Both sympathetic & parasympathetic Efferents are a 2 neuron system w/ presynaptic/preganglionic & post synaptic/postganglionic synapses Cell bodies

of preganglionic neurons of both para & sym are w/in CNS Cell bodies of postsynaptic autonomic neurons are in ganglia throughout the body A particular autonomic ganglion will be associated with synapses of either the parasympathetic nervous system or the sympathetic nervous system, but it may have fibers from both systems running through it. Usually parasympathetic is acetylcholine & sympathetic is norepinephrine Sympathetic division(aka Thoracolumbar outflow) has its presynaptic cell bodies are in lateral horns of spinal grey matter, cell bodies only T1-L2 and thus white rami only T1-L2 Paravertebral ganglia are in R & L sympathetic trunks, home to many postsynaptic sympathetic nerve cell bodes & many synapses; Adjacemt ganglia of sympathetic chain are connected to each other by interganglionic rami(have sympathetic nerve fibers ascending or descending b/t ganglia) From lateral horns presynatpic nerve fibers exit spinal cord in ventral roots spinal nerves ventral primary rami of segments T1-L2 exit ventral primary rami via white rami communicantes sympathetic trunk *When presynaptic Efferent fibers have arrived in sympathetic chain can: 1) synapse immediately in ganglion at that level 2) ascend or descend in sympathetic trunk 3) pass through sympathetic chain ganglia & synapse in prevertebral ganglion Many postsynatpic Efferent fibers re=enter ventral primary rami via grey rami communicates & get distributed to body w/ ventral & dorsal primary rami, gray rami communicantes carry postsynaptic Efferemt sympathetics to every spinal nerve allowing sympathetic innervation to reach every part of the body; other postsynatpic Efferents leave ganglia & travel directly to target organs, others form perivascular plexuses along blood vessels *So, let's summarize the general plan of the sympathetic nervous system. Presynaptic sympathetic fibers arise within the lateral horn of the spinal cord between T1 and L2 levels of the cord. ALL of these fibers leave the spinal cord in ventral rootlets, travel through the spinal nerve, and then enter the first few millimeters of the ventral primary ramus before leaving to travel to the sympathetic chain within the white rami communicantes. The sympathetic chains are bilateral strings of paravertebral sympathetic ganglia, connected by interganglionic rami, that lie beside or on the vertebral column.

Once a presynaptic sympathetic neuron reaches the sympathetic chain, it faces a choice. It may: 1. synapse at the level it entered and then either:

a. leave within a gray ramus communicans to reach the ventral ramus at the level at which it synapsed, or b. leave the chain as a direct branch to organs (thoracic visceral nerve, T1-T4/5). 2. travel up or down the chain to synapse at a higher or lower ganglion, where it may either: a. leave within a gray ramus communicans to reach a ventral ramus at the level at which it synapsed, or b. leave the chain as a direct branch to organs (cervical cardiac nerve or sacral splanchnic nerve) or to a perivascular plexus (internal or external carotid plexus). 3. leave the chain without synapsing, to travel within a thoracic (T5-T12) or lumbar splanchnic nerve to either: a. reach a prevertebral (preaortic) ganglion, where it will synapse and then join a perivascular plexus to reach an organ, or b. reach cells of the suprarenal medulla to synapse. These universal truths must be remembered: 1. White rami communicantes only exist to connect T1 to L2 ventral primary rami to the sympathetic chain. The terms "white ramus" and "presynaptic" are not synonymous and interchangeable. 2. Gray rami communicantes exist at ALL spinal nerve levels. EVERY ventral primary ramus is connected to the sympathetic chain by a gray ramus, which carries postsynaptic sympathetic fibers to the VPR. 3. The sympathetic chain exists to carry some of the presynaptic fibers from the T1-L2 levels up to the neck and head and down into the lower abdomen and pelvis. ANS Part II: For sympathetic postsynaptic fibers to reach structures in body they exit sympathetic trunk via gray rami communicantes then enter spinal nerves to be passed to ventral & dorsal primary rami for distribution to the periphery Sympathetic chain ends below base of skull as the superior cervical ganglion, so cell bodies of postsynatpic sympathetic fibers to head are located in R & L superior cervical ganglia; presynatpic sympatheric fibers ascend through sympathetic trunk to reach superior cervical ganglion to synaspse; postsynaptic sympathetic fibers leave sympathetic trunk via external & internal carotid nerves that travel to carotid arteries; these postynatpic fibers form perivascular plexuses *For postsynaptic sympathetic fibers reach the heart, trachea, bronchi, lungs, esophogas by exiting sympathetic trunk as cervical cardiac branches & thoracic visceral nerves *Presynatpic sympathetic fibers reach prevertebral ganglia in abdomen by splanchnic nerves: greater, lesser, least, thoracic splanchnic nerves & lumbar splanchnic nerves; thoracic & lumbar splanchnic nerves enter prevertebral ganglia on major branches of abdominal aorta: celiac, aorticornenal, siperior mesenteric and inferior mesenteric ganglia and synapse; the postsynaptic fibers then form perivascular plexuses along branches of aorta and follow vessels *white rami communicantes carry presynaptic sympathetic fibers from the ventral primary rami to the sympathetic trunk and exist only between spinal cord segments T1 and L2. Gray rami communicantes carry postsynaptic sympathetic fibers from the sympathetic trunk to all spinal nerves. In spinal cord segments T1-L2 the sympathetic trunk is attached to the spinal nerve by two short branches, the white and gray rami communicantes. Above T1 and below L2, the sympathetic trunk is attached to the spinal nerve (actually, its ventral primary ramus) only by gray rami communicantes. *Parasympathetic presynatpic neuron cell bodies are located in brainstem(CN III, VII, IX, X) & S2-4, parasympathetic more limited to head, thorax, abdoman, pelvis, doesn't reach limbs or body wall *presynaptic parasympathetic fibers synapse with terminal ganglion cells that are located individually

in or near the wall of the target organ. (This is in contrast to the sympathetic nervous system, in which presynaptic sympathetic fibers synapse in ganglia relatively further away from the target organ.) *The presynaptic fibers of the parasympathetic nervous system reach the locations where they synapse by one of three pathways. 1. Most commonly, presynaptic parasympathetic axons travel with their nerves of origin directly to ganglia. 2. In the head, some presynaptic parasympathetic axons join the course of an unrelated nerve to arrive at their postsynaptic parasympathetic neuron cell body. 3. In the abdomen, presynaptic parasympathetic neurons pass through a sympathetic ganglion without synapsing and join a perivascular plexus to form a combined autonomic nerve plexus. They then synapse on cells within the organ wall *Cranial nerve X, the vagus nerve, provides parasympathetic innervation to all the thoracic viscera via cardiac branches, and to the GI tract from the esophagus to the left colic flexure of the colon, including the pancreas, spleen, liver and gallbladder. *Pelvic splanchnic nerves, containing presynaptic parasympathetic fibers, branch from the ventral primary rami shortly after dorsal and ventral primary rami branch, post-ganglionic cell bodies of pelvic spanchnics in terminal ganglia on organ *unconscious sensation is carried on afferent fibers accompanying parasympathetic fibers, and visceral pain is carried on afferent fibers accompanying sympathetic fibers. *Sympathetic presynaptic nerve cell bodies are located in the lateral horn of spinal cord segments T1L2. Sympathetic postsynaptic cell bodies are in ganglia, either sympathetic chain ganglia or prevertebral ganglia. Sympathetic presynaptic fibers get to the sympathetic chain via white rami communicantes and either synapse at the level they enter, ascend or descend to synapse, or leave the sympathetic trunk without synapsing as a splanchnic nerve to go to a prevertebral ganglion. Sympathetic postsynaptic fibers may enter the spinal nerves via gray rami communicantes to be distributed with dorsal and ventral primary rami, may form perivascular plexuses to be distributed with blood vessels, or may travel to the target organ directly. The sympathetic nervous system provides sympathetic innervation to essentially every part of the body. Parasympathetic presynaptic cell bodies are located in the brainstem and the lateral horns of spinal cord segments S2, S3, and S4 and leave the CNS in cranial nerves III, VII, IX and X, and in pelvic splanchnic nerves arising from the ventral primary rami of spinal nerves S2, S3, and S4. The parasympathetic postsynaptic cell bodies are located in four pairs of ganglia in the head (associated with cranial nerves III, VII and IX), and otherwise in microscopic ganglia either on or in the wall of the target organ. The distribution of the parasympathetic nervous system is more limited than the sympathetic nervous system, with cranial nerves III, VII and IX supplying smooth muscle and glands of the head, the vagus nerve supplying the visceral organs up to the left colic flexure, and the pelvic splanchnics supplying the descending and sigmoid colon, rectum and pelvic viscera. With the exception of the external genitalia, the parasympathetic nervous system does not reach the body wall.