Autonomic Nervous system Anatomy Lecture

Why do liver function tests?

1. Detect the presence of disease 2. Narrow Differential Diagnosis 3. Gauge the extent of known liver damage 4. Follow response to treatment

The axons for the preganglionic sympathetic neurons are shorter than those for the ____________ of the preganglionic parasympathetic neurons.

Axons

The preganglionic parasympathetic neurons that arise from sacral spinal cord levels S2, S3 and S4 synapse of terminal ganglia. The postganglionic parasympathetic neurons that arise from these ganglia innervate smooth muscle and glands of the ______, ______, _______ and _________ organs.

Colon, ureters, bladder, and reproductive

The sympathetic nervous system is always excitatory in nature. (T/F)

False

What are some direct disease states for bilirubin?

Gallstones Extrahepatic duct obstruction Extensive liver mets Dubin-Johnson syndrome (AR)

Preganglionic sympathetic neurons can also synapse on __________ cells in the adrenal medulla. These cells contain _________ receptors. These cells then synthesize and release the hormones/neurotransmitters ____________________. 80% of the hormone released is epinephrine.

Chromaffin nicotinic norepinephrine and epinephrine

What is bilirubin used for?

Used to evaluate liver function, hemolytic anemia and Jaundice

Sensory input into the system occurs via_______ ________ ________.

Visceral afferent neurons

What is Bilirubin?

It is a by product of heme metabolism

Beta-1 receptors are also found on the _____________________________cells of the kidney resulting in secretion of the hormone ______. There are also beta-1 receptors in the posterior pituitary which results in the release of _____.

JG (now also called granule cells) renin ADH

What are some of the short commings of liver function tests?

Liver tests have shortcomings rarely suggest a specific diagnosis More likely to suggest a general category of liver diseases When used in combination, can narrow down the possibilities

The axons for the postganglionic sympathetic neurons are________ than those for the axons of the postganglionic parasympathetic neurons.

Longer

What are some indirect disease states for bilirubin?

Transfusion reaction SSA Hemolytic jaundice Hemolytic anemia Pernicious anemia Resolution of large hematoma Gilbert's Syndrome Sepsis Neonatal hyperbilirubinemia Hepatitis Cirrhosis

The organ system where the sympathetic and parasympathetic nervous system do not work in an opposite manner, but rather in a cooperative manner with each system having its own unique role is the __________system.

reproductive

The parasympathetic nervous system is classically described as the "rest and digest" system or the SLUDD system. SLUDD stands for ________________________________________

salivate, lacrimate, urinate, digest and defecate.

Beta-2 receptors are also found on the blood vessels to heart, muscle,________ tissue and __________________. The sympathetic responses in these sites is ________

skeletal adipose tissue and liver dilatation

Identify the sites that contain nicotinic receptors: _____________________________________________________________________

skeletal muscle, ganglia for both sympathetic and parasympathetic nervous system, chromaffin cells, target organs for parasympathetic nervous system.

The axon of the preganglionic neurons are_____________________.

small diameter, myelinated axons (B fiber).

The axon of the postganglionic neurons are _________, _____________

small diameter, unmyelinated (C fiber).

The three categories of target organs in the ANS are ________, _______ and_______.

smooth muscle, cardiac muscle and glands

Autonomic networks are tangles of nerves in the thoraci, abdominal and pelvic cavities. They contain only sympathetic/only parasympathetic/both axons. Many of these are in the same location as major blood vessels. The autonomic networks are the _____________________

cardiac, pulmonary, celiac, superior mesenteric, inferior mesenteric and renal

There are five major prevertebral ganglia. These are the ______________________________

celiac, superior mesenteric, inferior mesenteric, aortorenal and renal.

Preganglionic parasympathetic neurons that originate from the oculomotor nucleus in the midbrain synapse in the _____ ganglia. The postganglionic neuron synapses on ciliary muscles of the iris and result in ______________of the pupil.

ciliary constriction (miosis)

There are three groupings of paravertebral ganglia in the cervical region. These are termed the ________, ______ and _______________. The_____ receives innervation from all three of these ganglia.

superior, middle and inferior cervical ganglia heart

The sweat gland is unique. It is considered part of the _________ nervous system. However, it uses acetylcholine at both its synapses. The sweat gland itself contains __________ receptors.

sympathetic muscarinic

The cell body and dendrites for postganglionic neurons are located in _______.

ganglia

The sympathetic nervous system favors the rapid production of ATP. It does so by _______ in the liver to release glucose, ______ in adipose cells to release fatty acids.

glycogenolysis lipolysis

The pathway for a postganglionic sympathetic neuron's axon would be through the _____ ramus ....into the ______ nerve to then travel to the target organ.

gray spinal

Sympathetic nerve can form nerve plexuses after a synapse in the prevertebral ganglia. These nerves are the _______________________________________. The nerves innervate multiple organs and structures in the abdominal cavity.

greater splanchnic, lesser splanchnic and least splanchnic, lumbar splanchnic and splanchnic nerves to the adrenal medulla.

In general, the hypothalamus ___________ the effect of the sympathetic nervous system.

increases

Alpha-2 and beta-2 receptors are generally associated with ________effects.

inhibatory

The lower portion of the parasympathetic nervous system arise from cell bodies and dendrites in the ______________ gray matter from spinal cord levels _____.

lateral (intermediate) S2-S4

The preganglionic parasympathetic neuron's axon is _________. The postganglionic parasympathetic neuron's axon is __________. The cell bodies and dendrites for postganglionic neurons are located in terminal or ________.

long very short terminal and intramural ganglion

The sites where there is ONLY sympathetic innervation are_________________________________________________________________________

most peripheral blood vessels, sweat glands, arrector pili muscles, adrenal medulla, kidney and spleen

The autonomic nervous system is predominantly a _____ _______.

motor system

Alpha-1 receptors are also found in the radial muscles of the iris and produce ________of the pupil.

mydiriasis

Acetylcholine binds to cholinergic receptors which come in two varieties: _______________________

nicotinic and muscarinic.

The neurotransmitter released by the postganglionic sympathetic neurons is ___________ and this neurotransmitter binds to ___________ receptors. This effect is either _____________________

norepinephrine adrenergic excitatory or inhibitory depending on the target organ.

Preganglionic parasympathetic neurons that originate in the glossopharyngeal nucleus of the brainstem synapse in the _____ ganglia. Postganglionic parasympathetic neurons that arise in this ganglia innervate the ______gland.

otic parotid

The innervation to organs above the diaphragm come from __________ ganglia. Innervation to organs below the diaphragm come from ___________ ganglia.

paravertebral prevertbral

The ganglia for the sympathetic nervous system are termed the ________________________

paravertebral ganglia and prevertebral ganglia.

The autonomic nervous system is part of the _______ _____ ________.

peripheral nervous system

Muscarinic receptors are found on the target tissues for the ___________________as well as __________ glands.

postganglionic parasympathetic neurons sweat

There are two neurons in the ANS system which are termed the __________ and ____________.

preganglionic and postganglionic neurons.

Preganglionic parasympathetic neurons that originate in the facial nucleus of the brainstem synapse in the _________ and __________ganglia. Postganglionic parasympathetic neurons that innervate the glands of the nasal mucosa, pharynx, palate and lacrimal glands arise in the ________ ganglia. Postganglionic parasympathetic neurons that innervate the submandibular and sublingual glands arise from the ______ ganglia.

pterygopalatine and submandibular pterygopalatine submandibular

The neurotransmitter released by the postganglionic parasympathetic neurons is _________ and this neurotransmitter binds to ________receptors. This effect is either excitatory or inhibitory depending on the target organ._________________________

acetylcholine muscarinic either excitatory or inhibitory depending on the target organ.

The neurotransmitter released by the preganglionic sympathetic neurons is __________ and this neurotransmitter binds to ________receptors. This effect is __________.

acetylcholine nicotinic always excitatory

The neurotransmitter released by the preganglionic parasympathetic neurons is ___________ and this neurotransmitter binds to ________ receptors. This effect is ___________.

acetylcholine nicotinic always excitatory

Acetylcholine is degraded by the enzyme ___________________

acetylcholinesterase.

The other sites that contain alpha-2 receptors are the _______cells of the pancreas which inhibits the production of digestive enzymes.

acinar

Norepinephrine and epinephrine bind to__________ receptors which come in two major varieties: _____________

adrenergic alpha and beta

The beta cells of the pancreas contain _______ receptors. The effect of the sympathetic nervous system is thus ________ insulin secretion.

alpha -2 decreased

When acetylcholine binds to a nicotinic receptors the effect is _______________

always excitatory

What are some of the functions of the liver?

- Carbohydrate metabolism and maintaining glucose levels -lipid metabolism - protein metabolism - detoxification -Bilirubin excretion

A preganglionic sympathetic neuron may synapse onto the cell body and dendrites of the postganglionic neuron at the same spinal cord level. It may also synapse ______________________________________. The third major route is to pass through the ______________________ ganglia.

- in a ganglia several levels above or below where it entered - pass through the paravertebral ganglia and synapse in the prevertebral

Effects of the sympathetic nervous system include __________ in heart rate, an _________ in respiratory rate, ______ of airway diameter, production of ______ by sudiferous eccrine glands, _______ of pupils, _________ of peripheral blood vessels to skin, GI and urinary system, _______ of blood vessels to heart, skeletal muscle, liver and adipose tissue.

-increase -an increase -dilation -sweat -dilation -vasoconstriction -vasodilation

Parasympathetic preganglionic neurons typically synapse on only _____ postganglionic neurons. Postganglionic neurons typically only innervate _______ target site.

4-5 single

What medications increase bilirubin?

Allopurinol Anabolic steroids Abx Antimalarials Ascorbic acid Cholinergics Diuretics Narcotics Sulfonamides OCPs MAO inhibitors Methotrexate Pyridium Methyldopa

The smooth muscle of most peripheral blood vessels contain ________receptors. The sympathetic response is __________ This response occurs in the blood vessels to the _______ glands, _____, mucous membranes, _____________ viscera.

Alpha-1 Vasoconstriction Salivary Skin kidneys and abdominal skin

What medications decrease bilirubin?

Barbiturates Caffeine PCN Salicylates (high dose)

The four cranial nerves that are part of the parasympathetic nervous system are CNs_______________

III, VII, IX and X.

80% of the total craniosacral outflow travels in the ________nerve. The postganglionic neurons for this nerve innervate a ________ organs of the thoracic and abdominal cavity.

vagus multiple

What are the function of the liver?

Synthesis of bile salts Storage of A,D,E, K, B12, Cu & Fe Apoferritin joins with Fe to make ferritin Phagocytic action of Kupffer cells Activation of Vitamin D

The cardiac conduction system (SA and AV nodes) as well as myocardial cells contain ________ receptors. The sympathetic effect is to ________ heart rate and contractility.

beta-1 increase

The smooth muscle wrapped around the respiratory airways contain ____________. The effect of the sympathetic nervous system when NE or epi binds to these receptors is _______ of the smooth muscle and ____________________

beta-2 receptors relaxation bronchodilation

The cell body and dendrites for preganglionic neurons are located in the ________________.

brain or spinal cord (CNS)

Beta-3 receptors are found on _________ and function in the process of ______________.

brown fat thermogenesis

The other name for the parasympathetic nervous system is the ___________nervous system.

craniosacral

Alpha-1 and beta-1 receptors are generally associated with ________ effects.

excitatory

The sympathetic nervous system is classically termed the "fight or flight" system or the system associated with E activities. These E activities include ____________________________________________________________

exercise, excitement, embarrassment, emergency (the monster is chasing you).

The pathway for a preganglionic sympathetic neuron's axon would be from the lateral gray matter.... through the ________ root.... through the ________ ramus to synapse on the cell bodies and dendrites of the postganglionic neuron.

ventral white

The other name for the sympathetic nervous system is the ___________ system as the cell bodies and dendrites of preganglionic sympathetic neurons originate from spinal cord levels __________ These cell bodies are located in the ______________.

thoracolumbar T1 to L2. intermediate (lateral) gray matter of spinal cord.

Most organs have dual innervation by both sympathetic and parasympathetic nervous systems. (T/f)

true

A single preganglionic neuron can synapse with _______ or more postganglionic neurons. Thus the sympathetic nervous system can affect all of body simultaneously. Postganglionic neurons can synapse on _____________.

twenty several target organs.