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Acid-Base Imbalances The normal pH range of systemic arterial blood is between 7.35 and 7.45.

Acidosis(or academia) is a condition in which blood pH is below 7.35; alkalosis(or alkalemia) is a condition in which blood pH is higher than 7.45. - The major physiological effect of acidosis is depression of the central nervous system through depression of synaptic transmission. If the systemic arterial blood pH falls below 7, depression of the nervous system is so severe that the individual becomes disoriented, then comatose, and may die. Patients with severe acidosis usually die while in coma. - A physiological effect of alkalosis, by contrasts, is over excitability in both the central nervous system and peripheral nerves. Neurons conduct impulses repetitively, even when not stimulated by normal stimuli; the results are nervousness, muscle spasms, and even convulsions and death. A change in blood pH that leads to acidosis or alkalosis may be countered by compensation, the physiological response to an acid-base imbalance that acts to normalize arterial blood pH. Compensation may be either complete, if pH indeed is brought within the normal range, or partial, if systemic arterial blood pH is still lower than 7.35 or higher than 7.45. y y If a person has altered blood pH due to metabolic causes, hyperventilation or hypoventilation can help bring blood pH back toward the normal range; termed: respiratory compensation If person has altered blood pH due to respiratory causes, then renal compensation- changes in secretion of H+ and reabsorption of HCO3- by the kidney tubules- can help reverse the change. o Respiratory Acidosis is an abnormally high Pco2 in systemic arterial blood-above 45 mmHg. Inadequate exhalation of CO2 causes the blood pH to drop. Any condition that decreases the movement of CO2 from the blood to the alveoli of lungs to the atmosphere causes a buildup of CO2, H2CO3, and H+  Examples: emphysema, pulmonary edema, injury to the respiratory center of the medulla oblongata, airway obstruction, or disorders of the muscles involved in breathing. y If the respiratory problem is not too severe, the kidneys can help raise blood pH into the normal range by increasing excretion of H+ and reabsorption of HCO3 Treatment: to increase the exhalation of CO2, as for instance by providing ventilation therapy. Intravenous administration of HCO3- may be helpful o Respiratory Alkalosis systemic arterial blood Pco2 falls below 35 mmHg. The cause of the drop in Pco2 and the resulting increase in pH is hyperventilation, which occurs in conditions that stimulate the inspiratory area in the brain stem.  Examples: oxygen deficiency due to high altitude, pulmonary disease, cerebrovascular accident (stroke), or severe anxiety. y Renal compensation may bring blood pH into the normal range if the kidneys are able to decrease excretion of H+ and reabsorption of HCO3-

Treatments: aimed at increasing the level of CO2. Have the person inhale and exhale into a paper bag for a short period. Metabolic Acidosis systemic arterial blood HCO3- level drop below 22 mEq/liter. Blood pH to decrease.  Examples: (1) actual loss of HCO3-, such as may occur with severe diarrhea or renal dysfunction (2) accumulation of an acid other than carbonic acid, as may occur in ketosis or (3) failure of kidneys to excrete H+ from metabolism of dietary proteins. y If problem is not too severe, hyperventilation can bring blood pH into the normal range.  Treatment: consists of administering intravenous solutions of sodium bicarbonate and correcting the cause of the acidosis Metabolic Alkalosis systemic arterial blood HCO3- concentration is above 26 mEg/liter. A nonrespiratory loss of acid or excessive intake of alkaline drugs causes the blood pH to increase above 7.45.  Examples: Excessive vomiting of gastric contents, which results in a substantial loss of hydrochloric acid, is probably the most frequent cause of metabolic alkalosis. Other causes include gastric suctioning, use of certain diuretics, endocrine disorders, excessive intake of alkaline drugs(antacids), and severe dehydration. y Respiratory compensation through hypoventilation may bring blood pH into the normal range.  Treatment: consists of giving fluid solutions to correct Cl-, K+ and other electrolyte deficiencies plus correcting the cause of alkalosis

Acidosis of the blood is pH less than 7.35 and Alkalosis is pH above 7.45. Normal blood pH is 7.35-7.45 What is the system (buffer system) that maintains normal blood pH? Carbonic acid/ bicarbonic buffer system Carbonic Acid/Bicarbonic buffer system: y H+ (+) HCO3H CO3 H O (+) CO

In this buffer system, what we have is. There are molecules floating around the blood. H+ is our strong acid. Any change in the amount of H+ is going to significantly change blood pH. Whether we add or remove H+ is going to significantly change blood pH. HCO3- is bicarbonate. Bicarbonate is a weak base. o Example: if we have too much acid (H+ in our blood) what this buffer system does is, it takes excess H+ and it makes the bicarbonate bind to any extra H+. It s trying to take the strong acid and make it less powerful. It does that by combing with the weak base. There is a basic chemistry principle balance. H CO3 is carbonic acid. Carbonic acid is a weak acid.

Too many H+ is going to push the reaction to the other side. Bicarbonate is going to bind to H+ and form H CO3 molecule. When it does this it is weakening the strong acid. Making H CO3 a weak acid. Now we have a buildup of H CO3 of carbonic acid. The body wants to get rid of the excess acid so: What molecules could we make up H CO3 (basic familiar molecule)? H 0 (+) CO (slightly acidic) How do you get rid of extra CO ? Exhale which helps take care of acidosis - Another way is through your urinary system: The kidney helps regulate and filters things out of the blood. Takes the blood and actually filters out any execs molecule via water or certain electrolytes and that includes H+. Your kidney plays a great role in regulating how much base or acid floating around your blood. o

Four different Conditions: 1. Metabolic acidosis pH causes diarrhea, renal dysfunction, accumulation of acid o The blood pH is going to go down which is more acidic. We are going to end up with too much acid and by getting rid of the acid, we exhale it out. The compensation is what we refer to as respiratory hyperventilation. o Respiratory hyperventilation meaning when you are breathing it refers to the diffusion of oxygen and carbon dioxide from the lungs. Into and out from the blood. 2. Metabolic alkalosis pH causes vomiting, diuretics, intake of alkaline drugs o When you vomit you re going to get rid of too much H+ which raises your pH. Essentially you re losing your acids. o How s your body going to bring high pH level back to normal? It s going to take H CO3 and break it down. Infuse more strong acid into the blood. What s going to happen to the carbon dioxide? You re going to retain it. And your breathing with be hypoventilation. You re going to be breathing but will not be exhaling as much carbon dioxide as you normally do. What kind of metabolic/gastrointestinal things that go on that ultimately cause your blood to have an acidic pH? Diarrhea and vomiting What happens when you vomit? It affects the pH of your blood and when you vomit the acid comes out from your stomach causing metabolic alkalosis. Physically removing H+ from your body. What happens when you have diarrhea? Diarrhea is the cause of metabolic acidosis. When you have diarrhea your body doesn t have time to reabsorb certain bicarbonate ions. Bicarbonate ions are not a strong base but it will affect your pH. Example: If you have one episode of diarrhea it is not going to change the pH dramatically but it will slightly change it. If you catch a bug and been sitting on the toilet for weeks than metabolic acidosis will become an issue. emphysema. Kidneys kick in and tries to get rid of H+ excess.

3. Respiratory Acidosis pH

What kind of conditions that are going to decrease the diffusion of carbon dioxide? (Hint: factors that affect the rate of passive diffusion)1. Emphysema you re missing less lung tissue. There is less surface area for carbon dioxide to leave 2. Pulmonary edema- swelling; fluid accumulation in the lungs. Which factor is going to affected? And Why does carbon dioxide take a long time to level your lungs? The molecules will travel a longer distance in order to get out. Not only do they have to pass through plasma membrane of your lungs cells it also has to go through water 3. Trauma to the Respiratory center- in your CNS there is an area that is responsible in controlling respiratory 4. Airway Obstructions- blockage of your airways (Surface area, diffusion distance, size of the molecule, concentration gradient, temperature/pressure) 5. Dysfunction of Muscle Respiration- being sick and weak such as ammonia. What muscles are involved with respiration? Diaphragm 75% of respiration and intercostals muscle 25%.

4. Respiratory Alkalosis pH due to hyperventilation (getting rid of too much CO2) due to oxygen deficiency, pulmonary disease, cerebrovascular accident or severe anxiety. You re kidney is going to keep as much as H+ in your blood as much as possible. When do you hyperventilate? Panic attack and oxygen deficiency

Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

low pH due to diarrhea High pH due to vomiting low pH due to hypoventilation (example: Emphysema) High pH due to hyperventilation (example: anxiety attack)

Hyperventilate Hypoventilation Kidney gets rid of H+ and retains HCO3Kidney gets rid of HCO3- and retains H+

Chapter 12: Nervous Tissue What two category do we divide the nervous system? Central and Peripheral Nervous system Divisions of the Nervous System: 1. Central Nervous System (CNS) contains the brain and spinal cord 2. Peripheral Nervous System (PNS) contains all other nervous tissue. Neurons 3 main parts: 1. 2. 3. y Cell body where most of the organelles are housed contains the nucleus and etc Dendrites is the receiving portion of the neuron (input) Axon sends nerve impulses to another neuron, muscle fiber, gland cells, etc The part that receives messages is the dendrites and the one that sends the message is the axon. The information that dendrites receives is called the input. The axon sends nerve impulses to next neuron. It could send nerve impulses for instance; to the neuromuscular junction (nerve

and muscle meet) you don t necessarily have to have a neuron right after each neuron. You can have a muscle cell. If there is another neuron after a neuron, what is that meeting point called? The synapse, which is the sight of communication between 2 neurons How does the message get from neurons to neurons (transmitted)? Axon is connected to another dendrite. Neurotransmitter that gets sent from the axon to the dendrites. It depends on the neurotransmitter. Sometimes it can but a lot of times there are receptors on the surface of the area where the dendrites are. Usually the way the message gets sent; 1 of many ways the neurotransmitter gets released into the synapse. Instead of neurotransmitter actually entering the next cell, there are receptors on the surface of the dendrite that are ready to receive neurotransmitter. Once the neurotransmitter binds to the receptor it s going to trigger a set of reactions that will send messages along another neuron. Synaptic Vesicles (vesicles which are filled with neurotransmitters) vesicles in the synaptic bulb (swelling at the end of an axon). The vesicles will store neurotransmitter. Different Neurotransmitter has different effect on the postsynaptic cell. Postsynaptic cell meaning it includes any other structures coming after a neuron such as whether it s another neuron, muscle fiber, gland cells or etc. These little bubbles at the end of axon are filled with chemicals called neurotransmitter. These chemical can either stimulate something or block something. These little bubbles reach the end of the axon terminal and release the chemicals and depending on which neurotransmitter we are referring to it affects on the next cell. Classification of Neurons according to function: 1. Sensory or (afferent neurons) sends messages from the periphery to the CNS o When referring to periphery it can mean skin, eyes and etc o Homeostasis example: negative feedback; pressure sensitive receptors in certain blood vessels that detect blood pressure. 2. Motor or (efferent neurons) sends messages from the CNS to the periphery (to the effectors) o The CNS (control center) is going to decide what it is going to do with that information. Blood pressure has dropped what we are going to do to bring it up. The control center is going to tell the effectors what to do. It s going to tell the blood vessels to vasocontrict so we can bring up blood pressure. Most of the time messages travel from the nervous system. What other ways do messages travel other than through the nerves? Endocrine system. Hormones can send messages from on structure to another.

3. Interneurons (association neurons) located within the CNS, they process the incoming sensory information and elicit a motor response by activating the appropriate motor neurons. o It s going to help process information. It s not going to receive information from a receptor; it s not going to send information to the periphery (effectors). It is going to help process the information within the CNS. You will have all these receptors that are sending certain sensory messages through the sensory neurons to the control central. o Basically, they get the information/ input, decide what to do, and then initiate that signal that will eventually get to the effectors. (do this do that) Neuroglia (Also known as glial cells) y y y Smaller than neurons They can actually do cell division. Neurons are one of those cells that are stuck in G1 of mitosis. Neuroglia are there to support the neurons

Besides neurons what other cell that stay in G1 phase of interphase? Muscle fiber. You can t make more muscle fibers that you already have. 95 % of muscle fiber cannot do cell division. o o There is a brain tumor that you can get from the neuroglia cells known as glioma. This type of brain tumor is often found as malignant. Brain tumors derive from glial cells. Some brain tumors, known as gliomas are pretty nasty as they grow very rapidly. 6 Type of Neuroglia: In the Central Nervous System 1. Astroyctes are most common one and largest neuroglia 2 type of Astroyctes: protoplasmic and fibrous a. Protoplasmic is found in grey matter b. Fibrous is found in white matter What astroyctes do is they have arms/projections that stick out of them; they wrap themselves around blood vessels in the CNS. They can control what enters from the blood vessels into the brain tissue and vice versa. blood-brain barrier Key role in forming the blood-brain barrier. The astroyctes wrap around the capillaries in the brain. And decide what can go through and what cannot get through.

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The processes of astroyctes can wrap around blood capillaries to restrict what can enter from the blood into the brain tissue called blood-brain barrier . Important for pharmacology Example: researchers who try to come up with new drug such as anti-depressants are going to target neurons in your CNS. Researchers need to make sure whatever drug they are making up can actually get passed these astrocytes.

2. Oligodentrocyte forms and maintains the myelin sheath around the CNS. Myelin sheath made up of a lipid and protein covering around axons. What does myelin do? Best analogy is a wire. Is a covering around our axons that help the message get through the axon as quickly and efficiently as possible because if it doesn t messages would not reach the end or get too slowly. What condition is called if you have damage to the myelin sheath? Multiple sclerosis (MS). When your immune system actually gets screwed up and attacks your own body. In MS it attacks the myelin sheath, wearing down the myelin sheath. Eventually the neurons will not work Multiple Sclerosis (MS) an autoimmune (self) disease where the immune system attacks the myelin sheath. 3. Microglia function as phagocytes Whenever there is an invading organism or particle the microglia will try to attack the organism y Swallow up and kill the organism

4. Ependymal cells they line the ventricles of the brain and central canal (space that goes along the length of the spinal cord) to assist in circulation of cerebo-spinal fluid (CSF) and form the blood-CSF barrier. In the Peripheral Nervous System 5. Schwann cells similar to the oligodentrocyte but in the PNS. 6. Satellite cells provide physical/ structural support to the peripheral nervous tissue.

What is the flow of a neuron? Dendrites to the axon What are the two cells that create the myelin sheath? CNS- oligodentrocyte and PNS- Schwann cells y Synaptic end bulbs is the area where neurotransmitters are released and get sent into that space between one axon and beginning of one neuron.

Myelination a lipid and protein covering over the axons. It electrically insulates the axon to increase the speed of nerve impulses conduction. Those Nodes of Ranvier are gaps in the myelin sheath.

Myelination occurs from birth to maturity. In the infant the response to stimuli is not as fast as in the adult, because the axons of neurons have less myelin, and therefore the action potential is not conducted as fast. One of the reason why infants have slower reflexes because the amount of myelinated axon is lesser than as an adult. As you get older axons become more myelinated. Infants have slower responses partly due to having less myelin than adults.

Multiple Sclerosis an autoimmune disease where the myelin sheaths surrounding the axons in the CNS are destroyed . The way information flows from neuron to neuron: Action potential Action potential A sequence of events that decreases and reverses the membrane potential and than restores it to its resting phase. There is a certain amount of electricity or charges within a neuron. What kind of molecule has those charges that contribute to the electricity within a cell? Sodium and Potassium ions. Normally, is there more potassium in the cell or out the cell at rest? More potassium in the cell. Higher concentration of potassium in the cell and higher concentration of sodium outside the cell. When there is potassium inside the cell and it leaves the cell what is the overall electrical charge of the cell? More negative because you are taking away the positive out of the cell. Phase: 1. Depolarizing phase the membrane potential (voltage of the membrane) increases (becomes less negative, then more positive) because sodium (Na+) rushes into the cell  The resting membrane potential of your typical cell is going to be -70mv. Before a message is sent along a neuron nothing is happening. The amount of voltage is going to be -70mv and once a message is sent certain ions are coming in and out which this changes the electricity within a neuron. Similar concept to electricity of a cord.  Normally higher concentration of sodium outside of the cell at resting state. The channels that allow some sodium to enter in are closed before message is sent along the neuron.  Sodium is going to rush into the cell and this causes the total charge of the cell to become more positive

2. Repolarzing phase the membrane potential goes back to the resting state (-70mv) because potassium (k +) rushes out of the cell  What causes this? Potassium. Potassium is higher inside a cell. When gates open up potassium rushes out of the cell. [3]. after hyperpolarizing phase membrane potential becomes even more negative than the resting level (because K+ channels remain open and more K+ leaves the cell) When the potassium gates remain open. The potassium continues to flow out of the cell and eventually goes back to the resting rate potential 70mv. This process doesn t happen randomly. The thing that will trigger the sodium channels to open is called the stimulus. The stimulus is going to raise that voltage but there is a certain minimal amount. All or none response . y According to the All-Or-None principle, if a stimulus is strong enough to generate an action potential, the impulse travels at a constant and maximum strength for the existing conditions; a stronger stimulus will not cause a larger impulse. A stimulus must bring the membrane potential to the threshold in order to generate an action potential Subthreshold stimulus a stimulus that cannot bring the membrane potential to threshold (no action potential). Sodium potassium pump is used here to restore the membrane potential. The balance of potassium so that the cell can be ready for the next time. The reason why these gates open because basically the sodium gets through the plasma membrane to the channel. At certain voltage the channel is open/or closed called voltage gated channel. Concept: these channels are voltage gated channels that are sensitive of changes within the cell. The first thing that will get open is the sodium channels. The Na+ and K+ channels are voltage gated channels which means that when the membrane potential reaches a specific voltage, the channels open. The wave of electricity that flows through the nerves doesn t die out this is referred to as propogation (it is more like a domino effect than a wave)

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Clinical Correlation: 1. Neurotoxins toxins that produce a poisonous effect of the nervous system Example: Japanese puffer fish which contains a toxin (tetrodotoxin) that blocks the action potential by blocking the Na+ channels so they can t open

2. Anesthesia use of drugs to block pain Example: Liducaine and Novacaine which blocks Na+ channels 3. Cold Compress cooling an area produces an anesthetic effect because action potentials happen much more slowly in colder temperatures Factors that affect the speed of propogation: 1. Temperature 2. Amount of myelination: infants don t have as myelination than adults 3. Axon diameter if you have a thin axon versus a thicker axon. The thicker one is actually going to get more information along the axon faster than the thinner one. The thicker diameter propogate action potentials faster than smaller diameter. Synapses Synapse is the site of communication between two neurons. y y Pre-synaptic neuron- giving the message Post-synaptic- neuron receives the message

There are two types of synapse; two types of ways of transmitting the message from one neuron to the next: electrical and chemical synapse 1. Electrical synapse action potential travels between cells through gap junctions y The action potential is going to travel from one cell to the next using a certain type of cell junction that will allows very quick movement of substances from cell to the next y What kind of cell junction is that? Gap junction y Using gap junction to send signal it will give a faster communication between neurons and it also allows (synchronization) a whole bunch of neurons to send message to set a neurons at the same time. y Which organ that has gap junction between cells? Heart y Gap junction is there to make sure the message flows in a synergize way. o Advantages: 1. Faster communication(vs. chemical) 2. Synchronization a large number of neurons can produce an action potential at the same time (important in heart). 2. Chemical Synapse (neurotransmitters) chemicals are released into the space between the two neurons (synaptic cleft) and trigger action potential in the post synaptic neuron Is slower than electrical synapse y The action potential is going to flow down the presynaptic neuron, reach the end and trigger a release of chemicals at the presynaptic neuron and the chemicals will release. The chemicals

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that are release to the other neuron (post synaptic neuron) are going to affect the other part of the neuron by causing an action potential. What are the chemicals referred to as? Neurotransmitter Excitatory neurotransmitters- neurotransmitters that send positive message along. Positive meaning to do something. Inhibitory neurotransmitters-neurotransmitters that send along the message that says don t do that. Some neurotransmitters are excitatory cause depolarization; and some are inhibitory cause hyperpolarization (The action potential isn t given a chance to reach threshold) o Threshold termed used to described that level of voltage that stimulus have to bring it to in order for the sodium gates to open and therefore to depolarize. Which polarization stage phase does excitatory trigger? Depolarization Which polarization stage phase does inhibitory trigger? After, Hyperpolarization.

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Some neurotransmitters are both binds to

excitatory and inhibitory, depending on which receptors it

Post-Synaptic Receptors 1. Ionotropic Receptor is directly attached to low channel  This receptor is directly associated to an ion channel  It could be for be a positive ion such as sodium or a negative ion like chlorine (Cl-). Just opening the channel doesn t tell us what s going to happen to the voltage within a cell.  Which one will increase the voltage (cause depolarization)? Sodium a positive ion. If a positive ion enters the cell it is going to cause the depolarization. Example: 1. Say we have a cell; we have more sodium outside than inside. Once the channel opens we know sodium would like to enter the cell. If this Ionotropic receptor triggers the voltage to open that it would lead to depolarization because it is increasing the positive charge in the cell. a. Believe the same thing is true for calcium b. Depolarization action potential 2. For potassium we have more potassium inside the cell rather than outside the cell, potassium is going to flow outside of the cell when voltage channel open which is going to make the membrane potential to decrease. a. Cause a hyperpolarization no action potential 3. Situation where we are dealing with chlorine which is higher outside the cell than inside the cell. Chlorine is going to rush into the cell making causing decrease in membrane potential (?)

a. Cause a hyperpolarization no action potential 2. Metabotropic Receptor the receptor is NOT attached to an ion channel. The receptor sends a messenger to an ion channel  This is not associated with an ion channel Once a message is sent, neurotransmitter are dumped in the synaptic cleft, there are few different ways to remove neurotransmitters. Once the message is sent, the neurotransmitter needs to be removed 3 ways to remove Neurotransmitters: 1. Diffusion neurotransmitter diffuses away from the synaptic cleft (it doesn t have to diffuse back to the neuron it can diffuse way from that area) Neuron and synaptic cleft: the neurotransmitters are dumped in through vesicles. So the vesicles meet with the plasma membrane. The neurotransmitters are dumped into the synaptic cleft. Neurotransmitters go away from this place. 2. Enzymatic digestion an enzyme digests the neurotransmitter so it s no longer functional (enzymes speed up reaction the reaction here is breaking up the neurotransmitter) 3. Uptake by cells neurotransmitter is actively transported back into the presynaptic neuron Whenever we are sending a message from pre to postsynaptic neuron a lot of times it s not always a one to one ratio of presynaptic to postsynaptic neuron meaning that you can have a whole bunch of neurons sending messages to the same one neuron. This one neuron that is receives messages from multiple neuron has to decide what to do. You don t always have the same message being sent to the postsynaptic neuron. Example: 1 neuron is sending an inhibitory message saying, hey tell that muscle not to contract the 2 other neurons may say tell that muscle to contract. The question is what the end result is, is the muscle going to contract or not contract, this postsynaptic neuron has to add up all these messages to figure out what the final message would be to that muscle. In reality you can have one postsynaptic neuron making a connection with a thousand or whatever numbers. y y One post-synaptic neuron receives impulses from many pre-synaptic neurons. Some presynaptic neurons send excitatory messages and some send inhibitory messages. The sum of all the presynaptic neuron determine the effects on the postsynaptic neuron: 1. ESPS (excitatory post-synaptic potential) means the net effect is excitatory but threshold is not reached (NO AP)  What we mean by this the sum is excitatory but remember she put up the graph of action potential that the stimulus has to bring it up to the threshold and only than depolarization, repolarization etc. There is a situation where the end result is excitatory, and excitatory nerve impulse continues down that second neuron. Sometimes it s excitatory but it s not enough to reach threshold. So the sum of all those message from presynaptic neurons may be excitatory but in the end there are so many inhibitory ones they cancel a lot of the excitatory out.

2. Nerve impulse means that threshold was reached and an Action potential resulted 3. IPSP(inhibitory post-synaptic potential) means that the net effect is inhibitory (the membrane hyperpolarizes)  What this mean is Not only is the membrane potential getting more positive its actually getting more negative. This is what an inhibitory message does.  What is the term we used that the membrane potential is kept very low? Hyperpolarization Example: Of Neurotransmitters  Acetylcholine ; can be either one excitatory or inhibitory  GABA-gamma amino-butyric acid; *Classic INHIBITORY  Epinephrine/Norepinephrine fight or flight response, can be excitatory or inhibitory; HORMONE y What is another word for epinephrine? Adrenaline, where does it stimulates? Fight or flight response; if you are in that mode your adrenaline is pumping up. It stimulates some parts of your body example running faster than they normally can. It could also inhibit other parts of the body such as the gastrointestinal system, it s not going to be active when you are in fight or flight response.  Dopamine active in addictive behavior whether its drug or even it s a certain habit like biting your nails when nervous ; HORMONE  Serotonin active in sleep, appetite; HORMONE  Endorphins can block pain Clinical example: Depression; we don t know exactly what causes depression but we do know there are certain neurotransmitter that affect depression. y SSRI (selective serotonin reuptake inhibitor) an example of one type of medication that can treat depression o Which neurotransmitter affects SSRI? Serotonin o Say if you leave serotonin longer in the synapse that could treat symptoms of depression. Normally serotonin goes back into the presynaptic neuron, what SSRI do is it delays the process (reuptake is delayed) meaning instead of serotonin leaving the synapse it will stay there for a little longer but not that long. Slowing it down slightly which relieves some depression symptoms  Example of drugs: Zoloft and Prozac

Chapter 13: Spinal Cord and Spinal Nerves

Spinal cord is extremely sensitive; any minor injury can result in significant pain, significant loss of sensation or inability to us certain parts of your body. We have all these mechanisms to protect our spinal cord. The outer most protection that we have is the vertebral column. Those bones that surround the spinal cord all along the spinal column are there to protect the spinal cord, located within the vertebral canal, between each vertebrae there are actual ligaments that hold the vertebrae so they don t move around and we have coverings that are referred to as meninges. y What are the 3 meninges? Dura mater, arachnoid mater and pia mater o The first meninges the outer most is referred to as Dura mater; mater is mother, Dura is tough. Dura mater is a tough covering. So we have bone(vertebrae column) Dura mater, arachnoid mater. Second the middle later called arachnoid mater is said that the connective tissue have a spider like appearance. And Last pia mater, it adheres to the spinal cord it s self and for the brain as well.

Protective covering around the spinal cord: Outer Inner: 3 meninges First we have the vertebral column o The space between vertebral column and Dura mater is the epidural space. Epimeaning around. This is where people get an epidural and injects anesthetic drugs to numb/block all those messages going along the neurons anywhere from the point they injected it to down. Dura Mater (tough) thicker layer surrounds the brain and spinal cord o The space between Dura mater and arachnoid mater is called subdural space. Beneath the Dura Mater. Arachnoid Mater connective tissue fiber that looks like spider o The space between the Arachnoid Mater and Pia Mater is called the subarachnoid space. o When we talk about CSF( Cerebrospinal fluid) the fluid that the brain and spinal cord float, the space that it is filling is the subarachnoid space. o Subarachnoid space contains CSF Pia Mater is shrieked wrapped onto the brain and spinal cord ( adheres to the brain and spinal cord)

Clinical: Epidural injection often used in labor. Narcotics are injected into the epidural space. Epidural injection that can also be subdural. o Are there side effects of epidural injections? There are side effects that are possible but it has been getting better throughout the years. There is a case where a patient had

numbness for longer time than usual. One patient got numbness in parts of their body for a week and that s a rare condition. Spinal-epidural injections, injections into the subarachnoid space and catheter is left in the epidural space. Not being done on labor. The injection into the subarachnoid space. y The Pia Mater thickens at the spinal root and fuse with the arachnoid mater Denticulate ligaments  What she means by spinal roots. It is the beginning part where nerve branches off.  In between each vertebra there are spaces that these branches that come off the spinal cord and contain these nerves called spinal nerves. Example: We name different vertebrae C1, C2 etc..; we also name the spinal nerves for example C1 vertebrae which is associated with C1 spinal nerve. And so we have C1 spinal nerve coming out of the left side and right side.  What level does the spinal cord end? In adults L2/ L3 In Newborns, the spinal cord ends around L4; in adults around L2/L3 When someone is suspected of having meningitis. One must get a lumbar puncture where you take a needle, puncture it in the subarachnoid space, and sucks out the CSF and look for meningitis. Meningitis is an inflammation of the meninges could be any of the meninges or all of them. Test for bacteria, viruses and can see WBC. You are not supposed to have WBC in the CSF so it means it s trying to kill off the bacteria. Important when doing a lumbar puncture for example to test for meningitis. There are many other reason to do a lumbar puncture such as if someone has a lot of pressure/fluid. You would do a lumbar puncture to release the fluid to decrease pressure. The spinal cord is about a foot and a half long. There are 2 areas where we see thickening in the spinal cord (around the cervical and lumbar area) called enlargements. 1. Cervical enlargements (C4-T1) nerves that branch off the spinal cord innervate the upper limbs  In the last half of cervical area, goes from C4-T1. The nerves that branch off the spinal cord area provide innervations for the upper limbs. That s why we have extra nervous tissue there. 2. Lumbar enlargements (T9-T12) nerves that branch off the spinal cord innervate the lower limbs  When she talks about C4-T1 or T9-T12 she refers to the vertebral column level not the spinal nerves. This cone shape which is upside down is the end of the spinal cord. Conus medullaris refers to the end of the spinal cord (cone-shaped) Filum ter minale is not nervous tissue it s actually pia mater which is the most inner layer from the meninges. The filum ter minale is an extension of the pia mater not nerves. What happens is after we

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get the conus medullaris you still have pia mater that covers it but instead of the pia mater pitching off of the end and ending it there it attaches to bone and anchors off. Filum ter minale is a tail-like extension of pia mater that eventually fuses with the arachnoid and Dura maters and is anchored in the coccyx. y How many vertebrae there are in the vertebral column in an adult? Cervical 7, Thoracic 12, Lumbar 5, Sacral 1, Coccyx 1= 26 in adults. In children the sacral is 5, coccyx 4= 33 y Adults: 26, Children: 33 Vertebrae ( actual bones) Spinal nerves: -Cervical- C1-C8 (We get an extra one in the cervical area ) -Thoracic- T1-T12 -Lumbar- L1-L5 -Sacral- S1-S5 (in childhood we start off with 5 vertebrae and they all fuse into one bone but the spinal nerves still stick out making it a set of 5 spinal nerve) -Coccygol- Co1 (even though we started out with 4 coccyx it fuses to one but still have 1 Cauda equina ( horses tail ) the nerve root of spinal nerves that exit the vertebral column below the conus medullaris

When you are trying to figure out the anterior and posterior side of the spinal cord, the posterior side is the one with a bulged coming off and the anterior side had a slit in the middle. The roots are bundles of axons; we are referring to the structure of the nerve cell of a neuron. The roots are axons, we have these really long neurons that one end of them are in the spinal cord the other end is somewhere further out. Which types of nerve are in the posterior part as appose to the anterior? There are two types sensory and motor; Posterior is going to be sensory, Anterior is going to be motor. For example: if you touch something hot that information that message going from the thermal receptors in your skin. When that information gets sent to your central nervous system and

says hey you re touching something hot pull away, the message is going to ultimately go through the spinal cord not through the front but it s going to go to the posterior end. The reflex to pull your hand away that message is not going to the posterior end but it s going to the anterior end. Anterior end is motor. Sensory whether it s the five senses all the information being sent is going to the posterior end roots and the motor neurons messages are going through the anterior end. Posterior root ganglion is cell body of those neurons. The reason why there is a bulges because there is a group of cell bodies. On the anterior root ganglion we don t see the bulge because cell body is inner than out. The roots are bundles of axons: y y y Posterior (dorsal) root sensory axons Posterior (dorsal) root ganglion contains the cell bodies of sensory neurons Anterior (ventral)root contains axons of motor neurons (no anterior root ganglion because the cell body is within the spinal cord) - Where is the cell body in the anterior root? Within the spinal cord

The White matter is literally looks white rather than grey. The butterfly looking area is the grey matter. White matter we have two indentations (anterior median fissure and posterior median fissure). The white matter contains axons that are myelinated. The Grey Matter has a few things but the axons tend to be unmyelinated. It s also going to have dendrites and neuroglia. The bridge between the right and left have of the spinal cord is referred to the grey commissure. In the middle is a pin point hole called the central canal. We have CSF going through the central canal. Internal anatomy of spinal cord: y y White matter consists mainly of myelinated axons. Two grooves in whites matter: anterior median grove and posterior median groove Grey matter consists mainly of dendrites with cell bodies, unmyelinated axons, neuroglia  Grey commissure if you draw you would see an H. The bridge on the H is the grey commissure  Central canal runs along the entire length of the spinal cord; contains CSF

Horns of the grey matter: y Posterior gray horn contains axons of sensory neurons. Cell bodies and axons of interneurons o We have these sensory nerves that are sending sensory information to CNS. We have cell body posterior root ganglion and the axon continues into the posterior gray horn. The posterior gray horn is going to contain the axon of incoming sensory neurons and then we have synapse between sensory neuron axon (interneuron) which helps to communicate and decided what plan of action would be. Interneuron is going to send the message to the motor neuron

Anterior gray horn contains somatic motor. Nuclei (cell bodies of somatic/voluntary motor neurons. Example: skeletal muscles o It s going to contain some motor cell body. Cell body of motor neuron which are somatic and voluntary. * patellar reflex Which muscle do we not have voluntary control over? Heart (cardiac)

Lateral gray horn contains autonomic motor nuclei (cell bodies of autonomic/involuntary motor neurons) .You will see it more in thoracic and lumbar areas not going to see it in other parts in the spinal cord. Example: cardiac muscle, smooth, glands

Columns of the white matter: Just like the grey matter we have posterior, anterior and lateral categories for white matter. y y y Anterior white columns (ventral) Posterior white columns (dorsal) Lateral white columns

Within these columns what we have is called tracts which are nerves that are embedded with within the spinal cord. Meaning bundles of axons that come from the same place. They connect one part of the body to another whether it s an area in the brain down the spinal cord to an organ (motor) or coming from hand up to spinal cord to brain (sensory). They are like these nerves that are embedded. Tracts are bundles within each column containing axons from the same origin/ destination 1. Sensory (ascending tracts) 2. Motor (descending tracts) o We have ascending tracts and descending tracts. Meaning we have messages sending up the spinal cord superiorly and we have tract sending messages down the spinal cord. Which one do you think are the sensory ones? Ascending, for instance have a message spinal cord, keeps going up to brain saying ouch I just stubbed my toe. This would be referred as ascending tract because message is going up to the brain. Motor is descending (going down) because once I stub my toe, gets sent to my brain that I felt it; brain is going to tell the toe pull away or whatever. That message is descending result in some kind of movement or gland secretion etc. Nerves bundles of axons in the Peripheral Nervous System Tracts bundles of axons in the Central Nervous System y Example: reflex- In an exam Doctor hits hammer below your patella (patellar reflex); a reflex is when the message get sent to your spinal cord and back. You don t do any brain thinking in order for a response to happen. We refer this reflex pathway.

y y y y

We have the Reflex, Somatic and Autonomic pathway Which pathway is Voluntary? Somatic Which pathway is Involuntary? Autonomic and Reflex Use the same example (patellar reflex) The doctor hits you with the rubber hammer under the patella bone, you feel something such as that pressure from the hammer, so you re going to have these sensory receptors in that tendon that s going to send the message to the spinal cord saying hey you have this change in pressure and these sensory receptors detect some sort of stimulus. Sensory neurons is going to send message [input] (homeostatic mechanism: receptor, input, control center etc) to the control center. The control centers not the brain but the spinal cord and its going to be sent through the nerves (posterior root). The message continues along the spinal nerve through the posterior root and then it goes through the interneuron of the posterior gray horn. The Spinal cord quick decides what to do, it s the control center and it s going to synapse with the interneuron, interneuron synapse with the motor neuron to say hey muscle to kick out (reflex), synapse with a somatic motor neuron which sends nerve impulse through the nerves and reaches the skeletal muscle. o Somatic motor neuron whenever you do some sort of voluntary movement o Autonomic motor neuron General Components of a Reflex Arc Sensory receptor responds to a stimulus by producing a generator or receptor potential Sensory Neuron axon conducts impulses from receptor to integrating center Interneuron Integrating Center one or more regions within the CNS that relay impulses from sensory to motor neurons 5. Motor Neuron axon conducts impulses from integrating center to effector 6. Effector muscle or gland that responds to motor nerve impulses 1. 2. 3. 4.

Pathways: 1. Reflex pathways Sensory receptors detect stimulus though input message gets sent as input through nerves spinal nerves posterior root ganglion posterior gray horn synapse with interneuron ( in spinal cord) synapse with somatic motor neuron in the anterior gray horn spinal nerve other nerves effector (ex would be the muscle in this case because it moves)  What part of the interneuron is synapsing with in the spinal cord? Motor neuron in the anterior gray horn 2. Somatic pathway Sensory receptors detect stimulus sensory neurons sends inputs through nerves spinal nerves posterior roots posterior white column (ascending tract) synapse with interneuron in brain synapse with neurons down anterior white column (descending) synapse with somatic motor neurons in anterior gray horn anterior root spinal nerve other nerves effector y Voluntary action

Where in the spinal cord are the neurons are going to synapse when we are dealing with autonomic pathways. Which part of the grey matter? Lateral 3. Autonomic Pathway Sensory receptors detect stimulus sensory neurons sends inputs through nerves spinal nerves posterior roots posterior white column (ascending tract) synapse with interneuron in brain synapse with neurons down anterior white column (descending) synapse with the autonomic motor neurons in lateral grey horn anterior root spinal nerve other nerves effector y Covering around Nerves: 1. Epineurium surrounds entire nerve 2. Perineurium surrounds fascicles (groups of neurons) 3. Endoneurium surrounds individual neurons Distribution of Spinal Nerves: Posterior Ramus connects to deep muscles and skin of posterior surface of trunk Anterior Ramus connects to the muscles and other structures enteriorly and upper and lower limbs skin on lateral and anterior surfaces of trunk Meningeal Branch re-enters the vertebral canal and connects to the vertebrae, blood vessels of the spinal cord and meninges