Referred pain Flashcards
Where does the aorta enter the diaphragm?
Where does it bifucates into the iliac arteries?
T12
L4 - forms 2 common iliac arteries
Is the coeliac artery, SMA, IMA paired or unpaired?
Unpaired
Are the adrenal arteries, renal and gonadal arteries paired or unpaired?
Paired
Which arteries are the adrenal glands supplied by?
ADRENAL GLANDS are supplied by
SUPERIOR, INFERIOR AND MIDDLE ADRENAL ARTERIES
Sup: from the INFERIOR PHRENIC ARTERY
Mid: ABDOMINAL ARTERY
Inf: RENAL ARTERY
Which veins drain the adrenal gland?
L & R adrenal veins. They drain the glands.
R: into the IVC
L: Left renal vein
Where do the renal arteries arise?
Paired arteries directly from the abd aorta (L1/2)
- immediately distal to SMA (L1)
As the aorta is left of the midline, the L artery is shorter than the right. R crosses the IVC posteriorly.
How do the renal vein relate?
Anterior to arteries
L = longer, anterior to aorta and L renal a
R = shorter
Both drain directly into IVC
Where do gondal arteries arise?
Features of that artery
Paired visceral arteries
Arise from L2
In men it’s the testicular (through inguinal gland) and n women it’s ovarian
What is an aortic aneurysm?
What does it cause?
It’s a dilation of an artery
abdominal artery is common site
Abdominal pulsations and abdo and back pain
it causes compression of nerve roots - pain/numbers in th lower limbs
What vessels join to form the IVC?
Where does it cross the dia?
2 common iliac veins at L5.
Leaves diaphragm at T8
what are some tributeries of the IVC. Look at the fashcard 4-19
Common Iliac veins Lumbar veins Renal veins Right testicular/ovarian a. L => L renal v. Right suprarenal vein Inferior phrenic vein Hepatic veins Portal venous system Spleen, pancreas, gallbladder, abdominal part of GI tract
Describe the functional separation of the lymph drainage
There is a superficial and a deep drainage.
Superficial - above umbilicus lymph goes up to the axillary node. BELOW the umbilicus goes to the superficial inguinal nodes
Deep - above the umbilicus goes t the parasternal nodes. BELOW - paraaortic and the external iliac nodes.
Where do the sympatetic nerves originate from?
T1 - L2
ACh in ganglion and NA at the effector organ
Short preganglionic and long post ganglionic
Motor to the vascular smooth muscle
Sensory aspects are pain and sensation
Where do the nerves from PSNS oringate from?
Craniosacral origin (CN 3,7,9,10, S2-4)
ACh at both
Long pregang and short post
Provide motor sensation to the muscles and secretomotor to the glands
Sensory aspects - functional and sensation (stretch)
What are 3 ways in which the SNS can travel up and down the column?
1) Ascend or descend along the paravertebral column and then synpase either above or below their level at the head or the spinal nerve.
2) Synapse at the entry level like the throacic viscera - at teh same level
3) Pass THROUGH the paracvertebral column, like the splanchnic nerves and synapse at the pre-vertebral ganglion like the coeliac plexus or SM plexus
What are the splanchnic nerves?
they come from T5 - L2
THORACIC:-
Greater t5-t9 - Coeliac gangia
Lesser t10 - t11 - Superior mesenteric ganglia
Least t12 -> rena plexus (arotorenal plexus)
LUMBAR: 3-4 nerves
L1-L2 - Inferior mesenteric gaglia, hypogastric plexus
PELVIC SPLANCHNIC nerves carry parasympathetic nerves not symp. they’re the only ones/
how is the nomenclature of the fibres of the splanhic related to the vessel?
Fibres form plexuses named after arteries/ganglia
Eg. coeliac plexus
These plexuses are MIXED sympathetic and parasympathetic
Fibres synpase in the ganglia and travel to the effector organ with arteries
Eg. fibres in coeliac ganglia run with the coeliac trunk to organs
What is the diff // paravertebral and pre-vertebral?
Paravertebral ganglia: sympathetic chain
Prevertebral ganglia: distal ganglia eg. coeliac
Fibres to ABDOMINOPELVIC viscera pass through the paravertebral ganglia WITHOUT synapsing
They then pass via the SPLANCHNIC nerves to the prevertebral ganglia and associated plexuses
All SYNAPSE here except the fibres to the adrenal glands (these synapse on the adrenals)
They then run with the ARTERIES to the effector organs
Describe the origin o the PSNS
CN 37910
S 2-4 - hindgut, kidneys an bladder and gonads
Vagus does basically everything, it has sensory and motor functions of both the somatic and autonomic (parasympathetic)
what i the enteric ns?
brain of the gut
2 plexus with interconnecting fibres:
- MYENTERIC (AUERBACH’S)
- SUBMUCOSAL (MEISSNER’S)
Control the gut function like secretion and motilit and local blood flow.
They are regulated by the SNS and PSNS
What is referred pain
Briain has no sensory map of the visceral organs unlike somatic
So cannot localise precisely the pain
pain is referred to the dermatomes - the area of skin that is ALSO supplied by that spinal nerve
What is a dermatome?
area of skin supplied by a singe spinal nerve (tehse areas can overlap)
eg Where do you feel pain in a heart attack?
Heart is innervated by thoracic splanchnic nerves (T1-4)
Pain is felt in the dermatomes supplied by T1-4
How to locate pain on the dermatome map?
Know the organs which reside in each region of the abdomen e.g. epigastric, hypoasgrtic
Epigastric: FOREGUT
Umbilical: MIDGUT
Hypogastric: HINDGUT
How to draw the abdominal reions?
9
horizontal
subcostal
- 10th rib
- body of the L3 vert, region of the inferior mesenteric artery and 3rd part of duo
transtubercular
- line corresponding to joining teh two iliac crests
- upper border of L5 vert
vertical
mid clavicular point to the mid inguinal point.
Appendicitis
pain is initally diffuse around the unbilical
as it becomes inflammed more, it irritates the peritoneum
pain is well localised by the omatic sensory nerves
where would pain to the liver, gallbladder and duodenum go?
to the shoulder where the dermatome for the diaphragm is as they irritate the diaphragm
where would the kidney an ureter pain be felt?
in the t11 - l2 region
