Pelvic Autonomics Flashcards
What is the origination for pelvic autonomics?
Sympathetic trunk (T10-L2) & S2-S4 providng parasympathetic innervation
As the aortic plexus goes below the birurcation of the aorta, what does its name change to?
superior hypogastric plexus
At what level does the superior hypogastric plexus start to split?
What does it split into & why does this happen?
As we reach the sigmoid colon
Splits into right & left hypogastric nerves – more of a consolidated plexus than a singular nerve
this happens to get into the pelvis bilaterally, on either side of the organs
When the right & left hypogastric nerves reach the level of the rectum, what happens & what is the name change?
reform combined plexus
Inferior hypogastric plexus
can be spoken or more specifically as vesical plexus or prostatic plexus
The inferior hypogastcin plexus can be composed of nerves originating from what places?
- Lesser & least splanchnic pulling info from lower thoracic
- from thoracic cavity via the aortic plexus
- lumbar splanchnics that tie into the plexus
- pelvic splanchnic from S2-S4
- sacral sympathetic chain giving of sacral splanchnic
Synapsing for pelvic autonomic can occur at what locations?
- All over the place
- Sympathetics (T10-L2)
- T10 all the way to the inferior hypogastci plexus
- aorticorenal ganglion
- superior hypogastric plexus
- tiny & not very distinct
- sympathetic chain ganglia
- inferior hypogastric plexus
- T10 all the way to the inferior hypogastci plexus
- Parasympathetic (S2-S4)
- in organ wall
- in plexus near organ wall (inferior hypogastric or specific organ plexus)
The inferior hypgastric plexus exists in what layer of fascia?
Superficial to visceral fascia in the endopelvic fascia
Organs of the pelvic cavity are innervated in what ways?
- Dual innervation (para + symp)
- reciprocal innervation
- one excites where other inhibits
- different regions of a particular organ
- reciprocal innervation
- Sensation
- follow somatic nerves (pudendal)
- follow sympathetic (into lower thoracic/upper lumbar)
- follow parasympathetic (into S2-S4)
What is the highest level of viscera that is innervated by sacral parasympathetic nerves?
What is their function here?
- sacral origin parasympathetics will go as high as left colic flexure/distal end of transverse colon
- important moving fecal matter down the descending colon into the sigmoid & preparing for movement in to the rectum for defecation
What transition occurs midsigmoid?
- midsigmoid to the first half of the anal canal, the pain afferent nerves follow parasympathetic nerves (ie. excessive stretching) rather than sympathetic
What autonomic system contols most regulatory functions of the pelvis?
- most regulatory, stature, subconscious control of pelvic organs we can simplify down to following parasympathetic
Afferent pain fibers from the pelvic viscera follows what nervous system architecture?
- Above the dotted line (blue viscera)
- pain follows sympathetic architecture
- T10-L2 referred pain/general vague sensation
- Below the dotted line (grey viscera)
- pain follows parasympathetic
- S2-S4 level
- Dotted line is the pelvic pain line
- it is determiend by the level of visceral peritoneum & include the segment of organ that is covered by visceral peritoneum
What are the 3 sites of nerve block that would be necessary to prevent pain for a person giving birth?
- Upper part (in contact with peritoneum)
- sympathetic – T10 - L2
- spinal block via lumbar puncture
- Lower part uterus / upper part of vagina
- parasympathetic S2 - S4
- caudal epidural block
- Lower vagina closer to skin
- somatic innervation
- pudendal nerve block
How are the gonads innervated?
- T10 - pain in abdomen
- Plexus of nerves off of that aortic plexus that is following in the vasculature all the way to the gonad
- not using hypogastric plexus system
How are the ureters innervated?
- Ureters are regionally innervated (T10-L2)
- proximal ureter - T10 level, off of aorticorenal ganglion
- distal ureter- inferior hypogastric plexus
- Referred pain relative to kidney stone with be related to the location of the stone within the ureter
Describe efferent innervation of the bladder
- Mixed innervation
- parasympathetic induce contraction, sympathetic inhibit (reciprocal relationship)
- Sympathetic
- T11-L2
- Trigone & Internal urethral sphincter
- Parasympathetic
- S2-S4
- detrussor – contractility
- Somatic (voluntary control)
- pudendal - S2-S4
- external urethral sphincter
Pain from the bladder follow was architecture
(most) parasympathetic (S2-S4)
Describe innervation of the urethra
close to the bladder, any type of sensation & control will happen through parasympathetics
Distal urethra, will be more somatic system (S2-S4)
Describe the innervation of the rectum & anal canal
- motor
- Reflex/regulation with sympathetic
- Peristaltic motion with parasympathetic (S2-S4)
- interal anal sphincter
- below pectinate line with somatic (inferior rectal nerve)
- external anal sphincter
- Pain
- mid sigmoid to mid-anal canal is with parasympathetic
- below pectinate line is somatic
- inferior rectal from (S2-S4)
Describe the innervation of the male genetalia
- Erection = parasympathetic
- point, prime
- cavernous nerves
- get into the erectile tissue to cause the change in the vasculature so that you can have the change in blood flow for engorgement
- Ejaculation = sympathetic
- Somatic sensation (pudendal nerve), at the skin
Describe the innervation of the female genetalia
- Parasympathetic
- arousal
- gladular secretion
- engorgement of erectile tissue
- Sympathetic
- orgasm
- Pain
- think pelvic pain line
Describe the innervation involved with micturition.
Micturition: action of urinating
- Stretch S2-S4
- parasympathetic - bladder contraction
- decrease in side & pushing the urine out a (hopefully relaxed) internal & external urethral sphincter
- Sympathetic - inhibits complete filling
- parasympathetic - bladder contraction
- Relax diaphragms (pelvic & u.g.)
- parasympathetic - inhibits internal urethral sphincter & activates detrusor
- changes its position, which changes the bladder’s position & interface with the urethra which allows urine to get out of the system
- Pudendal
- external urethral sphincter & bulbospongiosus
What are physiological reasons someone may not be able to urinate?
What is a physiological reason someone cannot control urination (can’t keep it in)?
- Inabiltiy to urinate
- not getting urine from kidneys to bladder
- not filling the bladder
- not controlling the output of the system
- enlarged prostate closing off the exit
- not getting urine from kidneys to bladder
- Inabiltiy to control urination (keep it in)
- unable to control sphincters
Describe the innervation involved with defecation
- Stretch ampulla (S2-S4)
- sensation that you have to defecate
- Reflexive inhibition of interal anal sphincter
- voluntary relaxation puborectalis (to relax anorectal flexure) & external anal sphincter
- Peristaltic activity
- parasympathetic (to move feces down through the rectum)
What is the role of sympathetics, parasympathetics & somatic innervation during ejaculation?
- Ejaculation
- sympathetic closes internal urethral sphincter
- parasympathetic narrows urethra
- pudendal contracts bulbospongiosus muscle
What additional type of stimulation is necessary during the sex act?
cognitive stimulation
What is the role of autonomics & somatic innervation during an erection?
- parasympathetic
- cavernous nerves, helicine arteries, erection
- somatic - pudendal
- contractin of bulbospongiosus and ischiocavernosus
What are the features of female uniqueness to genital stimulation?
- Parasympathetic
- erection, engorgement & secretion
- Sympathetic
- orgasm, rhythmic contractions of vagina & cervix
