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Questions and Answers
Which type of fibers are responsible for carrying stretch and pain information from the pelvic viscera to the spinal cord?
Which type of fibers are responsible for carrying stretch and pain information from the pelvic viscera to the spinal cord?
- Efferent somatic fibers
- Afferent somatic fibers
- Afferent visceral fibers (correct)
- Efferent sympathetic fibers
What is the primary function of autonomic efferent fibers in the pelvic viscera?
What is the primary function of autonomic efferent fibers in the pelvic viscera?
- Modulate reflexes for defecation and micturition (correct)
- Assist in voluntary muscle control
- Regulate nutrient absorption
- Transmit pain signals to the brain
Which of the following structures is NOT typically innervated by visceral efferent autonomic fibers?
Which of the following structures is NOT typically innervated by visceral efferent autonomic fibers?
- Reproductive organs
- Skeletal muscles (correct)
- Bladder
- Rectum
In terms of clinical application, why is knowledge of referred pain areas important?
In terms of clinical application, why is knowledge of referred pain areas important?
Which plexuses are involved in conveying autonomic fibers to the pelvic viscera?
Which plexuses are involved in conveying autonomic fibers to the pelvic viscera?
Which component is primarily responsible for initiating the micturition reflex?
Which component is primarily responsible for initiating the micturition reflex?
What role do visceral afferent fibers play in the pelvic region?
What role do visceral afferent fibers play in the pelvic region?
How does Vesicare act in the treatment of Overactive Bladder (OAB)?
How does Vesicare act in the treatment of Overactive Bladder (OAB)?
What role does Flomax play in managing Benign Prostatic Hypertrophy (BPH)?
What role does Flomax play in managing Benign Prostatic Hypertrophy (BPH)?
Which of the following mechanisms prevents defecation until circumstances allow?
Which of the following mechanisms prevents defecation until circumstances allow?
What initiates the activation of visceral afferent mechanoreceptors in the rectum?
What initiates the activation of visceral afferent mechanoreceptors in the rectum?
What is the function of somatic efferent fibers carried by the pudendal nerve during the defecation reflex?
What is the function of somatic efferent fibers carried by the pudendal nerve during the defecation reflex?
What structures do the sympathetic nerves innervate in the male reproductive system?
What structures do the sympathetic nerves innervate in the male reproductive system?
Which route do the preganglionic SANS fibers take when they travel through the sympathetic trunk?
Which route do the preganglionic SANS fibers take when they travel through the sympathetic trunk?
What type of fibers synapse in the gonadal ganglia?
What type of fibers synapse in the gonadal ganglia?
What is the function of the inferior hypogastric plexus?
What is the function of the inferior hypogastric plexus?
Where do most preganglionic SANS fibers destined for pelvic organs mainly synapse?
Where do most preganglionic SANS fibers destined for pelvic organs mainly synapse?
Which nerve route do the preganglionic SANS fibers take to reach the inferior hypogastric plexus from the aortic plexus?
Which nerve route do the preganglionic SANS fibers take to reach the inferior hypogastric plexus from the aortic plexus?
What is the primary role of the sympathetic trunk in the autonomic nervous system?
What is the primary role of the sympathetic trunk in the autonomic nervous system?
What pathway is involved for the sympathetic innervation of the bladder?
What pathway is involved for the sympathetic innervation of the bladder?
When do the preganglionic SANS fibers destined for the gonads synapse?
When do the preganglionic SANS fibers destined for the gonads synapse?
At what age do children typically master volitional control of micturition?
At what age do children typically master volitional control of micturition?
Which condition describes involuntary urination that can occur at night?
Which condition describes involuntary urination that can occur at night?
What describes the inability to void urine in certain settings, often associated with anxiety?
What describes the inability to void urine in certain settings, often associated with anxiety?
What type of urinary incontinence occurs due to excessive involuntary muscle contractions?
What type of urinary incontinence occurs due to excessive involuntary muscle contractions?
Which condition is associated with the narrowing of the urethra due to an enlarged prostate?
Which condition is associated with the narrowing of the urethra due to an enlarged prostate?
What type of incontinence is a result of neural circuitry dysregulation?
What type of incontinence is a result of neural circuitry dysregulation?
What mechanism can trigger urination in response to strong emotions?
What mechanism can trigger urination in response to strong emotions?
What is the main problem associated with detrusor-sphincter dysynergia?
What is the main problem associated with detrusor-sphincter dysynergia?
Which condition is caused by a narrowing or blockage of the urethra?
Which condition is caused by a narrowing or blockage of the urethra?
What is the effect of urinary tract infections (UTIs) on the bladder?
What is the effect of urinary tract infections (UTIs) on the bladder?
Which spinal levels do the preganglionic PANS fibers originate from?
Which spinal levels do the preganglionic PANS fibers originate from?
What is the function of pelvic splanchnic nerves?
What is the function of pelvic splanchnic nerves?
How can pelvic splanchnics be distinguished from sacral splanchnics?
How can pelvic splanchnics be distinguished from sacral splanchnics?
What is a key role of surgeons in relation to autonomic pathways during surgery?
What is a key role of surgeons in relation to autonomic pathways during surgery?
Which plexus is involved in pelvic organ innervation for both males and females?
Which plexus is involved in pelvic organ innervation for both males and females?
What type of sensory information is conveyed by visceral afferents in pelvic plexuses?
What type of sensory information is conveyed by visceral afferents in pelvic plexuses?
What are cavernous nerves responsible for innervating?
What are cavernous nerves responsible for innervating?
What is a significant consideration for anesthesiologists regarding pelvic organ nerve pathways?
What is a significant consideration for anesthesiologists regarding pelvic organ nerve pathways?
Which plexuses are formed by PANS and SANS fibers in the pelvic region?
Which plexuses are formed by PANS and SANS fibers in the pelvic region?
What is conveyed via the pudendal nerve in relation to pelvic sensory innervation?
What is conveyed via the pudendal nerve in relation to pelvic sensory innervation?
Flashcards
Pelvic Visceral Efferent Fibers
Pelvic Visceral Efferent Fibers
Autonomic nerve fibers that control the function of pelvic organs, including the bladder, rectum, and reproductive organs.
Pelvic Visceral Afferent Fibers
Pelvic Visceral Afferent Fibers
These sensory fibers transmit information about stretch and pain from the pelvic organs to the spinal cord.
Autonomic Innervation of Pelvic Viscera
Autonomic Innervation of Pelvic Viscera
Nerves control involuntary functions like bladder control (micturition), bowel movements (defecation), and sexual function.
Gross Anatomical Organization of Pelvic Visceral Nerves
Gross Anatomical Organization of Pelvic Visceral Nerves
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Sympathetic Innervation of Pelvic Viscera
Sympathetic Innervation of Pelvic Viscera
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Parasympathetic Innervation of Pelvic Viscera
Parasympathetic Innervation of Pelvic Viscera
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Pelvic Subsidiary Plexuses
Pelvic Subsidiary Plexuses
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Pelvic Autonomic Nerves
Pelvic Autonomic Nerves
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Sacral Splanchnic Nerves
Sacral Splanchnic Nerves
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Pelvic Splanchnic Nerves
Pelvic Splanchnic Nerves
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Inferior Hypogastric (Pelvic) Plexus
Inferior Hypogastric (Pelvic) Plexus
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Vesical Plexus
Vesical Plexus
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Rectal Plexus
Rectal Plexus
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Uterovaginal Plexus
Uterovaginal Plexus
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Prostatic Plexus
Prostatic Plexus
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Pelvic Visceral Afferents
Pelvic Visceral Afferents
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Sympathetic Innervation of the Pelvis
Sympathetic Innervation of the Pelvis
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Origin of Sympathetic Fibers
Origin of Sympathetic Fibers
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Sympathetic Fiber Pathways
Sympathetic Fiber Pathways
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Aortic Plexus Route
Aortic Plexus Route
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Synapse in Inferior Hypogastric Plexus
Synapse in Inferior Hypogastric Plexus
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Sympathetic Trunk Route
Sympathetic Trunk Route
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Sacral Splanchnic Nerve Connection
Sacral Splanchnic Nerve Connection
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Gonadal Route
Gonadal Route
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Inferior Hypogastric Plexus (Pelvic Plexus)
Inferior Hypogastric Plexus (Pelvic Plexus)
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Mass Movement
Mass Movement
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Visceral Afferent Mechanoreceptors in Rectum
Visceral Afferent Mechanoreceptors in Rectum
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Visceral Efferent SANS Fibers in Hypogastric Nerves
Visceral Efferent SANS Fibers in Hypogastric Nerves
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Somatic Efferent Fibers in Pudendal Nerve
Somatic Efferent Fibers in Pudendal Nerve
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Defecation Reflex
Defecation Reflex
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Enuresis
Enuresis
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Paruresis (Shy Bladder)
Paruresis (Shy Bladder)
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Urinary Tract Infections (UTIs)
Urinary Tract Infections (UTIs)
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Urinary Incontinence
Urinary Incontinence
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Stress Incontinence
Stress Incontinence
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Urge Incontinence
Urge Incontinence
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Overflow Incontinence
Overflow Incontinence
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Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH)
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Neurogenic Incontinence
Neurogenic Incontinence
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Detrusor-Sphincter Dysynergia
Detrusor-Sphincter Dysynergia
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Study Notes
Autonomic Innervation of Pelvic Viscera
- Summarize pelvic visceral efferent and afferent nerve fibers
- Summarize the autonomic functional effects on pelvic viscera
- Describe the gross anatomical organization of the pelvic visceral nerves
- Explain sympathetic innervation of the pelvic viscera
- Explain parasympathetic innervation of the pelvic viscera
- Describe afferents from the pelvic viscera
- Describe pelvic subsidiary plexuses
Micturition Reflex
- Describe the circuitry of the micturition reflex
- Apply anatomical knowledge to discuss clinical problems affecting micturition
Defecation Reflex
- Describe the circuitry of the defecation reflex
- Apply anatomical knowledge to discuss clinical problems affecting defecation
Erection/Ejaculation Reflex
- Describe the circuitry of the erection/ejaculation reflex
- Apply anatomical knowledge to discuss clinical problems affecting erection/ejaculation
Innervation of the Pelvic Viscera
- Pelvic visceral efferent fibers innervate pelvic organs (rectum, bladder, reproductive organs) for reflexes (defecation, micturition, reproduction)
- Visceral afferent fibers carry stretch and pain information to the spinal cord via the same nerve plexuses carrying autonomic fibers—this helps in localizing pelvic pathology
- Parasympathetic (PANS) fibers for pelvic organs originate from spinal levels S2-S4 and travel in pelvic splanchnic nerves
- Sympathetic (SANS) fibers for pelvic organs originate from spinal levels T10-L2 and travel in thoracic, lumbar, and sacral splanchnic nerves
Autonomic Effects
- Parasympathetic (PANS): vasodilation, contract bladder detrusor muscle, stimulate erectile tissues, increased colorectal peristalsis, relax internal urethral and anal sphincters
- Sympathetic (SANS): vasoconstriction, contract internal urethral and anal sphincters, promotes sperm movement
Gross Anatomical Organization
- Sacral plexus sits on posterior wall of pelvic cavity, with ventral rami emerging from anterior sacral foramina
- Pudendal nerve emerges and is critical for bladder, rectal, and reproductive reflexes
- Sympathetic trunk also descends into the pelvic cavity, with 4 sacral ganglia converging at ganglion impar (pubococcygeus muscle area)
Sympathetic Innervation
- Preganglionic SANS axons from T10-L2 synapse in either aortic plexus (then inferior hypogastric plexus) or directly in sacral sympathetic ganglia
- Aortic Plexus Route: travels through thoracic and lumbar splanchnic nerves, through superior hypogastric plexus, then utilizes left/right hypogastric nerves to reach the inferior hypogastric plexus, then synapse in ganglia within the inferior hypogastric plexus
- Sympathetic Trunk Route: descends via sympathetic trunk to sacral sympathetic ganglia, then as sacral splanchnic nerves synapse with preganglionic fibers in the inferior hypogastric plexus
- Gonadal Route: SANS fibers synapse in gonadal ganglia positioned around the abdominal aorta and along the vessels supplying the gonads
Parasympathetic Innervation
- Preganglionic PANS axons originate from S2-S4 spinal levels and travel via ventral rami of S2-S4 spinal nerves entering the pelvic cavity
- Pelvic splanchnic nerves join the inferior hypogastric plexus and synapse in terminal PANS ganglia in pelvic viscera
Pelvic Subsidiary Plexuses
- Rectal plexus
- Vesical plexus
- Uterovaginal plexus
- Prostatic plexus
Afferents
- Somatic afferents conveying touch and pain sensations from external genitalia travel through the pudendal nerve to S2-S4 spinal cord
- Visceral afferents conveying stretch and pain from pelvic organs travel through the same plexuses carrying visceral efferent autonomic nerves
- Pelvic pain line refers to visceral pain that travels superiorly to contact the peritoneum vs. subperitoneal pelvic cavity
Micturition (Bladder control)
- Filling: Stretch receptors in the bladder wall are quiet, but become active when walls are stretched
- Micturition Centers: S2-S4 spinal cord; brainstem (pons) centers
- Reflex Mechanism: PANS stimulation of the bladder's detrusor muscle relaxes the external urethral sphincter.
- Control Mechanisms: SANS (T10-L2) maintains contraction of the internal urethral sphincter; SE pudendal nerve maintains contraction of the external urethral sphincter..
Defecation
- Stimulation: Stretch receptors in the rectum become active with fecal mass movement
- Control: Visceral efferent SANS fibers maintain internal anal sphincter tone; somatic efferent fibers maintain external anal sphincter tone
- Reflex Mechanism: Sufficient rectal volume triggers PANS stimulation of colon, relaxation of the internal anal sphincter, and contraction of the external anal sphincter.
Erection/Ejaculation
- Erection: PANS-mediated; spinal levels S2-S4; pelvic splanchnic and cavernous nerves stimulate NO release, vasodilation, and blood engorgement. Venous return decreases due to tunica albuginea expansion
- Ejaculation: SANS-mediated, T11-L2; contraction of internal urethral sphincter, movement of fluid from vas deferens, prostate, and seminal vesicle. Relaxation of external urethral sphincter, contraction of muscles involved in semen expulsion.
Clinical Problems
- Urinary Incontinence: Stress, urge, overflow, neurogenic
- Constipation: Normal transit, slow transit
- Defecation Disorders: Impaired pelvic floor/anal sphincter function
- Erectile Dysfunction
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Description
Test your knowledge on the autonomic nervous system and its role in the pelvic viscera. This quiz covers topics such as fiber types, functions, innervation, referred pain, and reflex actions. Assess your understanding of important concepts related to pelvic anatomy and physiology.
