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Thoracic Neurology Flashcards

1
Q

What is the function of the

Thoracic Esophagus?

A

Joins Laryngopharynx to stomach

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2
Q

What are the characteristics of the

Thoracic Esophagus?

A

Double layered, muscular tube w/ internal circular layer and external longitudinal layer

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3
Q

What makes up the Upper 2/3rds of the Thoracic Esophagus?

A

Combo of Smooth and SKeletal m.

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4
Q

What are the regions of the THoracic Esophagus?

A
  1. Cervical part
  2. Thoracic part
  3. Abdominal part
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5
Q

Where is the
Thoracic part of the Esophagus?

What will it travel thru?

A

B/w T1 and Esophageal hiatus of thoracic diaphragm

Travels thru posterior mediastinum

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6
Q

What are the potential constriction points in the Thorax re: esophagus?

A
  • cricopharyngeus m.
  • aortic arch
  • left bronchus
  • esophgeal hiatus of the thoracic diaphragm
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7
Q

What is the Cricopharyngeus m. Also known as?

A

Upper esophageal sphincter

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8
Q

What is the Esophageal Hiatus of the Thoracic diaphragm also known as?

A

Lower esophageal sphincter

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9
Q

What is the course of the Vagus nerve in the thorax?

A
  1. Enters thorax via Superior thoracic aperture
  2. Travels to Posterior mediastinum
  3. Enters abdomen becoming Anterior and posterior Vagal trunk
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10
Q

What branches does Vagus N. Give off after entering thorax thru Superior thoracic aperture?

A

Left recurrent laryngeal n.

Pulmonary branch

Inferior cardiac branch

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11
Q

What branches does Vagus N. Give off as it travel to posterior mediastinum?

A

Esophageal branches

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12
Q

What will the R and L vagus nerve become after entering abdomen?

A

R. Vagus N = Posterior Vagal Trunk

L. Vagus N. = Anterior Vagal trunk

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13
Q

What is the route of the Left Recurrent Laryngeal N.

What will it innervate?

A

Loops under aortic arch and Ligamentous arteriosus

To innervate larynx

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14
Q

How will the RIght Recurrent Laryngeal N. Travel?

A

It loops under the Subclavian A. To go back and innervate Larynx

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15
Q

What is the Phrenic N. Derived from?

A

Cervical spinal nerve associated w/ thorax

Derived from ANTERIOR rami of C3-C5

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16
Q

How does the Phrenic N. travel?

What will it innervate?

A

Travels thru superior thoracic aperture —> space b/w mediastinal PARIETAL pleura and FIBROUS pericardium

Innervates thoracic diaphragm

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17
Q

What sensory info will the Phrenic N. Convey?

A

Conveys sensory info from central diaphragmatic and mediastinal pleura and pericardium

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18
Q

What characterizes Intercostal Ns.?

A

11 pairs of nerves derived from ANTERIOR rami of Thoracic Spinal Ns.

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19
Q

Where do Intercostal Ns. Travel?

A

Travel along inferior edge of the Supeiror rib in intercostal space b/w internal and innermost intercostal Ms.

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20
Q

What will the Intercostal Ns. Innervate?

A

Skin

Subcutaneous tissue

Musculature

Costal and Diaphragmatic Parietal Pleura

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21
Q

What are the “Typical” intercostal Ns.?

A

3-6

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22
Q

What is the branching pattern of Typical Intercostal Ns.?

A
  1. Rami communicates
  2. Collateral branches
  3. Lateral Cutaneous branches
  4. Anterior cutaneous branches
  5. Muscular branches
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23
Q

What is the function of Rami Communicates of the Typical Intercostal Ns.?

A

Connects INtercostal N. To ipsilateral thoracic sympathetic trunk

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24
Q

What is the Role of the collateral Branches of Typical Intercostal Ns.?

Where do these travel?

A

Assists in innervating intercostal m.

Travels on superior edge of rib inferior to intercostal space

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25
What is the role of the Lateral Cutaneous branches of Typical Intercostal Ns.?
Split into Anterior and Posterior branches and supply skin of thoracic wall T4-T6 will supply the Breast
26
What is the role of Anteiror Cutaneous branches of the Typical Intercostal Ns.?
Supply anterior aspect of thoracic wall T4-T6 will supply the Breast
27
What is the role of the Muscular Branches of the Typical Intercostal Ns.?
Supply intercostal Ms., Subcostal M., and Transversus Thoracis M.
28
What are the “Atypical” intercostal ns.?
1,2, 7-11
29
What characterizes the 1st Intercostal N.?
No cutaneous branches Majority of supeiror portions joins the brachial plexus
30
What characterizes the 2nd Intercostal N.? What is the role of its lateral cutaneous branch? Aka?
Majority travels in costal groove as typical intercostal n. W/ small part joining w/ brachial plexus Lateral cutaneous branch to supply skin and subcutaneous tissue of Axilla Aka Intercostobrachial n.
31
What characterizes 7th-11th Intercostal Ns.?
Begin as intercostal N. But as they travel anteriorly, they cease to exist b/w ribs and transition over abdomen to become.. thoracoabdominal N.
32
What are the two divisions of the Autonomic system?
SNS PNS
33
Where do we see PNS distribution?
Head, neck, and trunk viscera | Never in body wall or extremities
34
Where do we see SNS distribution?
Distributed to all vascular areas of the body
35
How is glandular secretion controlled?
Stimulated via PNS (except sweat) Decreased secretion via SNS (using vasoconstriction)
36
What levels do we see sympathetic division?
Thoracolumbar T1-L2
37
How are the pre and post synaptic fibers in the SYMPATHETIC division? Where are the cell bodies in each?
``` Pre = short, cell bodies in lateral horn Post = long, cell bodies in paravertebral or prevertebral ganglia ```
38
How do presynaptic fibers of the SYMPATHETIC fibers travel?
Lateral horn —> anterior root —> anterior ramus —> Paravertebral ganglia
39
What are the Synaptic Options for Presynaptic fibers in the SYMPATHETIC division (3)?
1. Paravertebral ganglion —> postsynaptic neuron in SAME spinal level 2. Paravertebral ganglion —> Post-syn. Neuron on DIFFERENT Spinal level 3. Paravertebral ganglion —> exit w/o synapsing —> ABDOMINOPELVIC Splanchnic n. —> post sym. Neuron in PRE-vertebral ganglion
40
What characterizes the Paravertebral Ganglion?
Where cell bodies of post synaptic fibers in the Sympathetic div. are - linked vertically to form sympathetic trunks on either side of the vertebral column - also 3 ganglia in Cervical, Lumbar, and Pelvic Regions
41
What characterizes the PRE-vertebral ganglia?
Where cell bodies of Post syn. Fibers of the SYMP. Division end up Ganglia and corresponding plexuses surround main unpaired branches of the Abdominal Aorta
42
What are the 4 PRE-vertebral Ganglions?
1. Celiac ganglion 2. Superior Mesentery Ganglion 3. Aorticorenal Ganglion 4. Inferior Mesentery Ganglion
43
Where do we see Presence of Sympathetics in the Thorax? (3)
1. Thoracic Sympathetic Trunk 2. Cardiopulmonary Splanchnic Ns. 3. Abdominopelvic Splanchnic Ns.
44
What does the Thoracic Sympathetic Trunk allow for?
Is location of presynaptic sympathetic nerve fibers synapsing onto Long pOst synaptic nerve cell bodies
45
What nerves are classified as Cardiopulmonary SPlanchnic Ns.?
Cardiac Splanchnic N. Pulmonary Splanchnic N.
46
How does the Cardiac SPlanchnic N. Travel? What will it send fibers to?
Presynaptic cell bodies in Lateral Horn of SC at Level of T1-5/6 —> Post-Syn. Cell bodies in Cervical or THoracic Sympathetic trunk Send fibers to the Superficial and Deep Cardiac Plexuses
47
How does the Pulmonary Splanchnic N. Travel? Where will it send fibers to?
Presyn. Cell bodies in lateral horn of SC at Levels T2-3 —> Postsyn. Cell bodies in thoracic Sympathetic trunk -sends fibers to Pulmonary Plexuses
48
What is the role of the Abdominopelvic Splanchnic Ns.?
Travels from Thoracic Sympathetic Trunk to Corresponding PRE-vertebral ganglia in abdomen (Pre-vertebral = celiac, superior mesentery, aorticorenal, inferior mesentery)
49
What are the Abdominopelvic SPlanchnic Ns.?
1. Greater splanchnic n 2. Lesser splanchnic n. 3. Least splanchnic n.
50
How does the Greater splanchnic n. Travel?
From T5-9/10 Sends fibers to esophageal plexus and to Celiac Ganglion —> celiac Plexus
51
How does the Lesser SPlanchnic N. Travel?
from T10 and T11 Send fibers to Celiac and Superior Mesenteric Ganglion in abdomen —> superior Mesenteric plexus
52
How does the Least Splanchnic N. Travel?
From T12 Sends fibers to the Aorticorenal Ganglion in abdomen
53
What comprises the Paraysympathetic Nervous System?
Craniosacral CNs 3, 7, 9, and 10, S2-4
54
How are the pre and post synaptic fibers in the PARA sympathetic nervous system?
``` Pre= long Post = short ```
55
Where are the nuclei of the Pre-synaptic fibers of the PARAsympathetic nervous system?
Nuclei in brainstem and sacral spinal levels
56
What CNS are components of the Parasympathetic Nervous system?
CN3 (oculomotor) CN7 (facial) Cn9 (glossopharyngeal) CN10(vagus)
57
What are the Sacral components of the Parasympathetic Nervous System?
Sacral component exits spinal levels as Pelvic Splanchnic Ns.
58
Where is the ganglia/post-synaptic neurons of the Postsynaptic fibers of the PARAsympathetic nervous system?
Near or in target organs (why they are short!!)
59
What are the 4 ganglions associated w/ Postsynaptic fibers of the PARAsympathetic Nervous System?
1. Ciliary 2. Pterygopalatine 3. Submandibular 4. Otic Gnaglion
60
What presynaptic fibers will the Ciliary Gnaglion receive?
Fibers from CN3
61
What presynaptic fibers will the Pterygopalatine Gnaglion receive?
Fibers from Cn 7
62
What presynaptic fibers will the submandibular Gnaglion receive?
Fibers from CN 7
63
What presynaptic fibers will the Otic Gnaglion receive?
Fibers from CN 9
64
What are Intrinsic Parasympathetic ganglia?
Post-synaptic parasympathetic cell bodies located in wall of target organs
65
What are the branches of the Vagus N. In the Thorax?
1. Superior cardiac branch 2. Middle cardiac branch 3. inferior cardiac branch 4. Pulmonary branches 5. Esophageal branches
66
What does the Vagus n. Allow for in the Thorax?
Presynpatic parasympathetic innervation to the ``` Lungs Bronchi Heart Pleurae Pericardium ```
67
How does the Superior Cardiac Branch of the Vagus N. Travel? what will it from?
Originates in neck —> descend thru Superior Thoracic Aperture -forms cardiac plexus w/ cardiac splanchnic ns.
68
How does the MIddle Cardiac Branch of the Vagus N. Travel? what will it from?
Originates in neck —> descends thru Superior THoracic APerture -forms cardiac plexus w/ cardiac splanchnic Ns.
69
How does the Inferior Cardiac Branch of the Vagus N. Travel? what will it from?
Originates in thorax -forms cardiac plexus w/ cardiac splanchnic Ns.
70
How do the Pulmonary Branches of the Vagus N. Travel? what will it from?
Originates in thorax -forms Pulmonary Plexus w/ Pulmonary Splanchnic Ns.
71
How do the Esophageal Branches of the Vagus N. Travel? what will it from?
Originates in thorax 0joins esophageal plexus that covers inferior 2/3rds of the esophagus
72
What makes up the Pulmonary Plexus? Sympathetic from? Parasympathetic from?
Sympathetic input from: Pulmonary Splanchnic Ns. Parasymp. Input from: Pulmonary branches of CNX
73
What will the Pulmonary Plexus inner term?
Lungs Bronchi Pleurae
74
What will the sympathetic input of the Pulmonary Plexus do?
- bronchodilator to bronchi and bronchioles - inhibitor to gland of bronchi and bronchioles - vasoconstrictor to pulmonary vessel - visceral sensory from lungs, bronchi and pleurae
75
What will the parasympathetic input of the Pulmonary Plexus do?
◦ Bronchoconstrictor to bronchi and bronchioles ◦ Secretomotor to glands of the bronchi and bronchioles ◦ Vasodilator to pulmonary vessels ◦ Sensory from Bronchiol mucosa (cough reflex) stretch receptors from bronchial musculature ◦ Reflexive from interalveolar connective tissue ◦ Pressure sensory from Pulmonary A. ◦ Chemoreceptors from Pulmonary V.
76
What makes up the Cardiac Plexus? Sympathetic from? Parasympathetic from?
Symp. Input from: Cardiac Splanchnic Ns. Parasymp. Input from: Superior, Middle and Inferior Cardiac Branches of CNX
77
Where will the post synaptic fibers of the Superior, Middle and Inferior cardiac branches of the Vagus N. Terminate?
Terminate near the SA and AV nodes
78
What is the function of the Sympathetic fibers of the Cardiac Plexus?
◦ Innervates NOdal Tissue ‣ Increases HR and force of heart contractions ◦ vasomotor to pericardium
79
What is the function of the Parasympathetic fibers of the Cardiac Plexus?
◦ Innervation Decfrease HR, reduces force of heart contraction ◦ Vasoconstriction Coronary As. (!!!)
80
Where is the Superior Cardiac Plexus?
Covers anterior surface of aorta
81
Where is the Deep Cardiac Plexus?
Exits anteiror to bifurcation of the Trachea, posterior to aortic arch, superior to bifurcation of the pulmonary trunk
82
What characterizes the Aortic Plexus?
Continuous superiorly w/ Superficial Cardiac Plexus Continuous inferiorly as Aortic Plexus in Abdomen, feeds into the InterMesenteric Plexus
83
What makes up the Esophageal Plexus? Sympathetic input? Parasympathetic Input?
Symp. Input from: Greater Splanchnic N. And AOrtic Plexus Parasymp. Input from: Esophageal branches of the Vagus N.
84
What is the function of the Sympathetic input to the Esophageal Plexus?
Inhibit peristalsis and esophageal glands
85
What is the function of the Parasympathetic input to the Esophageal Plexus?
Stimulates peristalsis and esophageal glands

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