ANATOMY -Abdominopelvic Neurology Lumbar Plexus (Anterior Rami of L1-L3 and most of L4)

Branch Muscular Branches N to quadratus lumborum m N to psoas major m N to psoas minor m Iliohypogastric N Ilioinguinal N Anterior Scrotal N (male) Anterior Labial N (female) Genitofemoral N Gential Branch Femoral Branch Lateral Femoral Cutaneous N Femoral N Obturator N Nerve Root T12-L4 L2-4 L1,2 L1 L1 Travels Innervates

Lateral to psoas major m First to disappear from view Lateral to posas major m Through canal

Lateral buttock & hypogastric region Skin of groin, scrotum & labia Anterior scrotum Anterior labia majora

L1-2

Through psoas major m Divides into 2 branches Goes through canal thus more lateral

L2-3 L2-4 L2-4

Accessory Obturator N Lumbosacral Trunk

L3-4 L4,5

Lateral to psoas major m Largest branch of lumbar plexus Lateral to psoas major m Medial to psoas major m Passes through obturator canal Branches into ant & post divisions Variable, only occurs 10% of the time Medial to psoas major m Inferiorly overala of sacrum & joins w/ sacral plexus of n

Anterolateral scrotum & cremaster m in males Skin over femoral triangle Skin on lateral thigh Anterior thigh musculature Medial thigh musculature

Pctineus m

Autonomic Nervous System HN: General Principles of the Autonomic Nervous System 1. Typically Sympathetic stimulation is Catabolic, fight of flight 2. Typically Parasympathetic stimulation is Anabolic, normal function and energy conservation 3. The Parasympathetic Nervous System has a limited distribution (Head, Neck and Trunk Viscera, never in the body wall or extremities), whereas the Sympathetic Nervous System distributes to all vascular areas of the body 4. Glandular secretion is stimulated by the Parasympathetic Nervous System (except Sweat Glands), the Sympathetic Nervous System can indirectly decrease non-Sweat Gland Glandular secretion through Vasoconstriction 5. Vasoconstriction is Sympathetically Stimulated (except Coronary As.) Sympathetic Division (Thoracolumbar T1-L2) 1. Presynaptic Fibers (short) a. Cell Bodies exist in the Lateral Horn of the Spinal Cord b. Always travels in the Anterior Root c. Always travels into the Anterior Ramus d. Quickly exit Anterior Ramus & enters the Paravertebral Ganglia via White Ramus Communicante 2. Synaptic Options (one exception innervation to the Suprarenal Glands) a. Presynaptic Fibers can enter the Paravertebral Ganglion and synapse onto a Postsynaptic Neuron in the same spinal level b. Presynaptic Fibers can enter the Paravertebral Ganglion ascend or descend to synapse on a Postsynaptic Neuron a different spinal level c. Presynaptic Fibers can enter the Paravertebral Ganglion and exit without synapsing and continue on through an Abdominopelvic Splanchnic Nerve on their way to a Postsynaptic Neuron in Prevertebral Ganglion d. Associated Ganglia 1. Paravertebral Ganglia (linked vertically to form Sympathetic Trunks on either side of the Vertebral Column, three Ganglia also exist in the Cervical,Lumbar and Pelvic Regions) 2. Prevertebral Ganglia (ganglia and corresponding plexuses surrounding the Main unpaired Branches of the Abdominal Aorta) a. Celiac Ganglion b. Superior Mesenteric Ganglion c. Aorticorenal Ganglion d. Inferior Mesenteric Ganglion 3. Postsynaptic Fibers (long, cell bodies exist in the Paravertebral or Prevertebral Ganglia, axons typically feed into a mixed Autonomic Plexus) a. Grey Rami Communicans (exit the Paravertebral Ganglion and return to the Anterior Ramus of the Spinal nerve to innervate body walls and limbs) b. Carotid Periarterial Plexus (to the head and neck) c. Cardiopulmonary Splanchnic nerves (feed into Cardiac and Pulmonary mixed autonomic plexuses) d. Mixed Autonomic Plexus Fibers Parasympathetic Nervous System (Craniosacral CN III, VII, IX and X, S2-4) 1. Presynaptic Fibers (long) a. Nuclei in the Brain Stem and Sacral Spinal levels b. Cranial component exists as Cranial Nerves 1. Oculomotor N. (CN III) 2. Facial N. (CN VII) 3. Glossopharyngeal N. (CN IX) 4. Vagus N. (CN X) c. Sacral Component exists Spinal Levels as Pelvic SplanchnicvNerves 2. Postsynaptic Fibers (usually short, with Ganglia/ Postsynaptic Neurons near or in the target organ)

a. Nuclei are in four Specific Cranial Ganglia or in the wall of the target organ) 1. Ciliary Ganglion (receives fibers from Oculomotor N.) 2. Pterygopalatine Ganglion (receives fibers from the Facial N.) 3. Submandibular Ganglion (receives fibers from the Facial N.) 4. Otic Ganglion (receives fibers from the Glossopharyngeal N.) 5. Intrinsic Parasympathetic Ganglia (Postsynaptic parasympathetic Cell Bodies located in the walls of target organs)