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LR Renal > Anatomy: Urinary Incontinence & Pain > Flashcards

Anatomy: Urinary Incontinence & Pain Flashcards

1
Q

What are the 5 modalities of nerve fibre?

A

Somatic sensory (sensation from body wall)
Somatic motor (motor response to body wall)
Visceral afferent (sensation from organs)
Sympathetic (motor response to smooth muscle, cardiac muscle and glands)
Parasympathetic (motor response to smooth muscle, cardiac muscle and glands)

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2
Q

List the aspects of the renal system which receive somatic sensory innervation

A
  • The perineum and lower limbs (via the lumbar and sacral plexus)
  • The part of the distal urethra which is found in the perineum
  • (testicular pain if the scrotum is involved)
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3
Q

List the aspects of the renal system which receive somatic motor innervation

A
  • The perineum and lower limbs (via the lumbar and sacral plexus)
  • External urethral sphincter
  • Levator ani
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4
Q

List the aspects of the renal system which involve visceral afferent innervation

A

Pain from the…

  • kidneys
  • ureters
  • bladder
  • urethra
  • testis
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5
Q

List the aspects of the renal system which involve sympathetic/parasympathetic innervation

A
  • Ureteric peristalsis
  • Bladder contraction
  • Internal urethral sphincter control
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6
Q 
What type of nerves carry sympathetic fibres to the smooth muscles/glands of the...
-Body wall
-Thoracic organs
-Abdominal organs
...?
A
  • Body wall: spinal nerves T1-L2 (thoracolumbar)
  • Thoracic organs: cardiopulmonary splanchnic nerves
  • Abdominal organs: abdominopelvic splanchnic nerves
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7
Q

How do sympathetic fibres reach the head?

A

By forming a plexus around arteries surrounding the same structures that they are going to supply

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8
Q

Describe the route of sympathetic nerve fibres to the kidneys, ureters, and bladder

A
  • Presynaptic sympathetic nerve fibres leave the spinal cord at ~T10-L2
  • They enter the sympathetic chains but do not synapse
  • They leave the sympathetic chains within abdominopelvic splanchnic nerves
  • They synapse at the abdominal sympathetic ganglia found around the abdominal aorta
  • Postsynaptic sympathetic nerve fibres form a periarterial plexus around the arteries heading towards the organ they are going to innervate (i.e., the kidneys, ureter or bladder)
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9
Q

What sort of nerve fibres are found in a periarterial plexus?

A

Postsynaptic sympathetic nerve fibres
Parasympathetic nerve fibres
Visceral afferent fibres

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10
Q

Parasympathetic nerves innervate the smooth muscle/glands of the body wall. T/F?

A

False

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11
Q

What type of nerves carry parasympathetic fibres to the smooth muscles/glands of the…
-Head
-Body (minus the hindgut and pelvic regions)
-Hindgut and pelvic regions
…?

A
  • Head and body (minus the hindgut and pelvic regions): cranial nerves 3, 7, 9 and 10
  • Hindgut and pelvic regions: pelvic splanchnic nerves
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12
Q

What is the difference between abdominopelvic and pelvic splanchnic nerves?

A 
Abdominopelvic = sympathetic 
Pelvic = parasympathetic
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13
Q

Describe the route of parasympathetic nerve fibres to the kidneys and ureters

A
  • Presynaptic parasympathetic fibres are carried within the vagus nerves (CN X)
  • CN X enters the abdominal cavity through the diaphragm on the surface of the oesophagus
  • Presynaptic parasympathetic fibres are passed into the periarterial plexuses that will carry them to the kidneys and ureters
  • They synapse directly onto the organs they are supplying
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14
Q

Describe the route of parasympathetic nerve fibres to the bladder

A
  • Presynaptic parasympathetic nerve fibres leave the spinal cord at levels S2, S3 and S4 via the pelvic splanchnic nerves
  • The pelvic splanchnic nerves join the periarterial plexus heading towards the bladder
  • They synapse directly onto the bladder
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15
Q

Which somatic motor nerve supplies the body wall structures important in the renal system? What are these structures?

A

The pudendal nerve (S2, S3, S4) - i.e., the ‘nerve of the perineum’

These structures are the levator ani muscle and the external urethral sphincter
(S2, 3, 4 keeps the pelvis off the floor)

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16
Q 
Where is pain arising from the...
- Kidney
- Ureter
- Bladder
- Distal part of the urethra
... usually felt?
A
  • Kidney: posterior aspect of the flank region (the loin) on the affected side
  • Ureter: radiating from ‘loin to groin’ (posterior flank to anterior flank) on affected side
  • Bladder: suprapubic region, midline
  • Distal part of the urethra: localised in the perineum (as distal urethra is in perineum so receives somatic sensory innervation)
17
Q

Describe the route that visceral afferent nerve fibres take when carrying pain from the kidneys back to the CNS

A
  • Visceral afferents from the kidneys run alongside sympathetic fibres back to the spinal cord
  • They enter the spinal cord ~T11-L1
  • The patient feels this pain in these dermatomes posteriorly (‘the loin’)
18
Q

Give differential diagnoses for loin pain (6)

A
  • Kidney origin (e.g., acute hydronephrosis)
  • Skin origin (e.g., herpes zoster - shingles)
  • Muscular (e.g., quadratus lumborum pain)
  • Vertebrae (bony pain)
  • Spinal nerve root compression (neurological pain)
  • Lower lobe pneumonia
19
Q

Describe the route that visceral afferent nerve fibres take when carrying pain from the ureters back to the CNS

A
  • Visceral afferents from the ureters run alongside sympathetic fibres back to the spinal cord
  • They enter the spinal cord ~T11-L2
  • The patient tends to feel pain anywhere along these dermatomes (‘from loin to groin’)
20
Q

Give differential diagnoses for groin pain (4)

A
  • Ureter origin
  • Hernia (inguinal or femoral)
  • Lymphadenopathy
  • Testicular pathology
21
Q

Describe the 2 possible routes that visceral afferent nerve fibres can take when carrying pain from the bladder back to the CNS

A

Superior part of the bladder which is in contact with the perineum:

  • Visceral afferents run alongside sympathetic fibres back to the spinal cord
  • They enter the spinal cord ~T11-L2
  • The pain is perceived in the suprapubic midline region

The rest of the bladder which is not touching the perineum:

  • Visceral afferents run alongside parasympathetic nerve fibres back to the spinal cord
  • They enter the spinal cord ~S2, S3, S4
22
Q

Give differential diagnoses for suprapubic pain (2)

A
  • Single, midline pelvic organs whose superior aspect touches the peritoneum (e.g., bladder, uterus)
  • Hindgut organs e.g., sigmoid diverticula
23
Q

Describe the route that visceral afferent nerve fibres take when carrying pain from the proximal urethra back to the CNS

A
  • Visceral afferents from the proximal urethra (i.e., above the pelvic floor) run alongside parasympathetic nerve fibres back to the spinal cord
  • They enter the spinal cord ~S2, S3 and S4
24
Q

Describe the route that somatic sensory nerve fibres take when carrying pain from the distal urethra back to the CNS

A
  • Somatic sensory nerves from the distal urethra (i.e., below levator ani) are carried back to the spinal cord by the pudendal nerve
  • The pudendal nerve enters the spinal cord at S2, S3, S4
  • Pain is localised within the perineum
25
Q

Give differential diagnoses for perineal pain (4)

A
  • Distal urethra pathology
  • Vaginal tear
  • Anal canal fissure
  • Perineal genital ulcers e.g., herpes
26
Q

Describe the route that pain fibres take when carrying pain from the testis back to the CNS

A
  • Visceral afferents from the testis run alongside sympathetic fibres back to the spinal cord
  • They enter the spinal cord at T10-T11
  • Due to its close relationship to the scrotal wall, pain from the testis can also present localised to the scrotum/groin (L1 region)
27
Q

Why do visceral afferents from the testes enter the spinal cord relatively high (T10-11)?

A

Due to their embryological development higher up in the posterior wall of the abdomen before their descent

28
Q

Give differential diagnoses for scrotal pain (3)

A
  • Testis pathology
  • Skin lesions
  • Strangulated inguinal hernia
29
Q

The nerves entering and leaving the spinal cord at what spinal cord levels are key in the control of micturition (urine flow)?

A

S2-S4

30
Q

What 3 nerve types are involved in the control of micturition (urine flow) i.e., leave the spinal cord at levels S2-S4?

A
  • Visceral afferent fibres
  • Pelvic splanchnic nerves
  • Pudendal nerve
31
Q 
What role do each of the following nerve types have in the control of urination:
- Visceral afferent fibres
- Pelvic splanchnic nerves
- Pudendal nerve
...?
A
  • Visceral afferent fibres: stretch receptors sense filling of the bladder
  • Pelvic splanchnic nerves: parasympathetic fibres stimulate the detrusor muscle to contract and (in males) the internal urethral sphincter to relax
  • Pudendal nerve: somatic motor fibres voluntary contract the external urethral sphincter and the levator ani to prevent micturition until it is appropriate, then they relax to allow urine to pass through
32
Q

How do the anterolateral abdominal wall muscles help with micturition?

A

They contract under control of somatic motor nerve fibres

This increases intra-abdominal pressure to force urine out of the external urethral orifice

LR Renal (16 decks)

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