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sistema nervoso autonomo
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Autonomic Nervous System of the Gut
F.H. Willard, Ph.D.
University of New England
College of Osteopathic Medicine
Innervation of the GI System
• Sympathetic origins:– Thoracic, lumbar and sacral splanchnic n.
– Celiac, superior and inferior mesenteric and hypogastric ganglia
• Parasympathetic origins:– Vagus nerve and pelvic splanchnic nerves
• Enteric Nervous System– Myenteric ganglia
– Submucosal ganglia
Prevertebral Ganglia
• Abdomen– Celiac ganglia– Superior mesenteric ganglia– Inferior mesenteric ganglia
• Pelvis– Hypogastric ganglia
The Celiac Territory:The Foregut
• Distal esophagus, stomach and proximal duodenum
• Pancreas, liver and gall bladder
• Spleen
Celiac Innervation
• Sympathetic innervation– Spinal segments T6 to T9
• Parasympathetic innervation– Vagus nerve
The Superior Mesenteric Territory: The Midgut
• Small intestine– Distal duodenum– Jejunum– Ileum
• Proximal large intestine– Cecum– Ascending colon– Transverse colon
Superior Mesenteric Innervation
• Sympathetic nervous system– Spinal cord segments T9-L1
• Parasympathetic nervous system– Vagus nerve
The Inferior Mesenteric Territory: The Hindgut
• The distal large intestine– Descending colon– Sigmoid colon– Rectum
Inferior Mesenteric Innervation
• Sympathetic nervous system– Spinal cord segments L1 to L2
• Parasympathetic nervous system– Pelvic splanchnic nerves from spinal cord
segments S2 to S4
Enteric Ganglia
• Submucosal ganglia and plexus of Meissner
• Myenteric ganglia and plexus of Auerbach
The Great Abdominopelvic Plexus
• Extends from thoracoabdominal diaphragm to pelvic diaphragm
• Sympathetic origins from T5-L2• Parasympathetic origins from the vagus
nerve and the pelvic splanchnic nerves (S2-S4)
• Sensory input to the spinal cord T5-L2 and S2-S4
Sympathetic Parasympathetic
CGSMG
IMG
HG
Great Abdomino-Pelvic Plexus
Abdomen
Pelvis
ThoracicSplanchnic
N.
Sympathetic Parasympathetic
CGSMG
IMG
HG
Great Abdomino-Pelvic Plexus
Abdomen
Pelvis
ThoracicSplanchnic
N.
LumbarSplanchnic
N.
Sympathetic Parasympathetic
CGSMG
IMG
HG
Great Abdomino-Pelvic Plexus
Abdomen
Pelvis
ThoracicSplanchnic
N.
SacralSplanchnic
N.
LumbarSplanchnic
N.
Sympathetic Parasympathetic
CGSMG
IMG
HG
Great Abdomino-Pelvic Plexus
Abdomen
Pelvis
ThoracicSplanchnic
N.
SacralSplanchnic
N.
VagusNerve
LumbarSplanchnic
N.
Sympathetic Parasympathetic
CGSMG
IMG
HG
Great Abdomino-Pelvic Plexus
Abdomen
Pelvis
ThoracicSplanchnic
N.
SacralSplanchnic
N.
VagusNerve
PelvicSplanchnic
N.
LumbarSplanchnic
N.
Sympathetic Parasympathetic
CGSMG
IMG
HG
Great Abdomino-Pelvic Plexus
Abdomen
Pelvis
Origin BloodSupply
SympatheticInnervation
Para-sympatheticInnervation
Lymphatic Drainage
Foregut Celiac
Artery
Celia
Ganglia
T5-T9
Vagus
Nerve
Celiac Lymph
Nodes
Midgut Superior
Mesenteric
Artery
Superior
Mesenteric
Ganglia
T9-T12
Vagus
Nerve
Superior
Mesenteric
Lymph Nodes
Hindgut Inferior
Mesenteric
Artery
Inferior
Mesenteric
Ganglia
L1-L2
Pelvic
Splanchnic
Nerves
S2-S4
Inferior
Mesenteric
Lymph nodes
The Enteric Nervous System
• Auerbach’s ganglia and plexus– Myenteric plexus
• Motor coordination for peristalsis
• Meissner’s ganglia and plexus– Submucosal plexus
• Sensory integration for both plexuses
• Secretomotor coordination for the gut wall
Referred Abdominal Pain
• Celiac or foregut territory: T5-T9– Upper right and left quadrant pain– Midback pain
• Superior or midgut mesenteric territory: T9-L1– Central or periumbilical pain– Thoracolumbar junction and above
• Inferior or hindgut mesenteric territory: L1-L2 (S2-S4)– Groin and retropubic pain– Thoracolumbar junction and below– Sacral Pain