Refers to nerve fibers that release norepinephrine

All preganglionic neurons and parasympathetic post-granglionic neurons releaseacetylcholine.

Norepinephrine is released from post-ganglionic nn.

(Exceptions include sweat glands and some muscle arteries)

What hormones are secreted by the adrenal medulla and from what types of cells?

Epinephrine (80%) and Norepinephrine (20%)

They are secreted from neuroendocrine cells called Chromaffin cells.

It is actually one of the permissive effects of the sympatho-adreno system.

CORTISOL induces the expression of PNMT (phenylethanolamine-N-methyle transferase) which is involved in the conversion of NE to Epi.

False

Adrenal medulla is NOT essential for life.

Unlike the cortex, which has essential hormones, especially gluccocorticoids.

The adrenal medulla is part of the sypatho-adrenal system and has sympathetic preganglionic fibers synapsing directly onto the adrenal medulla and releasing Ach. 

In essence the medulla is acting like a sympathetic ganglion that secretes Epi directly into the blood stream.

Duration of Effects and Location

Nervous sympathetic stimulation results in a very localized short term response to NE and Epi.

The adrenal medulla on the other hand releases a cocktail of 80% epi and 20% NE into the general circulation which results in systemetic effects with extended duration (Half-life is about 2 minutes on wiki, far left on Romito's time line)

You gotta be ready to FIGHT or FLY

(in other words)

GLUCOSE! GLUCOSE! GLUCOSE!

In general blood glucose is elevated

-glycogenolysis in muscle produces lactate, which is converted to glucose in Liver

-Lypolysis is increases which creates glycerol, this is also converted into glucose in the liver.

-Fatty acids are also converted to glucose

The heart increase output (increase HR and contractility)

Blood is routed away from organs and skin and sent to the skeletal muscles.  (vasoconstriction in guts and vasodilation in muscles).  You don't need your GI tract during Fight or flight...except to crap yourself.

Metabolism focuses on creating sugar for short term energy (insulin down, glucagon and lipolysis UP)

DECREASE

The satiety hormone, leptin, is inhibited

Also CRH has an effect on appetite.

The SNS and vagus are stimulated which decrease gastric motility but the Locus Ceruleus is stimulated which increases colonic motility.

IRRITABLE BOWL SYNDROME!

"Ahhh POOP, ceruleusly"

It antagonizes GH, insulin, and sex steroids

leads to decreased bone/muscle and insulin resistance

vasovagal syncope is fainting

(Romito's explanation in her verbatims is incorrect)

Vasovagal syncope, as the name implies, is parasympathetic stimulation through the vagus nerve with loss of sympathetic stimulation.  This results in cardioinhibitory (decrease HR which decreases BP), vasodepression (decrease in BP by vasodilation b/c of sympathetic withdrawal), or a mixture of both.

Treat by putting patient's legs above their head and smelling salts/ammonia.

FYI:  Fainting can also occur from Fight or flight response in which the patient is hyperventilating.  The shallow breathing blows out CO2 resulting in alkalosis of the blood.  If the blood pH fluctuates to high out of the safe range a person passes out, and breathing returns to normal.  The theory behind breathing into a paperbag is to recycle the CO2 and lower the pH of the blood to a safe range.  tmi...TMI!!!

1.  Early morning appointments (everyone is a little slower in the morning).

2.  Shortest appointments possible

3.  Soothing environment

4.  Nitrous oxide, oral sedatives, IV sedation

5.  Proper anethesia and post-op pain control