G 34

Question 1

SCL for all abdominopelvic splanchnic nerves

Answer 1

Greater T5-T9
Lesser T10-T11
Least T12
Lumbar L1-L2
Sacral L1-L2

Question 2

Men have prostatic plexus, women have ____

Answer 2

Uterovaginal plexus

Question 3

Sacral splanchnic nerves are ______

Answer 3

sympathetic

Question 4

Pelvic splanchnic nerves are ______

Answer 4

parasympathetic

Question 5

Explain pelvic pain line

Answer 5

Threshold determines how visceral pain is sent back.
Above or in contact with the inferior peritoneum will send visceral pain signals back through sympathetic pathways.
Structures below this line will send visceral pain back through parasympathetic pathways such as the pelvic splanchnic nerve

Question 6

What is dual is the rule?

Answer 6

Most visceral organs receive innervation from both sympathetic and parasympathetic pathways

Question 7

Explain innervation of the suprarenal glands

Answer 7

Receive only sympathetic innervation
Preganglionic axons from greater, lesser, least splanchnic nerves
Axons innervating the vasculature to the glands synapses in the celiac plexus. Increased innervation causes vasodilation.
Axons innervating the secretory cells pass through the celiac plexus without synapsing and violate the two neuron rule where usually only post-synaptic nerves innervate the target. These synapse on chromaffin cells. Innervation causes secretion of adrenal hormones.

Question 8

Chromaffin cells are _____ ______ _____ ______

Answer 8

modified postganglionic sympathetic neurons

Question 9

Explain innervation of the kidney

Answer 9

Sympathetic controls most actions of the kidney through controlling the blood flow to the kidney.

Sympathetics through least splanchnic nerve (T12 SCL). Synapses in aorticorenal plexus and runs along renal artery to control diameter. Innervation results in vasoconstriction.

Parasympathetics come from the vagus nerve and synapse on intrinsic ganglia. Role is unclear.

Because above pelvic pain line, visceral pain through sympathetics. Non-pain through vagus nerve.

Question 10

Innervation of the proximal ureter

Answer 10

Preganglionic sympathetics from T11-L2 SCL
Postganglionic sympathetics from renal and intermesenteric plexuses. Function is to control vascular tone.

Parasympathetic innervation from vagus nerve. Function is to control peristalsis.

Pain and non-pain follow normal feedback pathways.

Question 11

Innervation of the abdominal ureter

Answer 11

Pregang. sympathetics from T11-L2 SCL
Postgang. sympathetics from superior hypogastric plexus
Controls vascular tone

Parasympathetic innervation from the vagus nerve to control peristalsis

Normal pain/non-pain return pathways

Question 12

Innervation of the pelvic ureter

Answer 12

Pregang. sympathetics from T11-L2 SCL
Postgang. sympathetics from inferior hypogastric plexus
Controls vascular tone

Parasympathetic innervation from the pelvic splanchnic nerve to control peristalsis

Normal pain/non-pain return pathways through respective symp. and parasymp. pathways

Question 13

Pain pattern for kidney stone

Answer 13

Loin to groin

Middle back down and around to the groin

Question 14

Innervation for the urinary bladder

Answer 14

Pregang. sympathetics from L1-L2 SCL through lumbar and sacral splanchnic nerves
Pass through the inf. hypogastric plexus, but synapse in the vesical plexus.
Postgang. sympathetics distributed through vesical plexus

Parasympathetics from S2-S4 SCL pelvic splanchnic nerves through inferior hypogastric plexus and vesical plexus but synapse on intrinsic ganglia.

All non-pain through pelvic splanchnic.

Pain: top of bladder through lumbar and sacral splanchnic nerves, rest of bladder through pelvic splanchnic nerves

Question 15

Explain control of micturition

Answer 15

Sympathetics: contract internal urethral sphincter and relax detrusor muscle to fill bladder
Visceral non-pain: convey fullness from trigone through pelvic splanchnic nerves
Parasympathetics: relax internal urethral sphincter and contract detrusor muscle to expel urine
Somatic: pudendal nerve maintains tonic contraction of external sphincter until voluntarily relaxed

Question 16

Innervation of the rectum

Answer 16

Preg. Symp. from lumbar splanchnic nerves (L1-L2). Synapse in inferior mesenteric ganglion and superior hypogastric. Distributed through periarterial plexus of IMA and superior rectal arteries to the superior part of the rectum and through the rectal plexus to the inferior part.

Parasympathetics through the pelvic splanchnic nerves through the inferior hypogastric and rectal plexuses. Synapse on intrinsic ganglia

Pain and non-pain through pelvic splanchnic because below pain line.

Question 17

Innervation of the superior anal canal

Answer 17

Superior portion of anal canal is above the pectinate line.
Pregang. symp. from lumbar and sacral splanchnic nerves (L1-L2). Synapse in inferior hypogastric plexus.
Postgang. symp. distribute through rectal plexus

Parasympathetics from pelvic splanchnic nerves (S2-S4) through inferior hypogastric plexus and rectal plexus. Intrinsic ganglia.

All pain through pelvic splanchnic because below pain line.

Question 18

Innervation of inferior anal canal

Answer 18

Below pectinate line is somatic controlled through inferior rectal nerves which are branches of pudendal nerve.

Question 19

Control of defecation

Answer 19

Sympathetic: inhibit peristalsis, tonic contraction of internal anal sphincter
Parasympathetic: peristalsis, secretion of colorectal glands, relax internal anal sphincter, peristalsis of anal canal
Somatic: voluntarily relax external anal sphincter and puborectalis

Question 20

Innervation of the gonads

Answer 20

Preganglionic Symp. from T11-L1 SCL
Synapse at small ganglia near origin of gonadal arteries
Distributed along gonadal arteries

No appreciable parasympathetic innervation

Question 21

Pain innervation for gonads

Answer 21

Ovaries are intraperitoneal, thus above the pain line, testes act as if above the pain line.
Both return pain through sympathetic splanchnic to T11-L1 SCL along gonadal arteries.
Ovarian pain can refer to umbilical region
Testicular pain can refer pain in loin to groin pattern?

Question 22

Innervation of prostate and seminal vesicles

Answer 22

Pregang. symp. from lumbar splanchnic (L1-L2) SCL
Synapse in inferior hypogastric plexus
Distributed via prostatic plexus

Parasympathetic from pelvic splanchnic through inf. hypogastric and prostatic plexuses. Intrinsic ganglia

Below pain line, so all pain through pelvic splanchnic

Question 23

Innervation of vagina and uterus

Answer 23

Most distal part of vagina (1/5) is somatic innervation through perineal nerve from pudendal nerve. Only part that is sensitive to touch.

Pregang. symp. from lumbar splanchnic nerves
Synapse in inferior hypogastric plexus
Postgang. symp. through uterovaginal plexus

Parasympathetics from pelvic splanchnic nerves through inf. hypogastric and uterovaginal plexuses. Intrinsic ganglia

Question 24

Pain for vagina and uterus

Answer 24

Fundus and body through sympathetic pathway. Non pain through pelvic spl.

Cervix and vagina both through pelvic spl.

Question 25

Explain anesthesia for parturition

Answer 25

Lumbar puncture into subarachnoid space produces complete anesthesia inferior to injection site.

Caudal epidural bathes S2-S4 so everything below pelvic pain line is numb: cervix, vagina, perineum. Does not affect structures above the pain line

Pudendal nerve block: only perineum (S2-S4) dermatomes

Question 26

Cavernous nerves from ______ plexus provide ______ innervation to _______ & _________ in males

Answer 26

Cavernous nerves from the prostatic plexus provide parasympathetic innervation to corpora cavernosa and corpus spongiosum in males

Question 27

Cavernous nerves from _____ plexus provides ______ innervation to _______ & ________ in females

Answer 27

Cavernous nerves from the uterovaginal plexus provides parasympathetic innervation to the crura of clitoris and bulb of vestibule in females

Question 28

What type of innervation facilitates penile erection and vaginal secretion, erection of clitoris, engorgement of tissue in the bulbs of the vestibule?

Answer 28

Parasympathetic innervation

Question 29

What somatic nerve contributes to erection?

Answer 29

Pudendal nerve contributes through innervation of bulbospongiosus and ischiocavernosus muscles

Question 30

Explain AV shunt and erection process

Answer 30

Increased PSNS activity closes the AV shunt and causes blood to pool in the erectile tissues. This further closes the drainage veins which contributes to erection. Contraction of bulbospongiosus and ischiocavernosus muscles also impedes venous return of blood

Question 31

Emission vs Ejaculation and all the control involved

Answer 31

Emission is movement of sperm into the prostatic urethra controlled by sympathetic activity

Ejaculation: SNS closes internal urethral sphincter, PSNS contracts urethra, Somatic spinal reflex contracts bulbospongiosus via pudendal nerve

Question 32

What reestablishes the AV shunt after erection?

Answer 32

Sympathetic nervous system

Question 33

What is priapism and clitorism?

Answer 33

Erection lasting long enough to cause ischemia of erectile tissues