Overview on the Autonomic Nervous System
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The Baseline Structure of the Enteric Nervous System and Its Role in Parkinson’S Disease
life Review The Baseline Structure of the Enteric Nervous System and Its Role in Parkinson’s Disease Gianfranco Natale 1,2,* , Larisa Ryskalin 1 , Gabriele Morucci 1 , Gloria Lazzeri 1, Alessandro Frati 3,4 and Francesco Fornai 1,4 1 Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; [email protected] (L.R.); [email protected] (G.M.); [email protected] (G.L.); [email protected] (F.F.) 2 Museum of Human Anatomy “Filippo Civinini”, University of Pisa, 56126 Pisa, Italy 3 Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, 00135 Rome, Italy; [email protected] 4 Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, 86077 Pozzilli, Italy * Correspondence: [email protected] Abstract: The gastrointestinal (GI) tract is provided with a peculiar nervous network, known as the enteric nervous system (ENS), which is dedicated to the fine control of digestive functions. This forms a complex network, which includes several types of neurons, as well as glial cells. Despite extensive studies, a comprehensive classification of these neurons is still lacking. The complexity of ENS is magnified by a multiple control of the central nervous system, and bidirectional communication between various central nervous areas and the gut occurs. This lends substance to the complexity of the microbiota–gut–brain axis, which represents the network governing homeostasis through nervous, endocrine, immune, and metabolic pathways. The present manuscript is dedicated to Citation: Natale, G.; Ryskalin, L.; identifying various neuronal cytotypes belonging to ENS in baseline conditions. -
Enteric Nervous System (ENS): 1) Myenteric (Auerbach) Plexus & 2
Enteric Nervous System (ENS): 1) Myenteric (Auerbach) plexus & 2) Submucosal (Meissner’s) plexus à both triggered by sensory neurons with chemo- and mechanoreceptors in the mucosal epithelium; effector motors neurons of the myenteric plexus control contraction/motility of the GI tract, and effector motor neurons of the submucosal plexus control secretion of GI mucosa & organs. Although ENS neurons can function independently, they are subject to regulation by ANS. Autonomic Nervous System (ANS): 1) parasympathetic (rest & digest) – can innervate the GI tract and form connections with ENS neurons that promote motility and secretion, enhancing/speeding up the process of digestion 2) sympathetic (fight or flight) – can innervate the GI tract and inhibit motility & secretion by inhibiting neurons of the ENS Sections and dimensions of the GI tract (alimentary canal): Esophagus à ~ 10 inches Stomach à ~ 12 inches and holds ~ 1-2 L (full) up to ~ 3-4 L (distended) Duodenum à first 10 inches of the small intestine Jejunum à next 3 feet of small intestine (when smooth muscle tone is lost upon death, extends to 8 feet) Ileum à final 6 feet of small intestine (when smooth muscle tone is lost upon death, extends to 12 feet) Large intestine à 5 feet General Histology of the GI Tract: 4 layers – Mucosa, Submucosa, Muscularis Externa, and Serosa Mucosa à epithelium, lamina propria (areolar connective tissue), & muscularis mucosae Submucosa à areolar connective tissue Muscularis externa à skeletal muscle (in select parts of the tract); smooth muscle (at least 2 layers – inner layer of circular muscle and outer layer of longitudinal muscle; stomach has a third layer of oblique muscle under the circular layer) Serosa à superficial layer made of areolar connective tissue and simple squamous epithelium (a.k.a. -
What Is the Autonomic Nervous System?
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.74.suppl_3.iii31 on 21 August 2003. Downloaded from AUTONOMIC DISEASES: CLINICAL FEATURES AND LABORATORY EVALUATION *iii31 Christopher J Mathias J Neurol Neurosurg Psychiatry 2003;74(Suppl III):iii31–iii41 he autonomic nervous system has a craniosacral parasympathetic and a thoracolumbar sym- pathetic pathway (fig 1) and supplies every organ in the body. It influences localised organ Tfunction and also integrated processes that control vital functions such as arterial blood pres- sure and body temperature. There are specific neurotransmitters in each system that influence ganglionic and post-ganglionic function (fig 2). The symptoms and signs of autonomic disease cover a wide spectrum (table 1) that vary depending upon the aetiology (tables 2 and 3). In some they are localised (table 4). Autonomic dis- ease can result in underactivity or overactivity. Sympathetic adrenergic failure causes orthostatic (postural) hypotension and in the male ejaculatory failure, while sympathetic cholinergic failure results in anhidrosis; parasympathetic failure causes dilated pupils, a fixed heart rate, a sluggish urinary bladder, an atonic large bowel and, in the male, erectile failure. With autonomic hyperac- tivity, the reverse occurs. In some disorders, particularly in neurally mediated syncope, there may be a combination of effects, with bradycardia caused by parasympathetic activity and hypotension resulting from withdrawal of sympathetic activity. The history is of particular importance in the consideration and recognition of autonomic disease, and in separating dysfunction that may result from non-autonomic disorders. CLINICAL FEATURES c copyright. General aspects Autonomic disease may present at any age group; at birth in familial dysautonomia (Riley-Day syndrome), in teenage years in vasovagal syncope, and between the ages of 30–50 years in familial amyloid polyneuropathy (FAP). -
The Neuroanatomy of Female Pelvic Pain
Chapter 2 The Neuroanatomy of Female Pelvic Pain Frank H. Willard and Mark D. Schuenke Introduction The female pelvis is innervated through primary afferent fi bers that course in nerves related to both the somatic and autonomic nervous systems. The somatic pelvis includes the bony pelvis, its ligaments, and its surrounding skeletal muscle of the urogenital and anal triangles, whereas the visceral pelvis includes the endopelvic fascial lining of the levator ani and the organ systems that it surrounds such as the rectum, reproductive organs, and urinary bladder. Uncovering the origin of pelvic pain patterns created by the convergence of these two separate primary afferent fi ber systems – somatic and visceral – on common neuronal circuitry in the sacral and thoracolumbar spinal cord can be a very dif fi cult process. Diagnosing these blended somatovisceral pelvic pain patterns in the female is further complicated by the strong descending signals from the cerebrum and brainstem to the dorsal horn neurons that can signi fi cantly modulate the perception of pain. These descending systems are themselves signi fi cantly in fl uenced by both the physiological (such as hormonal) and psychological (such as emotional) states of the individual further distorting the intensity, quality, and localization of pain from the pelvis. The interpretation of pelvic pain patterns requires a sound knowledge of the innervation of somatic and visceral pelvic structures coupled with an understand- ing of the interactions occurring in the dorsal horn of the lower spinal cord as well as in the brainstem and forebrain. This review will examine the somatic and vis- ceral innervation of the major structures and organ systems in and around the female pelvis. -
Brainstem Dysfunction in Critically Ill Patients
Benghanem et al. Critical Care (2020) 24:5 https://doi.org/10.1186/s13054-019-2718-9 REVIEW Open Access Brainstem dysfunction in critically ill patients Sarah Benghanem1,2 , Aurélien Mazeraud3,4, Eric Azabou5, Vibol Chhor6, Cassia Righy Shinotsuka7,8, Jan Claassen9, Benjamin Rohaut1,9,10† and Tarek Sharshar3,4*† Abstract The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting. Keywords: Brainstem dysfunction, Brain injured patients, Intensive care unit, Sedation, Brainstem -
The Autonomic Nervous System and Gastrointestinal Tract Disorders
NEUROMODULATION THE AUTONOMIC NERVOUS SYSTEM AND GASTROINTESTINALTRACT DISORDERS TERRY L. POWLEY, PH.D. PURDUE UNIVERSITY • MULTIPLE REFRACTORY GI DISORDERS EXIST. • VISCERAL ATLASES OF THE GI TRACT ARE AVAILABLE. • REMEDIATION WITH ELECTROMODULATION MAY BE PRACTICAL. TERRY l. POWLEY, PH.D. PURDUE NEUROMODUlATION: THE AUTONOMIC NERVOUS SYSTEM AND GASTP.OINTESTINAL TRACT DISORDERS UNIVERSITY 50 INTERNATIONAL I:"' NEUROMODULATION SOCIETY 0 40 ·IS 12TH WORLD CONGRESS -I: -• 30 !"' A. -..0 20 ..a• E 10 z::::t TERRY l. POWLEY, PH.D. PURDUE NEUROMODUlATION: THE AUTONOMIC NERVOUS SYSTEM AND GASTP.OINTESTINAL TRACT DISORDERS UNIVERSITY DISORDERS TO TREAT WITH NEUROMODULATION ACHALASIA DYSPHAGIA GASTROPARESIS GERD GUT DYSMOTILITY MEGA ESOPHAGUS DYSPEPSIA ,, VISCERAL PAIN l1 ' I NAUSEA, EMESIS OBESITY ,, ' 11 I PYLORIC STENOSIS ==..:.= --- "" .:.= --- .. _ _, DUMPING REFLUX COLITIS I:' . - IBS -·-- - CROHN'S DISEASE HIRSCHSPRUNG DISEASE CHAGAS DISUSE Gastrointestinal Tract Awodesk@ Ma;·a@ TERRY l. POWLEY, PH.D. PURDUE NEUROMODUlATION: THE AUTONOMIC NERVOUS SYSTEM AND GASTP.OINTESTINAL TRACT DISORDERS UNIVERSITY TIME The Obesity Epidemic in America ·. TERRY l. POWLEY, PH.D. PURDUE NEU ROMODUlATION : THE AUTO N OMIC NERVOUS SYSTEM A N D G A STP.OINTESTINAL TRACT DISORDERS UNI V E R SI TY ROUX-EN-Y BYPASS Bypassed portion of stomach Gastric -"'~ pouch Bypassed - Jejunum duodenum -1" food -___----_,,.,. digestivejuice TERRY l. POWLEY, PH.D. PURDUE NEU ROMODUlATION: THE AUTONOMIC NERVOUS SYSTEM A N D GASTP.OINTESTINAL TRACT DISORDERS UNIVERSITY 8y~s~ portionof i t()(l\3Ch • TERRYl. POWLEY, PH.D. PURDUE NEUROMOOUlATION: THE AUTONOMIC NERVOUS SYSTEM ANO 0.-STP.OINTESTINAL TRACT DISORDERS UHIVlflSITY • DESPERATE PATIENTS • ABSENCE OF SATISFACTORY PHARMACOLOGICAL TREATMENTS • POPULAR MEDIA HYPE • ABSENCE OF A SOLID MECHANISTIC UNDERSTANDING • UNCRITICAL ACCEPTANCE OF PROPONENT'S CLAIMS • MYOPIA REGARDING SIDE EFFECTS TERRY l. -
Biology 251 Fall 2015 1 TOPIC 6: CENTRAL NERVOUS SYSTEM I
Biology 251 Fall 2015 TOPIC 6: CENTRAL NERVOUS SYSTEM I. Introduction to the Nervous System A. Objective: We’ve discussed mechanisms of how electrical signals are transmitted within a neuron (Topic 4), and how they are transmitted from neuron to neuron (Topic 5). For the next 3 Topics, we will discuss how neurons are organized into functioning units that allow you to think, walk, smell, feel pain, etc. B. Organization of nervous system. Note that this is a subdivision of a single integrated system, based on differences in structure, function and location (Fig 7.1). Such a subdivision allows easier analysis and understanding than trying to comprehend the system as a whole. 1. Central Nervous System (integrates and issues information) a) brain b) spinal cord 2. Peripheral Nervous System a) Afferent Division (sends information to CNS) b) Efferent Division (receives information from CNS) (1) Somatic nervous system (2) Autonomic nervous system (a) Sympathetic nervous system (b) Parasympathetic nervous system C. Three classes of neurons (Fig 7.4) 1. afferent neurons a) have sensory receptors b) axon terminals in CNS c) send information to CNS from body 2. efferent neurons a) cell body in CNS b) axon terminals in effector organ c) send information from CNS to body 3. interneurons a) lie within CNS b) some connect afferent neurons and efferent neurons (1) integrate peripheral responses and peripheral information c) some connect other interneurons (1) responsible for activity of the “mind”, i.e., thoughts, emotions, motivation, etc. d) 99% of all neurons are interneurons II. The Brain: Gross Structure and Associated Functions (Fig 9.11) A. -
1 the Anatomy and Physiology of the Oesophagus
111 2 3 1 4 5 6 The Anatomy and Physiology of 7 8 the Oesophagus 9 1011 Peter J. Lamb and S. Michael Griffin 1 2 3 4 5 6 7 8 911 2011 location deep within the thorax and abdomen, 1 Aims a close anatomical relationship to major struc- 2 tures throughout its course and a marginal 3 ● To develop an understanding of the blood supply, the surgical exposure, resection 4 surgical anatomy of the oesophagus. and reconstruction of the oesophagus are 5 ● To establish the normal physiology and complex. Despite advances in perioperative 6 control of swallowing. care, oesophagectomy is still associated with the 7 highest mortality of any routinely performed ● To determine the structure and function 8 elective surgical procedure [1]. of the antireflux barrier. 9 In order to understand the pathophysiol- 3011 ● To evaluate the effect of surgery on the ogy of oesophageal disease and the rationale 1 function of the oesophagus. for its medical and surgical management a 2 basic knowledge of oesophageal anatomy and 3 physiology is essential. The embryological 4 Introduction development of the oesophagus, its anatomical 5 structure and relationships, the physiology of 6 The oesophagus is a muscular tube connecting its major functions and the effect that surgery 7 the pharynx to the stomach and measuring has on them will all be considered in this 8 25–30 cm in the adult. Its primary function is as chapter. 9 a conduit for the passage of swallowed food and 4011 fluid, which it propels by antegrade peristaltic 1 contraction. It also serves to prevent the reflux Embryology 2 of gastric contents whilst allowing regurgita- 3 tion, vomiting and belching to take place. -
Review of Sympathetic Blocks Anatomy, Sonoanatomy, Evidence, and Techniques
CHRONIC AND INTERVENTIONAL PAIN REVIEW ARTICLE Review of Sympathetic Blocks Anatomy, Sonoanatomy, Evidence, and Techniques Samir Baig, MD,* Jee Youn Moon, MD, PhD,† and Hariharan Shankar, MBBS*‡ Search Strategy Abstract: The autonomic nervous system is composed of the sympa- thetic and parasympathetic nervous systems. The sympathetic nervous sys- We performed a PubMed and MEDLINE search of all arti- tem is implicated in situations involving emergent action by the body and cles published in English from the years 1916 to 2015 using the “ ”“ ”“ additionally plays a role in mediating pain states and pathologies in the key words ultrasound, ultrasound guided, sympathetic block- ”“ ”“ body. Painful conditions thought to have a sympathetically mediated com- ade, sympathetically mediated pain, stellate ganglion block- ”“ ” “ ” ponent may respond to blockade of the corresponding sympathetic fibers. ade, celiac plexus blockade, , lumbar sympathetic blockade, “ ” “ ” The paravertebral sympathetic chain has been targeted for various painful hypogastric plexus blockade, and ganglion impar blockade. conditions. Although initially injected using landmark-based techniques, In order to capture the breadth of available evidence, because there fluoroscopy and more recently ultrasound imaging have allowed greater were only a few controlled trials, case reports were also included. visualization and facilitated injections of these structures. In addition to There were an insufficient number of reports to perform a system- treating painful conditions, sympathetic blockade has been used to improve atic review. Hence, we elected to perform a narrative review. perfusion, treat angina, and even suppress posttraumatic stress disorder symptoms. This review explores the anatomy, sonoanatomy, and evidence DISCUSSION supporting these injections and focuses on ultrasound-guided/assisted tech- nique for the performance of these blocks. -
Sympathetic Tales: Subdivisons of the Autonomic Nervous System and the Impact of Developmental Studies Uwe Ernsberger* and Hermann Rohrer
Ernsberger and Rohrer Neural Development (2018) 13:20 https://doi.org/10.1186/s13064-018-0117-6 REVIEW Open Access Sympathetic tales: subdivisons of the autonomic nervous system and the impact of developmental studies Uwe Ernsberger* and Hermann Rohrer Abstract Remarkable progress in a range of biomedical disciplines has promoted the understanding of the cellular components of the autonomic nervous system and their differentiation during development to a critical level. Characterization of the gene expression fingerprints of individual neurons and identification of the key regulators of autonomic neuron differentiation enables us to comprehend the development of different sets of autonomic neurons. Their individual functional properties emerge as a consequence of differential gene expression initiated by the action of specific developmental regulators. In this review, we delineate the anatomical and physiological observations that led to the subdivision into sympathetic and parasympathetic domains and analyze how the recent molecular insights melt into and challenge the classical description of the autonomic nervous system. Keywords: Sympathetic, Parasympathetic, Transcription factor, Preganglionic, Postganglionic, Autonomic nervous system, Sacral, Pelvic ganglion, Heart Background interplay of nervous and hormonal control in particular The “great sympathetic”... “was the principal means of mediated by the sympathetic nervous system and the ad- bringing about the sympathies of the body”. With these renal gland in adapting the internal -
NROSCI/BIOSC 1070 and MSNBIO 2070 November 15, 2017 Gastrointestinal 1 Functions of the Digestive Tract
NROSCI/BIOSC 1070 and MSNBIO 2070 November 15, 2017 Gastrointestinal 1 Functions of the Digestive Tract. The digestive system has two primary roles: digestion, or the chemical and mechanical breakdown of foods into small molecules that can absorbed, or moved across the intestinal mucosa into the bloodstream. In order to accomplish these functions, the secretion of enzymes, hormones, mucus, and paracrines by the gastrointestinal organs is needed. Furthermore, motility, or controlled movement of materials through the digestive tract is required. In addition to these primary functions, the gastrointestinal tract faces a number of challenges. Almost 7 liters of fluid must be released into the lumen of the digestive tract per day to allow for digestion and absorption to occur. Clearly, most of this fluid must be reabsorbed or dehydration will occur. Furthermore, the inner surface of the digestive tract is technically in contact with the external environment; for this reason, protective mechanisms are needed. In part, these mechanisms must protect against the secretions of the GI tract, including acid and enzymes. Anatomy of the Gastrointestinal System November 15, 2017 Page 1 GI 1 The anatomy of the GI system is illustrated in the previous 2 figures. The organs involved in digestion and absorption include the salivary glands, esophagus, stomach, small intestine, liver, pancreas, and large intestine. In addition, 7 sphincters control the movement of material and secretions between the organs. The total length of the GI tract is about 15 feet, of which 13 feet are comprised of intestine. The processed material within the GI tract is referred to as chyme. -
Interactions of the Enteric Nervous System with the Gut Microbiome in the Neuroligin-3 R451C Mouse Model of Autism
Interactions of the enteric nervous system with the gut microbiome in the neuroligin-3R451C mouse model of autism M.H.M. Madusani Herath Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy September 2020 Department of Physiology The University of Melbourne ABSTRACT Autism patients are four times more likely to be hospitalized due to gastrointestinal (GI) dysfunction compared to the general public. However, the exact cause of GI dysfunction in individuals with autism is currently unknown. Genetic predisposition to autism spectrum disorder (ASD) has been highlighted in various studies and mutations in genes that affect nervous system function can drive both behavioural abnormalities and GI dysfunction in autism. Neuroligin-3 (NLGN3) is a postsynaptic membrane protein and the R451C missense mutation in the NLGN3 gene is associated with ASD. Recent studies revealed that the NLGN3 R451C mutation induces GI dysfunction in autism patients as well as in mice but, the cellular localization and the effects of this mutation on NLGN3 production in the enteric nervous system (ENS) have not been reported to date. The intestinal mucosal barrier is the interface separating the external environment from the interior of the body. Mucosal barrier functions are directly regulated by the enteric nervous system. Therefore, ENS dysfunction can induce mucosal barrier impairments. An impaired intestinal barrier has been reported in autism patients, but neurally-mediated barrier dysfunctions have not been assessed in transgenic autism mouse models with an altered nervous system. The intestinal mucus layer is the outermost layer of the mucosa which separates the intestinal microbiota from the intestinal epithelium.