Located in the back of the psoas major, ahead of the transverse processes of lumbar vertebrae. It is formed by the ventral rami of the first 3 lumbar nerves and part of item 4 ventral ramus. Forms a series of branches from these ventral rami:
- Branches side:
or N.
iliohypogastric or N. ilioinguinal
- Terminal branches
or N. genitofemoral.
or N. lateral femoral cutaneous.
or N.
femoral or N.
shutter or N. accessory obturator. Fig
branches of lumbar plexus
1. N. iliohypogastric:
- I was born the
lumbar nerve - enters the abdomen from behind of the medial arcuate ligament, leaving the upper outer edge of the psoas major, inferior oblique cross the kidney and, subsequently, passes the square back.
- Close to the ASIS drilling to M. transversus abdominis and between M. external oblique and M. internal oblique is divided into an external cutaneous branch and a cutaneous branch.
- The external cutaneous branch, pierces the internal and external oblique muscles of the abdomen above the iliac crest. Dispatched by the skin of the superolateral gluteal region.
- The cutaneous branch previous runs from the M. internal oblique and transversus abdominis, giving bouquets for both muscles. Then pierce M. internal oblique on the inner side of the ASIS, perforates the aponeurosis of M. external oblique inguinal ring above the surface and is distributed by the skin of the abdomen above the pubis.
2. N. Ilioinguinal:
- I was born with lumbar nerve.
- Sale outer edge of the psoas major, accompanied by N. iliohypogastric, crosses obliquely to quadratus lumborum and the top of the ilium.
- Drilling to M. transversus abdominis near the front of the iliac crest. Then, Pierce M. internal oblique, giving some sprigs.
- is located below the spermatic cord and accompanies him through the superficial inguinal ring.
- Dispatched by the skin: superomedial thigh area, root of penis, upper scrotum, mons, and adjacent portions of the labia.
3. N. genitofemoral:
- originates from the ventral rami of LI and LII.
- Passes obliquely forward and crosses the psoas major, going on the abdominal surface of the muscle near its inner edge against L3 and L4. Descends on the surface of the psoas, covered with its fascia, up to form a cross with the ureter and then a branch is divided into genital and femoral branches.
- The genital branch crosses the end of the A. external iliac and inguinal canal enters the deep inguinal ring. It supplies the cremaster and gives some twigs to the skin of the scrotum (male). Accompanies the round ligament of the uterus and ends in the skin of the mons pubis and labia majora (female).
- The femoral branch descends on the left side of A. external iliac. After crossing the A. deep iliac circumflex artery, passes behind the inguinal ligament and enters the femoral sheath and then be on the outside of A. femoral. It supplies the skin of the upper femoral triangle.
4. N. lateral femoral cutaneous:
- originates from the ventral rami of L2 and L3 below N. Ilioinguinal.
- emerges from the Psoas major and its lateral border, and then stood in front of M. Ilium below the iliac fascia. Is directed obliquely to the ESIA and then passes behind the inguinal ligament and penetrates the fascia lata to be subcutaneous and divided after a previous industry or femoral, and posterior or buttocks.
- The anterior branch follows the path of the nerve and becomes superficial below the ASIS, goes down the front of the thigh, reaching to the knee.
- The posterior branch crosses the tensor fascia lata and distributed in the skin of the buttocks. Fig
terminals N. Ramos ilioinguinal, N.genitofemoral, N.
femoral
5. N. Shutter
- is a mixed nerve, for the medial thigh and the adductors. Originates from the ventral rami of L2, L3 and L4, which converge in the thickness of psoas major, below and medial to N. femoral. The trunk of the N. seal is formed at the height of the transverse process of L5.
- The nerve is down and medially oblique. Sale of the medial psoas, crosses the sacroiliac joint is located below the top opening of the pelvis.
- Go behind the common iliac vessels. Is directed downward and forward along the inner wall of the pelvis, standing on the M. internal stop above and below obturator vessels. Reaches the obturator foramen, is inserted into the obturator groove and divides into its two terminal branches anterior and posterior.
6. N. Femoral
- is the largest branch of the lumbar plexus. Arises from the ventral rami of L2, L3 and L4.
- is a sensory and motor nerve at a time, for the muscles of the anterior thigh and anteromedial skin of the lower limb.
- descends through the fibers of the psoas major arises from the lower lateral border of this muscle and continues down between him and the ilium.
- then passes behind the inguinal ligament and is crossed anteriorly by the A. lateral deep circumflex. Behind the lig. Inguinal, is separated from the A. femoral portion of M. psoas major.
- Within the pelvic cavity, N. femoral emits collaterals:
or N. iliopsoas: a medial branch to the psoas for which penetrates the posterior and lateral branches gives a (2-4 branches) entering the posterior iliac crest on his face.
or N. of A. Femoral can be highly variable. There one that originates high up, descend in the femoral close to him. Below the inguinal ligament, is situated on the lateral aspect of the femoral artery accompanying her to the middle of the thigh.
or N. the pectineus: exit the inner side of N. femoral, above the inguinal ligament, passes behind the femoral sheath and enters the anterior surface of the muscle.
- The N. femoral, also issues a terminal branches N. medial anterior cutaneous, N. anterior lateral cutaneous, N. quadriceps and N. saphenous.
lumbar sympathetic chain
extends from the diaphragm to the promontory. Consists of 4 lumbar ganglia which are interconnected by intermediate segments of the trunk.
is located in the extraperitoneal tissue anterior to the spine. It runs between the pillars of the diaphragm medially and forward, and continues along the inner side of the psoas major. This in connection with the vertebral posteromedially and lumbar arteries and veins that pass between the concavity of the vertebral bodies. Posterolaterally is related to the fascia of the ilio-psoas. On the right side overlaps the VCI, and the left external aortic lymph nodes. Above is crossed by the A. kidney and in the bottom two logs were crossed by the common iliac vessels.
The ventral rami of L1, L2 and L3 times, white communicating rami sent to the corresponding node. Since the lymph
will lumbar spinal nerves gray communicating rami, which accompany the lumbar arteries on their way around the vertebral bodies and through the arches of the psoas tendon. Since the lymph
out lumbar splanchnic nerves, which will be distributed in the celiac plexus, superior hypogastric and intermesentérico well:
- 1 N. lumbar splanchnic, leaving the first node and goes to the celiac plexus, renal and intermesentérico.
- 2 ° N. lumbar splanchnic: out of the second node and goes to the bottom
intermesentérico plexus - 3 ° N. lumbar splanchnic, leaving the 3rd or 4th node and goes to the superior hypogastric plexus
- 4 ° N. splanchnic lumbar: lower node leaves and goes to the bottom of the superior hypogastric plexus, or N. hypogastric.
intermesentérico plexus vascular branches reach all lumbar ganglia.
The lumbar sympathetic trunk through their communicating branches to provide vegetative nerve fibers of the abdominal wall, especially in the flat anteromedial lower limb through N. femoral and N. internal obturator.
Through its vascular branches, commands vasomotricity lower limb and pelvis.
Through its visceral branches, innervate the colon and pelvic organs.
1. Celiac Plexus:
training is odd, medium, located at T12 and L1 top. It is the largest of the main autonomic plexuses. Surrounding the celiac and superior mesenteric root. Consists of a network of nerve fibers that communicate with each major celiac ganglia, and a number of afferent and efferent branches. Three groups of nodes on each side: the lymph semilunar, and superior mesenteric lymph nodes aorticorenal.
The celiac plexus is located posterior to the stomach and lesser sac, anterior to the pillars of the diaphragm and the birth of the abdominal aorta between the adrenal glands. A. Lymph
celiac plexus: a.
CELIAC GANGLIA O semilunar, crescent-shaped
has superior concavity, with a horn and a horn medial to the right side and left of the celiac trunk. On top
receive: classes of N. phrenic
On the bottom edge get: steaks N. lesser splanchnic.
For his horn medial receive: the anterior vagal trunk. On the lateral horn
get: steaks N. greater splanchnic.
Relations: celiac ganglia are in front of T12-L1. Located at the front of the aorta and the pillars of the diaphragm. They are mostly retropancreatic. Are crossed earlier by the splenic vessels. The celiac ganglion is located right behind the IVC. B. Mesenteric ganglion
O AORTICOMESENTERICOS:
are located on both sides of the origin of the AMS, behind the pancreas and above the V. left kidney. They are united, up, semilunar ganglia and lateral to the aorticorenal. C.
aorticorenal GANGLIA:
are located in the anterior aspect of the A. kidney. Attached to the semilunar ganglia by short, thick fillets that are connected together. Fig
celiac plexus nodes with afferent branches
B. Branches:
correspond to the N. splanchnic thoracic vagal trunk anterior and incidentally the right phrenic nerve.
- N. greater splanchnic, ends in the deep aspect of the lateral horn for celiac ganglion.
- N. splanchnic Minor: going to the semilunar ganglion, near the tip side. Gives branches to the superior mesenteric ganglion and the ganglion aorticorenal.
- N. splanchnic imo, when it exists, goes to the lymph aorticorenal.
- anterior vagal trunk, gives a constant field for the medial horn of the right semilunar ganglion and a fickle bunch horn left medial semilunar ganglion. It also gives steaks for superior mesenteric plexus, spleen and liver. The form with the right vagus nerve and semilunar ganglion splanchnic right handle "memorable."
- N. right phrenic: provides a variable fillet the right semilunar ganglion. C.
efferent branches:
As celiac plexus, all efferent nerves are mixed, ie, parasympathetic and sympathetic at once.
fibers contain conflicting each other. These branches come together around the vessels originating from the abdominal aorta to reach the organs or viscera for: phrenic plexus, spleen, liver, left gastric, intermesentérico, adrenal, renal, testicular or ovarian, superior mesenteric and inferior mesenteric. A.
phrenic plexus: accompanies A. inferior phrenic corresponding to the diaphragm and some of the strands going to the adrenal gland. Stems from the top of the semilunar ganglion; receive one or two branches of the N. phrenic, and between the phrenic nerve plexus is a small nodal mass, the phrenic ganglia. Plexus takes a few branches to the IVC and the adrenal plexus and liver. B.
hepatic plexus: the largest derivatives celiac plexus, receives filaments of N. right and left vagus n. right phrenic. Join the V. common hepatic and all its derivatives forming a small plexus cystic, and V. portal to the liver. The accompanying:
or A. right hepatic innervate the pylorus.
or A. gastroduodenal and its branches innervate the pylorus and upper duodenum (1st part).
or A. gastroepiploic: supplies the right side of the stomach and the greater curvature.
or A. superior pancreaticoduodenal: innervates the descending part of duodenum (2nd part), the head of the pancreas and bile duct bottom.
cystic plexus contains both parasympathetic and sympathetic afferent and efferent and is believed to vagal constituents have a motor action on the musculature of the gallbladder and bile ducts.
c. left gastric plexus, accompanying A. left gastric along the lesser curvature of the stomach and is attached to the gastric branches of the N. vague. It has a motor action to the pyloric sphincter, and inhibits the muscle layers of stomach. Plexus
d. Splenic formed by branches from the celiac plexus, celiac ganglion left and N right vagus. Join A. splenic to the spleen. The fibers are mainly of sympathetic origin and end in vessels sanguíneos y en el musculo liso de la capsula esplénica y de las trabéculas.
Fig. Plexo gástrico izquierdo, hepático, esplénico.
e. Plexo suprarrenal: formado por ramos procedentes del ganglio celiaco, plexo celiaco y N. esplácnico mayor.
La glándula suprarrenal tiene el mayor aporte autónomo del organismo.
f. Plexo renal: está formado por filamentos procedentes del ganglio y plexo celiacos, ganglio aorticorrenal, N. esplácnico torácico inferior (imo), 1° nervio esplácnico lumbar y plexo aórtico.
El plexo se continua en el interior del riñón alrededor branch of the A. renal, supplying vessels and glomeruli and renal tubules, mainly in the cortex. Most of the N. have renal vasomotor function. G.
gonadal plexus, accompanying A. gonad to the testis and ovary and fallopian tubes. Its upper part is formed by branches from the aortic plexus and kidney, and its bottom is formed by branches from the superior and inferior hypogastric plexus.
this plexus nerves are sympathetic afferent and efferent fibers, efferent fibers vasomotor in nature. Parasympathetic fibers are of a vasodilator.
h. superior mesenteric plexus, below the bottom of the celiac plexus. Get a bunch of the union of N. right vagus to the celiac plexus. Surrounding the AMS, accompanied into the mesentery, and divided into several plexuses that are distributed through the area irrigated by the artery, pancreatic branches, jejunal and ileal branches, branches ileocolic, right colic and middle.
The sympathetic nerves that go to the intestine have a motor action on the ileocecal sphincter, but also has an inhibitory action of intestinal muscle. In addition, vasoconstrictor fibers lead. I.
Abdominal aortic plexus (intermesentérico): formed by branches from the celiac plexus, celiac ganglia and aorticorenal, also called filaments of the lumbar splanchnic nerves 1 and 2 °. It is located on the sides and front of the aorta, between the origin of the AMS and AMI. Continue over the celiac plexus and celiac ganglia and aorticorenal, and below the superior hypogastric plexus.
gives rise to the testicular plexus, superior mesenteric, iliac and superior hypogastric, and gives some filaments to the VCI. J.
inferior mesenteric plexus, comes mainly from abdominal aortic plexus, but also receives branches lumbar splanchnic nerves of 1 ° and 2 °. Surrounding the AMS and is distributed throughout their branches, as follows:
or left colic plexus, innervates the left side of the transverse colon, descending colon and sigmoid colon.
or superior rectal plexus, innervates the rectum.
The sympathetic nerves are inhibitors cramping of the muscle layers of the colon and rectum. The branches from the parasympathetic pelvic splanchnic nerves run between the inferior mesenteric plexus and superior hypogastric to supply the large intestine from the left side of the transverse colon to the rectum.
parasympathetic innervation to the distal colon is due to direct branches of the pelvic splanchnic nerve and not takes place through the inferior mesenteric and hypogastric plexuses.
Fig. plexus superior mesenteric plexus intermesentérico.
2. Plexus superior hypogastric:
is located in front of the bifurcation of the abdominal aorta, left common iliac vein, the middle sacral vessels, the body of L5 and the sacral promontory, and between two common iliac arteries. It is sometimes called the presacral nerve.
It is located in the extraperitoneal tissue. The root of the sigmoid mesocolon is located at the bottom left of the plexus.
is formed by branches from the aortic plexus lumbar splanchnic nerves 3 and 4 °. Below is divided into right and left hypogastric nerves, which descend to the two inferior hypogastric plexuses. Fig
superior hypogastric plexus, inferior mesenteric plexus, superior mesenteric plexus. RAMOS
THORACIC SYMPATHETIC TRUNK RELATED POSTERIOR ABDOMINAL WALL:
1. N. greater splanchnic:
is composed of myelinated fibers, preganglionic and visceral afferent: branches from the thoracic ganglia V-IX.
descends obliquely on the vertebral bodies, through the diaphragm between the pillars and the accompanying medial arcuate ligament medial root of lumbar vein and terminates in the celiac ganglion lateral horn or crescent.
His journey into the abdomen is very short, is transverse and is supported on the pillar of the diaphragm, is hidden deep in the IVC to the right and the left adrenal gland. After having given numerous branches to the adrenal gland to reach the celiac ganglion which gives its sympathetic component.
2. N. splanchnic minor:
is formed filaments from the thoracic ganglia 9 and 10 °, sometimes of 10 ° and 11 °. Medially directed downwards and remains greater splanchnic lateral, having the same anatomical relationships. Passes through the diaphragm along with the greater splanchnic aorticorenal ends at the node.
3. N. splanchnic or less imo:
born the last thoracic ganglion. Reaches the abdomen accompanying the sympathetic trunk and ends in the renal plexus.
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