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Autonomic Nervous System Flashcards

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1
Q

Autonomic Nervous System (ANS)

Regulation of Function ~

A

paired endocrine (slow / long-lasting) and ANS (rapid / short-acting)

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2
Q

Autonomic Nervous System

Sensory System ~

A

GVA from only the core, NOT the periphery

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3
Q

ANS Sensory System Receptors:

A

nocireceptors (pain), mechanoreceptors (fullness), other specialized receptors

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4
Q

ANS Sensory System Cell Bodies:

A

pseudounipolar neurons in DRG of T1-L2 (SNS) + S2-S4 (PaNS) and CN IX / X nuclei

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5
Q

Autonomic Nervous System

Motor System ~

A

rapid single/multi-synaptic effector motor system with sensory input @ spinal cord, brainstem and cerebral hemisphere

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6
Q

ANS Motor System Efferent (GVE):

A

2-neuron system; contrast w/somatic (GSE) 1-neuron

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7
Q

ANS Motor System Target:

A

smooth muscle (BP / peristalsis), cardiac muscle (HR, Force) and glands (secretion)

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8
Q

ANS Motor System Core + Periphery:

A

parasympathetics only core; SNS both core & periphery

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9
Q

Input to ANS =

A

Hypothalamus

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10
Q

ANS 1° Neuron has cell body in

A

hypothalamus —> axon via descending pathways to:

a) PaNS: CN III, VII, IX and X nuclei in brainstem/medulla + S2-S4 lateral horn
b) SNS: intermediolateral horn of T1-L2

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11
Q

Sympathetic (Thoracolumbar T1-L2)

1° Neuron (descending pathway) —>

A

2° Neuron (Interomedolateral Horn) —> Ventral Root —> White Rami —> Sym Chain

  • Synapse: at same level —> gray rami —> peripheral nerve
  • Rise/Drop: at different level —> gray rami —> peripheral nerve at different level
  • Leaves w/Out Synapse: synapses in prevertebral ganglion (splanchnic); pelvic + abdominal viscera
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12
Q

Sympathetic (Thoracolumbar T1-L2)

Preganglionic —> Postganglionic

A

Preganglionic —> AcH —> Postganglionic —> NorEpi
- Exception: sweat glands + erector pili muscle receive AcH
- Note: adrenal medulla chromaffin cells get direct
preganglionic with AcH

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13
Q

Parasympathetic (Craniosacral)

CN III:

A

Edinger-Westphal (Midbrain) —> Ciliary Ganglion

—> Constrict Pupil

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14
Q

Parasympathetic (Craniosacral)

CN VII:

A

Superior Salivatory (↑Medulla) —> PP/SMD —> Lacrimal/Salivary

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15
Q

Parasympathetic (Craniosacral)

CN IX:

A

Inferior Salivatory (↑Medulla) —> Otic —> Parotid Gland

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16
Q

Parasympathetic (Craniosacral)

CN X:

A

Nucleus Ambiguus/Dorsal Motor Nuc of Vagus (mid-Medulla) —> Visceral —> bronchioconstriction, ↓HR, dilate abdominal arteries

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17
Q

Parasympathetic (Craniosacral)

S2-S4:

A

Lateral Horn S2-S4 —> syn peripheral —> desc colon/pelvic viscera

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18
Q

Parasympathetic (Craniosacral)

Preganglionic —> Postganglionic

A

Preganglionic —> AcH —> postganglionic —> AcH

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19
Q

Enteric System Organization:

A

receives SNS (tertiary neuron w/NorEpi) and PaNS (AcH) + intrinsic enteric nervous system = Myenteric / Submucosal Plexi

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20
Q

Myenteric (Auerbach) Plexus =

A

between circular and longitudinal muscle layer; regulates smooth muscle / motility

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21
Q

Submucosal (Meissner) Plexus =

A

between muscularis mucosa and circular smooth muscle; regulates glandular secretions

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22
Q

Enteric System can operate independently of

A

ANS; final common pathway is via enteric neurons with AcH as nueroTx

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23
Q

Parasympathetics
Eye
Targets/Response

A

Pupil = Constricts
radial muscle = contracts
ciliary muscle = contracts
near vision

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24
Q

Sympathetics
Eye
Targets/Response

A

Pupil = Dilates
radial muscle = relaxes
ciliary muscle = relaxes
far vision

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25
Parasympathetics Gland Targets/Response
``` Lacrimal = ↑ Salivary = watery Parotid = watery Sweat = n/a ```
26
Sympathetics Gland Targets/Response
``` Lacrimal = n/a Salivary = thick Parotid = thick Sweat = ↑ ```
27
Parasympathetics Heart Targets/Response
Muscle = ↓ force Coronary Arteries = dilate SA/AV Nodes = ↓ rate/conduction
28
Sympathetics | Heart
Muscle = ↑ force Coronary Arteries = constrict (ɑ) / dilate (β) SA/AV Nodes = ↑ rate/conduction
29
Parasympathetics Arterioles Targets/Response
``` Skin = Dilate Skeletal = Dilate Pulmonary = Dilate Abdominal = Dilate Renal = Dilate ```
30
Sympathetics Arterioles Targets/Response
``` Skin = constrict (ɑ) / dilate (β) Skeletal = constrict (ɑ) / dilate (β) Pulmonary = constrict (ɑ) / dilate (β) Abdominal = constrict (ɑ) / dilate (β) Renal = constrict (ɑ) / dilate (β) ```
31
Parasympathetics | Lung
Bronchial Muscle = Contracts (constricting bronchi)
32
Sympathetics | Lung
Bronchial Muscle = Dilates bronchi
33
Parasympathetics GI Targets/Response
Wall Muscle = ↑ Peristalsis Sphincter Muscle = opens Secretions = ↑
34
Sympathetics GI Targets/Response
Wall Muscle = ↓ Peristalsis Sphincter Muscle = close Secretions = ↓
35
Parasympathetics Pancreas Targets/Response
Endocrine Pancreas = ↑ Insulin-glucagon
36
Sympathetics Pancreas Targets/Response
Endocrine Pancreas = ↑ glucagon; ↓insulin | *(both SNS/PaNS ↑glucagon)*
37
Parasympathetics Liver Targets/Response
Hepatocytes = n/a
38
Sympathetics Liver Targets/Response
Hepatocytes = ↑ glycogenolysis
39
Parasympathetics Adrenal Targets/Response
Chromaffin Cells = n/a
40
Sympathetics Adrenal Targets/Response
Chromaffin Cells = ↑ epinephrine
41
Parasympathetics Ureter/Bladder Targets/Response
Wall muscle = ↑ contraction | Sphincter = relaxes
42
Sympathetics Ureter/Bladder Targets/Response
Wall muscle = relaxes | Sphincter = ↑ contraction
43
Parasympathetics Reproductive Targets/Response
Erectile Tissue = “point” = erection (relaxes vessels)
44
Sympathetics Reproductive Targets/Response
Erectile Tissue = “shoot” = ejaculation
45
Signs of ANS Damage
- Syncope (fainting), Near Syncope (light headedness), orthostasis (syncopic episodes when rising) ~ CN X - Constipation (↓PaNS), Diarrhea (↑PaNS), Urinary Incontinence/Retention ~ CN X / SNS - Skin flushing, pallor, Raynaud’s ~ SNS (ɑ / β receptors)
46
Horner’s Syndrome
Sympathetic lesion anywhere from hypothalamus to ciliary nerves
47
Horner’s Syndrome | Two Types of Lesions:
- Patient with C8-T1 spinal cord lesion ---> Central Horner’s Syndrome - Patient with C8-T1 nerve root lesion ---> Peripheral Horner’s Syndrome ∴Anything before first synapse in interomediolateral horn = Central
48
Horner’s Syndrome Sympathetic Course
1. 1° Neuron originate in hypothalamus --> spinal cord to T1/T2 ---> Synapse 2. 2° Neuron (interomediolateral horn) --> exit T1/T2 --> sup cervical gangl 3. Tertiary Neuron (sup cer gan) --> carotid plexus - -> long/short ciliary nn 4. Target: tarsal muscle (eyelid) + dilator
49
Horner’s Syndrome Presentation
1. Meiosis: small pupil 2. Ptosis: drooping eyelid 3. Anhidrosis: inability to sweat - Complete Loss on 1 Side = Central Lesion (hypo, brainstem, spinal cord) - Head/Neck Only = Peripheral Lesion (T1/T2, Chain, Carotid Plexus)
50
Cardiovascular Function Via
CN IX and X
51
Cardiovascular Function Baroreceptors:
sense pressure; found in aortic arch & carotid sinus
52
Cardiovascular Function Chemoreceptors:
sense O2/CO2 content; found in carotid body
53
Cardiovascular Course CN IX and X:
all afferent (GVA) via CN IX and X 1. ΔBP / CaO2 ---> GVA ---> Nucleus of Solitary Tract 2. Interneurons communicate to Nucleus Ambiguus / Dorsal Motor Nucleus - Consequence is GVE via CN X to ↓HR / BP 3. Interneurons communicate to Rostral Ventroalteral Medulla ---> preganglionic sympath in lateral horn - Consequence is GVE via 2° --> tertiary sympathetics to ↑HR / BP
54
ANS Disease | Neurodegnerative
1. Multisystemic Atrophy | 2. Idiopathic Parkinson’s Disease
55
ANS Disease | Acute Neuropathies
1. Guillan Barre (Acute Inflammatory Demyelination) 2. Acute Autonomic Neuropathy 3. Paraneoplastic (Eaton-Lambert)
56
ANS Disease | Chronic Neuropathies
1. Diabetes 2. Amyloidosis 3. EtOH 4. Chemotherapy (MT Damagers) 5. HIV 6. Infectious: lyme disease / syphilis 7. Hereditary Sensory Neuropathy ~ Riley-Day
57
Pre-Synaptic ~
Δ synthesis, storage or release of neuroTx
58
Pre-Synaptic ↓ Synthesis --->
↓AcH or NorEpi
59
Pre-Synaptic Metabolic Transformation of Precursor --->
replace NorEpi with methyl-NorEpi (~clonidine ~ ɑ2 agonist) ---> ↓SNS outflow
60
Pre-Synaptic Block Reuptake --->
accumulation of NorEpi + ↓choline recycling (but recall AcH would still be degraded)
61
Pre-Synaptic Block Transport / Storage Vesicle --->
↓AcH storage + destroy NorEpi via mitochondrial MAO
62
Pre-Synaptic Promote Exocytosis of neuroTx from Storage --->
↑AcH or NorEpi activity
63
Pre-Synaptic Prevent Exocytosis of neuroTx --->
↓AcH or NorEpi activity
64
Post-Synaptic ~
Δ binding or physiologic effect
65
Post-Synaptic Mimic neuroTx ~
effect determined by location of receptors
66
Post-Synaptic Block Post-Synaptic Receptor ~
effect determined by location
67
Post-Synaptic inhibition of Enzymatic Breakdown ~
↑AcH, little effect on NorEpi (adjunctive agents in Parkinson’s)

Clinical Neuroscience (14 decks)

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