Final: Unit VII--Sympathetics Flashcards
Where are cell bodies located for preganglionic sympathetic neurons?
lateral horn or cord levels T1-L2 or L3
How do the preganglionic sympathetic neurons exit the cord?
in anterior rootlets
What do the preganglionic sympathetic neurons follow as they exit the cord?
anterior primary ramus
When the preganglionic sympathetic neurons exit the anterior primary ramus, what do they enter and how?
enter sympathetic trunk via white ramus communicans
Where do most preganglionic sympathetic neurons synapse?
on postganglionic cells in ganglia of sympathetic trunk
What will some preganglionic sympathetic neurons do that are not synapsing in the sympathetic trunk?
they pass THROUGH the sympathetic trunk and are carried in splanchnic nerves–> to synpase in prevertebral plexuses ass. w/ abdominopelvis viscera
What main NT do preganglionic sympathetic fibers release?
ACh
What does the sympathetic trunk consist of?
two paravertebral columns of interconnected ganglia
What can fibers do once they enter the sympathetic trunk?
ascend or descend
Where does the sympathetic trunk extend from?
superior cervical ganglion–> to ganglion impar (inferiorly)
(ganglion impar is on ant. side of coccyx)
How many ganglia are usually in each sympathetic trunk? How many per level?
21 or 22 (21 if combine Inf. Cervical and Superior most thoracic ganglia = Stellate Ganglion) C--> 3 T--> 11 L --> 4 S--> 4
Describe the path of the sympathetic trunk in the cervicals, thoracic, and lumbar, sacral, and coccyx areas.
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
What does the cervical sympathetic trunk lies between?
the carotid sheath and longus colli and capitis muscles
T/F. All levels of the cervical sympathetic trunk have communication with white rami communicans.
FALSE– (b/c that carries preganglionic sympathetic fibers and sympathetics are T1-L2 cord levels)
Are gray ramus communicans associated with cervical nerves?
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)
How many cervical ganglia are there usually?
three 1. Superior Cervical ganglion 2. Middle Cervical ganglion 3. Inferior Cervical ganglion ~~inferior may fuse with first thoracic ganglion to form stellate ganglion
If present, what forms the Stellate ganglion?
inferior cervical ganglion and first thoracic ganglion
Which one is the largest of the cervical ganglion?
Superior cervical ganglion
What is the Superior cervical ganglion formed by the union of?
the upper four cervical ganglia
What level is the Superior cervical ganglion located at? What is it between?
C2-C3; b/w carotid sheath and longus capitis muscle
How are the postganglionic sympathetic fibers distributed from the superior cervical ganglion?
Anterior Branch
Medial Branch
Lateral Branch
Which of the three branches at the Superior Cervical ganglion carry the gray rami communicans? What do they communicate with?
Lateral Branches
Communicate with:
- anterior primary rami of C1-C4
- CN IX, X, XII
What do the medial branches off the superior cervical ganglion travel to?
(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.)
Where do the superior cardiac nerves carrying postganglionic sympathetic fibers come from? What type of info do they carry?
the medial branch off the superior cervical ganglion
carry Efferent info ONLY
What do the anterior branches off the superior cervical ganglion follow? What do they innervate?
follow common and external carotid arteries–> innervate blood vessels that supply structures inside an outside the skull
(how sympathetics get inside head)
Which is the smallest of the cervical ganglia? What level is it located at
Middle Cervical Ganglion; at level of C6
What do the “lateral branches” of the Middle Cervical Ganglion communicate with?
anterior primary rami of C5 and C6 nerves via gray rami communicans
What do the “medial branches” of the Middle Cervical Ganglion communicate with?
thyroid branches–> reach thyroid and parathyroid glands
–primarily vasomotor
What are the three ways fibers are distributed from the Middle Cervical Ganglion?
- communicate w/ ant. primary rami of C5 and C6 nerves via gray rami communicans (lat. branches)
- Thyroid branches –> thyroid and parathyroid; primarily vasomotor (medial branches)
- Cardiac Branches–> make up “middle cardiac nerves”–> go to deep part of cardiac plexus
What ganglion are the Middle Cardiac Nerves coming from? Where are they going?
coming from the Middle Cervical Ganglion
going to contribute to deep part of cardiac plexus
How often does the Inferior cervical ganglion fuse with another ganglion? What ganglion does it fuse with? What does this fusion form?
80% of the time is fuses with the first thoracic ganglion to form a Stellate Ganglion
What level does the Inferior Cervical Ganglion lay at?
C7 transverse process and neck of first rib
How are the fibers distributed from the Inferior Cervical Ganglion?
- communicates w/ ant. primary rami of C7 and C8 (T1 if form stellate) nerves via gray rami communicans (lat. branches)
- Cardiac branches to heart as–> inferior cardiac nerves (medial branches)
- branches to subclavian artery and forms plexuses around it and its branches (anterior branches)
What do the “lateral branches” of the inferior cervical ganglion communicate with?
anterior primary rami of C7 and C8 (also T1 if fused to form Stellate) nerves–> via gray rami communicans
What ganglion are the Inferior Cardiac nerves carrying postganglionic sympathetic information from?
Inferior Cardiac Ganglion–> and are the cardiac branches
What blood vessel are branches form the inferior cardiac ganglion sent to?
subclavian artery and forms a plexuses around it and its branches–> which are the axillary artery and vertebral artery
How many thoracic ganglion are there usually?
11, sometimes 12
Which thoracic nerves have communication with white rami communicans and gray rami communicans?
ALL 12 thoracic nerves have a gray and white rami communicans
Where are the thoracic ganglion located in the superior thorax? What about in the lower part of the thorax?
superior thorax–> anterior to rib heads
Lower thorax–> lateral aspects of vertebral bodies
Branches form what thoracic ganglia travel medially and supply structures in the thoracic cavity? What type of fibers do they carry?
upper 5 thoracic ganglion–> carry postganglionic fibers and visceral afferents (heart, lungs, esophagus..)
What are associated with the lower seven thoracic ganglia in the sympathetic trunk?
Three splanchnic nerves
- Greater Splanchnic Nerves
- Lesser Splanchnic Nerves
- Least Splanchnic Nerves
What type of fibers do the three splanchnic nerves associated with the lower seven thoracic sympathetic chain ganglia carry? Where do these fibers go?
PREganglionic sympathetic fibers –> to plexuses in the abdominal and pelvic cavities–where they will synapse
also carry visceral afferent info
Of the sympathetic trunk, fibers from what thoracic ganglion form the Greater Splanchnic nerve? Where does it terminate?
5th-9th ganglia and terminates in the celiac ganglion
Of the sympathetic trunk, fibers from what thoracic ganglion form the Lesser Splanchnic Nerve? Where does it terminate?
9-10 or 10-11th ganglia and terminates in the aorticorenal ganglion
Of the sympathetic trunk, fibers from what thoracic ganglion form the Least Splanchnic Nerve? Where does it terminate?
from the most inferior thoracic ganglion and terminates in the renal plexus
What spinal nerve roots form the Least Splanchnic nerve and what does it supply?
T12 nerve root–> goes to renal plexus to supply kidneys
Where does the sympathetic trunk lie in the lumbars?
retroperitoneal space, on lateral aspects of lumbar VBs
How many lumbar ganglia are there usually in the sympathetic trunk?
four
What lumbar nerves have communication with white rami communicans and gray rami communicans?
first 2, ~3 lumbar nerves–> w/ white rami communicans
ALL 5 lumbar nerves –> w/ gray rami communicans
Do the lumbars have splanchnic nerves associated with them? If so, how many and where is info carried to?
yes, 2-4 Lumbar Splanchnic Nerves carrying preganglionic sympathetic axons –> to the plexus surrounding the abdominal aorta
Where does the sympathetic trunk lie in the sacral area?
anterior aspect of sacrum, medial to anterior sacral foramina
How many Sacral sympathetic chain ganglia are typically present?
4-5
What sacral nerves have communication with white rami communicans and gray rami communicans?
white rami–> none
gray rami–> ass. w/ ALL sacral nerves and coccygeal nerve
What happens as the two sympathetic trunks descend at the sacral region?
they travel medially to form the ganglion impar on the anterior surface of the coccyx
What cord levels do preganglionic axons travel to enter the sympathetic trunk? What may they do once they get into the trunk?
T1-L2–> may ascend to higher levels of the trunk or descend to lower levels of the trunk
Generally speaking, preganglionic sympathetic fibers from what levels with ascend? What levels will descend?
ascend–> T1-T5
descend–> T5-L2
What nerve levels will carry preganglionic sympathetic info relayed to the head and neck? Where will these fibers synapse?
T1 and T2–> will ascend in sympathetic trunk and synapse in the superior cervical ganglion (on postganglionic sympathetics)
What nerve levels will carry preganglionic sympathetic fibers to the heart? Where will they synapse?
T1-T4, will ascend in sympathetic trunk to 1 of the 3 cervical ganglia OR will pass directly to the heart
What structures will preganglionic sympathetic fibers from T1-T2 nerve roots supply?
head and neck
What structures will preganglionic sympathetic fibers from T1-T4 nerve roots supply?
the heart
What nerve roots do axons supplying the lungs come from? Where do these preganglionic fibers synapse?
T2-T4 nerves; synapse in second, third, and fourth thoracic ganglia
What nerve are preganglionic fibers carrying information for the upper extremities carried in? Where will they synapse?
T3-T7 nerves; ascend in sympathetic trunk and synapse in middle cervical and inferior cervical/stellate ganglia
What nerve levels are preganglionic fibers influencing the abdominal viscera arise from? Where will they synapse?
T5-T12 nerves; synapse in lower thoracic ganglia OR may pass through sympathetic trunk and be carried in Greater, Lesser, and Least Splanchnic nerves
What nerve levels do preganglionic fibers that supply the pelvic viscera arise from? Where will they synapse?
T10-L2 nerves; will descend in sympathetic trunk to ganglia in lower thoracic, lumbar, and pelvic areas
What nerve levels do pregangliionic fibers carrying info for the lower extremities arise from?
T10-L2 nerves; will descend in sympathetic trunk and synapse w/ 2nd-4th lumbar sacral ganglia
What structures will preganglionic sympathetic fibers from T2-T4 nerve roots supply?
lungs
What structures will preganglionic sympathetic fibers from T3-T7 nerve roots supply?
upper extremities
What structures will preganglionic sympathetic fibers from T5-T12 nerve roots supply?
abdominal viscera
What structures will preganglionic sympathetic fibers from T10-L12 nerve roots supply?
pelvic viscera and lower extremities
What are the three ways fibers are carried from the sympathetic trunk?
- Names Nerves
- Blood vessels
- Direct branches
What type of fibers to virtually all peripheral nerves carry? W/in this distribution for that nerve, what three functions will these fibers have?
postganglionic sympathetic fibers
Fxns:
1. vasoconstrictor (smooth ms in vessels)
2. sudomotor
3. motor to arrector pili (hair stands up)
What five things will direct branches to the viscera from the sympathetic trunk likely do? (consider role of “fight or flight”?
- constrict blood vessels
- dilate bronchial tree
- stimulate glandular secretion (except glands in GI tract/digestion)
- dilate pupils
- inhibit digestive activity
What three cranial nerves does the Superior Cervical Ganglion send branches to?
- IX (inf. ganglion)
- X (Recurrent Laryngeal and Auricular branches)
- XII (smooth ms of blood vessels to tongue)
What are the three arteries that branches from the cervical sympathetic trunk accompany?
- internal carotid nerve accompanies the Internal Carotid Artery –> cranial cavity
- branches with Inferior Thyroid Artery –> thyroid gland
- branches with Subclavian Artery –> axillary and brachial arteries–> upper extremity
Branches from what cervical ganglion will accompany the Internal Carotid Artery? Where is this going and does the nerve have a specific name?
from superior cervical ganglion–> the internal carotid nerve –> enters cranial cavity and divides into lateral and medial internal carotid nerve branches
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)
forms the internal carotid plexus
many branches terminate on blood vessels inside skull
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)
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
What is supplied by the combination of the Caroticotympanic nerves and tympanic branch of CN IX, into the tympanic plexus?
supply glands and blood vessels of middle ear
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?
the nerve of the pterygoid canal
lacrimal, nasal, palatine, and some pharyngeal glands
What cranial nerve ganglion does the internal carotid plexus have communication with?
with the trigeminal ganglion–> therefore postganglionic sympathetic fibers can reach any structure w/in distribution of the trigeminal nerve
What cranial nerve does the internal carotid plexus send postganglionic sympathetic fibers with that will travel with blood vessels a muscle in the eye?
Abducens nerve–> to supply blood vessels in lateral rectus
HISTORY! Elaborate on why Harvey Lillard’s adjustment form DD Palmer at T1/T2 area could impact his hearing?
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
What does the Medial Internal Carotid Nerve form? Where is the new structure located?
(branch of cervical sympathetic trunk–off internal carotid nerve from SCG)
forms the cavernous plexus–> in the cavernous sinus alongside the sella turcica
What five places will postganglionic fibers from the cavernous plexus be sent?
- through ciliary ganglion–> to eyeball–> to ciliaris and dilator pupillae
- to Oculomotor nerve–> blood vessels ass. w/ ms
- to Trochlear nerve–> blood vessels in sup. oblique
- to V1–> to arrector pili, sweat glands, blood vessels w/in field of distribution
- Pituitary Gland
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?
THROUGH the ciliary ganglion
What are the postganglionic sympathetic fibers that are traveling THROUGH the ciliary ganglion from the cavernous plexus supplying?
- ciliaris ms
- dilator pupillae ms
- some tarsus muscles of uppper eyelid
What three CNs does the cavernous plexus have communication with? What do the postganglionic sym. fibers supply?
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
What gland does the cavernous plexus send postganglionic sympathetic fibers to?
pituitary gland (to the smooth muscle of blood vessels
What ganglion are the branches accompanying the inferior thyroid artery from? What do they supply?
from the Middle Cervical Ganglion–> supply the thyroid gland
What ganglion are the branches from that reach the subclavian artery? What other vessels will they travel with and what will they supply?
from the Inferior cervical/ Stellate Ganglion
supply upper extremity via axillary and brachial arteries
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?
- Laryngeopharyngeal branches from the superior cervical ganglion
- Cardiac branches from each cervical ganglion
What plexuses does the Laryngeopharyngeal branches from the superior cervical ganlgion form? Fibers from where else also help from this plexus?
the pharyngeal plexus
Fibers also from:
- CN IX
- CN X
Laryngeal plexus
–> each plexus supplies blood vessels and glands
What nerve do the Cardiac branches from each cervical ganglion accompany? what do they travel through and where are they going to?
accompany branches of the vagus nerve–> THROUGH the cardiac plexus–> to the sinoatrial node
What will sympathetic stimulation do to the heart rate and coronary arteries?
increase HR and DILATE coronary arteries
What nerves will branches from the thoracic sympathetic trunk accompany?
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
What thoracic ganglia send postganglionic sympathetic fibers to the thoracic aorta?
ganglia 1-5
What are the 2 branches from the thoracic sympathetic trunk that travel DIRECTLY to visceral structures?
- Cardiac branches
2. Pulmonary branches (Greater, Lesser, Least Splachnic Nerves)
What ganglia are the Cardiac branches of the sympathetic trunk extending from? What plexus do they pass through? What effect do they have?
T2-T4 ganglia–> pass through cardiac plexus
- increase HR
- dilate coronary arteries
- afferents as well
What ganglia are the Pulmonary branches of the sympathetic trunk extending from? What plexus do they travel through? What do they supply?
T2-T4 ganglia --> pass through pulmonary plexus Supply: - pleura - smooth ms and blood vessels of lungs - bronchial glands
What effect with sympathetics have on the bronchials?
cause bronchial dilation and decrease glandular secretion
What will chemicals in inhales given to individuals that have Asthmatics mimic?
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
What are the three nerves associated with the thoracics that are traveling THROUGH the sympathetic trunk? What type of fibers do they all contain?
- Greater Splanchnic nerve
- Lesser Splanchnic nerve
- Least Splanchnic nerve
–preganglionic sympathetic fibers
What ganglia are the following nerves associated with?
- Greater Splanchnic nerve
- Lesser Splanchnic nerve
- Least Splanchnic nerve
- Greater Splanchnic nerve—> T5-T9/T10 ganglia
- Lesser Splanchnic nerve–> T9 or T10-T11 ganglia
- Least Splanchnic nerve –> lowest thoracic ganglia
What does the Greater Splanchnic nerve supply?
- esophagus (above diaphragm)
- thoracic aorta (above diaphragm)
- abdominal viscera (via plexuses)
What plexuses does the Greater Splanchnic nerve sends fibers through in order to reach the abdominal viscera it supplies?
Fibers through:
- gastric plexus
- hepatic plexus
- superior mesenteric plexus
VIA the celiac plexus
Fibers from what ganglia does the Lesser Splanchnic nerve contain? What structures are supplied?
fibers from T9 or T10-T11 ganglia
Supply:
- some same abd. structures as Greater Splanchnic Nerve
- also suprarenal glands
Fibers from what ganglia does the Least Splanchnic nerve contain? What does it supply?
lowest thoracic ganglion
Supply:
- kidneys via renal plexus
What are the branches form the lumbar sympathetic trunk that accompany nerves? What do they supply?
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
What will the vascular branches off the lumbar sympathetic trunk supply? (accompany blood vessels)
follow lumbar arteries back to abdominal aorta–> as far as the median sacral artery and common iliac arteries
What branches travel through the lumbar sympathetic trunk that go directly to visceral structures? What do they supply? Via what plexuses?
lumbar splanchnic nerves–> supply pelvic plexuses via:
- superior hypogastric plexus
- inferior hypogastric plexus
- inferior mesenteric plexus
What are the branches form the sacral sympathetic trunk that accompany nerves? What do they supply?
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
What will the vascular branches off the sacral sympathetic trunk supply? (accompany blood vessels)
vascular branches given off that follow median sacral artery
What branches travel through the sacral sympathetic trunk that go directly to visceral structures? What do they supply? Via what plexuses?
Sacral Splanchnic nerves–> supply pelvic viscera via:
- inferior mesenteric plexus
Fibers directly to:
- ureters
- rectum
