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GI Midterm > Lumbar Plexus and Pain > Flashcards

Lumbar Plexus and Pain Flashcards

1
Q

Locations of parasympathetic pre-ganglionic cell bodies

A

CN III, VII, IX, and X

Sacral cord (S2-4)

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2
Q

Location of preganglionic parasympathetic cell bodies for vagus nerve

A

Dorsal motor nucleus

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3
Q

Location of parasympathetic postganglionic cell bodies relevant to the abdomen

A

Wall of the organ (terminal)

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4
Q

Parasympathetic NTs and receptors

A

ACh - pre and post synaptic

Nicotinic receptor

Muscarinic receptor

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5
Q

Location of sympathetic preganglionic cell bodies

A

Intermediolateral cell column, T1-L2

[aka lateral horn]

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6
Q

Location of sympathetic postganglionic cell bodies

A

Superior cervical ganglion

Sympathetic chain ganglion

Prevertebral ganglion (celiac, superior mesenteric, inferior mesenteric)

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7
Q

Sympathetic NTs and receptors

A

ACh - pre-ganglionic

NE - post-ganglionic to alpha and beta receptors

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8
Q

Sympathetics supplying parietal GI structures

A

Abdominal body wall: T7-T11

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9
Q

General Sympathetics supplying visceral GI structures

A

Body wall abdominal viscera = T7-T11

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10
Q

Which sympathetics supply viscera of stomach, liver, gallbladder, pancreas?

A

T6-T9

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11
Q

Which sympathetics supply viscera of appendix and colon?

A

T10, T11

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12
Q

Which sympathetics supply viscera of small bowel?

A

T7-T10

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13
Q

Which sympathetics supply visceral pelvic and lower limb structures

A

T12-L2(3)

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14
Q

Trace pathway of presynaptic sympathetic neurons, which all follow the same course from CNS to sympathetic trunk

A

Cell body in presynaptic neuron of lateral horn (T1-L2/3)

Leaves via anterior root of spinal n., becoming mixed spinal n

Fibers exit spinal nerves to autonomic paravertebral ganglion via white rami communicans to sympathetic trunk

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15
Q

T/F: paravertebral ganglia run the entire length of the vertebral column

A

True

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16
Q

4 options for presynaptic fibers entering sympathetic trunks

A

Ascend to higher level to synapse

Descend to lower level to synapse

Synapse at level of entry

Traverse the trunk without synapsing to become part of abdominopelvic splanchnic n. or for innervation of the suprarenal glands

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17
Q

Postsynaptic fibers of the sympathetic trunks exit at level of cell body to supply the body wall and limbs via _____ nerves in _____ rami communicantes

A

Spinal; gray

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18
Q

Postsynaptic sympathetic nerves travel to body wall and limbs. What are their 3 main functions?

A

Vasomotion (typically vasoconstriction)

Sudomotion (sweating)

Pilomotion (goosebumps)

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19
Q

Sympathetic innervation to the lower limbs has presynaptic fibers take descent option, travelling on nerves or vessels.

Sympathetic innervation to upper limbs has presynaptic fibers take ascent option, travelling on brachial plexus or blood vessels like the subclavian.

Sympathetic innervation to the head has presynaptic fibers take ascent option where they synapse with superior cervical ganglion, travelling with the carotids.

Describe sypathetic innervation to the abdomen

A

4th option! Presynaptic fibers pass through sympathetic trunk without synapsing to enter an abdominopelvic splanchnic nerve, which they travel with to prevertebral ganglion like celiac, superior mesenteric, or inferior mesenteric

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20
Q

T/F: abdominopelvic splanchnic nn pierce the diaphragm

A

True

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21
Q

What do sympathetic fibers do once they have joined up with abdominopelvic splanchnics and synapsed at prevertebral ganglion?

A

Hop on periarterial plexus to their intended abdominopelvic viscera

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22
Q

Abdominopelvic splancnic nerves include greater, lesser and least. What are their respective spinal levels?

A

Greater = T5-9

Lesser = T10,11

Least = T12

23
Q

Visceral branches of sympthetic trunks:
Splanchnic nn arise as _____ branches of the trunks

Cardiopulm splanchnic nn convey _____ fibers to thoracic viscera and synapse in ____ ganglia

Abdominopelvic splanchnic nn convey ____ fibers to innervate the abdominal and pelvic viscera and synapse in _____ ganglia

A

Medial

Postsynaptic; paravertebral

Presynaptic; prevertebral

24
Q

Cell bodies of sympathetic postsynaptic fibers are found in what 2 places?

A

Paravertebral ganglia of sympathetic trunks - fibers distributed to all parts of body EXCEPT abdominopelvic viscera (pass thru but do not synapse)

Prevertebral ganglia of paraaortic plexus; clustered around roots of major branches, fibers distributed to abdominopelvic viscera

25
Q

One exception to the normal path taken by abdominal sympathetics is innervation of the suprarenal glands. What path do autonomics to the suprarenals follow?

A

The same path as abdominopelvic splanchnics until the prevertebral ganglia - where they will bypass the ganglia without synapsing! They synapse directly on secretory cells of the medulla which act as neurons

26
Q

Sympathetic nerves have short presynaptic fibers and long postsynaptic fibers

Parasympathetic nerves have _______ presynaptic fibers that synapse on intrinsic ganglia such as the _______ plexus of visceral organs

A

Very long; myenteric

27
Q

Parasympathetic presynaptic neuron fibers are transmitted only via which 2 pathways? Which one is dominant?

A

Cranial outflow = CN III, VII, IX, or X = dominant (extends to left colic flexure of gut)

Sacral outflow = S2-S4

28
Q

What is the difference between postsynaptic ganglia in the trunk vs. the head?

A

In the trunk, ganglia are widely scattered, irregularly spaced, microscopic, and usually located in/on effector organ

In the head there are 4 discrete ganglia: ciliary, otic, pterygopalatine, submandibular

29
Q

T/F: parasympathetic nerves travel with spinal nerves and their peripheral branches

A

False, this is never the case. Parasympathetics usually travel with vagus n.

30
Q

Functions of sympathetics in GI tract

A

Constriction of blood vessels of skin and GI tract (diverting blood to skeletal muscle)

Decreases peristalsis, constricts sphincters

Stimulates suprarenal galnds to release adrenaline

Vasomotion, sudomotion, pilomotion

31
Q

Functions of parasympathetics in the GI tract

A

Stimulates peristalsis
Inhibits sphincters, stimulates contraction of bladder and rectum

Primary stimulator of GI tract

Active in elimination

32
Q

A “splanchnic nerve” is made up of what 2 nerve components?

A

Visceral afferent (sensory) fiber - receptors for pain and reflexes

Visceral motor (autonomic) fiber - smooth muscle, glands, etc.

33
Q

Visceral afferent fibers travel with sympathetics or parasympathetics?

A

Both! 80% of fibers in vagus are afferents, 20% of fibers in splanchnic nn are afferent

34
Q

Physiologic receptors, such as those detecting O2 saturation, travel with parasympathetics or sympathetics?

A

Parasympathetics (vagus or pelvic splanchnics)

35
Q

Pain travels with sympathetics or parasympathetics?

A

Sympathetics, EXCEPT below the pelvic pain line (distal to middle of sigmoid colon)- where it travels with parasympathetics

36
Q

Acute vs. chronic vs. subacute abdomen

A

Acute = less than 3 days duration

Chronic = greater than 3 weeks duration

Subacute = 3 days - 3 weeks

37
Q

Pathologies of abdomen that cause pain

A 
Inflammation
Ischemia
Stretching
Obstruction
Trauma
Functional disease (IBS)
38
Q

2 types of abdominal pain

A

Visceral - diffuse, poorly localized, often referred to somatic regions, injury to internal organs and tissues that support them

Somatic - well localized, caused by injury to skin, muscles, joint, bone, and CT

39
Q

Parietal pain, in contrast to visceral pain, can be localize to the ______ superficial to the site of painful stimulus

Visceral pain that progresses can lead to parietal pain

A

Dermatome

40
Q

Visceral pain can be localized by the sensory cortex to an approximate spinal cord level determined by the embryologic origin of the organ involved. Where does pain localize from foregut vs midgut vs hindgut?

A

Foregut (stomach, duodenum,biliary tract) = epigastric pain

Midgut (small bowel, appendix, cecum) = periumbilical pain

Hindgut (most of colon, including sigmoid) = suprapubic or hypogastric pain

41
Q

Visceral pain travels with what sympathetics for:

Liver
Stomach
Pancreas
Spleen
Small intestine
Kidneys
Cecum
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum/anus
A 
Liver = T6-9
Stomach = T6-9
Pancreas = T6-9
Spleen = T6-8
Small intestine = T8-10
Kidneys = T10-L1
Cecum = T10
Ascending colon = T10
Transverse colon = T11
Descending colon = T12-L1
Sigmoid colon = L2(3)
Rectum/anus = S2-4
42
Q

Esophagitis
Peptic ulcer
Perforated ulcer
Pancreatitis

The above would refer pain to what embryologic origin?

A

Foregut

43
Q

Early appendicitis
Mesenteric adenitis
Meckel’s diverticulitis
Lymphomase

The above would be referred to what embryologic origin

A

Midgut

44
Q

Testicular torsion
Urinary retention
Cystitis
Placental abruption

The above would refer pain to what embryologic origin?

A

Hindgut

45
Q

Intermittent cramp like pain caused by obstruction of hollow muscular viscus

A

Colicky pain

46
Q

Pain associated with gastric ulcer

A

Foregut visceral pain

Worse on eating, patient tends to avoid meals

47
Q

What condition might be indicated by the following?

Foregut chronic visceral pain
Sudden severe pain spreading all over abdomen
Signs of generalized peritonitis

A

Perforated gastric ulcer

48
Q

What condition might be indicated by the following?

foregut visceral pain
Somatic pain in RUQ
Referred pain to right shoulder
Nausea/vomiting
Fever
Tender RUQ
Positive Murphy’s sign
A

Acute cholecystitis

49
Q

What condition might be indicated by the following?

Midgut visceral pain
Somatic pain in RLQ
N/V
Fever
Tender RLQ
A

Acute appendicitis

50
Q

What condition might be indicated by the following?

Midgut visceral colicky pain
Vomiting
No flatus or bowel action
Possible dehydration
Distended soft abdomen, nontender
Increased bowel sounds
Hx of abdominal surgery
A

Adhesive SBO

51
Q

What condition might be indicated by the following?

sudden onset severe colicky pain from loin to groin
Severe back pain
Patient writhing or pacing about
Possible hematuria
Afebrile
Soft abdomen
CVA tenderness
A

Passage of kidney stone

52
Q

What condition might be indicated by the following?

Older age
Weight loss
Hindgut visceral colicky pain
No flatus or feces
Distended abdomen
Increased bowel sounds
Mass in LLQ
A

Obstructing cancer of descending colon

53
Q

What condition might be indicated by the following?

Woman of childbearing age
Missed LMP
Sudden onset severe hypogastric pain radiating to sacral area
Afebrile
Localized peritonitis in suprapubic area
Tenderness in rectouterine pouch
A

Ruptured ectopic pregnancy

54
Q

What condition might be indicated by the following?

Elderly male with hx of atherosclerotic disease such as HTN or cardiac disease
Sudden onset severe back pain
Pale and shocked, hypotensive
Tender epigastrium
Palpable impulse from aneurysm in epigastrium

A

Leaking aortic aneurysm

GI Midterm (14 decks)

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