Autonomics of the pelvis (funk)

Question 1

what is the plexus of the pelvis

Answer 1

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

Question 2

what 4 things do autonomic nerve plexuses contain

Answer 2

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

Question 3

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

Answer 3

lumbar splanchnic (preganglionic symp)
sacral splanchnic (preganglionic symp)
pelvic splanchnic (preganglionic parasympathetic)

Question 4

what do sympathetic efferents do

Answer 4

vasoconstrict
contract sphincters
inhibition of peristalsis
inhibition of glandular secretion

Question 5

what do parasympathetic afferents do

Answer 5

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

Question 6

what is the parasympathetic innervation to the pelvis

origin
destination
where are the postganglionic cell bodies

Answer 6

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.

Question 7

what is the sympathetic innervation of the pelvis

Answer 7

lumbar splanchnic (major)

sacral splanchnic (minor)

Question 8

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

Answer 8

lumbar T11-L2

sacral T12-L2

Question 9

where do lumbar splanchnics synapse as they exit the sympathetic chain

Answer 9

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

Question 10

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

Answer 10

hypogastric nerves

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

Question 11

where do sacral splanchnics synapse and how did they get there

Answer 11

inferior hypogastric plexus by traveling in the sympathetic chain

Question 12

via what do sacral splanchnics enter the pelvis

Answer 12

via pelvic sympathetic chain

Question 13

via what do pelvic splanchnics enter the pelvis

Answer 13

via S2-S4 spinal nerves

Question 14

via what do lumbar splanchnics enter pelvis

Answer 14

via hypogastric nerves

Question 15

what is the parasympathetic innervation to the perineum

Answer 15

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

Question 16

what is the sympathetic innervation of the perineum

Answer 16

pudendal `n (postganglionic sympathetics)

Question 17

what is the sympathetic innervation of the bladder and which parts

Answer 17

T10-L2 via lumbar and sacral splanchnics

trigonal muscle and protion of urethra mm

Question 18

parasympathetic innervation to the bladder

Answer 18

pelvic splanchnics

detrusor

Question 19

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

Answer 19

from T10 -T11 via lesser splanchnic nerves

postganglionic cell bodies are located in the aorticorenal ganglion

Question 20

what is the parasympathetic innervation to the testes

Answer 20

vagus

Question 21

what is the sympathetic innervation to the internal male reproductive organs

and what is the function of sympathetics

Answer 21

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

Question 22

what is the parasympathetic innervation to the male internal reproductive organs

Answer 22

pelvic splanchnics

increases secretion from prostate, seminal vesciles and bulbourethral glands

cause vasodilation of the erectile tissue (boner)

Question 23

what is the erection mediated by

Answer 23

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

Question 24

what is ejaculation controlled by

Answer 24

sympathetics and somatics *pudendal from foreceful contraction of the bulbospongiosus

Question 25

what is remission

Answer 25

a sympathetic response involving contraction of helicine arteries

Question 26

sympathetic innervation of the ovary and uterine tube

Answer 26

preganglionic fibers T10-T11 via lesser splanchnic nerve postganglionic cell bodies are in the aorticorenal ganglion

Question 27

parasympathetic innervation to the ovary and uterine tube

Answer 27

vagus

Question 28

sympathetic innervation to the uterus, cervix and vagina

Answer 28

T12-L2 via lumbar and sacral splanchnic **pain from uterus

Question 29

parasympathetic innervation to the uterus, cervix and vagina

Answer 29

pelvic splanchnics (S2-S4) vasomotor --> contraction of smooth muscle pain from cervix and upper vagina

Question 30

what is the somatic innervation of the vagina

Answer 30

pudendal nerve (inferior 1/4 of vagina)

Question 31

sympathetic innervation to the rectum and proximal anal canal

Answer 31

preganglionic fibers (L1-L2) via lumbar and sacral splanchnics motor control of internal sphincter muscle inhibit gland secretion

Question 32

parasympathetic innervation of the rectum and proximal anal canal

Answer 32

preganglionic fibers travel with pelvic splanchnics contraction of smooth muscle (peristalsis) stimulation of glandular secretion

Question 33

innervation of distal anal canal

Answer 33

somatic innervation from pudendal nerve

Question 34

what is the autonomic control of defecation

Answer 34

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

Question 35

what are the two major types of afferent information in autonomics

Answer 35

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

Question 36

what is the pelvic pain line

Answer 36

inferior limit of the pelvic peritoneum distinguishes organs covered with pelvic peritoneum and organs not covered with pelvic peritoneum

Question 37

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

Answer 37

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

Question 38

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

Answer 38

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

Question 39

afferent information of ureter

Answer 39

pain travels with sympathetic fibers

Question 40

afferent info of urinary bladder

Answer 40

superior protion --> peritonealized --> travel with sympathetic nerves to T10-L2 inferior portion--> subperitoneal --> parasympathetic fibers to S2-S4

Question 41

afferent info of urethra

Answer 41

all pain afferents travel with pelvic splanchnic nerves EXCEPT very distal portion, which is somatic (pudendal nerve).

Question 42

where is the pelvic pain line for GI viscera

Answer 42

occurs at the rectosigmoidal junction

Question 43

afferent information of the rectum

Answer 43

all pain afferents travel with parasympathetics

Question 44

anal canal afferent information

Answer 44

above pectinate line --> parasympathetics to S2-S4 below pectinate line --> somatic innervation (pudendal)

Question 45

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

Answer 45

testes epididymis and distal ducts deferns (T10-T11)

Question 46

internal pelvic male reproductive viscera afferent info

Answer 46

pain travels with pelvic splanchnic nerves to S2-S4 all below pelvic pain line

Question 47

penis afferent info

Answer 47

somatic innervation (pudendal n.)

Question 48

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

Answer 48

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

Question 49

afferent information of cervix, superior vagina

Answer 49

pelvic splanchnics (S2-S4)

Question 50

inferior 1/4 of vagina afferent information

Answer 50

somatic (pudendal n) S2-S4

Question 51

where is pain from uterine contractions felt

Answer 51

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

Question 52

where is pain from passage of fetus through birth canal

Answer 52

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.

Question 53

where is pain from the inferior vagina during birth

Answer 53

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

Question 54

lumbar epidural

Answer 54

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

Question 55

caudal epidural

Answer 55

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

Question 56

pudendal nerve block

Answer 56

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)