HNS02 Peripheral Nervous System Flashcards

1
Q

***Division of nervous system

A

CNS:

  • Brain
  • Spinal cord

PNS:
- Sensory division
—> Visceral sensory division (very complicated, different versions, referred pain)
—> Somatic sensory division
- Motor division
—> Visceral motor division: Sympathetic + Parasympathetic
—> Somatic motor division

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2
Q

PNS

A

Consists of nerve fibres and nerve ganglia outside the brain and spinal cord, and special nerve ending

Only Cranial nerve within CNS: Optic nerve

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3
Q

Nerve ganglia

A

Collection of cell bodies

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4
Q

Classification of PNS

A

Based on anatomical structures

  • Cranial nerves + Cranial nerve ganglia (comes out from brain)
  • Spinal nerves + Spinal nerve ganglia (comes out from spinal cord)
  • Autonomic nerves + ganglia

Based on function

  • Somatic nervous system (SoNS)
  • Autonomic nervous system (ANS)

Based on direction

  • Sensory (Afferent)
  • Motor (Efferent)
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5
Q

Cranial nerves

A
  • 12 pairs
  • arise mainly from within the brain
  • ALL belongs to PNS, except Optic nerve (CN2)

1: Olfactory
2: Optic
3: Oculomotor
4: Trochlear
5: Trigeminal
6: Abducent
7: Facial
8: Vestibulocochlear
9: Glossopharyngeal
10: Vagus
11: Accessory
12: Hypoglossal

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6
Q

Spinal nerves

A
  • 31 pairs (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal)
  • Axons from neurons in spinal cord (Ventral root) + Dorsal root ganglia
    —> Spinal nerves
    —> Somatic Sensory + Somatic Motor + Autonomic Sensory + Autonomic Motor (4 types of signal)
  • 4 plexuses (branching network of intersecting nerves):
    1. Cervical plexus (C1-C4)
    2. Brachial plexus (C5-T1)
    3. Lumbar plexus (T12/L1-L4)
    4. Sacral plexus (L4-S4)
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7
Q

Cranial nerve sensory ganglia vs Spinal nerve sensory ganglia

A

Cranial nerve sensory ganglia:

  1. Trigeminal ganglion (CN5; for sensation of oral cavity + nasal cavity)
  2. Geniculate ganglion (CN7; sensation of face, taste)
  3. Spiral ganglion (CN8)
  4. Vestibular ganglion (CN8)
  5. Superior (jugular) ganglion of Glossopharyngeal (CN9)
  6. Inferior (petrosal) ganglion of Glossopharyngeal (CN9)
  7. Superior (rostral) ganglion of Vagus nerve (CN10)
  8. Inferior (nodose) ganglion of Vagus nerve (CN10)

Spinal nerve sensory ganglia:
1. Dorsal root ganglion (group of cell bodies of primary sensory neurons)

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8
Q

Somatic NS: Motor system vs Sensory system

A

Motor system:

  • Cell bodies located in CNS (Brainstem / ***Ventral horn of spinal cord)
  • One step system: Only 1 neuron
  • Axons organised into nerve bundle + located in PNS
  • Terminals / Nerve endings located in skeletal muscle to form NMJ

Sensory system:
- Cell bodies located in PNS (sensory ganglia)

  • Axons (***pseudo-unipolar) divided into:
    —> Central axons: projects into CNS and terminates within CNS
    —> Peripheral axons: connects with peripheral organ and forms sensory endings (specialised dendrites)
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9
Q

Autonomic NS

A
  • Sympathetic + Parasympathetic
  • 2 neuron system: Presynaptic (Preganglionic) + Postsynaptic (Postganglionic) neuron
  • Centre (presynaptic neurons) of SNS: located in Lateral horn of T1-L2/3 spinal cord (intermediolateral cell column)
  • Centre of PNS: located in Brainstem + S2-S4 spinal cord
  • Higher centre of ANS: located in Hypothalamus
  • Special division: Enteric nervous system
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10
Q

Major functions of ANS

A
SNS:
Eye: Pupillary dilation
Sweat gland: Sweat secretion
Heart: ↑ HR
Bronchi: Dilation
GI tract: Inhibition of movement
Bladder: Relaxation
Genitalia: Orgasm
PNS:
Eye: Pupillary constriction
Sweat gland: None
Heart: ↓ HR
Bronchi: Constriction
GI tract: Enhance of movement
Bladder: Contraction
Genitalia: Sexual arousal
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11
Q

Arrangement of postganglionic neuron in Sympathetic NS

A
  1. Paravertebral ganglia
    - contain postganglionic neuron
    - located very close to vertebral column
    - form chains on either side of vertebral column —> ***Sympathetic chain / trunk
    —> 3 cervical ganglia
    —> 12 thoracic ganglia
    —> 4 lumbar ganglia
    —> 4-5 sacral ganglia
    —> 1 Ganglion impar
  2. Prevertebral ganglia (Prevertebral plexuses)
    - also contain postganglionic neuron
    - anterior, further away to vertebral column
    - in ***abdominal region
    - major ones:
    —> Celiac ganglia
    —> Aorticorenal ganglion
    —> Superior mesenteric ganglia
    —> Inferior mesenteric ganglia
    - minor ones: superior / inferior hypogastric plexuses
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12
Q

Paravertebral ganglia

A
  • Interconnected with spinal nerves via communicating rami
  • White communicating ramus (ONLY in T1-L2):
    —> carries small **myelinated **presynaptic fibres from lateral horn
    —> sympathetic trunk / chain
  • Gray communicating ramus (at every pairs of spinal nerves):
    —> carries **unmyelinated **postsynaptic fibres from ganglion
    —> back to spinal nerve (入sympathetic chain兜個圈出返黎)
    —> supply body
- Whole flow:
Presynaptic neuron (in lateral horn) —> spinal nerve —> synapse with Postsynaptic neuron in sympathetic trunk —> spinal nerve —> supply body
  • Presynaptic neuron can go up above T1/L2, but can only do so within sympathetic chain
    —> must enter respective level (T1-L2) first via White ramus
    —> then travel up / down in sympathetic chain to synapse with other postsynaptic neuron
    (∴ white rami只有 T1-L2有, gray ramus可以度度有, 甚至多過一, 一個sympathetic ganglia裡面有好多postsynaptic fibres出 e.g. cervical ganglia得3個, 但控制好多部位)
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13
Q

Presynaptic fibres route (within Paravertebral ganglia)

A
  1. Synapse with postsynaptic fibres at the same level (T1-L2)
  2. Travel up and down to synapse with upper / lower postsynaptic fibres at different levels of paravertebral ganglia
  3. Pass through paravertebral ganglia without synapsing —> via splanchnic nerves —> reach prevertebral ganglion
    - i.e. Splanchnic nerve route
    - arise from T5 and below
    - T5 or above: cardiac, pulmonary, carotid plexuses: ***Postsynaptic fibres
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14
Q

Postsynaptic fibres route (within Paravertebral ganglia)

A
  1. Spinal nerve route (i.e. Gray ramus)
  2. Sympathetic nerve route (i.e. Splanchnic nerves in cardiac and pulmonary plexuses / carotid plexuses: NOT presynaptic fibres ∵一早已經係sympathetic chain synapsed左 —> 變左做postsynaptic fibres)
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15
Q

Splanchnic nerves (Presynaptic fibres)

A
  1. Greater splanchnic nerves
    - sympathetic
    - T5-T9
    - to Celiac plexus
  2. Lesser splanchnic nerves
    - sympathetic
    - T10-T11
    - to Abdominal aortic plexus / renal plexus (include superior mesenteric ganglion)
  3. Least splanchnic nerves
    - sympathetic
    - T11-T12
    - to Abdominal aortic plexus / renal plexus
  4. Lumbar splanchnic nerves
    - sympathetic
    - L1-L2
    - to Abdominal aortic plexus / hypogastric plexus
  5. Sacral splanchnic nerves
    - sympathetic
    - mostly presynaptic (sacral part of sympathetic trunk to inferior hypogastric plexus)
  6. Pelvic splanchnic nerves
    - ***parasympathetic
    - S2-S4
    - to Terminal ganglia (very close to organs)

Note:
- ALL splanchnic nerves are presynaptic except for cardiopulmonary nerves (from Stellate ganglia) and minor parts of sacral splanchnic nerves (一早係sympathetic chain裡面synapse左)

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16
Q

Adrenal medulla

A

Chromaffin cells act as postsynaptic neurones
—> receive presynaptic sympathetic fibres from Celiac / Renal plexus
—> very long presynaptic fibres, very short postsynaptic fibres

17
Q

Arrangement of Parasympathetic NS: Parasympathetic ganglia

A
  1. Parasympathetic ganglia of head and neck
    - Ciliary ganglion
    - Pterygopalatine ganglion
    - Submandibular ganglion
    - Otic ganglion
  2. Terminal ganglia
18
Q

Arrangement of Parasympathetic NS: Nerves carry parasympathetic fibres

A

Nerves carry parasympathetic fibres (presynaptic fibres):

  1. CN 3 (Oculomotor)
  2. CN 7 (Facial)
  3. CN 9 (Glossopharyngeal)
  4. CN 10 (Vagus)
  5. Pelvic splanchnic nerves

Rmb: Cranial nerve只係講緊anatomical location, 唔係function

19
Q

Enteric nervous system

A

Digestive tract’s own nervous system

2 plexuses:

  1. Myenteric (Auerbach’s) plexus
  2. Submucosal (Meissner’s) plexus
  • embedded in lining of GI tract
  • does not arise from brainstem / spinal cord
  • regulates **motility + **secretion of GI tract
  • coordinates local reflexes
  • self-contained (even without spinal cord can still self-regulate)
  • communicates with sympathetic / parasympathetic
  • capable of operating independently of brain and spinal cord
  • contains own efferent, afferenyt neurones and interneurons
  • can form local reflex arc independently of CNS (does not need to pass through spinal cord)
20
Q

Structure of nerve fibres

A

Axon and myelin sheath (surrounded by endoneurium)
—> Nerve fascicle (surrounded by perineurium)
—> Nerve trunk (surrounded by epineurium)

Unmyelinated neurons:

  • groups of axons fit into a groove/grooves of Schwann cells (axons嵌入Schwann cell)
  • no nodes of Ranvier
  • series of Schwann cells cover entire length of axons
21
Q

Glial cells in PNS

A
  1. Perineuronal satellite cells:
    - do not form myelin sheath
    - within ganglia surrounding cell body controlling microenvironment
    - electrical insulation
    - pathway for metabolic exchanges
  2. Schwann cells: myelin sheath in PNS
22
Q

Nerve endings

A
  1. NMJ
    - Spinal motor neuron axon endings on muscle fibres
    - Axon terminals contain vesicles of ACh
    - Synaptic cleft located between axon terminal and muscle cell membrane
  2. Sensory nerve endings
    - in skin, muscles, tendons, internal organs etc.
    - responsible for afferent sensory inputs related to touch, pain, temperature, pressure, special senses etc.
23
Q

Disorder and injury of PNS

A
  • Peripheral nerves capable of regeneration under certain circumstances (e.g. Schwann cell wrapped around weakened/narrowed axon)
  • Peripheral Neuropathy: functional disturbances and pathological changes in PNS, damage to neurons and their myelin sheath
  • Neuritis: inflammation of PNS
  • Injury: injury to axons / cell bodies of axons
    e. g. IM injection: deltoid avoid radial nerve, buttock avoid sciatic nerve
24
Q

Seddon’s Classification of Peripheral nerve injuries

A
  1. Neurapraxia: injury without any anatomical discontinuity but resulting in functional disruption (nerve concussion)
  2. Axonotmesis: microscopic division of nerve fibres (axons) without obvious discontinuity of the nerve sheath (epineurium / 出面still intact)
  3. Neurotmesis: complete anatomic division of the nerve fibres with obvious discontinuity of the nerve sheath