G23 ANS of Abdomen Flashcards
Sympathetic innervation of abdomen
preganglionic sympathetic cell bodies innercating abdominal viscera located in
T5-L2 IMLCC spinal cord levels
abdominopelvic splanchnic nerves exit the sympathetic trucnk from T5-S5 chain ganglia/vertebral levels and synapse in paravertebral ganglion
abdominopelvic splanchnic nerves
T5-L9: greater splanchnic T5-T9 SyC
-celiac G- Foregut
T10-T11: lesser splanchnic T10-T11 SyC
- SM G midgut
T12 least splanchnic T12 SyC
-aorticorenal G Kidneys
L1-L2 lumbar splanchnic L1-L4(5) SyC
-IM G Hindgut, pelvic organs
L1-L2 sacral splanchnic S1-S4(5) SyC
-Inferior Hypogastric G- Hindgut (lower Rectum, Pelvic organs)
paravertebral sympathetic ganglia
celiac G (base of celiac trunk)
SM G (base of SMA)
IM G (base of IMA)
aorticorenal G (base of renal arteries)
abdominal/pelvic visceral plexuses
celiac plexus
superior mesenteric plexus
intermesenteric plexus
inferior mesenteric plexus
superior hypogastric plexus
-connected by hypogastric nerves
inferior hypogastric plexus
parasympathetic innervation of abdomen
preganglionic parasympathetic neuronal cell bodies are located in brain stem and axons travel through VAGUS nerve (CN X)
-synapse in intrinsic ganglia (organ)
prepanglionic parasympathetic neuronal cell bodies to hindgut located in S2-S4 spinal chord and axins travel in pelvic splanchnic nerves
-synapse in intrinsic ganglia
Vagus
enters abdomen as anterior and posterior (originally R) vagal trunks on esophagus
preganglionic axons pass thourhg celiac and superior Mesenteric plexuses and distribnuted along periartierial plexuses to target organs of foregut and midgut
-synapse in intrinsic ganglia
pelvic splanchnic nerves
S2-S4 SCL, exit anterior rami of S2-S4 spinal nerves
preganglionic axons pass thorugh hypogastric and inferior mesenteric clexuses and are distributed along periarterial plexuses to the target organs of the hidgut.
synapse in intrinsic ganglion
Pelvic Splanchnic nerves
-parasympathetic
sacral splanchnic nerves
-sympathetic
Foregut, midgut and hindgut innervation and main ganglion
Sympathetic:
F Greater Splanchnic Celiac Ganglion
M Lesser Splanchnic Superior Mesenteric G
H Lumbar splanchnic inferior mesenteric G
Parasympathetic
F Vagus intrinsic ganglia
M Vagus intrinsic ganglia
H PELVIC SPLANCHNIC intrinsic ganglia
Foregut
sympathetic: Greater splanchnic, post ganglionic cell bodies are in the celiac ganglia, course through celiac plexus and distributed along periarterial plexuses on branches of trunk
parasympathetic innervationL via vagus, distributed along periarterial plex on branches of celiac trunk
Visceral Affarent: (NON PAIN)L peripheral processes conveyed by vagus
- cell body in nodose ganglia
- cental process in brain stem
Visceral Afferent (PAIN): in sympathetic nerves, greater splanchnic, pseudounipolar neuronal cell body located posterior to root ganglia, central processes enter spinal chord
Vagotomy
resection of branches of the vagus
treatement for chronic peptic ulcers, esp those not responsive to therapies against H Pylori
Denervation of parietal cells which produce gastric acid
typically requires vitamin B12 supplements, loss of intrinsic factor
Midgut
sympathetic: lesser splanchnic, post gang cell bodies in superior mesenteric ganglia, course through superior mesenteric plexus and distributed along periartieral plexuses on branches of SMA
parasympathetic: vagus nerve, distributed along periarterial plexuses on branches of SMA
- synapse in intrinsic ganglion
Visceral Afferent: (NON PAIN)
-peripheral process along vagus
psuedounipolar neuronal cell body in nodose
-central process in brain stem
Visceral afferent (PAIN)
- along sympathetic nerves (lesser splanchnic)
- pseudounipolar neuronal cell body located in posterior root ganglion
- central process in spinal cord
hindgut
sympathetic innervation: lumbar splanchnic nerves
-postganglioninc cell bodies in inferior mesenteric ganglia. Postgang axons course thourhg inferior mesenteric plexus and are distributed along periarterial plexuses on IMA
parasympathetic: PELVIC SPLANCHNIC NERVES, pass thorugh hypogastric nerves and infererior mesenteric plexus. Are distributed along periarterial plexuses on branches of IMA
- synapse at intrinsic ganglion
Visceral Afferent NOn Pain: pelvic splanchnic nerves, pseudounipolar bodes in PRG
central process enters SC
Visceral Afferent (PAIN) distal 1.3 of transverse colon to proximal 1.2 of sigmoid colon: lumbar splanchnic, PU bodies in PRG
distal 1.2 of sigmoid colon to upper rectum PELVIC SPLANCHNIC NERVES.
-pseudounipolar nerve bodies in PRG S2-S4.
THIS IS THE EXCEPTION
-pelvic splanchnic nerves carry both visceral pain and visceral non pain
Enteric Nervous system
myenterif aka auerbachs plexus (between circular and long layer
submucosal aka Meissners in submucosa
PSNS: smooth muscle contraction and stim secretions
SYmp: inhibits smoothmuscle contraction, vasoconstriction
-isolation of GI from autonomics does not greatly diminish fxn of enteric ns
peristalsis occurs spontaneously in bowel segments in vitro
Hirschsprungs Disease
congenital aganglionic megacolon
-failure of NC to micrate to distal GI.
fecal accumulation, males, surgical resection of affected colon
Reffered Pain of Abdomen
visceral peritoneum conveys non pain sensation but NO visceral pain sensation
-visceral pain is diffuse and poorly localized, but can be referred to general dermatomal areas
irrigation of parietal peritoneum (somatic innervation) cases acute well localized pain with reflexive guarding/splinding of ab wall muscles
-rebound tenderness
GB has additional somatic sensory inntervation from a branch of the phrenic
look at section
