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PNS -- Torgerud > Final: Unit VII--Sympathetics > Flashcards

Final: Unit VII--Sympathetics Flashcards

1
Q

Where are cell bodies located for preganglionic sympathetic neurons?

A

lateral horn or cord levels T1-L2 or L3

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2
Q

How do the preganglionic sympathetic neurons exit the cord?

A

in anterior rootlets

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3
Q

What do the preganglionic sympathetic neurons follow as they exit the cord?

A

anterior primary ramus

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4
Q

When the preganglionic sympathetic neurons exit the anterior primary ramus, what do they enter and how?

A

enter sympathetic trunk via white ramus communicans

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5
Q

Where do most preganglionic sympathetic neurons synapse?

A

on postganglionic cells in ganglia of sympathetic trunk

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6
Q

What will some preganglionic sympathetic neurons do that are not synapsing in the sympathetic trunk?

A

they pass THROUGH the sympathetic trunk and are carried in splanchnic nerves–> to synpase in prevertebral plexuses ass. w/ abdominopelvis viscera

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7
Q

What main NT do preganglionic sympathetic fibers release?

A

ACh

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8
Q

What does the sympathetic trunk consist of?

A

two paravertebral columns of interconnected ganglia

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9
Q

What can fibers do once they enter the sympathetic trunk?

A

ascend or descend

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10
Q

Where does the sympathetic trunk extend from?

A

superior cervical ganglion–> to ganglion impar (inferiorly)

(ganglion impar is on ant. side of coccyx)

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11
Q

How many ganglia are usually in each sympathetic trunk? How many per level?

A 
21 or 22  (21 if combine Inf. Cervical and Superior most thoracic ganglia = Stellate Ganglion)
C--> 3
T--> 11
L --> 4
S--> 4
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12
Q

Describe the path of the sympathetic trunk in the cervicals, thoracic, and lumbar, sacral, and coccyx areas.

A

Cervicals–> posterior to carotid sheath
Upper Thoracic–> anterior to necks of ribs
Lower Thoracic/Lumbars–> more medially located and lateral aspect of VBs
Sacrum–> lies on anterior aspect
Coccyx–> joins on anterior side as ganglion impar

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13
Q

What does the cervical sympathetic trunk lies between?

A

the carotid sheath and longus colli and capitis muscles

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14
Q

T/F. All levels of the cervical sympathetic trunk have communication with white rami communicans.

A

FALSE– (b/c that carries preganglionic sympathetic fibers and sympathetics are T1-L2 cord levels)

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15
Q

Are gray ramus communicans associated with cervical nerves?

A

Yes; typically 7 b/c superior most gray ramus communicans communicates with loop b/w C1 and C2 in cervical plexus
(so each Cervical spinal nerve has communication with them)

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16
Q

How many cervical ganglia are there usually?

A 
three
1. Superior Cervical ganglion
2. Middle Cervical ganglion
3. Inferior Cervical ganglion
~~inferior may fuse with first thoracic ganglion to form stellate ganglion
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17
Q

If present, what forms the Stellate ganglion?

A

inferior cervical ganglion and first thoracic ganglion

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18
Q

Which one is the largest of the cervical ganglion?

A

Superior cervical ganglion

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19
Q

What is the Superior cervical ganglion formed by the union of?

A

the upper four cervical ganglia

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20
Q

What level is the Superior cervical ganglion located at? What is it between?

A

C2-C3; b/w carotid sheath and longus capitis muscle

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21
Q

How are the postganglionic sympathetic fibers distributed from the superior cervical ganglion?

A

Anterior Branch
Medial Branch
Lateral Branch

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22
Q

Which of the three branches at the Superior Cervical ganglion carry the gray rami communicans? What do they communicate with?

A

Lateral Branches
Communicate with:
- anterior primary rami of C1-C4
- CN IX, X, XII

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23
Q

What do the medial branches off the superior cervical ganglion travel to?

A

(travel directly to visceral structures)

  • larynx
  • pharynx
  • heart–> called “Superior Cardiac Nerves”–> as efferent info ONLY (diff from ones ass. with CN X carrying pregang. parasym.)
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24
Q

Where do the superior cardiac nerves carrying postganglionic sympathetic fibers come from? What type of info do they carry?

A

the medial branch off the superior cervical ganglion

carry Efferent info ONLY

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25
Q

What do the anterior branches off the superior cervical ganglion follow? What do they innervate?

A

follow common and external carotid arteries–> innervate blood vessels that supply structures inside an outside the skull
(how sympathetics get inside head)

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26
Q

Which is the smallest of the cervical ganglia? What level is it located at

A

Middle Cervical Ganglion; at level of C6

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27
Q

What do the “lateral branches” of the Middle Cervical Ganglion communicate with?

A

anterior primary rami of C5 and C6 nerves via gray rami communicans

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28
Q

What do the “medial branches” of the Middle Cervical Ganglion communicate with?

A

thyroid branches–> reach thyroid and parathyroid glands

–primarily vasomotor

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29
Q

What are the three ways fibers are distributed from the Middle Cervical Ganglion?

A
  1. communicate w/ ant. primary rami of C5 and C6 nerves via gray rami communicans (lat. branches)
  2. Thyroid branches –> thyroid and parathyroid; primarily vasomotor (medial branches)
  3. Cardiac Branches–> make up “middle cardiac nerves”–> go to deep part of cardiac plexus
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30
Q

What ganglion are the Middle Cardiac Nerves coming from? Where are they going?

A

coming from the Middle Cervical Ganglion

going to contribute to deep part of cardiac plexus

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31
Q

How often does the Inferior cervical ganglion fuse with another ganglion? What ganglion does it fuse with? What does this fusion form?

A

80% of the time is fuses with the first thoracic ganglion to form a Stellate Ganglion

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32
Q

What level does the Inferior Cervical Ganglion lay at?

A

C7 transverse process and neck of first rib

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33
Q

How are the fibers distributed from the Inferior Cervical Ganglion?

A
  1. communicates w/ ant. primary rami of C7 and C8 (T1 if form stellate) nerves via gray rami communicans (lat. branches)
  2. Cardiac branches to heart as–> inferior cardiac nerves (medial branches)
  3. branches to subclavian artery and forms plexuses around it and its branches (anterior branches)
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34
Q

What do the “lateral branches” of the inferior cervical ganglion communicate with?

A

anterior primary rami of C7 and C8 (also T1 if fused to form Stellate) nerves–> via gray rami communicans

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35
Q

What ganglion are the Inferior Cardiac nerves carrying postganglionic sympathetic information from?

A

Inferior Cardiac Ganglion–> and are the cardiac branches

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36
Q

What blood vessel are branches form the inferior cardiac ganglion sent to?

A

subclavian artery and forms a plexuses around it and its branches–> which are the axillary artery and vertebral artery

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37
Q

How many thoracic ganglion are there usually?

A

11, sometimes 12

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38
Q

Which thoracic nerves have communication with white rami communicans and gray rami communicans?

A

ALL 12 thoracic nerves have a gray and white rami communicans

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39
Q

Where are the thoracic ganglion located in the superior thorax? What about in the lower part of the thorax?

A

superior thorax–> anterior to rib heads

Lower thorax–> lateral aspects of vertebral bodies

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40
Q

Branches form what thoracic ganglia travel medially and supply structures in the thoracic cavity? What type of fibers do they carry?

A

upper 5 thoracic ganglion–> carry postganglionic fibers and visceral afferents (heart, lungs, esophagus..)

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41
Q

What are associated with the lower seven thoracic ganglia in the sympathetic trunk?

A

Three splanchnic nerves

  1. Greater Splanchnic Nerves
  2. Lesser Splanchnic Nerves
  3. Least Splanchnic Nerves
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42
Q

What type of fibers do the three splanchnic nerves associated with the lower seven thoracic sympathetic chain ganglia carry? Where do these fibers go?

A

PREganglionic sympathetic fibers –> to plexuses in the abdominal and pelvic cavities–where they will synapse

also carry visceral afferent info

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43
Q

Of the sympathetic trunk, fibers from what thoracic ganglion form the Greater Splanchnic nerve? Where does it terminate?

A

5th-9th ganglia and terminates in the celiac ganglion

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44
Q

Of the sympathetic trunk, fibers from what thoracic ganglion form the Lesser Splanchnic Nerve? Where does it terminate?

A

9-10 or 10-11th ganglia and terminates in the aorticorenal ganglion

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45
Q

Of the sympathetic trunk, fibers from what thoracic ganglion form the Least Splanchnic Nerve? Where does it terminate?

A

from the most inferior thoracic ganglion and terminates in the renal plexus

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46
Q

What spinal nerve roots form the Least Splanchnic nerve and what does it supply?

A

T12 nerve root–> goes to renal plexus to supply kidneys

47
Q

Where does the sympathetic trunk lie in the lumbars?

A

retroperitoneal space, on lateral aspects of lumbar VBs

48
Q

How many lumbar ganglia are there usually in the sympathetic trunk?

A

four

49
Q

What lumbar nerves have communication with white rami communicans and gray rami communicans?

A

first 2, ~3 lumbar nerves–> w/ white rami communicans

ALL 5 lumbar nerves –> w/ gray rami communicans

50
Q

Do the lumbars have splanchnic nerves associated with them? If so, how many and where is info carried to?

A

yes, 2-4 Lumbar Splanchnic Nerves carrying preganglionic sympathetic axons –> to the plexus surrounding the abdominal aorta

51
Q

Where does the sympathetic trunk lie in the sacral area?

A

anterior aspect of sacrum, medial to anterior sacral foramina

52
Q

How many Sacral sympathetic chain ganglia are typically present?

A

4-5

53
Q

What sacral nerves have communication with white rami communicans and gray rami communicans?

A

white rami–> none

gray rami–> ass. w/ ALL sacral nerves and coccygeal nerve

54
Q

What happens as the two sympathetic trunks descend at the sacral region?

A

they travel medially to form the ganglion impar on the anterior surface of the coccyx

55
Q

What cord levels do preganglionic axons travel to enter the sympathetic trunk? What may they do once they get into the trunk?

A

T1-L2–> may ascend to higher levels of the trunk or descend to lower levels of the trunk

56
Q

Generally speaking, preganglionic sympathetic fibers from what levels with ascend? What levels will descend?

A

ascend–> T1-T5

descend–> T5-L2

57
Q

What nerve levels will carry preganglionic sympathetic info relayed to the head and neck? Where will these fibers synapse?

A

T1 and T2–> will ascend in sympathetic trunk and synapse in the superior cervical ganglion (on postganglionic sympathetics)

58
Q

What nerve levels will carry preganglionic sympathetic fibers to the heart? Where will they synapse?

A

T1-T4, will ascend in sympathetic trunk to 1 of the 3 cervical ganglia OR will pass directly to the heart

59
Q

What structures will preganglionic sympathetic fibers from T1-T2 nerve roots supply?

A

head and neck

60
Q

What structures will preganglionic sympathetic fibers from T1-T4 nerve roots supply?

A

the heart

61
Q

What nerve roots do axons supplying the lungs come from? Where do these preganglionic fibers synapse?

A

T2-T4 nerves; synapse in second, third, and fourth thoracic ganglia

62
Q

What nerve are preganglionic fibers carrying information for the upper extremities carried in? Where will they synapse?

A

T3-T7 nerves; ascend in sympathetic trunk and synapse in middle cervical and inferior cervical/stellate ganglia

63
Q

What nerve levels are preganglionic fibers influencing the abdominal viscera arise from? Where will they synapse?

A

T5-T12 nerves; synapse in lower thoracic ganglia OR may pass through sympathetic trunk and be carried in Greater, Lesser, and Least Splanchnic nerves

64
Q

What nerve levels do preganglionic fibers that supply the pelvic viscera arise from? Where will they synapse?

A

T10-L2 nerves; will descend in sympathetic trunk to ganglia in lower thoracic, lumbar, and pelvic areas

65
Q

What nerve levels do pregangliionic fibers carrying info for the lower extremities arise from?

A

T10-L2 nerves; will descend in sympathetic trunk and synapse w/ 2nd-4th lumbar sacral ganglia

66
Q

What structures will preganglionic sympathetic fibers from T2-T4 nerve roots supply?

A

lungs

67
Q

What structures will preganglionic sympathetic fibers from T3-T7 nerve roots supply?

A

upper extremities

68
Q

What structures will preganglionic sympathetic fibers from T5-T12 nerve roots supply?

A

abdominal viscera

69
Q

What structures will preganglionic sympathetic fibers from T10-L12 nerve roots supply?

A

pelvic viscera and lower extremities

70
Q

What are the three ways fibers are carried from the sympathetic trunk?

A
  1. Names Nerves
  2. Blood vessels
  3. Direct branches
71
Q

What type of fibers to virtually all peripheral nerves carry? W/in this distribution for that nerve, what three functions will these fibers have?

A

postganglionic sympathetic fibers
Fxns:
1. vasoconstrictor (smooth ms in vessels)
2. sudomotor
3. motor to arrector pili (hair stands up)

72
Q

What five things will direct branches to the viscera from the sympathetic trunk likely do? (consider role of “fight or flight”?

A
  1. constrict blood vessels
  2. dilate bronchial tree
  3. stimulate glandular secretion (except glands in GI tract/digestion)
  4. dilate pupils
  5. inhibit digestive activity
73
Q

What three cranial nerves does the Superior Cervical Ganglion send branches to?

A
  • IX (inf. ganglion)
  • X (Recurrent Laryngeal and Auricular branches)
  • XII (smooth ms of blood vessels to tongue)
74
Q

What are the three arteries that branches from the cervical sympathetic trunk accompany?

A
  1. internal carotid nerve accompanies the Internal Carotid Artery –> cranial cavity
  2. branches with Inferior Thyroid Artery –> thyroid gland
  3. branches with Subclavian Artery –> axillary and brachial arteries–> upper extremity
75
Q

Branches from what cervical ganglion will accompany the Internal Carotid Artery? Where is this going and does the nerve have a specific name?

A

from superior cervical ganglion–> the internal carotid nerve –> enters cranial cavity and divides into lateral and medial internal carotid nerve branches

76
Q

What will the lateral internal carotid nerve form or terminate? (This is the lat. branch of the internal carotid nerve that is accompanying the internal carotid artery)

A

forms the internal carotid plexus

many branches terminate on blood vessels inside skull

77
Q

From the Carotid Plexus, what CNs will postganglionic sympathetic fibers communicate with? (if they are named, list the names of the nerves from the carotid plexus)

A

V –> communication with trigeminal ganglion (reach anything w/in field of trigeminal N.)
VI –> communicant w/ Abducens N. –> blood vessels in lateral rectus
VII –> form deep petrosal nerve–> combines w/ Greater Petrosal Nerve–> forms nerve to the pterygoid canal
IX–> via Caroticotympanic Nerve–> combine w/ tympanic branch of IX nerve –> form tympanic plexus

78
Q

What is supplied by the combination of the Caroticotympanic nerves and tympanic branch of CN IX, into the tympanic plexus?

A

supply glands and blood vessels of middle ear

79
Q

What do the postganglionic sympathetic fibers coming from the internal carotid plexus and the greater petrosal nerve form? What structures do these fibers go to?

A

the nerve of the pterygoid canal

lacrimal, nasal, palatine, and some pharyngeal glands

80
Q

What cranial nerve ganglion does the internal carotid plexus have communication with?

A

with the trigeminal ganglion–> therefore postganglionic sympathetic fibers can reach any structure w/in distribution of the trigeminal nerve

81
Q

What cranial nerve does the internal carotid plexus send postganglionic sympathetic fibers with that will travel with blood vessels a muscle in the eye?

A

Abducens nerve–> to supply blood vessels in lateral rectus

82
Q

HISTORY! Elaborate on why Harvey Lillard’s adjustment form DD Palmer at T1/T2 area could impact his hearing?

A

T1 and T2 have sympathatic fibers going up to the head to smooth muscles of blood vessels–> may have influence on those going to the ear and restore some of his hearing

83
Q

What does the Medial Internal Carotid Nerve form? Where is the new structure located?

A

(branch of cervical sympathetic trunk–off internal carotid nerve from SCG)

forms the cavernous plexus–> in the cavernous sinus alongside the sella turcica

84
Q

What five places will postganglionic fibers from the cavernous plexus be sent?

A
  1. through ciliary ganglion–> to eyeball–> to ciliaris and dilator pupillae
  2. to Oculomotor nerve–> blood vessels ass. w/ ms
  3. to Trochlear nerve–> blood vessels in sup. oblique
  4. to V1–> to arrector pili, sweat glands, blood vessels w/in field of distribution
  5. Pituitary Gland
85
Q

Where do postganglionic sympathetic fibers from the cavernous travel through to get to the ciliaris and dilator pupillae muscles and some tarsus muscles of upper eyelid?

A

THROUGH the ciliary ganglion

86
Q

What are the postganglionic sympathetic fibers that are traveling THROUGH the ciliary ganglion from the cavernous plexus supplying?

A
  • ciliaris ms
  • dilator pupillae ms
  • some tarsus muscles of uppper eyelid
87
Q

What three CNs does the cavernous plexus have communication with? What do the postganglionic sym. fibers supply?

A

III–> blood vessels ass. w/ muscles supplied by nerve
IV–> blood vessels in superior oblique
V (opthalmic division)–> arrector pili, sweat glands, blood vessels w/in field of distribution

88
Q

What gland does the cavernous plexus send postganglionic sympathetic fibers to?

A

pituitary gland (to the smooth muscle of blood vessels

89
Q

What ganglion are the branches accompanying the inferior thyroid artery from? What do they supply?

A

from the Middle Cervical Ganglion–> supply the thyroid gland

90
Q

What ganglion are the branches from that reach the subclavian artery? What other vessels will they travel with and what will they supply?

A

from the Inferior cervical/ Stellate Ganglion

supply upper extremity via axillary and brachial arteries

91
Q

What are the names of the two branches from the cervical sympathetic trunk that will go to supply visceral structures DIRECTLY? What ganglion do they come from?

A
  1. Laryngeopharyngeal branches from the superior cervical ganglion
  2. Cardiac branches from each cervical ganglion
92
Q

What plexuses does the Laryngeopharyngeal branches from the superior cervical ganlgion form? Fibers from where else also help from this plexus?

A

the pharyngeal plexus
Fibers also from:
- CN IX
- CN X

Laryngeal plexus

–> each plexus supplies blood vessels and glands

93
Q

What nerve do the Cardiac branches from each cervical ganglion accompany? what do they travel through and where are they going to?

A

accompany branches of the vagus nerve–> THROUGH the cardiac plexus–> to the sinoatrial node

94
Q

What will sympathetic stimulation do to the heart rate and coronary arteries?

A

increase HR and DILATE coronary arteries

95
Q

What nerves will branches from the thoracic sympathetic trunk accompany?

A 
a gray ramus communicans is ass. with each T nerve (ant. and post. primary rami)
Supply w/ Thoracic Nerve distribution:
- arrector pili
- sweat glands
- blood vessels
96
Q

What thoracic ganglia send postganglionic sympathetic fibers to the thoracic aorta?

A

ganglia 1-5

97
Q

What are the 2 branches from the thoracic sympathetic trunk that travel DIRECTLY to visceral structures?

A
  1. Cardiac branches

2. Pulmonary branches (Greater, Lesser, Least Splachnic Nerves)

98
Q

What ganglia are the Cardiac branches of the sympathetic trunk extending from? What plexus do they pass through? What effect do they have?

A

T2-T4 ganglia–> pass through cardiac plexus

  • increase HR
  • dilate coronary arteries
  • afferents as well
99
Q

What ganglia are the Pulmonary branches of the sympathetic trunk extending from? What plexus do they travel through? What do they supply?

A 
T2-T4 ganglia --> pass through pulmonary plexus 
Supply:
- pleura
- smooth ms and blood vessels of lungs
- bronchial glands
100
Q

What effect with sympathetics have on the bronchials?

A

cause bronchial dilation and decrease glandular secretion

101
Q

What will chemicals in inhales given to individuals that have Asthmatics mimic?

A

mimics SNS stimulation (b/c w/ asthma the bronchials constrict and there is an increase in glandular secretion) –> SNS will dilate bronchials and decrease glandular secretion

102
Q

What are the three nerves associated with the thoracics that are traveling THROUGH the sympathetic trunk? What type of fibers do they all contain?

A
  1. Greater Splanchnic nerve
  2. Lesser Splanchnic nerve
  3. Least Splanchnic nerve

–preganglionic sympathetic fibers

103
Q

What ganglia are the following nerves associated with?

  1. Greater Splanchnic nerve
  2. Lesser Splanchnic nerve
  3. Least Splanchnic nerve
A
  1. Greater Splanchnic nerve—> T5-T9/T10 ganglia
  2. Lesser Splanchnic nerve–> T9 or T10-T11 ganglia
  3. Least Splanchnic nerve –> lowest thoracic ganglia
104
Q

What does the Greater Splanchnic nerve supply?

A
  • esophagus (above diaphragm)
  • thoracic aorta (above diaphragm)
  • abdominal viscera (via plexuses)
105
Q

What plexuses does the Greater Splanchnic nerve sends fibers through in order to reach the abdominal viscera it supplies?

A

Fibers through:

  • gastric plexus
  • hepatic plexus
  • superior mesenteric plexus

VIA the celiac plexus

106
Q

Fibers from what ganglia does the Lesser Splanchnic nerve contain? What structures are supplied?

A

fibers from T9 or T10-T11 ganglia
Supply:
- some same abd. structures as Greater Splanchnic Nerve
- also suprarenal glands

107
Q

Fibers from what ganglia does the Least Splanchnic nerve contain? What does it supply?

A

lowest thoracic ganglion
Supply:
- kidneys via renal plexus

108
Q

What are the branches form the lumbar sympathetic trunk that accompany nerves? What do they supply?

A

a gray ramus communicans is ass. w/ each lumbar nerve (ant. and post. primary rami)
Supply w/ field of distribution of lumbar nerves:
- arrector pili
- sweat glands
- blood vessels

109
Q

What will the vascular branches off the lumbar sympathetic trunk supply? (accompany blood vessels)

A

follow lumbar arteries back to abdominal aorta–> as far as the median sacral artery and common iliac arteries

110
Q

What branches travel through the lumbar sympathetic trunk that go directly to visceral structures? What do they supply? Via what plexuses?

A

lumbar splanchnic nerves–> supply pelvic plexuses via:

  • superior hypogastric plexus
  • inferior hypogastric plexus
  • inferior mesenteric plexus
111
Q

What are the branches form the sacral sympathetic trunk that accompany nerves? What do they supply?

A

a gray ramus communicans is ass. w/ each sacral and coccygeal nerve
Supply w/ field of distribution of sacral/coccygeal nerves:
- arrector pili
- sweat glands
- blood vessels

112
Q

What will the vascular branches off the sacral sympathetic trunk supply? (accompany blood vessels)

A

vascular branches given off that follow median sacral artery

113
Q

What branches travel through the sacral sympathetic trunk that go directly to visceral structures? What do they supply? Via what plexuses?

A

Sacral Splanchnic nerves–> supply pelvic viscera via:
- inferior mesenteric plexus

Fibers directly to:

  • ureters
  • rectum

PNS -- Torgerud (17 decks)

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