Peripheral pathways

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The peripheral nervous system pathways of abdominal visceral sensation have been defined in humans and are summarized in Figure 3.1. Most viscera have a dual, or in some cases triple, source of afferents travelling via the vagus nerve, the pelvic nerve, and/or via the splanchnics (nerves travelling in association with sympathetic efferent fibers). Spinal visceral afferent fibers have their cell bodies in dorsal root ganglia and central terminals in the superficial dorsal horn of the spinal cord (lamina I and II), deeper laminae (IV, V), the intermediolateral cell column and sacral parasympathetic nucleus (pelvic nerve), and in the area around and dorsal to the central canal (lamina X). It is notable that visceral primary afferents differ significantly from cutaneous primary afferents in both number and pattern of distribution. Grossly, peripheral axons of visceroceptive primary afferents are diffusely organized into web-like plexuses rather than forming distinct peripheral nerve entities. Afferents with endings in a specific visceral site may have cell bodies in the dorsal root ganglia of ten or more spinal levels in a bilaterally distributed fashion. In contrast, afferents arising in cutaneous structures travel to a limited number (three to five levels) of unilaterally located dorsal root ganglia. Individual visceroceptive afferent C-fibers have been demonstrated to branch within the spinal cord and to spread over ten or more spinal segments and to branch into superficial, deep, and even contralateral spinal dorsal horn laminae.19 Individual cutaneous afferent C-fibers, on the other hand, have been demonstrated to form tight unilateral baskets of input to localized spinal cord segments and terminate predominantly in superficial laminae.19

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Lumbar

Sacral

Prevertebral ganglia

Liver Stomach Small intestine Proximal colon Distal esophagus

Gall bladder

Pancreas

Spleen

Testis/ovaries Kidney

Distal colon Rectum Uterus Prostate Urinary bladder

Figure 3.1 The nervous supply of the viscera in humans. Abbreviations are as follows: SCN, MCN, ICN, superior middle and inferior cardiac nerves; TSN, GSN, LSN, LeSN, LuSN, thoracic, greater, lesser, least, lumbar splanchnic nerves; PN, pelvic nerve; IMN, intermesenteric nerve; HGN, hypogastric nerve; SCG, MCG, superior and middle cervical ganglia; Stell: stellate ganglion; CG, celiac ganglion; SMG, IMG, superior and inferior mesenteric ganglia; PG, pelvic ganglion; GI, ganglion impar; CP, SHP, celiac and superior hypogastric plexuses; NG, nodose ganglion; ENS, enteric nervous system. Adapted from Ness and Gebhart, 1990.1

Sympathetic Gl^ I chain

(paravertebral ganglia)

Prevertebral ganglia

Liver Stomach Small intestine Proximal colon Distal esophagus

Gall bladder

Pancreas

Spleen

Testis/ovaries Kidney

Distal colon Rectum Uterus Prostate Urinary bladder

Figure 3.1 The nervous supply of the viscera in humans. Abbreviations are as follows: SCN, MCN, ICN, superior middle and inferior cardiac nerves; TSN, GSN, LSN, LeSN, LuSN, thoracic, greater, lesser, least, lumbar splanchnic nerves; PN, pelvic nerve; IMN, intermesenteric nerve; HGN, hypogastric nerve; SCG, MCG, superior and middle cervical ganglia; Stell: stellate ganglion; CG, celiac ganglion; SMG, IMG, superior and inferior mesenteric ganglia; PG, pelvic ganglion; GI, ganglion impar; CP, SHP, celiac and superior hypogastric plexuses; NG, nodose ganglion; ENS, enteric nervous system. Adapted from Ness and Gebhart, 1990.1

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