thigh, anterior scrotum, mons. pubis and cremaster?

A

Genitofemoral nerve

75
Q

How to tell the difference between the femoral and obturator nerve on a prosecution?

A

Femoral sits lateral to psoas major, obturator sits medial to psoas major

76
Q

What nerve supplies the anterior compartment of the thigh?

A

Femoral nerve

77
Q

What nerve supplies the medial compartment of the thigh?

A

Obturator nerve

78
Q

what nerve supplies the posterior compartment of the thigh?

A

Sciatic nerve

79
Q

What nerve supplies the lateral compartment of the leg?

A

Superficial fibular nerve

80
Q

What nerve supplies the anterior compartment of the leg?

A

deep fibular

81
Q

What nerve supplies the posterior compartment of the leg and intrinsic sculls of the foot?

A

Tibial nerve

82
Q

What initiates ureteric peristalsis?

A

Autonomic action initiated and propagated by ureteric cells which have their own in-built auto-rhythmicity

83
Q

What type of fibres stimulate the detrusor muscle to contract?

A

Parasympathetic (from S2, S3, S4 via the pelvic splanchnic nerves)

84
Q

What type of fibres stimulate the internal urethral sphincter muscle to contract?

A

Sympathetic

85
Q

What type of fibre inhibit the internal urethral sphincter muscle contraction?

A

Parasympathetic fibres

86
Q

What type of nerves stimulates the external urethral sphincter muscle and levator ani to contract?

A

Somatic motor within pudendal nerve

2nd Year - Renal (6 decks)

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