innervation of the gi tract - university of utah gi n pelvis.ppt.pdf · innervation of the gi tract...
TRANSCRIPT
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Innervation of the GI TractInnervation of the GI Tract
•• Sympathetic innervation (T5-L2)Sympathetic innervation (T5-L2)
•• Paravertebral gangliaParavertebral ganglia
•• Prevertebral gangliaPrevertebral ganglia
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Sympathetic AutonomicsSympathetic Autonomics
Unit II, p22Unit II, p22
ParavertebralParavertebral
PrevertebralPrevertebral
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Innervation of the GI TractInnervation of the GI Tract
•• Sympathetic innervationSympathetic innervation
•• Paravertebral gangliaParavertebral ganglia
•• Prevertebral gangliaPrevertebral ganglia
•• Celiac gangliaCeliac ganglia
•• Superior mesenteric gangliaSuperior mesenteric ganglia
•• Aorticorenal gangliaAorticorenal ganglia
•• Inferior mesenteric gangliaInferior mesenteric ganglia
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Innervation of the GI TractInnervation of the GI Tract
•• Parasympathetic innervationParasympathetic innervation
•• Vagus nerves (CN X)Vagus nerves (CN X)
•• Mouth to the sigmoid colonMouth to the sigmoid colon
•• Vagus means the wandererVagus means the wanderer
•• Sacral plexus (pelvic splanchnicSacral plexus (pelvic splanchnic
nerves, S2-S4)nerves, S2-S4)
•• Sigmoid colon to the rectumSigmoid colon to the rectum
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Innervation of the GI TractInnervation of the GI Tract
Unit II, p23Unit II, p23
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ComparisonComparison
Unit II, p24Unit II, p24
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Enteric InnervationEnteric Innervation
Unit II, p25Unit II, p25
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Referred Pain from AbdominalReferred Pain from Abdominal
VisceraViscera
•• Pain is perceived as originating inPain is perceived as originating in
areas supplied by the somaticareas supplied by the somatic
nerves because the autonomicnerves because the autonomic
afferent fibers enter the spinal cordafferent fibers enter the spinal cord
at the same spinal segment as theat the same spinal segment as the
sensory nerves from the bodysensory nerves from the body
wall/limbswall/limbs
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Referred Pain from AbdominalReferred Pain from Abdominal
VisceraViscera
•• Visceral pain is dull and diffuseVisceral pain is dull and diffuse
•• Somatic pain is sharp and focusedSomatic pain is sharp and focused
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Organ Spinal CordSegment
Referred Pain Site(s)
Stomach T6-T9 Epigastric and left hypochondriacregions
Duodenum T5-T9, T10 Epigastric region (right shoulder if ulcerperforates)
Pancreatic head T8-T9 Inferior part of epigastric region
Spleen T6-T8 Left hypochondriac region
Gallbladder and liver T6-T9 Epigastric region, right hypochondriacregion, posterior thoracic wall, rightshoulder
Jejunum and ileum T5-T9 Periumbilical region
Proximal colon T10-T12 Hypogastric region
Distal colon L1-L3 Left lower quadrant
Kidneys and ureters T11-T12 Lower back, flank, extending to groin
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Pain Fields
(From Moore and Dalley, p 233, 1999)
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DermatomesDermatomes
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PelvisPelvis
PelvisPelvisTrueTrue
FalseFalse
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Bony PelvisBony Pelvis
•• 3 fused bones (os coxae)3 fused bones (os coxae)
•• Ilium (NOT ileum)Ilium (NOT ileum)
•• Ischium (is-kIschium (is-k --um)um)
•• PubisPubis
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Bony PelvisBony Pelvis
•• 3 fused bones (os coxae)3 fused bones (os coxae)
•• Ilium (NOT ileum)Ilium (NOT ileum)
•• Ischium (is-kIschium (is-k --um)um)
•• PubisPubis
•• Other partsOther parts•• AcetabulumAcetabulum•• RamiRami•• Pubic (Superior and inferior)Pubic (Superior and inferior)•• IschialIschial
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Bony PelvisBony Pelvis
Ilium
Pubis
Ischium
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Bony Pelvis
Ilium
Pubis
Ischium
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Pelvic AnatomyPelvic AnatomyAnterior ViewAnterior View Superior ViewSuperior View
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Anterior View
Ala of the ilium
Pubis
Ischium
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Notches and ForaminaNotches and Foramina
•• Greater sciatic notch/foramenGreater sciatic notch/foramen
•• Lesser sciatic notch/foramenLesser sciatic notch/foramen
NotchesNotches
GreaterGreatersciaticsciatic
foramenforamen
LesserLessersciaticsciatic
foramenforamen
ForaminaForamina
GreaterGreatersciaticsciaticnotchnotch
LesserLessersciaticsciaticnotchnotch
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Sciatic ForaminaSciatic Foramina
Sacro-Sacro-
spinousspinous
ligamentligament
Sacro-Sacro-
tuberoustuberous
ligamentligament
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PosteriorView
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Sacrospinousligament
PosteriorView
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Sacrospinousligament
Sacrotuberous ligament
PosteriorView
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Pelvic Inlet MeasurementsPelvic Inlet Measurements- OB/GYN -- OB/GYN -
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Sex Differences in the PelvisSex Differences in the Pelvis
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FemaleFemaleMaleMale
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MaleMale FemaleFemale
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Pelvic MusclesPelvic Muscles
•• Lateral (wall) musclesLateral (wall) muscles
•• PiriformisPiriformis
•• Obturator internusObturator internus
•• Floor muscles (Floor muscles (““pelvic diaphragmpelvic diaphragm””))
•• 2 muscles2 muscles
•• Levator ani (has 3 parts)Levator ani (has 3 parts)
•• ““CoccygeusCoccygeus”” (ischiococcygeus) (ischiococcygeus)
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Levator Ani MuscleLevator Ani Muscle- 3 Parts -- 3 Parts -
•• Puborectalis (Puborectalis (““rectal slingrectal sling””))
•• PubococcygeusPubococcygeus
•• IliococcygeusIliococcygeus
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Pelvic Muscles
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Pelvic DiaphragmPelvic Diaphragm
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Arteries in the Pelvis
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Arteries in the PelvisArteries in the Pelvis
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Anterior Division AA VVVessel Male Female
Umbilical
Superior vesical X X
Obturator X X
Inferior vesical X
Artery to the ductus deferens X
Prostatic X
Uterine X
Vaginal X
Internal pudendal X X
Middle rectal X X
Inferior gluteal X X
Syllabus G09B.69Syllabus G09B.69
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Pelvic Vasculature
Syllabus G09B.67Syllabus G09B.67
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Pelvic Vasculature
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Nerves in the PelvisNerves in the Pelvis
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