The sympathetic system in the Thorax by 9kv3Z4MN


									The sympathetic system
    in the Thorax.
The autonomic nervous system is a division of the
  peripheral nervous system regulating the
  involuntary/unconsciously systems in the body eg
  breathing, heart beat , digestion etc by innervating
  visceral organs eg heart, stomach, gland, and intestines. It
  consists of the sympathetic and the parasympathetic
  divisions both using similar nerve pathways but generally
  having antagonistic effects on target tissues.
The sympathetic system has a thoracolumbar outflow.
The thoracic sympathetic system consists of the
  sympathetic chain and the ganglia (about 12) lying
  posterior to the costovertebrea pleura.
There 12 ganglia; the stellate or cervicothoracic is the
  ganglion of the first thoracic vertebrae. It is usually fused
  with the last cervical vertebrae ganglion. The first nine
  thoracic ganglia lie anterior to the neck of the ribs while
  the last three lie lateral to the body of the vertebrae body.
The preganglionic neuron – arises in the anterior ramus of
  the corresponding spinal nerve (T1 to L1 or L2 -the lower
  limit varies) to relay in the ganglion. The preganglionic
  neuron can travel up and down the sympathetic chain to
  synapse in adjacent ganglia or synapse in the ganglion that
  it enters.
The postganglionic neuron leaves the ganglion by way of the
  gray communicating ramus usually medial to the white
  ramus of the preganglionic to re-enter the thoracic nerve.
Postganglionic neurons travel peripherally to act on
  smooth muscles, cardiac muscles and glands of the
  heart, lungs, trachea, oesophagus, thoracic aorta and its
  branches. The postganglionic neurons from the stellate
  ganglion and ganglia T2-T4 enter the cardiac plexus
  regulating the heart.
The splanchnic nerves from the 5th to the 12th ganglia are
  mainly preganglionic fibres which pierce the diaphragm
  to the abdomen. The greater splanchnic nerve are from
  the 5th-9th ganglia; lesser splanchnic nerve from the 10th
  and 11th ganglia and the least splanchnic nerve from the
  12th ganglion.
Raynauld’s syndrome-
Sympathectomy-different levels
                    - approaches-axillary,
             cervical, thoracoscopy,
Stellate sparing upper thoracic gangliectomy to
  avoid Horner’s syndrome.

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