CP Neurology Flashcards
Where are the four primary restriction points of the esophagus?
At the…
Cricopharyngeus muscle
Arch of the aorta
Left main bronchus
Passage of the esophagus through the diaphragm
What major nerve does the left recurrent laryngeal nerve come off of?
The left vagus nerve
What nerve contributes to the anterior vagal trunk?
Left vagus nerve
What nerve contributes to the posterior vagal trunk?
Right vagus nerve
What three cervical nerves supply the phrenic nerve?
C3, C4, C5
Where will you find the phrenic nerve near to the heart?
Almost “buried in the heart.”
Between the fibrous pericardium and the mediastinal parietal pleura
What are the atypical intercostal nerves?
1-2
7-11
What are the three major branches of the intercostal nerves?
Lateral cutaneous branches
Muscular branches
Anterior cutaneous branches
(rami communicans and collaterals, too)
Why does the anterior ramus of the 1st thoracic spinal nerve make an atypical intercostal nerve?
Because most of the 1st thoracic spinal nerve joins with the brachial plexus.
Why is the second intercostal nerve atypical?
Because it makes a cutaneous branch that joins with “a brachial component” to make the intercostobrachial nerve
Why are intercostal nerves 7-11 atypical?
As they run around the ribs, they continue past the ribs and become thoracoabdominal nerves
Where is the lateral horn of the spinal cord found?
T1-L2
What do we call a presynaptic nerve fiber heading to a prevertebral ganglion?
A Splanchnic nerve
What are the five major divisions of the parasympathetic element of the vagus nerve in the thorax?
Superior cardiac branch
Middle cardiac branch
Inferior cardiac branch
Pulmonary branches
Esophageal branches
What are the sympathetic and parasympathetic contributions to the:
Pulmonary plexus
Sympathetic: Pulmonary splanchnic nerves
Parasympathetic: Pulmonary branch of the vagus nerve
What are the sympathetic and parasympathetic contributions to the:
Superficial and Deep Cardiac Plexus
Sympathetic: Cardiac Splanchnic Nerves
Parasympathetic: Superior, Middle, and Inferior Cardiac branches of the vagus nerve.
The aortic plexus has the same sympathetic and parasympathetic contribution as what other plexus?
The cardiac plexus
(Cardiac splanchnic nerves / Superior, middle, and inferior cardiac branches of the vagus nerve.)
What are the sympathetic and parasympathetic contributions to the:
Esophageal Plexus
Sympathetic: Greater splanchnic nerve
Parasympathetic: Esophageal branches of the vagus nerve
What are the regions of the esophagus?
Cervical Part
Thoracic Part: T1-esophageal hiatus of diaphragm
Abdominal Part
What are the upper and lower sphincters of the esophagus?
At the Cricopharyngeus M. (Upper esophageal constrictor)
At the Esophageal Hiatus of the Thoracic Diaphragm (Lower esophageal sphincter)
What are three other branches off of the Vagus N.?
Left Recurrent Laryngeal N. (Loops under Lig. Arteriosum)
Anterior Vagal Trunk
Posterior Vagal Trunk
The PNS has limited distribution in the head/neck/trunk, whereas sympathetic innervation
distributes to all vascular areas of the body and contributes indirectly to non-sweat gland secretions through vasoconstriction
Glandular secretion is stimulated by
PNS (except sweat glands)
Are the coronary arteries sympathetically stimulated to vasoconstrict?
NO
What paravertebral sympathetic ganglia that contains presynaptic sympathetic nerve fibers is presence in the thorax?
Thoracic Sympathetic Trunk
What are the presynaptic cell bodies in the lateral horn of the SC at T1-5/6 synapsing in the cervical and thoracic sympathetic trunks called?
Cardiac Splanchnic N. (send fibers to the superficial and deep cardiac plexus)
what are the presynaptic cell bodies in the lateral horn of the spinal cord at levels T2-3 that synapse onto the postsynaptic cell bodies in the thoracic sympathetic trunk called?
Pulmonary splanchnic N. (send fibers to the pulmonary plexus)
What are the spinal levels and associations of the Greater Splanchnic N?
T5-9/10
sends fibers to esophageal plexus and celiac ganglion/plexus
What are the spinal levels for the Lesser Splanchnic N. and where do its fibers go?
T10-11
sends fibers to the celiac and superior mesenteric ganglion/plexus
What is the spinal level of the Least Splanchnic N. and where do its fibers go?
T12
sends fibers to the aorticorenal ganglion
What does the superior cardiac branch originate and where does it go?
originates in neck and goes through the superior aperture with the cardiac splanchnic nerves to form the cardiac plexus
Where does the middle cardiac branch originate and where does it go?
originates in neck and goes through superior throacic aperture with cardiac splanchnic to make cardiac plexus
Where does the inferior cardiac branch originate and where does it go?
originates in the thorax and goes with cardiac splanchnic Ns. to make cardiac plexus
Where doe the esophageal branches come from and where do they go?
after making pulmonary branches, the vagus nerve becomes indistinguisable from the esophageal plexus that covers the inferior 2/3 of the esophagus
What is the function of the pulmonary plexus?
innervates lungs, bronchi and pleura
Symp: dilates bronchi, inhibits glands, vasoconstricts, visceral sensor
Parasymp: constricts bronchi, glands, vasodilates, cough reflex, sensor, chemoreceptor
What is the function of the Cardiac Plexus?
symp: nodal tissue in heart, contraction force, vasomotor to pericardium
Parasymp: decrease HR, reduces the force of heart contraction and vasoconstricts arteries
What is the function of the esophageal plexus?
Symp: inhibit peristalsis and esophageal glands
Parasymp: stimulates peristalsis and esophageal glands
Are cardiopulmonary splancnic N. post-synaptic or pre-synaptic
POST synaptic
presynaptic descend before synapsing
Are abdominopelvic splanchnic N. pre-synaptic or post-synaptic?
pre-synaptic (includes great, lesser and least splanchnic nerves)
Overview of the autonomic elements in the thorax:
Sympathetic
presynaptic cell bodies: lateral horn of Spinal Cord
presynaptic cell fibers: go to paravertebral ganglion at same level and become abdominopelvic splanchnic N.
post-synaptic cell bodies: at paravertebral ganglion in same or different level and prevertebral ganglion
Overview of the autonomic elements of the thorax:
Parasympathetic
presynaptic cell bodies: cranial part (brain stem) and sacral part
Presynatic cell fibers: cranial nerves or pelvic splanchnic N.
postsynaptic cell bodies: 4 cranial ganglia in the target organ
