Transcript 32-innervation of abdomen & lymph drainage

NERVE SUPPLY
Somatic: Lumbar plexus. 
Autonomic : Sympathetic trunk. 
Aortic plexuses. 
LUMBAR PLEXUS
It is the main nervous 
supply of the lower
limb.
It is formed from the 
anterior rami of the
upper four lumbar
nerves.
It has a contribution 
from T12 (subcostal
nerve).
LUMBAR PLEXUS
The plexus is 
formed in the psoas
muscle.
The branches of the 
plexus emerge from
the anterior surface
the lateral & medial
borders of the
muscle.
BRANCHES OF THE PLEXUS
Emerging from the 
lateral side :
Iliohypogastric (L1). 
Ilioinguinal (L1). 
Lateral cutaneous 
nerve of the thigh
(L2&3).
Femoral nerve 
(L2,3&4 ) DORSAL
DIVISIONS.
BRANCHES OF THE PLEXUS
Emerging from the 
medial side :
Obturator nerve(L2,3 
&4) VENTRAL
DIVISIONS.
Fourth lumbar root of 
the lumbosacral
trunk.
Emerging from the 
anterior surface:
Genitofemoral nerve 
(L1&2).
ILIOHYPOGASTRIC &
ILIOINGUINAL
They enter the 
lateral and anterior
abdominal walls.
ILIOHYPOGASTRIC &
ILIOINGUINAL
Iliohypogastric : 
Supplies the skin of the 
lower part of anterior
abdominal wall.
Ilioinguinal : 
Passes through the 
inguinal canal.
It supplies the skin of 
scrotum or labia
majora.
LATERAL CUTANEOUS NERVE
OF THE THIGH
It crosses the front 
of the iliacus
muscle.
It enters the thigh 
behind the lateral
end of the inguinal
ligament.
LATERAL CUTANEOUS NERVE
OF THE THIGH
It supplies the skin 
on the anterior and
lateral thigh to the
level of the knee.
FEMORAL NERVE
It is the largest branch 
of the plexus.
It descends between 
the psoas and iliacus
muscles.
It supplies the iliacus. 
It enters the thigh 
behind the inguinal
ligament and
immediately it divides
into many branches.
OBTURATOR NERVE
It crosses the 
pelvic brim in front
of the sacroiliac
joint.
It leaves the pelvis 
to enter the thigh
by passing through
the obturator
foramen.
th
4
lumbar root
It is part of the 
lumbosacral trunk.
It descends anterior 
to the ala of the
sacrum.
It joins the 1st sacral 
nerve.
It shares in the 
formation of the
sacral plexus.
GENITOFEMORAL NERVE
It descends in front 
of the psoas.
It divides into a 
genital branch and
a femoral branch.
GENITOFEMORAL NERVE
Femoral branch : 
Supplies a small area 
of the skin of the
thigh.
Genital branch : 
It enters the 
spermatic cord.
It supplies the 
cremaster muscle.
It is the nervous 
pathway for the
cremasteric reflex.
SYMPATHETIC TRUNK
It is the continuation of 
the thoracic trunk.
It is formed of (4-5) 
ganglia.
It enters the abdomen 
behind the medial
arcuate ligament.
It descends along the 
medial border of the
psoas muscle.
SYMPATHETIC TRUNK
It lies on the bodies of 
the lumbar vertebrae.
It enters the pelvis by 
passing behind the
common iliac vessels.
The left trunk: close to 
the left border of the
aorta.
The right trunk : 
behind right border of
the inferior vena cava.
BRANCHES
(1) White rami 
communicantes :
Carry preganglionic 
nerve fibers.
Connect the first 
two ganglia with
lumbar nerves
(L1&2).
BRANCHES
(2) Gray rami 
communicantes :
They contain 
postganglionic nerve
fibers.
They join each 
ganglion to a
corresponding
lumbar nerve.
BRANCHES
(3) Medial fibers : 
They join the 
sympathetic
plexuses on the
front of the
abdominal aorta
and its branches.
BRANCHES
(4) Infero- medial 
fibers:
They enter the pelvis in 
front of the common
iliac vessels.
They join branches from 
the sympathetic
plexuses to form the
superior hypogastric
plexus.
AORTIC (PREVERTEBRAL)
PLEXUSES
They contain the 
following fibers :
Pre and post 
ganglionic
sympathetic.
Preganglionic 
parasympathetic.
Visceral afferent. 
AORTIC (PREVERTEBRAL)
PLEXUSES
The plexuses are : 
Celiac. 
Renal. 
Superior mesenteric. 
Inferior mesenteric. 
Their postganglionic 
branches are distributed
along the corresponding
arteries.
CELIAC PLEXUS
It is formed of two ganglia 
connected by network of
fibers surrounding the
origin of the celiac artery.
It receives preganglionic 
sympathetic fro the greater
and lesser nerves.
The parasympathetic from 
the vagus.
INFERIOR MESENTERIC
PLEXUS
It has the 
parasympathetic
from the sacral
parasympathetic (S
2,3&4).
LUMBAR SYMPATHECTOMY
It aims to produce 
vasodilatation in
patients complaining
from vasoconstrictor
disorders.
The preganglionic 
sympathetic arise
from (T11_L2).
LUMBAR SYMPATHECTOMY
They synapse in the 
lumbar and sacral
ganglia.
The postganglionic 
fibers are distributed
among the branches of
the lumbar and sacral
nerves.
Postganglionic fibers 
can pass directly from
the lumbar ganglia to
the common iliac and
external iliac arteries.
LUMBAR SYMPATHECTOMY
As far down as the 
inguinal ligament.
Bilateral lumbar 
sympathectomy in
male can be
followed by loss of
the ejaculatory
power.
LYMPH DRAINAGE
Lymph nodes : Preaortic. 
Para aortic (lumbar) 
Lymph vessels : Cisterna chyli. 
Thoracic duct. 
PREAORTIC LYMPH NODES
Celiac. 
Superior mesenteric. 
Inferior mesenteric. 
They are around the origin 
of the corresponding
arteries.
They drain the GIT (lower 
1/3 of esophagus to upper
½ of anal canal), pancreas,
spleen,gall bladder and
most of liver.
PREAORTIC LYMPH NODES
Their efferent 
vessels pass to the
intestinal lymph
trunk.
PARA AORTIC (LATERAL)
LYMPH NODES.
Their afferent vessels 
are from :
Kidneys and suprarenal 
glands.
Testes & ovaries. 
Uterine tubes & fundus 
of uterus.
Common iliac nodes. 
Deep lymph vessels of 
abdominal wall.
PARA AORTIC (LUMBAR)
LYMPH NODES.
Their efferent 
vessels form the
right and left
lumbar lymph
trunks.
CISTERNA CHYLI
It is below the 
diaphragm to the
right of the aorta in
front of the 1st and 2nd
lumbar vertebrae.
CISTERNA CHYLI
It receives lymph from : 
Intestinal trunk. 
Right and left lumbar 
trunks.
Lower part of the thorax. 
Its efferent is the Thoracic 
Duct.