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System Neuroscience > The Autonomic Nervous System > Flashcards

The Autonomic Nervous System Flashcards

1
Q

Autonomic nervous system

A

1) OS
2) PS
3) Enteric nervous system
4) Autonomic afferents
5) Central controle of the ANS

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2
Q

Motivational behavior

A

Close relationship between hypothalamus and limbic structures of the forebrain (amygdalae, hippocampus, cingular and orbitofrontal cortex)

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3
Q

Roles for the ANS

A
  • Afferent and efferent innervation of:
    1) Internal organs
    2) Different glands of the body
    3) Blood vessels
  • These functions are strongly linked to the specific functions of the organs, and they are mostly regulated by spinal or brainstem reflexes
  • ANS also via the amygdalae and the hypothalamus associated with the expression of emotions
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4
Q

Dysfunctions of the ANS can lead to

A
  • Symptoms related to:
    1) Internal medecine –> endocrine dysfunctions, immune dysfunctions and inflammatory processes
    2) Psychiatry –> stress and adaptation
    3) Neurology –> focal and multifocal leasions of CNS and PNS can lead to dysfunctions of the ANS
  • Diffuse disease processes can also lead to dysfunctions of the ANS –> diabetes mellitus, amyloïdosis
  • Strictly localized autonomic dysfunctions –> Horner syndrome
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5
Q

General relationships between CNS and PNS and the ANS

A
  • Motor fibres –> General visceral and somatic efferent
  • Sensory fibres –> General visceral ans somatic afferent
  • Visceral efferent: Spinal cord –> ventral root –> sympathic chain and ganglia –> viscera
  • Visceral afferent: Viscera –> sympathic chain and ganglia –> dorsal root –> spinal cord
  • Somatic efferent: Ventral root –> body wall and extremities
  • Somatic afferent: Body wall and extremities –> dorsal root –> spinal cord
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6
Q

Effects of the ANS: Eye

A
  • Pupil:
    1) OS –> Widening
    2) PS –> Narrowing
  • M. ciliaris:
    1) OS –> Relaxation (tele-vision)
    2) PS –> Contraction (accommodation)
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7
Q

Effects of the ANS: Glands

A
  • Nasal mucosa, lacrimal gland, salivary gland, glands of stomach and intestine, pancreas
  • OS –> VC + mucous secretion
  • PS –> VD + serous secretion
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8
Q

Effects of the ANS: Sweat glands

A
  • OS –> Strong transpiration

* PS –> Transpiration of palm of the hand

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9
Q

Effects of the ANS: Apocrine gland

A
  • OS –> Transpiration (smell)

* PS –> No effect

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10
Q

Effects of the ANS: Heart

A
  • Muscle
    1) OS –> Increased frequency (tachycardie) + enhanced contraction force
    2) PS –> Decreased frequency (bradycardie) + reduced contraction force
  • aa. coronariae
    1) OS –> Depending on the adrenergic receptors either dilatation or constriction
    2) PS –> Dilatation
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11
Q

Effects of the ANS: Lungs

A
  • Bronchi:
    1) OS –> Dilatation
    2) PS –> Constriction
  • Blood vessels:
    1) OS –> Slight constriction
    2) PS –> Dilatation
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12
Q

Effects of the ANS: Intestine

A
  • Lumen:
    1) OS –> Decrease of peristalsis and tonus
    2) PS –> Increase of peristalsis and tonus
  • Sphincter:
    1) OS –> Increase tonus
    2) PS –> decrease tonus
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13
Q

Effects of the ANS: Liver

A
  • OS –> Glucose secretion

* PS –> Glycogen synthesis

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14
Q

Effects of the ANS: Gall bladder

A
  • OS –> Relaxation

* PS –> Contraction

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15
Q

Effects of the ANS: Kidney

A
  • OS –> Reduced secretion

* PS –> No effect

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16
Q

Effects of the ANS: Bladder

A
  • M. detrusor:
    1) OS –> Slight relaxation
    2) PS –> Contraction
  • Sphincter:
    1) OS –> Contraction
    2) PS –> Relaxation
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17
Q

Effects of the ANS: Penis/prostate

A
  • OS –> Ejaculation

* PS –> Erection

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18
Q

Effects of the ANS: Arterioles

A
  • GI-tract
    1) OS –> Constriction
    2) PS –> No effect
  • Muscles:
    1) OS –> Depending on adrenergic receptors constriction or dilatation, dilatation for cholinergic
    2) PS –> No effect
  • Skin
    1) OS –> Constriction
    2) PS –> No effect
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19
Q

Effects of the ANS: Blood

A
  • Coagulation, glucose and lipids
  • OS –> Enhanced
  • PS –> No effect
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20
Q

Effects of the ANS: Basal metabolism

A
  • OS –> Enhanced

* PS –> No effect

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21
Q

Effects of the ANS: Adrenal medulla (adrenalin)

A
  • OS –> Activated

* PS –> No effect

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22
Q

Effects of the ANS: Mental activity

A
  • OS –> Activated

* PS –> No effect

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23
Q

Effects of the ANS

A

1) Eye
2) Glands
3) Sweat glands
4) Apocrine glands
5) Heart
6) Lungs
7) Intestine
8) Liver
9) Gall bladder
10) Kidney
11) Bladder
12) Penis/prostate
13) Arterioles in GI-tract, muscle and skin
14) Blood
15) Basal metabolism
16) Adrenal medulla (adrenalin)
17) Mental activity
18) M. arrector pili
19) Skeletal muscle
20) Adipocytes

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24
Q

Effects of the ANS: M. arrector pili

A
  • OS –> Pilo-erection

* PS –> No effect

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25
Q

Effects of the ANS: Skeletal muscle

A
  • OS –> Enhanced glycogenolyse

* PS –> Enhanced contraction force

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26
Q

Effects of the ANS: Adipocytes

A
  • OS –> Lipolysis (brown fat)

* PS –> No effect

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27
Q

Functional anatomy of the ANS: OS

A
  • Affects the body mostly by paravertebral and prevertebral ganglia
  • Ramus dorsalis and vertebralis:
    1) Somatosensory and somatomotoric fibres (myel)
    2) Postganglionar motoric autonomic fibres (mostly non-myel)
  • Ramus communicans albus:
    1) Viscerosensory and visceromotoric fibres (myel)
    2) Preganglionar somatomotoric fibres (myel)
  • Ramus communicans griseus:
    Postganglionar fibres to for example m. arrector pili, skin glands (non-myel)
28
Q

Functional anatomy of the ANS: PS

A
  • Nervus oculomotorius:
    1) Starts at Edinger-Westphal nucleus
    2) Makes synaps in ciliary ganglion
    3) Divides into 2 short ciliary nerves
    4) Go to pupillary dilator muscle, pupillary constrictor muscle and ciliary muscles
  • Nervus facialis:
    1) Starts at superior salivatory nucleus
    2) Divides into greater petrosal nerve (GPN) and chords tympani nerve (CTN)
    3a) GPN makes synaps in pterygopalatine ganglion
    3b) CTN makes synaps in submandibular ganglion
    4a) GPN goes to lacrimal gland, nasal gland, and oral and palatine glands
    4b) CTN goes to sublingual gland and submandibular gland
  • Nervus glossopharyngeus:
    1) Starts in inferior salivatory nucleus
    2) Changes into tympanic nerve
    3) Goes through tympanic plexus
    4) Changes into lesser petrosal nerve
    5) Makes synaps in otic ganglion
    6) Goes to parotid gland
29
Q

Differences between OS and PS

A

1) PS affects the individual organs via ganglia within or near the target organs (ganglia for OS are further away)
2) PS and OS exhibit different (not always antagonistic) effects on the target organs
3) OS prepares the body for fight or flight, while PS prepares the body for rest and recovery

30
Q

Enteric nervous system: Roles

A

ENS involved in:

1) Regulation of intestine motility
2) Controle of the blood flow
3) Controle of the water and electrolyte transport
4) Controle of the acid secretion
5) Neuro-immune interactions
6) Also in the regulation of the functioning of associated structures (liver, pancreas, gallbladder)

31
Q

Enteric nervous system: Pathway

A

1) Starts at level of L1-L2
2) Makes synaps in inferior mesenteric ganglion
3) Goes to GI-tract

OR

1) Starts at level of S2-S3-S4
2) Makes synaps near GI-tract
3) Enters GI-tract

32
Q

Enteric nervous system: Plexuses

A
  • The 3 most important plexuses are:
    1) Plexus myentericus (Auerbach)
    2) Plexus submucosus externus (Schabadasch)
    3) Plexus submucosus internus (Meissner)
  • 4 other plexuses:
    1) Plexus muscularis mucosal
    2) Plexus muscularis profondus
    3) Plexus muscularis superficialis
    4) Plexus mucosus
33
Q

Enteric nervous system: Classification neurons

A

Different methods possible:

1) Morphological –> shape of cell body and dendrites, one or more axons, Dogiel type
2) Electrophysiological –> presence of AH, fast excitatory synaptic inputs, inflection on spikes
3) Neurochemical –> different combination of chemicals detected by immunohistochemistry for neuropeptides, calcium binding proteins, structural proteins, enzymes
4) Pharmacological
5) Retrograde labeling –> projections to muscle layers, mucosa, polarity

34
Q

Electrophysiological classification of myenteric neurons and role of [Ca2+]i

A

AH-neurons

1) Ca2+ is a key regulator of the AH-neuron excitability
2) A component of the AH-neuron AP is due to Ca2+ influx
3) After a burst of APs, there is a prolonged afterhyperpolarization
4) The AH is due to opening of the Ca2+-activated K+-channels

S-neurons

1) Role of Ca2+ in S-neurons excitability in unclear
2) APs of most S-neurons are blocked by TTX and lack a significant Ca2+ component
3) S-neurons lack a prominent long AHP
4) They fire mostly 1-4 APs in response to a depolarizing current
5) They are not spontaneously active

35
Q

Major NT that regulate GI-motility

A

1) Excitatory NT:
a) Intrinsic (enteric) NT: ACh, tachykinins
b) Extrinsic (sympathic) NT: ATP (?), NA
- -> They activate non-selective cation channels in GI-muscles

2) Inhibitory NT:
Intrinsic (enteric): NO, ATP (?), VIP

36
Q

Postulated roles of Glia in the ENS

A

1) Homeostatic role:
* Provision of mechanical support
* Provision of isolation
* Provision of nutrition
* Clearance of excessive K+ and NT from the extracellular space
2) Role in information processing
* Monitoring neuronal activity
* Modulation of synaptic transmission
* Bi-directional signaling between enteric glia and neurons
3) Role in maintenance of mucosal barrier
4) Role in maintenance of blood/plexus barrier
5) Role in modulation of intestinal immune responses

37
Q

Axonal reflex

A

Collaterals of the visceral afferents can influence internal organs and the skin without intervention of the CNS

38
Q

Referred pain

A

Visceral pain experienced at other locations in the body

39
Q

Central control of the ANS

A

Descending pathways originating from the hypothalamus and the brainstem influence the intermediolateral column of the spinal cord

40
Q

Effects of lung innervation

A

Regulation of :

1) Airway smooth muscle tonus
2) Mucus secretion from glands
3) Permeability and blood flow in bronchial circulation
4) Transport of fluid across the epithelium
5) Release of mediators from inflammatory cells
6) Influence on the diffuse neuroendocrine system

41
Q

2 efferent pathways lung innervation

A

1) PS:
* Nervus vagus (ACh): Nucleus dorsalis n. vagi –> Intrinsic PS ganglion –> smooth muscles + glands
* Nervus vagus (ACh): Nucleus ambiguous n.vagi –> ganglion nodosum –> smooth muscles
* Nervus vagus (ACh): Nucleus ambiguous n.vagi –> ganglion jugulare –> Epithelium, smooth muscles, intrinsic PS ganglion

2) OS:
* Nervus sympathicus (NA): Thoracal part of spinal cord –> Dorsal root ganglion –> Intrinsic parasympathetic ganglion and epithelium
* Nervus sympathicus (NA): Thoracal part of spinal cord –> Cerv.-Thor.- ganglion –> Blood vessels, intrinsic parasympathetic ganglion, smooth muscles and glands

42
Q

Airway smooth muscle

A
  • ACh –> M3-receptor on airway smooth muscles –> bronchoconstrictie
  • Negative feedback mechanism on M2-receptors on cholinergic nerve (Also beta-blockers –> epinephrine)
  • Astma –> use of bronchodilators, not beta-blockers ( –> auto-receptor deficit on M2-receptor, epinephrine doesn’t connect to M2, so no effect and constriction will continue)
43
Q

Sniffer patch recording

A

Is used to detect ATP-release –> released by NEB cells after mechanical stimulation

44
Q

The hypothalamus: Functions

A

Coordinates autonomic and endocrine responses:

1) Respiratory
2) Cardiovascular circulation
3) GI-functions
4) Fluid balans
5) Body temperature
6) Metabolism/homeostasis
7) Biological/circadian rhythms
8) Growth
9) Development/Sexual differentiation/Emotional behavior

45
Q

The hypothalamus: Anatomical organization

A
  • Comprises the ventral part of the diencephalon
  • Comprises a number of functionally distinct regions, organized as many small nuclei crossed by several important fibre tracts
  • Can be subdivided into a lateral and a medial part:
    1) Lateral part: diffusely organized + integrates information from forebrain and brainstem
    2) Medial part: comprises a number of clearly delineated nuclei:
  • -> Rostrally: nucleus paraventricularis, nucleus supraopticus, nucleus suprachiasmaticus
  • -> Intermedially: nucleus arcuatus, nucleus dorsemedialis, nucleus ventromedialis
  • -> Caudally: corpus mammillary
46
Q

Monoaminergic nuclei in brainstem and hypothalamus project directly to the cortex cerebri

A

1) Locus coeruleus:
* In dorsal tegmentum of the pons in lateral margin of the floor of the 4th ventricle
* Main source of noradrenergic pathways to cortex cerebri –> these excitatory pathways constitute part of the arousal system

2) Raphe nuclei:
* Located across the median line of the mesencephalon
* Project serotonergic axons to the total cortex cerebri –> large part runs to limbic-related areas and influences mood and affection
* Serotonergic system also plays role in the sleep-wake cycle

3) Ventral tegmental area and substantia nigra in ventral mesencephalon:
* Project dopaminergic fibres to frontal lobe
* Influence motor activity, behavior and cognition

4) Caudal hypothalamus:
* Located dorsally from the corpus mammillare
* Projects histaminergic fibers to all areas of the cortex cerebri

47
Q

Corpus mammillare

A

Strongly connected to hippocampus and involved in memory processes

48
Q

Some functional aspects and some examples of dysfunctions of the hypothalamus: It uses reference values and feedback mechanisms to control homeostasis

A

It uses reference values and feedback mechanisms to control homeostasis:
To keep homeostasis, the hypothalamus initiates compensatory mechanisms when the actual value starts to deviate from the set point. These mechanisms contain complex interactions of autonomic, endocrine and behavior responses

49
Q

Some functional aspects and some examples of dysfunctions of the hypothalamus: It controles our body temperature by balancing the amounts of production and loss of body heat

A

Heat is produces by metabolic processes and heat loss depends on the environmental temperature and can by influences by peripheral VC/VD, transpiration/shivering, behavior.

Outside temperature is measured by thermosensors in the skin, and blood temperature is measured by the hypothalamus (preoptical area)
Dysfunction in this area can lead to hyperthermia, and dysfunction of the posterior part of the hypothalamus can lead to hypothermia. In severe cases this can lead to poikilothermia (the outside temperature determines body temperature)

Body temperature can also be affected by emotions
Inflammatory conditions –> production of interleukins which act as pyrogens: rise in temperature because of increased set point
Salicylates –> decrease of body temperature because of their inhibitory effect on the production of prostaglandins
Prostaglandins, serotonin –> rise of temperature
Bom, som, ACh and naloxone –> decrease of temperature

Life-Threatening situations:

  • Maligne hyperthermia syndrome: after anesthesia, involves metabolic dysregulation of striated muscle and occurrence of myoglobulinuria
  • Maligne neuroleptic syndrome: the symptoms are rigidity, akinesia and fever. The patient needs to be treated with dopamine-agonists
50
Q

Some functional aspects and some examples of dysfunctions of the hypothalamus: Plays an important role in controlling the body weight

A

Long term eating behavior is influences by the amount of accumulated fat
Short term eating behavior is controlled by peptides –> stop eating - signal

The role of hypothalamus in eating disorders is still unclear, but dysfunctions of the ventromedial hypothalamus can occasionally lead to gluttony with sometimes aggression

51
Q

Some functional aspects and some examples of dysfunctions of the hypothalamus: The nucleus suprachiasmaticus acts as our biological clock

A

The circadian rhythm consists of:

1) The infradian rhythm –> cycle longer than 24h
2) The ultradian rhythm –> cycle shorter than 24h

52
Q

Some functional aspects and some examples of dysfunctions of the hypothalamus: It is involved in sexual behavior

A
  • Key players –> connections between hypothalamus with limbic structures and with the frontal lobe
  • HH-axis –> crucial in sexual development and differentiation
  • Morphological differences in hypothalamus of hetero- and homosexuals –> hypothalamus is also involved in sexual orientation and gender-feeling
  • Dysfunctions can lead to:
    1) Aggression
    2) Hypo-/hyper-sexuality

Loss of libido could be because of lack of gonadotropin releasing hormone

53
Q

Some functional aspects and some examples of dysfunctions of the hypothalamus: Dysfunction in hypothalamus/hypophysis acid leads to endocrine dysfunction

A
  • Damage of the hypophysis can be caused by:
    1) Trauma cerebri
    2) Intracerebrale neurosurgery
    3) Compression due to intracerebral tumors
    4) Radiotherapy
    5) Inflammation
    6) Cerebrovascular bleeding
    7) Cerebral infarction
  • Damage of neurohypophysis:
    1) Diabetes insipidus (symptoms can also be caused by dysfunction of the kidney)
    2) Syndrome of inappropriate ADH-secretion
  • Damage of adenohypophysis:
    1) Decreased activity of the adenohypophysis:
  • -> Simmonds disease: growth hormone deficiency with growth retardation and hypoglycemia and reduced prolactine secretion as consequence
  • -> Additional reduced production of LH + FSH: retarded puberty with infertility, amenorroe or impotence
  • -> Thyrotropin deficiency: hypothyroidea
  • -> POMC + ACTH-production: hypoadrenalism (if these symptoms start postpartum, then Sheehan Syndrome)

2) Increased activity of the adenohypophysis:
- -> Overproduction growth hormone: giantism, acromegaly
- -> Hyperprolactinemie: retarded puberty, hypogonadism, infertility
- -> Overproduction of LH, FSH: precocious puberty, galactorroe, amenorroe, polycystic ovaria
- -> Overproduction of thyrotropin: hyperthyroidea
- -> Overproduction of POMC: Cushing syndrome, Nelson’s syndrome

54
Q

Pinealocyten

A

These are endocrine cells, modified glia cells; which secrete melatonin and form perivascular contacts with sinusoidal capillaries

Function:

1) Role in circadian rhythm
2) Role in sexual behavior and reproduction
3) Role in thermoregulation
4) Role in colour changes

55
Q

Interactions between ANS and immune system

A
  • Central role hypothalamus-hypophysis-adrenal gland axis:
    1) Hormonal effects:
  • -> Corticosteroids: inhibitory effect on immune system
  • -> Somatotropin, prolactine: stimulatory effect on the immune system

2) Neural effects:
- -> OS innervation of thymus, bone marrow, spleen, lymph nodes, Peyer’s plaques
- -> Peptidergic (opioid) receptors on lymphocytes and macrophages
- -> Feedback to AND via cytokines

  • The hypothalamus-hypophysis-adrenal gland axis is crucial in stressrespons:
    1) Stressrespons: changes in behavior, activation of OS and of HHAG-axis
    2) Behavioral respons –> Short term survival
    3) Behavioral activities associated with long term survival are stopped
    4) Increase of OS-activity
    5) CRH release
56
Q

ANS disorders

A
  • Primary disorders –> independent dysfunction of the global ANS
  • Secondary disorders –> as a result of specific disorders
57
Q

ANS disorders: Primary autonomic dysfunctions

A
  • Can be focal or diffuse
  • Pure autonomic faillure –> both OS and PS are involved, but other neurological structures. These diseases are characterized by following symptoms:
    1) Orthostatic hypotension (tractus circulatorius)
    2) Stridor, apnoe, inspiratory gasping (tractus respiratorius)
    3) Constipation (tractus digestivus)
    4) Incontinence, nocturia, retention impotence (tractus urogenitalis)
    5) Anisocoria, Horner syndrome (eye)
    6) Anhydrosis (sweat glands)
  • Autonomic faillure associated with dysfunctions of other neurological structures:
    1) Shy-Drager syndrome (ANS + faillure of extrapyramidal motor system). Resembles Parkinson symptoms (there are 3 types: Parkinson type, cerebellar type or combination of both)
    2) Olivopontocerebellar atrophy (combination of ANS/extrapyramidal + loss of function in pyramidal or cerebellar areas)
58
Q

Autonomic functions and dysfunctions of specific organ systems: The ocular system

A

ANS determines pupil size and curvature of the lens

  • m. sphincter pupillae –> innervated by PS
  • m. dilator pupillae –> innervated by OS
  • m. levator palpebrae –> innervated by OS
  • m. ciliaris –> innervated by PS –> lens becomes more convex
  • Lacrimal gland –> innervated by PS –> lacrimal secretion

Disturbed function can be associated with:

  • Enlargement op pupil
  • Horner syndrome:
  • -> Narrowing of pupil, weakness of m. levator palpebrae, deepening of eyeball in orbita
  • -> Anhydrosis in face and neck
  • Raeder syndrome: paratrigeminal syndrome, see Horner, but no dysfunction in sweat secretion
59
Q

Autonomic functions and dysfunctions of specific organ systems: The sudomotoric system and thermoregulation

A
  • Sweat glands are exclusively innervated by OS
  • In most sweat glands is ACh the main transmitter
  • In apocrine sweat glands is (N)A the main transmitter
  • Dysfunctions affect thermoregulation:
  • -> Spinal cord leasion: anhydrosis –> hyperthermia
  • -> Parkinson: hyperhydrosis of face and thorax
60
Q

Autonomic functions and dysfunctions of specific organ systems: Cardiovascular system

A
  • Balance OS/PS regulates activity of the heart and blood pressure:
  • -> Enhanced vagal activity: decrease of heart frequency
  • -> Enhanced OS activity: increase of heart frequency and peripheral resistance
  • -> Enhanced blood pressure: baroreceptors activated: via n. vagus activation of n. solitarius –> activation of cardiovascular center in reticular formation of mesencephalon –> activates DMX –> inhibition of tonic active OS
  • Diffuse autonomic dysfunctions –> prominent orthostatic hypotension
  • Secondary autonomic dysfunctions –> Paroxysmal hypertension
61
Q

Autonomic functions and dysfunctions of specific organ systems: The respiratory system

A

ANS regulates diameter of airways and mucus secretion:

  • -> OS: bronchodilatation + weak pulmonary VC
  • -> PS: bronchoconstriction + increased water and mucus secretion

Autonomic dysfunction can lead to:

  • -> apnoe
  • -> gasping
62
Q

Autonomic functions and dysfunctions of specific organ systems: The urogenital system

A

Control muscular components of bladder and urethra:

1) Nervus pudendus: urethral sphincter contracts –> filling of bladder
2) Nervus pelvinus (PS): stimulation leads to contraction of m. detrusor –> emptying of bladder. Inhibition leads to relaxation of m. detrusor: relaxation of bladder
3) nervus hypogastricus (OS): stimulates alfa-adrenoceptors on muscles at bladder entrance + inhibition of contraction of m. detrusor

63
Q

Micturation reflex = spinal reflex

A
  • Controlled by caudal brainstem, which is controlled by the cerebral cortex and cerebellum:
    1) PS stimulation of m. detrusor
    2) Inhibition of n. pudendus
    3) inhibition of OS innervation of m. detrusor and neck muscles of the bladder
64
Q

Micturation disturbances

A
  • Most disturbances are caused by primary urological causes
  • Micturation disturbances caused by neurological dysfunctions:
    1) Urge-incontinence –> pollakisuria: can have several causes:
  • -> dysfunctions in sensible pathways
  • -> dysfunctions in motor pathways
  • -> obstructive causes
  • -> idiopathic causes
    2) Reflex-incontinence
    3) Neurogenic micturation faillures:
  • -> Total denervated bladder - urine retention
  • -> Spastic (sacral) reflex bladder
  • -> Imperative bladder
  • -> Cerebral bladder
65
Q

Sexual functions and dysfunctions

A

Erection –> priaprism:
Requires intact sacral PS autonomic reflexes controlled by descending pathways originating from the reticular formation in the brainstem and by cortical and limbic brain areas

Reflex erection failure (due to autonomic peripheral neuropathy)

Ejaculation:

  • Requires 2 reflexes
  • Coordination by ejaculative reflex at lever T12-L1
66
Q

Autonomic functions and dysfunctions of specific organ systems: The GI-system

A
  • Regulated by ENS
  • Salivary glands stimulated by OS and PS
  • Other GI-glands influenced by local effectors –> PS stimulates secretion and induces VD whereas OS has the reverse effects
  • Mechanism of defecation similar to micturation reflexes
  • Primary autonomic dysfunctions are in general associated with obstipation, gastroparese, incontinence, paralytic ileum associated with intestinal ulcers due to enhanced gastric acid secretion
67
Q

Therapeutic options for autonomic dysfunctions

A
  • Orthostatic hypotension –> elastic stockings, fludrucortison, vasopressin-agonists
  • Hypertension –> sympatholytica
  • Hyperhydriosis –> Anticholinergica
  • Hypothermia –> hot drinks
  • Hyperthermia –> cold drinks + cold bathing
  • Gastroparese –> Domperidon
  • Paralytic ileus –> I.v. feeding, nasal catheter to remove gastric acid, histamine 2 receptor antagonists to prevent ulcers
  • Diarrea –> opiates
  • Obstipation –> fiber rich diet, laxatives
  • Mechanical obstructions for micturation –> prostatectomy, transurethral resection, sphincterotomy, enhancement of tone of m. detrusor by anticholinergica
  • Inspiratory stridor –> tracheostomy
  • Periodic apnoe –> surgical placement of tongue anchor

System Neuroscience (2 decks)

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