Autonomics and Neurogenic Bladder Flashcards
The intermediolateral cell column is found at what spinal levels?
T1-L2
The rostral ventrolateral medulla is associated with what reflex?
Baroreceptor reflex (and maintenance of BP)
What fibers are transmitted through the white rami communicantes?
Preganglionic sympathetic fibers
What ganglion is the main distribution center for sympathetic fibers of the head? What level?
Superior cervical ganglion (C4)
How do the post-ganglionic sympathetic fibers leave the sympathetic trunk?
Via grey rami communicantes => Cephalic arterial ramus => Periarterial plexus on the carotid arteries
What cranial nerves do the parasympathetic outputs travel in?
III - oculomotor
VII - Facial
IX - Glossopharyngeal
X - Vagus
What nucleus is involved with accommodation of the pupil? Cranial nerve? Where is it found?
Edinger-Westphal (PNS, CN II and III)
Found in the midbrain
What nucleus is involved with activation of lacrimal, submandibular, and sphenopalatine glands? What cranial nerve is it associated with? Where is it found?
Superior salivatory nucleus (CN VII)
Pons
What nucleus is involved with innervation of the parotid duct? What cranial nerve? Where is it found?
Inferior salivatory nucleus (CN IX)
Medulla
What nucleus is involved with outputs to visceral organs? What nucleus? Where is it found?
Dorsal nucleus of vagal nerve (CN X)
Medulla
What happens to the light reflex if CN II is lesioned?
No pupillary constriction or consensual response when light shined in affected eye
What happens to the pupillary light reflex if CN III is lesioned?
Affected eye has a large, dilated pupil that does not respond to direct light and does not produce a consensual response
Where do fibers from the superior salivatory nucleus synapse?
Sphenopalatine ganglion => lacrimal gland
Submandibular ganglion => submandibular and sublingual glands
Where do fibers from the inferior salivatory nucleus synapse?
Otic ganglion => parotid gland
Horner syndrome that has been caused by a preganglionic lesion has been damaged where?
Sympathetic chain (May have Pancoast tumor at apex of lung)
Horner syndrome that has been caused by a postganglionic lesion has been damaged where?
Internal carotid artery dissection (cavernous sinus)
Horner syndrome with normal facial swelling, no pupil dilation in response to release of NE, and an exaggerated pupil dilation in response to E has been lesioned where?
Post-ganglionic fibers
Horner syndrome that has been lesioned in CNS or pre-ganglionic fibers will have what response to epinephrine and norepinephrine?
NE - Pupil dilation
E - No pupil dilation
(also no sweating)
Where are the baroreceptors mainly found in the body? What do they respond to?
Carotid sinus (CN IX) - Increase AND decrease in BP
Aortic arch (CN X) - only increases in BP
What is the effect of the nucleus ambiguus on sympathetic motor activity? What is its overall effect on BP?
Inhibits sympathetic activity => Vasodilation of blood vessels => Lower BP
How is the valsalva maneuver work with baroreceptor reflex?
Valsalva => Increased intrathoracic pressure => less venous return to heart => decreased HR => syncope
When is carotid massage appropriate?
Evaluation of SVTs
Massage baroreceptors can stimulate vagal inhibition of the heart
What is the main consequence of baroreflex afferent failure?
Fluctuationg hypertension
What is the main consequence of baroreflex efferent failure?
Orthostatic hypotension
What nerve fibers are involved in preventing urinary incontinence? What levels? What is their action on the detrusor M. and Internal urethral sphincter?
Lumbar Sympathetics (T12-L2), sacral splanchnic N/hypogastric N.
Relax detrusor
Contract internal urethral
(don’t want to pee during the test)
What nerve fibers are involved in voiding the bladder? From what levels? What is their action on the detrusor M. and the internal urethral sphincter?
Sacral parasympathetics (S2-4), pelvic splanchnic Ns.
Contract detrusor m.
Relax internal urethral sphincter
In the micturition reflex, where are the excitatory and inhibitory signals sent?
Excitatory => Sacral parasympathetic nucleus
Inhibitory => Onuf nucleus
What cortex is involved in voluntary inhibition of the micturition reflex?
Medial frontal cortex
Uninhibited neurogenic bladder is caused by a lesion where?
Medial frontal cortex => unable to inhibit pontine micturition center
(seen in elderly, w/ parkinson’s, hydrocephalus, dementia, meningioma)
Lesion between the pontine micturition center and the sacral spinal cord will cause what type of neurogenic bladder?
Spastic bladder - lack of coordination b/w detrusor and sphincter
(occurs in trauma or multiple sclerosis)
Spastic bladder has what effect on bladder volume, intravesicular pressure, and retention?
Decreased bladder volume
Increased intravesicular pressure => hypertrophy of bladder wall => volume reduction
Urinary retention occurs in late phase
Where is the lesion in a flaccid neurogenic bladder?
Sacral spinal cord/Cauda equina/Conus medullaris
What happens to bladder volume, intravesicular pressure, retention, and anal reflex?
Increased bladder volume
Decreased intravesicular pressure
Urinary retention
Absent anal reflex and perianal anesthesia
