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Sistem Saraf Tepi : Nervi Craniales Bok. DMS. Anatomi Kuliah 3 Fitranto Arjadi . 16/11/2014
Sistem Saraf Tepi : Nervi Craniales Bok. DMS. Anatomi Kuliah 3 Fitranto Arjadi . 16/11/2014
Sistem Saraf Tepi : Nervi Craniales Bok. DMS. Anatomi Kuliah 3 Fitranto Arjadi . 16/11/2014
Sistem Saraf Tepi : Nervi Craniales Bok. DMS. Anatomi Kuliah 3 Fitranto Arjadi . 16/11/2014

Sistem Saraf Tepi

: Nervi Craniales

Bok. DMS. Anatomi Kuliah 3 Fitranto Arjadi .

Nervous system organization

Nervous system organization
Sistem Saraf Tepi (SST) 1. Sistem saraf somatik a. Nervi Spinalis 1) neuron afferent (sensory)

Sistem Saraf Tepi (SST) 1. Sistem saraf somatik a. Nervi Spinalis

Saraf Tepi (SST) 1. Sistem saraf somatik a. Nervi Spinalis 1) neuron afferent (sensory) 2) neuron

1) neuron afferent (sensory)

2) neuron efferent (motor) 3) interneuron b. Cranial nerves

2. Sistem saraf Otonom

a. Sistem saraf simpatis nervous system

b. Sistem saraf parasimpatis

Divisi Motorik Division: 2 Bagian Besar

1. Sistem Saraf Somatis

Pusat kesadaran

otot skelet

2. Sistem saraf otonom

Mengatur otot

polos, otot jantung dan kelenjar 2 bagian :

Simpatis

Parasimpatis

skelet 2. Sistem saraf otonom  Mengatur otot polos, otot jantung dan kelenjar  2 bagian

Saraf kranialis

Saraf kranialis Penamaan :  dengan angka Romawi, berdasarkan urutan dari anterior ke posterior,  dengan

Penamaan :

dengan angka Romawi, berdasarkan

urutan dari anterior ke

posterior,

dengan nama, menunjukkan distribusi dari saraf ataupun fungsinya

Asal

hidung (I),

mata (II),

brainstem (III XII) dan

medulla spinalis

(sebagian dari XI).

Asal  hidung (I),  mata (II),  brainstem (III – XII) dan  medulla spinalis

12 Pasang

Saraf Kranialis

Fungsi

Sensorik& Motorik Pada Leher

& Kepala

12 Pasang Saraf Kranialis Fungsi Sensorik& Motorik Pada Leher & Kepala
12 Pasang Saraf Kranialis Fungsi Sensorik& Motorik Pada Leher & Kepala
Special Sense Nerves NERVE TARGET EXIT FROM CRANIAL CAVITY I. Olfactory Olfactory Cribiform plate

Special Sense Nerves

NERVE

TARGET

EXIT FROM CRANIAL CAVITY

I. Olfactory

Olfactory

Cribiform plate (ethmoid)

epithelium

II. Optic

Retina

Optic canal

(sphenoid)

VIII. Auditory

Inner ear

Internal auditory meatus (temporal)

Somatic Motor Nerves

(eye muscles and tongue)

NERVE

TARGET

EXIT CR. CAVITY

IV.

Trochlear

Superior oblique m. (with trochlea)

Sup. Orbital fissure (sphenoid)

VI.

Abducens

Lateral rectus

III.

Oculomotor

Sup.,med.,inf.rectus Inferior Oblique Levator palpebrae superioris

(Also parasympathetic to ciliary mm, constrictor pupillae)

XII. Hypoglossal

Intrinsic, extrinsic mm. of

Hypoglossal canal

tongue

(occipital)

“Rest of body” nerves

(all exit from jugular foramen)

NERVE TARGET X: Vagus XI: (Spinal) Accesory IX: Glosso- pharyngeal  Somatic motor to larynx/pharynx
NERVE TARGET X: Vagus XI: (Spinal) Accesory IX: Glosso- pharyngeal  Somatic motor to larynx/pharynx

NERVE

TARGET

X: Vagus

XI: (Spinal)

Accesory

IX: Glosso-

pharyngeal

Somatic motor to larynx/pharynx

Parasympathetic to most of gut

Taste to back posterior pharynx

Motor to traps,

sternocleidomastoid

Sensory to carotid body/sinus

Taste to posterior tongue

Sensory to ear opening/middle

ear

Parotid salivary gland

N. Olfactorius
N. Olfactorius
N. Olfactorius
N. Olfactorius
N. Olfactorius
N. Olfactorius
Function : Special sensory (special visceral afferent ) ---special sense of smell. Olfaction : sensation
Function : Special sensory (special visceral afferent ) ---special sense of smell. Olfaction : sensation
Function : Special sensory (special visceral afferent ) ---special sense of smell. Olfaction : sensation
Function : Special sensory (special visceral afferent ) ---special sense of smell. Olfaction : sensation

Function:

Special sensory (special visceral afferent) ---special sense of smell.

Olfaction : sensation of odors aerosolized in the environment

The cell bodies : olfactory organ in the roof of the nasal cavity and along the nasal

septum and medial wall of the superior nasal concha. Via lamina cribriformis os ethmoid, fibers run through the olfactory bulb and terminate in the primary olfactory cortex

from the detection of odorous substances

run through the olfactory bulb and terminate in the primary olfactory cortex from the detection of
N. opticus
N. opticus
N. opticus
N. opticus
N. opticus
N. opticus
Fungsi : Special sensory (special somatic afferent) special sense of vision. Berjalan posteromedial mata Keluar

Fungsi: Special sensory (special somatic

afferent) special sense of vision. Berjalan posteromedial mata

Keluar melalui canalis optikus menuju fossa kranialis media membentuk kiasma optika dari sebagian pars nasal (medial)

retina menyilang chiasma dan bergabung

dengan serabut yang lurus/ dari serabut sebagian pars (lateral) retina untuk membentuk traktus optikus.

Separo serabut saraf II yang menyilang kiasma optika = penglihatan inocular,

persepsi kedalaman penglihatan

= penglihatan inocular, persepsi kedalaman penglihatan ( penglihatan 3 dimensi). Serabut dari separo kanan retina

( penglihatan 3 dimensi).

Serabut dari separo kanan retina membentuk traktus optikus kiri. Penyiangan serabut saraf kiasma membentuk traktus optikus kanan yang

membawa impuls dari lapngan pandang

kiri dan sebaliknya. Sbgn besar serabut traktus optikus berakhir di nuclei geniculatum laterale thalamus --- dibawa ke lobus ccipitalis

N. Occulomotorius, N. Trochlearis, N. Abduscen
N. Occulomotorius, N. Trochlearis, N. Abduscen
N. Occulomotorius, N. Trochlearis, N. Abduscen
N. Occulomotorius, N. Trochlearis, N. Abduscen
N. Occulomotorius, N. Trochlearis, N. Abduscen

N. Occulomotorius, N. Trochlearis, N. Abduscen

Oculomotor Nerve (CN III) Functions : Somatic motor (general somatic efferent) Visceral motor (general visceral

Oculomotor Nerve (CN III)

Functions:

Somatic motor (general somatic efferent) Visceral motor (general visceral efferent parasympathetic).

Fibers extend from the ventral midbrain, pass through the

superior orbital fissure, and go to the extrinsic eye muscles

Nuclei: 2 oculomotor nuclei,

a.Somatic

midbrain. b.Visceral motor (parasympathetic) accessory (Edinger-Westphal) nucleus of the oculomotor nerve lies dorsal to the rostral two thirds of the somatic motor nucleus

the

motor nucleus

of

the oculomotor nerve is in

Proprioceptive and Motor to the striated muscle of four of the six extraocular muscles (superior, medial, and inferior recti and

inferior oblique) and superior eyelid (L. levator palpebrae

superioris)

Parasympathetic via ciliary ganglion to the smooth muscle sphincter pupillae : constriction pupil and ciliary body -- accommodation lens to become more rounded) for near vision.

Chief motor nerve to the ocular and extraocular muscles.

Emerges from the midbrain --- pierces the dura lateral to the sellar diaphragm roofing over the hypophysis --- runs through the roof and lateral wall of the cavernous sinus --- enters the orbit through the superior orbital fissure and divided into a superior division (supplies the superior rectus and levator palpebrae superioris) and

an inferior division (supplies the inferior and

medial rectus and inferior oblique)

(visceral

efferent) fibers to the ciliary ganglion Postsynaptic fibers from ciliary ganglion pass to the eyeball in the short ciliary nerves to innervate the ciliary body and sphincter of the pupil.

carries

presynaptic

parasympathetic

Trochlear Nerve (CN IV) Functions : Somatic motor (general somatic efferent) and proprioceptive to one
Trochlear Nerve (CN IV) Functions : Somatic motor (general somatic efferent) and proprioceptive to one
Trochlear Nerve (CN IV) Functions : Somatic motor (general somatic efferent) and proprioceptive to one

Trochlear Nerve (CN IV)

Functions: Somatic motor (general somatic efferent) and proprioceptive to one extraocular muscle (superior oblique). Nucleus: midbrain, immediately caudal to the oculomotor

nucleus.

smallest cranial nerve. from the posterior surface of the midbrain --- passing anteriorly around the brainstem, running the longest intracranial (subarachnoid) -- pierces the dura mater at the

margin of tentorium cerebelli -- passes anteriorly in the lateral

wall of the cavernous sinus -- pass through the superior orbital fissure into the orbit ---supplies the superior oblique muscle

Cranial Nerve IV: Trochlear

Cranial Nerve IV: Trochlear

Cranial Nerve IV: Trochlear
Abducent Nerve (CN VI) Functions: Somatic motor (general somatic efferent and proprioceptive) to one extraocular
Abducent Nerve (CN VI) Functions: Somatic motor (general somatic efferent and proprioceptive) to one extraocular
Abducent Nerve (CN VI) Functions: Somatic motor (general somatic efferent and proprioceptive) to one extraocular
Abducent Nerve (CN VI) Functions: Somatic motor (general somatic efferent and proprioceptive) to one extraocular

Abducent Nerve (CN VI)

Functions: Somatic motor (general somatic efferent and

proprioceptive) to one extraocular muscle (lateral rectus).

Nucleus: pons near the median plane deep to colliculud in floor of 4 th ventricles for lateral rectus.

emerge from the brainstem between the pons and the

medulla --- traverse the pontine cistern of the subarachnoid space, straddling the basilar artery -- pierces the dura --- intradural course --- bends sharply over the crest of the petrous part of the temporal bone --- Cavernous sinus -- traverses anulus tendineus communis orbita --- penetrating the medial surface of the lateral rectus - abducts

the eye ( function = basis for the name of the nerve)

Cranial Nerve VI: Abdcuens

Cranial Nerve VI: Abdcuens
Cranial Nerve VI: Abdcuens
Trigeminal Nerve (CN V) Functions : General sensory (general somatic afferent) and branchial motor (special

Trigeminal Nerve (CN V)

Functions: General sensory (general somatic afferent)

and branchial motor (special visceral efferent) to derivatives of the 1st pharyngeal arch.

Nuclei: There are four trigeminal nuclei one motor and

three sensory.

The trigeminal nerve (CN V) is the largest cranial nerve.

Emerges from the lateral aspect of the pons by a large

sensory root and a small motor root.

Principal general sensory nerve for the head (face, teeth, mouth, nasal cavity, and dura of the cranial cavity).

The trigeminal ganglion is flattened and crescent

shaped (=semilunar ganglion) and is housed within a dural recess (trigeminal cave) lateral to the cavernous sinus.

V: Trigeminal (3 nerves in 1!)

Conveys sensory impulses from various areas of the face (V1) and (V2), and supplies motor fibers (V3) for mastication

Composed of three divisions:

V1. Ophthalmic

Exits with eye muscle group (superior orbital fissure, through orbit to superior orbital notch/foramina)

Sensory to forehead, nasal cavity

V2. Maxillary

Exits foramen rotundum through wall of maxillary sinus to inferior orbital foramina)

Sensory to cheek, upper lip, teeth, nasal cavity

V3. Mandibular

Exits foramen ovale to mandibular foramen to mental foramen

Motor to jaw muscles--Masseter, temporalis, pterygoids, digastric

Sensory to chin

Sensory to tongue

Nerve VII: Facial Mixed nerve with five major branches  Temporal  Buccal  Cervical
Nerve VII: Facial Mixed nerve with five major branches  Temporal  Buccal  Cervical
Nerve VII: Facial Mixed nerve with five major branches  Temporal  Buccal  Cervical

Nerve VII: Facial

Mixed nerve with five major branches

Temporal

Buccal

Cervical

Zygomatic

Mandibular

chorda tympani” (crosses interior ear drum to join V 3 )

Taste to anterior 2/3 of tongue

Submandibular, sublingual salivary glands

Lacrimal glands

Motor functions include facial expression,

and the transmittal of autonomic impulses

to lacrimal and salivary glands

Sensory function is taste from the anterior two-thirds of the tongue

Facial muscles (five branches fan out over

face from stylomastoid foramen)

VII. = N. facialis 3 nuclei in pons  somatomotor branchial (2nd arch)  ncl.

VII. = N. facialis

3 nuclei in pons

somatomotor branchial (2nd arch) ncl. n. VII

visceromotor (parasympathetic) ncl.

salivatorius superior

ncl. gustatorius (rostral part of ncll. tractus

solitarii) sensory (taste)

n. intermedius = VM fibres + taste fibres

course: pons angulus pontocerebellaris fossa

cranii posterior porus acusticus internus

meatus a.i. fundus m.a.i. (vetrocranial quadrant) canalis nervi facialis Falloppii foramen stylomastoideum glandula parotidea

Facial Nerve (CN VII)

Facial Nerve (CN VII) Functions : Sensory (special visceral afferent and general somatic afferent), motor (branchial

Functions: Sensory (special visceral afferent and general somatic afferent), motor (branchial motor or special visceral efferent), and parasympathetic (general visceral

efferent). It also carries proprioceptive fibers from the muscles it innervates.

Nuclei: The motor nucleus branchiomotor nucleus in the ventrolateral part of the pons. The cell bodies = eniculate ganglion. The central processes of those concerned with taste end in the nuclei of the solitary tract in the medulla. The processes of those concerned with general sensations (pain, touch, and thermal) from around the external ear end in the spinal nucleus of the trigeminal nerve.

The facial nerve (CN VII) emerges from the junction of the pons and medulla as two divisions, the motor root and the intermediate nerve. The larger motor root (facial nerve proper) innervates the muscles of facial expression, and the smaller intermediate nerve (L. nervus intermedius) carries taste, parasympathetic, and somatic sensory fibers. During its course, CN VII traverses the posterior cranial fossa, internal acoustic meatus, facial canal, stylomastoid foramen of the temporal bone, and parotid gland. After traversing the internal acoustic meatus, the nerve proceeds a short distance anteriorly within the temporal bone and then turns abruptly posteriorly to course along the medial wall of the

tympanic cavity. The sharp bend is the geniculum of the facial nerve (L. genu, knee),

sometimes called the external genu of CN VII, the site of the geniculate ganglion (sensory ganglion of CN VII). While traversing the temporal bone within the facial canal, CN VII gives rise to the: Greater petrosal nerve. Nerve to the stapedius. Chorda tympani nerve.

.

 Then, after running the longest intraosseous course of any cranial nerve, CN VII emerges
 Then, after running the longest intraosseous course of any cranial nerve, CN VII emerges
 Then, after running the longest intraosseous course of any cranial nerve, CN VII emerges
 Then, after running the longest intraosseous course of any cranial nerve, CN VII emerges

Then, after running the longest intraosseous course of any cranial nerve, CN VII emerges from

the cranium via the stylomastoid foramen; gives off the posterior auricular branch; enters the

parotid gland; and forms the parotid plexus, which gives rise to the following five terminal

motor branches: temporal, zygomatic, buccal, marginal mandibular, and cervical.

Branchial Motor As the nerve of the 2nd pharyngeal arch, the facial nerve supplies striated muscles derived from its mesoderm, mainly the muscles of facial expression and auricular muscles. It also supplies the posterior bellies of the digastric, stylohyoid, and stapedius muscles.

Presynaptic Parasympathetic

CN VII provides presynaptic parasympathetic fibers to the pterygopalatine ganglion for

innervation of the lacrimal mucous glands and to the submandibular ganglion for innervation

of the sublingual and submandibular salivary glands. The pterygopalatine ganglion is

), which distributes its postsynaptic fibers, whereas

). Parasympathetic

associated with the maxillary nerve (CN

the submandibular ganglion is associated with the mandibular nerve (CN

fibers synapse in these ganglia, whereas sympathetic and other fibers pass through them.

V 2

V

3

General Sensory Some fibers from the geniculate ganglion supply a small area of the skin of the concha of the auricle, close to external acoustic meatus.

Taste (Special Sensory) Fibers carried by the chorda tympani join the lingual nerve to convey

taste sensation from the anterior two thirds of the tongue and soft palate

VII. = N. facialis - branches
VII. = N. facialis - branches

outside skull n. auricularis posterior somatomotor fibres rudimentary muscles of auricle + 3 mm. auriculares nn. for m. stylohyoideus + venter post. m. digastrici plexus intraparotideus 5 branches

 

VII. = N. facialis branches courses in canalis

nervi fasialis

n. petrosus major parasympathetic

canalis n.p.m.sulcus n.p.m. foramen lacerum

canalis pterygoideus Vidii fossa pterygopalatina ggl.

pterygopalatinum via branches of n.V2 to gll. lacrimalis, nasales, palatinae, nasopharyngeae

n. stapedius somatomotor

eminetia pyramidalis: m. stapedius

chorda tympani parasympathetic + taste

canaliculus ch.t. posterior cavitas tympani canaliculus

ch.t. anterior fissura petrotympanica Glaseri fossa

infratemporalis n. lingualis

gg. submandibulare via branches of n. V3 to gll. linguales, submandibularis + sublingualis

ventral 2/3 of tongue = dorsum linguae - taste

Innervation of tongue somatosensory x sensory (taste)

Innervation of tongue somatosensory x sensory (taste)
Vestibulocochlear Nerve (CN VIII) Functions : sensations of hearing and equilibrium. Nuclei : Four vestibular
Vestibulocochlear Nerve (CN VIII) Functions : sensations of hearing and equilibrium. Nuclei : Four vestibular
Vestibulocochlear Nerve (CN VIII) Functions : sensations of hearing and equilibrium. Nuclei : Four vestibular
Vestibulocochlear Nerve (CN VIII) Functions : sensations of hearing and equilibrium. Nuclei : Four vestibular

Vestibulocochlear Nerve (CN VIII)

Functions:

sensations of hearing and equilibrium.

Nuclei: Four vestibular nuclei are located at the junction of the pons and medulla in the lateral part of the floor of the 4th ventricle; two cochlear nuclei are in the medulla. The vestibulocochlear nerve (CN VIII) emerges from the junction of the

pons and medulla and enters the internal acoustic meatus. Here it

separates into the vestibular and cochlear nerves.

The vestibular nerve is concerned with equilibrium. It is composed of the central processes of bipolar neurons in the vestibular ganglion; the peripheral processes of the neurons extend to the maculae of the utricle and saccule (sensitive to the line of linear acceleration relative to the

position of the head) and to the ampullae of the semicircular ducts

(sensitive to rotational acceleration). The cochlear nerve is concerned with hearing. It is composed of the central processes of bipolar neurons in the spinal ganglion; the peripheral processes of the neurons extend to the spiral organ.

Special

sensory (special

somatic afferent) that is, special

Cranial Nerve VIII: Vestibulocochlear  Fibers arise from the hearing and equilibrium apparatus of the

Cranial Nerve VIII: Vestibulocochlear

Fibers arise from the hearing and equilibrium apparatus of

the inner ear, pass through the

internal acoustic meatus, and enter the brainstem at the pons-medulla border

Two divisions cochlear (hearing) and vestibular (balance)

Functions are solely sensory equilibrium and hearing

6 nuclei in pons (under recessus lat. fossae rhomboidae)  2 cochlear: ncl. cochlearis ant.+post.
6 nuclei in pons (under recessus lat. fossae rhomboidae)  2 cochlear: ncl. cochlearis ant.+post.
6 nuclei in pons (under recessus lat. fossae rhomboidae)  2 cochlear: ncl. cochlearis ant.+post.
6 nuclei in pons (under recessus lat. fossae rhomboidae)  2 cochlear: ncl. cochlearis ant.+post.

6 nuclei in pons (under recessus lat. fossae rhomboidae) 2 cochlear: ncl. cochlearis ant.+post.

4 vestibular: ncl. vestibularis sup.+inf.+medi.+lat. course: angulus pontocerebellaris fossa cranii

posterior porus acusticus internus meatus a.i.

fundus m.a.i.

pars vestibularis ganglion vestibulare Scarpae on

floor of meatus.a.i. (bipolar neurons)

pars cochlearis ganglion cochleare Corti inside bony cochlea (spiral shape, bipolar neurons)

VIII. - Nervus vestibulocochlearis obsolete term: n. statoacusticus  special sensory – hearing + balance
VIII. - Nervus vestibulocochlearis obsolete term: n. statoacusticus  special sensory – hearing + balance

VIII. - Nervus vestibulocochlearis

obsolete term: n. statoacusticus special sensory hearing + balance

VIII. - Nervus vestibulocochlearis obsolete term: n. statoacusticus  special sensory – hearing + balance
Glossopharyngeal Nerve (CN IX ) Functions : Sensory (general somatic afferent, special visceral afferent, general

Glossopharyngeal Nerve (CN IX)

Functions: Sensory (general somatic afferent, special visceral afferent, general visceral afferent), motor (special visceral efferent), and parasympathetic (general visceral efferent)

Nuclei: Four nuclei in the medulla send or receive fibers via CN IX:

two motor and two sensory. Three of these nuclei are shared with CN X. Emerges from the lateral aspect of the medulla -- passes

anterolaterally to leave the cranium through the anterior aspect

foramen jugular -- superior and inferior (sensory) ganglia, -- followsm. stylopharyngeus, the only muscle the nerve supplies, - -passses between the superior and the middle constrictor muscles of the pharynx --creach the oropharynx and tongue (sensory fibers)

CN IX is afferent from the tongue and pharynx (hence its name) and efferent to the stylopharyngeus and parotid gland.

 Branchial Motor ; m. stylopharyngeus.  Parasympathetic (Visceral Motor)  Following a circuitous route
 Branchial Motor ; m. stylopharyngeus.  Parasympathetic (Visceral Motor)  Following a circuitous route

Branchial Motor ; m.stylopharyngeus.

Parasympathetic (Visceral Motor)

Following a circuitous route initially involving the tympanic nerve, presynaptic parasympathetic fibers are provided to the otic ganglion for innervation of the parotid gland -- associated with the mandibular nerve (CN V 3 ), branches of which convey the postsynaptic parasympathetic fibers to the parotid gland .

Sensory (General Sensory)

The tympanic nerve. The carotid sinus nerve to the carotid sinus, a baro- (presso) receptor sensitive

to changes in blood pressure, and the carotid body, a

chemoreceptor sensitive to blood gas (oxygen and carbon dioxide levels).

The pharyngeal, tonsillar, and lingual nerves to the mucosa of the oropharynx and isthmus of the

fauces (L. throat), including palatine tonsil, soft

palate, and posterior third of the tongue.

Taste (Special Sensory) Taste fibers are conveyed from the posterior third of the tongue to the sensory ganglia.

Innervation of tongue somatosensory + sensory (taste)

Innervation of tongue somatosensory + sensory (taste)
Functions : Vagus Nerve (CN X) Sensory (general visceral afferent), Motor (special visceral efferent), and

Functions:

Functions : Vagus Nerve (CN X) Sensory (general visceral afferent), Motor (special visceral efferent), and parasympathetic

Vagus Nerve (CN X)

Sensory (general visceral afferent),

Motor (special visceral efferent), and parasympathetic (general visceral

efferent). Sensory from the inferior pharynx, larynx, and thoracic and abdominal organs. Motor to the soft palate; pharynx; intrinsic laryngeal muscles

(phonation); and a nominal extrinsic tongue muscle, the palatoglossus,

which is actually a palatine muscle based on its derivation and innervation. Proprioceptive to the muscles Parasympathetic to thoracic and abdominal viscera. Nuclei:

Four nuclei of CN X in the medulla send or receive fibers via CN IX two

motor and two sensory. Three of these nuclei are shared with CN IX.

general

somatic afferent,

special

visceral

afferent,

 The vagus nerve (CN X) longest course -- extensive --- Latin word vagari =

The vagus nerve (CN

X)

longest course

--

extensive --- Latin word vagari = wandering.

--- most

Arises from the lateral aspect of the medulla that merge and leave the cranium through the jugular foramen positioned between CN IX and CN XI

has a superior ganglion in the jugular foramen= general sensory

Inferior foramen = inferior ganglion (nodose ganglion) = visceral sensory .

CN X continues inferiorly in the carotid sheath to the root of the neck, supplying branches to the palate, pharynx,

supplies branches to the heart, bronchi, and lungs.

join the esophageal plexus surrounding the esophagus, which is formed by branches of the vagi and sympathetic

trunks -- follows the esophagus through the diaphragm

into the abdomen -- anterior and posterior vagal trunks break up into branches -- innervate esophagus, stomach, and intestinal tract.


 X. - N. vagus SM: pharynx ( except m. stylopharyngeus ), soft palate ( except

X. - N. vagus

SM: pharynx (except m. stylopharyngeus), soft palate (except m. tensor veli palatini), larynx (4th arch),

upper half of oesophagus

SS: part of meatus acusticus externus + of meninges

VS: ggl. superius n.X + inferius n.X. mucosa of larynx, lower ½ of pharynx , foregit and midgut + liver, gallbladder, pancreas; spleen, kidneys, suprarenal glands, testis/ovaries, ½ of uterine tube

taste: part of root of tongue, epiglottis

VM: glands and smooth muscles of pharynx, lower

respiratory tract, foregut and midgut, heart, thymus

Cabang

Cabang  rr. pharyngei – mucosa, glands, muscles  n. laryngeus superior – mucosa, glands, muscles

rr. pharyngei mucosa, glands, muscles

n. laryngeus superior mucosa, glands, muscles

n. laryngeus recurrens idem

right is shorter and passes under a. subclavia dextra left is longer and under arcus aortae

rr. cardiaci cervicales sup.+inf., thoracici

rr. bronchiales

rr. coeliaci, hepatici, renales, gastrici ant.+post.

Innervation of tongue somatosensory x sensory (taste)

Innervation of tongue somatosensory x sensory (taste)
Spinal Accessory Nerve (CN XI)

Spinal Accessory Nerve (CN XI)

Functions:

sternocleidomastoid and trapezius muscles.

Nuclei: nucleus of the accessory nerve, a column of

anterior horn motor neurons in MS segmen 5-6

Motor

to

the

striated

Nuclei : nucleus of the accessory nerve, a column of anterior horn motor neurons in MS
combined nerv (2 independent components grown in one trunk) 2 nuclei  2 roots 
combined nerv (2 independent components grown in one trunk) 2 nuclei  2 roots 
combined nerv (2 independent components grown in one trunk) 2 nuclei  2 roots 
combined nerv (2 independent components grown in one trunk) 2 nuclei  2 roots 

combined nerv (2 independent components grown in one trunk)

2 nuclei 2 roots 1 trunk 2 branches

somatomotor branchial (6th arch)/cranial root

nucleus in medulla oblongata: ncl. ambiguus radix cranialis truncus n.XI ramus internus n. X

soft palate muscles (4) + lateral muscle group of larynx

(3)

somatomotor somite (cervical somites)/spinal root

nucleus in cervical spinal cord: ncl. n. XI. medullae

spinalis radix spinalis truncus n.XI ramus

externus m. sternocleidomastoideus + m. trapezius

direct fibres via n. spinalis C2-4 loop between both ways = ansa Maubraci

Hypoglossal Nerve (CN XII) Functions : Motor (general somatic efferent) to the intrinsic and extrinsic

Hypoglossal Nerve (CN XII)

Functions: Motor (general somatic efferent) to the intrinsic and extrinsic

muscles of the tongue (G. glossa) styloglossus, hyoglossus, and genioglossus.

Arises as motor nerve -- leaves cranium through the hypoglossal canal -- after

exiting the cranial cavity, joined by branches of the cervical plexus general

somatic motor fibers from C1 and C2 spinal nerves and general somatic sensory fibers from the spinal ganglion of C2. -- hitch a ride with CN XII to reach the hyoid muscles, ---CN XII passes inferiorly medial to the angle of the mandible -- -curves anteriorly to enter the tongue --- ends in many branches that supply all the extrinsic muscles of the tongue, except the palatoglossus

CN XII has the following branches:

A meningeal branch -- returns to the cranium through the hypoglossal canal and innervates the dura mater on the floor and posterior wall of the posterior cranial fossa. The superior root of the ansa cervicalis -- branches from CN XII to supply the infrahyoid muscles (sternohyoid, sternothyroid, and omohyoid). -- some

fibers continue past the descending branch to reach the thyrohyoid muscle.

Terminal lingual branches supply the styloglossus, hyoglossus, genioglossus, and intrinsic muscles of the tongue.

XII. = N. hypoglossus

XII. = N. hypoglossus  1 nucleus in medulla oblongata: ncl. n. XII course : ventrally

1 nucleus in medulla oblongata: ncl. n. XII

course: ventrally to olive from medulla oblongata

(= sulcus preolivaris)

fossa cranii posterior

canalis nervi hypoglossi spatium retrostyloideum

(spatium

parapharyngeum) trigonum caroticum trigonum submandibulare tongue

7 muscles of tongue

3 extraglossal and 4 intraglossal

caroticum  trigonum submandibulare  tongue  7 muscles of tongue  3 extraglossal and 4
Sistem Saraf Tepi : Nervi Spinales 16/11/2014
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Sistem Saraf Tepi : Nervi Spinales 16/11/2014

Sistem Saraf Tepi

: Nervi Spinales

Nerve Plexus

Nerve Plexus  Complex interwoven network of nerves  Occurs in segments that control skeletal musculature

Complex interwoven network of nerves

Occurs in segments that control skeletal

musculature of the neck and limbs

- peripheral distribution of the ventral rami do not directly proceed to their peripheral targets

Ventral rami of adjacent spinal nerves blend their

fibers to produce compound nerve trunks

- formed during development when small skeletal muscles fuse to form larger muscles with compound origins

- compound muscles contain sensory and motor fibers

- ventral rami converge and branch to form compound

nerves

4 Major Nerve Plexuses

Cervical plexus

Brachial plexus

Lumbar plexus

Sacral plexus

Fig 14.9

4 Major Nerve Plexuses  Cervical plexus  Brachial plexus  Lumbar plexus  Sacral plexus

Figure 13-10 Peripheral Nerves and Nerve Plexuses

C Lesser occipital nerve 1 C 2 Cervical C 3 Great auricular nerve Transverse cervical
C
Lesser occipital nerve
1
C
2
Cervical
C
3
Great auricular nerve
Transverse cervical nerve
plexus
C
4
C
Supraclavicular nerve
5
C
6
Phrenic nerve
Brachial
C
7
C
plexus
8
T
1
T
2
T
Axillary nerve
3
T
4
T
5
T
6
T
Musculocutaneous
7
nerve
T
8
T
9
Thoracic nerves
T
10
T
11

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Figure 13-10 Peripheral Nerves and Nerve Plexuses T 12 L Radial nerve 1 Lumbar L
Figure 13-10 Peripheral Nerves and Nerve Plexuses
T
12
L
Radial nerve
1
Lumbar
L
2
plexus
Ulnar nerve
L
3
Median nerve
L
4
L
5
S
1
Iliohypogastric
Sacral
nerve
S
plexus
2
S
3
Ilioinguinal
S
4
nerve
S
5
Co 1
Lateral femoral
cutaneous nerve
Genitofemoral
nerve
Femoral nerve
Obturator nerve
Superior
Gluteal nerves
Inferior
Pudendal nerve
Saphenous nerve
Sciatic nerve

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Cervical Plexus

Cervical Plexus  Consists of cutaneous and muscular branches in the ventral rami of spinal nerves

Consists of cutaneous and muscular branches in the

ventral rami of spinal nerves C1-C4, some C5

Position: lies in front of the origin of levator scapulae and scalenus medius and deep to the superior part of the sternocleidomastoid

The cutaneous branches innervate areas on the head,

neck, and chest

The muscular branches innervate muscles of the neck and shoulder

Major nerve of this plexus the phrenic nerve provides the

entire nerve supply to the diaphragm

Cervical Plexus

Branches

Cutaneous branches:

Lesser occipital

Great auricular

Transverse nerve of neck

Supraclavicular nerves

Emerge around middle of

posterior border of sternocleidomastoid, to supply skin of neck and scalp between auricle and

external occipital protuberance

of sternocleidomastoid, to supply skin of neck and scalp between auricle and external occipital protuberance Figure
of sternocleidomastoid, to supply skin of neck and scalp between auricle and external occipital protuberance Figure

Muscular branches: supply the deep muscles of neck

Phrenic nerve (anterior rami of

C3-C5) to diaphragm (motor and

sensory):

Descends over scalenus anterior to enter thorax

Accompanied by pericardiophrenic vessels and

passes anterior to lung roots

between mediastinal pleura and pericardium to supply motor and sensory innervation to

diaphragm

Sensory fibers supply to pleurae,

pericardium and peritoneum of

diaphragm; usually right phrenic nerve may be distributed on live, gallbladder and biliary system.

and peritoneum of diaphragm; usually right phrenic nerve may be distributed on live, gallbladder and biliary
The Cervical Plexus
The Cervical Plexus
The Cervical Plexus
The Cervical Plexus
The Cervical Plexus

The Cervical Plexus

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Brachial Plexus

Brachial Plexus  Larger, more complex innervates pectoral girdle & upper limb (except trapezius (accessory nerve)

Larger, more complex innervates pectoral girdle & upper limb

(except trapezius (accessory nerve) and skin of tip of shoulder

Passes through the scalene fissure to posterosuperior of

subclavian artery, then enters the axilla to form three cords

Formed by the ventral rami of spinal nerves C5-T1

-Radiks trunkus divisicorda nerve.

- membentuk trunkus superior, middle dan inferior

- trunks dibagi menjadi divisi anterior dan posterior

- Seluruh divisi 3 posterior bergabung mjd corda posterior

- Divisi anterior trunkus superior dan media bergabung mjd

corda lateral

- Corda medial dibentuk dari lanjutan divisi anterior trunkus inferior

- Saraf keluar dari 1 atau lebih trunkus atau corda

Brachial Plexus

Brachial Plexus  5 ventral rami form  3 trunkus  separate into 6 divisi 
Brachial Plexus  5 ventral rami form  3 trunkus  separate into 6 divisi 

5 ventral rami form

3 trunkus

separate into 6 divisi

then form 3 corda

that give rise to

branches/nerve

a. Musculocutaneous nerve (lateral cord)

b. Median nerve (lateral and medial cords)

c. Ulnar nerve (medial cord)

d. Axillary nerve (posterior cord)

e. Radial nerve (posterior cord)

Brachial plexus

Brachial plexus Copyright 2009, John Wiley & Sons, Inc.

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Brachial Plexus Organization

Brachial Plexus Organization  Flow chart summarizing relationships within the brachial plexus - dashed lines to

Flow chart summarizing relationships within the brachial plexus - dashed lines to the posterior cord merely indicate that the posterior division lie posterior to the anterior divisions

Cervical and Brachial Plexuses

 N. musculocutaneous Distribusi: Biceps brachii, brachalis and coracobrachialis ‘BBC nerve’; skin on anterior
 N. musculocutaneous Distribusi: Biceps brachii, brachalis and coracobrachialis ‘BBC nerve’; skin on anterior

N. musculocutaneous

Distribusi: Biceps brachii,

brachalis and coracobrachialis ‘BBC nerve’; skin on anterior aspect of

forearm

 Median nerve Distribusi: Flexor of forearm except brachioradialis, flexor carpi ulnaris and ulnar half
 Median nerve Distribusi: Flexor of forearm except brachioradialis, flexor carpi ulnaris and ulnar half

Median nerve

Distribusi:

Flexor of forearm except brachioradialis,

flexor carpi ulnaris and ulnar half of flexor digitorum profundus, thenar except adductor pollicis, first two lumbricals;

skin of thenar, central part of

palm,

palmar aspect of radial three and one-half fingers, including

middle and distal fingers on

dorsum

Ulnar nerve

Distribusi:

Flexor carpi ulnaris,

ulnar half of flexor digitorum profundus,

hypothenar muscles,

interossei, 3rd and 4th lumbricals and adductor pollicis;

skin of hypothenar, palmar surface of ulnar one and one- half fingers,

ulnar half of dorsum of hand,

posterior aspect of ulnar two and one-half fingers

Injury: clawhand

Ulnar nerve palsy- inability to abduct or adduct fingers

of ulnar two and one-half fingers  Injury : clawhand  Ulnar nerve palsy- inability to
of ulnar two and one-half fingers  Injury : clawhand  Ulnar nerve palsy- inability to
 Radial Distribution: Extensor muscles of arm and forearm, brachioradialis; skin on back of arm,

Radial

Distribution:

Extensor muscles of arm

and forearm, brachioradialis;

skin on back of arm,

forearm, and

radial side of dorsum of hand and radial two and one-half fingers

Wrist drop- inability to extend the wrist and

fingers

 Axillary  Distribution: Deltoid and teres minor muscle;  skin over deltoid and upper

Axillary

Distribution:

Deltoid and teres

minor muscle;

skin over deltoid and upper posterior aspect of arm

Injury:

result in deltoid and teres minor paralysis (loss of shoulder abdution and external

rotation) with loss of

sensation over the deltoid

Anterior branches of thoracic nerves

Anterior branches of thoracic nerves  Intercostal nerves (anterior rami of T1- T11)  Subcostal nerve

Intercostal nerves (anterior

rami of T1- T11)

Subcostal nerve (anterior ramus of T12)

Distribution: distributed to

intercostales and anterolateral

abdominal muscles, skin of

thoracic and abdominal wall, parietal pleura and peritoneum

T2

T4 Nipple

Xiphoid process

Costal arch

T10 Umbilicus

T12 Midpoint between umbilicus and symphysis pubis

Sternal angle

T6

T8

Fig 14.11 The Trunks and Cords of the Brachial Plexus
Fig 14.11
The Trunks and Cords of
the Brachial Plexus

Figure 13-12b The Brachial Plexus

Figure 13-12b The Brachial Plexus Anterior Posterior Radial nerve Ulnar nerve Median nerve Areas of the
Anterior Posterior Radial nerve Ulnar nerve Median nerve Areas of the hands serviced by nerves
Anterior
Posterior
Radial
nerve
Ulnar
nerve
Median
nerve
Areas of the hands serviced by
nerves of the right brachial plexus

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Table 13-2 The Brachial Plexus

Table 13-2 The Brachial Plexus © 2012 Pearson Education, Inc.
Table 13-2 The Brachial Plexus © 2012 Pearson Education, Inc.

© 2012 Pearson Education, Inc.

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Lumbar and Sacral Plexuses

Arises from L 1 -L

4

& L -S

4

4

and innervates the thigh,

abdominal wall, psoas muscle, the buttock, lower limb,

pelvic structures, and the perineum

Ventral rami of these nerves supply the pelvis and lower limb

- ventral rami of both plexuses are distributed to the lower limb (often

referred to as the lumbosacral plexus)

Major nerves of the lumbar plexus

- genitofemoral, lateral femoral cutaneous, and femoral nerve

Major nerves of the sacral plexus

- the sciatic nerve which branches into the common fibular nerve and the tibial nerveand the pudendal nerve

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Lumbar plexus  Formation : formed by anterior rami of L1-L3, a part of anterior

Lumbar plexus

Formation: formed by anterior rami of L1-L3, a part of anterior rami of T12and L4

Position: lies within

substance of psoas major

Branches

Femoral

Obturator Iliohypogastric

Ilioinguinal

Lateral femoral cutaneous

Genitofemoral

 Femoral  Obturator  Iliohypogastric  Ilioinguinal  Lateral femoral cutaneous  Genitofemoral

n. femoralis

Berjalan ke bawah dan

lateral diantara m. psoas

dan m. iliacus, menuju ke profunda lig inguinal Innervasi m. paha anterior (quadriceps, sartorius and

pectineus), panggul dan sendi lutut, dan kulit pada

sisi anteromedia l paha, n. saphenous didistribusikan ke kulit di sisi medial tungkai atas dan bawah

lutut, dan kulit pada sisi anteromedia l paha, n. saphenous didistribusikan ke kulit di sisi medial
lutut, dan kulit pada sisi anteromedia l paha, n. saphenous didistribusikan ke kulit di sisi medial

n. obturatorius

Masuk ke paha via

foramen obturatorius

Innervasi medial group otot paha , m.

obturator externus,

dan kulit sisi medial paha

ke paha via foramen obturatorius Innervasi medial group otot paha , m. obturator externus, dan kulit
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Plexus Sacral  Formation : formed by anterior rami of L4 and L5 spinal nerves

Plexus Sacral

Formation: formed by anterior rami of L4 and L5

spinal nerves (the lumbrosacral trunk) and anterior

rami of sacral and coccygeal nerves

Position: lies in pelvic cavity, anterior to sacrum and piriformis

Pembuluh darah besar

N. Superior gluteal

N. Pudendal

N. Posterior femoral cutaneou

N. Sciatic , bercabang dua

1. Fibular nerve

2. Tibial nerve

Figure 13-13b The Lumbar and Sacral Plexuses

Figure 13-13b The Lumbar and Sacral Plexuses Spinal Nerves Forming the Sacral Plexus Lumbosacral trunk L
Spinal Nerves Forming the Sacral Plexus Lumbosacral trunk L 4 nerve L 5 nerve Nerves
Spinal Nerves
Forming the
Sacral Plexus
Lumbosacral trunk
L 4 nerve
L 5 nerve
Nerves of the
Sacral Plexus
S 1 nerve
Superior gluteal
S 2 nerve
Inferior gluteal
S 3 nerve
S 4 nerve
Sciatic
S 5
Posterior femoral
cutaneous
Co 1
Pudendal
Sacral plexus, anterior view

© 2012 Pearson Education, Inc.

N. Sciatica

Keluar dari foramen infrapiriformis menuju ke regio glutealis, berjalan inferiolateral profunda ke m. gluteus

maximus, jaan ke tengah diantara

trochanter mayor os femur dan tuberositas ischiadika di belakang paha, terbentang di dalam caput longus m.

biceps femoris, normal terbagi menjadi

n.tibialis dan n. peronealis communis di

atas fossa popliteal ; Innervasi

m. semitendinosus,

m. semimembranosus

m. biceps femoris

Cabang articular panggul dan sendi lutut

popliteal ; Innervasi m. semitendinosus, m. semimembranosus m. biceps femoris Cabang articular panggul dan sendi lutut

N. tibialis

Turun ke fossa popliteal

dan terletak di m.

popliteus; berjalan inferior dengan a. tibialis posterior dan berakhir

dibawah flexor

retinaculum dan terbagi mjd n. plantaris medial dan lateral

Menginervasi otot bagian

posterior tungkai bawah dan sendi lutut

dan terbagi mjd n. plantaris medial dan lateral Menginervasi otot bagian posterior tungkai bawah dan sendi
dan terbagi mjd n. plantaris medial dan lateral Menginervasi otot bagian posterior tungkai bawah dan sendi

N. peroneus communis

Timbul dari apeks fossa popliteal dan mengikuti tepi medial m.biceps femoris dan tendonnya; berjalan ke aspek caput fibula dan mengelilingi collum fibula, menuju ke dalam m. peroneus

longus, dan terbagi 2 mjd :

a. n. peroneus profundus

Timbul dari n. peroneus longus dan collum fibula; turun pada membrana interosseous dan masuk ke

dorsum kaki, menginervasi otot bagian anterior

tungkai dan kulit pada celah interdigital pertama

b. n. peroneus superficialis

Timbul diantara n. peroneus longus dan colum fibula, turun pada kompartment latreal tungkai

bawah; menginervasi m. peroneus longus dan

brevis dan kulit permukaan anterior surface tungkai bawah dan dorsum kaki.

bawah; menginervasi m. peroneus longus dan brevis dan kulit permukaan anterior surface tungkai bawah dan dorsum
Fig 14.13
Fig 14.13
Fig 14.13
Fig 14.13

Nerves of the lower extermity

Nerves of the lower extermity
Lumbar and Sacral Plexuses

Lumbar and Sacral Plexuses

Fig 14.14
Fig 14.14

Table 13-3 The Lumbar and Sacral Plexuses

Table 13-3 The Lumbar and Sacral Plexuses © 2012 Pearson Education, Inc.
Table 13-3 The Lumbar and Sacral Plexuses © 2012 Pearson Education, Inc.

© 2012 Pearson Education, Inc.

Plexus Coccygeal  Dibentuk oleh rami anterior S4-S5 dan n. coccygeus  Innervasi kulit sekitar

Plexus Coccygeal

Dibentuk oleh rami

anterior S4-S5 dan n.

coccygeus

Innervasi kulit sekitar regio coccygeus

Plexus Coccygeal  Dibentuk oleh rami anterior S4-S5 dan n. coccygeus  Innervasi kulit sekitar regio
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2. Sistem Saraf Otonom

Untuk kewaspadaan dan kesadaran. Persiapan lawan

atau lari / fight

or flee from a scene (fight or flight).

Sympatis: Persiapan aksi. Parasimpatis :

persiapan

menyimpan

energi Mempengaruhi banyak organ

flight). S y m p a t i s : Persiapan aksi. Parasimpatis : persiapan menyimpan

. Sistem Saraf Otonom

Rangsang kelenjar dan komando ke

otot polos

Tak bisa ditur oleh pikiran sadar Terdiri atas komponen yang berlawanan

Parasimpatis

Kontrol fungsi normal

Menyimpan energi melalui perlambatan proses

Simpatis

Saat stress

Mengatur reaksi “fight-or-flight”

Meningkatakan denyut jantung, nadi, dan napas

Simpatis  Saat stress  Mengatur reaksi “fight -or- flight”  Meningkatakan denyut jantung, nadi, dan
AUTONOMIC MOTOR SYSTEM
AUTONOMIC MOTOR SYSTEM

Spinal Cord

-Simpatis: T1- L3 /torakolumbal -Parasimpatis: S2-S4 /craniosacral
-Simpatis: T1-
L3 /torakolumbal
-Parasimpatis:
S2-S4
/craniosacral

Brain Stem Parasimpatis NC X NC IX

NC VII

NC

III

Simpatis

a. Pengeluaran adrenalin& noradrenalin

b. Peningkatan detak jantung & tekanan darah& rata2 pernapasan & produksi keringat

c. Peningkatan aliran darah ke otot skeletal

d. Menghambat fungsi digestif

e. Meningkatkan diamater sal. Napas

f. Dilatasi pupil

g. Kontriksi spingter kandung kemih

h. Respons“ Fight or flight”

spingter kandung kemih h. Respons“ Fight or flight” CENTRAL NERVOUS SYSTEM Brain SYMPATHETIC Dilates pupil
spingter kandung kemih h. Respons“ Fight or flight” CENTRAL NERVOUS SYSTEM Brain SYMPATHETIC Dilates pupil

CENTRAL NERVOUS SYSTEM

Brain

SYMPATHETIC

Dilates pupil Stimulates salivation Salivary glands Relaxes bronchi Spinal cord Lungs Accelerates heartbeat Heart
Dilates pupil
Stimulates salivation
Salivary
glands
Relaxes bronchi
Spinal
cord
Lungs
Accelerates heartbeat
Heart
Inhibits activity
Stomach
Pancreas
Stimulates glucose
Liver
Adrenal
Secretion of adrenaline,
gland
nonadrenaline
Kidney
Relaxes bladder
Sympathetic
ganglia
Stimulates ejaculation
in male

Parasimpatis

Parasimpatis CENTRAL NERVOUS SYSTEM PARASYMPATHETIC a. Sistem “ Istirahat & cerna ” b. Menurunkan gerak

CENTRAL NERVOUS SYSTEM

PARASYMPATHETIC

a.

Sistem “ Istirahat & cerna ”

b.

Menurunkan gerak tubuh untuk menyimpan dan mempertahankan energi

c.

Menurunkan detak jantung,

respirasi rate & tekanan darah

d.

Meningkatkan aktivitas umum sistem cerna

e.

Meningkatkan sekresi kelenjar

sistem cerna

f.

Meningkatkan produksi urin

g.

dan merelaksasi sfingter Ereksi

h.

Kontriksi pupil

Brain

Contracts pupil Stimulates salivation Constricts bronchi Spinal cord Slows heartbeat Stimulates activity Stimulates
Contracts pupil
Stimulates salivation
Constricts bronchi
Spinal
cord
Slows heartbeat
Stimulates activity
Stimulates gallbladder
Gallbladder
Contracts bladder
Stimulates erection
of sex organs
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