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TREATMENT OF ORTHOSTATIC HYPOTENSION
Roy Freeman, MB, ChB

Man's evolution from a quadrupedal to a bipedal animal, with the accompanying move from a horizontal to an erect posture, placed considerable demands on the ability of the cardiovascular system to maintain adequate cerebral blood flow.(1;2) The assumption of the upright posture results in a complex sequence of physiological reactions in response to the pooling of 500 to 1000 ccs of blood in the lower extremities and splanchnic circulation. There is a decrease in venous return to the heart and the reduced ventricular filling results in diminished cardiac output and blood pressure. These hemodynamic changes provoke a baroreceptor initiated compensatory reflex mediated via the central nervous system and effected by the peripheral efferent autonomic outflow. (Click here to download entire article)


TREATMENT OF AUTONOMIC DYSFUNCTION OF THE GASTROINTESTINAL TRACT
Roy Freeman, MB, ChB

The autonomic control of the gastrointestinal tract is mediated by the extrinsic parasympathetic and sympathetic nervous sytems and the intrinsic enteric nervous system. The parasympathetic input to the gut originates from the vagus and pelvic nerves from second through fourth sacral segments. The postsynaptic cholinergic neurons provide exitatory inut to the gastrointestinal tract. The sympathetic nervous system provides inhibitory input to the gastrointestinal tract. Extrinsic sympathetic efferents arising in the intermediolateral grey column synapse in the celiac, superior and inferior mesenteric ganglia, and ramify throughout the gastrointestinal tract in the distribution of their respective arterial trunks. The upper gastrointestinal tract is innervated by the greater splanchnic nerve which synapses in the celiac ganglion and travel, with the celiac artery; the small intestine (mid-gut) is innervated by the lesser splanchnic nerve which synapses in the superior mesenteric ganglion and travels with the superior mesenteric artery; and the large intestine is innervated by the lumbar splanchnic nerve which synapses in the inferior mesenteric ganglion and travels with the inferior mesenteric ganglion.(1-3) (Click here to download entire article)


TREATMENT OF PERIPHERAL AUTONOMIC DYSFUNCTION OF THE URINARY BLADDER
Roy Freeman, MB, ChB

The bladder wall is comprised of three layers of interdigitating smooth muscle and serves as a receptacle for the storage and appropriate evacuation of urine. This smooth muscle - the detrusor muscle - forms the internal sphincter at the junction of the bladder neck and urethra while the external sphincter is formed from the striated muscle of the urogenital diaphragm and is a true anatomical sphincter. Higher centers involved in bladder control include the anterior and medial frontal lobes, limbic regions, basal ganglia, thalamus, hypothalamus and brainstem(1-4) These regions receive afferent fibers from and send efferent fibers to "micturition centers" in the lower spinal cord. The bladder has parasympathetic, sympathetic and somatic innervation.(5) (Click here to download entire article)

 

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