Essay Sample on Severe Head Trauma & Spinal Cord Injury: Brain & Spine Damage & Swallowing

Introduction

The severe head trauma and spinal cord injury suffered by Mr. S resulted in damage to his brain and spine. Swallowing is a complex process that involves the coordination of various muscles in the mouth, brain, esophagus, and the neck. Nerves mediate the coordination of these muscles; therefore, accident to both the brain and spinal cord, which have a vibrant network of nerves is likely to have detrimental effects. Some parts of the brain that have the role of regulating both the mouth and throat muscles are likely to have sustained damage from the accident. This also affects the nerves that receive and transmit the impulse to the brain as well as the reflex triggers located in the throat. There are 26 known muscles situated in the mouth, esophagus, and the neck, all of which are controlled by the brain when one is taking food and fluids (Hvingelby, 2019). All muscles have nerves that control them as they perceive impulse from the brain to work in a systematic and coordinated manner. When the brain sustains injury from trauma, these nerves are affected and therefore seize to work in a coordinated way, thus affecting swallowing.

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Differences Between Parasympathetic and Sympathetic Innervation of the GI System

In the gastrointestinal tract, both parasympathetic and sympathetic parts of the nervous system are involved in the process of digestion by engaging with the enteric nervous system located within the walls of the digestive tract. In essence, the parasympathetic innervation takes the role of stimulating digestion while on the other hand, the sympathetic innervation inhibits the process. Parasympathetic innervation functions by sending of preganglionic signals to synapses containing enteric neurons by both the vagus and pelvic splanchnic nerves while the sympathetic innervation is mediated by postganglionic signals to smooth muscles, glands as well as blood vessels and also indirectly by synapses in the enteric nervous system (Cardinali, 2017). It is also important to note that the preganglionic neurons mediating gastrointestinal tract innervation have their source in the thoracic and lumbar sections of the spinal cord while preganglionic neurons mediating the parasympathetic innervation originate from the lumbosacral part of the spinal cord (Gibbons, 2019). Additionally, parasympathetic innervation causes an elevation in stomach movement, secretions, and also saliva production. On the other hand, sympathetic innervation reduces stomach movements, secretions, and even saliva production (Gibbons, 2019).

Reasons for Vomiting, Nausea, and Anorexia

The probable cause of vomiting by Mr. S is a skull fracture from the head injury, which is usually indicated by post-traumatic vomiting (Ali, Zarif & Sajid, 2017). Impact from the accident results to shearing forces in the brain stem, which subsequently may result to transient changes within the stem thus resulting in the activation of the vomiting center of the brain within the lateral medulla. Injury to the spinal cord is an additional cause of vomiting and nausea in accident victims. The primary cause of nausea and vomiting in spinal cord injuries is rhabdomyolysis (Mathews, Sinclair, Steele & Grubb, 2018). This is a condition that arises from muscle injury resulting in the destruction/death of the muscle fibers. The death of the fibers causes the release of the resultant contents to the bloodstream resulting in nausea. Anorexia is a condition where one loses appetite resulting in detrimental effects such a low body weight. It is essential to note that appetite is conditioned or rather controlled by the hypothalamus, which is part of the brain. Injury to the hypothalamus from the severe accident suffered by Mr. S was a likely occurrence, therefore, affecting the production of hormones that mediate both hunger and thirst and therefore anorexia.

Treatment for Nausea and Vomiting

Both nausea and vomiting are treatable by the combination of drugs and other forms of care. For instance, vomiting can be treated by the regular intake of large contents of clear liquids such as water, avoiding the intake of solid food until the urge to vomit subsidizes, resting and stopping an oral medication that may be irritating the stomach which contributes to vomiting. Treatment of nausea and vomiting can also be done by the use of a group of drugs referred to as antiemetics (Haft & McAffee, 2015). Examples of such medications include Meclizine hydrochloride, Emetrol, Bismuth subsalicylate, ondansetron, Zofran, and promethazine among many others. Nausea can also be controlled by observing some regulations such as avoiding activity after a meal, not taking fried/greasy foods and eating slowly in small quantities, among others.

Reasons for Difficulty in Bowel Movement

Mr. S is having difficulty in passing out stool due to an injury to the spinal cord. Damage to the spinal cord affects bowel movement making it a tough process, thus resulting in constipation. Injuries to the spinal cord result to tightness otherwise known as spasticity or loosening, also known as flaccidity of muscles found in the rectum, sphincters as well as the pelvic floor. The severity of the injury determines the extent of the tightness or looseness. The passing of stool is coordinated by muscles and nerves found around the rectum and the anus. These muscles need to function in conjunction with a bowel movement to work correctly ("Neurogenic Bowel | Cedars-Sinai," 2019). Nerves in the rectum signal when the rectum is full, resulting in the urge to defecate. Damage to these nerves interferes with bowel movement and injury of muscles, which makes peristalsis difficult. Tightening of the sphincter and pelvic floor muscles result in constipation, thus difficulty in defecation.

References

Ali, S., Zarif, P., & Sajid, S. (2017). Vomiting as a Predictor of Fracture Skull in Head Injury Patients. PAKISTAN JOURNAL OF MEDICAL & HEALTH SCIENCES, 11(3), 959-962.

Cardinali, D. P. (2017). Autonomic Nervous System: Basic and Clinical Aspects. Springer.Gibbons, C. H. (2019). Basics of autonomic nervous system function. In Handbook of clinical neurology (Vol. 160, pp. 407-418). Elsevier.

Haft, W. A., & McAffee, R. (2015). Antiemetics. In Basic Clinical Anesthesia (pp. 159-163). Springer, New York, NY.

Hvingelby, E. (2019). Difficulty Swallowing After Brain Injury Is Common. Retrieved 29 July 2019, from https://www.verywellhealth.com/swallowing-difficulty-is-common-after-head-trauma-4067418

Mathews, K., Sinclair, M., Steele, A., & Grubb, T. (2018). Analgesia and Anesthesia for Head and Neck Injuries or Illness. Analgesia and Anesthesia for the Ill or Injured Dog and Cat, 336.

Neurogenic Bowel | Cedars-Sinai. (2019). Retrieved 29 July 2019, from https://www.cedars-sinai.org/health-library/diseases-and-conditions/n/neurogenic-bowel.html