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ENDO exam 2 > Autonomics of the pelvis (funk) > Flashcards

Autonomics of the pelvis (funk) Flashcards

1
Q

what is the plexus of the pelvis

A

inferior hypogastric plexus (a continuation of the superior hypogastric plexus via the hypogastric nerves)

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2
Q

what 4 things do autonomic nerve plexuses contain

A

Preganglionic parasympathetic fibers
Preganglionic sympathetic fibers
Postganglionic sympathetic fibers
Prevertebral sympathetic ganglia

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3
Q

what are the 3 main nerves that feed into the inferior hypogastric plexus that supply autonomic innervation to the pelvis

A 
lumbar splanchnic (preganglionic symp)
sacral splanchnic (preganglionic symp)
pelvic splanchnic (preganglionic parasympathetic)
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4
Q

what do sympathetic efferents do

A

vasoconstrict
contract sphincters
inhibition of peristalsis
inhibition of glandular secretion

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5
Q

what do parasympathetic afferents do

A

vasodilation
peristalsis
contraction of detrusor muscle of bladder
myometrial muscle of uterus contraction

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6
Q

what is the parasympathetic innervation to the pelvis

origin
destination
where are the postganglionic cell bodies

A

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.

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7
Q

what is the sympathetic innervation of the pelvis

A

lumbar splanchnic (major)

sacral splanchnic (minor)

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8
Q

where are the preganglionic cell bodies located for the lumbar splanchnics and sacral splanchnics

A

lumbar T11-L2

sacral T12-L2

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9
Q

where do lumbar splanchnics synapse as they exit the sympathetic chain

A

they enter the intermesenteric and superior hypogastric plexus and synapse with postganglionic neurons found here

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10
Q

via what do postganglionic neurons (lumbar splanchnics) travel from the superior hypogastric plexus to the inferior hypogastric plexus

A

hypogastric nerves

if these were lesioned you would lose sympathetic innervation to the pelvis

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11
Q

where do sacral splanchnics synapse and how did they get there

A

inferior hypogastric plexus by traveling in the sympathetic chain

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12
Q

via what do sacral splanchnics enter the pelvis

A

via pelvic sympathetic chain

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13
Q

via what do pelvic splanchnics enter the pelvis

A

via S2-S4 spinal nerves

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14
Q

via what do lumbar splanchnics enter pelvis

A

via hypogastric nerves

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15
Q

what is the parasympathetic innervation to the perineum

A

from the cavernous plexus which is a continuation of the pelvic splanchnics

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16
Q

what is the sympathetic innervation of the perineum

A

pudendal `n (postganglionic sympathetics)

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17
Q

what is the sympathetic innervation of the bladder and which parts

A

T10-L2 via lumbar and sacral splanchnics

trigonal muscle and protion of urethra mm

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18
Q

parasympathetic innervation to the bladder

A

pelvic splanchnics

detrusor

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19
Q

sympathetic innervation to the testes and where are the postganglionic cell bodies located

A

from T10 -T11 via lesser splanchnic nerves

postganglionic cell bodies are located in the aorticorenal ganglion

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20
Q

what is the parasympathetic innervation to the testes

A

vagus

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21
Q

what is the sympathetic innervation to the internal male reproductive organs

and what is the function of sympathetics

A 
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

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22
Q

what is the parasympathetic innervation to the male internal reproductive organs

A

pelvic splanchnics

increases secretion from prostate, seminal vesciles and bulbourethral glands

cause vasodilation of the erectile tissue (boner)

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23
Q

what is the erection mediated by

A

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

24
Q

what is ejaculation controlled by

A

sympathetics and somatics *pudendal from foreceful contraction of the bulbospongiosus

25
Q

what is remission

A

a sympathetic response involving contraction of helicine arteries

26
Q

sympathetic innervation of the ovary and uterine tube

A

preganglionic fibers T10-T11 via lesser splanchnic nerve

postganglionic cell bodies are in the aorticorenal ganglion

27
Q

parasympathetic innervation to the ovary and uterine tube

A

vagus

28
Q

sympathetic innervation to the uterus, cervix and vagina

A

T12-L2 via lumbar and sacral splanchnic

**pain from uterus

29
Q

parasympathetic innervation to the uterus, cervix and vagina

A

pelvic splanchnics (S2-S4)

vasomotor –> contraction of smooth muscle

pain from cervix and upper vagina

30
Q

what is the somatic innervation of the vagina

A

pudendal nerve (inferior 1/4 of vagina)

31
Q

sympathetic innervation to the rectum and proximal anal canal

A

preganglionic fibers (L1-L2) via lumbar and sacral splanchnics

motor control of internal sphincter muscle
inhibit gland secretion

32
Q

parasympathetic innervation of the rectum and proximal anal canal

A

preganglionic fibers travel with pelvic splanchnics

contraction of smooth muscle (peristalsis)
stimulation of glandular secretion

33
Q

innervation of distal anal canal

A

somatic innervation from pudendal nerve

34
Q

what is the autonomic control of defecation

A

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

35
Q

what are the two major types of afferent information in autonomics

A

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

36
Q

what is the pelvic pain line

A

inferior limit of the pelvic peritoneum

distinguishes organs covered with pelvic peritoneum and organs not covered with pelvic peritoneum

37
Q

superior to the pain line (organs which are peritonealized) visceral pain fibers travel with what

A

Acute pain afferents travel with sympathetic neurons to T11-L2.

38
Q

inferior to the pain line (organs which are subperitoneal )visceral pain fibers travel with what

A

Acute pain afferents travel with parasympathetic neurons to S2-S4.

39
Q

afferent information of ureter

A

pain travels with sympathetic fibers

40
Q

afferent info of urinary bladder

A

superior protion –> peritonealized –> travel with sympathetic nerves to T10-L2

inferior portion–> subperitoneal –> parasympathetic fibers to S2-S4

41
Q

afferent info of urethra

A

all pain afferents travel with pelvic splanchnic nerves

EXCEPT very distal portion, which is somatic (pudendal nerve).

42
Q

where is the pelvic pain line for GI viscera

A

occurs at the rectosigmoidal junction

43
Q

afferent information of the rectum

A

all pain afferents travel with parasympathetics

44
Q

anal canal afferent information

A

above pectinate line –> parasympathetics to S2-S4

below pectinate line –> somatic innervation (pudendal)

45
Q

what portions of the male reproductive system send afferent info with sympathetics

A

testes epididymis and distal ducts deferns (T10-T11)

46
Q

internal pelvic male reproductive viscera afferent info

A

pain travels with pelvic splanchnic nerves to S2-S4

all below pelvic pain line

47
Q

penis afferent info

A

somatic innervation (pudendal n.)

48
Q

what portions of the female reproductive viscera are going to send afferent information with the sympathetic nerves

A

ovaries (T10-T11)
uterine tubes
uterus (fundus and body (T12-L2)

49
Q

afferent information of cervix, superior vagina

A

pelvic splanchnics (S2-S4)

50
Q

inferior 1/4 of vagina afferent information

A

somatic (pudendal n) S2-S4

51
Q

where is pain from uterine contractions felt

A

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

52
Q

where is pain from passage of fetus through birth canal

A

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.

53
Q

where is pain from the inferior vagina during birth

A

Pain from inferior vagina/perineum will be well-localized somatic pain (pudendal n).

54
Q

lumbar epidural

A

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

55
Q

caudal epidural

A

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

56
Q

pudendal nerve block

A

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)

ENDO exam 2 (4 decks)

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