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LSS Anatomy of the Abdomen, Pelvis and Perineum > lecture 4 visceral pain > Flashcards

lecture 4 visceral pain Flashcards

1
Q

what does the enteric nervous system consist of

A

400-600 million intrinsic neurones that extend most of length of GIT

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2
Q

what is the ENS arranged in

A

glanglionated plexuses with interconnecting bundles of unmyelinated nerve fibres

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3
Q

what is the function of the ENS

A

enable GIT to preform basic reflex functions of secretion, absorption, mixing and gut movement without influence of CNS or ANS

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4
Q

how does the CNS communicate with ENS intrinsic neurones to modulate GIT functions

A

via sympathetic and parasympathetic nerves

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5
Q

where do axons of intrinsic neurones of ENS also project to

A

sympathetic ganglia, pancreas, gall bladder, trachea, spinal cord, brain stem

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6
Q

structure of GIT (lumen to exterior)

A

lumen - mucosa (lamina propria and muscularis mucosae; glands) - MALT - submucosa (glands; submucosal plexus of Meissner) - muscularis (for peristalsis; circular then myenteric plexus of Auerbach, then longitudinal) - serosa (epithelium) - mesentery (nerve and artery)

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7
Q

where is intrinsic network of neurones of ENS situated

A

2 plexuses in tissues of gut wall from oesophagus to anus (submucosal and muscularis)

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8
Q

structure and divisions of ANS

A

different to somatic NS (ganglia, myelination, neurotransmitters); 2 divisions (sympathetic and parasympathetic) which innervate organs of abdomen and pelvis

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9
Q

where does ANS arise from

A

different anatomical regions of CNS; sympathetic from spinal cord segments T1-L2, parasympathetic from cranial nerves III, VII, IX, X in brain stem, and spinal cord segments S2-S4

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10
Q

slide 8

A

sympathetic chain; ganglia form separate spinal cord segments; parasympathetic: vagus to abdomen, sacral parasympathetic outflow to pelvis

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11
Q

functions of efferent ANS nerves to abdomen

A

motor to smooth muscle; secretomotor to glands

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12
Q

functions of afferent ANS nerves to abdomen

A

sympathetic: pain; parasympathetic: specific functional sensation e.g. stretch

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13
Q

sympathetic nerves to abdomen (visceral)

A

from T1-L2; sympathetic trunks, diaphragm, splanchnic (visceral) nerves, coeliac ganglion

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14
Q

vagus nerves to abdomen (visceral)

A

left and right vagus nerves splitting into anterior and posterior vagul trunks

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15
Q

sympathetic chain to abdomen: greater splanchnic nerve level

A

T5-T9

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16
Q

sympathetic chain to abdomen: lesser splanchnic nerve level

A

T10-T11

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17
Q

sympathetic chain to abdomen: least splanchnic nerve level

A

T12

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18
Q

nerves from lumbar sympathetic chain

A

go to different parts; all splanchnic nerves and autonomic plexus won’t be retained in dissection

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19
Q

parasympathetic supply

A

vagus (cranial nerve X) and S2-S4

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20
Q

what ANS division goes to peripheral vessels and skin

A

sympathetic

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21
Q

what do sympathetic nerves run with to same region of peripheral vessels and skin

A

somatic nerves (no parasympathetic supply to somatic nerves; don’t run with spinal nerves)

22
Q

what do autonomic nerves run with to same organs which lack somatic innervation

A

arteries, but a few run separately

23
Q

peripheral distribution of ascending sympathetics

A

C1/C2-C8 (posterior and anterior ramus)

24
Q

peripheral distribution of descending sympathetics

A

L3-coccyx (posterior and anterior primary rami)

25
Q

T1 to L2

A

lateral horn of spinal cord to sympathetic chain to body wall

26
Q

sympathetic nerves to viscera

A

greater, lesser and least splanchnic nerves, lumbar splanchnic nerves (L1-L2), sacral splanchnic nerves from paravertebral sympathetic trunk

27
Q

where are ANS nerves to abdomen routed via and where is this

A

preverterbal plexus at midline of body surrounding abdominal aorta and its branches, synapse at ganglia associated with plexuses

28
Q

what are plexuses and ganglia named according to

A

associated blood vessels

29
Q

autonomic plexuses and ganglia

A

anterior (left) vagal trunk, superior mesenteric ganglion, inferior mesenteric ganglion, sympathetic trunk and ganglion, coeliac trunk and ganglion, renal plexus and ganglion, superior hypogastric plexus (at bifurcation of abdominal aorta), inferior hypogastric plexus

30
Q

what are the 3 nerve plexuses and ganglia around aorta and branches

A

parasympathetic nerves from vagus, sympathetic nerves from sympathetic chain T5-L2, parasympathetic nerves from S2-S4

31
Q

organs supplied by nerve plexuses and ganglia around aorta and branches; sympathetic ganglion chain continue to coccyx to form plexus

A

coeliac artery (T5-9, vagus), superior mesenteric artery (T10-11, vagus), renal arteries (T10-12, vagus), testicular/ovarian arteries (T10-11, vagus), inferior mesenteric artery (T12-L2, S2-4), superior and inferior hypogastric plexuses (T12-L2, S2-4)

32
Q

what is referred pain

A

pain referred from visceral organs and diaphragm (contains somatic nerves but no “sensory map”) to dermatomes supplied by nerves with same segmental supply (autonomic nerve supply in abdomen)

33
Q

define dermatome

A

area of skin supplied by single spinal nerve

34
Q

significance of overlapping dermatomes

A

at least 3 spinal nerves would have to be blocked to produce region of complete anaesthesia

35
Q

what cervical level is there no dermatome

A

C1

36
Q

dermatomes in limbs

A

larger (more drawn out)

37
Q

sensory map of cerebral cortex

A

lips, hand and face more sensitive

38
Q

motor map of cerebral cortex

A

hand and face more innovated

39
Q

abdominal regions

A

9 abdominal regions so referred pain to these

40
Q

what level is the epigastric region

A

T7/T8 (sympathetic and somatic)

41
Q

visceral source of epigastric pain

A

referred pain from foregut structures, as far as duodenal papilla

42
Q

structures involved in epigastric referred pain

A

stomach, proximal duodenum, pancreas, liver, gall bladder

43
Q

visceral source of umbilical pain

A

T10; referred pain from midgut structures, from duodenal papilla to splenic flexure

44
Q

what can be referred to periumbilical region

A

inflamed appendix pain

45
Q

feature of periumbilical region

A

colicky (intermittent with bowel contractions)

46
Q

where do afferent pain fibres from midgut structures enter spinal cord

A

T10 (same as umbilical dermatome region)

47
Q

what level is inguinal region

A

T12/L1

48
Q

progression of pain in appendicitis (type of pain and region)

A

when inflammation spreads to surrounding peritoneum; at right inguinal region pain becomes localised and constant

49
Q

what elicits pain in appendicitus

A

movement of hip joint, coughing

50
Q

visceral source of subrapubic (hypogastric) pain

A

referred pain from hindgut structures, descending colon to anal canal

51
Q

what level is suprapubic region

A

T12, L1-L2

52
Q

visceral referred pain

A

stomach (T7-8), spleen (T10), kidney and ureter (T11-L2)

LSS Anatomy of the Abdomen, Pelvis and Perineum (10 decks)

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