Thoracic Neurology Flashcards
What are the 4 constriction points of the esophagus?
- cricopharynxgeus m. (upper esophageal sphincter)
- aortic arch
- L bronchus
- esophageal hiatus
What are the branches of the vagus n.?
- superior cardiac branch
- middle cardiac branch
- recurrent laryngeal*
- inferior cardiac branch *
- pulmonary branches
- esophageal branches
- anterior/posterior vagal trunk
Through what space does the vagus nerve travel through to get to the thorax?
-superior thoracic aperture
What is special about the path of the L recurrent laryngeal and what is a clinical not about it?
it loops under the arch of the aorta to go to the larynx
-aortic aneurysms near ligaments arteriosum can cause a hoarse voice
What muscles does the recurrent laryngeal n. innvervate?
- posterior circiothyroid m.
- lateral cricothyroid m.
- transverse & oblique cretinoid m.
- thyroarytenoid m.
- vocalis m.
Does the R recurrent laryngeal enter the thorax?
no, out stays in the neck
What is the path of the phrenic n. ?
- > anterior rami of C3,4,5
- travels inferiorly and anterior to the anterior scalene
- it passes through the superior thoracic aperture
- travels b/w the fibrous pericardium and the parietal mediastinal pleura
What does the phrenic nerve innervate?
thoracic diaphragm
What part of the CNS does the intercostal nerve originate from?
the anterior rams of thoracic spinal n.
What are the typical intercostal n. ?
Where do the travel?
1-11th anterior rami of thoracic spinal n.
-travel in costal groove on the inferior portion of the rib in the intercostal space b/w internal intercostal m. and innermost intercostal m
What do the intercostal n.s innervate?
skin, subs tissue, muscles of thorax
-costal and diaphragmatic pleurae
What is the rami communicants?
structure that connects the intercostal n. to the ipsilateral sympathetic trunk
What does the lateral cutaneous branch of the intercostal n. innervate?
-skin of thoracic wall, T4-T6 supply breast
What are the atypical intercostal n?
1st ,2nd, 7-11th
What is atypical about the 1st intercostal n.?
- no cutaneous branch
- joins brachial plexus
What is atypical about the 2nd intercostal n.?
- small part joins brachial plexus
- intercostobrachial n. -> supplies skin & subQ of axilla (later cutaneous branch)
What happens as the 7th -11th intercostal never run anteriorly?
no longer b/w ribs and are now called the thoracoabdominal n.s
What are the 3 main sympathetic components in the thorax?
1) thoracic sympathetic trunk
2) cardiopulmonary splanchnic n.s
3) abdominopelvic splanchnic n.s
What composes the thoracic sympathetic trunk?
paravertebral sympathetic ganglia
What are the 2 cardiopulmonary splanchnic nerves, where are their cell bodies, and where do they send their fibers?
- cardiac splanchnic -> lateral horn T1-T5/6 ; superficial and deep cardiac plexus
- pulmonary splanchnic -> lateral horn T2-3 ; pulmonary plexus
Are the cardiopulmonary splanchnic n.s pre or post synaptic?
POST SYNAPTIC
Are the abdominopelvic splanchnic n.s ore or post synaptic?
PRE SYNAPTIC
What are the 3 abdominosplanchnic n.s?
- greater splanchnic n.
- lesser splanchnic n.
- least splanchnic n.
What is the path of the greater splanchnic n.?
T5-T9/10 -> esophageal plexus and celiac ganglion -> celiac plexus
What is the path of the lesser splanchnic n.?
T10-11 -> celiac & superior mesenteric ganglion -> superior mesenteric plexus
What is the path of the least splanchnic n.?
t12-> aorticorenal ganglion
Where do the abdominosplanchnic nerves synapse?
prevertebral ganglion (complete pass paravertebral ganglion)
What are the 4 thoracic autonomic plexi?
- Cardiac
- pulmonary
- aortic
- esophageal
What does the pulmonary plexus innervate and what are its sympathetic and parasympathetic contributions?
-lungs, bronchi, and pleura
sympathetic : pulmonary splanchnic n.
parasympathetic : pulmonary branches of the vagus
What does the cardiac plexus innervate and what are its sympathetic and parasympathetic components?
heart (SA and AV nodes)
sym: cardiac splanchnic n.
parasympathetic : superior , middle, and inferior cardiac branches of the vagus n.
Where is the deep cardiac plexus located?
anterior to the bifurcation of the tranchea
- posterior to aortic arch
- superior to bifurcation of the pulmonary trunk
What does the aortic plexus feed into and what is its role?
- feeds into the mesenteric plexus
- is a conduit for symp and parasympathetic fiber from the cardiac plexus into the abdomen
What does the esophageal plexus innervate and what are its sympathetic and parasympathetic contributions?
-esophagus
- sym = greater splanchnic n. and aortic plexus
- parasym : esophageal branches of the vagus n.
What does activation of the pulmonary splanchnic n. do?
- bronchodilator & inhibit glands of bronchi & bronchioles
- Vasoconstrict pulmonary vessels
- visceral sensory
What does activation of the pulmonary branches of the vagus n. do?
- bronchoconstrictor & secretor motor to glands of bronchi and bronchioles
- vasodilate pulmonary vessels
What are the sensory components of the lungs? (hint : 5)
- bronchial mucosa = cough reflex
- bronchial m. = stretch receptors
- intracellular CT = reflexive
- Pulmonary a. = pressure
- pulmonary v. = chemoreceptor
What does activation of the cardiac splanchnic n. do ?
- increase HR and force of contractions
- vasomotor pericardium
What does activation of the cardiac branches of the vagus n. do?
- decrease HR and force of contraction
- vasoconstrict coronary a.s
What does activation of the greater splanchnic n. do?
-inhibit peristalsis & esophageal glands
What does activation of the esophageal branches of the vagus n. do?
-stimulate peristalsis & esophageal glands
