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The Renal System > Clinically Relevant Anatomy of Urinary Continence and Renal System Pain > Flashcards

Clinically Relevant Anatomy of Urinary Continence and Renal System Pain Flashcards

1
Q

How many different modalities of nerve fibre exist?

A

5

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2
Q

What are the different types of sensory nerve?

A

Somatic sensory (from body wall)

Visceral afferent (from organ)

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3
Q

What are the different types of motor nerves?

A

Somatic motor (skeletal muscle contraction)

Parasympathetic (smooth muscle, cardiac muscle or glands)

Sympathetic (smooth muscle, cardiac muscle or glands)

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4
Q

The ureter and bladder are both innervated by which type of motor nerves?

A

Autonomic

(allows for ureteric peristalsis and bladder contraction)

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5
Q

The urethra is innervated by which type of nerve?

A

Sympathetic and parasympathetic (internal sphincter)

Somatic motor (external sphincter and levator ani)

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6
Q

How many pairs of spinal nerves exist?

A

31

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7
Q

What is the only means by which any type of nerve fibre can communicate with the CNS?

A

Being carried within cranial or spinal nerves

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8
Q

Sympathetic nerves will leave the spinal cord via spinal nerves between which levels?

A

T1-L2

(Thoracolumbar outflow)

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9
Q

How do sympathetic fibres reach the smooth muscle/glands of the body wall (other than the head)?

A

Within spinal nerves

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10
Q

How do sympathetic fibres reach the smooth muscle/glands of the body (other than the head)?

A

Within splanchnic nerves

(cardiopulmonary or abdominopelvic)

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11
Q

How do sympathetic nerve fibres reach the smooth muscles and glands in the head?

A

Mostly by following the path of arteries which supply the same structures

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12
Q

How do sympathetic nerve fibres access the kidneys, ureters and bladder?

A

Leave spinal cord between approc T10 and L2

Enter sympathetic chains but pass through in abdominopelvic splanchnic nerves

Synapse at abdominal sympathetic ganglia located aroufn the aorta

Post-synaptic sympathetic nerve fibres pass onto the surface of arteries (forming a perarterial plexus) which head towards relevant organs

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13
Q

Which spinal nerves can access post-synaptic sympathetic nerves?

A

Any (accessed via sympathetic chain)

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14
Q

What are the two classes of splanchnic nerves?

A

Cardiopulmonary splanchnic nerves

Abdominopelvic splanchnic nerve

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15
Q

Sympathetic nerves leave the spinal cord via the ________ root

A

Sympathetic nerves leave the spinal cord via the ventral root

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16
Q

The spinal nerve can enter the sympathetic chain via what?

A

Rami communicans

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17
Q

Once the spinal nerve enters the sympathetic ganglion, what are its options from there?

A

Re-enter the spinal nerve via rami communicans

Become a splanchnic nerve

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18
Q

In which ways can parasymapthetics exit the CNS?

A

Cranial nerves (CN III, VII, IX and X)

Sacral spinal nerves (S2, 3 and 4)

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19
Q

The body wall is innervated by both the sympathetic and parasympathetic nerve fibres

True or false?

A

False

Only sympathetic

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20
Q

How do parasympathetic fibres reach the smooth muscle/glands of he head and body?

A

Cranial nerves

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21
Q

Parasympathetics to abdominal organs are supplied by what?

A

Vagus nerve

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22
Q

The parasympathetics to the pelvic organs are supplied by what?

A

Sacrospinal nerves

(form pelvic splanchnic nerves)

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23
Q

The kidneys are ureters are supplied by which parasympathetic nerve?

A

Vagus

24
Q

Parasymapthetic nerve fibres which innervate the bladder are carried within what?

A

Pelvic splanchnic nerves

25
Q

What is the only part of the urinary system which has a somatic motor supply?

A

Distal part of urethra in the perineum (which is a body wall structure)

(external urethral sphincter and levator ani)

26
Q

Mostly, visceral afferents accomany which other type of fibres?

A

Sympathetics

(somethimes they will travel with parasymapthetics instead)

27
Q

In which region can pain from the bladder be felt?

A

Suprapubic region

(in the midline)

28
Q

How do visceral afferents from the bladder enter the spinal cord?

A

Visceral afferents from the superior aspect of the bladder (which is in contact with the peritoneum) travel via sympathetic nerve fibres and enter the spinal cord at T11-L2

Visceral afferent from the rest of the bladder travel via parasympathetics to S2, S3 and S4

29
Q

In which region can pain from the kidneys be felt?

A

Loin

(posterior aspect of the flank region)

30
Q

Why is it that pain from the kidneys is felt in the loin region?

A

Visceral afferents run with (mostly) sympathetic fibres back to the spinal cord and enter between the levels of approx T11 and L1

(pain is therefore felt in these dermatomes)

31
Q

In which region can pain from the ureters be felt?

A

Loin to groin

32
Q

Why is it that pain from the ureters is felt in the loin to groin region?

A

Visceral afferent run with (mostly) sympathetic fibres back to the spinal cord and enter between the levels of approx T11 and L2

(pain is therefore felt in these dermatomes)

33
Q

Where is pain from the urethra usually felt?

A

Localised in the perineum

(always in females, only in males in distal urethra is affected)

34
Q

Which spinal nerves contribute to the pudendal nerve?

A

S2, 3 and 4

35
Q

How do visceral afferents from the proximal urethra and somatosensory nerve fibres from the distal urethra travel back to the spinal cord?

A

Visceral afferents travel with parasymapthetics back to spinal cord levels S2, S3 and S4

Somatic sensory nerve fibres travel within the pudendal nerve back to spinal cord levels S2, S3 and S4

36
Q

How do pain fibres from the testes get to the CNS?

A

Visceral afferents run alongside sympathetic fibres to spinal cord levels T10-11

The close relationship with the scrotal wall means pain will also present localised to the scrotum and/or groin (due to somatic sensory nerve fibres in scrotum wall)

Hence pain from testes is felt locally and in the lower abdomen

37
Q

Which nerves are key in controlling micturation?

A

S2, 3 and 4

38
Q

Describe how the reflex to empty the bladder comes about

A

Stretch receptors are activated as the bladder fills

Information is relayed to the CNS via visceral afferents which enter the spinal cord at levels S2,3 and 4

The reflex induces relaxation of the internal sphincter muscle (in males) and contraction of the detrusor muscle in the bladder via parasympathetics carried within pelvic splanchnic nerves

39
Q

How can the reflex to urinate be over-ridden?

A

Action potentials within inhibitory nerve fibres from the cortex pass inferiorly to areas which are under voluntary control:

  1. External sphincter
  2. Levator ani muscles
40
Q

What do the anterior rami of spinal nerves form in the lumbosacral area?

A

Lumbosacral plexus

(formed from lumber plexus and sacral plexus)

41
Q

Where does the sciatic nerve arise fro and which nerve roots is it comprised of?

A

Sacral plexus

L4-S3

42
Q

Which nerve root comprise the pudendal nerve?

A

S2, 3 and 4

43
Q

Which nerves does the lumbar plexus give rise to?

A
  1. Iliohypogastric
  2. Ilioinguinal
  3. Lateral cutaneous nerve of the thigh
  4. Genitofemoral nerve
  5. Femoral nerve
  6. Obturator nerve
44
Q

What is the nerve root(s) which give rise to the following nerves:

  1. Iliohypogastric
  2. Ilioinguinal
  3. Lateral cutaneous nerve of the thigh
  4. Genitofemoral nerve
  5. Femoral nerve
  6. Obturator nerve
A
  1. Iliohypogastric = L1
  2. Ilioinguinal = L1
  3. Lateral cutaneous nerve of the thigh = L2, L3
  4. Genitofemoral nerve = L1, L2
  5. Femoral nerve = L2, L3 and L4
  6. Obturator nerve = L2, L3 and L4
45
Q

What is the path of the femoral nerve?

A

Under inguinal ligament into anterior compartment of thigh

46
Q

What is the path of the obturator nerve?

A

Through obturator foramen into medial compartment of thigh

47
Q

What is the path of the sciatic nerve?

A

Into posterior compartment of the thigh via the gluteal region

48
Q

What does the tibial nerve supply?

A

Posterior compartment of thigh (minus short head of biceps femoris)

Posterior compartment of the leg

Intrinsic muscles of the foot and plantar aspect of the foot

49
Q

Which nerve supplies the:

Lateral compartment of the leg

Anterior compartment of the leg

A

Lateral compartment of the leg - Superficial fibular

Anterior compartment of the leg - Deep fibular

(both nerves arise from common fibular)

50
Q

What supplies the innervation to the lateral aspect of the foot?

A

Sural nerve

(from tibial and common fibular nerves)

51
Q

The first dorsal web space of the foot is supplied by which nerve?

A

Deep fibular nerve

52
Q

The posterior portion of the medial foot is supplied by which nerve?

A

Saphenous nerve

(from femoral)

53
Q

The majority of the dorsal aspect of the foot is supplied by which nerve?

A

Superficial fibular nerve

54
Q

In which instance would sympathetic fibres stimulate the internal urethral sphincter to contract?

A

Ejaculation

55
Q

Which two nerves allow for control over urination?

A

Pudendal nerve (to external urethral sphincter)

Nerve to levator ani (S3, S4)

The Renal System (37 decks)

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