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*GIGU I > Lecture 10: Lumbar Plexus and Pain > Flashcards

Lecture 10: Lumbar Plexus and Pain Flashcards

1
Q

What is the excitatory hormone of the somatic NS, are there ganglia, and what are the axons like?

A
  • Ach
  • No ganglia in this pathway
  • Axons are thick and myelinated
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2
Q

What is the NT used by pre-ganglionic cell bodies in the sympathetics; how about post-ganglionic?

A

Pre-ganglionic = Ach

Post-ganglionic = NE

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3
Q

What are the 2 components of the sympathetic trunk?

A

Paravertebral ganglion + Interganglionic connections

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4
Q

What are the 3 cervical ganglion?

A
  • Superior
  • Middle
  • inferior
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5
Q

What ganglion is formed by the fusion of the inferior cervical ganglion w/ the ganglion of T1?

A
  • Stellate ganglion
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6
Q

What are the 4 options for pre-synaptic fibers entering the sympathetic trunk?

A

1) Ascend
2) Descend
3) Synapse at same level
4) Traverse the trunk w/o synapsing and become part of an abdominopelvic splanchnic nerve or for innervation of the suprarenals

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7
Q

What are gray rami communicans; how many spinal nerves?

A
  • All 31 spinal nerves
  • Arise as lateral branches
  • Carry post-synaptic fibers to body wall and limbs for distribution via spinal nerves
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8
Q

What are the cephalic arterial rami?

A
  • Go to periarterial plexuses of carotid arteries
  • Arise from cervical ganglia
  • Post-synaptic fibers to head for distribution via periarterial plexuses
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9
Q

What are the 3 primary effects of the parietal branches of sympathetic trunks?

A

1) Vasomotion
2) Sudomotion - sweating
3) Pilomotion - erector pilae m. = goosebumps

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10
Q

What is the primary contribution to the celiac ganglion?

A

Greater splanchnic n

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11
Q

What is the primary contribution to the aorticorenal ganglion?

A

Predominantly lesser splanchnic

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12
Q

What is the primary contribution to the SMG?

A

Contributions from all

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13
Q

What is the primary contribution to the IMG?

A

Primarily lumbar

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14
Q

How do abdominopelvic splanchnic nerves enter the diaphragm?

A

They pierce the muscle

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15
Q

Which fiber type do the cardiopulmonary splanchnic nerves convey and what kind of ganglia do they synapse in?

A
  • Convey POST-synaptic fibers to thoracic viscera

- Synapse in PARA-vertebral ganglia

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16
Q

Which fiber type do the abdominopelvic splanchnic nerves convey and what kind of ganglia do they synapse in?

A
  • Convey PRE-synaptic fibers

- Synapse in PRE-vertebral ganglia

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17
Q

Do the paravertebral ganglia of sympathetic trunks distribute fibers to the abdominopelvic viscera?

A

NO, everywhere else

*Pre-vertebral ganglia of para-aortic plexus distribute to abdominopelvic viscera

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18
Q

Why is innervation of the suprarenal glands an exception?

A

Pre-synaptic fibers to the suprarenals will pass through the pre-vertebral ganglia WITHOUT synapsing. The synapse occurs directly on the secretory cells of the medulla which act as postsynaptic neurons.

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19
Q

How are the pre-synaptic neurons of the sympathetics and parasympathetics different?

A

Sympathetics = short

Parasympathetics = long

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20
Q

What is the dominant outflow of the parasympathetic presynaptic neurons; where does it extend to?

A

Cranial outflow is dominant (extends to left colic flexure)

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21
Q

Where are the parasympathetic postsynaptic neurons located in the trunk?

A
  • Widely spread and irregularly spaced
  • Located in or on effector (intrinsic/enteric ganglia)
  • Found in the Musculosa Externa
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22
Q

What are the parasympathetic postsynaptic neurons in the head?

A

1) Ciliary
2) Otic
3) Pterygopalantine
4) Submandibular

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23
Q

Do the parasympathetics go to body walls or limbs; are they components of spinal nerves?

A
  • Do NOT go to body walls or limbs, except erectile tissue of external genitalia
  • Never components of spinal nerves of their peripheral branches, except for initial parts of S2-S4
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24
Q

What is the left colic (splenic) flexure a landmark for?

A

Where cranial outflow (i.e., Vagus n.) stops and the Sacral outflow (S2-S4) starts

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25
Q

What is the effect of the sympathetic NS on the BV’s of the GI, sphincters, peristalsis, and suprarenal glands?

A
  • Constricts BV’s of skin and GI tract
  • Decreases peristalsis of gut, constricts sphincters
  • Stimulates suprarenal glands to release adrenaline
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26
Q

Where does the sympathetic NS not produce vasoconstriction?

A

The heart and muscles

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27
Q

What is the effect of the parasympathetic NS on gut peristalsis, sphincters, the rectum, and bladder?

A
  • Increases peristalsis
  • Inhibits sphincters
  • Stimulates contraction of bladder and rectum
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28
Q

Which part of the autonomics is the primary stimulator of the GI tract?

A

Parasympathetic

*Is active in elimination (defecation and urination)

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29
Q

Where are the cell bodies for visceral afferent fibers?

A

Dorsal root ganglion

30
Q

Normal homeostatic reflexes (physiologic receptors) travel w/ which part of the autonomics?

A

The parasympathetics

31
Q

Pain travels with which part of the autonomics and what is the transition point?

A

The sympathetics until the pelvic pain line, then switches to parasympathetics

32
Q

Where is the pelvic pain line?

A

Middle of the sigmoid colon

33
Q

Differentiate acute, chronic, and subacute abdominal pain?

A

Acute = <3 days

Chronic = >3 weeks

Subacute = 3 days - 3 weeks

34
Q

Which type of pain is well localized, which type of pain is not?

A

Visceral = not well localized

Parietal (somatic) = well localized

35
Q

Parietal pain is caused by?

A

Irritation of fibers that innervate the parietal peitoneum (i.e somatic nerves - thoracoabdominals)

36
Q

How can parietal pain be localized?

A

To the dermatome superficial to the site of the pain stimulus

37
Q

How can visceral pain be localized?

A

By the sensory cortex to an approximate spinal cord level determined by the embryologic origin of the organ involved

38
Q

Where is pain produced from: foregut, midgut, and hindgut organs?

A 
Foregut = Epigastrium
Midgut = Periumbilical
Hindgut = Suprapubic/Hypogastric region
39
Q

What pathologies will cause pain in the umbilical region?

A
  • Appendicitis (early)
  • Mesenteric adenitis
  • Meckel’s diverticulitis
  • Lymphomas
40
Q

What pathologies will cause pain in the right inguinal region?

A
  • Appendicitis (late)
  • Chron’s Disease
  • Cecum obstruction
  • Ovarian Cyst
  • Ectopic pregnancy
41
Q

Which pathologies can lead to pain in the shoulder; how?

A
  • Liver
  • Gallbladder
  • Duodenum

*Irritation of the diaphragm

42
Q

Retroperitoneal pain is commonly felt where; which structures cause this pain?

A
  • Felt in the back

- Pancreas, kidneys, aorta

43
Q

What is Colicky pain; causes?

A
  • Intermittent cramp-like pain

- Bowel obstructions/adhesions, stone in ureter, stone in neck of gallbladder

44
Q

If the patient has epigastric pain that is worse after eating what is the underlying pathology; how about 2-5 hours after eating?

A
  • Immediate = stomach

- Delayed (2-5 hrs) = Duodenum

45
Q

Anytime something ruptures or is extremely inflamed what kind of pain is likely to follow?

A

Generalized or localized peritonitis

46
Q

If patient has midgut visceral colicky pain, vomiting, NO flatus or bowel action, and increased bowel sounds, what is the likely pathology?

A

Adhesive small bowel obstruction

47
Q

Pt has a sudden onset of very severe colicky pain in the flank region, severe back pain, tender renal angle, possible hematuria, what is likely pathology?

A

Passage of a kidney stone

48
Q

Pt is older w/ sudden weight loss, hindgut visceral colicky pain, no flatus/feces, increased bowel sounds, a mass in LLQ, what is the pathology?

A

Obstructing cancer of descending colon

49
Q

Women of childbearing age, missed her last menstrual period, sudden onset of severe hypogastrium pain radiating to sacral area, localized suprapubic peritonitis; what is likely pathology?

A

Ruptured ectopic pregnancy

50
Q

Pt is an elderly male w/ hx of atherosclerotic disease (HTN or cardiac) w/ a sudden onset of severe back pale, appears pale and shocked, is HYPOtensive and has a palpable impulse in epigastrium; what is the likely dx?

A

Leaking aortic aneurysm

51
Q

Pain from which organs will be traveling with greater splanchnic afferent nerve fibers?

A
  • Liver
  • Stomach
  • Spleen
  • Supra-adrenals
52
Q

Pain at the ileocecal junction, cecum, appendix, ascending or transverse colon will travel with which afferent nerve fibers?

A

Lesser splanchnics

53
Q

Pain in the duodenum, ileum, and jejunum will be carried w/ which afferent nerve fibers?

A

Greater and Lesser splanchnic

54
Q

Pain in the descending colon will be carried w/ which afferent nerve fibers?

A

Least and lumbar splanchnic

55
Q

Pain in the kidneys will be carried with which afferent nerve fibers?

A

Lesser, least, and lumbar splanchnics

56
Q

Which nerve fibers will transmit pain from the sigmoid colon and rectum?

A

Pelvic splanchnic

57
Q

Which areas will cause pain initially in the suprapubic/hypogastric area?

A
  • Hindgut organs (most of colon, including 1/2 sigmoid)

- Intraperitoneal portions of the genitourinary tract

58
Q

Potential causes of epigastric pain

A
  • esophagitis
  • peptic ulcer
  • perforated ulcer
  • pancreatitis
59
Q

Potential causes of Right hypochondriac (RUQ) pain

A
  • gallstones
  • cholangitis
  • hepatitis
  • liver abscess
60
Q

Potential causes of left hypochondriac (LUQ) pain

A
  • spleen abscess
  • acute splenomegaly
  • spleen rupture
61
Q

Potential causes of flank/lumbar pain

A
  • ureteric colic

- pyelonephritis

62
Q

Potential causes of Hypogastric/pubic pain

A
  • testicular torsion
  • urinary retention
  • cystitis
  • placental abruption
63
Q

Potential causes of left inguinal pain

A
  • diverticulitis
  • ulcerative colitis
  • constipation
  • ovarian cyst
  • hernias
64
Q

What would you expect for a pain presentation for a gastric ulcer?

A
  • worse on eating

- foregut visceral pain = midline, colicky pain

65
Q

What would you expect for a pain presentation for a perforated gastric ulcer

A
  • sudden severe pain spreading diffusely
  • generalized peritonitis signs
  • foregut chronic visceral pain
  • epigastric pain when localized
66
Q

What would you expect for a pain presentation for acute cholecystitis

A
  • foregut visceral pain
  • somatic pain in RUQ w/ referred to right shoulder
  • N/V, fever, tender RUQ
    • Murphy’s sign
67
Q

What would you expect for a pain presentation for acute appendicitis?

A
  • midgut visceral pain
  • somatic pain in RLQ
  • N/V, fever
  • tender RLQ
  • if ruptured, localized peritonitis in RLQ
68
Q

What would you expect for a pain presentation for adhesive small bowel obstruction

A
  • hx of previous abd surgery
  • midgut visceral colicky pain
  • V, no flatus or bowel action
  • possible dehydration
  • distended, soft, non tender abdomen
  • increased bowel sounds
69
Q

What would you expect for a pain presentation for kidney stones?

A
  • sudden very severe colicky pain from loin-> groin and severe back pain
  • writhing and pacing in pain
  • possible hematuria
  • afebrile
  • soft abdomen w/ tender renal angle
70
Q

What would you expect for a pain presentation for an obstructing cancer of descending colon?

A
  • older pt w/ weight loss
  • hindgut visceral colicky pain
  • no flatus, feces w/ distended abdomen
  • possible mass in LLQ
  • increased bowel sounds
71
Q

What would you expect for a pain presentation for a ruptured ectopic pregnancy?

A
  • missed LMP
  • sudden onset severe hypogastrium pain radiating to sacrum
  • afebrile
  • localized peritonitis in suprapubic (hypogastric) area
  • tender in rectouterine pouch on rectal/vag exam
72
Q

What would you expect for a pain presentation for a leaking aortic aneurysm?

A
  • hx of cardiac disease (ex: htn)
  • sudden severe back pain
  • pale, shocked, hypotensive
  • tender epigastrium
  • palpable impulse from aneurysm in epigastrium

*GIGU I (67 decks)

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