The autonomic nervous system (ANS) regulates physiological processes. This regulation is carried out without voluntary control, d. H. autonomous. The two main lines of business are the sympathetic system parasympathetic system disorders ANS cause insufficiency or failure of the autonomic functions and influence in the body of each system. Anatomy The ANS receives input from parts of the CNS, process the body’s stimuli and environmental stimuli and integrate. These shares of the CNS include hypothalamus, solitary nucleus, reticular formation, amygdala, hippocampus and olfactory cortex. Both the sympathetic and the parasympathetic system consists of two sets of nerve cells: one (preganglionic) is located in the CNS and is connected with the other in the ganglia outside the CNS. Efferent fibers from the ganglia (postganglionic fibers) pull to the target organs (autonomic nervous system). The preganglionic sympathetic autonomic nervous system cell body of the sympathetic nervous system in the intermediolateral horn of the spinal cord between Th1 and localized L2 or L3. The sympathetic ganglia are located next to the spinal cord and consists of the vertebral (sympathetic trunk of the sympathetic nervous system) and the prevertebral ganglion, which include the upper cervical, celiac, mesenteric, and upper and lower aortikorenalen ganglia. Long fibers draw from these ganglia to the effector organs, including the smooth muscle of blood vessels, lungs, abdominal viscera and scalp (Piloerektoren) as well as the pupils, the heart and glands (sweat, saliva and digestive). Inervación simpática var model = {thumbnailUrl: ‘/-/media/manual/professional/images/sympathetic_innervation_high_blausen_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/-/media/manual/professional/images/sympathetic_innervation_high_blausen_de.jpg ? lang = en & thn = 0 ‘, title:’ Inervación simpática ‘description:’ ‘credits”, hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘image-element-panel.’). ko.applyBindings (model, panel.get (0)); Parasympathetic preganglionic The cell bodies of the parasympathetic system are in the brain stem and located in the sacral portion of the spinal cord. Preganglionic fibers interact with the cranial nerves III, VII, IX and X (vagus) from the brain stem and leave the spinal cord at the level of S2 and S3; the vagus nerve contains about 75% of all parasympathetic fibers. Parasympathetic ganglia (z. B. ciliary ganglion, pterygopalatine ganglion, otic ganglion, pelvic and vagal ganglia) lie in the target organs, and the postganglionic fibers are only 1 or 2 mm long. Thus, the parasympathetic nervous system can generate specific, local reactions in the effector organs, such as the following:. Blood vessels of the head, the neck and the thoracoabdominal viscera lacrimal and salivary glands Smooth muscle of glands and intestines (eg, liver, spleen, colon, kidney, bladder, genitals) the muscles of the pupil physiology the ANS controls blood pressure, heart rate, body temperature, weight, digestion, metabolism, fluid and electrolyte balance, sweating, urination, defecation, sexual reactions and other processes. Many organs are primarily controlled by either the sympathetic or parasympathetic from, even if they can get from both input; Occasionally the functions of both opposite (e.g., for example, the sympathetic nervous system increases heart rate, the parasympathetic nervous system decreases it). The sympathetic nervous system acts catabolic, it activates fight-or-flight response (fight or flight). The parasympathetic nervous system anabolic, it preserves and restores (see Table: Structure of the autonomic nervous system). Outline of the autonomic nervous system area effects Sympathetic Increases the following functions: heart rate and contractility bronchodilation Hepatic glycogenolysis and glucose release Basal metabolic rate (BMR) muscle strength Causes moist palms Sets less rapidly life-sustaining functions down (. Eg digestion) controls the ejaculation Para Sympathetic Stimulates secretion and motility in the gastrointestinal tract (including emptying) the He Slows rzfrequenz lowers blood pressure Controls the erection Two major neurotransmitter in the ANS are acetylcholine: The fibers which secrete acetylcholine (cholinergic fibers) include all preganglionic, all postganglionic parasympathetic and some postganglionic sympathetic fibers (mm. arrectores pilorum, the sweat glands and blood vessels innervate). Norepinephrine: The fibers which secrete norepinephrine (adrenergic fibers) include most of the postganglionic sympathetic fibers. However, the sweat glands on the palms and soles also respond to a certain degree on adrenergic stimulation. There are several subtypes of adrenergic receptors, and cholinergic receptors, which vary depending on the location. Etiology autonomous insufficiency disorders that cause an insufficiency or failure of autonomic function, can in the peripheral or central nervous system originate and be primary or secondary to other disorders. The most common causes of autonomous insufficiency Peripheral neuropathies aging Parkinson’s disease Other causes include autoimmune autonomic neuropathy multiple system atrophy diseases of the spinal cord medication disorders neuromuscular junction (eg. As botulism, Lambert-Eaton syndrome) assessment of autonomous insufficiency history symptoms autonomous for speak failure, orthostatic intolerance (development of symptoms such as drowsiness, which is relieved by sitting down) are an early because of orthostatic hypotension heat intolerance loss of control over bladder and bowel Erectile dysfunction ( It symptom) Other possible, but less specific symptoms include dry eyes and a dry Mund.Körperliche investigation Important parts of the examination: blood pressure after changing position to stand and heart rate: In a normally hydrated patient has a sustained decrease (eg. B.> 1 min) of systolic blood pressure ? 20 mmHg, or a decrease in diastolic blood pressure ? 10 mmHg while standing in an autonomous way insufficiency (s. Orthostatic hypotension). The heart rate changes during breathing and standing should be registered; the lack of a physiological sinus arrhythmia and a lack of increase in heart rate with orthostatic indicate an autonomous insufficiency. In contrast, patients with postural tachycardia syndrome, a benign disorder, typically a tachycardia without hypotension on. Eye exam: miosis and slight ptosis (Horner syndrome) indicate a Sympathikusläsion. (Editor’s note: The Horner’s syndrome consists of the triad of miosis, ptosis and enophthalmos) A dilated, nichtreagible pupil (Adie pupil) indicates a Parasympathikusläsion. Urogenital and rectal reflexes: Abnormal urogenital and rectal reflexes may indicate faults of the ANS. The investigation includes the cremasteric (usually dissolves brushing the upper thigh inner side of the retraction of the test off), the anal reflex (usually leads brushing the perianal skin to a contraction of the anal sphincter) and the bulbo-cavernous reflex (usually results in compression of the glans penis or clitoris to a contraction of the anal sphincter) tools. Laboratory studies in patients with symptoms in favor of an autonomous insufficiency are usually carried out sudomotor, cardiovagal and adrenergic investigations to determine the extent and distribution of insufficiency. Sudomotor tests include: Quantitative sudomotor Axonreflextest: this evaluated the integrity of the postganglionic fibers. The fibers are activated by iontophoresis with acetylcholine. Standard locations on the leg and wrist are examined, and the amount of sweat is determined. The test reduced or absent perspiration can be detected. Thermoregulatory sweat test: This test verifies both the presynaptic and the postsynaptic tracks. Once a dye has been applied to the skin, the patient go into a closed space, which is heated so that maximum sweating is triggered. Sweating results in a color change of the dye, so that the areas without Schweißdrüsensekretion and sweat glands with decreased reaction be apparent to and can be specified as a percentage of the body surface. The cardiovagal study measures the impulse response (via an ECG rhythm strip) on deep inhalation and the Valsalva maneuver. Intact ANS pulse frequency varied during these maneuvers; normal reactions (deep breaths and the Valsalva ratio) vary depending on age. Rate adrenergic test the reaction of the blood pressure in beat-to-beat measurements: Upmarket head tilt: Blood is moved to the dependent parts, causing reflex responses of blood pressure and heart rate. Using this test can be distinguished from orthostatic tachycardia syndrome autonomic neuropathies. Valsalva maneuver: This maneuver increases intrathoracic pressure reduces the venous return, triggering changes in blood pressure and a reflex vasoconstriction from. When tested with elevated head in an inclined position and the Valsalva maneuver the response pattern is an index of adrenergic function. Noradrenaline plasma levels may occur in patients in the supine position and then be determined using> 5 min standing. Normally, the levels rise after standing. At patients with autonomic insufficiency, the mirrors can not rise in the standing and be low in the supine position, particularly in postganglionic disorders (eg. B. autonomic neuropathy, pure autonomic failure).

Health Life Media Team

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