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Vegetative System

Vegetative System

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Published by: jalan_z on Jul 26, 2010
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Vegetative nervous system and vegetativeVegetative nervous system and vegetative disturbance.disturbance.Neurogenic disturbance of the function of theNeurogenic disturbance of the function of the pelvic organspelvic organs
Short anatomy of vegetative nervous system.
Vegetative (autonomic) nervous system regulates the activity of internal organs andsystems, secretory glands and blood vessels. It ensures constancy of the internal medium(homeostasis) of organism and various forms of mental and physical activity. Thevegetative nervous system includes the hypothalamus, limbic system, reticular formationand peripheral divisions of sympathetic and parasympathetic nervous system.Hypothalamus, limbic system and reticular formation ensure the integration of vegetative regulation with other functional states - emotions, thinking, sleep andwakefulness. Hypothalamus (the most important structure of neuroendocrine system)obtains extensive information because of its close connection with different divisions of thebrain and special features of blood supply. In the hypothalamus, the releasing factors areformed and enter the hypophysis and stimulate the production of gonadotropic, thyrotropicand adrenocoritcotropic hormones of hypophysis. The activation of anterior part of hypothalamus leads to an increase in the parasympathetic activity, while the activation of its posterior part increases sympathetic activity. Along the descending ways thehypothalamus is connected with the reticular formation of midbrain, which carries itsimpulses to the peripheral sympathetic and the parasympathetic from vegetative nervoussystem. Limbic system is located in the deep divisions of frontal and temporal lobes of brain, it has extensive connections with different divisions of nervous system, and itparticipates in both vegetative regulation and in the formation of motivations, regulation of sleep and wakefulness, attention.Sympathetic neurons are localized in the lateral horns of thoracic and upper lumbarsegments of spinal cord (Th1-L2). Parasympathetic neurons are located in nuclei of cranialnerves (oculomotor, facial, glossopharyngeal and vagus) and in the sacral segments of spinal cord (S
). The axons of vegetative neurons leave together with the cranial nervesor the anterior rootlets of spinal cord and they reach the ganglia, where switching pulsesfrom the preganglionic neurons to the postganglionic occurs. Sympathetic fibers in thecomposition of the anterior rootlets of spinal cord reach the units of sympathetic stem(paravertebral and prevertebral ganglia), where their switching to the postganglionicneurons occurs. Sympathetic stem has about 24 pairs of units (3 pairs neck, 12 pairs of breast, 5 pairs of lumbar and 4 pairs of sacral). Postganglionic fibers in the composition of peripheral nerves or vessels reach the appropriate organs. The preganglionicparasympathetic fibers are longer than sympathetic, because ganglia are located near finalorgans, and postganglionic parasympathetic fibers respectively shorter.Parasympathetic nervous system ensures predominantly the homeostasis
(trophotrophic function),
sympathetic nervous system - various forms of the activity
(ergotrophic function).
Sympathetic nerve fibers render brake influence on the muscles of internal organs, of bladder, of rectum and stimulating action on heart, sweat, lacrimal,salivary and digestive glands. Parasympathetic fibers in the composition of the vagusnerve innervate heart, light and internal organs of abdominal cavity, with exception of partof large intestine and the rectum, as the bladder, sex organs are innervated by sacraldivision of parasympathetic nervous system. The activation of parasympathetic systemcauses decrease of cardiac rhythm, decrease in arterial pressure (BP), and increase in theperistalsis of bowels. Noradrenaline is mediator of sympathetic nervous system, in theparasympathetic - acetylcholine. The parasympathetic innervation of eye is presented earlier with the description of oculomotor nerve. The sympathetic innervation of eye is accomplished from the lateralhorns of spinal cord at the level C8-Th1. The axons of these sympathetic neurons arepassed, without being switched, through the upper breast and lower neck sympatheticganglia they conclude in the upper neck sympathetic unit. The axons of postganglionic
fibers reach internal carotid artery, they braid it and on the eye socket artery they reachthe eye socket, where they innervate the muscle, which expands the pupil,
(m. dilatator  pupillae),
the muscle, which expands the ocular slot
(m. tarsalis superior)
and the ciliarymuscles, which ensure certain position of anterior eyeball.
Symptoms and the syndromes of the vegetative the disturbances
 The defect of hypothalamus can lead to different neuroendocrine syndromes (diseaseItsenko-Cushing, diabetes melltitus and other), whose detailed account is given in theappropriate divisions of the course of endocrinology. The diffuse defect of the peripheral vegetative nervous system (predominantlysympathetic neurons) causes the peripheral vegetative insufficiency - syndrome, which ismanifested by the disturbance of innervations of internal organs, vessels and secretaryglands. More frequent and severe manifestation of peripheral vegetative insufficiency –orthostatic hypotension: head spins, shroud before eyes or development of syncope whenchanging from horizontal position to vertical or when prolonged standing. In expressedorthostatic hypotension, patient can be riveted to the bed. Orthostatic hypotension can beprovoked by abundant food, alcohol use, by physical load. For diagnostics, the orthostatictest is conducted: BP investigation is measured at lying position, it’s which it preliminarilywas located not less than 15 min, but then in vertical position for several minutes. Test isconsidered positive, if 3 min after getting up, systolic BP decreases 20 mmHg and moreand diastolic more than 10 mmHg and according to the relation to BP in horizontal position.Other manifestations of peripheral vegetative insufficiency can be observed as constanttachycardia (“fixed pulse”), sleep apneas (cessation of respiration in the sleep period),dyskinesia of gastrointestinal tract, pelvic disorders, disturbance of perspiration (increasedsweating or hypohydrosis and hyperthermia), cyanosis or hyperemia of the skin, peripheraledemas, dry eyes and mouth cavity.In damage of ciliospinal center where sympathetic fibers exit from, it appears as thedisturbance of the eye sympathetic innervation in the form of Claude-Bernard-Hornersyndrome: the contraction of ocular slot (ptosis), the contraction of pupil (myosis), theretraction of eyeball (enophthalmos), and also the disturbance of perspiration (anhydrosis)and reddening, the dryness of the skin. Horner's syndrome in the form of ptosis, myosisand enophthalmos is developed also with the defect of the brain stem (dorsolateraldivisions of medulla oblongata with Wallenberg-Zakharchenko syndrome) on the side of damage as a result of the involvement of central sympathetic fibers, which go to ciliospinalcenter from hypothalamus.
Reasons of vegetative disturbances and their treatments
Vegetative disturbances are observed with different psychic, neurological or somaticdiseases.Primary vegetative insufficiency appears in vegetative polyneuropathy, Parkinson's diseaseand other degenerative diseases of nervous system. Secondary vegetative insufficiency ispossible with polyneuropathies of different genesis (diabetic, alcoholic, and other), multiplesclerosis, tumors of head and spinal cord. Primary vegetative insufficiency (vegetativepolyneuropathy) is established only after the exclusion of the intake of medical drugs(hypotensive, etc), which can cause orthostatic hypotension, and also diseases of theblood, heart, endocrine system and electrolyte disturbances, which can be manifested bysimilar symptoms.
Table 9.1
Basic syndromes of defect of the peripheral of vegetative nervous systemSyndromes of defectLocalization of defect
Peripheral vegetative insufficiency: orthostatichypotension, constant tachycardia, sleep apneas,disturbance of perspiration, hyperthermia,cyanosis or hyperemia of skin, peripheraledemas, dry eyes and mouth cavityPredominantly sympathetic neurons
Syndrome Claude-Bernard-Horner:ptosis, myosis, enophthalmos, disturbance of theperspiration and reddening, dryness of the skinLateral horns of spinal cord on the levelof the segments C
, and sympatheticfibers from spinal cord to eye.Central sympathetic fibers at level of medulla oblongata The treatment of peripheral vegetative insufficiency is directed toward the basicdisease, which causes this insufficiency. In orthostatic hypotension, patient should avoidthe provoking factors (sharp getting up, a prolonged stay in the vertical position, abundantfood and other), to eliminate the possible drugs which render hypotensive action, toincrease the consumption of salt (up to 4-10g/day) and liquid (up to 3 L/day), to wearelastic stockings. If the non-medical means are ineffective, it is possible to usefludrocortisones (florinef) with 0,05 ppm of 1 mg/day, ephedrine on 12,5-25 mg/day,midodrine (gutron) with 5-15 mg/day.Claude-Bernard-Horner syndrome appears in defect of the brainstem (stroke,craniocerebral injury, multiple sclerosis, tumor and other), zone of C
spinal cordsegments, (tumor, syringomyelia and other), and also sympathetic fibers elongated fromspinal cord to the eye, which can be as a consequence of damage to carotid or eye socketartery, and also somatic diseases (neck lymphadenitis, tumor of apical lung and others).
Brief anatomical-physiological data of the neurogenic regulation of pelvic organs.
 The bladder represents the hollow organ composes of detrusor muscle in major portion,which pushes out urine (smooth muscle). Urination is achieved with the contraction of detrusor muscle and relaxation of internal sphincter (smooth muscle) and externalsphincter (transverse striated muscle). The filling of the bladder causes its tension and excitation of detrusor receptors, whichleads to the impulse flow of the afferent fibers into the cone (sacral division S2-S4 of spinalcord). The activation of parasympathetic neurons appears because it is transferred by theirfibers and is caused contraction of detrusor and the relaxation of internal sphincter, whichleads to the emptying of the bladder. So, involuntary or reflex urination occurs, whichoccurs in children up to a year and those with diseases, which lead to the disturbance of central control of urination. The arbitrary control of urination is achieved in a following manner. Impulses of fillingof bladder are transferred by sensitive fibers of peripheral nerves, to posterior rootlets, toposterior cords to the reticular formation of pons and further to the paracentral lobule,located on the medial surface of frontal portions. Arbitrary urination is achieved frommotor part of the paracentral lobule by means of the pulses, which reach the anteriorhorns of spinal cord at the level S
(along the fibers, located next to the fibers of crust-cerebrospinal way), and them they go along the fibers of somatic peripheral nerves to theexternal sphincter and its relaxation is caused. This leads to the reflector relaxation of internal sphincter, the reduction of detrusor and the emptying of the bladder. Thereduction of muscles of abdominal press can contribute to urination. The restraining of urination is ensured by the pulses, which go along the same way and which cause thereduction of external sphincter. The neurogenic regulation of rectum has some similarities to the control of bladder. The activation of parasympathetic fibers causes the peristalsis of rectum and relaxation of internal sphincter, which leads to defecation. Activation of sympathetic fibers slows downthe peristalsis of rectum. The filling of rectum causes the tension of its walls, the excitationof receptors and the propagation of pulses on sensitive fibers of peripheral nerves,posterior cords to the reticular formation of pons and further to the paracentral lobule.From the motor part of the paracentral lobule, impulses go along the lateral cords of spinalcord into the anterior horns of the spinal cord (S
-S4), from them to the external sphincter,whose relaxation causes the reflex relaxation of internal sphincter, the peristalsis of rectum and defecation. The neurogenic inspection of sex organs is complex and more in detail it is presentedin the course of urology. In men, activation of parasympathetic fibers causes erection,while activation of sympathetic fibers causes ejaculation. The central the inspection of sex

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