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Year 2(B7) - Renal > Week 1 - E - Anatomy 3 - Urinary autonomics and renal system pain > Flashcards

Week 1 - E - Anatomy 3 - Urinary autonomics and renal system pain Flashcards

1
Q

There are 5 types of nerve fibre which can be categorised as sensory and motor What are the five types?

A

Sensory (afferent) - Somatic afferent Visceral afferent Motor Somatic motor Parasympathetic + sympathetic - Autonomous nervous system

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2
Q

In the sensory types of nerves Where does sensory afferent and visceral afferent relay nerve impulses from? Remember soma - body wall visceral means organ

A

Somatic afferent - sensations from the body wall Visceral afferent - sensations from our organs

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3
Q

In the motor nerve types Which stimulate motor responses to our body wall and stimulate skeletal muscles to contract? Which give motor responses to our organs and stimulate smooth/cardiac muscle contraction and supply to our glands?

A

Body wall and skeletal muscle contraction - somatic motor motor responses to our organs Stimulate smooth/cardiac muscle and glands = Parasympathetic and sympathetic

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4
Q

Normal renal system motor function: ureteric peristalsis bladder contraction urethral sphincter control (internal and external) What nerve type supplies ureteric peristalsis and bladder contraction?

A

Ureteric peristalsis is sympathetic/parasympathetic - organ Bladder contraction - sympathetic/parasympathetic

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5
Q

What is the muscle of the bladder that causes contraction?

A

This is the detrusor muscle

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6
Q

Structures that are located in the pelvis have a motor function supply from the autonomic nervous system What is the region located below the pelvic floor known as and what is the nerve motor supply to structures located in this region?

A

This region is the perineum They have a somatic motor nerve supply - somatic motor is under voluntary control

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7
Q

What type of motor control is the urethral sphincter (internal and external) and the levator ani under?

A

Internal urethral sphincter - innervated by parasympathetic/sympathetic External urethral sphincter and levator ani - these are structures within the perineum and therefore under somatic motor control

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8
Q

How is pain from the urethra relayed back to the CNS?

A

Pain in the pelvic urethra is felt due to visceral afferent fibres Pain in the perineal urethra is in the perineum and therefore somatic sensory

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9
Q

What does the urethra extend through to enter the perineum?

A

extends through the levator ani muscle

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10
Q

How many spinal nerves and cranial nerves are there?

A

There are 12 cranial nerves and 31 spinal nerves

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11
Q

How are the spinal nerves named? Which nerve exists between C7 and T1?

A

C1-C7 cervical spinal nerves are named corresponding to the vertebra below it C8 lies between cervical vertebra C7 and T1 Then the spinal nerves are named according to the vertbra above it with the same name

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12
Q

How are there 31 spinal nerves yet 33 vertebrae?

A

8 cervical spinal nerves 12 thoracic spinal nerves 5 lumbar 5 sacral and 1 coccygeal

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13
Q

What forms the spinal nerve?Term

A

The fusion of the dorsal and ventral roots from the spinal cord

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14
Q

The only means by which any type of nerve fibre can communicate with the central nervous system is by being carried within cranial nerves or spinal nerves. What spinal nerves do the sympathetic presynaptic ganglia leave?

A

Leave in spinal nerves T1 to L2

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15
Q

How do sympathetic nerves travel to reach the smooth muscle/glands?

A

They do this by travelling within nerves called splachnic nerves

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16
Q

What are the two types of splanchic nerves? that help the the sympathetic fibres reach the smooth muscle (can be cardiac)/glands

A

Cardiopulmonary splanchnic nerves and abdominopelvic splanchnic nerves

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17
Q

They reach the smooth muscle/glands of the head mainly by following (“hitching a ride with”) what?

A

They follow the arteries

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18
Q

What are the two main arteries that the sympathetic fibres form plexi on to innervate the head and neck?

A

They form plexuses on the ICA and ECA

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19
Q

The sympathetic chain runs the entire length of the vertebral column The presynaptic sympathetic fibres synapse in the sympathetic chain ganglia (there are a few exceptions) What are the cervical ganglia?

A

Superior, middle and inferior ganglia

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20
Q

In the thoracic part of the sympathetic chain, the ganglia exist at each vertebral level What is the fusion of the inferior cervical ganglia and the 1st thoracic ganglia known as?

A

Stellate ganglion

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21
Q

From the spinal cord, how is the anterior and posterior rami formed? start at spinal cord

A

Spinal cord gives off posterior (dorsal) and anterior (ventral) rootlets that come together to make dorsal and ventral roots These roots fuse to become the spinal nerve The spinal nerve then splits into anterior and posterior rami

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22
Q

What is it that joins the anterior rami to the sympathetic ganglion?

A

The rami communicans

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23
Q

What level to the sympathetic fibres leave the spinal cord to innervate the kidneys and the bladder?

A

Leave at T10 to L2

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24
Q

Usually when the presynaptic nerve fibres enter the sympathetic chain they synapse at the sympathetic ganglion however they do not here, instead where do they synapse for when they go to supply the ureter and bladder? (this is true for all abdominopelvic splachnic nerves)

A

They leave the chain in the abdominopelvic splanchnic nerves and synapse at the abdominal sympathetic ganglia

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25
Q

Which artery is the abdominal sympathetic ganglia located around?

A

Around the abdominal aorta

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26
Q

Postsynaptic sympathetic nerve fibres pass from the ganglia onto the surface of the arteries which are heading towards the organs they need to innervate. What is the collection of nerve fibres found on the ouside of the artery known as?

A

The periarterial plexus

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27
Q

Other nerve fibre types also take part in such plexuses are what?

A

Parasympathetic fibres and visceral affernet fibres (sensory)

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28
Q

Parasympathetic nerve fibres leave the CNS only within 4 cranial nerves and the sacral spinal nerves What type of outflow can be used to describe the sympathetic and parasympathetic outflow?

A

Sympathetic = thoracolumbar Parasympathetic - craniosacral

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29
Q

Parasympathetic fibres reach the smooth muscle/glands of the head and body via cranial nerves Specifically, parasympathetic fibres reach the smooth muscle/glands of the hindgut and pelvic organs via pelvic splanchnic nerves How do arasympathetic fibres innervate the smooth muscle/glands of the body wall ?

A

They do not innervate the smooth mucle/glands of the body wall

30
Q

Parasympathetic fibres are carried within the sacral spinal nerves very briefly, what do the sacral spinal nerves then form for the parasympathetic fibres to travel?

A

Form the pelvic splachnic nerves

31
Q

Which craniosacral nerve provides parasympathetic from the oesophagus to proximal 2/3rds of the transverse colon? (ie end of midgut)

A

The vagus nerve

32
Q

What nerves supply the hindgut?

A

The pelvic splanchnic nerves

33
Q

What is the difference from the parasympathetic nerves of which innervate the kindeys, ureter and bladder?

A

Parasympathetic nerves innervating the kindeys and ureter travel within the vagus nerve Parasympathetic nerves innervating the bladder travel within the pelvic splanchnic nerves

34
Q

What does sympathetic and parasympathetic innervation do to urine production from the kidney?

A

Sympathetic stimulation decreases urine production by cause vasoconstriction of the arterioles and therefore the blood entering the glomerulus is less - hence why urge to pee goes away when you exercise Parasympathetic stimulation increases urine production as it causes vasodilation

35
Q

Vagus nerve transmits parasympathetic fibres to the periarterial plexus What are the pelvic splanchnic nerves?

A

S2,3,4

36
Q

What are the parasympathetic that innervate the detrusor muscle of the bladder?

A

The pelvic splanchnic nerves

37
Q

Kidneys, ureter and bladder do not receive any somatic innervation What is the only part of the urinary system that receives somatic fibres? (it exists below the levator ani)

A

This is the perineum

38
Q

we have control over the external urethral sphincter as it is in the perineum What is the type of nerve supply to the external urethral sphincter?

A

Somatic motor - via the pudendal nerve

39
Q

Where is pain in the kidneys usually felt? (eg due to hydronephrosis)

A

Felt in the loin region - posterior flank

40
Q

How can you see hydronephroiss on ultrasound

A

Distension of the renal pelvic and calcyces

41
Q

Is pain from the kidneys felt via somatic or visceral affernets?

A

Felt via visceral afferents

42
Q

Visceral afferents travel along sympathetic fibres back to the spinal cord at certain levels hence why the pain i felt in dermatomes What is a disease example which is felt along dermatomes as it remains latent in the nervous system?

A

Shingles - dermatomal rash

43
Q

Which dermatomes is pain in the kidney felt in? Remember it is usually in the loin regions of the flank

A

T10 and L1 dermatomes

44
Q

Pain in the ureters is felt in the groin and loin region Which dermatomes and what can potential differentials of other reasons for pain be?

A

T11 to L2 -could be hernia (inguinal or femoral), could be lymphadenopathy

45
Q

What region of the abdomen is pain in the bladder felt in? The visceral afferents that are in contact with the perineum (hence the abdominal pain)

A

The suprapubic region

46
Q

What are the nerves giving off the nerve supply to the bladder? (not the part in contact with the perinoeum) Therefore pain can also be felt on these dermatomes

A

S2,3 an 4 give off the pelvic splanchnic nerves

47
Q

due to its embryological descent, visceral afferents run alongside sympathetic fibres back to the spinal cord to levels T10-11 (umbilical region) However due to its close contact to the scrotum (body wall strcutre) where can pain also be felt?

A

Can be localised to the groin or scrotum

48
Q

GOOD TO KNOW

A

GOOD TO KNOW

49
Q

When the bladder stretches as it is becoming full, what nerve fibres carry this information back to the CNS?

A

The visceral afferent nerve fibres

50
Q

This information is relayed to the CNS via S2,S3,S4 spinal cord levels There is a reflex at this point to empty the bladder by stimulation of which muscle?

A

By stimulation of the detrusor muscle to cause contraction of the bladder Parasympathetics to the pelvic splanchnic nerves

51
Q

However in those infants who have been “potty trained” along with children and adults, the brain overrides this reflex; action potentials within inhibitory nerve fibres from the cortex pass inferiorly and inhibit this reflex. What nerve supplies the external urethral sphincter and the levator ani muscle so we have voluntary control?

A

Somatic motor control by the pudendal nerve

52
Q

When it is appropriate to micturate (urinate), the parasympathetic cause what and the pudendal nerve cause what? (to do with the bladder and urethra)

A

Parasympathetics cause contraction of the detrusor muscle and relaxation of the internal urethral sphincter Pudendal nerve (somatic motor) causes relaxation of the external urethral sphincter and levator ani The anterlateral abdominal wall muscles are somatic motor which contract to increase intraabdominal wall muscles and force urine out

53
Q

There is also a lumbar and sacral plexus collectively known as the lumbosacral plexus Which large nerve arises from the lumbosacral plexus and innervates many muscles of the lower limb?

A

The sciatic nerve - L4 to S3

54
Q

State the nerves of the lumbar plexus Start from subcostal nerve which is at T12 (not part of the lumbar plexus)

A

Iliohypogastric - L1 Ilioinguinal - L2 Lateral cutaneous nerve of the thigh - L2,3 Genitofemoral nerve - L1,2 Femoral nerve - L2-4 Obturator nerve - L2-4

55
Q

The iliohypogastric nerve and ilioinguinal nerve come from the same L1 origin before splitting What do the iliohypogastric supplu?

A

Iliohypogastric supplies skin in the lateral gluteal region – also motor to internal oblique and transversus abdmoninus region

56
Q

The ilioinguinal supplies the skin at the root of the penis and upper part of the scrotum in males What does it supply in females?y

A

Supplies the mons pubis and the labia majora - mons pubis divided into the labia majora on either side

57
Q

Where does the lateral cutaneous nerve arise and what does it supply?

A

Arises at L2,3 Supply skin over the lateral thigh

58
Q

The iliohypogastric, ilioinguinal and lateral cutaneous nerve of the thigh all arise lateral to the psoas major muscle Which nerve pierces the psoas major muscle? It arises at L1,2 and also provides sensory innervation to the mons pubis in females

A

This is the genitofemoral nerve

59
Q

Which nerve innervates the cremaster muscle of the scrotum?

A

The genitofemoral nerve

60
Q

Which nerve sits lateral to the psoas major and supplies all the muscles of the anterior compartment of the thigh? What is the one muscle?

A

This is the femoralnerve (l2-4) Innervates all the muscles of the anterior compartment of the thigh except the psoas major - innervated by the anterior rami of lumbar nerves (L1-3)

61
Q

Which nerve is made from branches L2-L4 and is medial to the psoas major muscle? What does it supply?

A

Obturator nerve Supplies the medial compartment of the thigh

62
Q

the posterior abdominal wall muscles - the psoas major and quadratus lumborus sit posterior to the kidney Whcih does the kidney sit medial to?

A

Kidney sits medial to the quadratus lumborus and lateral to the psoas major

63
Q

What does the femoral nerve pass under to reach the anterior thigh? What does the obturator nerve pass through to reach the medial thigh?

A

Femoral nerve - under the inguinal ligament - can see inguinal ligament from ASIS to pubic tubercle Obturator nerve - through the obturator foramen

64
Q

Sacrotuberous - ischial tuberosity to sacrum Sacrospinous - iliac spine to sacrum What foramen does the sciatic nerve pass through?

A

Through the greater sciatic foramen

65
Q

1,2,3,4,5,6,7,8

A
  1. iliac crest 2. greater sciatic foramen 3. sacrotuberous ligament 4. sacrospinous ligament 5. ischial spine 6. lesser sciatic foramen 7. sacrotuberous ligament 8. ischial tuberosity
66
Q

What nerve supplies the lateral, anterior and posterior compartments of the leg?

A

Lateral - superficial fibular nerve Anterior - deep fibular nerve Posterior - tibial nerve

67
Q

Lateral cutaneous - lateral thigh sensation Posterior cutaneous - posterior thigh Rest of thigh - femoral What does the femoral nerve give off to provide sensation to the anterior and posterior leg?

A

The saphenous nerve

68
Q

formed from the tibial and common fibular nerves) supplies sensation to the lateral aspect of the foot What is this? Which nerve provides innervation to the lateral leg? (same as the nerve which supplies the muscles of the lateral leg)

A

Sural nerve The superficial fibular nerve

69
Q

What supplies innervation to the plantar surface of the foot?

A

The tibial nerve

70
Q

What supplies innervation to the 1st web space?

A

Deep fibular nerve

Year 2(B7) - Renal (51 decks)

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