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

Lecture 4 - Visceral pain and Pelvis Flashcards

1
Q

What is the enteric NS?

A

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

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2
Q

How is the ENS arranged?

A

In ganglionated plexuses with interconnecting bundles of unmyelinated nerve fibres

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3
Q

What does the ENS allow the GIT to do?

A

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

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4
Q

How does the CNS communicate with the ENS?

A

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

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5
Q

Where do axons of intrinsic neurones of ENS project to?

A

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

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6
Q

What is the general plan of the GIT? FITB

A
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7
Q

Where is the ENS distributed?

A

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

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8
Q

Where does the ANS innervate?

A

It has 2 divisions which innervate organs of abdomen and pelvis

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9
Q

Where does the ANS arise from?

A

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

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10
Q

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

A

Motor to smooth muscle and secretomotor to glands

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11
Q

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

A

Sympathetic: pain Parasympathetic: specific functional sensation (stretch)

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12
Q

What are the sympathetic nerves to the abdomen? FITB

A
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13
Q

At what spinal level does the greater splanchnic nerve emerge?

A

T5-9

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14
Q

At what spinal level does the Lesser splanchnic nerve emerge?

A

T10-11

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15
Q

At what spinal level does the least splanchnic nerve emerge?

A

T12

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16
Q

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

A

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

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17
Q

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

A

Sympathetic nerves run with somatic nerves to the same region

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18
Q

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

A

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

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19
Q

What is a nerve plexus?

A

Interconnecting network of nerves

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20
Q

How are the autonomic nerves to the abdomen routed?

A

Via plexuses surrounding the aorta and its branches

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21
Q

Where do the sympathetic nerves synapse?

A

At the ganglia associated with these plexuses

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22
Q

How are plexuses and ganglia named?

A

According to associated blood vessels

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23
Q

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

A

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

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24
Q

Where are the 9 important plexuses/ganglia located? FITB

A
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25
Q

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

A
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26
Q

Why is referred pain caused?

A

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

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27
Q

Where is the pain from visceral organs referred to?

A

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

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28
Q

What is a dermatome?

A

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

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29
Q

How do dermatomes prevent complete anaesthesia in a region?

A

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

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30
Q

What does the dermatomal map of the body look like?

A
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31
Q

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

A
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32
Q

In which of the 9 regions is the appendix?

A

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

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33
Q

What pain is referred to the epigastric region?

A

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

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34
Q

What are the dermatomes of the abdominal wall?

A
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35
Q

What pain is referred to the umbilical region?

A

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

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36
Q

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

A

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

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37
Q

How does the pain in appendicitis progress?

A

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

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38
Q

What structures refer pain to the suprapubic region?

A

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

39
Q

Fill in the blanks of the visceral referred pain map

A
40
Q

Fill in the blanks of the pelvic girdle structures

A
41
Q

Fill in the structures of the right hip bone

A
42
Q

What are the main structures of the pelvic wall?

A

Sacrum and coccyx, pelvic bones and sacrospinous and sacrotuberous ligaments

43
Q

Fill in the structures of the right hip bone and sacrum

A
44
Q

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

A

45 degrees further backwards from the abdominal cavity

45
Q

Where is the pelvic inlet and outlet located?

A
46
Q

What does the iliac fossae form?

A

Shallow basin containing lower abdominal viscera

47
Q

How is the axis of the pelvic cavity inclined?

A

Anteroinferiorly

48
Q

What shape is the pelvic cavity?

A

Conical or cylindrical

49
Q

What lines the pelvic cavity?

A

Muscles and nerves

50
Q

Fill in the blanks of the pelvic wall structures

A
51
Q

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

A

Obturator internus muscle and its fascia

52
Q

Fill in the blanks of the pelvic wall muscles and ligaments

A
53
Q

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

A

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

54
Q

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

A
55
Q

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

A

Iliococcygeus, pubococcygeus, puborectalis

56
Q

What is the tendinous arch formed from?

A

Obturator internus fascia

57
Q

What does the pelvic diaphragm consist of?

A

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

58
Q

What is the function of the levator ani?

A

Support the main pelvic organs

59
Q

What are the pelvic organs?

A

Bladder, cervix/uterus and rectum

60
Q

What is the nerve supply to the pelvic diaphragm?

A

Pudendal S2-4 and directly by S4

61
Q

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

A
62
Q

Fill in the blanks of the pelvic diaphragm inferior view

A

x

63
Q

What are the openings in the levator ani muscle for?

A

Urethra, vagina (female) and anal canal

64
Q

What is the perineal membrane?

A

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

65
Q

What is underneath the pelvic diaphragm?

A

Perineum which contains voluntary sphincters and external genitalia

66
Q

Where is the urinary apparatus located?

A

Lower part is located in the pelvic cavity

67
Q

Fill in the blanks of the male pelvis in sagittal section

A
68
Q

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

A
69
Q

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

A

Ischio-anal fossa

70
Q

Fill in the blanks of the urethral sphincters in males

A
71
Q

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

A

Internal: Smooth External: skeletal

72
Q

Fill in the blanks of the female pelvis

A
73
Q

How are the internal urethral sphincter in the female organised?

A

The internal sphincter isn’t well organised

74
Q

What are the urethral sphincters present in the female?

A

Internal/external urethral sphincter, sphincter urethrovaginalis and compressor urethrae

75
Q

What is the external urethral sphincter made of?

A

Skeletal muscle surrounding the urethra in the deep perineal pouch

76
Q

Fill in the blanks of the urethral sphincters in the female

A
77
Q

What is the shape of the bladder?

A

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

78
Q

Fill in the blanks of the urinary bladder

A
79
Q

What structures enter at each corner?

A

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

80
Q

What covers the superior surface of the bladder?

A

Peritoneum

81
Q

Where does the bladder expand to?

A

Between transversalis fascia and lining peritoneum

82
Q

Where is the location of the 2 sphincters?

A

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

83
Q

What is the shape of the rectum?

A

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

84
Q

Fill in the blanks of the rectum

A
85
Q

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

A

By autonomic NS and mainly sensitive to filling

86
Q

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

A

By somatic nerves and extremely sensitive to injury

87
Q

Which muscles are important for faecal continence?

A

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
Q

How can the puborectalis be injured?

A

In a badly performed episiotomy

89
Q

How does the rectum become the anal canal?

A

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

90
Q

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

A

Smooth muscle - internal and skeletal muscle - external

91
Q

What is the main functional sphincter?

A

Pubo-rectalis sling of levator ani

92
Q

What type of nerves supply the rectum and anal canal?

A

Rectum -> visceral Anal canal -> somatic

93
Q

What artery supplies the pelvic organs?

A

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

94
Q

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

A

LSS 2 - Abdomen, Alimentary and Urinary systems (29 decks)

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