Abdominopelvic ANS Flashcards

1
Q

What two systems deliver visceroMOTOR activity?

A

SNS
ParaNS

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2
Q

What are the two types of visceroSENSORY activity?

A

Non-pain stimuli
Visceral pain: ischemia, distension, injury

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3
Q

Where do I find SNS PRE-ganglionic cells?

A

Interomediolateral (IML) of T1-L2

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4
Q

How do SNS PRE-ganglionic cells get to the paravertebral ganglia?

A

IML => anterior roots => spinal nerve => WHITE rami communicans => paravertebral ganglia

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5
Q

What options does the SNS PRE-ganglionc cell have once its in the paravertebral ganglion?

A

Synapse and exit
Ascend/descend, synapse, and exit
Exit as SPLANCHNICs without synapsing, synapsing instead with PREvertebral ganglia in the abdominopelvis.

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6
Q

What are the 3 thoracic splanchnic nerves and their origin?

A

Greater = T5-T9 vertebrae
Lesser = T10-T11 vertebrae
Least = T12 vertebrae

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7
Q

Where are the post-synaptic neurons that thoracic splanchnic nerves will synapse with?

A

Prevertebral ganglia

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8
Q

What is the main difference between lumbar and thoracic splanchnic nerves?

A

Lumbar splanchnics don’t bundle up.

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9
Q

Where are the PREvertebral ganglia of the abdomen located?

A

Celiac ganglia (by the celiac trunk)
Superior Mesenteric ganglia (by the superior mesenteric)
Aorticorenal ganglia (by the renal artery leaving the aorta)
Intermesenteric ganglia (Just above the inferior mesenteric artery)
Inferior mesenteric ganglia (by the inferior mesenteric artery)

Note:
All of the prevertebral ganglia are named for the ARTERY they are near.

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10
Q

Where are post-SNS ganglia located in the abdomen?

A

In each of the big PREvertebral ganglia. They then follow the arteries.

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11
Q

What is the pathway of the greater splanchnic nerve?

A

It goes down to the celiac ganglia, synapses, and then sends its POST-ganglionic axons to follow the celiac arteries to the foregut organs.
Forms the celiac plexus.

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12
Q

What is the pathway of the lesser splanchnic nerve?

A

It goes down to the superior mesenteric ganglia, synapses, and then sends it POST-ganglionc axons to follow the superior mesenteric arteries to the midgut organs.
Forms the superior mesenteric plexus.

ALSO

Helps innervate the aorticorenal ganglia with the least splanchnic nerve via following renal arteries.

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13
Q

What innervates the inferior mesenteric ganglion?

A

Lumbar splanchnic nerves. Follows the same pattern as all the other abdomen innervations.
Innervates hindgut organs.

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14
Q

What innervates the superior hypogastric plexus?

A

Lumbar AND sacral splanchnics.

Note:
It usually follows the iliac branches, but sometimes moves down to the inferior hypogastric plexus.

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15
Q

What innervates the inferior hypogastric plexus?

A

SACRAL splanchnic nerves.

Note:
There are TWO, a left and a right inferior hypogastric plexus. Generally goes straight to the pelvic organs, BUT sometimes goes back up to the superior hypogastric plexus.

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16
Q

What carries the PARAsympathetics PRE-ganglionic axons down to the abdomen?

A

Vagus nerve

It forms the Anterior and Posterior vagal trunks, running along down the esophagus.

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17
Q

What does the anterior vagal trunk innervate?

A

Liver and gallbladder

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18
Q

What does the posterior vagal trunk innervate?

A

Goes to all the plexi (celiac, superior mesenteric, aorticorenal, and gonadal)

Note:
They have NOT synapsed yet. They are still pre-ganglionics.

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19
Q

What innervates the hindgut?

A

S2-S4 spinal cord, aka the pelvic splanchnic nerves.

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20
Q

How do the pelvic splanchnic nerves get to the hindgut?

A

They join the inferior hypogastric plexi, go up to the superior hypogastric plexus, and then ascend up to the inferior mesenteric plexus.

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21
Q

What generally innervates the foregut and midgut?

A

Vagus nerve via the anterior and posterior vagal trunks.

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22
Q

What generally innervates the hindgut and pelvis?

A

S2-S4

23
Q

What options do pelvic splanchnic nerves have once they are in the inferior hypogastric plexi?

A

Ascend to inferior mesenteric plexus/gonadal plexus.
Ascend to superior hypogastric plexus and follow the iliac arteries to the pelvis.
Run straight to the pelvis within the inferior hypogastric plexi.

24
Q

Where do the pelvic splanchnics finally synapse at?

A

Organ walls!!!!!!!!!!!!

25
Q

Where can I find all parasympathetic post-ganglionic cell bodies in?

A

Organ walls

Note:
The only exception is the head.

26
Q

What does the subserosal plexus run along?

A

Deep to serosa
Superficial to the longitudinal layer of the muscularis externa.

27
Q

What does the myenteric/Auerbach’s plexus run along?

A

Superficial to the circular layer of the muscularis externa.

28
Q

What does the submucosal/Meissner’s plexus run along?

A

Superficial to the submucosa.

29
Q

What is Hirschsprung’s congenital megacolon? Cause?

A

Hyper-contracted colon, causing the proximal area to become backed up with feces.

Caused by failure of the POST-ganglionic ParaNS ganglia to migrate into the colon.

30
Q

What does the inferior hypogastric plexi split into for a female?

A

Vesical plexus
Uterovaginal plexus
Rectal plexus

31
Q

What does the inferior hypogastric plexi split into for a male?

A

Rectal plexus, which then splits into the vesical and prostatic plexus.

32
Q

In men, what does the ANS do during sex?

A

Parasympathetics cause erection
Sympathetics cause ejaculation

33
Q

In women, what does the ANS do during sex?

A

Parasympathetics cause erection
Sympathetics cause vaginal contraction

34
Q

How does visceral non-pain get back to the brain?

A

Parasympathetics backwards

35
Q

What is the region of the brain that gets visceral non-pain stimuli?

A

Caudal region of the solitary nucleus, the cardiorespiratory center.

36
Q

What is the cardiorespiratory center of the brain next to? Why is it important?

A

Next to the dorsal vagal motor nuclei.
Controls heartbeat, respiration, as well as peristalsis and secretion in the foregut and midgut.

37
Q

What is the pelvic pain line?

A

It is the line made up y the top of the bladder, uterocervical junction, and midpoint of the sigmoid.

38
Q

How does viscerosensory work ABOVE the pelvic pain line?

A

Visceral pain must use sympathetics (lumbar and sacral splanchnics)
Non-pain must use parasympathetics (pelvic splanchnic)

39
Q

How does viscerosensory work BELOW the pelvic pain line?

A

Everything returns via parasympathetics (pelvic splanchnics) to S2-S4.

40
Q

Describe the path of visceral pain stimuli if its coming from the chest.

A

Cardiopulmonary plexus
Cardiopulmonary splanchnics
Thoracic and cervical paravertebral ganglia
White ramus
Spinal nerve
Posterior root
Posterior horn of spinal cord.

41
Q

Describe the path of visceral pain stimuli if its coming from BELOW the pelvic pain line

A

Inferior hypogastric plexi
Pelvic splanchnics (S2-S4)
Anterior rami of S2-S4
Spinal Nerve
Posterior root
Posterior horn of S2-S4

(aka parasympathetics only)

42
Q

What do visceral afferents sometimes do on their way to the spinal cord? What does it result in?

A

Collateral synapsing onto SOMATIC afferents. This causes referred pain!

43
Q

What system is responsible for somatic pain?

A

Anterolateral to the VPL thalamus

44
Q

What is some referred pain for a gallbladder?

A

Right shoulder T5-T9

45
Q

What is some referred pain for the liver and gallbladder?

A

RUQ T5-T9

46
Q

What is some referred pain for the stomach?

A

LUQ (T5-T9

47
Q

What is some referred pain for the pancreas?

A

Epigastric region
Middle back
T5-T11

48
Q

What is some referred pain for the small intestine?

A

Small part of the umbilical region T9-T11

49
Q

What is some referred pain for the large intestine?

A

Inferior half of the umbilical region T8-L2

50
Q

What is the difference between the adrenal cortex and medulla when it comes to innervation?

A

The cortex is normal, receiving the thoracic splanchnics.

The medulla is itself a prevertebral ganglion. Essentially, its postganglioncs have NO axons, so they put epi/NE straight into your suprarenal vein.

51
Q

What is the effect of parasympathetic stimulation of the bladder?

A

Contraction of the detrusor.
Relaxation of the internal urethral sphincter.

52
Q

What is the effect of sympathetic innervation of the bladder?

A

Contraction of the internal urethral sphincter.

53
Q

Is the sphincter urethrae muscle somatic or visceral?

A

Somatic control. It is innervated by branches of the pudendal nerve.