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    Autonomic NS by Gerard J. Tortora

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    Mohammad Shafiq

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    ] 5 The Autonomic Nervous System The autonomic nervous system and homeostasis ‘As you learned in Chapter 12, the peripheral nervous system (PNS) includes cranial and spinal nerves and is divided into a somatic nervous system (SNS) and autonomic nervous system (ANS). Like the somatic nervous system, the autonomic nervous system (ANS) (aw’-t6-NOM-ik) operates via reflex ares. (The derivation is anto- = self; nomic law.) Structurally, the ANS includes autonomic sensory neurons, integrating centers in the central nervous system (CNS), autono. ‘motor neurons, and the enteric division or enterie nervous system (ENS). A continual flow of nerve impulses from (1) autonomic sensory neurons in visceral organs and blood vessels propagate into (2) integrating centers in the CNS. Then, impulses in (3) autonomic motor neurons propagate to various effector tissues, thereby regulating the activity of smooth muscle, cardiac muscle, and many glands. The enteric division isa part of the ANS that consists of a specialized network of nerves and ganglia, forming an independent nerve network within the wall of the gastrointestinal (GI) tract. The ANS usually operates without conscious control. However, ‘centers in the hypothalamus and brain stem do regulate ANS reflexes. In this chapter, we compare structural and functional features of the somatic and autonomic nervous systems. Then we discuss the anatomy of the motor portion of the ANS and compare the organization and actions of its two major parts, the ‘sympathetic and parasympathetic divisions. Did you ever wonder how some blood pressure medications exert their effects through the autonomic nervous system ()) 523 524 CHAPTER 15 » THE AUTONOMIC NERVOUS SYSTEM 15.1 Comparison of Somatic and Autonomic Nervous Systems @ onsective Compare the structural and functional differences between the somatic and autonomic parts of the nervous system Somatic Nervous System ‘The somatic nervous system includes both sensory and motor ‘neurons. Sensory neurons convey input from receptors for somatic senses (lactle, thermal, pain, and proprioceptive sensations; see Chapter 16) and from receptors for the special senses (sight, hearing, taste, smell, and equilibrium: see Chapter 17). All of these sensations normally are consciously perceived. In turn, somatic ‘motor neurons innervate skeletal muscles—the effectors of the somatic nervous system—and produce both reflexive and volun- lary movements. When a somatic motor neuron stimulates the muscle, it contracts; the effect always is excitation. If somatic ‘motor neurons cease fo stimulate a muscle, the result is a para- lyzed, limp muscle that has no muscle tone. Although we are generally not conscious of breathing, the muscles that generate respiratory movements are also skeletal muscles controlled by somatic motor neurons. Ifthe respiratory motor neurons become inactive, breathing stops. A few skeletal muscles, such as those in the middle ear, are controlled by reflexes and cannot be con- tracted voluntarily Autonomic Nervous System ‘The main input to the ANS comes from autonomic (visceral) Sensory neurons. Mostly, these neurons are associated with interoceptors (IN-ter-6-sep’-tors), sensory receptors located in blood vessels, visceral organs, muscles, and the nervous system that monitor conditions in the internal environment. Examples of interoceptors are chemoreceptors that monitor blood CO; level and mechanoreceptors that detect the degree of stretch in the walls of organs or blood vessels. Unlike those triggered by a flower's perfume, « beautiful painting, ora delicious meal, these sensory signals are not consciously perceived most of the time, although intense activation of interoceptors may produce con. scious sensations. Two examples of perceived visceral sensations are pain sensations from damaged viscera and angina pectoris (chest pain) from inadequate blood flow to the heart. Input that influences the ANS also includes some sensations monitored by somatic sensory and special sensory neurons. For example, pain ‘ean produce dramatic changes in some autonomic activities ‘Autonomic motor neurons regulate visceral activities by either increasing (exciting) or decreasing (inhibiting) ongoing activities Intheireffector tissues (cardiac muscle, smooth muscle, and glands). Changes inthe diameter ofthe pupils, dilation and constriction of blood vessels, and adjustment of the rate and force of the heart beat are examples of autonomic motor responses. Unlike skeletal ‘muscle, tissues innervated by the ANS often function to some cextent even if their nerve supply is damaged. For example, the heart continues to beat when itis removed for transplantation into ‘another person, smooth muscle inthe lining ofthe gastrointestinal tract contracts rhythmically on its own, and glands produce some secretions in the absence of ANS control. Most autonomic responses cannot be consciously altered to any great degree. You probably cannot voluntarily slow your heartbeat to half its normal rate, For this reason, some autonomic responses are the basis for polygraph ("Iie detector") tess. How- ever, practitioners of yoga or other techniques of meditation may learn how to regulate atleast some of their autonomic activities through long practice. Biofeedback, in which monitoring devices display information about a body function such as heart rate or blood pressure, enhances the ability to learn such con- scious control. (For more on biofeedback, see the Medical ‘Terminology section at the end ofthis chapter.) Signals from the ‘general somatic and special senses, acting via the limbic system, also influence responses of autonomic motor neurons. Seeing bike about to hit you, hearing squealing brakes of a nearby car, or being grabbed by an attacker would all increase the rate and force of your heartbeat Comparison of Somatic and Autonomi Motor Neurons Recall from Chapter 10 thatthe axon of a single, myelinated so- ‘matic motor neuron extends from the central nervous system (CNS) all the way to the skeletal muscle fibers in its motor unit Figure 15.18). By contrast, most autonomic motor pathways consist of two ‘motor neurons in series, that is, one following the other (Figure 15.1b). The first neuron (preganglionic neuron) has its cell body in the CNS; its myelinated axon extends from the CNS to an auto- nomic ganglion. (Recall that a ganglion is collection of neuronal ‘ell bodies in the PNS.) The cell body of the second neuron (post- ganglionic neuron) is also in that same autonomic ganglion; its ‘unmyelinated axon extends directly from the ganglion tothe effec. tor (smooth muscle, cardiac muscle, or a gland). Alternatively, in some autonomic pathways, the fist motor neuron extends to spe- alized cells called chromaffin celts in the adrenal medullse (inner portions of the adrenal glands) rather than an autonomic ‘ganglion. Chromaffin cells secrete the neurotransiitters epineph- rine and norepinephrine (NE). All somatic motor neurons release ‘only acetylcholine (ACh) as their neurotransmitter, bat autonomic ‘motor neurons release either ACh o norepinephrine (NE). Unlike somatic output (motor), the output part of the ANS has jons: the sympathetic division and the parasympa- Most organs have dual innervation; that is, they receive impulses from both sympathetic and parasympathetic neurons. In some organs, ne:ve impulses from one division of the ANS stimulate the organ to increase its activity (excitation), and impulses from the other division decrease the organ’s activity (in- hibition). For example, an increased rate of nerve impulses from the sympathetic division increases heart rate, and an increased rate ‘of nerve impulses from the parasympathetic division decreases heart rate. The sympathetic division is often called the fight-or-flight division, Sympathetic activities result in increased alertness and 15.1 COMPARISON OF SOMATIC AND AUTONOMIC NERVOUS SYSTEMS 525 a @— somatic nervous system stimulation always excites its effectors (skeletal muscle fiber); stimulation by the autonomic nervous system either excites or inhibits visceral effectors Figure 15.1 Motor neuron pathways in the (a) somatic nervous system and (b) autonomic nervous system (ANS). Note that autonomic motor neurons release either acetylcholine (ACH) or norepinephrine (NE); somatic motor neurons release only ACh, tector: skeletal muses (0 Sonate ares sym ‘tonic Se ald ‘Sympathetic ‘Sympathetc Somicot aren rane enmeomone (myelinated) gangion (unmyelinated) smooth muscle (@.g., in ‘unnary blader). 2 ‘Adrenal mackie Chromatin cel! epineptine ta one 2 8 a ane ewes “ute pein ye a Bregenpone Gurgn poston Stace ero " Pe caa) neh muscle (9 tinny blader) (©) Autonomic nervous system @ What does dual innervation mean? metabolic activities in order to prepare the body for an emergency situation. Responses to such situations, which may oceur during ample, the gastrointestinal tract and kidneys), and release of glu- cose from the live. physical activity or emotional stress, include a rapid heart rate, faster breathing rate, dilation of the pupils, dry mouth, sweaty but ‘cool skin, dilation of load vessels to organs involved in combat- ing stress (such asthe heart and skeletal muscles), constriction of blood vessels to organs not involved in combating stress (for ex- “The parasympathetic division is often referred to as the rest- dand-digest division because its activities conserve and restore body energy during times of rest or digesting a meal; the majority ofits output is directed to the smooth muscle and glandular tissue of the gastrointestinal and respiratory tracts, The parasympathetic 526 CHAPTER 15 * THE AUTONOMIC NERVOUS SYSTEM division conserves energy and replenishes nutrient stores. Although both the sympathetic and parasympathetic divisions are concerned with maintaining homeostasis, they do so in dramatically different ways Table 15.1 compares the somatic and autonomic nervous systems, G@cnecerorns {ow do the autonomic nervous stem and somatic enous stem comporein sure thd futon? 2. What are the main nput and output component ofthe dutonomicneneus tem? 15.2 Anatomy of Autonomic Motor Pathways @ onsecrives ‘* Describe preganglionic and postganglionic neurons of the autonomic nervou sytem. + Compare the anatomical components ofthe sympathetic and parasympathetic divisions ofthe autonomic nervous stem. Anatomical Components Each two motor neurons in any autonomic motor pathway ivision of the ANS has two motor neurons. The frst ofthe called a preganglionic neuron (Figure 15.1b). Its cell body is in the brain ‘or spinal cor; its axon exits the CNS as part of a cranial or spinal nerve. The axon of a preganglionic neuron is a small-diameter, myelinated type B fiber that usually extends to an autonomic gan- lion, where it synapses witha postganglionic neuron, the second ‘neuron in the autonomic motor pathway. Note that the postgangli- ‘onic neuron lies entirely outside the CNS ia the PNS. Is cell body and dendrites are located in an autonomic ganglion, where it forms synapses with one or more preganglionic axons. The axon ‘of a postganglionic neuron is a small-diameter, unmyelinated type C fier that terminates in a visceral effector. Thus, pregangli- ‘onic neurons convey nerve impulses from the CNS to autonomic sanglia, and postganglionic neurons relay the impulses from auto- ‘nomic ganglia to visceral effectors Preganglionic Neurons Inthe sympathetic division, the preganglionic neurons have their ‘ell bodies inthe lateral horns ofthe gray matter in the 12 thoracie segments and the first two (and sometimes three) lumbar segments ‘of the spinal cord (Figure 15.2). For this reason, the sympathetic impulses in postganglionic earns. Epinephrine and norepinephrine secretion, Extation - ontaton. In ome receptors, excitation: in others, inition Increased sweating. Inhibition eaxation > vscltion. Exetation contraction, which ates ‘vasoconstriction, dilation of pup and closing of sphiaces Secretion of K* and water Incremed sweating Inhibition eaxaion > vasction, or Deceased insln secretion Aegteation to form platelet plug. ciuton > increased free and ate of contraction. Renin secretion Amiioreic hormone (ADE seetion, Breakdown of wighyeerdes eae of at acids ‘nt blood, rea Inhibition > eatin, which causes ation of aleways, vasodilation, and elaeton of ogsn wall, Inhibition relaxation iycogenolysis (breakdown of lycoge into siuose) ‘Themogenesis (heat production). same time it tums down parasympathetic tone, and vice versa. ‘The two divisions can affect body organs differently because their postganglionic neurons release different neurotransmitters and because the effector organs possess different adrenergic and cholinergic receptors. A few structures receive only sympathetic innervation—sweat glands, arrector pli muscles attached to hair follicles in the skin, the kidneys, the spleen, most blood vessels, and the adrenal medullae (see Figure 15.2). In these structures there is no opposition from the parasympathetic division. Still, an increase in sympathetic tone has one effect, and a decrease in sympathetic tone produces the opposite effect. ‘Sympathetic Responses During physical or emotional stress, the sympathetic division dominates the parasympathetic division. High sympathetic tone favors body funetions that can support vigorous physical activity and rapid production of ATP. At the same time, the sympathetic division reduces body functions that favor the storage of energy Besides physical exertion, various emotions—such as fear, em- barrassment, or rage—stimlate the sympathetic division. Visua- lizing body changes that occur during “E situations” such as exercise, emergency, excitement, and embarassment will help You 538 CHAPTER 5 » THE AUTONOMIC NERVOUS SYSTEM remember most of the sympathetic responses. Activation of the sympathetic division and release of hormones by the adrenal ‘medullae set in motion a series of physiological responses col- lectively called the fight-or-flight response, which includes the following effects: + The pupils of the eyes dilate + Heart rate, force of heart contraction, and blood pressure increase. + The airways dilate, allowing faster movement of air into and ‘out of the lungs. + The blood vessels that supply the kidneys and gastrointestinal tract constrict, which decreases blood flow through these sues. The result isa slowing of urine formation and digestive activities, which are not essential during exercise. *+ Blood vessels that supply organs involved in exercise or fight- ing off danger—skeletal muscles, cardiac muscle, liver, and adipose tissue—dilate, allowing greater blood flow through these tissues. + Liver cells perform glycogenolysis (breakdown of glycozen to glucose), and adipose tissue cells perform lipolysis (break- down of triglycerides to fatty acids and glycerol) + Release of glucose by the liver increases blood glucose level + Processes that are not essential for meeting the stressful situation are inhibited. For example, muscular movements of the gastroin- testinal tract and digestive secretions slow dawn or even stop. ‘The effects of sympathetic stimulation are longer lasting and more widespread than the effects of parasympathetic stimulation for three reasons: (1) Sympathetic postganglionic axons diverge mote extensively; as a resull, many tissues are activated simulta- neously. (2) Acetylcholinesterase quickly inactivates acetyl- ‘choline, but norepinephrine lingers in the synaptic cleft for a lon- ‘ger period. (3) Epinephrine and norepinephrine secreted into the blood from the adrenal medullae intensify and prolong the re- sponses caused by NE liberated from sympathetic postganglionic axons. These blood-borne hormones circulate throughout the body, affecting all tissues that have alpha and beta receptors. In time, blood-borne NE and epinephrine are destroyed by enzymes inthe Parasympathetic Responses Incontrast tothe fightor light activities of the sympathetic division, the parasympathetic division enhances rest-and- aeway constriction. Conraction release file into sal otestine Taste 15.4 continues 540 cnapren 15 Dore INUED ‘+ THE AUTONOMIC NERVOUS SYSTEM Effects of Sympathetic and Parasympathetic Divisions of the ANS Stomach and intestines Spleen Ureter Urinary bladder uterus Sexorgans Hair flies, arrctr pi ‘muscle \VASCULAR SMOOTH MUSCLE Salivary gland arterioles ‘Gastric gland arterioles Intestinal gland arterioles Coronary (heart) arterioles ‘Skin and mucosal arterioles ‘Skeletal muscle arterioles ‘Abdominal viscera arterioles rain arterioles Kidney arterioles Systemic veins receptors ae sted known. EFFECT OF SYMPATHETIC STIMULATION (2 OR ADRENERGIC RECEPTORS, EXCEPT AS NOTED)* Decreased motility and tone (2-2-6); coaretion af pices (a) CComacton an discharge of stored blood into general cication Increases mast (0). Relaxation of rascal wal (8); contraction finer wrath pincer (a). Tabb contraction in nonpregnant wom (3) rompiesconraton in pegrant wornn (2) nals contaton of smo muscle of dacs (5) ferns, post, nd somial vesicle esuling ineulaton a) CConrction~ econ fs resting in oose bas a). ‘Vasoconstiton, which decreases seretion of saliva (a) ‘asoconstition, which inks secretion) ‘Vasoconstition, which inks secretion) Relaxation + vasaation ); narcton > vasoconrition (a: sntstion ~ vasoeamsreton musirnie ‘ACh recep) CConrcton > vasocostrtion (a) CConrction-> vasoconstriction) relaxation vaseiaton (2): relaxation > vasodlaon (muscarinic ‘ACh recep) Coniston vasoconstriction (a, Sight contrition -»vasoomsriton (a) CConstction of bod vessels deresed tine volume (ai). CConrction > constriction ah relation distion EFFECT OF PARASYMPATHETIC STIMULATION (MUSCARINIC ACh RECEPTORS) Increased moity and tone; elataton of sinter. [No imervtion. Increases mast Contraction of muscular wall relaxation of internal ‘Minimal eff ‘asoilaton; rection of eit (females) and penis (mals No imeration Vesolation, which increases secretion of saliva ‘Secretion of sti juice Secretion of testinal juice Contraction + vasoconstrieton. ‘asolaton, which my nt be physiologically Sipnican [No mervation. No inmeration No ineraton, No imeration. [No marvin. 15.5 Integration and Control of Autonomic Functions @ opsectives + Describe the components of an autonomic reflex + Explain the relationship of the hypothalamus tothe ANS. Autonomic Reflexes Autonomic reflexes are responses that occur when nerve impulses pass through an autonomic reflex arc These reflexes play akey role regulating controlled conditions in the body, such as blood pres- sure, by adjusting heart rate, force of ventsicular contraction, and blood vessel diameter; digestion, by adjusting the motility (move- rent) and muscle tone of the gastrointestinal tract; and defecation and urination, by regulating he opening and closing of sphincters. ‘The components of an autonomic reflex are ae as follows: + Receptor. Like the receptor in a somatic reflex are (see Fig. lure 13.14), the receptor in an autonomic reflex ar isthe distal end ‘of a sensory neuron, which responds oa stimulus and produces a change that will ultimately wigger nerve impulses. Autonomic sensory receptors are mostly associated with interoceptos. + Sensory neuron, Conducts nerve impulses from receptors to the CNS, + Integrating center. Interneurons within the CNS relay signals from sensory neurons to motor neurons, The main integrating ‘centers for most autonomic reflexes are located in the hypo- thalamus and brain stem, Some autonomic reflexes, such as ‘those for urination and defecation, have integrating centers in the spinal cord. + Motor neurons. Nerve impulses triggered by the integrating ‘center propagate out of the CNS along motor neurons toan effec tor In an autonomic reflex arc, two motor neurons connect the ‘CNS to an effector: The preganglionic neuron conducts motor impulses from the CNS to an autonomic ganglion, and the postganglionic neuron conducts motor impulses from an auto- ‘nomic ganglion to an effector (see Figure 15.1). + Effector. In an autonomic reflex are, the effectors are smooth ‘muscle, cardiac muscle, and glands, and the reflex is called an autonomic reflex, Autonomic Control by Higher Centers Normally, we are not aware of muscular contractions of our digestive organs, our heartbeat, changes in the diameter of our blood vessels, and pupil dilation and constriction because the integrating centers for these autonomic responses are i the spinal ‘cord or the lower regions of the brain. Somatic or autonomic sensory neurons deliver input to these centers, and autonomic motor neurons provide output that adjusts activity in the vis- eral effector, usually without our conscious perception “The hypothalamus is the major conteol and integration center of the ANS. The hypothalamus receives sensory input related 10 visceral functions, olfaction (smell), and gustation (taste), as well as changes in temperature, osmolarity, and levels of various sub- DISORDERS: HOMEOSTATIC IMBALANCES Autonomic Dysreflexia ‘Autonomic dysreflexia (dis/r@FLEKS-¢-a) is an exaggerated re sponse of the sympathetic division of the ANS that occurs in about '85% of indviduals with spinal coed injury ator above the level fT, ‘The condition is seen after recovery from spinal shock (see Disorders Homeostatic Imbalances in Chapter 13) and occurs dv to intertup- tion ofthe control of ANS neurons by higher centers. When certain sensory impulses, such as those resulting from stretching of a ful Urinary bladder, are unable to ascend the spinal cord, mass stimula tion of the sympathetic nerves inferior to the level of injury occurs Other triggers include stimulation of pain receptors and the visceral Contractions resuiting from sexual stimulation, labordelivery, and bowel stimulation. Among the effects of increased sympathetic actv- ityssovere vasoconstriction, which elevates blood presure. in response, the cardiovascular center in the medulla oblongata (1) increases parasympathetic output via the vagus (X) nerve, which decreases heart rate, and (2) decreases sympathetic output, which causes di ton of blood vessels superior tothe level of the injury DISORDERS: HOMEOSTATIC IMBALANCES 541 stances in blood. It also receives input relating to emotions from the limbic system. Output from the hypothalamus influences au- tonomic centers in both the brain stem (such as the cardiovascu- Jar, salivation, swallowing, and vomiting centers) and the spinal cord (such as the defecation and urination reflex centers in the saeral spinal cord), ‘Anatomically, the hypothalamus is connected to both the sym- pathetic and parasympathetic divisions of the ANS by axons of neurons with dendrites and cell bodies in various hypothalamic nucle. The axons form tracts from the hypothalamus to parasymn- pathetic and sympathetic nuclei in the brain stem and spinal cord through relays in the reticular formation, The posterior and lateral parts of the hypothalamus control the sympathetic division. Stimu- lation ofthese areas produces an increase in heart rate and force of contraction, a rise in blood pressure due to constriction of blood vessels, an inerease in body temperature, dilation of the pupils, and inhibition ofthe gastrointestinal tract. In contrast, the anterior and medial parts of the hypothalamus control the parasympathetic division. Stimulation ofthese areas results in 2 decrease in heart rate, lowering of blood pressure, constriction of the pupils, and increased secretion and motility of the gastrointestinal tract. Ocuecxroinr 16. Give thee examples of controlled condition inthe body that are kept in homeostatic balance by autonomic reflexes 17 How does an autonomic reflex arc iffer rom a somatic reflon ar? Now that we have discussed the structure and function of the nervous system, you can appreciate the many ways that this sys- tem contributes to homeostasis of other body systems by examin- ing Focus on Homeostasis: Contributions of the Nervous System. The condition is characterized by a pounding headache; hyperten- sion; flushed, warm skin with profuse sweating above the injury wel, pale, cOld, dry skin below the injury level and anxiety. This femergency condition requires immediate intervention. The fist ap- proach isto quickly identity and remove the problematic stimulus. If ‘this doesnot relieve the symptoms, an antihypertensive drug such as clonidine or nitroglycerin can be administered. Untreated autonomic ddysreflexia can cause seizures, stroke, or heart attack Raynaud Phenomenon In Raynaud phenomenon (riNO) the digits (fingers and toes) be- come Ischemic ack blood) after exposure to cold or with emotional stress. The condition is due to excessive sympathetic stimulation of smooth muscle in the arterioles of the digits anda heightened response tostimuli that cause vasoconstriction, When arterioles the digit vaso- consti in response to sympathetic stimulation, blood flow is greatly diminished. Asa resul, the digits may blanch (look white due to block ‘age of blood flow) or become cyanotic (look blue due to deoxygenated ne rea 542 a | SYSTEM Sympathetic nerves of the autonomic nervous system (ANS) control contraction of smooth muscies attached to hair follicles and secretion of perspiration from sweet glands SKELETAL SYSTEM ain receptors in bone tissue wern of bone trauma or damage ain —fP- SYSTEM " ‘Somatic motor neurons receive instruc- ‘tions from motor areas of the brain and stimulate contraction of skeletal muscles to bring about body movements Basal nucle! and reticular formation set level of muscle tone ‘Cerebellum coordinates skilled move- ments oom SYSTEM Hypothalamus regulates secretion of hormones from anterior and posterior pituitary ANS regulates secretion of hormones ‘from acrenal medulla and pancreas ne | ‘SYSTEM Cardiovascular center in the medulla ‘oblongata provides nerve impulses to 'ANS that govern heart rate and the {orcefulness of the heartbeat Nerve impulses from ANS also regulate blood pressure and blood flow through blood vessels CONTRIBUTIONS OF THe NERVOUS SYSTEM FOR ALL BODY SYSTEMS ‘© Together with hormones from the endocrine system, nerve impulses provide communication and regulation (of most body tissues LYMPHATIC SYSTEM K and IMMUNITY Certain neurotransmitters help regulate immune responses « Activity in nervous system may increase for decrease immune responses SYSTEM ‘ Respiratory areas in brainstem control breathing rate and depth ‘© ANS helps regulate diameter of airways SYSTEM ‘ Enteric division of the ANS helps regulate digestion «# Parasympathetic division of ANS. stimulates many digestive processes URINARY é SYSTEM ‘© ANS helps regulate blood flow to kidneys, thereby influencing the rate of urine formation ‘Brain and spinal cord centers govern emptying of the urinary bladder REPRODUCTIVE SYSTEMS, ‘© Hypothalamus and limbic system ‘govern a variety of sexual behaviors ‘© ANS brings about erection of penis in males ané cltorisin females and ejaculation of semen in males ‘© Hypothalamus regulates release of anterior pituitary hormones that Control gonads (ovaries and testes) # Nerve impulses elicited by touch stimuli from suckling Infant cause release of ‘oxytocin and milk ejection in nursing mothers blood in capillaries. n extreme cases, the digits may become necrotic from lack of oxygen and nutrients. With rewarming after cold expo- sure, the arterioles may dilate, causing the fingers and toes to look re. ‘Mary patients with Raynaud phenomenon have low blood pressure. Some have increased numbers of alpha adrenergic receptors, Raynaud | most common in young women and occurs more often in cold MEDICAL TERMINOLOGY ‘CHAPTER REVIEW AND RESOURCE SUMMARY 543

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