Gray's Autonomics Flashcards
A 23-year old woman is admitted with severe abdominal pain, nausea and vomiting. The pain began in the epigastric region and radiated bilaterally around the chest to just below the scapula. CT scan shows a gallbladder stone. Which nerves carries the afferent fibers of the referred pain?
The greater thoracic splanchnic nerve carries general visceral afferent fibers from abdominal organs, specifically the foregut.
A 56-year old man is admitted to the hospital with severe abdominal pain. The patient has IBS which affects his rectum. Which of the nerve most likely trasmit pain in this case?
Below the PPL line, so pain travels with parasympathetics. The visceral afferent innervation of the rectum is transmitted by way of the pelvic splanchnic nerves.
A 41-year old woman is admitted to the hospital with upper abdominal pain. A gastroscopic examination reveals multiple small ulcerations in the body of the stomach. Which nerve trasmits pain from this region?
The greater thoracic splanchnic nerves arise from the levels of the T5-T9 thoracic sympathetic ganglia and are responsible for carrying general visceral afferents from upper abdominal organs.
A 74-year old woman has diverticulosis of the lower portion of the descending colon. Which vessels and nerves will be cut during the operation to remove this part of the colon?
Pelvic splanchnic nerves and the left colic artery supply the descending colon.
A 22 year old woman complains of severe pain in the epigastric region. CT scan reveals an inflamed appendix. Which structure contains the nerve cell bodies from the appendix that are causing the referred pain in the epigastrium?
Afferent fibers from the appendix travel in the dorsal root ganglia of T8-T10.
A 30 year old woman complains of weakness. She was diagnosed with pheochromocytoma. Which nerve fibers will need to be cut when the adrenal gland and tumor are removed?
The preganglionic sympathetic fibers running to the adrenal gland would be cut during adrenalectomy. Unlike the normal route of symp. innervation which is to first synapse in a sympathetic ganglion and then send postganglionic fibers to target tissue, the chromaffin cells of the adrenal gland ae innervated directly by preganglionic symp. fibers. Chromaffin cells are postganglionic neurons.
A 48 year old woman is admitted to the ER with abdominal pain. A celiac plexus is performed. Which nerve structures are present in the celiac ganglion?
The cell bodies of postganglionic sympathetic fibers are contained within the celiac ganglion and their axons pass to the foregut. Preganglionic PS nerves also run through the ganglion but do not synapse; these are extensions of the vagus nerve.
A 47-year old male had bilateral vagotomy, with division of both vagus trunks. What will this affect?
Interruption of both vagus nerves would deprive the abdominal viscera (foregut and midgut) of PS supply. The hindgut structures receive PS nerves from the pelvic splanchnic nerves.
A 68 year old woman is diagnosed with posterior abdominal wall tumor that has invaded the superior mesenteric plexus. Which structure is most likely affected?
The superior mesenteric plexus supplies the midgut structures.
The foregut is innervated mainly by the celiac plexus.
The descending colon and the rectum are supplied by the inf. mesenteric and intermesenteric plexuses.
A 45-year old woman is admitted to ER with abdominal pain and vomiting. Initially, her pain was poorly localized at the epigastric region, but became sharp and well localized in the right hypochondrium. What mechanism explains the initial pain pattern?
Visceral afferents that innervate the gallbladder will be stimulated by the inflammation. These visceral afferents return to the spinal cord by traveling with sympathetics. Since the gallbladder is a foregut structure, it receives major sympathetic supply from the greater thoracic splanchnic nerve which originates from T5-T9.
A 70-year old woman is admitted to the hospital with intesnse abdominal pain from a pancreatic tumor. A neurectomy is performed to interrupt the neural pathway carrying pain from the pancreas. Which structure was severed?
The visceral afferent fibers from the pancreas accompany sympathetic nerves. Postganglionic sympathetic nerves to the foregut, including the pancreas, are located in the celiac ganglion, as are visceral afferent fibers.
A 40 year old woman with jaundice and epigastric pain was taken to the ER where examination showed stones in the bile duct and gallbladder. During surgery, the surgeon had to ligate and cut the cystic artery. A branch from which nervous strcture traveling along the artery was also cut?
The gallbladder and its biliary trees are foregut structures. The celiac ganglion contains cell bodies of postganglionic sympathetic fibers from the greater thoracic splanchnic nerve that innervate these structures.
