DSA Autonomic Nervous System Flashcards
What is the ANS
Two neuron chain connecting preganglionic neurons through ganglia to visceral target tissue like Cardiac muscles Smooth muscles Secretory glands Connective tissues Immune cells
Somatic nervous system
Voluntary control of the musculoskeletal system
Autonomic nervous system
Involuntary
Important for homeostasis
Regulated by hypothalamus, Limbic, and brainstem
3 sequential neurons in the output pathway
Sympathetic
Cervical ganglia
Paravertebral ganglia
Prevertebral ganglia
Cervical ganglia
Superior middle and stellate
Paravertebral ganglia
Thoracolumnar
Paravertebral ganglia
Celiac
Superior mesenteric
Inferior mesenteric
Parasympathetic
CN3, 7, 9, X, sacral s2,3,4
CN3
Eye
Cn7
Lacrimal , palatine and submandibular
Cn9
Parotid
CnX
Cardiopulmonary, GI
Sacral
Colon, rectum GU
Enteric nervous system
Capable of sustaining local reflex activity independent of CNS
Complex interactions between ANS and CNS
Paraganglia
Extrasuprarenal aggregations of chromatin tissue (abdominal, adrenal and paraspinal)
Synthesize and store catecholamines
Types of paraganglia
Pheochromocytoma 85%
Paraganglioma 5-15%
Symptoms of pheochromocytoma and paraganglia
Headache, sweating, tachycardia
Sympathetic vascular
Fascia, smooth muscle, and sweat glands, trunk and extremities
Sympathetic visceral
SM, cardiac, nodal and glandular tissue in thoracoabdominaopelvic cavity
Parasympathetic vascular
No
Parasympathetic viscera;
Same as sympathetic but also in viscera of head and neck
Adaptation
In stress-involves activation of neural, neuroendocrine, and neuroendocrine-immune mechanisms
Physiologic harmony
Maintains well being result of a relatively stable state or equilibrium among the interdependent body function
Allosteric load
Frequent activation of allosteric systems
Continuation of feedback pathways meant to reestablish normal homeostasis
Long term exposure may cause atrophy of the hippocampus affecting feedback, memory and autonomic function
Facilitated segment
Lowered neuronal threshold
Hypersensitivity of receptive fields
Goals of OMT to reestablish homeostasis and decrease energy
Reduce allostatic load by balancing ANS
Reduce postural strain
Improve biochemechanics of gait
Remove obstructions to fluid flow and drainage
Improve biomechanics of respiration
Augment fluid flow
Optimize tissue healing and homeostatic reserve
Limbic system
Hippocampus, amygdala, prefrontal cortex, cingulate cortec
Limbic system sends infor to
Hypothalamus
What does the hypothalamus give into to
Sympathetic and parasympathetic
What does sympathetic do
Lateral horn of the thoracolumbar spinal cord (CNS)—->PNS to paravertebral and prevertebral ganglia to end organ
What does parasympathetic send info to
Brainstem nuclei and lateral horn of the sacral spinal cord (CNS) —>PNS organ ganglia to end organ
The ___(-) system arising from the intermediolateral cell column of the lateral horn of the spinal cord, acting through chain ganglia and collateral ganglia-fight of flight
Thoracolumnar (t1-l2)
The ___ system arising from brain stem nuclei associated with CN _, _, _, _ and from intermediate gray __ of spinal cord
Craniosacral
3, 7, 9, 10
S2-s4
Homeostatic reparative system
Head neck innervation
T1-4
Heart lung innervation
T1-T6
Upper GI innervation
T5-T9
Small intestine and R colon innervation
T10-11
Appendix innervation
T12
L colon/pelvis innervation
T12-L2
Adrenal innervation
T10-T11
GU tract innervation
T10-L2
Ureter-upper/lower innervation
T10-11/T12-L2
Bladder innervation
T12-L2
Upper extremities innervation
T2-8
Lower extremity innervation
T11-L2
Vagus nerve
Heart, lungs, thyroid, carotid
Upper/middle GI, liver
Kidney, upper ureter
Ovaries/testes
S2-S4 pelvic splanchnic
Lower GI,uterus/cervix, penis/clitoris
Lower ureter, bladder
Vagus parasympathetic assessment
Look for condylar compression
Occipitomastoid structure restrictions
OA AA SD
Sacrum S2-4 assessment
Sacral SD
Distant ganglia (sympathetic) assessment
Cervical and celiac and mesenteric
What else look for for sympathetic
Appropriate spinal levels
Paraspinal msucle spasms
Rib restrictions
Threshold potential (spinal facilitation)
The maintenance of a pool of neurons in a state of partial or subthreshold excitation
-in this state, less afferent stimulation is required to trigger the discharge of impulses
Contributions to pain facilitation
Nociception Neuropathic Affective Cognitive Behavioral Opoid tolerance
Spinal facilitation
May be due to sustained increase in afferent input, aberrant patterns of afferent input, or changes within the affected neurons themselves or their environment
Once established, spinal facilitation can be sustained by normal ___
CNS activity
General techniques for balancing the ANS
CV4 osteopathic cranial manipulative technique
Regional techniques for balancing the ANS
Rib raising techniques
Paraspinal muscle inhibition
Abdominal collateral ganglia technique
Target non-neutral (type II) somatic dysfunction if present
Sphenopalatine ganglia release
Sacral inhibition and rocking
Sacroiliac joint gapping
OMT to decrease sympathetic activity
Rib raising techniques
Paraspinal msucle inhibition
Cervical ganglia inhibition
Abdominal collateral ganglia technique
Target non neutral (type II) somatic dysfunction if present
OMT to normalize parasympathetic tone
-suboccipital inhibition
Sphenopalatine ganglia release
Sacral inhibition and rocking
Sacroiliac joint gapping
Balanced ligamentous tension
Gentle muscle energy
52 yo female with chronic neck pain, stable 4 hrs s/p MI about to be transferred for angioplasty and stent placement
Neck pain? Cardiogenic?
Appropriate doses of MS Contin do not make pain gone
HEART INNERVATION
T1-T5
CNX
VISCERAL AND SOMATIC COMMON PATHWAYS
EVERY INTERNEURON THAT RECEIVES INPUT FROM A VISCERAL NOCICEPTORS ALSO RECEIVES INPUT FROM A SOMATIC SOURCE
ALMOST 80% OF INTERNEURONS THAT RECEIVE INPUT FROM SOMATIC STRUCTURES ALSO RECEIVE VISCERAL INPUT
What researchers distinguish visceral from somatic pain
Michael Patterson and Robert wurster
Louisa burns
Look at rabbits and induced SD weekly at tales, C6 and T3
Measured pulse, response to exercise, EKG, and tissue sample
See cardiac changes with vertebral lesion
T3 lesion functional change
Immediate-rapid weak and somewhat irregular pulse
10 min -slightly stronger, slower and more regulat…but did not return to normal as long as SD persisted
2 months-gradually weaker with staccato quality (ticking)..similar to that found in elderly
-not present in rabies without T3 SD
Atlas lesion SD induction
Immediate-stronger and irregular pulse
10 min-closer to normal as long as SD persisted
2 months-developed arrhythmias -result of vagus nerve facilitation
Atlas and T3 cardiac cross sections
Abnormalities in the muscle patterns
- abnormal color to tissue, irregular cross strait ions, abnormally abundant fibrils
- muscle fibers with variable nuclear relations
Edema, hemorrhagic areas, overgrowth of CT, neurotrophic
Reflex
Involuntary nervous system reponse toa. Sensory input. The sum total of any particular involuntary activity
Somatosomatic reflex
Localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures
Somatovisceral reflex
Localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures
Viscerosomatic reflex
Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures
Viscerovisceral reflex
Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures
Lung innervation
T2-4
CNX
Patient day 1 in hospital with smoke inhalation after being hospitalized after 2 days after surviving fire and discharged history of asthma
Address pain
OMT indirect
OMT lymphatics
Tread slowly just it of hospital
72 yo male ab surgery for tumors not popping on his own he is on ABR
SI T9-10, CNX
Ascending transverse T11-L1, CNX
Descending sigmoid L1-L2, S2-S4
5 principles
Posture motion Behavior Neurologic Metabolic Respiratory circulatory
Patient cant pee
Kidney T10-l1, CNX
Ureters T11-L2, CNX
Bladder T10-L1, S2-S4
Diaphragm restriction
Direct MFR
T10-L2 NRlSr, thoracolumbar junction myofascial restriction
BLT MFR
Quadratics lumborum on the right significantly hypertonic with TP bilaterally
Coutnerstrain-bilaterally
Bilateral SI joint compression; right pelvic hemidiaphragm ISD
MFR-indirect
Raynaud
Digital ischemia, manifested clinically by the sequential development of digital blanching, cyanosis and rubor of the fingers or toes after cold exposure and subsequent rewarding
Emotional strep may precipitate
Systemic sclerosis
CT disorder of unknown etiology, heterogenous clinical manifestations, and chronic and often progressive course
Diffuse cutaneous form of SSc (dcSSc)
Thickening of the skin (scleroderma) and distinctive involvement of multiple internal organs, most notably the lungs, gastrointestinal tract, heart, and kidneys
Early state of SSc
Prominent inflammatory features
Over time SSc
Develop functional and structural alterations in multiple vascular beds and progressive visceral organ dysfunction due to fibrosis
Carpal tunnel
Compression fo the median nerve in the carpal tunnel at the wrist
How does the median nerve enter the hand through the carpal tunnel
Coursing under the transverse carpal ligament
The symptoms of carpal tunnel
Numbness, paresthesia, variable in the thumb(or spread up hand and arm), index, middle and half of the ring finger
Pain in hand and forearm and sometimes in proximal arm
UE sympathetic supply to vasculature
Upper thoracic
Hand dermatomal and myotomes nerve supply
C6-8
5 models
Posture/motion
Psychology and behavior
Neurologic
Metabolic
Respiratory/circulatory
What does Limbic forebrain send to
Hippocampus, amygdala, prefrontal and cingulate cortex
What does the hippocampus, amygadala, prefrontal and cingulate cortex send infor to
Sympathetic and parasympathetic
Take home points
Through reflex interaction the ANS and the MSK system reflect each other
Osteopathic practices and principles can help in both diagnosing and treating these reflex interactions
The ANS is influenced by out psychological state and this also influences the MSK system and our viscera
