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DSA Autonomic Nervous System Flashcards

1
Q

What is the ANS

A 
Two neuron chain connecting preganglionic neurons through ganglia to visceral target tissue like 
Cardiac muscles
Smooth muscles
Secretory glands
Connective tissues
Immune cells
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2
Q

Somatic nervous system

A

Voluntary control of the musculoskeletal system

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3
Q

Autonomic nervous system

A

Involuntary
Important for homeostasis
Regulated by hypothalamus, Limbic, and brainstem

3 sequential neurons in the output pathway

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4
Q

Sympathetic

A

Cervical ganglia

Paravertebral ganglia

Prevertebral ganglia

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5
Q

Cervical ganglia

A

Superior middle and stellate

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6
Q

Paravertebral ganglia

A

Thoracolumnar

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7
Q

Paravertebral ganglia

A

Celiac
Superior mesenteric
Inferior mesenteric

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8
Q

Parasympathetic

A

CN3, 7, 9, X, sacral s2,3,4

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9
Q

CN3

A

Eye

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10
Q

Cn7

A

Lacrimal , palatine and submandibular

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11
Q

Cn9

A

Parotid

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12
Q

CnX

A

Cardiopulmonary, GI

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13
Q

Sacral

A

Colon, rectum GU

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14
Q

Enteric nervous system

A

Capable of sustaining local reflex activity independent of CNS

Complex interactions between ANS and CNS

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15
Q

Paraganglia

A

Extrasuprarenal aggregations of chromatin tissue (abdominal, adrenal and paraspinal)

Synthesize and store catecholamines

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16
Q

Types of paraganglia

A

Pheochromocytoma 85%

Paraganglioma 5-15%

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17
Q

Symptoms of pheochromocytoma and paraganglia

A

Headache, sweating, tachycardia

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18
Q

Sympathetic vascular

A

Fascia, smooth muscle, and sweat glands, trunk and extremities

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19
Q

Sympathetic visceral

A

SM, cardiac, nodal and glandular tissue in thoracoabdominaopelvic cavity

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20
Q

Parasympathetic vascular

A

No

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21
Q

Parasympathetic viscera;

A

Same as sympathetic but also in viscera of head and neck

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22
Q

Adaptation

A

In stress-involves activation of neural, neuroendocrine, and neuroendocrine-immune mechanisms

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23
Q

Physiologic harmony

A

Maintains well being result of a relatively stable state or equilibrium among the interdependent body function

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24
Q

Allosteric load

A

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

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25
Q

Facilitated segment

A

Lowered neuronal threshold

Hypersensitivity of receptive fields

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26
Q

Goals of OMT to reestablish homeostasis and decrease energy

A

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

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27
Q

Limbic system

A

Hippocampus, amygdala, prefrontal cortex, cingulate cortec

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28
Q

Limbic system sends infor to

A

Hypothalamus

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29
Q

What does the hypothalamus give into to

A

Sympathetic and parasympathetic

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30
Q

What does sympathetic do

A

Lateral horn of the thoracolumbar spinal cord (CNS)—->PNS to paravertebral and prevertebral ganglia to end organ

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31
Q

What does parasympathetic send info to

A

Brainstem nuclei and lateral horn of the sacral spinal cord (CNS) —>PNS organ ganglia to end organ

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32
Q

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

A

Thoracolumnar (t1-l2)

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33
Q

The ___ system arising from brain stem nuclei associated with CN _, _, _, _ and from intermediate gray __ of spinal cord

A

Craniosacral
3, 7, 9, 10

S2-s4

Homeostatic reparative system

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34
Q

Head neck innervation

A

T1-4

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35
Q

Heart lung innervation

A

T1-T6

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36
Q

Upper GI innervation

A

T5-T9

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37
Q

Small intestine and R colon innervation

A

T10-11

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38
Q

Appendix innervation

A

T12

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39
Q

L colon/pelvis innervation

A

T12-L2

40
Q

Adrenal innervation

A

T10-T11

41
Q

GU tract innervation

A

T10-L2

42
Q

Ureter-upper/lower innervation

A

T10-11/T12-L2

43
Q

Bladder innervation

A

T12-L2

44
Q

Upper extremities innervation

A

T2-8

45
Q

Lower extremity innervation

A

T11-L2

46
Q

Vagus nerve

A

Heart, lungs, thyroid, carotid

Upper/middle GI, liver

Kidney, upper ureter

Ovaries/testes

47
Q

S2-S4 pelvic splanchnic

A

Lower GI,uterus/cervix, penis/clitoris

Lower ureter, bladder

48
Q

Vagus parasympathetic assessment

A

Look for condylar compression

Occipitomastoid structure restrictions

OA AA SD

49
Q

Sacrum S2-4 assessment

A

Sacral SD

50
Q

Distant ganglia (sympathetic) assessment

A

Cervical and celiac and mesenteric

51
Q

What else look for for sympathetic

A

Appropriate spinal levels

Paraspinal msucle spasms

Rib restrictions

52
Q

Threshold potential (spinal facilitation)

A

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

53
Q

Contributions to pain facilitation

A 
Nociception
Neuropathic
Affective
Cognitive
Behavioral
Opoid tolerance
54
Q

Spinal facilitation

A

May be due to sustained increase in afferent input, aberrant patterns of afferent input, or changes within the affected neurons themselves or their environment

55
Q

Once established, spinal facilitation can be sustained by normal ___

A

CNS activity

56
Q

General techniques for balancing the ANS

A

CV4 osteopathic cranial manipulative technique

57
Q

Regional techniques for balancing the ANS

A

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

58
Q

OMT to decrease sympathetic activity

A

Rib raising techniques

Paraspinal msucle inhibition

Cervical ganglia inhibition

Abdominal collateral ganglia technique

Target non neutral (type II) somatic dysfunction if present

59
Q

OMT to normalize parasympathetic tone

A

-suboccipital inhibition

Sphenopalatine ganglia release

Sacral inhibition and rocking

Sacroiliac joint gapping

Balanced ligamentous tension

Gentle muscle energy

60
Q

52 yo female with chronic neck pain, stable 4 hrs s/p MI about to be transferred for angioplasty and stent placement

A

Neck pain? Cardiogenic?

Appropriate doses of MS Contin do not make pain gone

61
Q

HEART INNERVATION

A

T1-T5

CNX

62
Q

VISCERAL AND SOMATIC COMMON PATHWAYS

A

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

63
Q

What researchers distinguish visceral from somatic pain

A

Michael Patterson and Robert wurster

64
Q

Louisa burns

A

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

65
Q

T3 lesion functional change

A

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

66
Q

Atlas lesion SD induction

A

Immediate-stronger and irregular pulse
10 min-closer to normal as long as SD persisted

2 months-developed arrhythmias -result of vagus nerve facilitation

67
Q

Atlas and T3 cardiac cross sections

A

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

68
Q

Reflex

A

Involuntary nervous system reponse toa. Sensory input. The sum total of any particular involuntary activity

69
Q

Somatosomatic reflex

A

Localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures

70
Q

Somatovisceral reflex

A

Localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures

71
Q

Viscerosomatic reflex

A

Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures

72
Q

Viscerovisceral reflex

A

Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures

73
Q

Lung innervation

A

T2-4

CNX

74
Q

Patient day 1 in hospital with smoke inhalation after being hospitalized after 2 days after surviving fire and discharged history of asthma

A

Address pain
OMT indirect
OMT lymphatics
Tread slowly just it of hospital

75
Q

72 yo male ab surgery for tumors not popping on his own he is on ABR

A

SI T9-10, CNX

Ascending transverse T11-L1, CNX

Descending sigmoid L1-L2, S2-S4

76
Q

5 principles

A 
Posture motion 
Behavior
Neurologic
Metabolic
Respiratory circulatory
77
Q

Patient cant pee

A

Kidney T10-l1, CNX
Ureters T11-L2, CNX

Bladder T10-L1, S2-S4

78
Q

Diaphragm restriction

A

Direct MFR

79
Q

T10-L2 NRlSr, thoracolumbar junction myofascial restriction

A

BLT MFR

80
Q

Quadratics lumborum on the right significantly hypertonic with TP bilaterally

A

Coutnerstrain-bilaterally

81
Q

Bilateral SI joint compression; right pelvic hemidiaphragm ISD

A

MFR-indirect

82
Q

Raynaud

A

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

83
Q

Systemic sclerosis

A

CT disorder of unknown etiology, heterogenous clinical manifestations, and chronic and often progressive course

84
Q

Diffuse cutaneous form of SSc (dcSSc)

A

Thickening of the skin (scleroderma) and distinctive involvement of multiple internal organs, most notably the lungs, gastrointestinal tract, heart, and kidneys

85
Q

Early state of SSc

A

Prominent inflammatory features

86
Q

Over time SSc

A

Develop functional and structural alterations in multiple vascular beds and progressive visceral organ dysfunction due to fibrosis

87
Q

Carpal tunnel

A

Compression fo the median nerve in the carpal tunnel at the wrist

88
Q

How does the median nerve enter the hand through the carpal tunnel

A

Coursing under the transverse carpal ligament

89
Q

The symptoms of carpal tunnel

A

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

90
Q

UE sympathetic supply to vasculature

A

Upper thoracic

91
Q

Hand dermatomal and myotomes nerve supply

A

C6-8

92
Q

5 models

A

Posture/motion

Psychology and behavior

Neurologic

Metabolic

Respiratory/circulatory

93
Q

What does Limbic forebrain send to

A

Hippocampus, amygdala, prefrontal and cingulate cortex

94
Q

What does the hippocampus, amygadala, prefrontal and cingulate cortex send infor to

A

Sympathetic and parasympathetic

95
Q

Take home points

A

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

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