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NERVES OF ABDOMEN

Learning Objectives

By the completion of lecture, the student should be able to:

Develop a basic knowledge of nerve supply of

Anterior and posterior abdominal wall.

Create a visual representation of nerves supplying the abdomen.

Sequence and catagorize information on the segmental sympathetic supplies andreferred pain.

Understand the basic structure ofparavert ebral plexuses.

Obtain information about somatic nervous supply

of abdomen.

Nerve Supply of Anterolateral Abdominal Wall

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 subcostalnerve (T12).

Inferior part supplied by two branches of ventral ramus of first lumbar nerve viailiohypogastric and ilioinguinal nerves.

Main trunks ofintercostal nerves pass anteriorly

from intercostal spaces and run between internaloblique and transversus abdominis muscles.

Common nerve supply of the skin and the muscles of

the anterolateral wall explain why palpating theabdomen with cold hands causes the muscles of the

abdominal wall to contract.

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Nerve Supply of the Posterior AbdominalWall

Psoas major: ventral rami ofL1-L3 spinal nerves.

Iliacus: branch offemoral nerve (L2-L3).

Quadratus lumborum: ventral rami ofT12, L1-L4.

Abdominal Part of Oesophagus

- 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:

- Derived from celiac sympathetic plexus and right and left vagusnerve.

- Sympathetic innervation of stomach carries a proportion ofpain transmitting nerve fibers.

-

While parasympathetic vagal fibers are secretomotor togastric glands and motor to muscular wall of stomach.

Nerve Supply of Small Intestine

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

Parasympathetic N/supply to large intestine is partly from vagiand partly from pelvic splanchnic nerve.

Sympathetic supply is derived from spinal cord segment t10-l2.

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Phrenic Plexus:

This accompanies the inferior phrenic artery to the diaphragm and suprarenal gland.

Hepatic Plexus:

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 thecystic plexus to the gallbladder.

Branches may also supply the pylorus, greater curvature of stomach as well as the lowerbile duct, pancreatic head and 1st and 2nd part of duodenum.

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 .

Suprarenal Plexus:

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

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 thetransverse colon.

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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:

This receives supply from the aortic plexus and 2nd and

3rd lumbar splanchnic nerves.

It supplies the colon from the left trisection of thetransverse colon to the rectum.

Paravertebral Plexuses Cont:

Superior Hypogastric Plexus:

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, whichdescend to the 2 inferior hypogastric plexuses , which lie anterior

to the sacrum.

Inferior Hypogastric Plexus

This is formed from the pelvic splanchnic nerves (from the sacralplexus, S2-4) and also receives the sacral splanchnic nerves .

Several plexuses arise from the inferior hypogastric plexuses,including:

Middle rectal plexus

Vesical plexus

Prostatic plexus

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Uterovaginal plexus.

Segmental Sympathetic Supplies and Referred Pain

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

Part Segement(s) Referred pain

Oesophagus (causal part) T5-6 Retrosternal/

epigastrium

Stomach T6-10 Epigastrium

Small intestine (duodenum, ileum andjejunum) 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

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