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GIGU > Abdominal Autonomics and Pain > Flashcards

Abdominal Autonomics and Pain Flashcards

1
Q

What NS has axons that are thick and myelinated?

A

somatic nervous system

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2
Q

What utilizes sensory input from general and special senses–>motor output to skeletal muscle?

A

somatic NS

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3
Q

What NS doesn’t involve ganglia?

A

somatic NS

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4
Q

What NS is under voluntary/subconscious control of single neuron pathway?

A

somatic NS

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5
Q

What only uses ACh for excitation?

A

somatic NS

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6
Q

What NS is under involuntary control via 2 neuron pathway?

A

ANS

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7
Q

What NS has sensory input from general and visceral senses–>motor output to cardiac, SM and glands?

A

ANS

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8
Q

What NS has thin axons with some myelination?

A

ANS

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9
Q

What do many visceral effects have in terms of innervation?

A

dual innervation that oppose each other

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10
Q

Where does the PNS not innervate?

A 
adrenal glands
semnal vesicles
vas deferens
uterus
splene
liver
pancreas
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11
Q

What do autonomic plexuses contain?

A
  • POSTganglionic sympathetic axons
  • PREganglionic parasympathetic axons
  • visceral sensory axons
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12
Q

Where do sympathetic axons in automonic plexuses come from?

A

spinal cord via sympathetic trunk

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13
Q

Where do parasympathetic axons in autonomic plexuses come from?

A

cranial and caudal repositories

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14
Q

Do plexuses close together interact or synapse with each other?

A

no

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15
Q

What is contained in the abdominal aortic plexus?

A

celiac plexus
superior mesenteric plexus
inferior mesenteric plexus

–>autonomic control of digestion

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16
Q

What is contained in the hypogastric plexuses?

A

superior and inferior plexuses

–>innervate pelvic viscera for autonomic control of urinary and reproductive fxn

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17
Q

Describe typical parasympathetic pathway

A

Cranial or caudal repositories–>pregang–> ganglion (releases ACh)–> postgang–> releases ACh at target organ

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18
Q

What NS is mass activaton part of ?

A

ANS

—>sympathetic

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19
Q

Define mass activation?

A

large # ganglionic neurons may activate effector organs

–>heightened sense of alterness d/t + reticular activation system

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20
Q

Describe general sympathetic pathway

A

CNS–>pregang–>ACh @ gang–>postgang–>NE

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21
Q

Where do sympathetic preganlgionic neuron cell bodes originate?

A

T1-L2 lateral horns

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22
Q

Preganglionic symp axons travel with ___________ to exit spinal cord and first enter anterior roots, then _________

A

somatic motor neuron axons, T1-L2 spinal nerves

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23
Q

Where are the L and R sympathetic trunks?

A

lateral to VC, anterior to spinal nerves

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24
Q

What is another name for the sympathetic paravertebral ganglia?

A

sympathetic trunks

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25
Q

Every spinal nerve has a sympathetic trunk ganglion EXCEPT?

A

cervical portion

–>superior, middle and inferior cervical ganglia instead of 8

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26
Q

What are white rami?

A

myelinated preganglionic axons that carry pregang symp axons from T1-L2 spinal nerves to the sympathetic trunk

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27
Q

What spinal nerves are the white rami associated with?

A

T1-L2

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28
Q

What is similar to entrance ramps on a highway?

A

white rami

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29
Q

Why is similar to exit ramps on a highway?

A

gray rami

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30
Q

What rami are myelinated vs unmyelinated?

A

White vs gray rami

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31
Q

What connects to all spinal nerves so info can start out in thoracolumbar and disperse to all parts of body?

A

Gray rami

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32
Q

What connect postgang symp axons from symp trunk to the spinal nerve?

A

gray rami

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33
Q

What are examples of sympathetic pathways?

A

spinal nerve
postgang symp
splanchnic
adrenal medulla

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34
Q

Describe a typical symp spinal nerve pathway

A

Ventral root from cell body–>spinal nerve–>white rami–>symp trunk and synapse–>gray rami–> same spinal nerve to destination

OR

same up until white rami–>symp trunk and synapse–>asc/desc level–>gray rami–>destination

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35
Q

What are examples of destinations of spinal nerves?

A

arrector pili, dilate BV in skin, activate sweat glands

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36
Q

What is the difference between the postgang symp pathway and spinal nerve pathway?

A

instead of going back to spinal nerve via gray rami, it becomes one long gray rami and hops onto vessels–>target organ

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37
Q

What are examples of destinations of postgang symp N?

A

heart, lung, salivary gland

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38
Q

Describe the adrenal medulla pathway

A

NO SYNAPSING d/t direct + of adrenal medulla via splanchnic N

axon via cell body lateral horn–>ventral root–>spinal nerve–>white rami–>symp trunk–> continues out without synapsing in trunk as thoracic splanchnic N–> directly synapses on cells in medulla

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39
Q

Describe the splanchnic nerve pathway

A

cb from lateral horn–>ventral root–>spinal N–>white rami–>symp trunk NO SYNAPSE–> out as splanchnic N–>synapse in prevertebral ganglia–> into plexus–>abd organs

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40
Q

Where are prevertebral ganglia located?

A

ONLY IN ABDOMINOPELVIC CAVITY

–>single structures clustered around major arteries (same name)

41
Q

What are examples of prevertebral ganglia?

A
  • celiac ganglia
  • superior mesenteric ganglia
  • inferior mesenteric ganglia
42
Q

What axons compose “thoracic” splanchnic nerves?

A

pregang symp axons

43
Q

What splanchnic nerves are not classified in the “thoracic” splanchnic N pathway?

A
  • cardiopulmonary splanchnic N (postgang symp)

- pelvic splanchnic N (parasymp)

44
Q

What are examples of sympathetic pregang splanchnic N?

A

Greater thoracic (celiac gang)

Lesser thoracic (sup mes)

Least thoracic (sup mes)

Lumbar (sup mes)

Sacral (inf mes)

45
Q

What splanchnic N supplies the foregut?

A

greater thoracic splanchnic N

46
Q

What splanchnic Ns supply midgut?

A

lesser, least, lumbar splanchnic N

47
Q

What splanchnic N supplies the hindgut?

A

sacral splanchnic N

48
Q

What ganglia are anterior to VC on the anterolateral wall of the abd aorta?

A

prevertebral ganglia

49
Q

What NS is most active during times when body must process nutrients and conserve energy?

A

PNS

50
Q

What aspect of PNS prevents mass activation?

A

lack of extensive divergence in pregang axons

51
Q

What NS has discrete and localized effects?

A

PNS

52
Q

What is special about PNS in terms of turning on organs?

A

can turn one on without turning on all other organs

53
Q

Craniosacral division AKA

A

PNS

54
Q

What CN are associated with parasympathetic system?

A

3, 7, 9, 10

Oculomotor
Facial
Glossopharyngeal
-->all to head
Vagus
-->thoracic and abd organs
55
Q

What parasym innervates distal gut tube and pelvic viscera?

A

pelvic splanchnic N (S2-4)

–>to sup and inf hypogastric plexus

56
Q

Pain travels with _____ except for below pelvic pain line

A

sympathetics

57
Q

What is the boundary of the pelvic pain line?

A

middle of sigmoid colon

58
Q

What percent of vagus fivers are afferents?

A

80%

59
Q

What percent of thoracic splanchnic nerves are afferents?

A

20%

60
Q

Innocuous (not pain) input will travel with?

A

parasympathetics

61
Q

Where is the thoracic pain line?

A

sternal angle (T4-5)

62
Q

What carries pain input above thoracic pain line?

A

Parasymp

63
Q

What carries pain input between thoracic and pelvic pain lines?

A

sympathetic

64
Q

What carries pain input below pelvic pain line (lower peritoneum and perineum)?

A

parasymp

65
Q

What duration consitutes acute abd pain?

A

less than 3 days

66
Q

What duration consitutes chronic abd pain?

A

more than 3 weeks

67
Q

What duration consitutes subacute abd pain?

A

3 days to 3 weeks

68
Q

What pathologies can cause pain?

A 
inflammation
ischemia
stretching
obstruction
trauma
fxnl disease
69
Q

What is visceral pain?

A
  • diffuse, poorly localized
  • referred to somatic regions
  • injury to internal organs and tissues that support them
70
Q

What is somatic pain?

A
  • well localized

- caused by injury to skin, muscles, bone, joint and CT

71
Q

What is parietal pain?

A
  • caused by irritation of fibers that innervate parietal peritoneum
  • localized to dermatome
  • can stem from visceral pain–>tenderness and guarding
72
Q

What is the progression of visceral to parietal pain in abd?

A

visceral to parietal causes tenderness and guarding

localized peritonitis develops rigidity and rebound

73
Q

Visceral pain can be localized to______

A

embryologic origin of organ

–>foregut produces pain in epigastric

–>midgut produces periumbilical pain

–>hindgut produces suprapubic or hypogastric pain

74
Q

What can cause umbilical pain?

A
  • early appendicitis
  • mesenteric adenitis
  • Meckel’s diverticulum
  • lymphomas
75
Q

What causes flank or lumbar pain?

A

ureteric colic

pyelonephritis

76
Q

What causes epigastric pain?

A
  • esophagitis
  • peptic ulcer
  • perforated ulcer
  • pancreatitis
77
Q

What causes R inguinal pain?

A 
late appendicitis
Crohn's disease
cecum obstruction
ovarian cyst
ectopic pregnancy
hernia
78
Q

What causes hypogastric/suprapubic pain?

A

testicular torsion
urinary retention
cystitis
placental abruption

79
Q

What causes L inguinal pain?

A 
diverticulitis
ulcerative colitis
constipation
ovarian cyst
hernia
80
Q

What causes L hypochondriac pain?

A

spleen abscess
acute splenomegaly
spleen rupture

81
Q

What causes R hypochondriac pain?

A

gallstones
cholangitis
hepatitis
liver abscess

82
Q

What causes referred pain?

A

results of network of interconnecting sensory nerves that supply different tissues

–>converge at same level of SC

83
Q

What causes retroperitoneal pain?

A

pancreas
kidney
aorta

–>back pain

84
Q

What causes colicky pain?

A

intermittent, cramp-like

d/t obstruction of hollow muscular viscus
–> SBO, stones

Down middle of abd

85
Q

What causes pain from loin to groin?

A

urinary tract obstruction

86
Q

What causes foregut visceral pain that is worse with eating?

A

gastric ulcer

87
Q

What produces foregut chronic visceral pain with sudden severe pain that spreads over abd?

A

perforated gastric ulcer

–>signs of generalized peritonitis

88
Q

What would acute cholecystitis cause?

A
  • foregut visceral pain
  • somatic pain RUQ
  • referred pain R shoulder
  • N, V
  • F
  • tender RUQ
  • positive Murphy’s sign
89
Q

What would acute appendicitis cause?

A
  • midgut visceral pain
  • somatic pain RLQ
  • N, V, F
  • tenderness RLQ
  • localized peritonitis RLQ if ruptured
90
Q

What would an adhesive SBO cause?

A
  • hx prev abd surg
  • midgut visceral colicky pain
  • vomiting
  • no gas, bowel action
  • possible dehydration
  • distended soft abd, nontender
  • increased bowel sounds
91
Q

What would passage of kidney stone cause?

A
  • sudden onet severe colicky pain from loin to groin
  • sever back pain
  • pt writing in pain, pacing
  • possible hematuria
  • afebrile
  • soft abd
  • tender renal angle
92
Q

What would obstructing cancer of descending colon cause?

A
  • older age patient
  • weight loss
  • hindgut visceral colicky pain
  • no flautus or feces
  • distended abd
  • possible mass felt LLQ
  • increased bowel sounds
93
Q

What would rupture of ectopic pregnancy cause?

A
  • woman childbearing age
  • missed LMP
  • sudden onset severe pain hypogastrium radiating to sacral area
  • afebrile
  • localized peritonitis in hypgastric area
  • tenderness on DRE or vaginal examination
94
Q

What would a leaking aortic aneurysm cause?

A
  • elderly male with hx HTN or CAD
  • sudden onset severe back pain
  • pale, shocked, hypotensive
  • tender epigastrium
  • palpable impulse epigastrium
95
Q

Where would gallbladder refer pain to?

A

R side below ribs, around to upper mid back

96
Q

Where would liver refer pain to?

A

R side around back to mid lower flank

97
Q

Where would stomach refer pain to?

A

upper mid back, mid abdomen

98
Q

Where would kidney/ureter refer pain to?

A

lower groin around to mid/lower flank

99
Q

Where would liver, gallbladder, duodenum refer pain to?

A

R shoulder

GIGU (37 decks)

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