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Download G10B: GI Innervation/Pelvis Osteo
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Innervation of the GI Tract • Sympathetic innervation (T5-L2) • Paravertebral ganglia • Prevertebral ganglia Sympathetic Autonomics Paravertebral Prevertebral Unit II, p22 Innervation of the GI Tract • Sympathetic innervation • Paravertebral ganglia • Prevertebral ganglia • Celiac ganglia • Superior mesenteric ganglia • Aorticorenal ganglia • Inferior mesenteric ganglia Innervation of the GI Tract • Parasympathetic innervation • Vagus nerves (CN X) • Mouth to the sigmoid colon • Vagus means the wanderer • Sacral plexus (pelvic splanchnic nerves, S2-S4) • Sigmoid colon to the rectum Innervation of the GI Tract Unit II, p23 Comparison Unit II, p24 Enteric Innervation Unit II, p25 Referred Pain from Abdominal Viscera • Pain is perceived as originating in areas supplied by the somatic nerves because the autonomic afferent fibers enter the spinal cord at the same spinal segment as the sensory nerves from the body wall/limbs Referred Pain from Abdominal Viscera • • Visceral pain is dull and diffuse Somatic pain is sharp and focused Organ Stomach Duodenum Spinal Cord Segment T6-T9 T5-T9, T10 Referred Pain Site(s) Epigastric and left hypochondriac regions Epigastric region (right shoulder if ulcer perforates) Pancreatic head T8-T9 Inferior part of epigastric region Spleen T6-T8 Left hypochondriac region Gallbladder and liver T6-T9 Epigastric region, right hypochondriac region, posterior thoracic wall, right shoulder Jejunum and ileum T5-T9 Periumbilical region T10-T12 Hypogastric region L1-L3 Left lower quadrant Proximal colon Distal colon Kidneys and ureters T11-T12 Lower back, flank, extending to groin Pain Fields (From Moore and Dalley, p 233, 1999) Dermatomes Pelvis False Pelvis True Bony Pelvis • 3 fused bones (os coxae) • Ilium (NOT ileum) • Ischium (is-k-um) • Pubis Bony Pelvis • 3 fused bones (os coxae) • Ilium (NOT ileum) • Ischium (is-k-um) • Pubis • Other parts • Acetabulum • Rami • Pubic (Superior and inferior) • Ischial Bony Pelvis Ilium Pubis Ischium Bony Pelvis Ilium Pubis Ischium Pelvic Anatomy Anterior View Superior View Anterior View Ala of the ilium Pubis Ischium Notches and Foramina Notches Foramina Greater sciatic notch Greater sciatic foramen Lesser sciatic notch Lesser sciatic foramen • Greater sciatic notch/foramen • Lesser sciatic notch/foramen Sciatic Foramina Sacrospinous ligament Sacrotuberous ligament Posterior View Posterior View Sacrospinous ligament Posterior View Sacrospinous ligament Sacrotuberous ligament Pelvic Inlet Measurements - OB/GYN - Sex Differences in the Pelvis Male Female Male Female Pelvic Muscles • Lateral (wall) muscles • Piriformis • Obturator internus • Floor muscles (“pelvic diaphragm”) • 2 muscles • Levator ani (has 3 parts) • “Coccygeus” (ischiococcygeus) Levator Ani Muscle - 3 Parts - • Puborectalis (“rectal sling”) • Pubococcygeus • Iliococcygeus Pelvic Muscles Pelvic Diaphragm Arteries in the Pelvis Arteries in the Pelvis Anterior Division AA VV Vessel Male Female Superior vesical X X Obturator X X Inferior vesical X Artery to the ductus deferens X Prostatic X Umbilical Uterine X Vaginal X Internal pudendal X X Middle rectal X X Inferior gluteal X X Syllabus G09B.69 Pelvic Vasculature Syllabus G09B.67 Pelvic Vasculature Nerves in the Pelvis
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