NERVE SUPPLY Somatic Lumbar plexus n Autonomic Sympathetic

NERVE SUPPLY Somatic: Lumbar plexus. n Autonomic : Sympathetic trunk. n Aortic plexuses. n

LUMBAR PLEXUS It is the main nervous n supply of the lower limb. It is formed from the n anterior rami of the upper four lumbar nerves. It has a contribution n from T 12 (subcostal nerve).

LUMBAR PLEXUS The plexus is n formed in the psoas muscle. The branches of the n plexus emerge from the anterior surface the lateral & medial borders of the muscle.

BRANCHES OF THE PLEXUS Emerging from the n lateral side : Iliohypogastric (L 1). n Ilioinguinal (L 1). n Lateral cutaneous n nerve of the thigh (L 2&3). Femoral nerve n (L 2, 3&4 ) DORSAL DIVISIONS.

BRANCHES OF THE PLEXUS Emerging from the n medial side : Obturator nerve(L 2, 3 n &4) VENTRAL DIVISIONS. Fourth lumbar root of n the lumbosacral trunk. Emerging from the n anterior surface: Genitofemoral nerve n (L 1&2).

ILIOHYPOGASTRIC & ILIOINGUINAL They enter the n lateral and anterior abdominal walls.

ILIOHYPOGASTRIC & ILIOINGUINAL Iliohypogastric : n Supplies the skin of the n lower part of anterior abdominal wall. Ilioinguinal : n Passes through the n inguinal canal. It supplies the skin of n scrotum or labia majora.

LATERAL CUTANEOUS NERVE OF THE THIGH It crosses the front n of the iliacus muscle. It enters the thigh n behind the lateral end of the inguinal ligament.

LATERAL CUTANEOUS NERVE OF THE THIGH It supplies the skin n on the anterior and lateral thigh to the level of the knee.

FEMORAL NERVE It is the largest branch n of the plexus. It descends between n the psoas and iliacus muscles. It supplies the iliacus. n It enters the thigh n behind the inguinal ligament and immediately it divides into many branches.

OBTURATOR NERVE It crosses the n pelvic brim in front of the sacroiliac joint. It leaves the pelvis n to enter the thigh by passing through the obturator foramen.

4 th lumbar root It is part of the n lumbosacral trunk. It descends anterior n to the ala of the sacrum. It joins the 1 st sacral n nerve. It shares in the n formation of the sacral plexus.

GENITOFEMORAL NERVE It descends in front n of the psoas. It divides into a n genital branch and a femoral branch.

GENITOFEMORAL NERVE Femoral branch : n Supplies a small area n of the skin of the thigh. Genital branch : n It enters the n spermatic cord. It supplies the n cremaster muscle. It is the nervous n pathway for the cremasteric reflex.

SYMPATHETIC TRUNK It is the continuation of n the thoracic trunk. It is formed of (4 -5) n ganglia. It enters the abdomen n behind the medial arcuate ligament. It descends along the n medial border of the psoas muscle.

SYMPATHETIC TRUNK It lies on the bodies of n the lumbar vertebrae. It enters the pelvis by n passing behind the common iliac vessels. The left trunk: close to n the left border of the aorta. The right trunk : n behind right border of the inferior vena cava.

BRANCHES (1) White rami n communicantes : Carry preganglionic n nerve fibers. Connect the first n two ganglia with lumbar nerves (L 1&2).

BRANCHES (2) Gray rami n communicantes : They contain n postganglionic nerve fibers. They join each n ganglion to a corresponding lumbar nerve.

BRANCHES (3) Medial fibers : n They join the n sympathetic plexuses on the front of the abdominal aorta and its branches.

BRANCHES (4) Infero- medial n fibers: They enter the pelvis in n front of the common iliac vessels. They join branches from n the sympathetic plexuses to form the superior hypogastric plexus.

AORTIC (PREVERTEBRAL) PLEXUSES They contain the n following fibers : Pre and post n ganglionic sympathetic. Preganglionic n parasympathetic. Visceral afferent. n

AORTIC (PREVERTEBRAL) PLEXUSES The plexuses are : n Celiac. n Renal. n Superior mesenteric. n Inferior mesenteric. n Their postganglionic n branches are distributed along the corresponding arteries.

CELIAC PLEXUS It is formed of two ganglia n connected by network of fibers surrounding the origin of the celiac artery. It receives preganglionic n sympathetic fro the greater and lesser nerves. The parasympathetic from n the vagus.

INFERIOR MESENTERIC PLEXUS It has the n parasympathetic from the sacral parasympathetic (S 2, 3&4).

LUMBAR SYMPATHECTOMY It aims to produce n vasodilatation in patients complaining from vasoconstrictor disorders. The preganglionic n sympathetic arise from (T 11_L 2).

LUMBAR SYMPATHECTOMY They synapse in the n lumbar and sacral ganglia. The postganglionic n fibers are distributed among the branches of the lumbar and sacral nerves. Postganglionic fibers n can pass directly from the lumbar ganglia to the common iliac and external iliac arteries.

LUMBAR SYMPATHECTOMY As far down as the n inguinal ligament. Bilateral lumbar n sympathectomy in male can be followed by loss of the ejaculatory power.

LYMPH DRAINAGE Lymph nodes : Preaortic. n Para aortic (lumbar) n Lymph vessels : Cisterna chyli. n Thoracic duct. n

PREAORTIC LYMPH NODES Celiac. n Superior mesenteric. n Inferior mesenteric. n They are around the origin n of the corresponding arteries. They drain the GIT (lower n 1/3 of esophagus to upper ½ of anal canal), pancreas, spleen, gall bladder and most of liver.

PREAORTIC LYMPH NODES Their efferent n vessels pass to the intestinal lymph trunk.

PARA AORTIC (LATERAL) LYMPH NODES. Their afferent vessels n are from : Kidneys and suprarenal n glands. Testes & ovaries. n Uterine tubes & fundus n of uterus. Common iliac nodes. n Deep lymph vessels of n abdominal wall.

PARA AORTIC (LUMBAR) LYMPH NODES. Their efferent n vessels form the right and left lumbar lymph trunks.

CISTERNA CHYLI It is below the n diaphragm to the right of the aorta in front of the 1 st and 2 nd lumbar vertebrae.

CISTERNA CHYLI It receives lymph from : n Intestinal trunk. n Right and left lumbar n trunks. Lower part of the thorax. n Its efferent is the Thoracic n Duct.