S Djoni Husodo , dr.

Mkes
Bagian Ilmu Faal FK Hang Tuah
The somatosensory

 Exteroceptive
 Enteroceptive
Exteroceptive
 information about contact of the
skin with objects in the external
world( cutaneous mechanoceptive,
nociceptive (pain), and thermal
receptors)
The proprioceptive
 Information about body and limb
position and movement and relies
primarily on receptors(joints, muscles,
and tendons) the control of body.
These provide a sense of body position and
allow fine control of skeletal movements
 Muscle spindles sensors for monitoring of joint
position and movement. Muscle spindles function to
regulate muscle length
 Golgi tendon organs arranged in series with the
muscle and respond to the contraction of only a few
motor units or more. Their primary function is to
regulate muscle tension
Enteroceptive

Monitoring the internal state of the

body (includes mechanoreceptors that
detect distention of the gut or fullness
of the bladder)
 Somatic Senses

 Chemoreceptors
 Photoreceptors
 Thermoreceptors
 Mechanoreceptors

Figure 10-10: The somatosensory cortex

Sensasi Kulit
 Serat aferen primer
a. Serat A β, diameter besar, bermielin rangsangan
mekanik
b. Serat A δ, diameter kecil, bermielin  rangsangan
dingin, nyeri (fast pain), mekanik.
c. Serat C , diameter kecil, tidak bermielin
rangsangan nyeri, suhu , mekanik
 Receptor in the skin
 Touch and pressure receptors
 Heat and cold receptors
Receptors for cold  upper region of the
dermis, just below the epidermis.
Warm receptors  deeper in the dermis
 Nociceptors (pain receptors)
Receptor in the skin

Figure 10-11: Touch-pressure receptors

Nociceptive / pain
 "visceral," "deep somatic" and "superficial somatic"
pain.
 Visceral : nociceptor in the viscera (organs) and often is
extremely difficult to locate "referred" pain
 Deep somatic : nociceptors in ligaments, tendons,
bones, blood vessels, fasiae and muscles, and is dull,
aching, poorly-localized pain.
 Superficial : nociceptors in the skin or superficial
tissues, and is sharp, well-defined and clearly
located.
 Alur sensoris somatik :
Reseptor s/d cortex sensoris

kortex sensoris somatik

cerebelum

Hippotalamus
Thalamus
Limbic system

Reseptor Medulla spinalis /

brainstem
SDJONIH
Sensory Pathways

 The dorsal column–medial lemniscal

system

 The anterolateral system

SDJONIH
The dorsal column–medial lemniscal system
 Carries signals upward to the medulla of the brain
mainly in the dorsal columns of the cord.
 They continue upward, after the signals synapse
and cross to the opposite side in the medulla
oblongata,
 They continue upward through the brain stem to
the thalamus by way of the medial lemniscus.
 The dorsal column–medial lemniscal system is
composed of large, myelinated nerve fibers

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SDJONIH
Dorsal Column–Medial
Lemniscal System
 Touch sensations requiring a high degree of
localization of the stimulus
 Touch sensations requiring transmission of fine
gradations of intensity
 Phasic sensations, such as vibratory sensations
 Sensations that signal movement against the skin
 Position sensations from the joints
 Pressure sensations having to do with fine degrees
of judgment of pressure intensity

SDJONIH
The anterolateral system
 After entering the spinal cord from the dorsal spinal
nerve roots, synapse in the dorsal horns of the spinal
gray matter
 Then cross to the opposite side of the spinal cord
and ascend through the anterior and lateral white
columns of the cord.
 They terminate at all levels of the lower brain stem and
in the thalamus.
 Composed of smaller myelinated fibers

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SDJONIH
Anterolateral System
 Pain
 Thermal sensations, including both warmth
and cold sensations
 Crude touch and pressure sensations
capable only of crude localizing ability on
the surface of the body
 Tickle and itch sensations
 Sexual sensation
SDJONIH
Somatic Pathways

Hukum Bell-Magendi ?

Figure 10-9: Sensory pathways cross the body’s midline

SDJONIH
SDJONIH
SDJONIH
DERMATOME
•the C2 dermatome
begins in front of the ear
and ends at the occipital
hairline
•the T1 dermatome
comes to themidline of
the forearm;
•the T4 dermatome is at
the level of the nipples
(which, however, belong
to T5)
•the T10 dermatome
includes the navel
•the L1 dermatome is in
the groin
•the S1 dermatome is at
the outer edge of the foot
and heel.
SDJONIH
 PAIN
 Pain results from the interaction of a noxious (i.e.,
pain-producing) stimulus with a receptor, and the
subsequent transmission and processing of pain-
related signals in the PNS and CNS; the entire
process is called nociception.
 Pain evokes a behavioral response involving
nocisensor activity as well as motor and autonomic
reflexes.
 Pain reception
 Nociceptors for mechanical, thermal, and chemical
stimuli are found in all body organs except the brain
and spinal cord.
 By releasing neuropeptides, the nociceptors can
produce a neurogenic sterile inflammatory response
that enhances nociception (peripheral
sensitization).
Pain substance
 Pain transmission
 Nociceptive impulses travel in peripheral nerves to the
posterior horn of the spinal cord. Here, the incoming
information is processed by both pain-specific and
nonspecific (wide dynamic range) neurons.
 Central sensitization processes arising at this level
may lower the nociceptor threshold and promote the
development of chronic pain (such as phantom limb
pain after amputation).
 Pain processing
 The reticular formation regulates arousal
reactions, autonomic reflexes, and emotional
responses to pain.
 The thalamus relays and differentiates
nociceptive stimuli.
 The hypothalamus mediates autonomic and
neuroendocrine responses.
 The limbic system mediates emotional and
motivation-related aspects of nociception.
 The somatosensory cortex is mainly responsible
for pain differentiation and localization.
 Pain
 Fast pain (sharp pain, pricking pain, acute
pain, and electric pain )
 0.1 second after a pain stimulus is applied,
 Making the person react immediately to
remove himself or herself from the
stimulus .
 The fast-sharp pain signals are elicited by
either mechanical or thermal pain stimuli
 Small myelinated type Aδ fibers .
 Neurotransmitter substance : Glutamate
 The neospinothalamic tract
 Slow pain (slow burning pain, aching pain,
throbbing pain, nauseous pain, and chronic pain)
 slow pain begins only after 1 second or more and then
increases slowly over many seconds and sometimes
even minutes
 The slow pain tends to become greater over time.
This sensation eventually produces the intolerable
suffering of long-continued pain and makes the
person keep trying to relieve the cause of the pain .
 Chemical, mechanical or thermal stimuli.
 unmyelinated type C fibers.
 Neurotransmitter : Substance P
 The paleospinothalamic pathway
 The glutamate transmitter acts
instantaneously and lasts for only a few
milliseconds.

 Substance P is released much more

slowly, building up in concentration
over a period of seconds or minutes.
Sensory Modality

Figure 10-6: Lateral inhibition

Figure 10-7: Sensory coding for stimulus intensity and duration
Nyeri Dalam
 Beda dengan nyeri superfisial
 Lokalisasi kabur
 Disertai kontraksi otot rangka cedera tulang,
tendon, sendi
 Nyeri organ viseral tidak terlokalisir, disertai gejala
otonom dan menyebar (Referred pain)
Referred Pain
 Asal segmen atau dermatom embrional yang sama
 Dermatomal rule

Muscle & skin

/ Visceral organ
Referred Pain

Figure 10-13: Referred pain

 Lesi suatu sel, mengakibatkan;
Kerusakan membran sel

Membrane phospholipid
Phospholipase A 2

Arachidonic acid
Lipoxygenase Cyclooxygenase

Leukotriene Prostaglandins
Thromboxanes
 Anestesi lokal
Potensial aksi
Saluran ion natrium
tak mau membuka

Impuls stop
 Anestesi lokal
Na+ Na+

Closed

Opened
Na+
gate
 Reseptor Opiat
yang berperanan terhadap
impuls nyeri
terdapat di :

Nuclei periaquaductus midbrain

Nuclei raphe magnus medulla oblongata

Substantia grisea medulla spinalis

 Reseptor Opiat
Sensitif terhadap :

Opium eksogen &

derivatnya

Opium endogen / neurotransmitter :

Endorphin, Enkephalin, dynorphin
 Interneuron inhibisi

Modulasi terhadap
impuls nosisepsi
dengan cara inhibisi
Modulasi impuls nosisepsi

1. Kompetisi / inhibisi oleh

saraf sensoris A yang
membawa impuls raba / vibrasi

2. Dilakukan oleh interneuron

di substantia grisea
( adanya receptor opiat )
Pain and Itching

Figure 10-12: The gate control theory of pain modulation

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