Anatomy of Urinary Incontinence and Renal Pain Flashcards
What conveys sensory nerve fibres from body wall to CNS?
somatic sensory
What conveys sensory nerve fibres from organs to CNS?
visceral afferent
What conveys motor from CNS to body wall?
somatic motor
What conveys motor from CNS to organs?
parasympathetic or sympathetic
Sympathetic nerve fibres leave the CNS only within the spinal nerves between spinal cord levels of what, and what is this called?
T1-L2 (“thoracolumbar outflow”)
Which cranial nerves are parasympathetic?
III, VII, IX & X
Parasympathetic nerve fibres which innervate the kidneys & ureter are carried within which nerves?
vagus nerves
Parasympathetic nerve fibres which innervate the bladder are carried within which nerves?
the pelvic splanchnic nerves
Where is bladder pain normally felt?
suprapubic region (midline)
Pain from a calculus obstructing the ureter can often be felt where?
radiating from “loin to groin”, on the affected side
Pain from the kidney itself (e.g. in acute hydronephrosis) is felt where?
In the “loin”: posterior aspect of the flank region, on the affected side
Pain from the (perineal part of the) urethra is usually felt where?
localized to perineum
Visceral afferents from the KIDNEYS
enter the spinal cord approx. between which vertebra levels?
T11 and L1
Give 5 differentials for loin pain.
skin origin (e.g. herpes zoster) muscular vertebrae spinal nerve root compression lower lobe pneumonia
Visceral afferents from the URETER
enter the spinal cord approx. between which vertebra levels?
T11 and L2
Differentials of groin pain?
hernias (inguinal or femoral)
lymphadenopathy
testicular pathology
Visceral afferents from the BLADDER
enter the spinal cord approx. between which vertebra levels?
T11 and L2
How Do Visceral Afferent & Somatic Sensory Nerve Fibres get from the Urethra to the CNS?
visceral afferents enter back at spinal cords levels S2,S3,S4
Differential diagnosis of perineal pain?
vaginal tear
anal canal fissure
perineal genital ulcers (e.g. herpes)
Differential diagnosis of scrotal pain
skin lesions
strangulated inguinal hernia
How Do Pain Fibres get from the Testis to the CNS?
visceral afferents enter back at spinal cords levels T10-11
Where can testicular pain also present?
localised to the scrotum and/or groin (L1 region)
Describe pain from the kidneys themselves.
dull, achy type pain in the loin (posterior flank region)
Describe pain from the ureters.
if obstruction, “loin to groin” pain
Describe pain from the bladder.
usually dull, achy suprapubic pain
Describe urethral pain.
distal urethra (that within the perineum) is felt localised and is a relatively sharp pain within the perineum
Describe pain from the testis.
often felt in scrotum but can radiate to the groin and the anterior lower abdomen (can also initially present in one of the latter two)
The nerve fibres entering and leaving spinal cord levels S2-S4 are key in the control of what?
micturition (urine flow)
As the bladder fills, this is sensed by stretch receptors at the end of which fibres?
visceral afferent nerve fibres
Describe what happens to the detrusor muscle during micturition.
The detrusor muscle contracts (parasympathetic)
Describe what happens to the internal urethral sphincter during micturition.
relaxes (parasympathetic)
Describe what happens to the external urethral sphincter during micturition.
relax
Describe what happens to the levator ani muscles during micturition.
relax
Describe what happens to the anterolateral abdominal wall muscles during micturition.
contract to increase intra-abdominal pressure and force urine out of the external urethral orifice (somatic motor nerve fibres)
Where does the sciatic nerve arise from?
the sacral plexus (nerve roots L4-S3)
What is the pudendal nerve from?
S2,S3,S4
Where does the femoral nerve go?
anterior compartment of thigh
Where does the obturator nerve go?
medial compartment of thigh
Where does the sciatic nerve go?
posterior compartment of thigh via the gluteal region
What does the tibial nerve supply?
muscles of the posterior part of the leg and the intrinsic muscles of the foot
What does the sciatic nerve split into?
tibial and common fibular nerves
What does the femoral nerve become?
saphenous nerve
What supplies sensation to plantar aspect of foot?
tibial nerve
What supplies sensation to the lateral aspect of the foot?
sural nerve (formed from the tibial and common fibular nerves)
What supplies the “1st web space” in the foot?
deep fibular nerve
What is pelvic kidney?
one kidney fails to ascend
What is horseshoe kidney?
kidney trapped beneath IMA
