Lymphatics and Autonomics of the Abdomen Flashcards Preview

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Flashcards in Lymphatics and Autonomics of the Abdomen Deck (103):
1

See figure figure 2.90 (very important) in Clinically oriented anatomy.  Pages 301-305 also.

2

What are the two types of abdominal lymphatics?

Parietal and Visceral

3

Parietal lymphatics are composed of a chain of lumbar nodes and their lymphatic channels that ascend the aorta and IVC forming?

Lumbar Trunks

4

What are the afferent trunks that deliver lymph from the lower limb, pelvis, perinum, gluteal area and lower abdominal wall?

External and internal iliac trunks

5

Where do lumbar nodes primarily recieve lymph from?

retroperitoneal structures

(kidneys, ureters, suprarenal glands, lateral and posterior abdominal wall, abdominal surface of the diaphragm, as well as from the testes, ovaries, uterin tubes and superior portion of the uterus)

6

Which lumbar trunk recieves a portion of the lymphatic drainage from the inferior mesenteric trunk?  What else does it often revceive lymph from?

The left.  

Also, the left lumbar trunk receives the intestinal lymphatic trunk 70% of the time.  

7

At what spinal level do the lumbar trunks join?  What do they form in 25% of specimens?

LV1-2

Dilatation - The cisterna Chyli

8

What is the cisterna chyli drained by?

The thoracic duct

9

Visceral lymphatics are composed of a chain of mesenteric and celiac nodes and their lymphatic channels.  Where do they receive lymph from?

The organs of digestion via specific organ lymph nodes and lymphatic channels. 

 

10

Lymphatics draining visceral structures parallel the specific arterial supply of those viscera and therefore drain to nodes named for the three ventral unpaired arteries.  What are they?

celiac

 superior and inferior mesenteric.  

11

 The inferior mesenteric nodes are located at the root of the inferior mesenteric artery.  Where do they recieve lymph from?  Where do they drain to?

Receive from... sigmoid lymph nodes and left colic nodes

  • rectum
  • sigmoid colon
  • descending colon

 

Drain to...

  • Major: superior mesenteric nodes
  • Minor: left lumbar trunk

12

The superior mesenteric nodes are located at the root of the mesentery, where do they recieve lymph from?

Via what nodes?

  • transverse and ascending colon, ileum and jejunum
  • via mesenteric, ileocolic, right colic and middle colic nodes as well as lymph from the inferior mesenteric nodes.

13

Where do the superior mesenteric nodes drain to?

Major: celiac nodes

Minor: Intesitnal trunk

14

The celiac nodes are clustered at the root of the celiac trunk.  Where do they recieve lymphatic channels from?

Via what nodes?

  • liver, stomach, pancreas and spleen
  • via hepatic, gastric and pancreaticosplenic nodes as well as lymph from the superior mesenteric nodes

15

Where do celiac nodes drain to? 

Intestinal lymph trunk

16

The intestinal lymph trunk is formed by efferent lymphatic channels of the celiac nodes joined by the minor drainage of the superior mesenteric nodes.

Where does it drain to?

Either the...

cisterna chyli (30%)

left lumbar trunk (70%)

17

Where does cancer of the organs of digestion spread to?

(4 steps)

  1. celiac nodes
  2. cisterna chyli
  3. thoracic duct
  4. venous system

18

Abdominal sympathetic innervation originates in thoracic and lumbar segments of the spinal cord and travels to collateral (pre-aortic) ganglia via what nerves?

 thoracic and  abdominal (lumbar), splanchnic nerves.

19

Abdominal parasympathetic innervation originates in the brainstem (dorsal motor nucleus of the vagus) and in spinal cord segments ______________, and travels to submucosal and myenteric ganglia via what nerves?

S2,3,4 

the vagus (submucosal ganglia and pelvic splanchnic nerves (myenteric ganglia)

20

What impact do the SNS and PNS have on the following?

  1. sphincters
  2. vasomotor tone
  3. glandular secretion

SNS

  1. Constricts sphincters
  2. increases vasomotor tone
  3. decreases glandular secretion

PNS

  1. Relaxes sphincters
  2. decreases vasomotor tone
  3. increases glandular secretion
  4. (also, increases peristalsis)

21

What do PNS afferents respond to?  Contribute to? 

  • register hunger, nausea and distension
  •  contribute to visceral reflexes

22

How do PNS afferents return to the CNS?  

  1. Vagus nerve
  2. pelvic splanchnic nerves to sacral nerves and drg of S2,3,4

23

What do SNS afferents register in the abdomen?  

acute pain from viscera and mesenteries

24

How do SNS afferents reach the CNS?

  1. Splanchnic nerves
  2. spinal nerves
  3. drg at TV1-LV2(3)

25

The thoracic sympathetic trunk continues into the abdomen by passing beneath the?

 medial arcuate ligament.

26

Lying superficial to the medial border of the psoas, the thoracic sympathetic trunk hugs the lateral surface of the vertebral bodies becoming more __________as it descends.

ventral

27

How many ganglia are in the lumbar region?

variable; 2-6

28

What levels doe the lumbar sympathetic trunk receive white rami communicantes from?

L1,2 and sometimes 3 (4 in some illustrations)

29

The greater splanchnic originates from what cord levels?  Where does it go from there?

T5-T9

to celiac & superior mesenteric ganglia

30

What cord levels does the lesser splanchnic n. arise from?

Where does it go?

T10-T11

aorticorenal & superior mesenteric ganglia

31

What cord levels does the least splanchnic n. arise from?

Where does it go?

T12

renal plexus & inferior mesenteric ganglion

32

What cord levels does the lumbar splanchnic nerve arise from?  Where does it go?

L1,2,(3)

inferior mesenteric ganglion, renal, intermesenteric and hypogastric plexuses

33

renal plexus & inferior mesenteric ganglion recieve sympathetic innervation from?

The least splanchnic n. (T12)

34

celiac & superior mesenteric ganglia recieve sympathetic innervation from?

Greater splanchnic n. (T5-T9)

35

aorticorenal & superior mesenteric ganglia receive sympathetic innervation from?

Lesser splanchnic n. (T10 - T11)

36

Where do the inferior mesenteric ganglion, renal, intermesenteric and hypogastric plexuses recieve sympathetic innervation from?

Lumbar splanchnic n.n. (L1, 2, (3))

37

Where do the lumbar splanchic nerves synapse?

scattered ganglia cells located diffusely within the renal, superior and inferior mesenteric plexuses.

38

Where does the lumbar splanchnic n. specifically not synapse?

The inferior mesenteric ganglion

39

What is the major provider of sympathetic innervation to the pelvic structures?

Lumbar splanchnic nn.

40

Sacral splanchnic nn. (L1 ‑ L2) ‑ descend in the sympathetic chain to synapse in the pelvic portion of the chain ganglia before joining the _________________ of the pelvis or pass directly into the ___________________ to synapse on scattered ganglia cells located there.

inferior hypogastric plexus

hypogastric plexus

41

Autonomic fibers cover the anterior and lateral surfaces of the aorta forming an intricate abdominal aortic autonomic plexus divisible into what subsidiary plexuses?

(4)

  1. Celiac
  2. Intermesenteric
  3. superior hypogastric
  4. inferior hypogastric

42

Where is the celiac plexus found (from-to)?

from - root of celiac artery

to - superior mesenteric artery

43

Where it the intermesenteric plexus found?

Between aortic origins of the superior and inferior mesenteric arteries

44

Where is the superior hypogastric plexus found?

From- root of inferior mesenteric artery to the sacrum below the aortic bifurcation (anterior to LV4-SV1)

45

What fibers can the abdominal autonomic plexuses contain?

(4)

  1. preganglionic sympathetic fibers (from splanchnic nn.)
  2. postganglionic sympathetic fibers (from associated ganglia)
  3. preganglionic parasypmathetic fibers (vagus and pelvic splanchnic nn.)
  4. sympathetic prevertebral ganglia

 

46

What do the sympathetic prevertebral ganglia contain (celiac, aorticorenal, superior and inferior mesenteric ganglia)?

postganglionic sympathetic cell bodies

47

From the abdominal aortic autonomic plexus' subsidiaries postganglionic sympathetic and preganglionic para-sympathetic fibers travel to the derivatives of the foregut, midgut and hindgut via subsidiary plexuses located on the surface of arterial blood vessels, i.e..  What are these secondary subsidiaries?

(8)

  1. celiac plexus
  2. left gastric plexus
  3. splenic plexus
  4. hepatic plexus
  5. superior mesenteric
  6. inferior mesenteric
  7. renal
  8. hypogastric

48

Preganglionic parasympathetic fibers of the vagus nerve distribute with the sympathetic elements of the ___________, ____________, __________plexuses along arterial blood vessels to their terminal destinations (components of the gut from the stomach to the distal 2/3 of the transverse colon and accessory organs of digestion – liver, gallbladder, pancreas).

celiac, aorticorenal, and superior mesenteric 

49

Where does the distribution of preganglionic parasympathetic fibers (Vagal) end?  Meaning they are not found in the?

  • Distribution ends at superior mesenteric plexus
  • not found in the intermesenteric plexus

50

Distal to the distal 1/3 of the transverse colon the preganglionic fibers originate from the parasympathetic I.M.L.C.C. of the sacral spinal cord at levels?

 

These preganglionic fibers are termed?  and merge with?

S 2, 3, 4.

pelvic splanchnic nerves

Inferior hypogastric plexuses of the pelvis

51

PNS Fibers destined to innervate the distal 1/3 of the transverse colon, descending and sigmoid colon, ascend from the pelvis exclusive of the hypogastric nerves, travel parallel to the rectum, sigmoid and descending colon within the attachments of the _____________ and distribute among the ____________.

sigmoid mesocolon

perivascular plexuses found there.

52

Postganglionic parasympathetic innervation is provided to target organs via what ganglia?

Two examples are?

Parasympathetic ganglia locaterd in the walls of the organs

 (i.e. Submucosal and myenteric ganglia)

53

Innervation of hte thoracic esophagus is accomplished by nerves of the thorax... What is the upper 1/3 innervated by?

vagus nerve

recurrent laryngeal nn. (skeletal muscle innervation)

54

What is the sympathetic innervation to the lower 2/3 of the esophagus?

(2 components)

  1. branches of the sympathetic trunk directly via cardiac and pulmonary plexi
  2. greater splanchnic n. (T5-T9)

55

What is the impact of sympathetic innervation on the esophaguse with regard to...

  1. peristalsis
  2. glandular secretion
  3. vasomotor tone

  1. decrease
  2. decrease
  3. increase

56

What is the impact of parasympathetic innervation on the esophaguse with regard to...

  1. peristalsis
  2. glandular secretion

  1. increase
  2. increase

57

What is the parasympathetic innervation to the esophagus?

Vagal esophageal plexus

58

What are the origins of the sympathetic innervation of abdominal esophagus, stomach, proximal duodenum and dorsal pancreas?

(supracolic compartment)

Where do they synapse?

spinal cord levels T6 - T9; synapse in celiac ganglion

59

What does the posterior vagal trunk join in the supracolic compartment?

celiac plexus

60

What does the anterior vagal trunk join in the supracolic compartment?

(4)

  1. hepatic plexus
  2. stomach
  3. duodenum
  4. dorsal pancrease

61

Postganglionic sympathetic fibers from the celiac ganglion along with preganglionic vagal fibers distribute via what plexuses?

(4)

  1. celiac
  2.  left gastric
  3.  splenic
  4.  hepatic plexus

62

Where do the preganglionic sympathetic fibers from the greater splanchnic n. synapse in the supracolic compartment?

Postganglionic cell bodies in the celiac ganglion at the base of the celiac trunk

63

What are the five over all effects of sympathetic innervation on the abdominal esophagus, stomach, proximal duodenum and dorsal pancreas?

(5)

(1) Decrease peristalsis

                              (2) Closes pyloric sphincter

                              (3) Decrease glandular secretion

                              (4) Increase vasomotor tone

                              (5) Afferents for acute pain 

64

What is the origin of the parasympathetics for the abdominal esophagus, stomach, proximal duodenum and dorsal pancreas?

anterior and posterior vagal trunks

65

What is the overall parasympathetic effect on the abdominal esophagus, stomach, proximal duodenum and dorsal pancreas?

(1) Increases peristalsis; relaxes pyloric sphincter

2) Increases HCl secretion (stomach); increases elaboration of pancreatic enzymes 

(3)      Afferents for distension 

 

66

How is the secretion of pancreatic enzymes controlled?

hormonally

67

What are the sympathetic origins of the innervation to the Liver, gallbladder & extra-hepatic biliary tree, hepatopancreatic ampulla?

spinal cord levels T6-T9

68

After synapsing in the celiac ganglion where do the sympathetics destined for the Liver, gallbladder & extra-hepatic biliary tree, hepatopancreatic ampulla go next?

Distribute to organs via the hepatic plexus

69

What impact do sympathetics have on the Liver, gallbladder & extra-hepatic biliary tree, hepatopancreatic ampulla?  Where do the afferents for acute pain refer to?

Increase vasomotor tone

refer to central epigastrium

70

What is the parasympathetic origin for the hepatic plexus?

Anterior vagal trunk

71

What effect does the PNS have on the gallbladder?

  1. Contraction of gallbladder and extra-hepatic biliary tree smooth muscle. 
  2. Relaxation of the hepatopancreatic sphincter

(secondary effects, primary effects are hormonal)

72

The spleens sympathetic origins derive from T6-T8, synapse in the celiac ganglion and distribute via what plexus?

The splenic plexus

(conveniently named)

73

What are the sympathetic effects on the spleen?

Vasomotor and contractile to smooth muscle of capsule (Increase?  Not sure)

74

GVA's from the parenchyma of the spleen are ill defined, they refer to the...

central epigastrium

75

Referred pain from distended splenic capsule and stretched peritoneal ligamentous attachments is to where?

Posterior left upper quadrant

76

What impact does the parasympathetic ns have on the spleen?

Impact not described

77

What are the midgut derivatives of the infracolic compartment?

Described in the notes as infracolic compartment I

distal ½ of duodenum

 ventral pancreas

 jejunum

 ileum

cecum & appendix

 ascending colon

 proximal 2/3 of transverse colon 

78

The Preganglionic sympathetic fibers reach the infracolic compartment I from spinal cord levels T8 - T11 via greater, lesser, synapse on postganglionic cell bodies in the what ganglia?

Greater: celiac ganglia

Lesser: superior mesenteric ganglia

79

Postganglionic fibers from the celiac and superior mesenteric ganglia along with preganglionic vagal fibers (post. Vagal trunk) distribute to the distal ½ of the duodenum, ventral pancreas, jejunum, ileum, cecum, appendix, ascending and proximal 2/3 of the transverse colon via what plexus?

The superior mesenteric plexus located on the superior mesenteric artery and its branches.

80

What are the sympathetic effects on the Infracolic compartment I? 

(distal ½ of duodenum, ventral pancreas, jejunum, ileum, cecum & appendix, ascending colon, proximal 2/3 of transverse colon (midgut derivatives))

(3)

 

1)  Decrease peristalsis

2)  Increase vasomotor tone

3)  Decrease glandular secretion

81

Where do the afferents for acute pain in the infracolic compartment I refer to?  How about from the appendix?

T8-T11

Appendix: Specifically to the umbilicus (T10)

82

What are the parasympathetic effects on the infracolic compartment I?

(3)

  1. Increase glandular secretion
  2.  elaboration of pancreatic enzymes
  3. Increase peristalsis
     

83

What do the parasympathetic vagal afferents in the infracolic compartment I sense?

Distension (cramping)

84

Where do the preganglionic sympathetic fibers for the Infracolic compartment II: distal 1/3 of the transverse colon, descending colon & sigmoid colon (hind gut derivatives) arise from?  Where do they synapse?

 

T12-L2(3)

Postganglionic cell bodies in the inferior mesenteric ganglion

85

Where do the preganglionic parasympathetic fibers for the Infracolic compartment II: distal 1/3 of the transverse colon, descending colon & sigmoid colon (hind gut derivatives) arise from?

What do they ascend from the pelvis with?

 

S2,3,4

sigmoid mesentery

86

How do the postganglionic fibers from the inferior mesenteric ganglion alond with the pelvis splanchnic nn distribute to the Infracolic compartment II?

Via the inferior mesenteric plexus on the inferior mesenteric artery and it's branches

87

As usual, the sympathetic effects on the infracolic compartment II include...

1)  Decrease peristalsis

2)  Increase vasomotor tone

3)  Decrease glandular secretion

Where do the afferents for pain refer to?

T12- L2,3

88

What are the parasympathetic effects on infracolic compartment II?  sigh...

(2)

  1. Increase peristalsis
  2. Increase glandular secretion

89

What is the origin of the preganglionic sympathetic fibers going to the Infracolic compartment III: rectum, anal canal proximal to pectinate line (hindgut derivatives)?  

Where do these synapse?

What do the postganglionic fibers descend into the pelvis with to enter the inferior hypogastric and rectal plexuses?

  • Lumbar splanchnic nerves L1,2,(3)
  • inferior mesenteric ganglion or intermesenteric/superior hypogastric plexus
  • hypogastgric nerve

90

Sacral splanchnic nn. (L1-2) descend within the sympathetic chain and exit within the pelvis to join the ___________ where they will synapse in scattered ganglial cells located there.

 inferior hypogastric plexus 

91

How do pelvic splanchnic nerves enter the inferior hypogastric plexus?

Directly

92

Where do the afferents for acute pain and distension from the distal sigmoid and anal canal above the pectinate line return to?

Spinal cord levels S2,3,4

93

Describe the innervation of the anal canal distal to the pectinate line.

By what nerve(s) is it accomplished?

Somatic innervation only

 Accomplished by branches of inferior rectal n:

  •    Branch of the pudendal n. (S 2,3,4)

94

What does Hirschprungs Disease (Aganglionic/Toxic Megacolon)  result in?

Results in a constricted segment of the colon (acting as a sphincter due to chronic tonic contraction of visceral smooth muscle) which will not relax causing the fecal mass to build up proximal to the obstruction.

95

What is Hirschprings disease due to?

Failure of neural crest cells to colonize a portion of the gut, usually distal colon and rectum, resulting in lack of development of submucosal and intramural autonomic ganglia. 

96

Viscera are segmentally innervated by branches of spinal nerves that correlate to the dermatomes. Recall:  Afferent fibers for pain travel with the sympathetic visceral motor system. Therefore, dermatomes which are implicated in referred pain syndromes are limited to what levels?

T1 - L2(3)

97

What sensations do afferent (sensory) tract neurons conduct?

Both cutaneous and visceral sensations (usually at different times)

98

Normally, stimulation of visceral afferent fibers is?

Subthreshold (stimulation not percieved)

99

visceral efferent and visceral afferent fibers to specific viscera or portions of viscera originate from?.

identical spinal levels

100

Visceral afferent fibers entering the spinal cord synapse not only on ascending tract neurons, but also on interneurons that synapse on cells of the IMLCC and ventral horn.  What does this cause?

IF this is coupled with referred pain as the same level or levels of entry, what occurs?

  • These interneurons therefore stimulate contraction of vascular smooth muscle (preganglionic sympathetic stimulation) as well as contraction of paraspinal musculature (ventral motor horn cell stimulation).
  • Viscerosomatic reflex

101

Define viscerosomatic reflex.  What are the three things commonly associated with this?

 visceral afferent stimulation resulting in somatic responses:

  1. change in the character of the connective tissue due to reduced vascular flow
  2.  tightness due to increased muscular contraction
  3. referred pain

102

What is the osteopathic term for the conglomeration of effects that leads to a viscerosomatic reflex?

What is the significance of this?

  • Facilitated Segment
  • areas of somatic dysfunction, those that display the effects of viscerosomatic reflexes, can lead to the identification and localization of visceral disease. 

103

What can specific osteopathic manipulation applied to facilitated segments do?  How does it do this?

  • can help to ‘tone’ down the effects of visceral afferents stimulated by the underlying disease process.

  • through stimulation of somatic afferent fibers and spinal interneurons