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Anaesthetic FRCA Primary - Teaching Days > Basic Sciences - Autonomic Nervous System Physiology > Flashcards

Basic Sciences - Autonomic Nervous System Physiology Flashcards

1
Q

Global constituents of autonomic nervous system (ANS)

A

Afferent pathways
Efferent pathways

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2
Q

Role of afferent pathways in ANS

A

Transmit sensory information from visceral structures
Also chemical and mechanical data from chemo- and baro- receptors

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3
Q

Role of efferent pathways in ANS

A

Control cardiac muscle, smooth muscle and glands

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4
Q

Central components of the ANS

A

Midbrain
Medulla
Limbic system
Hypothalamus
Brainstem
Spinal cord

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5
Q

Limbic system

A

Emotion

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6
Q

Two main divisions of the ANS

A

Sympathetic nervous system (SNS)
Parasympathetic nervous system (PNS)

Often antagonistic

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7
Q

Parts of the body supplied by SNS

A

All parts of body including trunk and limbs

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8
Q

Parts of the body supplied by PNS

A

Viscera only
(except adrenal glands and gonads - only SNS supply)

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9
Q

Efferent pathways of both SNS and PNS structure

A

Preganglionic neurones
Intermediary ganglion
Postganglionic neurones

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10
Q

Preganglionic neurones features

A

Cell bodies in brain or lateral horns of spinal cord
Myelinated axons
Slow conducting B fibres

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11
Q

Number of postganglionic neurones innervated by each preganglionic neurone

A

8 to 9 postganglionic cells
Produces diffuse responses characteristic of ANS

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12
Q

Postganglionic neurones features

A

Unmyelinated
C fibres

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13
Q

Outflow of sympathetic efferent neurones

A

Thoracolumbar outflow
T1 - L2

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14
Q

Methods of preganglionic neurone axon termination

A

1) Most synapse in paravertebral sympathetic chain

2) Some pass through sympathetic chain via splanchnic nerves to synapse in a peripheral autonomic ganglion in abdo / pelvis

3) Few preganglionic fibres synapse directly with chromaffin cells in medulla of adrenal gland

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15
Q

Examples of peripheral autonomic ganglions in the abdomen or pelvis

A

Coeliac ganglion
Superior mesenteric ganglion
Inferior mesenteric ganglia

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16
Q

Location of preganglionic cell bodies in SNS

A

Lateral horns of spinal cord levels T1 - L2

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17
Q

Outflow of efferents in PNS

A

Cranio-sacral outflow from:
- Cranial nerves 3, 7, 9 and 10
- Spinal roots S2-4

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18
Q

Location of preganglionic cell bodies of PNS

A

Cranial nerve nuclei or lateral horns of sacral spinal cord

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19
Q

Parasympathetic ganglia sites from vagus an sacral efferents where preganglionic neurones synapse

A

Diffusely located in the walls of the viscera they supply

Eg. heart, gut, lungs

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20
Q

Parasympathetic ganglia sites from cranial nerve 3, 7 and 9 efferents where preganglionic neurones synapse

A

4 discrete intermediary ganglia:
- Ciliary
- Sphenopalatine
- Submaxillary
- Otic ganglion

21
Q

Sympathetic efferent outflow to head and neck

A

Indirect through sympathetic chain via superior, middle or inferior cervical ganglia

22
Q

Location of inferior cervical ganglion

A

Often fused with 1st thoracic ganglion to form the stellate ganglion at level C6

Just anterior to neck of first rib

23
Q

Approximate spinal level origin of sympathetic supply of different organs

A
24
Q

Visceral autonomic afferent and pain fibre course of travel

A

Travel with autonomic efferent nerves:

  • Pain fibres from lungs, bronchi and pelvis travel with PNS nerves
  • Pain fibres from abdo an heart travel with SNS nerves
25
Q

Referred pain

A

Pain from viscera is poorly localised and often ‘referred’ to corresponding somatic segment

26
Q

Use of thoracic sympathectomy

A

Treat severe Reynaud’s or hyperhidrosis of palms

27
Q

Use of lumbar sympathectomy

A

Treat circulatory insufficiency of lower limb or phantom limb pain

28
Q

Use of coeliac plexus bloack

A

Treat pain associated with upper GI malignancy or acute / chronic pancreatitis

29
Q

Neurotransmitters in the ANS

A

Acetylcholine
Noradrenaline

30
Q

Neurones in ANS which use ACh as neurotransmitter

A
  • All preganglionic neurones
  • All postganglionic PNS neurones
  • Postganglionic SNS neurones that innervate sweat glands and skeletal muscle blood vessels
31
Q

Neurones in ANS which use noradrenaline as neurotransmitter

A

All postganglionic SNS neurones EXCEPT postganglionic SNS neurones that innervate sweat glands and skeletal muscle blood vessels

32
Q

Types of ACh receptor

A

Muscarinic (M1 - M5)
Nicotinic

33
Q

Muscarinic ACh receptor location

A

Smooth muscle, glands, heart and the brain

34
Q

Muscarinic ACh receptor type

A

G protein linked
Blocked by atropine

35
Q

Nicotinic ACh receptor location

A

Sympathetic ganglia
Motor end plates of skeletal muscle

36
Q

Nicotinic ACh receptor type

A

Ligand gated ion channel
Unaffected by atropine

37
Q

Nicotinic ACh receptor actions mimicked by…?

A

Nicotine

38
Q

Muscarinic ACh receptor actions mimicked by…?

A

Muscarine

39
Q

Types of adrenergic receptor, their site and G protein type

A

Alpha 1, Vascular smooth muscle, Gi
Alpha 2, Brain, Gq
Beta 1, Heart, Gs
Beta 2, Lungs, Gs
Beta 3, Adipose tissue, Gs

40
Q

Adrenergic receptors and secondary messengers

A
41
Q

Adrenergic receptors with higher affinity for Noradrenaline

A

Alpha receptors

42
Q

Adrenergic receptors with higher affinity for Adrenaline

A

Beta receptors

43
Q

Effects of ANS on cardiovascular system

A
44
Q

Effects of ANS on lungs, GI and skin

A
45
Q

Side effects of atropine

A

Pyrexia
Confusion
Bronchodilation
Dry mouth
Dilated pupils
Tachycardia
Dry secretions

46
Q

Side effects of neostigmine

A

GI spasms
Bradycardia
Nausea
Salivation
Bronchorrhoea
Bronchoconstriction

47
Q

Side effects of propranolol

A

Cold extremities
Worsened intermittent claudication
Wheeze

48
Q

Mechanism of action of propranolol (and therefore reason for side effects caused)

A

Non selective beta antagonist

49
Q

Reason for regional anaesthesia inducing sympathetic block

A

Sympathetic nerves travel with the somatic nerves

Anaesthetic FRCA Primary - Teaching Days (64 decks)

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