Lecture 4 - Visceral pain and Pelvis Flashcards Preview

LSS 2 - Abdomen, Alimentary and Urinary systems > Lecture 4 - Visceral pain and Pelvis > Flashcards

Flashcards in Lecture 4 - Visceral pain and Pelvis Deck (94):
1

What is the enteric NS?

'Brain of the gut', consisting of more than 100m intrinsic neurones that extend most of the GIT

2

How is the ENS arranged?

In ganglionated plexuses with interconnecting bundles of unmyelinated nerve fibres

3

What does the ENS allow the GIT to do?

Perform basic reflex functions of secretion, absorption, mixing and gut movements without the influence of CNS or ANS

4

How does the CNS communicate with the ENS?

Via para/sympathetic nerves with intrinsic neurones of ENS to bring about modulation GIT functions

5

Where do axons of intrinsic neurones of ENS project to?

Sympathetic ganglia, pancreas, gall bladder, trachea, spinal cord and brain stem

6

What is the general plan of the GIT? FITB

7

Where is the ENS distributed?

Intrinsic network of neurones is in the tissues of the gut wall from oesophagus to anus

8

Where does the ANS innervate?

It has 2 divisions which innervate organs of abdomen and pelvis

9

Where does the ANS arise from?

Different anatomical regions of CNS -> sympathetic arising from spinal cord segments T1-L2 and the parasympathetic system arising from cranial nerves III, VII, IX and X and spinal cord segments S2-4

10

What is the function of the efferent autonomic nerves in the abdomen?

Motor to smooth muscle and secretomotor to glands

11

What is the function of the afferent autonomic nerves in the abdomen?

Sympathetic: pain Parasympathetic: specific functional sensation (stretch)

12

What are the sympathetic nerves to the abdomen? FITB

13

At what spinal level does the greater splanchnic nerve emerge?

T5-9

14

At what spinal level does the Lesser splanchnic nerve emerge?

T10-11

15

At what spinal level does the least splanchnic nerve emerge?

T12

16

Where does the parasympathetic supply come from in the organs of the abdomen and pelvis?

Vagus nerve (CNX) and sacral outflow (S2-4)

17

How are the sympathetic autonomic nerves to peripheral vessels and skin distributed?

Sympathetic nerves run with somatic nerves to the same region

18

How are the autonomic nerves to organs lacking somatic innervation distributed?

Most nerves run with arteries to same organs, with few cases where autonomic nerves run seperately

19

What is a nerve plexus?

Interconnecting network of nerves

20

How are the autonomic nerves to the abdomen routed?

Via plexuses surrounding the aorta and its branches

21

Where do the sympathetic nerves synapse?

At the ganglia associated with these plexuses

22

How are plexuses and ganglia named?

According to associated blood vessels

23

What are the 9 main plexuses/ganglia in the abdomen?

Anterior vagal trunk, superior mesenteric ganglion, coeliac trunk and ganglion, renal plexus and ganglion, inferior mesenteric ganglion, sympathetic trunk and ganglion, superior hypogastric plexus and inferior hypogastric plexus

24

Where are the 9 important plexuses/ganglia located? FITB

25

Which nerve plexuses and ganglia surround the aorta and where do they innervate?

26

Why is referred pain caused?

The cerebral cortex of the brain hasn't got a sensory map for visceral organs and diaphragm, so can't localise the pain from these, hence the pain is referred

27

Where is the pain from visceral organs referred to?

Regions of skin supplied by nerves with the same segmental supply (dermatomes)

28

What is a dermatome?

An area of skin supplied by a single spinal nerve (i.e. single segment of the spinal cord)

29

How do dermatomes prevent complete anaesthesia in a region?

Adjacent dermatomes overlap so that on the trunk at least 3 spinal nerves would have to be blocked to produce a region of complete anaesthesia

30

What does the dermatomal map of the body look like?

31

What are the 9 abdominal regions and how are they formed (which lines)?

32

In which of the 9 regions is the appendix?

Top right of the suprapubic region, nearly part of right inguinal region (main)

33

What pain is referred to the epigastric region?

T7/8 - pain from foregut structures -> including stomach, proximal duodenum, pancreas, liver, gall bladder

34

What are the dermatomes of the abdominal wall?

35

What pain is referred to the umbilical region?

From midgut structures (duodenal papilla to splenic flexure) including inflamed appendix referred to periumbilical region -> usually colicky

36

Where do the afferent pain fibres from the midgut enter the spinal cord?

Afferent pain fibres from midgut enters spinal cord at T10 and skin of umbilical region is also supplied by T10

37

How does the pain in appendicitis progress?

Inflammation of appendix spreads to surrounding peritoneum, becoming localised and constant at right inguinal region -> movement of hip joint, coughing eliciting pain

38

What structures refer pain to the suprapubic region?

Pain from hindgut structures (descending colon to anal canal) -> T12/L1-2)

39

Fill in the blanks of the visceral referred pain map

40

Fill in the blanks of the pelvic girdle structures

41

Fill in the structures of the right hip bone

42

What are the main structures of the pelvic wall?

Sacrum and coccyx, pelvic bones and sacrospinous and sacrotuberous ligaments

43

Fill in the structures of the right hip bone and sacrum

44

What is the difference in the axis of the pelvic and abdominal cavity?

45 degrees further backwards from the abdominal cavity

45

Where is the pelvic inlet and outlet located?

46

What does the iliac fossae form?

Shallow basin containing lower abdominal viscera

47

How is the axis of the pelvic cavity inclined?

Anteroinferiorly

48

What shape is the pelvic cavity?

Conical or cylindrical

49

What lines the pelvic cavity?

Muscles and nerves

50

Fill in the blanks of the pelvic wall structures

51

What covers most of the pelvic bone facing the pelvic cavity?

Obturator internus muscle and its fascia

52

Fill in the blanks of the pelvic wall muscles and ligaments

53

What are the names of the ligaments and muscles in the pelvic wall?

Piriformis muscle, obturator internus muscle, sacrospinous ligament and sacrotuberous ligament

54

Fill in the muscles forming the pelvic diaphragm in a medial aspect

55

What muscles does the levator ani muscle consist of - from the pelvic diaphragm muscles?

Iliococcygeus, pubococcygeus, puborectalis

56

What is the tendinous arch formed from?

Obturator internus fascia

57

What does the pelvic diaphragm consist of?

Bowl-like pair of skeletal muscles -> levator ani which are slung from the pelvis and sacrum

58

What is the function of the levator ani?

Support the main pelvic organs

59

What are the pelvic organs?

Bladder, cervix/uterus and rectum

60

What is the nerve supply to the pelvic diaphragm?

Pudendal S2-4 and directly by S4

61

Fill in the blanks of the pelvic diaphragm in a sagittal plane

62

Fill in the blanks of the pelvic diaphragm inferior view

x

63

What are the openings in the levator ani muscle for?

Urethra, vagina (female) and anal canal

64

What is the perineal membrane?

Inferior layer of the fascia of the urogenital part of the pelvic diaphragm

65

What is underneath the pelvic diaphragm?

Perineum which contains voluntary sphincters and external genitalia

66

Where is the urinary apparatus located?

Lower part is located in the pelvic cavity

67

Fill in the blanks of the male pelvis in sagittal section

68

Fill in the blanks of the male pelvis in a coronal section

69

What is the fat filled space in the male pelvis called?

Ischio-anal fossa

70

Fill in the blanks of the urethral sphincters in males

71

What kind of muscle makes up the internal and eternal urethral sphincter?

Internal: Smooth External: skeletal

72

Fill in the blanks of the female pelvis

73

How are the internal urethral sphincter in the female organised?

The internal sphincter isn't well organised

74

What are the urethral sphincters present in the female?

Internal/external urethral sphincter, sphincter urethrovaginalis and compressor urethrae

75

What is the external urethral sphincter made of?

Skeletal muscle surrounding the urethra in the deep perineal pouch

76

Fill in the blanks of the urethral sphincters in the female

77

What is the shape of the bladder?

Tetrahedral (when empty), with a structure at each corner of the tetrahedron

78

Fill in the blanks of the urinary bladder

79

What structures enter at each corner?

Ureters at supero-posterior angles. Urethra leaves through inferior angle

80

What covers the superior surface of the bladder?

Peritoneum

81

Where does the bladder expand to?

Between transversalis fascia and lining peritoneum

82

Where is the location of the 2 sphincters?

Smooth muscle (vesicae) sphincter at neck and skeletal muscle (urethrae) sphincter in perineum

83

What is the shape of the rectum?

Double-S bend -> probably acting as an anti-gravity device keeping the load off the sphicter

84

Fill in the blanks of the rectum

85

What is the rectum innervated with and what is it mainly sensitive to?

By autonomic NS and mainly sensitive to filling

86

What is the anal canal innervated with and what is it mainly sensitive to?

By somatic nerves and extremely sensitive to injury

87

Which muscles are important for faecal continence?

Sphincter ani is less important (surrounds anal canal) and puborectalis part of levator ani, which puts a sharp angle into the recto-anal junction

88

How can the puborectalis be injured?

In a badly performed episiotomy

89

How does the rectum become the anal canal?

Rectum descends within the concavity of sacrum, showing 3 lateral curvatures, with right angle bend back at recto-anal junction

90

What types of muscles form the external and internal sphincters of the rectum?

Smooth muscle - internal and skeletal muscle - external

91

What is the main functional sphincter?

Pubo-rectalis sling of levator ani

92

What type of nerves supply the rectum and anal canal?

Rectum -> visceral Anal canal -> somatic

93

What artery supplies the pelvic organs?

Internal iliac artery supplies pelvic organs (all but the ovaries), pelvic walls and much of the gluteal region

94

Fill in the blanks of the arterial supply of the pelvic organs