Anatomy - Referred pain Flashcards Preview

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Flashcards in Anatomy - Referred pain Deck (29)
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1
Q

Describe the arrangement of the enteric nervous system

A
  • Ganglionic plexuses with interconnecting bundles of unmyelinated nerve fibres
  • Project to sympathetic ganglia, the pancreas, gall bladder, trachea, spinal cord and brain stem
  • From the oesophagus to the anus following the gut wall
2
Q

What is the function of the enteric nervous system?

A
  • Allows the GI tract to perform its basic reflex functions of secretion, absorption, mixing and gut movements without influence of the CNS
  • CNS can modify GI tract functions by communicating with the ENS
3
Q

Compare the function of the myenteric plexus and the submucosal plexus

A
  • Submucosal plexus causes the muscularis mucosae to contract (making folds in the stomach for example)
  • Myenteric plexus causes peristalsis/ segmentation via the longitudinal and circular muscle
4
Q

What are the functions of the autonomic efferent nerves in the abdomen?

A
  • Motor to smooth muscle

- Secretomotor to glands

5
Q

What are the functions of the autonomic afferent nerves in the abdomen?

A
  • Sympathetic responds to pain

- Parasympathetic response to functional sensation, such as stretch

6
Q

Where does the greater splanchnic nerve arise adn where does it go?

A
  • T5-9

- Celiac ganglion

7
Q

Where does the lesser splanchnic nerve arise, and where does it go?

A
  • T10-11

- Aorticorenal ganglion

8
Q

Where does the least splanchnic nerve arise and where does it go?

A
  • T12

- Renal pelvis

9
Q

What are the two types of splanchnic nerves?

A
  • Thoracic, lumbar and sacral nerves from sympathetic trunk to ganglia in the prevertebral plexus
  • Pelvic splanchnic nerves are parasympathetic (S2-4) from prevertebral plexus (directly from S2-S4) to pelvis
10
Q

How many lumbar splanchnic nerves are there?

A

Two to four, pass from the lumbar part of the sympathetic trunk to the prevertebral plexus

11
Q

What is innervated by the pelvic splanchnic nerves?

A
  • Fibres pass upward to enter the abdominal prevertebral plexus and distribute with the arteries supplying the hindgut
  • Provides the pathway for innervation of the distal 1/3rd of the transverse colon, descending colon and sigmoid colon
12
Q

What are the three main abdominal prevertebral plexus divisions?

A
  • Present in the abdominal prevertebral plexus, scattered through the length of the abdominal prevertebral plexus
  • Celiac plexus
  • Aortic plexus
  • Superior hypogastric plexus
13
Q

Describe the position and ganglia of the celiac plexus

A
  • Associated with roots of the celiac trunk and the superior mesenteric artery.
  • Two celiac ganglia
  • A superior mesenteric ganglia
  • Two aorticorenal ganglia
14
Q

Describe the position and ganglia of the aortic plexus

A
  • Just below the superior mesenteric artery

- Major ganglion is the inferior mesenteric ganglion

15
Q

Describe the position and ganglia of the superior hypogastric plexus

A
  • Numerous small ganglia

- Final part of the prevertebral plexus

16
Q

What does the abdominal prevertebral plexus receive?

A
  • Preganglionic parasympathetic and visceral afferent fibers from the vagus nerves [X]
  • Preganglionic sympathetic and visceral afferent fibers from the thoracic and lumbar splanchnic nerves
  • Preganglionic parasympathetic fibers from the pelvic splanchnic nerves.
17
Q

What do the vagus nerves innervate in the abdomen?

A
  • Foregut and midgut

- Anterior (left) and posterior (right) vagal trunks

18
Q

How do sympathetic nerves in the abdomen run?

A
  • With somatic nerves of the same region

- To organs they run with the arteries to the same organ

19
Q

Why does referred pain occur?

A
  • The cerebral cortex has no sensory map for visceral organs and the diaphragm
  • Brain cannot localise sensation, so the pain is reffered to the skin supplied by nerves with the same segmental supply (dermatomes)
20
Q

Which spinal level has no dermatome?

A

C1

21
Q

Pain from which organs cause pain in the epigastric region?

A
  • Foregut structures
  • Stomach
  • Proximal duodenum
  • Pancreas
  • Liver
  • Gall bladder
22
Q

Pain from which organs cause pain in the umbilical region?

A
  • Pain from midgut structures

- Appendix causes a colicky pain (intermittent with bowel contractions)

23
Q

Describe the progression of pain in appendicitis

A

Pain becomes localized and constant at the right inguinal region when inflammation of the appendix spreads to surrounding peritoneum

24
Q

Pain from which organs cause pain in the suprapubic region?

A
  • Hidgut organs

- Descending colon to anal canal

25
Q

What nerves supply the epigastric region?

A

T7/8

26
Q

What nerves supply the umbilical region?

A

T10

27
Q

What nerves supply the inguinal region?

A

T12/L1

28
Q

What nerves supply the suprapubic region?

A

T12/L1-2

29
Q

List the pre-aortic lymph nodes

A
  • Celiac nodes (by the celiac trunk, drains the abdominal foregut as well as recieving lymph from superior/inferior mesenteric nodes to drain into the cisterna chyli)
  • Superior mesenteric nodes (recieves from inferior drains into celiac, main function to drain the midgut)
  • Inferior mesenteric nodes (drains the hind gut)