Autonomic Nerve Supply of Abdomen and Pelvis

Question 1

From which spinal cord segments do the preganglionic sympathetic fibers originate from in the lateral gray horn for those fibers that innervate the abdominal and pelvic viscera?

Answer 1

T5 to L2 or L3

Question 2

Which nerves supply preganglionic sympathetic nerves to the abdominopelvic viscera? (high yield)

Answer 2

Thoracic, lumbar, and sacral splanchnic nerves

Question 3

What two ganglia do presympathetic fibers from the thoracic lumbar and sacral splanchnic nerves reach?

Answer 3

The prevertebral (collateral ganglia) and the hypogastric plexus

Question 4

What are the 4 named ganglia based on the closely associated arteries in the abdominal region?

Answer 4

Celiac ganglion, superior mesentaric ganglion, aorticorenal ganglion, inferior mesentaric ganglion

Question 5

From which vertebrae do the greater splanchnic nerves arise, and where do they synapse?

Answer 5

Arise from T5-T9, synapse in celiac ganglion

Question 6

From which vertebrae do the lesser splanchnic nerves arise, and where do they synapse?

Answer 6

Arise in T10, T11 and synapse in the superior mesenteric ganglion

Question 7

From which vertebrae do the least splanchnic nerves arise, and where do they synapse?

Answer 7

Arise in T12, synapse in the aorticorenal ganglion

Question 8

From which vertebrae do the lumbar splanchnic nerves arise, and where do they synapse?

Answer 8

Arise from L1, L2, maybe L3. Synapse in inferior mesenteric ganglion and postganglionic neurons in scattered hypogastric plexuses

Question 9

From which vertebrae do the sacral splanchnic nerves arise, and where do they synapse?

Answer 9

Arise in L1, L2, maybe L3. Synapse in postganglionic neurons scattered in hypogastric plexuses

Question 10

What plexus supplies the pelvic organs?

Answer 10

The hypogastric plexuses (superior and inferior)

Question 11

What forms the superior hypogastric plexus?

Answer 11

Postganglionic sympathetic fibers from the inferior mesenteric ganglia
Preganglionic and some postganglionic sympathetic fibers from lower lumbar splanchnic nerves

Question 12

What two nerves arise from the superior hypogastric plexus?

Answer 12

Right and left hypogastric nerves which descend into the pelvis

Question 13

What gives rise to the inferior hypogastric plexus? By which organs are these plexuses situated?

Answer 13

The right and left hypogastric nerves which arose from the superior hypogastric plexus give rise to left and right inferior hypogastric plexuses. They are near the rectum, uterine cervix, and urinary bladder.

Question 14

What is everything that the inferior hypogastric plexus receives contributions from?

Answer 14

Receives all plexi that are coming down from the hypogastric nerves plus the sacral splanchnic nerves

Question 15

What are the two sources of parasympathetic supply to abdomen and pelvis?

Answer 15

Pelvic splanchnic nerves (S2 S3 S4) and the vagus nerve

Question 16

What areas of abdomen does the vagus nerve supply?

Answer 16

Sends branches to celiac plexus, superior mesenteric plexus, ad aorticorenal plexus thus supplying all of the foregut and midgut areas.

Question 17

What makes up pelvic splanchnic nerves? What regions do they supply?

Answer 17

Preganglionic parasympathetic fibers from spinal cord levels and spinal nerves S2, S3, and S4.

Supply the hindgut and all pelvic organs

Question 18

(High yield) What fibers make up the following plexuses:

1. Celiac plexus, superior mesenteric plexus, aorticorenal plexus, intermesenteric plexus, and inferior mesenteric plexus
2. Superior hypogastric plexus and hypogastric nerves
3. Inferior hypogastric (pelvic) plexus

Answer 18

1. Preganglionic sympathetic fibers, sympathetic ganglia, postganglionic sympathetic fibers, preganglionic parasympathetic fibers, and visceral sensory (afferent) fibers
2. Pregang. sympth. fibers, scattered postganglionic sympathetic neurons, postgang. sympth. fibers , preganglionic parasympathetic fibers, visceral sensory (afferent) fibers
3. Pregang. sympth. fibers, scattered postgang. sympth. neurons, postgang. sympth. fibers, pregang. parsympth. fibers, scattered postgang. parasympth. neurons, postgang. parasympth. fibers, visceral sensory fibers

Question 19

What path (of another nerve track) do the visceral afferents in the abdomen follow? In the thorax?

Answer 19

All abdominal visceral afferent fibers follow the sympathetic innervation. MOST thoracic do, but not all

Question 20

What are the spinal cord segments in which visceral afferent pain fibers innervate (from abdomen and pelvis)?

Answer 20

The visceral afferents follow sympathetic fibers back to sympathetic trunk and connect to spinal nerve via white communicating ramus to levels of T1 through L2

Question 21

Describe the pathway of visceral afferents for:
Most pelvic organs
Uterus
Bladder

Answer 21

Most pelvic organs follow the pelvic splanchnic nerves to S2-S4

This does not hold true for the fundus of the uterus, which has fibers following sympathetic innervation (to T11-T12) back (but the body and cervix follow parasympathetic)
The roof of the bladder also follows sympathetic (to T11-L2) while the floor follows parasympathetic