Visceral Pain Flashcards
Enteric Nervous system
Also called intrinsic nervous system
Considered “a second brain”
Autonomic nervous system …………….. enteric nervous system
Basic functions:
List 3
Consists of plexuses interconnected by …………………. nerve fibres
Also called intrinsic nervous system
Considered “a second brain”
Autonomic nervous system modulates enteric nervous system
Basic functions:
Secretion
Absorption
Gut movement
Consists of plexuses interconnected by unmyelinated nerve fibres
The intrinsic network of neurons of the ENS is situated in the tissues of the gut wall from oesophagus to anus.
Efferents to ENS (both sympathetic and parasympathetic)
…………. fibres to …………plexus
Secretomotor fibres to ………… plexus
Afferents to CNS
………… sensation (bundled with sympathetic)
Specific functional sensation e.g. stretch (bundled with ……………………
Efferents to ENS (both sympathetic and parasympathetic)
Motor fibres to myenteric plexus
Secretomotor fibres to submucosal plexus
Afferents to CNS
Pain sensation (bundled with sympathetic)
Specific functional sensation e.g. stretch (bundled with parasympathetic
Distribution of autonomic nerves
To peripheral vessels and skin
(sympathetic only):
Sympathetic nerves run with ……………… nerves to the same region
To organs (viscera) lacking somatic innervation:
most nerves run with the …………….. to the same organs
there are a few cases where autonomic nerves run separately
Distribution of autonomic nerves
To peripheral vessels and skin
(sympathetic only):
Sympathetic nerves run with somatic nerves to the same region
To organs (viscera) lacking somatic innervation:
most nerves run with the arteries to the same organs
there are a few cases where autonomic nerves run separately
The autonomic nerves to the ……………. are routed via plexuses* surrounding the aorta and its branches.
Sympathetic nerves synapse at ganglia associated with these plexuses.
Plexuses and ganglia are named according to the associated blood vessels (e.g. coeliac plexus and ganglia, renal plexus and ganglia).
*Plexus = interconnecting network of nerves (or vessels)
The autonomic nerves to the abdomen are routed via plexuses* surrounding the aorta and its branches.
Sympathetic nerves synapse at ganglia associated with these plexuses.
Plexuses and ganglia are named according to the associated blood vessels (e.g. coeliac plexus and ganglia, renal plexus and ganglia).
*Plexus = interconnecting network of nerves (or vessels)
Reffered Pain
Where do people have pain when they have a heart attack?
Brain has NO “…………….. ………” of visceral organs – unlike when someone touches your skin
Brain therefore cannot localise the pain from your organs
Pain is referred to the …………… i.e. the area of skin that is ALSO supplied by that spinal nerve
Define dermatome: An area of skin supplied by a single spinal nerve (these areas of skin can overlap)
Example: Heart – innervated by cardiopulmonary splanchnic nerves
Spinal-cord levels: T1-T4
Pain referred to upper thorax (chest), medial arm and can radiate to the jaw, neck and shoulder.
Reffered Pain
Where do people have pain when they have a heart attack?
Brain has NO “sensory map” of visceral organs – unlike when someone touches your skin
Brain therefore cannot localise the pain from your organs
Pain is referred to the dermatome i.e. the area of skin that is ALSO supplied by that spinal nerve
Define dermatome: An area of skin supplied by a single spinal nerve (these areas of skin can overlap)
Example: Heart – innervated by cardiopulmonary splanchnic nerves
Spinal-cord levels: T1-T4
Pain referred to upper thorax (chest), medial arm and can radiate to the jaw, neck and shoulder.
In what region is the appendix located?
Where is pain from the foregut structures felt?
Name the structures involved?
From what structure is umbilical pain indicating damage to?
Describe the pain associated with appendicitis?
Umbilical pain: pain from midgut structures (from duodenal papilla to splenic flexure) including inflamed appendix referred to periumbilical region.
It is usually colicky (intermittent with bowel contractions)
When the inflammation of the appendix spreads to the surrounding peritoneum the pain becomes localized and constant at the right inguinal region.
Movement of the hip joint, coughing elicits pain.
What are the corresponding dermatomes for epigastric, Umbilical, Inguinal and hypogastric (pubic) region?
Describe appendicitis pain?
uAppendicitis presents with pain here
uPain initially is “colicky”
uProgression: appendix compresses parietal peritoneum à constant focal pain in right iliac
What structures make up the pelvic girdle?
What are the bones of the fused hip bone?
Pelvic Girdle = Sacrum + Coccyx + Pair of Hip Bones
Bones of fused hip bone:
Ilium
Ischium
Pubis
Pelvic Cavity: greater and lesser
Greater Pelvis: Above pelvic brim
Lesser Pelvis: Below pelvic brim
What is the pelvic wall made up of and name the two ligaments?
uPelvic Wall = Pelvic Girdle + 2 ligaments
uSacrospinous
uSacrotuberous
What does the presence of ligaments in the pelvic wall give rise to?
Presence of ligaments gives rise to sciatic foramen:
Superior: Piriformis muscle
Inferior: Obturator internus
Obturator internus (and piriformis) line the inside of the pelvis
Most of the pelvic bone facing the pelvic cavity is covered by the …………….. ………………….. muscle and its fascia
Most of the pelvic bone facing the pelvic cavity is covered by the obturator internus muscle and its fascia
A bowl-like sheet of muscle called ……………. …… forms the pelvic diaphragm.
Slung from the pelvis and sacrum
Supports the main pelvic viscera (bladder, uterus, rectum)
Below the diaphragm is the ……………., containing voluntary sphincters and external genitalia
A bowl-like sheet of muscle called levator ani forms the pelvic diaphragm.
Slung from the pelvis and sacrum
Supports the main pelvic viscera (bladder, uterus, rectum)
Below the diaphragm is the perineum, containing voluntary sphincters and external genitalia
Coronal section of male pelvis showing how the urinary bladder and prostate sit in the ‘bowl’ formed by………….. …………
Coronal section of male pelvis showing how the urinary bladder and prostate sit in the ‘bowl’ formed by Levator ani.
- In females internal urethral sphincter is not well organized
- External urethral sphincter is skeletal muscle surrounding the urethra in the deep perineal pouch
- Two additional groups of muscles in females:
- In females internal urethral sphincter is not well organized
- External urethral sphincter is skeletal muscle surrounding the urethra in the deep perineal pouch
- Two additional groups of muscles in females:
1.Sphincter urethrovaginalis
2.Compressor urethrae
- Tetrahedral when empty
- Ureters enter at supero-posterior angles
- Urethra leaves through inferior angle
- Superior surface covered in peritoneum
- Expands between transversalis fascia and lining peritoneum
- Smooth muscle- …………………………. at neck
- Skeletal muscle- …………………………) in perineum
•
- Tetrahedral when empty
- Ureters enter at supero-posterior angles
- Urethra leaves through inferior angle
- Superior surface covered in peritoneum
- Expands between transversalis fascia and lining peritoneum
- Smooth muscle- Internal Urethral sphincter (vesicae) at neck
- Skeletal muscle- External Urethral sphincter (urethrae) in perineum
•
The skeletal muscle sphincter ani (external) surrounding the anal canal is much less important to faecal continence than the ……………… part of Levator ani, which puts a sharp angle into the recto-anal junction. Can be injured in a badly-performed episiotomy.
The skeletal muscle sphincter ani (external) surrounding the anal canal is much less important to faecal continence than the puborectalis part of Levator ani, which puts a sharp angle into the recto-anal junction. Can be injured in a badly-performed episiotomy.
•Main functional sphincter is pubo-rectalis sling of ……………. ……..
•Main functional sphincter is pubo-rectalis sling of levator ani
The………….. …………. Artery supplies all the pelvic organs (except the …………..), the pelvic walls and much of the buttock (gluteal) region
The Internal Iliac Artery supplies all the pelvic organs (except the ovaries), the pelvic walls and much of the buttock (gluteal) region
