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Flashcards in Renal Nervous Anatomy Deck (54):
1

What are the 3 Normal Motor Functions of the Renal System?

1. Ureteric Peristalsis
2. Bladder Contraction
3. Urethral Sphincter Control (internal and external urethral sphincters)

2

List areas from which sensory renal pain can arise

Kidneys
Ureters
Bladder
Urethra
Testis (not technically a part of the Renal System)

3

What is Urinary Continence?

The Voluntary Control of the elimination of Urine from the Bladder

4

What do the Nerves of the Lumbar and Sacral Plexus supply?

Perineum (distal part of the renal system) and the Lower Limbs

5

What are the 5 Modalities of the Nerve Fibres?

Somatic Sensory
Visceral Afferent
Somatic Motor
Parasympathetic
Sympathetic

6

What is Somatic Sensory?

When Sensations from the Body Wall (i.e. The External Environment) are conveyed to the CNS

7

What is Visceral Afferent?

When Sensations from the Visceral Organs (i.e. The Internal Environment) are conveyed to the CNS

8

What is Somatic Motor?

When Motor Responses to our Body Wall (i.e. The External Environment) are conveyed from the CNS to stimulate Skeletal Muscle Contractions

9

What are the Sympathetics and Parasympathetics?

Motor Responses to the Organs Visceral Organs (i.e. The Internal Environment) are conveyed from the CNS to stimulate Smooth Muscle, Cardiac Muscle and Glands

10

What Nerve Modality controls Ureteric Peristalsis and Bladder Contraction?

Sympathetics and Parasympathetics

11

What Nerve Modality controls the Urethral Sphincter?

Somatic Motor to the External Urethral Sphincter and Levator Ani

12

What Nerve Modality results in Sensory Renal Pain?

Visceral Afferent

N.B. Perineal Urethral Pain is driven by Somatic Sensory
Testes also have some Somatic Sensory presentation too.

13

What Nerve Modality controls the Voluntary Elimination of Urine from the Bladder?

COMBINATION

Somatic Motor
Visceral Afferent
Sympathetics and Parasympathetics

14

Which Nerve Modalities is involved in the Lumbar and Sacral Plexuses?

Somatic Sensory
Somatic Motor

15

How can Nerves communicate with the CNS?

For ANY type of Nerve Fibre to be able communicate with the CNS, it needs to be carried WITHIN the Cranial/Spinal Nerves.

The Distance a Type of Nerve Fibre is carried within a Cranial/Spinal Nerve Fibre will differ.

16

Which Nerve Fibres are carried the Entire Length of the Cranial/Spinal Nerves?

Somatic Motor
Somatic Sensory

Carried from Origin to Destination

17

Which Nerve Fibres use the Cranial/Spinal Nerve Fibres for Limited Portions to get in and out of the CNS?

Sympathetics and Parasympathetics
Visceral Afferents

18

What is the ONLY Point at which the Sympathetic Nerve Fibres leave the CNS?

T1-L2 Vertebral Levels
(a.k.a. Thoracolumbar Outflow)

19

Through which nerves do Sympathetic Fibres reach the Smooth Muscle/Glands of the Body Wall?

Spinal Nerves

N.B. NOT the case for the Smooth Muscle or Glands of the Head!

20

Through which nerves do Sympathetic Fibres reach the Smooth Muscle/Glands of the Body?

Splanchnic Nerves
(Cardiopulmonary or Abdominopelvic)

21

How do Sympathetic Fibres reach the Smooth Muscle/Glands of the Head?

By hitching a ride on the Arteries that supply the same structures

22

How Do Sympathetic Nerve Fibres get from the CNS to the Kidneys, Ureters & Bladder?

Leave the Spinal Cord between Levels T10 - L2

Enter the Sympathetic Chain bilaterally but do NOT Synapse

Then leave the Sympathetic Chain via the Abdominopelvic Splanchnic Nerves

Synapse at the Abdominal Sympathetic Ganglia located around the AA

Postsynaptic Sympathetic Nerves pass from Ganglia towards the Periarterial Plexus to supply the Kidneys, Ureters & Bladder

23

How do the Parasympathetic Nerve Fibres leave the CNS?

Only within the 4 Cranial Nerves (III, VII, IX and X) and the Sacral Spinal Nerves

(a.k.a. Craniosacral Outflow)

24

Do Parasympathetic Fibres innervate the smooth muscle/glands of the body wall?

NO.

25

How do the Parasympathetic Fibres reach the smooth muscle/glands of the head and body?

Via the Cranial Nerves

26

More specifically, how do the Parasympathetic Fibres reach the smooth muscle/glands of the hindgut and pelvic organs

Via the Pelvic Splanchnic Nerves

27

How Do Parasympathetic Nerve Fibres get from the CNS to the Kidneys, Ureters & Bladder?

Parasympathetic Nerve Fibres which innervate the Kidneys & Ureter are carried within CN X

Parasympathetic Nerve Fibres which innervate the Bladder are carried within the Pelvic Splanchnic Nerves

28

From which Spinal Nerves do the Pelvic Splanchnic Nerves arise?

Spinal Nerves S2, S3 and S4

29

What Nerve Modalities are contained within the Sacral Plexus?

Sympathetic and Parasympathetic
Visceral Afferent

30

How Do Somatic Motor Nerve Fibres get from the CNS to the Kidneys, Ureters & Bladder?

Trick Question!

Somatic Motor Fibres only go to Body WALL Structures.

Somatic Motor only supplies structures within the Perineum i.e. Perineal Urethra, External Urethral Sphincter and Levator Ani

31

Where is Pain from the Kidney itself usually felt?

In the Loin i.e. Posterior Aspect of the Flank Region, on the Affected Side

32

Where is Pain from the Bladder usually felt?

Midline of the Suprapubic Region

33

Where is Pain from the Perineal Urethra usually felt?

Quite localised in the Perineum

34

What is Characteristic of the Pain from an Obstructing Calculus?

Radiating Pain from the Loin to Groin on the Affected Side

35

How Do Visceral Afferent Nerve Fibres get from the Kidneys to the CNS?

Visceral Afferents from the kidneys run alongside the Sympathetic Fibres back to the Spinal Cord, entering it between the T11 - L1 Levels

Therefore, the patient feels Renal Pain in these Dermatomes, Posteriorly (i.e. the “Loin”)

36

What is the Differential Diagnosis of Loin Pain?

Muscular (Most Common)
Vertebral
Spinal Nerve Root Compression
Lower Lobe Pneumonia
Skin e.g. Herpes Zoster

37

How Do Visceral Afferent Nerve Fibres get from the Ureters to the CNS?

Visceral Afferents from the Ureters run alongside the Sympathetic Fibres back to the Spinal Cord, entering between Levels T11 - L2

Pain from these structures tends to be perceived by the Patient anywhere along this path

38

What is the Differential Diagnoses for Groin Pain?

Femoral/Inguinal Hernias
Lymphadenopathy
Testicular Pathology

39

How Do Visceral Afferent Nerve Fibres get from the Bladder to the CNS?

Visceral Afferents carrying Pain from the Superior Part of the Bladder run alongside the Sympathetic Fibres back to the Spinal Cord,
entering between levels T11 – L2.
Pain is perceived by the Patient as Suprapubic Midline Pain.

Visceral Afferent Fibres from the rest of the Bladder run alongside the Parasympathetic Fibres back to Spinal Cord Levels S2,S3, S4

40

What is the Differential Diagnoses for Suprapubic Pain?

Hindgut Organs e.g. Sigmoid Diverticula

Other Single, Midline Pelvic Organs whose Superior Aspect touches the Peritoneum, e.g. Uterus

41

How Do Visceral Afferent Nerve Fibres get from the Urethra to the CNS?

visceral afferents from the proximal urethra (i.e. above the levator Ani and in the Pelvis) run alongside the Parasympathetic Nerve fibres back to Spinal Cords Levels S2,S3,S4

42

How Do Somatic Sensory Nerve Fibres get from the Urethra to the CNS?

Somatic Sensory Nerve Fibres from the Remaining Urethra are carried within the Pudendal Nerve, back to Spinal Cord Levels S2,S3,S4.

43

What is the Differential Diagnoses of Perineal Pain?

Vaginal Tears
Anal Canal Fissures
Perineal Genital Ulcer e.g. Herpes

44

How Do Pain Fibres get from the Testis to the CNS?

due to its embryological descent, visceral afferents run alongside sympathetic fibres back to the spinal cord to levels T10-11
however, due to its close relationship to the scrotal wall (body wall), pain from the testis can also present localised to the scrotum and/or groin (L1 region)

45

What is the Differential Diagnoses of Scrotal Pain?

Skin Lesions
Strangulated Inguinal Hernia

46

How would Patients describe Pain from the Kidneys?

Dull, Achy type Pain in the Loin

47

How would Patients describe Pain from the Ureters?

If Obstruction is present, the classic is Radiation from the Loin to the Groin

48

How would Patients describe Pain from the Bladder?

Dull, Achy Suprapubic Pain

49

How would Patients describe Pain from the Urethra?

If originating in the Perineal Urethra, pain is Relatively Sharp and Localised

50

How would Patients describe Pain from the Testes?

Pain often felt in the Scrotum which can radiate to the Groin and Anterior Lower Abdomen or can present in 1 of the Latter 2 WITHOUT Radiation

51

What are the Nerves involved in Controlling Urine Flow?

Nerves that enter and leave the Spinal Cord at Levels S2-S4

Pelvic Splanchnic Nerves
Pudendal Nerve
Visceral Afferent Fibres

52

What happens to the Urinating Reflex in Potty Trained Children and Adults?

Reflex is Overridden as Action Potentials within Inhibitory nerve Fibres pass the Cortex inferiorly and inhibit this reflex.

Also, there is Voluntary Contraction of the EUS and Levator Ani Muscles

Reflex inhibition stops when urination is appropriate

53

What happens in Urination after Inhibition of the Reflex occurs?

Co-ordinated parasympathetic contraction of the Detrusor muscle

Somatic motor relaxation of the EUS and Levator Ani Muscles

Somatic Motor Contraction of the Anterior Abdominal Wall

54

What is the Origin of the Sciatic Nerve?

Sacral Plexus from Nerve Roots L4-S3