Human Anatomy
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Variations of Thoracic Splanchnic Nerves and Its Clinical Implications
Int. J. Morphol., 23(3):247-251, 2005. Variations of Thoracic Splanchnic Nerves and its Clinical Implications Variaciones de los Nervios Esplácnicos Torácicos y sus Implicancias Clínicas *Tony George Jacob; ** Surbhi Wadhwa; ***Shipra Paul & ****Srijit Das JACOB, G. T.; WADHWA, S.; PAUL, S. & DAS, S. Variations of thoracic splanchnic nerves and its clinical implications. Int. J. Morphol., 23(3):247-251, 2005. SUMMARY:The present study reports an anomalous branching pattern of the thoracic sympathetic chain. At the level of T3 ganglion, an anomalous branch i.e accessory sympathetic chain (ASC) descended anteromedial to the main sympathetic chain (MSC). The MSC and the ASC communicated with each other at the level of T9, T10 and T11 ganglion, indicating the absence of classical pattern of greater, lesser and least splanchnic nerves on the right side. However, on the left side, the sympathetic chain displayed normal branching pattern. We opine that the ASC may be representing a higher origin of greater splanchnic nerve at the level of T3 ganglion and the branches from MSC at T9, T10 and T11 ganglion may be the lesser and least splanchnic nerves, which further joined the ASC (i.e presumably the greater splanchnic nerve) to form a common trunk. This common trunk pierced the right crus of diaphragm to reach the right suprarenal plexus after giving few branches to the celiac plexus. Awareness and knowledge of such anatomical variants of thoracic sympathetic chain may be helpful to surgeons in avoiding any incomplete denervation or preventing any inadvertent injury during thoracic sympathectomy. KEY WORDS: Splanchnic nerves; Sympathetic chain; Trunk thoracic; Ganglion. -
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. -
Of the Pediatric Mediastinum
MRI of the Pediatric Mediastinum Dianna M. E. Bardo, MD Director of Body MR & Co-Director of the 3D Innovation Lab Disclosures Consultant & Speakers Bureau – honoraria Koninklijke Philips Healthcare N V Author – royalties Thieme Publishing Springer Publishing Mediastinum - Anatomy Superior Mediastinum thoracic inlet to thoracic plane thoracic plane to diaphragm Inferior Mediastinum lateral – pleural surface anterior – sternum posterior – vertebral bodies Mediastinum - Anatomy Anterior T4 Mediastinum pericardium to sternum Middle Mediastinum pericardial sac Posterior Mediastinum vertebral bodies to pericardium lateral – pleural surface superior – thoracic inlet inferior - diaphragm Mediastinum – MR Challenges Motion Cardiac ECG – gating/triggering Breathing Respiratory navigation Artifacts Intubation – LMA Surgical / Interventional materials Mediastinum – MR Sequences ECG gated/triggered sequences SSFP – black blood SE – IR – GRE Non- ECG gated/triggered sequences mDIXON (W, F, IP, OP), eTHRIVE, turbo SE, STIR, DWI Respiratory – triggered, radially acquired T2W MultiVane, BLADE, PROPELLER Mediastinum – MR Sequences MRA / MRV REACT – non Gd enhanced Gd enhanced sequences THRIVE, mDIXON, mDIXON XD Mediastinum – Contents Superior Mediastinum PVT Left BATTLE: Phrenic nerve Vagus nerve Structures at the level of the sternal angle Thoracic duct Left recurrent laryngeal nerve (not the right) CLAPTRAP Brachiocephalic veins Cardiac plexus Aortic arch (and its 3 branches) Ligamentum arteriosum Thymus Aortic arch (inner concavity) Trachea Pulmonary -
Vagus Nerve (CN X) That Supply All of the Thoracic and Abdominal Viscera, Except the Descending and Sigmoid Colons and Other Pelvic Viscera
DR. HAYTHEM ALI ALSAYIGH Assistant prof. BOARD CLINICAL SURGICAL ANATOMY F.I.M.B.S.-MB.CH,B COLLEGE OF MEDICINE –UNIVERSITY OF BABYLON III. Autonomic Nervous System in the Thorax Is composed of motor, or efferent, nerves through which cardiac muscle, smooth muscle , and glands are innervated. Involves two neurons: preganglionic and postganglionic. It may include general visceral afferent (GVA) fibers because they run along with general visceral efferent (GVE) fibers . Consists of sympathetic (or thoracolumbar outflow) and parasympathetic (or craniosacral outflow)systems. Consists of cholinergic fibers (sympathetic preganglionic, parasympathetic preganglionic, and postganglionic) that use acetylcholine as the neurotransmitter and adrenergic fibers (sympathetic postganglionic) that use norepinephrine as the neurotransmitter (except those to sweat glands [cholinergic]). A. Sympathetic nervous system Enables the body to cope with crises or emergencies and thus often is referred to as the fight-or-flight division. Contains preganglionic cell bodies that are located in the lateral horn or intermediolateral cell column of the spinal cord segments between T1 and L2. Has preganglionic fibers that pass through the white rami communicantes and enter the sympathetic chain ganglion, where they synapse. Has postganglionic fibers that join each spinal nerve by way of the gray rami communicantes and supply the blood vessels, hair follicles (arrector pili muscles), and sweat glands. Increases the heart rate , dilates the bronchial lumen , and dilates the coronary arteries. 1. Sympathetic trunk Is composed primarily of ascending and descending preganglionic sympathetic fibers and visceral afferent fibers, and contains the cell bodies of the postganglionic sympathetic (GVE) fibers. Descends in front of the neck of the ribs and the posterior intercostal vessels. -
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). -
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. -
Anatomy of the Anterior Vagus Nerve: an Anatomic Description and Its Application in Surgery Leopoldo M
ogy: iol Cu ys r h re P n t & R y e s Anatomy & Physiology: Current m e Baccaro et al., Anat Physiol 2013, 3:2 o a t r a c n h DOI: 10.4172/2161-0940.1000121 A Research ISSN: 2161-0940 Research Article Open Access Anatomy of the Anterior Vagus Nerve: An Anatomic Description and its Application in Surgery Leopoldo M. Baccaro*, Cristian N. Lucas, Marcos R. Zandomeni, María V. Selvino and Eduardo F. Albanese Universidad del Salvador, School of Medicine, Tucumán 1845/49, Buenos Aires, Argentina Abstract Objective: Anatomic study of human corpses in order to obtain specific measurements of the anterior vagus nerve for its application in the surgical field. Methods: After analyzing the literature, dissections were performed on 15 human corpses, provided by the Universidad del Salvador. Descriptions were made of our observations. Results: The most frequently found structure in esophageal hiatus was a plexus. The cardial branch was present in 100% of the dissections. There were a constant number of gastric branches, between five and seven. The hepatic branch originated from the plexus in the majority of the cadavers. The distance between first and last branch points was variable. No relationship between the hepatic branch and left hepatic artery was observed. Conclusions: The structure most commonly found in the esophageal hiatus was the terminal plexus of the anterior vagus nerve. The hepatic branch most frequently originated directly from this plexus, although in a considerable number of cases its origin was found either proximal or distal to this structure. We could not confirm the literature stating the relationship between the hepatic branch and the left hepatic artery through our studies. -
The Internal Thoracic (Mammary) Nerve A
Thorax: first published as 10.1136/thx.26.3.354 on 1 May 1971. Downloaded from Thorax (1971), 26, 354. The internal thoracic (mammary) nerve A. A. PEARSON and R. W. SAUTER Department of Anatomy, University of Oregon Medical School, Portland, Oregon, USA 97201 The internal thoracic (mammary) nerve is formed by contributions from the subclavian plexus and the phrenic nerve. It descends along the internal thoracic artery to the level of the seventh costal cartilage where it is lost. Some of its branches communicate with the intercostal nerves -and are thought to be distributed with these nerves. Others follow perforating and anterior mediastinal arteries. This study is based on human embryos and laboratory by the authors. Twenty-five human fetuses which were sectioned serially and prepared specimens which ranged in size from 12 to 111 with neurological stains. These include the mm crown-rump length were studied. protargol method of Bodian (1936), the silver The subclavian plexus is formed by fibres which method of Pearson and Whitlock (1949), and come from that portion of the sympathetic trunk other staining procedures developed in this and its ganglia which are located in the root of http://thorax.bmj.com/ on September 25, 2021 by guest. Protected copyright. FIG. 1. A composite drawing from cross-sections of a 47mm human fetus showing fibre bundles from the stellate ganglion passing to the internal thoracic nerve plexus and the phrenic nerve. Bodian method. x 51 approximately. 354 Thorax: first published as 10.1136/thx.26.3.354 on 1 May 1971. Downloaded from FIG. -
Anatomy Review: Digestive System
THE DIGESTIVE SYSTEM Topic 2: Control of the Digestive System Graphics are used with permission of: Pearson Education Inc., publishing as Benjamin Cummings (http://www.aw-bc.com) Page 1: Title Page • The autonomic nervous system, hormones, and other chemicals control motility and secretion of the digestive system. The Autonomic Nervous System Parasympathetic Sympathetic Page 2: Goals • To list the phases of GI control • To describe the interaction between the enteric and autonomic nervous systems • To discuss short and long reflexes. • To list the hormones that control digestion and describe the function of each hormone. Page 3: Control of the GI tract depends on the location of food • The sight, smell, taste, and mental images of food trigger the cephalic phase of digestion via the vagus nerve (N X) which includes: o salivation o gastric juice production o gastric contractions • Increased volume of food in the stomach and subsequent stimulation of stomach stretch receptors triggers the gastric phase of digestion which includes: o gastric juice production o increased gastric motility • As food moves into the small intestine (duodenum), the chemical composition and volume of that food triggers specific reflexes during the intestinal phase of digestion which may include: o pancreatic secretion of bicarbonate into the duodenum o pancreatic secretion of digestive enzymes into the duodenum o gall bladder release of bile into the duodenum o segmentation contractions of the small intestine • The small intestine reflexively slows gastric emptying to allow for neutralizing, enzymatic digestion, and absorption of its contents Page 4: Parasympathetic and sympathetic nerves innervate the GI tract • Both parasympathetic and sympathetic divisions of the autonomic nervous system control digestion by contacting the enteric nervous system in the wall of the digestive tract • The parasympathetic division typically stimulates digestion while the sympathetic division typically inhibits it. -
Sympathetic Control of Lower Esophageal Sphincter Function in the Cat: ACTION of DIRECT CERVICAL and SPLANCHNIC NERVE STIMULATION
Sympathetic Control of Lower Esophageal Sphincter Function in the Cat: ACTION OF DIRECT CERVICAL AND SPLANCHNIC NERVE STIMULATION Jacques Fournet, … , William J. Snape Jr., Sidney Cohen J Clin Invest. 1979;63(4):562-570. https://doi.org/10.1172/JCI109337. The purpose of this study was to determine the effect of direct stimulation of the sympathetic nerves on the lower esophageal sphincter (LES) in the anesthetized cat. Neither unilateral nor bilateral cervical sympathectomy, or splanchnicectomy significantly modified basal LES pressure in animals with intact vagi, or animals having undergone bilateral cervical vagotomy. Electrical stimulation of the cut, peripheral, cervical sympathetic trunk increased mean arterial blood pressure, but had no effect on LES pressure or LES relaxation as induced by vagal stimulation. Stimulation of the central end of the cervical sympathetic trunk had no effect on LES pressure. Stimulation of the central end of the cut splanchnic nerve produced a decrease in LES pressure with a maximal response of 69.1±16.0% (mean±SEM). This inhibitory response was not modified by either propranolol or bilateral cervical vagotomy. Stimulation of the peripheral end of the cut, greater splanchnic nerve gave an increase in LES pressure with a maximal response of 38.2±7.19 mm Hg. Guanethidine, in the presence or absence of the adrenal glands, significantly augmented this excitatory response. This response was also slightly increased by phentolamine alone at 10 V, 1 Hz, but was not altered by propranolol. The excitatory response was completely antagonized by atropine or by trimethaphan camsylate. Stimulation of the peripheral end of the splanchnic nerve inhibited LES relaxation as induced by […] Find the latest version: https://jci.me/109337/pdf Sympathetic Control of Lower Esophageal Sphincter Function in the Cat ACTION OF DIRECT CERVICAL AND SPLANCHNIC NERVE STIMULATION JACQUES FOURNET, WILLIAM J.