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11-13-09 The Autonomic Nervous System of the Abdomen 1.

List the known functions of the sympathetic and parasympathetics for each abdominal organ. First, keep in mind the general functions of sympathetic vs parasympathetic ● Sympatheticfi!ht"f#i!ht for respondin! to emer!encies ● $arasympatheticrest"di!est for rep#enishin! reserves Then, keep in mind the general distribution of sympathetic vs parasympathetic ● Sympatheticsdistributed every%here inc#udin! abdomina# viscera and abdomina# b#ood vesse#s ● $arasympatheticsnot found in body wall structures but do !o to abdomina# and pe#vic viscera and vesse#s &ast#y, keep in mind where they arise ● SympatheticsT1-&' spina# cord se!ments ● $arasympthateticsbrainstem and S'-S( spina# cord se!ments )r!ans )r!ans in the abdomina# %a##* ○ S%eat !#ands ■ Sympathetics stimu#ate s%eat secretion ○ Arrector pi#i ■ Sympathetics contract the musc#e +hairs stand erect, ○ Arteries of the skin ■ Sympathetics cause vasoconstriction ○ Arteries to ske#eta# musc#e ■ Sympathetics cause vasodi#ation ● )r!ans in the in!uina# re!ion ○ -artos musc#e of the scrotum ■ Sympathetics cause contraction ● ./ ○ Sympathetics inhibit smooth musc#e contraction and vasoconstrict arteries in ./ +reduce di!estion, ○ $arasympathetics enhance smooth musc#e contraction and secretion from intestina# !#ands +increase di!estion, ● 0eproduction ○ Sympathetics enhance smooth musc#e contraction in the vas deferens and promotes secretion from the semina# vesic#es and the prostate

2. Discuss the sympathetic and parasympathetic pathways to each abdominal organ. A## ho##o% abdomina# or!ans +./, are #ined by smooth musc#e, and a## so#id abdomina# or!ans +pancreas, #iver, kidneys, sp#een, have b#ood vesse#s that are #ined by smooth musc#e1 2onse3uent#y, a## abdomina# or!ans have autonomic innervation due to the presence of smooth, usua##y from both sympathetic and parasympathetic1 $arasympathetics cause ./ contraction and

!#and secretion +promotin! di!estion,, %hi#e sympathetics inhibit ./ contraction +reducin! !ut moti#ity,1 Sympathetics and parasympathetic fibers conver!e in plexuses and pre-aortic ganglia from the !reater thoracic sp#anchnic nerve +symp"pre and viscersensory pain,, the va!a# trunks +para"pre, viscerosensory ref#e4,, #umbar sp#anchnics +symp"pre, viscerosensory pain,, and pe#vic sp#anchnics +para"pre, viscerosensory ref#e4,1 ● The aortic plexus contains three pre-aortic !an!#ia celiac, superior mesenteric, and inferior mesenteric !an!#ia1 The !an!#ia, p#us the surroundin! mesh%ork, span from the aortic hiatus to the aortic bifurcation1 ○ Symp"pre synapses %ith symp"post ce## bodies in the ce#iac !an!#ion, superior mesenteric !an!#ion, and minute !an!#ia #ocated in the superior hypogastric plexus1 ○ $ara"pre does N)T synapse in the aortic p#e4us but simp#y passes throu!h Sympathetics and parasympathetic fibers course out of the p#e4uses to or!ans by coursing along the arteries to each or!an1 ● Perivascular plexuses surround each of the b#ood vesse#s that supp#y each of the abdomina# viscera1 They de#iver both sympathetics arisin! from T5-&' as %e## as parasympathetics arisin! form the brainstem to fore!ut, mid!ut, and hind!ut1 They contain symp"post, para"pre, viscerosensory pain, and viscerosensory ref#e4 ○ 6ach perivascu#ar p#e4us is named accordin! to the artery it surrounds, i1e1 superior mesenteric p#e4us surrounds the S7A ○ 8ere are the individua# perivascu#ar p#e4uses and the or!ans that they innervate ■ 2e#iac p#e4us esopha!us, stomach, crania# 9 duodenum, pancreas, #iver, !a## b#adder, bi#iary ducts, sp#een, ■ Superior mesenteric p#e4us cauda# 9 duodenum, :e:unum, i#eum, cecum, ascendin! co#on, crania# '"3 transverse co#on ■ /nferior mesenteric p#e4us cauda# 1"3 transverse co#on, descendin! co#on, si!moid co#on, rectum ● Pelvic splanchnic nerves specifica##y de#iver parasympathetics arisin! from S'-S( to hind!ut derivates1 They contain para"pre and viscersensory ref#e41 S;7$AT86T/2 path%ays ● )ri!in Symp"pre ce## bodies that trave# to abdomina# viscera arise on#y from the #atera# horns of !"L2 spina# cord se!ments1 ● The !enera# path%ay for symp"pre ○ Fore!ut and mid!ut ventra# horns of T5-T1'ventra# rootsspina# nerves%hite ramithoracic sympathetic trunk +N) S;NA$S/N.,!reater thoracic sp#anchnic nervesce#iac !an!#ion and superior mesenteric !an!#ion ○ 8ind!ut ventra# horns of T1'-&'ventra# rootsspina# nerves%hite rami#umbar sympathetic trunk +N) S;NA$S/N.,#umbar sp#anchnic nervesinferior mesenteric !an!#ion and superior hypo!astric p#e4us< ■ <note that sympathetics #ocated in the inferior hypo!astric p#e4us are a#so in char!e of innervatin! the vas deferens, seminal vesicles, and prostate

gland1 A## have smooth musc#e that contract durin! the ear#y phase of e:acu#ation in response to sympathetic innervation1 ● -ama!e to the superior hypo!astric p#e4us %i## #ead to absence of e:acu#ation due to vas deferens denervation1 ● For no%, %e don=t have to kno% parasympathetic innervation of repro ● The !enera# path%ay for symp"post there are t%o path%ays dependin! on the #ocation of the or!an*1 ○ Fore!ut and mid!ut derivatives synapsin! at celiac ganglion and superior mesenteric ganglionperivascu#ar p#e4usesor!an ○ 8ind!ut or!ans synapsin! at minute sympathetic !an!#ia in the superior hypogastric plexus and the inferior mesenteric ganglionperivascu#ar p#e4usesor!an $A0AS;7$AT86T/2 path%ays ● )ri!in para"pre ce## bodies have t%o distinct #ocations* ○ Fore!ut and mid!ut or!ans +buccopharyn!ea# membrane-crania# 3"( transverse co#on, have parasympathetic innervation ori!inatin! form the brainstem ○ 8ind!ut or!ans +cauda# 3"( duodenum-crania# 1"' of ana# cana#, have parasympathetic innervation arisin! from #2"#$ ● The !enera# path%ay for para"pre since there are t%o ori!ins, there are t%o path%ays> ○ ?rainstemva!us nerveva!a# trunksce#iac and superior mesenteric !an!#ia +N) S;NA$S/N.,perivascu#ar p#e4uses%a## of fore!ut"mid!ut or!ans +%here synapsin! occurs, ○ @pper re!ion of the ventra# horn in S'-S( spina# cord se!mentsventra# roots of S'-S(spina# nerves of S'-S(ventra# horns of S'-S(pelvic splanchnic nervesinferior hypogastric plexus% +#ocated on the pe#vic basin,perivascu#ar p#e4uses<%a## of hind!ut or!ans +%here synapsin! occurs, ■ <note that para"pre=s do not hook up %ith b#ood vesse#s of the hind!ut unti# they reach the vasa rectae +strai!ht arteries, comin! off of the mar!ina# artery ● The !enera# path%ay for para"post para"post ce## bodies are embedded in the %a## of the ./ tract &. race sympathetic pathways to the abdominal wall. Sympathetic path%ays to the abdominal wall ● 'liohypogastric nerve and 'lioinguinal nerve ○ Symp"pre ce## bodies are #ocated in L1, and the symp"pre a4on courses throu!h&1 ventra# root&1 spina# nerve&1 ventra# ramus%hite ramus&1 sympathetic chain !an!#ionsynapsin!> ○ Symp"post ce## bodies are #ocated in &1 sympathetic chain !an!#ion, %here synapsin! occurssymp"post a4on courses throu!h!ray ramus&1 ventra#

ramusi#iohypo!astric nerve +superior branch, and i#ioin!uina# nerve +inferior branch, ● (enitofemoral nerve ○ 8as simi#ar path%ays as the i#iohypo!astric and i#ioin!uina# nerve, e4cept the symp"pre ce## bodies ori!inate from both the L1 and L2 ce## bodies $. race pain and reflex viscerosensory pathways from abdominal viscera to the )*#. &ike in the thora4, ● viscerosensory pain courses %ith sympathetics and have their ce## bodies in thoracic -0.=s ● viscerosensory ref#e4 courses %ith parasympathetics +from both the brainstem and S'-S( ce## bodes, and have their ce## bodies in the va!a# sensory !an!#ia viscerosensory pain in the conte4t of stomachache> ● $ain path%ay from stomach to CNS stomach %a##ce#iac p#e4usce#iac !an!#ionthroacic sp#anchnic nervessympathetic !an!#ia +in the sympathetic trunk,communicatin! +%hite, ramispina# nervesdorsa# roots-0.s +#ocation of ce## body of this pseudounipo#ar neuron>,dorsa# horn ○ $roduce a du##, poor#y #oca#iAed, !na%in! pain Biscerosensory ref#e4 in the conte4t of vomitin!> ● 0ef#e4 path%ay from stomach to 2NS stomachce#iac p#e4usce#iac !an!#ionva!a# trunksva!a# trunksesopha!ea# p#e4uspu#monary p#e4usva!a# sensory !an!#iabrainstem +ce## bodies in the va!a# sensory !an!#ia, Additiona# notes on viscerosensory pain The ce## bodies for viscerosensory pain to each or!an are #ocated in the -0.s of the same spinal cord segments that contain the symp/pre cell bodies to that organ1 8ence, the ran!e of spina# cord se!ments for viscerosensory pain is the same as that of sympathetics, aka !"L21 -ia!ram on p! 10 demonstrates ho% T5 starts at the upper end of the ./ tract +stomach>,, %hi#e &' can be seen at the end of the ./ tract +si!moid co#on>,1 The rectum has pain supp#ied from -0.s #ocated in S3 and S(, %hich is an e4ception1 Cuestion Dhy does appendicu#ar pain shift to the ri!ht #o%er 3uadrant in advanced sta!es of appendicitisE ?ecause umbi#ica# pain is derived from T10 viscerosensory pain, %hich is a#so the se!menta# pain innervation in the appendi41 ● This is an e4amp#e of referred pain, %here a patient=s pain from abdomina# viscera +or!ans, can be referred to a different part of the body due to Fshort circuitin!G occurrin! at the dorsa# horn #eve# +%here t%o different fie#ds conver!e on the same spina# cord se!ement,1 ● /n other %ords, referred pain is a conse3uence of viscerosensory pain a4ons fo##o%in! the same path%ay as sympathetic a4ons1 +. Discuss the underlying ,*# problems leading to -irschsprung.s Disease.

-irschsprung.s Disease is the con!enita# absence of symp/post in the hindgut, resu#tin! in a #ack of perista#sis in hind!ut derivatives1 2onse3uent#y, a 76.A2)&)N deve#ops +Fsprin! a me!aco#onG, in chi#dren :ust pro4ima# to the hind!ut +i1e1 in the ascendin! and transverse co#ons,1 .enetic cause is be#ieved to be fau#ty mi!ration of neural crest cells, or fau#ty differentiation of neura# crest after mi!ration1 ● Side note neural crest cells !ive rise to A&& parasympathetic and sympathetic post!an!#ionic ce## bodies> Additiona# random notes ● the adrena# medu##a is on#y innervated by symp"PR a4ons1 ● T%o other diseases mentioned ○ Diabetic autonomic neuropathy H0I of chronic diabetics e4perience de#ayed !astric emptyin!, nausea, and vomitin!J mech is disruption of autonomics to smooth musc#e of the upper ./ ○ )hemotherapy"induced constipation vincristine inhibits microtubu#e formation in autonomic nerves, resu#tin! in #oss of perista#sis in ./