Parasympathetic innervation of the thoracic and abdominal organs. Brief overview of autonomic innervation of organs
Brief overview of the autonomic innervation of internal organs (anatomy)
Stories and comments (beginning)
In "Human Anatomy" edited by Honored Scientist of the RSFSR, Professor M.G. The weight gain is a chapter that gives a brief overview of the autonomic innervation of organs and, in particular, the innervation of the eye, lacrimal and salivary glands, heart, lungs and bronchi, gastrointestinal tract, sigmoid and rectum and bladder, as well as blood vessels. All this is necessary to build a logical chain of evidence, but it is too cumbersome to cite everything in the form of quotations - it is enough to cite one quotation relating only to the innervation of the lungs and bronchi, and in the future only adhere to the main semantic content (while maintaining the form of presentation of the material), already covered in anatomy, autonomic innervation of organs.
Describing real cases and comments on them, I will not adhere to the classical sequence practiced in the presentation of the pathology of internal organs, because this work is not a textbook. As well as to observe the exact chronology of these cases, too, I will not. In my opinion, this form of presenting information, despite some apparent confusion, is the most convenient for perception.
And now it's time to turn to a brief review of the autonomic innervation of the internal organs and give that fundamental quote on which the entire evidence base of this "Concept" is based.
Innervation of the lungs and bronchi
Afferent pathways from the visceral pleura are the pulmonary branches of the thoracic sympathetic trunk, from the parietal pleura - nn. intercostals n. phrenicus, from the bronchi - n. vagus.
Efferent parasympathetic innervation
Preganglionic fibers begin in the dorsal autonomic nucleus of the vagus nerve and go as part of the latter and its pulmonary branches to the plexus pulmonalis, as well as to the nodes located along the trachea, bronchi and inside the lungs. Postganglionic fibers are sent from these nodes to the muscles and glands of the bronchial tree.
Function: narrowing of the lumen of the bronchi and bronchioles and secretion of mucus; vasodilation.
Efferent sympathetic innervation
The preganglionic fibers emerge from the lateral horns of the spinal cord of the upper thoracic segments (Th2–Th6) and pass through the respective rami communicantes albi and the border trunk to the stellate and upper thoracic nodes. From the latter, postganglionic fibers begin, which pass as part of the pulmonary plexus to the bronchial muscles and blood vessels.
Function: expansion of the lumen of the bronchi. Constriction and sometimes dilation of blood vessels" (50).
And now, in order to understand why the spears break, it is necessary to imagine the following situation.
Suppose that there was a violation in the thoracic spine, at the level of Th2-Th6 (thoracic segments of the spinal column): a physiological block occurred or, in other words, a banal displacement of the vertebra occurred (for example, due to injury), which led to soft tissue compression, and, in particular, the spinal ganglion or nerve. And as we remember, the consequence of this will be a violation of the conduction of the bioelectric current, in this case, to the bronchi; moreover, the influence of the sympathetic autonomic innervation, which expands the lumen of the bronchi, will be excluded (or reduced). This means that the influence of the parasympathetic part of the autonomic nervous system will be predominant, and its function is the narrowing of the lumen of the bronchi. That is, the absence of the influence of the efferent sympathetic innervation, which expands the bronchial muscles, will lead to the predominant influence of the parasympathetic autonomic innervation of the bronchi, which will result in their narrowing. That is, there will be a spasm of the bronchi.
In case of violation of the conduction of electric current to the bronchi, an electrical (i.e. electromagnetic), and therefore energy, imbalance will immediately arise in them. Or, in other words, asymmetry, in the tension of sympathetic and parasympathetic innervation, or, in other words, a value other than zero.
After the motor segment of the spine is unblocked, the conduction of the bioelectric current to the bronchi from the sympathetic nervous system will be restored, and this will mean that the bronchi will begin to expand. And the balance of sympathetic and parasympathetic autonomic innervation, in particular, of the bronchi, will be restored.
Violation of the energy balance, I think, can be modeled on a computer or measured empirically.
During my practice as a chiropractor, I had more than one case when I managed to stop attacks of bronchial asthma and suppress the cough reflex in patients by unblocking the thoracic spine. And, always quickly and for everyone.
Once I had to work with a patient (a woman in her 40s) who, at the age of 10, fell into an ice hole. Her own father saved her, but since then she had a constant cough, and she was on the dispensary record for chronic bronchitis. However, she turned to me for a completely different reason - in connection with arterial hypertension. And I, as usual, worked with the spine. But what was the surprise of this woman (and mine, of course), when she noted both the absence of coughing and the fact that it became easier for her to breathe ("breathed deeply"). Blockage in the motor segment of the spinal column persisted for thirty years, and it took a week.
The following four quotes are the best illustration of the capabilities of the nervous system, in particular, and the body as a whole, and, most importantly, manual therapy.
1. The goal of manipulation treatment is to restore the function of the joint in those places where it is inhibited (blocked)."
2. "After successful manipulation, segment mobility is usually restored immediately."
3. "Manipulation causes hypotension of muscles and connective tissue, while patients experience a feeling of relief and at the same time a feeling of warmth. All this happens instantly."
4. And, "that the strength of relaxed muscles after manipulation can increase instantly" (51).
Although the authors of the above statements referred them only to the motor segment, and, one must think, not to what is said in this work, I, nevertheless, take the liberty of asserting what I assert. On the direct relationship of displacements or subluxations in the motor segment of the spinal column and the occurrence of diseases of the internal organs. The consequence of displacements is the appearance of functional blocks in compromised areas of the spine, which, in turn, leads to multilevel combinations of displacements in the entire spine, on which the pathogenesis of all human diseases, and animals, too, is based. And the above quotes only confirm the effectiveness of this method of treatment and, indirectly, all my conclusions. From my experience in the treatment of internal pathology using manipulations from the arsenal of manual therapy, I can definitely confirm both the direct connection of changes in the internal organs with blocks in the spinal column, and the speed of the onset of the effect when the spinal segments are unblocked. Spasm of the smooth muscles of the bronchi and blood vessels is replaced by dilation (expansion or stretching) almost instantly. For example, status asthmaticus stops within 3 to 5 minutes, as well as a decrease in blood pressure (if it was high) also occurs in about the same time limits (and in some patients even faster).
Functional blocks in the motor segments of the human spinal column (and vertebrates, by the way, too), leading to degenerative changes in the intervertebral discs due to chronic compression of the spinal ganglia and nerves, cannot but affect the conduction of bioelectrical impulses from the CNS to the periphery to the organs and back . And, therefore, necessarily, to one degree or another, they will disrupt the work of internal organs, which (violations) will be a mirror image of the energy imbalance in the autonomic nervous system.
Pleurisy exudative (post-traumatic)
In 1996, in the evening, the brother of my former classmate called me from the hospital. A friend got into a car accident, as a result of which he was caught between the steering wheel and the seat. Moreover, the chest was squeezed so that even after he was removed from the crumpled car, he could not breathe fully.
But he did not immediately turn to the doctors, believing that the problem would go away on its own. However, breathing did not become easier - moreover, the condition worsened, which forced him to turn to the doctors.
He was hospitalized in the therapeutic department, where he was diagnosed with exudative pleurisy.
Exudate (exudation of serous fluid) accumulated in the pleural cavity, which had to be removed (pumped out) in order to facilitate the work of both the lungs and the heart directly. He could no longer walk up to the third floor without stopping.
And it was precisely for tomorrow that the so-called pleural puncture was scheduled.
On the same evening, when he called, I invited him to come to my house to determine his condition and how he could be helped. And he came - barely, but he came! And that same evening I worked on his spine. After the very first complex of manipulations, Anatoly began to breathe easier, and the very next day, as he later said, he already climbed to the third floor of the hospital quite easily, i.e. Without stops. And on my recommendation, the next day, he refused a pleural puncture, which threw the doctors into bewilderment. And I worked with the back (spine) of a friend after that only twice more. And Anatoly had no more problems in this regard.
Two cases of pneumonia
One day a woman came to me for an appointment, in whom I, when listening to her lungs, diagnosed pneumonia (pneumonia). In accordance with the requirements, she was offered hospitalization, which the patient refused; She also refused the antibiotics offered for treatment, citing the fact that she had an allergy. The diagnosis of pneumonia was confirmed by x-rays and laboratory tests.
Then I was just beginning to think about the influence of changes in the spinal column on the occurrence and course of internal pathology, and that by removing blocks in the spine altered by displacements, it is possible to influence both the course of the disease and its outcome. And at that time it was possible to restore the problematic spinal column only with the help of manual therapy.
This is exactly what I suggested to the patient - to which I received consent. At that time, I was just starting to practice as a chiropractor, so I had to work with the patient five times within 10 days (later I worked no more than three times with each patient), with X-ray control in a week and a half - pneumonia resolved. No drugs! It was 1996.
Four years later, I again had the opportunity to cure pneumonia, through the correction of the spine. This time with a very young woman. And here also no antibiotics, and again with x-ray control after the prescribed 10 days. Although, as you know, the doctor heals, but nature heals!
And for everything about everything, it took only three sets (sessions) of manipulations. In fairness, it must be said that I still prescribed drugs that help eliminate bronchospasm. But, nevertheless - 10 days against three weeks! It is during this period (21 days) that pneumonia is cured, in accordance with the classical foundations of therapy. Think about it! The body restores the skin cut to the fascia to the formation of a scar in 21 days. And the skin is a rather rough substance, unlike the epithelium of the bronchi.
So how can all three cases be explained? But what. I'll start with the first case, and then in order.
The vertebrae displaced by trauma disrupted the conduction of bioelectric impulses not only to the bronchi, but also to the intercostal muscles. The latter circumstance was the main trigger in the occurrence of effusion into the pleural cavity. Our chest functions like bellows - when inhaling, inside the chest cavity, a rarefied space appears, so to speak, where blood and air rush easily and unhindered, and when exhaling, the intercostal muscles, contracting, squeeze both air and blood out of the lungs. . In case of violation of edge excursions on one side, the following situation arises. Blood is pumped to the lungs in full, and expelled in a smaller one from that half (lungs) where the work of the intercostal muscles will be disrupted. That is, where the excursions (movements) of the ribs are not complete (i.e., not in full), there conditions are created for the formation of an effusion of serous fluid, either into the pleural cavity, or into the lung parenchyma. A classic school problem with water flowing into and out of the pool through pipes with different diameters, and the question - how long will it take to fill the pool?
And as soon as the conduction of electrical impulses to the intercostal muscles is restored, the chest begins to work like a pump (the old name of the pump), which allows you to quickly expel all excess fluid from the pleural cavity, as in the case of Anatoly, or from the lung parenchyma, as in the case of spontaneous stopped pulmonary edema, described by me in the second part of this Concept.
P.S. Serous (serum, from Latin serum - serum) or similar to blood serum or the liquid formed from it.
As for pneumonia, there is a fairly simple explanation.
The inner wall of the bronchi is lined with the so-called ciliated epithelium, each cell of which has constantly shrinking villi. In the first phase, they, contracting, lie almost parallel to the outer membrane of the cell, and in the second, they return to their original position, and thus move the mucus (produced by goblet cells located under the ciliated epithelium) from the bronchi up. (The movement of the villi resembles wheat earing in the wind). We, reflexively, swallow this mucus together with foreign particles (dust, dead bronchial epithelium). In the nasal cavity, it is almost the same, with the only difference being that in the nose, the villi move the mucus from the nostrils into the oral cavity from top to bottom. That, by the way, is why, in the event of a violation of the autonomic innervation, a situation arises when too much mucus is produced (there is more liquid in it and it is less viscous than normal) and the villi cannot cope with the increased volume of qualitatively changed mucus, and it runs out of the nose like water .
So what about pneumonia or the same bronchitis?
In the case of displacement of the vertebrae in the thoracic region (Th2 - Th6), there is a violation of the conduction of bioelectric impulses along the sympathetic part of the autonomic nervous system, which expands the lumen of the bronchi, which will result in the predominance of parasympathetic innervation. And this is a narrowing of the lumen of the bronchi and the secretion of mucus, which cannot move up due to spasm.
And almost ideal conditions are created for the vital activity of microorganisms (staphylococci, streptococci, pneumococci, viruses). A lot of mucus (a mixture of glycoproteins - complex proteins containing carbohydrate components), moisture, heat and no movement. That is why leukocytes and macrophages immediately rush here, which, destroying the rapidly growing colonies of microbes, themselves die at the same time, turning into pus. But there is still no way out - the spasm persists! And there is an inflammatory focus. And we, doctors, already "treat - treat, treat - treat" ... The most powerful antibiotics, millions of units (units) daily, and even for three weeks. And not always well, alas.
Do you know the difference between pneumonia and bronchitis?
It depends only on the level of damage (spasm) of the bronchi. If the spasm occurred just above the terminal bronchioles, then we get - pneumonia. After the terminal bronchioles, there are only respiratory bronchioles, on the walls of which there are alveoli, through which gas exchange occurs. If the violation of the conductivity of the bronchial tree occurs higher, for example, in the bronchi of the eighth order (lobular bronchi) - here you have a banal bronchitis. We've only had him for two weeks. And why? But because at these overlying levels, persistent narrowing of the bronchi is resolved both easier and faster. If the defeat is even higher - please, here you have bronchial asthma! Of course, I'm exaggerating a little, but in general terms, this is exactly what happens.
Of course, in the treatment, doctors use drugs whose action is aimed at chemically blocking the muscles of the bronchi, which excludes the influence of parasympathetic innervation, leading to a persistent narrowing of the bronchial lumen (with all the ensuing consequences). But since the displacement in the spinal column has not been eliminated, when the drugs are canceled, everything returns to normal. That is, we are actually banally waiting for the displacement in the thoracic spine to spontaneously disappear (without even thinking about it!), And after it, the predominant influence of the parasympathetic component of the autonomic nervous system, leading to spasm in the bronchi. Just something and everything!
In the same way, one can approach the consideration of violations of the autonomic innervation of other organs, which, in principle, should be done. And let's start, or rather, continue, with the provision of vegetative control of the heart.
The innervation of the internal organs is based on the reflex activity of the nervous system. The sensitive link for the organs of the head is represented by the sensitive apparatus of the V, VII, IX and X cranial nerves - cranial sensitive afferent innervation. But the vagus nerve, justifying its name, reaches the descending colon with its fibers, these fibers contain, including a sensitive portion. On the face of the fact of cranial sensitive afferent innervation of the internal organs of the neck, chest, abdomen. These organs also have spinal sensory innervation, thus. there is a dual nature of sensitive innervation of the organs of the neck, chest and abdomen. The descending colon, sigmoid colon and pelvic organs receive only spinal sensitive innervation, since the branches of the vagus nerve do not reach them (the area of \u200b\u200bits innervation corresponds to the basin of the superior mesenteric artery). In addition to sensitive innervation, the internal organs must receive autonomic innervation, and in some cases they also need motor innervation. The question of the nature of the innervation of the internal organs is quite interesting. To answer it, it is necessary to clearly understand the structure of the organ, different tissues require different types of innervation, its localization and the place of its embryonic anlage. The path of innervation of the organ, as well as the blood supply, runs along the shortest straight line. Motor innervation will be absent in organs devoid of striated muscles.
Innervation gl. lacrimalis
Innervation of the muscle constricting the pupil and the ciliary muscle, m. sphincter pupilae et m. ciliaris.
Innervation of the muscle that dilates the pupil, m. dilatator pupilae
Innervation tunicae mucosae nasi et palati
| Names of the central nuclei | ||||
| SNA | N. caroticus internus è plexus caroticus internus, èn. petrosus profundus, è n. canalis pterygoidei è follows along with parasympathetic fibers | |||
| PSNS | N. facialis, en. petrosus major, è n. canalis pterygoidei | Pterygopalatine node, gangl. pterygopalatinum | N. trigeminus en. maxillaris, branches of the pterygopalatine node: rr. nasales posteriores superiores, laterales et mediales, n. nasopalatinus, n. palatinus major, nn. palatini minores, nn. nasales posteriores inferiores |
Innervation of glandulae submandibularis et sublingualis
| Names of the central nuclei | Course of preganglionic nerve fibers | Names of peripheral autonomic ganglia | Course of postganglionic nerve fibers | |
| SNA | Substantia intermedia lateralis, (Th I - Th IV) segments of the spinal cord | Anterior roots of spinal nerves è white communicating rami è internodal rami | Superior cervical ganglion, gangl. cervicale superius | N. caroticus externus è plexus caroticus externus, è plexus periarterialis a. lingualis |
| PSNS | Upper salivary nucleus, nucl. salivatorius superior (n. Intermedius, pons) | N. facialis è chorda tympani è n. lingualis, nodal branches, rr. ganglionares | Mandibular node, gangl. submandibulare, sublingual node, gangl. sublinguale | Glandular branches, rr. glandulares |
Innervation of the glandula parotis
| Names of the central nuclei | Course of preganglionic nerve fibers | Names of peripheral autonomic ganglia | Course of postganglionic nerve fibers | |
| SNA | Substantia intermedia lateralis, (Th I - Th IV) segments of the spinal cord | Anterior roots of spinal nerves è white communicating rami è internodal rami | Superior cervical ganglion, gangl. cervicale superius | N. caroticus externus è plexus caroticus externus, è plexus around the superficial temporal artery and its branches to the parotid salivary gland (rr. parotidei) |
| PSNS | Lower salivary nucleus, nucl. salivatorius inferior (n. glossopharyngeus, medulla oblongata) | N. glossopharyngeus and n. tympanicus è plexus tympanicus, è n. petrosus minor | Ear knot, gangl. oticum | Connecting branches with ear-temporal nerve, rr. communicantes cum n. auriculotemporalis, en. auriculotemporalis. |
Innervation of the heart
| Names of the central nuclei | Course of preganglionic nerve fibers | Names of peripheral autonomic ganglia | Course of postganglionic nerve fibers | |
| SNA | Substantia intermedia lateralis, (Th I - Th IV) segments of the spinal cord | Anterior roots of spinal nerves è white communicating rami è internodal rami | gangl. cervicale superius, medium, gangl. cervicothoracicum (stellatum), gangl. thoracica II-V | N. cardiacus cervicalis superior, medius, inferior, thoracic cardiac branches II-V of the thoracic nodes, rr. cardiaci thoracici |
| PSNS | N. vagus and rr. cardiaci cervicales superiores et inferiores, thoracic cardiac branches, rr. cardiaci thoracici | Nodes of parasympathetic visceral plexuses, gangl. parasympathica plexus visceralis (nodal fields of the six subepicardial plexuses of the heart) | cardiac plexus, plexus cardiacus |
Innervation of the trachea, bronchi, lungs, and esophagus
| Names of the central nuclei | Course of preganglionic nerve fibers | Names of peripheral autonomic ganglia | Course of postganglionic nerve fibers | |
| SNA | Substantia intermedia lateralis, (Th I - Th IV) segments of the spinal cord | Anterior roots of spinal nerves è white communicating rami è internodal rami | gangl. cervicothoracicum (stellatum), gangl. thoracica II-V | Rr. oesophagei of the thoracic nodes of the sympathetic trunk è plexus oesophagalis, rr. pulmonales of the thoracic nodes of the sympathetic trunk è plexus pulmonalis |
| PSNS | Posterior nucleus of the vagus nerve, nucl. dorsalis n. vagi (medulla oblongata) | N. vagus è plexus esophagalis, bronchial branches, rr. bronchiales, | Esophageal plexus, plexus oesophagalia, pulmonary plexus, plexus pulmonalis |
Innervation of the stomach, intestines, liver,
pancreas, kidney, spleen, adrenal cortex
| Names of the central nuclei | Course of preganglionic nerve fibers | Names of peripheral autonomic ganglia | Course of postganglionic nerve fibers | |
| SNA | Anterior spinal nerve roots è white connecting rami è internodal rami n. splanchnicus major, n. splanchnicus minor, nn. splanchnici lumbales, eplexus suprarenalis | gangl. coeliaca, gangl. aortorenalis, gangl. mesentericum superius, gangl. mesentericum inferius. | Plexus coeliacus plexus intermesentericus plexus hepaticus plexus lienalis plexus pancreaticus plexus renalis | |
| PSNS | Posterior nucleus of the vagus nerve, nucl. dorsalis n. vagi (medulla oblongata) | N. vagus è plexus esophagalis è truncus vagalis anterior; truncus vagalis posterior; Err. hepatici, rr. coeliaci, | Parasympathetic nodes, gangl. parasympathica, visceral plexuses, plexus visceralis, innervated organs | Plexus hepaticus, plexus lienalis, plexus pancreaticus, plexus gastricus, plexus entericus, plexus subserosus, plexus myentericus, plexus submucosus, plexus renalis |
Innervation of the adrenal medulla
(similar to terminal sympathetic ganglion)
| Names of the central nuclei | Course of preganglionic nerve fibers | Names of peripheral autonomic ganglia | Course of postganglionic nerve fibers | |
| SNA | Substantia intermedia lateralis, (Th IV - Th XII) segments of the spinal cord | Anterior spinal nerve roots è white connecting rami è internodal rami n. splanchnicus major, n. splanchnicus minor eplexus suprarenalis | Axoepithelial synapse of the endings of the first neuron of the sympathetic chain with the cells of the adrenal medulla | Postganglionic fibers are absent. Control signals of a chemical nature - hormones of the adrenal medulla are released into the bloodstream and are carried by the blood flow to the objects of control |
| PSNS | Posterior nucleus of the vagus nerve, nucl. dorsalis n. vagi (medulla oblongata) | N. vagus è plexus esophagalis è truncus vagalis posterior; e rr. renales | Parasympathetic nodes, gangl. parasympathica, visceral plexuses, plexus visceralis, innervated organs | Renal, plexus, plexus renalis, adrenal plexus, plexus suprarenalis. |
Innervation of the rectum, urinary organs, genital organs
| Names of the central nuclei | Course of preganglionic nerve fibers | Names of peripheral autonomic ganglia | Course of postganglionic nerve fibers | |
| SNA | Substantia intermedia lateralis, (Th IV - L II) segments of the spinal cord | Anterior spinal nerve rootsè white communicating ramiè internodal ramiè nn. splanchnici sacrales, plexus hypogastricus superior, plexus hypogastricus inferior | sacral plexus, gangl. sacralia trunci sympathies | Plexus rectales medii et inferiores, plexus prostaticus, plexus deferentialis, plexus uterovaginalis, plexus vesicales. |
| PSNS | Nucll. parasympathici sacrales (S II - S IV) segments of the spinal cord | Anterior roots of the spinal nerves – anterior branches of the spinal nerves – radices ventrales nn. spinales, è plexus sacralis, ènn. splanchnici pelvini | Pelvic nodes, gangl. pelvina, visceral ganglia, ganglia visceralia, lower rectal plexus, plexus rectalis inferioris | Plexus rectales inferiores, plexus prostaticus, plexus deferentialis, plexus uterovaginalis, plexus visceralis. |
Innervation of blood vessels
1. The cranial nucleus of Yakubovich is located:
1. in the diencephalon
2. in the medulla oblongata
3. in the midbrain
4. in telencephalon
2. In which part of the brain is Yakubovich's nucleus located?
1. in the intermediate
2. oblong
3. average
4. in the end
3. The dorsal nucleus of the vagus nerve is:
1. motor
2. sympathetic
3. parasympathetic
4. sensitive
4. Parasympathetic conductors are composed of:
1. I pair of head nerves
2. II pairs of head nerves
3. 3rd pair of head nerves
4 V pairs of head nerves
5. Parasympathetic ganglia include:
1. superior mesenteric node
2. spinal ganglion
3. pterygopalatine ganglion
4. celiac ganglion
6. Parasympathetic innervation of the pelvic organs is carried out from:
2. lateral intermediate nuclei of the thoracic segments of the spinal cord
3. lateral intermediate nuclei of the lumbar segments of the spinal cord
4. lateral intermediate nuclei of the sacral segments of the spinal cord
7. Sympathetic centers are localized in the following department of the central nervous system:
1. in the midbrain
2. in the medulla oblongata
3. in the spinal cord
4 in diencephalon
8. Pterygopalatine ganglion receives preganglionic conductors from
1. Yakubovich and Perlia kernels
2. dorsal nucleus of the vagus nerve
3.
4. lower salivary nucleus
9. Intermediate lateral nuclei of the gray matter of the spinal cord lie in:
1. anterior horns of the gray matter of the spinal cord
2. posterior horns of the gray matter of the spinal cord
3. lateral horns of the gray matter of the spinal cord
4. in the central part of the gray matter of the spinal cord
10. From which autonomic nuclei is the parasympathetic innervation of the pelvic organs carried out
1. dorsal nucleus of the vagus nerve
2. lateral intermediate nuclei of the thoracic segments
3. lateral intermediate nuclei of the lumbar segments
4. lateral intermediate nuclei of the sacral segments
11. Which vegetative nodes belong to the X pair
1. paraorganic
2. intramural
3. paravertebral
4. prevertebral
12. White connecting branches have:
1. all spinal nerves
2. thoracic spinal nerves
13. Which nerves contain parasympathetic fibers to the pelvic organs
1. great and small splanchnic nerves
2. lumbar splanchnic nerves
3. sacral splanchnic nerves
4. pelvic splanchnic nerves
14. From which nucleus originate the vegetative conductors of the intermediate nerve
1. dorsal nucleus of the vagus nerve
2. superior salivary nucleus
3. lower salivary nucleus
4. Yakubovich kernels
15. In which part of the CNS are the sympathetic centers located?
1. in the midbrain
2. in the rhomboid brain
3. in the spinal cord
4. in the diencephalon
16. Which nucleus of the gray matter of the spinal cord is sympathetic
1. own
2. breastfeeding
3. intermediate medial
4 intermediate lateral
17. Along the gray connecting branches, sympathetic conductors are sent to:
1. head and neck organs
2. breast organs
3. abdominal organs
4. soma
18. White connecting branches contain:
1. parasympathetic preganglionic
2. parasympathetic postganglionic
3. sympathetic preganglionics
4. sympathetic postganglionics
19. Gray connecting branches have:
1. all spinal nerves
2. thoracic spinal nerves
3. sacral spinal nerves
4. coccygeal spinal nerves
20. The celiac (solar) plexus innervates:
1. neck organs
2. organs of the chest cavity
3. upper abdominal organs
4. pelvic organs
21. The solar plexus does not contain:
1. sympathetic fibers
2. parasympathetic fibers
3. motor conductors
4. sensitive fibers
22. Gray connecting branches contain
1. parasympathetic preganglionic fibers
2. parasympathetic postganglionic fibers
3. sympathetic preganglionic fibers
4. sympathetic postganglionic fibers
23. Gray connecting branches represent the path of sympathetic conductors to
1. to the organs of the head and neck
2. to the organs of the chest
3. to the abdominal organs
4. to catfish
24. Internal nerves contain:
1. sympathetic preganglionics only
2. only sympathetic postganglionics
3. sympathetic preganglionic and postganglionic
4. sympathetic and parasympathetic preganglionic
25. Spinal nerves with gray connecting branches
1. All
2. none
3. breast only
4. sacral only
26. Solar plexus innervates organs
1. upper floor of the peritoneal cavity
2. middle floor of the peritoneal cavity
3. lower floor of the peritoneal cavity
4. chest cavity
27. Topography of the solar plexus
1. anterior semicircle of the thoracic aorta
2. anterior semicircle of the abdominal aorta
3. aortic bifurcation
4. anterior semicircle of the inferior vena cava
28. In what part of the brain does the arc of the pupillary reflex close?
1. in the intermediate
2. average (at the level of the superior colliculus)
3. on average (at the level of the lower colliculi)
4. in the bridge
29. Which nerve carries out the parasympathetic innervation of the bladder
1. wandering
2. large internal
3. sacral splanchnic
4. pelvic splanchnic
30. Vegetative conductors of the intermediate nerve begin:
1. from the dorsal nucleus of the vagus nerve
2. from the superior salivary nucleus
3. from the lower salivary nucleus
4. from Yakubovich's core
31. The following are involved in the innervation of the stomach:
1. celiac plexus
2. superior mesenteric plexus
3. inferior mesenteric plexus
4. hypogastric plexus
32. Branches of what autonomic plexuses are involved in the innervation of the liver
1. sunny
2. superior mesenteric
3. inferior mesenteric
4. hypogastric
33. Branches of which autonomic plexuses are involved in the innervation of the spleen
1.sunny
2. superior mesenteric
3. inferior mesenteric
4. hypogastric
34. Branches of what autonomic plexuses are involved in the innervation of the uterus and its appendages
1. solar
2. superior mesenteric
3. inferior mesenteric
4. hypogastric
35. The innervation of the small intestine takes part:
1. celiac and superior mesenteric plexus
Afferent Innervation. INTEROCEPTION ANALYZER
The study of the sources of sensitive innervation of the internal organs and the conducting pathways of interoception is not only of theoretical interest, but also of great practical importance. There are two interrelated goals for which the sources of sensitive innervation of organs are studied. The first of them is the knowledge of the structure of the reflex mechanisms that regulate the activity of each organ. The second goal is the knowledge of the pathways of pain stimuli, which is necessary for the creation of scientifically based surgical methods of anesthesia. On the one hand, pain is a signal of an organ disease. On the other hand, it can develop into severe suffering and cause serious changes in the functioning of the body.
Interoceptive pathways carry afferent impulses from receptors (interoceptors) of the viscera, blood vessels, smooth muscles, skin glands, etc. Pain sensations in the internal organs can occur under the influence of various factors (stretching, compression, lack of oxygen, etc.)
The interoceptive analyzer, like other analyzers, consists of three sections: peripheral, conductive and cortical (Fig. 18).
The peripheral part is represented by a variety of interoceptors (mechano-, baro-, thermo-, osmo-, chemoreceptors) - the nerve endings of the dendrites of the sensory cells of the nodes of the cranial nerves (V, IX, X), spinal and autonomic nodes.
The nerve cells of the sensory ganglia of the cranial nerves are the first source of afferent innervation of the internal organs. Peripheral processes (dendrites) of pseudo-unipolar cells follow as part of the nerve trunks and branches of the trigeminal, glossopharyngeal and vagus nerves to the internal organs of the head, neck, chest and abdominal cavity (stomach, duodenal intestine, liver).
The second source of afferent innervation of the internal organs is the spinal nodes, containing the same sensitive pseudo-unipolar cells as the nodes of the cranial nerves. It should be noted that the spinal nodes contain neurons both innervating skeletal muscles and skin, and innervating viscera and blood vessels. Therefore, in this sense, the spinal nodes are somatic-vegetative formations.
The peripheral processes (dendrites) of the neurons of the spinal nodes from the trunk of the spinal nerve pass as part of the white connecting branches into the sympathetic trunk and pass in transit through its nodes. To the organs of the head, neck and chest, afferent fibers follow as part of the branches of the sympathetic trunk - cardiac nerves, pulmonary, esophageal, laryngeal-pharyngeal and other branches. To the internal organs of the abdominal cavity and pelvis, the bulk of the afferent fibers pass as part of the splanchnic nerves and further, passing through the ganglia of the autonomic plexuses, and through the secondary plexuses reaches the internal organs.
To the blood vessels of the limbs and the walls of the body, afferent vascular fibers - peripheral processes of sensory cells of the spinal nodes - pass as part of the spinal nerves.
Thus, afferent fibers for internal organs do not form independent trunks, but pass as part of the autonomic nerves.
The organs of the head and vessels of the head receive afferent innervation mainly from the trigeminal and glossopharyngeal nerves. The glossopharyngeal nerve takes part in the innervation of the pharynx and vessels of the neck with its afferent fibers. The internal organs of the neck, chest cavity and the upper "floor" of the abdominal cavity have both vagal and spinal afferent innervation. Most of the internal organs of the abdomen and all organs of the pelvis have only spinal sensory innervation, i.e. their receptors are formed by the dendrites of the cells of the spinal nodes.
The central processes (axons) of pseudo-unipolar cells enter the sensory roots into the brain and spinal cord.
The third source of afferent innervation of some internal organs is the vegetative cells of the second type Dogel, located in intraorganic and extraorganic plexuses. The dendrites of these cells form receptors in the internal organs, the axons of some of them reach the spinal cord and even the brain (I.A. Bulygin, A.G. Korotkov, N.G. Gorikov), following either as part of the vagus nerve or through the sympathetic trunks in posterior roots of the spinal nerves.
In the brain, the bodies of the second neurons are located in the sensory nuclei of the cranial nerves (nucl. spinalis n. trigemini, nucl. solitarius IX, X nerves).
In the spinal cord, interoceptive information is transmitted through several channels: along the anterior and lateral spinal thalamic tracts, along the spinal cerebellar tracts, and along the posterior cords - thin and wedge-shaped bundles. The participation of the cerebellum in the adaptive-trophic functions of the nervous system explains the existence of wide interoceptive pathways leading to the cerebellum. Thus, the bodies of the second neurons are also located in the spinal cord - in the nuclei of the posterior horns and the intermediate zone, as well as in the thin and sphenoid nuclei of the medulla oblongata.
The axons of the second neurons are sent to the opposite side and, as part of the medial loop, reach the nuclei of the thalamus, as well as the nuclei of the reticular formation and the hypothalamus. Consequently, in the brainstem, firstly, a concentrated bundle of interoceptive conductors is traced, following in the medial loop to the nuclei of the thalamus (III neuron), and secondly, there is a divergence of autonomic pathways heading to many nuclei of the reticular formation and to the hypothalamus. These connections ensure the coordination of the activities of numerous centers involved in the regulation of various vegetative functions.
The processes of the third neurons go through the posterior leg of the internal capsule and end on the cells of the cerebral cortex, where the awareness of pain occurs. Usually these sensations are diffuse in nature, do not have an exact localization. IP Pavlov explained this by the fact that the cortical representation of interoceptors has little life practice. So, patients with repeated attacks of pain associated with diseases of the internal organs, determine their localization and nature much more accurately than at the beginning of the disease.
In the cortex, vegetative functions are represented in the motor and premotor zones. Information about the work of the hypothalamus enters the cortex of the frontal lobe. Afferent signals from the respiratory and circulatory organs - to the cortex of the insula, from the abdominal organs - to the postcentral gyrus. The cortex of the central part of the medial surface of the cerebral hemispheres (limbic lobe) is also part of the visceral analyzer, participating in the regulation of the respiratory, digestive, genitourinary systems, and metabolic processes.
Afferent innervation of internal organs is not segmental. The internal organs and vessels are distinguished by a multiplicity of sensory innervation pathways, among which the majority are fibers originating from the nearest segments of the spinal cord. These are the main pathways of innervation. The fibers of the additional (roundabout) pathways of innervation of the internal organs pass from the distant segments of the spinal cord.
A significant part of the impulses from the internal organs reaches the autonomic centers of the brain and spinal cord through the afferent fibers of the somatic nervous system due to the numerous connections between the structures of the somatic and autonomic parts of the single nervous system. Afferent impulses from the internal organs and the apparatus of movement can go to the same neuron, which, depending on the situation, ensures the performance of vegetative or animal functions. The presence of connections between the nerve elements of somatic and autonomic reflex arcs causes the appearance of reflected pain, which must be taken into account when making a diagnosis and treating. So, with cholecystitis, there are toothaches and a phrenicus symptom is noted, with anuria of one kidney, there is a delay in the excretion of urine by the other kidney. In diseases of the internal organs, skin zones of hypersensitivity appear - hyperesthesia (Zakharyin-Ged zones). For example, with angina pectoris, reflected pains are localized in the left arm, with a stomach ulcer - between the shoulder blades, with damage to the pancreas - girdle pains on the left at the level of the lower ribs up to the spine, etc. Knowing the structural features of segmental reflex arcs, it is possible to influence the internal organs, causing irritation in the area of the corresponding skin segment. This is the basis of acupuncture and the use of local physiotherapy.
EFFERENT INNERVATION
The efferent innervation of various internal organs is ambiguous. Organs, which include smooth involuntary muscles, as well as organs with a secretory function, as a rule, receive efferent innervation from both parts of the autonomic nervous system: sympathetic and parasympathetic, which have the opposite effect on the function of the organ.
Excitation of the sympathetic division of the autonomic nervous system causes an increase in heart rate, an increase in blood pressure and blood glucose levels, an increase in the release of hormones from the adrenal medulla, dilation of the pupils and lumen of the bronchi, a decrease in the secretion of glands (except sweat), inhibition of intestinal motility, causes spasm of sphincters .
Excitation of the parasympathetic division of the autonomic nervous system reduces blood pressure and blood glucose levels (increases insulin secretion), slows down and weakens heart contractions, constricts the pupils and the lumen of the bronchi, increases the secretion of glands, increases peristalsis and reduces the muscles of the bladder, relaxes sphincters.
Depending on the morphofunctional features of a particular organ, the sympathetic or parasympathetic component of the autonomic nervous system may predominate in its efferent innervation. Morphologically, this is manifested in the number of corresponding conductors in the structure and severity of the intraorgan nervous apparatus. In particular, in the innervation of the bladder and vagina, the decisive role belongs to the parasympathetic division, in the innervation of the liver - to the sympathetic.
Some organs receive only sympathetic innervation, for example, the pupillary dilator, the sweat and sebaceous glands of the skin, the hair muscles of the skin, the spleen, and the sphincter of the pupil and the ciliary muscle receive parasympathetic innervation. Only sympathetic innervation has the vast majority of blood vessels. In this case, an increase in the tone of the sympathetic nervous system, as a rule, causes a vasoconstrictive effect. However, there are organs (heart) in which an increase in the tone of the sympathetic nervous system is accompanied by a vasodilating effect.
Internal organs containing striated muscles (tongue, pharynx, esophagus, larynx, rectum, urethra) receive efferent somatic innervation from the motor nuclei of the cranial or spinal nerves.
Important for determining the sources of nerve supply to the internal organs is the knowledge of its origin, its movements in the process of evolution and ontogenesis. Only from these positions will the innervation, for example, of the heart from the cervical sympathetic nodes, and the gonads from the aortic plexus, be understood.
A distinctive feature of the nervous apparatus of internal organs is the multi-segmentation of the sources of its formation, the multiplicity of paths connecting the organ with the central nervous system and the presence of local centers of innervation. This may explain the impossibility of complete denervation of any internal organ by surgery.
Efferent vegetative pathways to internal organs and vessels are two-neuronal. The bodies of the first neurons are located in the nuclei of the brain and spinal cord. The bodies of the latter are in the vegetative nodes, where the impulse switches from preganglionic to postganglionic fibers.
Sources of Efferent Autonomic Innervation of Internal Organs
Organs of the head and neck
Parasympathetic innervation. First neurons: 1) accessory and median nucleus of the third pair of cranial nerves; 2) the upper salivary nucleus of the VII pair; 3) lower salivary nucleus of the IX pair; 4) dorsal nucleus of the X pair of cranial nerves.
Second neurons: near-organ nodes of the head (ciliary, pterygopalatine, submandibular, ear), intraorgan nodes of the X pair of nerves.
sympathetic innervation. The first neurons are the intermediate-lateral nuclei of the spinal cord (C 8 , Th 1-4).
The second neurons are the cervical nodes of the sympathetic trunk.
The organs of the chest
Parasympathetic innervation. The first neurons are the dorsal nucleus of the vagus nerve (X pair).
Sympathetic innervation. The first neurons are the intermediate-lateral nuclei of the spinal cord (Th 1-6).
The second neurons are the lower cervical and 5-6 upper thoracic nodes of the sympathetic trunk. The second neurons for the heart are located in all cervical and upper thoracic nodes.
Abdominal organs
Parasympathetic innervation. The first neurons are the dorsal nucleus of the vagus nerve.
The second neurons are near-organ and intra-organ nodes. The exception is the sigmoid colon, which is innervated as organs of the pelvis.
Sympathetic innervation. The first neurons are the intermediate-lateral nuclei of the spinal cord (Th 6-12).
The second neurons are the nodes of the celiac, aortic and inferior mesenteric plexus (II order). The chromophin cells of the adrenal medulla are innervated by preganglionic fibers.
The organs of the pelvic cavity
Parasympathetic innervation. The first neurons are the intermediate-lateral nuclei of the sacral spinal cord (S 2-4).
The second neurons are near-organ and intra-organ nodes.
Sympathetic innervation. The first neurons are the intermediate-lateral nuclei of the spinal cord (L 1-3).
The second neurons are the lower mesenteric node and the nodes of the upper and lower hypogastric plexuses (II order).
INNERVATION OF BLOOD VESSELS
The nervous apparatus of blood vessels is represented by interoceptors and perivascular plexuses that spread along the course of the vessel in its adventitia or along the border of its outer and middle membranes.
Afferent (sensory) innervation is carried out by the nerve cells of the spinal nodes and nodes of the cranial nerves.
The efferent innervation of the blood vessels is carried out by sympathetic fibers, and the arteries and arterioles experience a continuous vasoconstrictive effect.
Sympathetic fibers go to the vessels of the limbs and trunk as part of the spinal nerves.
The main mass of efferent sympathetic fibers to the vessels of the abdominal cavity and pelvis passes as part of the celiac nerves. Irritation of the splanchnic nerves causes narrowing of blood vessels, transection - a sharp expansion of blood vessels.
A number of researchers have discovered vasodilating fibers that are part of some somatic and autonomic nerves. Perhaps only the fibers of some of them (chorda tympani, nn. splanchnici pelvini) are of parasympathetic origin. The nature of most vasodilating fibers remains unclear.
TA Grigoryeva (1954) substantiated the assumption that the vasodilating effect is achieved as a result of contraction of not circular, but longitudinally or obliquely oriented muscle fibers of the vascular wall. Thus, the same impulses brought by sympathetic nerve fibers cause a different effect - vasoconstrictor or vasodilator, depending on the orientation of the smooth muscle cells themselves in relation to the longitudinal axis of the vessel.
Another mechanism of vasodilation is also allowed: relaxation of the smooth muscles of the vascular wall as a result of the onset of inhibition in the autonomic neurons innervating the vessels.
Finally, one cannot exclude the expansion of the lumen of the vessels as a result of humoral influences, since humoral factors can organically enter the reflex arc, in particular, as its effector link.
INNERVATION supplying organs and tissues with nerves. There are centripetal, or afferent nerves, through which irritation is brought to the central nervous system, and centrifugal, or efferent nerves, through which impulses are transmitted from the centers to the periphery. Directly related to the work of any organ are only its centrifugal nerves; the centripetal nerves coming from this apparatus do not necessarily participate in its functioning. In the case when the work of an organ is stimulated or regulated by a reflex path, the participation of centripetal nerves is necessary. It should be emphasized that the number of centripetal nerves, the irritation of which can cause a reflex impulse in one centrifugal nerve, is very large. Already within the same spinal cord number. the number of afferent nerves entering this segment significantly exceeds the number of efferent nerves leaving it (Sherrington's funnel). In the presence of the cerebral cortex, stimulation of any afferent nerve can, in the order of a conditioned reflex, cause an impulse in any efferent nerve and, consequently, any activity of the body. It is not known such activity of the organism, which would proceed completely independently of nervous influences. In some cases, the work of the effector apparatus occurs solely under the influence of nerve impulses. Such is, for example, the activity of all skeletal muscles, which is determined exclusively by reflex stimulation or direct irritation of the nerve centers. In these cases, the transection of the centrifugal nerve causes a complete loss of the function of this apparatus. In other rays, the work of an organ is caused both by nerve impulses (reflex) and by the direct action of certain stimuli on the tissue of this organ. Such is eg. work of the gastric glands, pancreas. Finally, cases are known when nerve impulses exert only a regulatory influence on the functioning of an organ (a typical example is cardiac activity). In some cases, I. is of relatively minor importance for the work of an organ (for example, urine secretion by the kidneys) or an unexplained value (for example, the separation of bile by the liver). Only very few processes do not appear to be directly influenced by nerves (for example, the diffusion of gases through the wall of the alveoli). It has now been proven that metabolic processes in tissues also depend on nervous influences. From what has been said, it is clear that for the normal functioning of an organ, its connection with the centers through the centrifugal nerves is necessary. The latter are divided into somatic, directly coming from the anterior horns of the spinal cord to the innervated apparatus (muscles), and vegetative, passing through the ganglia (see Fig. autonomic nervous system). Most, if not all, of the body's apparatuses seem to have a dual innervation, autonomic and somatic [muscles (Bouquet, Orbely)] or sympathetic and parasympathetic innervation (eg heart, intestines, stomach). Most of the data forces us to recognize that a special formation is included between the nerve and the innervated apparatus, which plays an important role in the processes of excitation transmission. According to some authors (Langley), this formation (substance /S) is not identical with the end of the nerve. Finally, however, the question of the existence of a special intermediate link between the nerve and the innervated apparatus cannot be resolved (Lapicque). Gist. side of the question - see Nerve endings. As a rule, not only those parts of the central nervous system, from which the nerves innervating the corresponding organs originate, are related to the work of organs. The higher parts of the brain are always related to the work of all organs. When talking about the center of any activity (for example, the breathing center), it should be borne in mind that we cannot talk about a narrowly limited anat. areas. Along with the main center (for a number of autonomic functions), located in the medulla oblong., There are always subordinates in the spinal cord. Even after the complete exclusion of the centers, some primitive innervation mechanisms are gradually restored due to the nerve ganglia and those nerve cells that are in the organ itself (the above applies only to the area of innervation by the autonomic nervous system). - Concerning the intimate mechanism of innervation processes and there is no exact and complete information about the mechanism of transmission of excitation from the nerve to the innervated device. Levi's experiments (Loewy) showed that when the cardiac nerves are irritated, some kind of chemical is produced. a substance that produces the same effect as the irritation of the nerves themselves. Samoilov expressed a similar view regarding the mechanism of transmission of irritation from the nerve to the muscle. From this point of view, the transmission of excitation is reduced, as it were, to the secretion by the nerve ending of a certain chemical agent that has a specific effect. Recently, it has been proven that the transmission of irritation from the nerve to the muscle is associated with the breakdown of creatine phosphoric acid into its components. For theories of the conduction of excitation along the nerve and theories of central innervation processes, see. Nervous system, Ionic theory of excitation. Innervation of individual organs - see the relevant organs and autonomic nervous system. G - Conradi.
