Autonomics of the pelvis (funk) Flashcards
what is the plexus of the pelvis
inferior hypogastric plexus (a continuation of the superior hypogastric plexus via the hypogastric nerves)
what 4 things do autonomic nerve plexuses contain
Preganglionic parasympathetic fibers
Preganglionic sympathetic fibers
Postganglionic sympathetic fibers
Prevertebral sympathetic ganglia
what are the 3 main nerves that feed into the inferior hypogastric plexus that supply autonomic innervation to the pelvis
lumbar splanchnic (preganglionic symp) sacral splanchnic (preganglionic symp) pelvic splanchnic (preganglionic parasympathetic)
what do sympathetic efferents do
vasoconstrict
contract sphincters
inhibition of peristalsis
inhibition of glandular secretion
what do parasympathetic afferents do
vasodilation
peristalsis
contraction of detrusor muscle of bladder
myometrial muscle of uterus contraction
what is the parasympathetic innervation to the pelvis
origin
destination
where are the postganglionic cell bodies
Pelvic splanchnics
Parasympathetic
Preganglionic
Originate – S2, S3, S4 (lateral horn)
Destination – will distribute to the hindgut AND PELVIC VISCERA
NOTE: Postganglionic cells are in the wall of the organ.
what is the sympathetic innervation of the pelvis
lumbar splanchnic (major)
sacral splanchnic (minor)
where are the preganglionic cell bodies located for the lumbar splanchnics and sacral splanchnics
lumbar T11-L2
sacral T12-L2
where do lumbar splanchnics synapse as they exit the sympathetic chain
they enter the intermesenteric and superior hypogastric plexus and synapse with postganglionic neurons found here
via what do postganglionic neurons (lumbar splanchnics) travel from the superior hypogastric plexus to the inferior hypogastric plexus
hypogastric nerves
if these were lesioned you would lose sympathetic innervation to the pelvis
where do sacral splanchnics synapse and how did they get there
inferior hypogastric plexus by traveling in the sympathetic chain
via what do sacral splanchnics enter the pelvis
via pelvic sympathetic chain
via what do pelvic splanchnics enter the pelvis
via S2-S4 spinal nerves
via what do lumbar splanchnics enter pelvis
via hypogastric nerves
what is the parasympathetic innervation to the perineum
from the cavernous plexus which is a continuation of the pelvic splanchnics
what is the sympathetic innervation of the perineum
pudendal `n (postganglionic sympathetics)
what is the sympathetic innervation of the bladder and which parts
T10-L2 via lumbar and sacral splanchnics
trigonal muscle and protion of urethra mm
parasympathetic innervation to the bladder
pelvic splanchnics
detrusor
sympathetic innervation to the testes and where are the postganglionic cell bodies located
from T10 -T11 via lesser splanchnic nerves
postganglionic cell bodies are located in the aorticorenal ganglion
what is the parasympathetic innervation to the testes
vagus
what is the sympathetic innervation to the internal male reproductive organs
and what is the function of sympathetics
preganglionic fibers (T12-L2) via lumbar and sacral splanchnics postganglionic cell bodies located in several ganglia
EMISSION
Contraction of smooth mm in wall of ductus deferens, ejaculatory duct, and within capsule of prostate and seminal vesicle.
dorsal n. of penis
what is the parasympathetic innervation to the male internal reproductive organs
pelvic splanchnics
increases secretion from prostate, seminal vesciles and bulbourethral glands
cause vasodilation of the erectile tissue (boner)
what is the erection mediated by
parasympathetics (via cavernous nerves) to the erectile tissue arteries (helicine arteries) which causes filling and engorgement of erectile bodies
contraction of the bulbospongiosus and ischiocavernosus m is also involved which presents venous drainage of blodo
what is ejaculation controlled by
sympathetics and somatics *pudendal from foreceful contraction of the bulbospongiosus
what is remission
a sympathetic response involving contraction of helicine arteries
sympathetic innervation of the ovary and uterine tube
preganglionic fibers T10-T11 via lesser splanchnic nerve
postganglionic cell bodies are in the aorticorenal ganglion
parasympathetic innervation to the ovary and uterine tube
vagus
sympathetic innervation to the uterus, cervix and vagina
T12-L2 via lumbar and sacral splanchnic
**pain from uterus
parasympathetic innervation to the uterus, cervix and vagina
pelvic splanchnics (S2-S4)
vasomotor –> contraction of smooth muscle
pain from cervix and upper vagina
what is the somatic innervation of the vagina
pudendal nerve (inferior 1/4 of vagina)
sympathetic innervation to the rectum and proximal anal canal
preganglionic fibers (L1-L2) via lumbar and sacral splanchnics
motor control of internal sphincter muscle
inhibit gland secretion
parasympathetic innervation of the rectum and proximal anal canal
preganglionic fibers travel with pelvic splanchnics
contraction of smooth muscle (peristalsis)
stimulation of glandular secretion
innervation of distal anal canal
somatic innervation from pudendal nerve
what is the autonomic control of defecation
once a critical mass in the rectum is obtained, stimulation of parasympathetic afferents occurs
internal anal sphincter must relax
peristalstic contractions (parasymp) move feces through rectum
what are the two major types of afferent information in autonomics
stretch involved in reflex information travelling with parsympathetic
pain- ischemia, inflammation, chemical exposure
typically travels with sympathetic but in the pelvis there is a the pelvic pain line
what is the pelvic pain line
inferior limit of the pelvic peritoneum
distinguishes organs covered with pelvic peritoneum and organs not covered with pelvic peritoneum
superior to the pain line (organs which are peritonealized) visceral pain fibers travel with what
Acute pain afferents travel with sympathetic neurons to T11-L2.
inferior to the pain line (organs which are subperitoneal )visceral pain fibers travel with what
Acute pain afferents travel with parasympathetic neurons to S2-S4.
afferent information of ureter
pain travels with sympathetic fibers
afferent info of urinary bladder
superior protion –> peritonealized –> travel with sympathetic nerves to T10-L2
inferior portion–> subperitoneal –> parasympathetic fibers to S2-S4
afferent info of urethra
all pain afferents travel with pelvic splanchnic nerves
EXCEPT very distal portion, which is somatic (pudendal nerve).
where is the pelvic pain line for GI viscera
occurs at the rectosigmoidal junction
afferent information of the rectum
all pain afferents travel with parasympathetics
anal canal afferent information
above pectinate line –> parasympathetics to S2-S4
below pectinate line –> somatic innervation (pudendal)
what portions of the male reproductive system send afferent info with sympathetics
testes epididymis and distal ducts deferns (T10-T11)
internal pelvic male reproductive viscera afferent info
pain travels with pelvic splanchnic nerves to S2-S4
all below pelvic pain line
penis afferent info
somatic innervation (pudendal n.)
what portions of the female reproductive viscera are going to send afferent information with the sympathetic nerves
ovaries (T10-T11)
uterine tubes
uterus (fundus and body (T12-L2)
afferent information of cervix, superior vagina
pelvic splanchnics (S2-S4)
inferior 1/4 of vagina afferent information
somatic (pudendal n) S2-S4
where is pain from uterine contractions felt
Pain from uterus (uterine contractions) will travel with sympathetic nn to T12-L2. Thus, referred pain from uterine contractions will be the lower back and radiating around to the inguinal and groin region
where is pain from passage of fetus through birth canal
cervix and upper portion of vagina are below pelvic pain line
Pain from passage of fetus through birth canal (cervix, vagina) will travel with pelvic splanchnic nn to S2, S3, S4. Pain will refer to perineal region.
where is pain from the inferior vagina during birth
Pain from inferior vagina/perineum will be well-localized somatic pain (pudendal n).
lumbar epidural
Lumbar epidural
- delivered around LV3/LV4
- **level of anesthesia is usally 3-4 levels higher than insertion
– anesthesia below T12 No pain from uterine contractions or passage of baby through birth canal, and no pain of perineum
ALL BLOCKED
draw backs–> can’t walk
if you can’t feel contractions you can’t time the pushing/contractions
can be given continuously through indwelling catheter
caudal epidural
Caudal epidural –
delivered into epidural space of sacral canal (sacral hiatus)
anesthesia below S1/S2, only sacral levels are anesthetized.
Pain will be felt from uterine contractions; but not from passage of baby through birth canal (so loss of pain from cervix, vagina, and perineum)
will be able to walk
pudendal nerve block
Pudendal nerve block –
pudendal nerve is localized by palpating the ischial spine and sacrospinous ligament (inside the vagina) b/c the pudendal goes right over ischial spine
pain from uterine contractions and passage through upper portion of birth canal will be felt
.
Anesthesia only to perineum (minimize pain from potential tearing or episiotomy)
