Adobe Systems Autonomic nervous system Adobe Systems ANS vs. somatic NS Adobe Systems Autonomic nervous system Adobe Systems Autonomic nervous system Preganglionic fibers ̶SNS, PNS ̶Nikotinic receptor ̶NN type and NM type ̶Excitatory receptors ̶ Adobe Systems Second messenger systems Adobe Systems Autonomic nervous system Postganglionic fibers ̶PNS ̶ Muscarinic receptor ̶G-protein coupled ̶Excitatory receptors (M1, M3, M5) ̶Inhibitory receptors (M2, M4) ̶ Adobe Systems Autonomic nervous system ̶Postganglionic fibers ̶SNS ̶ Adrenergic receptor ̶G-protein coupled ̶ Adobe Systems Autonomic nervous system Adrenergic receptor ̶G-protein coupled ̶Type α –Excitatory receptors ̶Type β – Inhibitory receptors ̶ Adobe Systems Autonomic nervous system Adobe Systems Brain control of ANS Eating behavior Urinary bladder control Secondary respiratory center Blood pressure control Respiratory center Temperature control Water balance Adobe Systems Baroreceptor vs. Chemoreceptor Adobe Systems Baroreflex I •Inotropic •Chronotropic •Dromotropic •Batmotropic Aferent pathway Parasympathetic pathway Sympathetic pathway BP=HR x SV x R R HR Adobe Systems Sinus respiratory arytmie Adobe Systems Something more… ̶Oculocardial reflex ̶Pressure on the eyebulbes decreases heart rate (activation of the vagus) ̶It is used to suppress or stop tachycardia ̶Low pressure baroreflex ̶greater expansion of the left ventricle stimulates baroreceptors –vagus→medulla - inhibition of SNS – vasodilation, bradycardia – decrease of BP ̶Diving reflex ̶Cold water on the face causes respiratory arrest, peripheral vasoconstriction and bradycardia ̶Coronary chemoreflex (Bezoldov-Hirtov-Jarisch reflex) ̶Substances applied to the left coronary artery (veratridine, capsaicin, some contrast agents, substances produced by ischemic tissue) induce apnea and then hyperpnea, hypotension, bradycardia (vagal afferentation) ̶ Adobe Systems Chemoreflex Adobe Systems ANS and blood vessels Adobe Systems GIT and ANS SNS PNS Adobe Systems GIT - Enteric Nervous System Adobe Systems ANS and urinary bladder PSN DETRUSOR CONTRACTION SPHINCTER RELAXATION SNS DETRUSOR RELAXATION SPHINCTER CONTRACTION Adobe Systems Neurogenic bladder NAME COMMENTS Uninhibited bladder Lesion: above the pontine micturition center Signs: reduced awareness of bladder fullness, incontinence may occur Upper motor neuron bladder (Detrusor-sphincter dyssynergia) Lesion: between the pontine micturition center and sacral cord Signs: detrusor is usually spastic, simultaneous detrusor and urinary sphincter contractions increase pressures in the bladder, can lead to vesicoureteral reflux that and renal damage Mixed type A bladder Lesion: sacral cord lesion at the detrusor nucleus with sparring of the pudendal nucleus Signs: the detrusor muscle is flaccid, bladder is large, external urinary sphincter is spastic, incontinence uncommon Mixed type B bladder Lesion: sacral cord lesion at the pudendal nucleus with sparring of the detrusor nucleus Signs: the bladder is spastic and the external urinary sphincter is flaccid, incontinence is common Lower motor neuron bladder Lesion: sacral cord or sacral root while the thoracic sympathetic outflow to the lower urinary tract is preserved Signs: bladder is large and hypotonic, incontinence uncommon Adobe Systems Valsalva maneuver Adobe Systems ̶A 36-year-old female began to have problems at the age of 18 years after she developed a severe case of mononucleosis. She began to experience palpitations, sweating, irritable bowel syndrome, and was diagnosed with anxiety. Her symptoms continued throughout subsequent years, and she continued to feel light-headed upon standing as well as noticing excessive palpitations. She had a few syncopal events, but she generally has enough warning to sit down and protect herself. ̶She cannot exercise much because of her very poor stamina. She has no other autonomic symptoms except for the irritable bowel, which is diarrhea predominant. She has a history of migraines, which have been fairly well controlled. She reports her sleep quality is quite good, but still she is exhausted at the end of the working day and oftentimes needs a nap before dinner. ̶The examination was normal. ̶Hematologic, endocrine, routine chemistry, and neuroimmunology panel were normal except for lower vitamin D levels. Plasma catecholamines were normal as were the 24-hour urinary sodium output and urine volume. ̶The echocardiogram was normal. ̶Autonomic reflex screen: marked tachycardia on tilt, but was otherwise normal. ̶Exercise study: normal hemodynamic profile but profound deconditionin Adobe Systems ANS and sexual function Adobe Systems ANS and sexual function Adobe Systems Thank you for your attention