CPR Thoracic Neurology Flashcards
What is the role of the esophagus?
What is it composed of?
joins the laryngopharynx to the stomach
2 layer muscle tube (internal circular layer & external longitudinal layer)
Where is the esophagus located in the thorax?
between T1 & esophageal hiatus
travels thru posterior mediastinum
Name the constrictors of the esophagus
@ cricopharyngeus m (upper esophageal sphincter)
@ aortic arch
@ left bronchus
@ esophageal hiatus of thoracic diaphragm (lower esophageal sphincter)
Which CN is associated w/ thorax?
Where does it enter?
vagus N (R & L)
enters thru superior thoracic aperture
What are the branches of the vagus N in the thorax?
L recurrent laryngeal N
pulmonary branches
sup/middle/inferior cardiac branches
esophageal branches
anterior vagal trunk
posterior vagal trunk
Anterior v Posterior vagal trunks
anterior from L vagus N
posterior from R vagus N
What cervical spinal N is assoc w/ the thorax?
phrenic N (anterior rami of C3-5)
Where does the phrenic N travel?
thru superior thoracic aperature into space btwn mediastinal parietal pleura & fibrous pericardium
What does the phrenic N innervate?
thoracic diaphragm
What do the intercostal Ns innervate?
skin, subcutaneous tissue, muscles, and costal & diaphragmatic parietal pleura
What composes the intercostal Ns?
Where do they run?
anterior rami of thoracic spinal Ns
along inf edge of superior rib in the intercostal space btwn internal & innermost intercostal ms
What are the typical intercostal Ns?
3rd-6th intercostal Ns
Which intercostal Ns supply the breast?
lateral cutaneous branches & anterior cutaneous branches of T4-T6
What do the collateral branches of intercostal Ns 3-6 innervate?
Where do the collateral branches travel?
innervate intercostal ms
along sup edge of rib inf to intercostal space
What do the muscular branches of intercostal Ns 3-6 innervate?
intercostal ms
subcostal m
transversus thoracic m
What are the atypical intercostal Ns?
1st & 2nd, 7th-11th
What do the rami communicates of intercostal Ns 3-6 do?
connected intercostal N to ipsilateral sympathetic trunk
What makes the 1st intercostal N atypical?
no cutaneous branches & majority superior portion joins brachial plexus
What makes the 2nd intercostal N atypical?
majority travels in costal groove w/ small part joining w/ brachial plexus
lateral cutaneous branch supplies skin/tissue of axilla (intercostobrachial N)
Where does the intercostobrachial N originate?
2nd intercostal N
What makes the 7th-11th intercostal Ns atypical?
travel anteriorly & no longer exist btwn ribs
transition over abdomen to become thoracoadominal N
What are the general principles of the autonomic nervous system (ANS)?
sympathetic stimulation is catabolic (fight or flight)
parasympathetic stimulation is anabolic (normal function & energy conservation)
parasympathetic is only in head/neck & trunk viscera while sympathetic distributes to every vascular area of body
parasympathetic controls gland secretion (except sweat glands)
sympathetic can indirectly decrease non-sweat gland secretion via vasoconstriction
vasoconstriction is sympathetically stimulation (except of coronary As)
Where does sympathetic division of ANS arise from?
presynaptic fibers have cell bodies in lateral horn of spinal cord from T1-L2
Presynaptic fibers of sympathetic
cells bodies in lateral horn of SC
always travel in anterior root
always travel into anterior ramus
quickly exit anterior ramus & enter paravertebral ganglia
What are the 3 synaptic options for sympathetic presynaptic fibers?
synapse @ paravertebral ganglion of same SC level
ascend/descend to synapse @ paravertebral ganglion of different SC level
exit paravertebral ganglion w/o synapsing & continue with abdominopelvic splanchnic nerve to a postsynaptic neuron in PREvertebral ganglion
Describe the paravertebral ganglia
contain postsynaptic cell bodies
linked vertically to form sympathetic trunks
3 ganglia exist in cervical, lumbar & pelvic regions
Describe the prevertebral ganglia
contain postsynaptic cell bodies
ganglia & corresponding plexuses surrounding the main unpaired branches of abdominal aorta
What are the 4 prevertebral ganglia?
celiac ganglion
superior mesenteric ganglion
aorticorenal ganglion
inferior mesenteric ganglion
Describe the sympathetic presence in the thorax
thoracic sympathetic trunk
cardiopulmonary splanchnic Ns
abdominopelvic splanchnic Ns
What is the thoracic sympathetic trunk?
paravertebral sympathetic ganglia
location of short presynaptic sympathetic fibers synapses w/ long postsynaptic cell bodies
Where are the presynaptic cell bodies of the cardiac splanchnic Ns?
where do these Ns synapse & send info?
pre cell bodies are in lateral horn of SC @ T1-T5/6
synapse @ postsynaptic cell bodies in cervical & thoracic sympathetic trunks (sending fibers to superficial & deep cardiac plexuses)
Where are the presynaptic cell bodies of the pulmonary splanchnic Ns?
where do they synapse & send info?
pre cell bodies in lateral horn of SC @ T2-3
synapse on postsynaptic cell bodies in thoracic sympathetic trunk (sending fibers to pulmonary plexus)
What are the 3 divisions of abdominopelvic splanchnic Ns?
Greater Splanchnic N
Lesser Splanchnic N
Least Splanchnic N
Greater Splanchnic N
T5-T9/10
send fibers to esophageal plexus & celiac ganglion in abdomen
feeds into celiac plexus
Lesser Splanchnic N
T10 & T11
send fibers to celiac & superior mesenteric ganglion in abdomen
feeds into superior mesenteric plexus
Least Splanchnic N
T12
sends fibers to aorticorenal ganglion in abdomen
What nerves make up the parasympathetic nervous system?
cranial components exit as CN III, VII, IX, X
sacral components exit spinal levels as pelvic splanchnic Ns (S2-4)
Where are the nuclei of parasympathetic NS?
nuclei in brainstem & sacral spinal levels
Where are the postsynaptic nuclei of the parasympathetic NS?
4 cranial ganglia or in wall of target organ (intrinsic parasympathetic ganglia)
What are the 4 cranial ganglia receiving parasympathetic stimulation?
Ciliary ganglion (CN III) Pterygopalatine ganglion (CN VII) Submandibular Ganglion (CN VII) Otic Ganglion (CN IX)
Parasympathetic present in thorax
vagus N
What does the vagus N provide innervation to in the thorax?
presynaptic innervation of lungs, bronchi, pleurae, heart & pericardium
What forms the cardiac plexus?
superior, middle & inferior cardiac branches of vaus N (paraysympathetic)
travel w/ cardiac splanchnic Ns (sympathetic)
What forms the pulmonary plexus?
pulmonary branches of vagus N (parasympathetic) traveling w/ pulmonary splanchnic Ns (sympathetic)
What forms the esophageal plexus?
parasympathetic from esophageal branches of vagus N (covers inf 2/3 of esophagus)
sympathetic from greater splanchnic N & aortic plexus
What are the thoracic autonomic plexuses?
Pulmonary plexus
Cardiac plexus
Aortic plexus
Esophageal plexus
What are the sympathetic functions of the pulmonary plexus?
dilate bronchi & bronchioles
inhibits glands of bronchi & bronchioles
constricts pulmonary vessels
visceral sensory from lungs/bronchi/pleurae
What are the parasympathetic functions of the pulmonary plexus?
constrict bronchi & bronchioles
increases gland secretion of bronchi & bronchioles
dilator of pulmonary vessels
sensory from bronchial mucosa (cough reflex)
reflex of interalveolar CT
pressure sensory from pulmonary A
chemoreceptor from pumonary V
Where do the postsynaptic fibers of the cardiac plexus terminate?
near SA & AV nodes
What are the sympathetic functions of the cardiac plexus?
increase HR via innervation of nodal tissue
increase force of heart contractions
vasomotor to pericardium
What are the parasympathetic functions of the cardiac plexus?
decrease HR
reduces force of heart contraction
vasoconstrics coronary arteries
Where is the superficial cardiac plexus?
Where is the deep cardiac plexus?
covers anterior surface of aorta
anterior to bifurcation of trachea, posterior to aortic arch & superior to bifurcation of pulmonary trunk
What is the aortic plexus?
continuous superiorly w/ superficial cardiac plexus & continues inferiorly as arotic plexus in abdomen
Where does the aortic plexus feed?
intermesenteric plexus
What are the sympathetic functions of the esophageal plexus?
inhibit peristalsis
inhibits esophageal glands
What are the parasympathetic functions of the esophageal plexus?
stimulates peristalsis
stimulates esophageal glands
