Download NERVE SUPPLY OF ABDOMEN

NERVES OF ABDOMEN
Learning Objectives
By the completion of lecture, the student should be able to:
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Develop a basic knowledge of nerve supply of
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Anterior and posterior abdominal wall.
Create a visual representation of nerves supplying the abdomen.
Sequence and catagorize information on the segmental sympathetic supplies and
referred pain.
Understand the basic structure of paravertebral plexuses.
Obtain information about somatic nervous supply
of abdomen.
Nerve Supply of Anterolateral Abdominal Wall
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Skin and muscles of anterior wall supplied mainly by ventral rami of inferior six thoracic
nerves (i.e., the continuation of the inferior intercostal nerves, T7 to T11) and subcostal
nerve (T12).
Inferior part supplied by two branches of ventral ramus of first lumbar nerve via
iliohypogastric and ilioinguinal nerves.
Main trunks of intercostal nerves pass anteriorly
from intercostal spaces and run between internal
oblique and transversus abdominis muscles.
Common nerve supply of the skin and the muscles of
the anterolateral wall explain why palpating the
abdomen with cold hands causes the muscles of the
abdominal wall to contract.
Nerve Supply of the Posterior Abdominal
Wall
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Psoas major: ventral rami of L1-L3 spinal nerves.
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Iliacus: branch of femoral nerve (L2-L3).
Quadratus lumborum: ventral rami of T12, L1-L4.
Abdominal Part of Oesophagus
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Anterior gastric nerve contain mainly left vagal fibers.
Posterior gastric nerves mainly the right vagal fibers
Few sympathetic fibers from greater splanchric nerve.
Nerves Of Stomach:
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Derived from celiac sympathetic plexus and right and left vagus nerve.
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SYMPATHETIC INNERVATION OF STOMACH
CARRIES A PROPORTION OF PAIN TRANSMITTING
NERVE FIBERS.
WHILE PARASYMPATHETIC VAGAL FIBERS ARE
SECRETOMOTOR TO GASTRIC GLANDS AND
MOTOR TO MUSCULAR WALL OF STOMACH.
Nerve Supply of Small Intestine
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Autonomic nerves reach wall of small intestine with its blood
vessel.
Parasypthetic vagal suppply augments peristaltic activity and intestinal
secretion.
Sympathetic supply, which is vaso constrictor and normally inhibits
to peristalsis is from t9 and t10 spinal segments.
Nerve Supply of large intestine
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Parasympathetic N/supply to large intestine is partly from vagi
and partly from pelvic splanchnic nerve.
Sympathetic supply is derived from spinal cord segment t10-l2.
Innervation of the Abdomen
Autonomic Nervous Supply:
The sympathetic supply includes:
• Greater splanchnic nerve (T5-9)
• Lesser splanchnic nerve (T9-10)
• Lowest (least) splanchnic nerve (T12)
• Lumbar splanchnic nerves (L1-3)
• Sacral splanchnic nerves
Autonomic Nervous Supply Cont:
The parasympathetic supply includes:
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Vagus nerve
Pelvic splanchnic nerve (S2-4)
These project to the paravertebral plexuses, which are situated anterior to the aorta and
vertebral column.
Paravertebral Plexuses
Coeliac Plexus:
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Closely related to coeliac ganglion.
Lies around the origin of coeliac trunk above the upper border of pancreas and around the
root of superior mesenteric artery.
Plexus extends on to the crura of diaphram.
The fibers making up the plexus are a follows:
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Preganglionic sympathetic fibers reach it through the greater and lesser splanchnic nerves.
Post Ganglionic sympathetic fibers arising in the coeliac ganglion.
Pre ganglionic vagal fibers are derived from posterior vagal trunk containing fibers from
both the right and left vagal nerves
Sensory fibers from the diaphragm reach the coeliac plexus along the inferior pherenic
nerve.
Paravertebral Plexuses Cont:
Phrenic Plexus:
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This accompanies the inferior phrenic artery to the diaphragm and suprarenal gland.
Paravertebral Plexuses Cont:
Hepatic Plexus:
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Largest coeliac derivative.
Receives filaments from both the right and left vagus as well as from the phrenic nerves.
Accompanies the hepatic artery and the portal vein and their branches and also supplies the
cystic plexus to the gallbladder.
Branches may also supply the pylorus, greater curvature of stomach as well as the lower
bile duct, pancreatic head and 1st and 2nd part of duodenum.
Paravertebral Plexuses Cont:
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Left Gastric Plexus:
This goes to the lesser curvature of the stomach.
Splenic Plexus:
This is formed by branches of the coeliac plexus, left coeliac ganglion and the right
vagus.
It supplies the blood vessels and smooth muscles of the splenic capsule and trabeculae.
Paravertebral Plexuses Cont:
Suprarenal Plexus:
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This supplies the medulla of the suprarenal gland.
Renal Plexus:
• This is formed by fibres from the coeliac ganglion and plexus, aorticorenal ganglion,
lowest thoracic splanchnic nerves, 1st lumbar splanchnic nerve and the aortic plexus.
• It gives off the ureter and gonadal plexuses (ovarian or testicular).
• The ureteric plexus accompanies the ureter and the gonadal plexuses accompany the
appropriate artery to the respective organs.
Paravertebral Plexuses Cont:
Superior Mesenteric Plexus
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This is a downward extension of the coeliac plexus.
It accompanies the superior mesenteric artery to the pancreas, small intestine
(duodenum, jejunum and ileum), and large intestine as far as the left trisection of the
transverse colon.
Paravertebral Plexuses Cont:
Abdominal Aortic Plexus (intermesenteric)
This supplies the IVC, and testicular plexuses as well as connecting
the superior and inferior mesenteric plexuses.
Paravertebral Plexuses Cont:
Inferior Mesenteric Plexus:
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This receives supply from the aortic plexus and 2nd and
3rd lumbar splanchnic nerves.
It supplies the colon from the left trisection of the
transverse colon to the rectum.
Paravertebral Plexuses Cont:
Superior Hypogastric Plexus:
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This is situated anterior to the aortic bifurcation, L5 and
the sacral promontory.
This plexus is formed from branches of the aortic plexus, 3rd and
4th lumbar splanchnic nerves.
It divides into the left and right hypogastric nerves, which
descend to the 2 inferior hypogastric plexuses, which lie anterior
to the sacrum.
Paravertebral Plexuses Cont:
Inferior Hypogastric Plexus
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This is formed from the pelvic splanchnic nerves (from the sacral
plexus, S2-4) and also receives the sacral splanchnic nerves.
Several plexuses arise from the inferior hypogastric plexuses,
including:
Middle rectal plexus
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Vesical plexus
Prostatic plexus
Uterovaginal plexus.
Segmental Sympathetic Supplies and Referred Pain
Part
Segement(s)
Referred pain
Oesophagus (causal part)
T5-6
Retrosternal/
epigastrium
Stomach
T6-10
Epigastrium
Small intestine (duodenum, ileum and
jejunum)
T9-10
Umbilical
Large intestine to splenic flexure
T11-L1
Umbilical
Splenic flexure to rectum
L1-2
Hypogastrium
Liver and gallbladder
T7-9
Epigastrium/right hypochondrium
Segmental Sympathetic Supplies and Referred Pain
Part
Segement(s)
Referred pain
Spleen
T6-10
Left hypochondrium
Pancreas
T6-10
Epigastrium
Kidney
T10-L1
Posterior lumbar
Suprarenal
T8-L1
Posterior lumbar
Gonads
T10-11
Lumbar to groin
Urinary bladder
T11-L2
Hypogastrium
Uterus
T12-L1
Hypogastrium
Somatic Nervous Supply
Thoracoabdominal Nerves :
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These are branches of T6-11 intercostal nerves.
They are motor to the anterolateral abdominal wall
muscles, sensory to the anterolateral abdomen,
gluteal region and lateral side of thigh.
T10 supplies the umbilicus, T12 supplies a strip
halfway between the umbilicus and pubic
symphysis, T8 supplies a strip halfway between the
umbilicus and xiphoid process.
Somatic Nervous Supply
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Phrenic Nerve:
This is from C3-5 and supplies the diaphragm and
related pleura and peritoneum.
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Contains both motor and sensory fibres.
Somatic Nervous Supply
Lumbar Plexus:
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Extends from spinal nerves L2-4, but branches of
L1 are often considered with the lumbar plexus.
L4 and l5 contribute to the sacral plexus by the
lumbosacral trunk.
Iliohypogastric nerve (l1)
Ilioinguinal nerve (l1)
Genitofemoral nerve (l1-2)
Lateral femoral cutaneous nerve (l2-3)
Femoral nerve (l2-4)
Obturator nerve (l2-4)