Anatomy II - ANS Referred Pain

Gastrointestinal System Sympatheic Division

Inhibited:

Vasoconstriction of blood vessels supplying gut

Inhibits peristalsis and digestion

Gastrointestinal System Parasympatheic Division

Stimulated:

Vasodilation of blood vessels supplying gut

Promotes peristalsis and digestion

T1-L2 spinal cord

Sympathetic Preganglionic neuronal cell bodies

brainstem; S2-S4 spinal cord

Parasympathetic Preganglionic neuronal cell bodies

Vagus Nerve (Cranial Nerve X)

Nerve for Preganglionic parasympathetic axons to Foregut and Midgut

Pelvic Splanchnic Nerves (S2-S4)

Nerve for Preganglionic parasympathetic axons to Hindgut

Acetylcholine

Neurotransmitter for parasympathetic division

Hirschsprung Disease

Failure of migration of neural crest cells, specifically enteric postganglionic parasympathetic progenitors into distal gut wall. Baby presents with constipation and abdominal distension

Pre-aortic Sympathetic Ganglia

Splanchnic nerves

Nerve associated with to pre-aortic sympathetic ganglia

T5-L2

Vertebrae associated with Sympathetic Division

Splanchnic Nerve (T5-L2), Preaortic Sympathetic Ganglia, Arterial Plexus

General pathway of Abdominal Sympathetic division

T5-T9, Greater Splanchnic Nerve, Celiac Ganglion, Celiac Trunk

Foregut pathway of Abdominal Sympathetic division

T10-T11, Lesser Splanchnic Nerve, Superior Mesenteric Ganglion, Superior Mesenteric Artery

Midgut pathway of Abdominal Sympathetic division

T12, Least Splanchnic Nerve, Aorticorenal Ganglion, Renal Arteries

Kidney pathway of Abdominal Sympathetic division

L1-L2, Lumbar Splanchnic Nerves, Inferior Mesenteric Ganglion, Inferior Mesenteric Artery

Hindgut pathway of Abdominal Sympathetic division

Greater Splanchnic Nerve

Early referred pain

dull, diffuse, i.e., difficult to localize exactly; Some part of the body wall (dermatone X)

Secondary visceral pain

precisely localizable, usually severe, lancinating; Inflammation from diseased organ spreads to the immediately adjacent parietal peritoneum, which is innervated by somatic nerves

Opposite of Sympathetic division

Visceral pain Pathway

Murphy's Sign

located at intersection between Costal Margin and Linea Semilunaris; Rebound tenderness at this point; Gallbladder disease

Kehr's Sign

Because the diaphragm is supplied by the Phrenic Nerve (C3-C5), splenic pain may be referred to the left shoulder; Classic indicator of possible splenic rupture

McBurney's Point

roughly one-third of the distance from ASIS to Umbilicus; indicates possible appendicitis

Parasympathetic Division

Micturition Stimulated; Erection (Points)

Sympathetic Division

Micturition Inhibited; secretion from Prostate and Seminal Vesicles ("Shoots")

Lumbar Splanchnic Nerve, Inferior Mesenteric Ganglia, Hypogastric Nerves

1st Path for Sympathetic Division for Urinary/Reproductive System

White Ramus, Sympathetic Ganglion, Sacral Splanchnic Nerves

2nd Path for Sympathetic Division for Urinary/Reproductive System

Preganglionic S2-S4, Pelvic Splanchnic Nerves

Parasympathetic Division for Urinary/Reproductive System

Pelvic Pain Line

Above pelvic pain line

Genitourinary Viscera in contact with Peritoneum

Below pelvic pain line

Subperitoneal parts of Genitourinary Viscera