Lecture 9: Abdominal and Pelvic Autonomics and Pain

Question 1

In the GIGU systems, PNS generally _____ while SNS generally _____ processes

Answer 1

activates; inhibits

Question 2

Important GIGU ganglia/plexuses

Answer 2

Celiac
Superior Mesenteric
Inferior Mesenteric
Hypogastric

*1st 3 are part of the abdominal aortic plexus

Question 3

The abdominal aortic plexus controls what?

The hypogastric plexuses control what?

Answer 3

• digestion

- urinary and reproductive function

Question 4

Compare and contrast the pre and post ganglionic synapses of the SNS and the PNS

Answer 4

SNS: short pre, long post, Ach at synapse 1, NE at synapse 2

PNS: long pre, short post, Ach on both synapses

Question 5

In general, what pathway do SNS signals take?

Answer 5

thoracolumbar lateral horn > anterior roots > spinal nerve > white rami (myelinated) > synapse at desired level sympathetic ganglion > post ganglionic returns to gray rami (unmyelinated) > spinal nerve to target organ or straight to target organ

Question 6

Spinal nerve pathway and destinations

Answer 6

gray ramus returns to spinal nerve to the level of skin, blood and hair it wants to go to

Question 7

Post ganglionic sympathetic nerve pathway and destinations

Answer 7

gray ramus directly innervates thoracic and neck viscera (skips the spinal nerve)

Question 8

Adrenal medulla pathway and destinations

Answer 8

preganglionic SNS pathway synapses directly on adrenal medulla (doesn’t pass through the trunk)

Question 9

Abdominal Splanchnic nerve pathway and destinations

Answer 9

white ramus to trunk but bypasses it and synapses at prevertebral ganglion instead > post ganglionic travels to destination abdominal viscera by leeching off the arteries in the abdomen

Question 10

What are the sympathetic splanchnic nerves serving the abdomen and pelvis?

Answer 10

Greater thoracic
Lesser thoracic
Least thoracic
Lumbar
Sacral

*thoracics are all preganglionic

Question 11

What are the prevertebral ganglia of the abdomen and pelvis?

Answer 11

Celiac, superior and inferior mesenteric (named after arteries they form around)

Question 12

SNS innervation pathway to foregut:

PNS innervation pathway to foregut:

Answer 12

Greater splanchnic > celiac > foregut (duodenum and proximal)

R/L vagus > P/A vagal trunks > foregut (duodenum and proximal)

Question 13

SNS innervation pathway to midgut and hindgut:

PNS innervation pathway to midgut and hindgut:

Answer 13

SNS:
Midgut - superior mesenteric plexus
Hindgut - inferior mesenteric plexus

PNS:
Midgut: R/L Vagus > P/A vagal trunks > duodenum to transverse colon
Hindgut: Pelvic splanchnic ns. > superior and inferior hypogastric plexus > descending colon onwards + reproductive organs

Question 14

In the GIGU system, the PNS enables

the major PNS players are ….

Answer 14

swallowing, peristalsis, digestion, reproduction, urination, defecation

CN 3,7,9,10 and Pelvic Splanchnic Ns (s2-4).

Question 15

Generally, sympathetics carry ______ while parasympathetics carry ______ signals

Answer 15

pain; physiologic

Question 16

in the abdomen above the pelvic pain line, pain travels with () nerves
In the thorax and below the pelvic pain line, pain travels with () nerves

Answer 16

sympathetics

parasympathetics

Question 17

Where is the pelvic pain line?

Answer 17

GI: middle sigmoid colon and distal structures
Pelvic: trigone, prostate and distal, cervix, upper vagina and distal

Question 18

Acute abdominal pain lasts for
Chronic abdominal pain lasts for
Subacute abdominal pain lasts for

Answer 18

<3 days
>3 weeks
3 days to 3 weeks

Question 19

Visceral vs. somatic pain

Answer 19

visceral: diffuse, visceral injury
somatic: localized, somatic (MSK, CT) injury

Question 20

Visceral vs. parietal pain

Answer 20

Visceral: remains dermatome localized

Parietal: initially dermatome localized > becomes more localized as disease progresses, parietal peritoneum is irritated over affected organ

Question 21

Foregut visceral pain hurts where?
Midgut visceral pain hurts where?
Hindgut visceral pain hurts where?

Answer 21

• epigastric
• periumbilical
• hypogastric/suprapubic

Question 22

What is referred pain?

Answer 22

pain at a location away from origin of painful stimulus due to network of interconnecting sensory nerves

Question 23

What is retro-peritoneal pain?

What is colicky pain?

Answer 23

-pain from pancreas, kidney and aorta, manifests as back pain

-intermittent, cramp like pain caused by some obstruction
GI issue if midgut or hindgut pain, urinary issue if loin to groin pain

Question 24

Identify the dx:
1.) foregut pain, worse when eating, pt avoids meals

2. ) foregut chronic pain, sudden and severe, generalized peritonitis
3. ) foregut pain in RUQ, rad to R. shoulder, n, v, fever
4. ) midgut pain, umbilicus to RLQ, n, v, fever
5. ) midgut pain, umbilicus to RLQ + periotnitis, n,v, fever
6. ) hx of abd. surgery, midgut colicky pain, distended non tender abdomen
7. ) severe loin to groin colicky pain, severe back pain, hematuria, CVAT, afebrile
8. ) hindgut colicky pain, distended abd., LLQ pain, older pt
9. ) hypogastrum pain rad. to sacrum, suprapubic peritonitis, rectouterine pouch tenderness
10. ) hx of atherosclerotic dz, sudden back pain, hypotension, tender epigastrium with palpable impulse

Answer 24

1. ) Gastric ulcer
2. ) Perforated gastric ulcer
3. ) Acute cholecystitis
4. ) Acute appendicitis
5. ) Perforated appendix
6. ) adhesive small bowel obstruction
7. ) passing kidney stone
8. ) descending colon cancer
9. ) ruptured ectopic pregnancy
10. ) leaking aortic aneurysm