Nervous System: Peripheral

Nervous System (PNS)

DIPLOMA PEMBANTU PERUBATAN

Unit Anatomi & Fisiologi

Kolej Sains Kesihatan Bersekutu Johor Bahru
 SISTEM SARAF

Peripheral Nervous System Central Nervous System

Autonomic Somatic Nervous Brain Spinal Cord

Nervous System System

Diencephalon Cerebellum Brain stem

Sympathetic Parasympathetic
Nervous System Nervous System Thalamus Midbrain
medula
Hypothalamus Pons
Epithalamus Medulla Oblongata

Cerebrum
1. Mempunyai sensory receptor yang
mengesan perubahan persekitaran:
• Penglihatan, pendengaran, smell, taste, touch,
chemoreceptor, baroreceptor, osmoreceptor
2. Mengawal aktiviti voluntary
• Somatic nervous system (pergerakan voluntary
muscle)
3. Mengawal aktiviti involuntary
• Autonomic nervous system (fungsi smooth muscle,
cardiac muscle dan glands)
 Merupakan semua tisu saraf yg terletak di luar CNS
 Peripheral nervous system terdiri daripada:
– 31 pairs spinal nerves
• Cervical 8 pair, Thoracic12 pair, Lumbar 5 pair, Sacral 5
pair, Coccyx 1 pair
– 12 pairs cranial nerves
• Motor: 5 nerves, Sensory: 3 Nerves, Motor/Sensory:4
nerves
• Dibahagikan kpd:
– Somatic Nervous System
– Autonomic Nervous System
• Setiap nerve terdiri daripada banyak nerve fibre
yang terkumpul dalam bundles
• Setiap bundle mempunyai beberapa lapisan
protective connective tissue
– Endoneurium
– Perineurium
– Epineurium
Endoneurium – delicate
tissue, mengelilingi setiap Epineurium
fibre

Perineurium – smooth
connective tissue,
mengelilingi setiap bundle
of fibre Perineurium
Epineurium – fibrous tissue
yang mengelilingi dan
menutupi beberapa bundles
of nerve fibre. Endoneurium
• Terdapat 31
pasang saraf
spina
– 8 cervical
– 12 thoracic
– 5 lumbar
– 5 sacral
– 1 coccygeal
• Terdapat 8 cervical spinal nerve
• 1st pair antara occipital bone dan atlas
• 8th pair berada di bawah cervical vertebrae
yang terakhir
• Lumbar, sacral dan coccygeal nerve terminate
di 1st lumbar dan menurun ke bawah
membentuk cauda equina
 8 Cervical nerves Spinal cord

12 Thoracic nerves

End of Spinal
nerves
5 Lumbar nerves
Cauda equina
5 Sacral &
1 coccygeal nerves Filum terminale
• Setiap nerve dibentuk oleh gabungan motor
(anterior) dan sensory (posterior) nerve root
Sensory nerve root

Motor nerve root

• Anterior nerve root terdiri daripada motor
nerve fibre dan sympathetic nerve fibre
• Posterior nerve root terdiri daripada sensory
nerve fibres.
Spinal Nerves  
• Sensory
– Posterior Roots
– Dorsal Roots
• Motor
– Anterior Roots
– Ventral Roots
• Spinal nerve membahagi kepada branches,
atau rami
– 1 ramus communican
– 1 posterior ramus
– 1 anterior ramus.
• Rami communican adalah sebahagian
daripada preganglionic sympathetic neurones
di autonomic nervous system

Posterior
ramus

Anterior
ramus

Ramus communicans
• Anterior rami bercantum di bahagian asalnya
untuk membentuk large masses of nerve
(nerve yang besar), plexuses.
• Di bahagian thoracic, anterior rami tidak
membentuk plexuses
• Terdapat 5 large plexuses mixed nerve di
setiap sisi vertebral column:
• Cervical plexuses
• Brachial plexuses
• Lumbar plexuses
• Sacral plexuses
• Coccygeal plexuses
Cervical Plexus Brachial Plexus
Lumbar plexus sacral plexus
• Thoracic nerve tidak membentuk plexuses.
• Terdapat 12 pasang thoracic nerve dan 11
pasangan yang pertama adalah intercostal
nerves
• Ia melalui di antara ribs untuk membekal
kepada intercostal muscle dan kulitnya.
• Pasangan yang ke-12 adalah subcostal nerves
• Thoracic nerve yang ke-7 hingga ke-12 juga
membekal kepada otot dan kulit posterior dan
anterior abdominal wall
 SARAF KRANIAL
• Terdapat 12 pasang saraf kranium
• 10 pasang saraf kranium terbit dari pangkal otak, 1 pasang
dari serebrum, 1 pasang dari talamus, ikut susunan dari
anterior ke posterior
• saraf kranial membentuk fungsi sensori @ motor , atau
sensori & motor
• Fungsi :
– Transmit impuls dari reseptor sensori ke otak (fungsi
sensori)
– Transmit arahan tindakbalas dari otak ke otot (fungsi
motor)
Lokasi Saraf Kranial
 Jenis Saraf Kranium
Nombor & nama Jenis & lokasi Fungsi Melalui laluan
foramen
(I) saraf olfaktori Sensori – olfaktori Bau Foramen dlm plat
mukus kribriform di
ethmoid
(II) saraf optik Sensori – retina Penglihatan Melalui foramen
mata optik berakhir di
giniculate nuclei di
thalamus
(III)Saraf Sensori – otot Pergerakan otot Superior orbital
okulomotor mata bola mata fissure
Motor – otot
tengah
(IV) Saraf troklea Motor – otot Pergerakan bola Superior orbital
tengah mata fissure
Sensori – otot
superior oblique
 Jenis Saraf Kranium
Nombor & nama Jenis & lokasi Fungsi Melalui laluan
foramen
(V) Saraf trigeminal Sensori – Bawa impuls dari Sensori –
i)Saraf ophtalmia – sentuhan, sakit, & i) Saraf ophtalmia
kelopak atas mata, suhu – superior
kelenjar lakrimal orbital fisure
ii)Saraf maksilari – ii) Saraf maksilari
hidung, farinks – foramen
iii)Saraf mandibular – rotundum
lidah , gigi, rahang iii) Saraf
bawah, pipi mandibular –
Motor – mandibular foramen ovale
pada pons Motor – foramen
ovale
 Jenis Saraf Kranium
Nombor & nama Jenis & lokasi Fungsi Melalui laluan
foramen
(VI) Saraf abdusens Sensori – lateral rectus Pergerakan bola Superior orbital fisure
muscle mata ke arah
Motor – pons lateral
(VII) Saraf fasial Sensori – deria rasa Rasa & reaksi wajah Foramen stylomastoid
Motor - pons
(VIII) Saraf Saraf vestibular sensori Saraf vestibular Saraf vestibular
vestibulokoklea / – kanal semicircular sensori – bawa sensori – melalui pons
auditori berakhir di pons impuls utk & serebelum
Saraf vestibular motor equilibrium Saraf vestibular motor
dlm pons Saraf koklea, – melalui pons
Saraf koklea, sensori sensori- bawa Saraf koklea sensori –
Saraf koklea motor dlm impuls melalui nuklei dalam
pons pendengaran medula
Saraf koklea motor Saraf koklea motor –
ubah fungsi sel melalui pons
rambut
berdasarkan bunyi
 Jenis Saraf Kranium
Nombor & nama Jenis & lokasi Fungsi Melalui laluan
foramen
(IX) Saraf Sensori – tunas rasa Rasa, penelanan, Foramen jugular
glossopharyngeal lidah berakhir di pembesaran farink,
medula penghasilan air liur
Motor – medula
(X) Saraf vagus Sensori – deria rasa Rasa, somatik Foramen jugular
di epiglotis sensasi, penelanan,
Motor - medula batuk, penghasilan
suara
(XI) Saraf aksesori Sensori – otot di Pergerakan otot Foramen jugular
farink & larink bahu & kepala,
Motor - medula mengunyah
(XII) Saraf Sensori – otot lidah Pergerakan lidah & Hypoglosal kanal
hypoglossal Motor – medula penelanan,
percakapan
Olfactory (I) Nerve

• Sensory nerve.
• Sense of smell.
• Olfactory cells converge to
become olfactory nerve.
Copyright 2009, John Wiley & Sons, Inc.
 Optic (II) Nerve

• Sensory nerve.
• Ganglion cells in the
retina of each eye join
to form an optic nerve.
• Nerve of vision.

Copyright 2009, John Wiley & Sons, Inc.

 Oculomotor (III) Nerve
• Motor cranial nerve.
• Originates in the midbrain.
• Supply extrinsic eye muscles
to control movements of
the eyeball and upper
eyelid.

Copyright 2009, John Wiley & Sons, Inc.

 Trochlear (IV) Nerve
• Motor cranial nerve.
• Smallest of the 12 cranial nerves.
• Origin: midbrain.
• Controls movement of the
eyeball.

Copyright 2009, John Wiley & Sons, Inc.

 Trigeminal (V) nerve
• Largest cranial nerve.
• Mixed nerve.
• Three branches:
Opthalmic, Maxillary
and Mandibular. Deal
with sensation of
touch, pain and
temperature.
• Motor axons supply
muscles of
mastication.

Copyright 2009, John Wiley & Sons, Inc.

 Abducens (VI) Nerve
• Motor cranial nerve.
• Originates from the
pons.
• Cause abduction of
the eyeball (lateral
rotation).

Copyright 2009, John Wiley & Sons, Inc.

 Facial (VII) Nerve
• Mixed cranial
nerve.
• Sensory portion
extends from the
taste buds of the
anterior two-
thirds of the
tongue.
• Motor portion
arises from the
pons and deal
with facial
expression.
Copyright 2009, John Wiley & Sons, Inc.
 Vestibulocochlear (VIII) Nerve

• Sensory cranial nerve.

• Originates in the inner ear.
• Vestibular branch carries impulses for equilibrium.
• Cochlear branch carries impulses for hearing.
 Glossopharyngeal (IX) Nerve

• Mixed cranial nerve.

• Sensory axons carry signals from the taste buds of the
posterior one-third of the tongue.
• Motor neurons arise from the medulla and deal with the
release of saliva.
 Vagus (X) Nerve
• Mixed cranial nerve.
• Distributed from the head
and neck into the thorax and
abdomen.
• Sensory neurons deal with a
variety of sensations such as
proprioception, and
stretching.
• Motor neurons arise from
the medulla and supply
muscles of the pharynx,
larynx, and soft palate that
are involved in swallowing
and vocalization.
 Accessory (XI) Nerve

• Motor cranial nerve.

• Divided into cranial accessory and spinal accessory nerves.
• Supplies sternocleidomastoid and trapezius muscles to
coordinate head movements.
 Hypoglossal (XII) Nerve

• Motor cranial nerve.

• Conduct nerve impulses for speech and swallowing.
Mneumonic:
1. On Old Olympus Towering Top A Famous
Vocal German Viewed A Hop
2. O O O Tengku Tunang Abang Felo Vali Gila
Van Antik, Habislah!!!
 NERVOUS SYSTEM PHYSIOLOGY
• Sensory Modalities (unique type of sensation)
– General Senses
• Somatic senses (body) – sakit, sentuhan, suhu
• Visceral senses (within internal organs)
– Special senses
• Smell
• Taste
Deria Lazim
• Vision
• Hearing
– Equilibrium or balance - proprioceptor
 Sensory receptor classification
• Functional characteristics
• Locations
• Microscopic Structure:
– Free nerve endings
– Encapsulated nerve endings
– Separate cells neurone
 Functional characteristics
chemo-receptors:  chemicals sense solutes in solvents,
taste, smell

osmo-receptors:  of hypothalmus which monitors blood

osmotic pressure
photo-receptors:  light - eye, eyespots, infrared receptors
of snakes, etc...
thermo-receptors:  radiant (heat) energy
noci-receptors:  pain receptors... naked dendrites of skin
(epidermis)
mechano-receptors:  mechanical forces - stretching alters
membrane permeability
 Location
• Exteroceptors – located at or near body surface,
sensitive to stimuli from outside body, provide
information about external environment, convey
visual, smell, taste, touch, pressure, vibration, thermal
& pain sensations.
• Interoceptors – located in blood vessels, visceral
organs & nervous system, provide information about
internal environment, impulses may be felt as pain or
pressure.
• Propioceptors – located in muscles, tendons, joints,
and inner ear; provide information about body
position, muscle length & tension, position & motion
of joints, and equilibrium.
 Microscopic Structure: Free nerve
endings
• Bare dendrites, lack any structural
specializations.
• Receptors carry impulses as:
– Pain
– Temperature
– Tickle
– Itch
– Some touch receptors
 Microscopic Structure:
Encapsulated nerve endings
• (Dendrites enclosed in a connective tissue
capsule ) receptors carry :
– Pressure
– Vibrations
– Some touch sensations
 Microscopic Structure: Separate
Cells
• Specialized cells
– Hair cells in ears (hearing & equilibrium)
– Gustatory receptor cells in taste buds (taste)
– Photoreceptors in retina of eye (vision)
Microscopic Structure: Separate
Cells
 Somatic senses
• Tactile sensations (touch, itch, pressure,
vibration, and tickle)
• Thermal sensation (warm & cold)
• Pain sensations (sharp & dull)
• Proprioceptive sensations (static positions of
limb & body , movements of the limbs &
head)
 Tactile sensation
• In skin and subcutaneous layer
– Touch : Meisnsner corpuscles or corpuscles of
touch , hair root plexuse, Merkel discs, Ruffini
Corpuscles
– Pressure : Pacinian
– Vibration : Meissner (low frequency) anad
Pacinian corpuscles (high frequency)
– Itch : free nerve endings (chemicals)
– Tickle : free nerve endings
 Thermal sensation
• Thermoreceptors – free nerve endings
– Warm receptors
– Cold receptors
 Pain Sensations
• Nociceptors – free nerve endings

• Type of pain :
– Fast pain
– Slow pain
 Process of sensation

• Stimulation of the sensory

receptor
• Transduction of the
stimulus
• Generation of nerve
impulses
• Integration of sensory input
 Electrical signal
• Graded potential
• Action potential – muscle & neuron action
potential
• Resting membrane potential
• Generation of action potetntial
• Propagation of nerve impulse
 Signal transmission at synapses
• Electrical synapses
• Chemical synapses
• Excitatory & inhibitory postsynaptic potentials
Somatic sensory neuron pathways
• First order neuron
• Second order neurons
• Third order neurons
 Major somatic sensory pathways
• To cerebral cortex:
– Posterior column – medial lemniscus pathway
– Anterolateral (spinothalamic) pathways
– Trigeminothalamic pathway
• To cerebellum :
– Spinocerebellar pathway
• Anterior spibocerebellar tract
• Posterior spinocerebellar tract
 Primary Somatosensory Area
• Primary somatosensory area / postcentral gyri
of the parietal lobes of the cerebral cortex
• Sensory input arrives to opposite side of the
primary somatosensory area

• White matter of cerebrum :

– Association tract
– Commissural tract
– Projecting tract
 Integration in CNS
• Common integrative and association areas
involved in processing and informing the
appropriate action to the motor area
 Motor pathway
• Somatic motor pathways
– Direct motor pathways
– Indirect motor pathways
• Mapping the motor area
– Primary motor area
– Premotor area
Direct motor pathways / corticospinal
pathways
• Lateral corticospinal tract
• Anterior corticospinal tract
• Corticobulbar pathway
 Indirect motor pathways /
extrapyramidal pathways
• Rubrospinal tract
• Tectospinal tract
• Vestibulospinal tract
• Lateral reticulospinal tract
• Medial reticulospinal tract