Pain, Temperature, and Crude Touch and Pressure

General somatic nociceptors, thermoreceptors, and mechanoreceptors sensitive to crude touch and pressure from the face conduct signals to the brainstem over GSA fibers of cranial nerves V, VII, IX, and X.

The afferent fibers involved are processes of monopolar neurons with cell bodies in the semilunar, geniculate, petrosal, and nodose ganglia, respectively.

The central processes of these neurons enter the spinal tract of V, where they descend through the brainstem for a short distance before terminating in the spinal nucleus of V.

Second-order neurons then cross over the opposite side of the brainstem at various levels to enter the ventral trigeminothalamic tract, where they ascend to the VPM of the thalamus.

Finally, third-order neurons project to the "face" area of the cerebral cortex in areas 3, 1, and 2 .

Discriminating Touch and Pressure

Signals are conducted from general somatic mechanoreceptors over GSA fibers of the trigeminal nerve into the principal sensory nucleus of V, located in the middle pons.

Second-order neurons then conduct the signals to the opposite side of the brainstem, where they ascend in the medial lemniscus to the VPM of the thalamus.

 Thalamic neurons then project to the "face" region of areas 3, I, and 2 of the cerebral cortex.

 Kinesthesia and Subconscious Proprioception

Proprioceptive input from the face is primarily conducted over GSA fibers of the trigeminal nerve.

The peripheral endings of these neurons are the general somatic mechanoreceptors sensitive to both conscious (kinesthetic) and subconscious proprioceptive input.

Their central processes extend from the mesencephalic nucleus to the principal sensory nucleus of V in the pons

The subconscious component is conducted to the cerebellum, while the conscious component travels to the cerebral cortex.

Certain second-order neurons from the principal sensory nucleus relay proprioceptive information concerning subconscious evaluation and integration into the ipsilateral cerebellum.

Other second-order neurons project to the opposite side of the pons and ascend to the VPM of the thalamus as the dorsal trigeminothalamic tract.

Thalamic projections terminate in the face area of the cerebral cortex.

Chemical Controls of Respiration

A.    Chemoreceptors (CO2, O2, H+)

1.    central chemoreceptors - located in the medulla
2.    peripheral chemoreceptors - large vessels of neck

B.    Carbon Dioxide Effects

1.    a powerful chemical regulator of breathing by increasing H+ (lowering pH)
    
a. hypercapnia            Carbon Dioxide increases -> 
                        Carbonic Acid increases ->
                        pH of CSF decreases (higher H+)- >
                        
DEPTH & RATE increase (hyperventilation)

b. hypocapnia - abnormally low Carbon Dioxide levels which can be produced by excessive hyperventilation; breathing into paper bag increases blood Carbon Dioxide levels

C.     Oxygen Effects

1.    aortic and carotid bodies - oxygen chemoreceptors

2.    slight Ox decrease - modulate Carb Diox receptors
3.    large Ox decrease - stimulate increase ventilation
4.    hypoxic drive - chronic elevation of Carb Diox (due to disease) causes Oxygen levels to have greater effect on regulation of breathing

D.    pH Effects (H+ ion)

1.    acidosis - acid buildup (H+) in blood, leads to increased RATE and DEPTH (lactic acid)

E.    Overview of Chemical Effects

 Chemical                             Breathing Effect

increased Carbon Dioxide (more H+)     increase
decreased Carbon Dioxide (less H+)     decrease

slight decrease in Oxygen             effect CO2 system
large decrease in Oxygen             increase ventilation

decreased pH (more H+)                 increase
increased pH (less H+)                 decrease

The Types of muscle cells. There are three types, red, white, and intermediate.

Intermediate Fibers: sometimes called "fast twitch red", these fibers have faster action but rely more on aerobic metabolism and have more endurance. Most muscles are mixtures of the different types. Muscle fiber types and their relative abundance cannot be varied by training, although there is some evidence that prior to maturation of the muscular system the emphasis on certain activities can influence their development

1) Storage - the stomach allows a meal to be consumed and the materials released incrementally into the duodenum for digestion. It may take up to four hours for food from a complete meal to clear the stomach. 
2) Chemical digestion - pepsin begins the process of protein digestion cleaving large polypeptides into shorter chains . 
3) Mechanical digestion - the churning action of the muscularis causes liquefaction and mixing of the contents to produce acid chyme. 
4) Some absorption - water, electrolytes, monosaccharides, and fat soluble molecules including alcohol are all absorbed in the stomach to some degree.

The hypothalamus is a region of the brain. It secretes a number of hormones.

• Thyrotropin-releasing hormone (TRH)
• Gonadotropin-releasing hormone (GnRH)
• Growth hormone-releasing hormone (GHRH)
• Corticotropin-releasing hormone (CRH)
• Somatostatin
• Dopamine

All of these are released into the blood, travel immediately to the anterior lobe of the pituitary, where they exert their effects.

Two other hypothalamic hormones:

• Antidiuretic hormone (ADH) and
• Oxytocin

travel in neurons to the posterior lobe of the pituitary where they are released into the circulation.

1. PATHOPHYSIOLOGY OF THE CONDUCTION SYSTEM


2. Cardiac arrhythmias = deviation from normal rate, rhythm

    

   1. Heart block (types) = conduction system damage
      1. Complete Heart Block = 3rd degree block
         1. idioventricular beat (35-45/min)
         2. Atria at normal sinus rhythm
         3. Periods of asystole (dizziness, fainting)
         4. Causes = myocardial infarction of ventricular septum, surgical correction of interseptal defects, drugs
      2. Incomplete Heart Block = 2nd degree block
         1. Not all atrial beats reach ventricle
         2. Ventricular beat every 2nd, 3rd, etc. atrial beat, (2:1 block, 3:1 block)
      3. Incomplete Heart Block = 1st degree block
         1. All atrial beats reach ventricle
         2. PR interval abnormally long = slower conduction
      4. Bundle branch blocks (right or left)
         1. Impulses travel down one side and cross over
         2. Ventricular rate normal, QRS prolonged or abnormal
   2. Fibrillation
      1. Asynchronous contractions = twitching movements
      2. Loss of synchrony = little to No output
      3. Atrial Fibrillation
         1. Irregular ventricular beat & depressed pumping efficiency
         2. Atrial beat = 125 - 150/min, pulse feeble = 60 - 70/min
         3. Treatment = Digitalis - reduces rate of ventricular contraction, reduces pulse deficit
      4. Ventricular Fibrillation
         1. Almost no blood pumped to systemic system
         2. ECG = extremely bizarre
         3. Several minutes = fatal
         4. Treatment = defibrillation, cardiac massage can maintain some cardiac output