AUTONOMIC NERVOUS SYSTEM

Second year MBBS

2013 - 14

 The ANS is part of the

peripheral nervous system and
it controls many organs and
muscles within the body.
In most situations, we are
unaware of the workings of the
ANS because it functions in an
involuntary, reflexive manner.

The ANS is most important in two situations:

1- In

emergencies that cause stress

and require us to "fight" or take
"flight" (run away).

2- In no emergencies that allow us

to "rest" and "digest".

 The autonomic nervous system

provides an involuntary control of
internal environment and the
viscera.

 The
two
systems
are
anatomically separated form
each other, but functionally they
cannot perform their work
independently, and they work
with each other in an integrated
manner

Peripheral Nervous System

Somatic NS

Autonomic NS

Consists of nerves
connected to
sensory receptors
and skeletal
muscles
Permits voluntary
action (writing
your name)

Permits the
Involuntary functions
of blood vessels,
Glands and
internal organs e.g.:the bladder
stomach
heart

Characteristic

Somatic nervous
system

Autonomic N.
system

Effectors

Voluntary muscle

Cardiac muscle
glands, s. muscle

General functions

Adjustment to
Adjustment within
external environment internal environment

Numbers of neurons 1

Ganglia outside the

CNS

------------

Chain ganglia,
collateral ganglia or
terminal ganglia

Neurotransmitter

acetylcholine

Acetylcholine,
adrenaline,
noradrenaline

Center

Anterior Horn cells

Lateral Horn cells

Comparison of Autonomic and

Somatic Motor Systems
Autonomic nervous system
Chain of two motor neurons
Preganglionic neuron
Postganglionic neuron

Conduction is slower due to thinly or

unmyelinated axons

Pre-ganglionic

Post-ganglionic

Ganglion

Sympathetic N.S.

Parasympathetic N.S.

Like the accelerator of

your car

Like the brakes in your car

Slows the body down to
keep its rhythm

Mobilized the body for

action

Enables the body to

conserve and store energy

Preganglionic: short, synapse Preganglionic: long, synapse

within the lateral & collateral
within the terminal ganglia
ganglia
Postganglionic: long

Postganglionic: short

Has a wide distributions

Has a restricted distributions

 Often work in
opposition

Autonomic Nervous System

Cooperate to finetune homeostasis

Regulated by the
brain;
hypothalamus, pons
and medulla

Can also be
regulated by spinal
reflexes; no higher
order input
Pathways both
consist of a two
neuron system
Preganglionic neuron
from CNS

autonomic ganglion
outside CNS

postganglionic neuron

target

HypothalamusArt)
activates
Fig. 45.34(TE

sympathetic division of
nervous system
Heart rate, blood pressure,
and respiration increase
Adrenal medulla
secretes
epinephrine and
norepinephrine

Blood flow to
skeletal muscles
increases

Stomach
contractions
are inhibited

Sympathetic division
Fight or Flight, Dealing with
stress

thoracolumber,
intermediolateral column,
T1 -L2

Parasympathetic division
Rest and Digest
Craniosacral

S2-S4

Sympathetic nerve endings also activate the release of NE and E from the adrenal
medulla
Enhances effects of NE from sympathetic nerve endings
Adds the effects of E to the overall arousal (fight or flight) pattern

The Autonomic System

Sympathetic
Sometimes called the
thoracolumbar division
Short preganglionic neurons;
long postganglionic neurons;
ganglia are called the chain
ganglia
Preganglionic neurons secrete
Ach onto nicotinic receptors
Postganglionic neurons
secrete NE on to a or b
receptors
Target tissues are smooth
muscle, cardiac muscle,
endocrine glands, brown fat

Parasympathetic
Sometimes called the
cranio-sacral division
Long preganglionic
neurons;

short postganglionic
neurons (often in the
target organ)
Preganglionic neurons
secrete Ach on to
nicotinic receptors
Postganglionic neurons
secrete Ach on to
muscarinic receptors

Target tissues are

smooth muscle,
cardiac muscle,
exocrine glands, brown
fat

Anatomical Differences in Sympathetic

and Parasympathetic Divisions

Anatomical Differences in Sympathetic

and Parasympathetic Divisions

Similarities between Sympathetic & Parasympathetic

Both are efferent (motor) systems: visceromotor

Both involve regulation of the internal environment

generally outside
of
our
conscious
control:
autonomous
Both involve 2 neurons that synapse in a peripheral
ganglion and Innervate glands, smooth muscle, cardiac
muscle
glands

ganglion

CNS

smooth
muscle
preganglionic
neuron

postganglionic
neuron

cardiac
muscle

Differences between Sympathetic & Parasympathetic

Location of Preganglionic Cell Bodies

Sympathetic

Parasympathetic

Thoracolumbar

Craniosacral

T1 L2/L3 levels of
the spinal cord

Brain: CN III, VII, IX, X

Spinal cord: S2 S4

Differences between Sympathetic & Parasympathetic

Relative Lengths of Neurons
Sympathetic
CNS

target

ganglion

short preganglionic
neuron

long postganglionic
neuron

Parasympathetic

ganglion

CNS

long preganglionic
neuron

target

short postganglionic
neuron

Overview of the Autonomic Nervous System

Differences between Sympathetic & Parasympathetic
Neurotransmitters
NE (ACh at sweat glands),
Sympathetic
ACh, +

+ / -, & receptors

All preganglionics release acetylcholine (ACh) & are excitatory (+)

Symp. postgangl. norepinephrine (NE) & are excitatory (+) or inhibitory (-)
Excitation or inhibition is a receptor-dependent & receptor-mediated response

Parasympathetic

ACh, +

ACh, + / muscarinic receptors

Parasymp. postgangl. ACh & are excitatory (+) or inhibitory (-)

Overview of the Autonomic Nervous System

Differences between Sympathetic & Parasympathetic
Target Tissues
Sympathetic
Parasympathetic
Organs of head, neck,
Organs of head, neck,
trunk, & external genitalia
trunk, & external genitalia
Adrenal medulla
Sweat glands in skin
Arrector muscles of hair
ALL vascular smooth muscle
Sympathetic system is distributed to essentially all
tissues (because of vascular smooth muscle)
Parasympathetic system never reaches limbs or
wall (except for external genitalia)

body

Overview of ANS
Functional Differences
Sympathetic
Fight or flight
Catabolic (expend energy)

Parasympathetic
Feed & breed, rest &
digest
Homeostasis

Dual innervation of many

organs having a brake and an
accelerator provides more
control

The reflex arc

The autonomic reflex The somatic reflex

arc
arc
Origin

Lateral horn cells

Anterior horn cells

Efferent

Relay in autonomic
ganglia outside the
CNS.
------------------------

Supply the effector

organ directly.

Smooth , cardiac
muscles,glands

skeletal

Inter
neuron
Effector
organs

present

Visceral Reflex Arc

Autonomic motor reflex

Dorsal root
Fig. 45.32(TE
Art)

Interneuron

Spinal
cord

ganglion

Preganglionic
neuron

Postganglionic neuron

Viscera

Autonomic
ganglion
Sensory
neuron

Autonomic and Somatic Motor

Systems

Structure of spinal nerves: Sympathetic pathways

dorsal
ramus

intermediolateral
gray column

spinal
nerve

ventral
ramus

gray ramus
communicans
sympathetic
ganglion

white ramus
communicans

Sympathetic Division of the ANS

Sympathetic System: Preganglionic Cell Bodies

Preganglionic cell bodies in
intermediolateral gray
T1 L2/L3
Somatotopic organization
intermediolateral
gray columns

T1
L2/L3

lateral
horn

Clinical Relevance
dysfunction due to cord injury
spinal nerve impingement & OMM
referred pain

somatic tissues
(body wall, limbs)

visceral tissues
(organs)

Sympathetic System: Postganglionic Cell Bodies

1. Paravertebral ganglia
Located along sides of vertebrae
United by preganglionics into Sympathetic Trunk
Preganglionic neurons are thoracolumbar (T1L2/L3)
but postganglionic neurons are cervical to coccyx
Some preganglionics ascend or descend in trunk

Paravertebral
ganglia

sympathetic
trunk (chain)
synapse at
same level

Prevertebral
ganglia
celiac ganglion
sup. mesent. g.
inf. mesent. g.
ascend to
synapse at
higher level

descend to
synapse at
lower level

aorta

Sympathetic System: Postganglionic Cell Bodies

2. Prevertebral (preaortic) ganglia
Located anterior to abdominal aorta, in plexuses
surrounding its major branches
Preganglionics reach prevertebral ganglia via
abdominopelvic splanchnic nerves

Paravertebral
ganglia

sympathetic
trunk (chain)

Prevertebral
ganglia
abdominopelvic
splanchnic
nerve

celiac ganglion
sup. mesent. g.
inf. mesent. g.

aorta

Sympathetic Trunk Ganglia

Sympathetic System: Summary

visceral tissues
(organs)

1- Cervical division
4- somatic tissues

2- Cardiopulmonary Splanchnics:
postganglionic fibers to thoracic
viscera

(body wall, limbs)

T1

postganglionics
via 31 spinal nerves
to somatic tissues of
neck, body wall, and
limbs

sympathetic
trunk

3- Abdominopelvic Splanchnics:
preganglionic fibers to
prevertebral ganglia,
postganglionic fibers to
abdominopelvic viscera

L2

prevertebral
ganglia

1- Cervical division
Origin: T1-2
Course: preganglionic fibres reach the sympathetic
chain and then ascend upwards to relay
in the superior cervical ganglion.
Postganglionic neuron: pass from ganglion
to the following organs: EYE: pupil dilatation, widening of palpebral fissure, exophthalmos, Vasoconstriction
of eye b.v. and Relaxation of ciliary muscle.
Salivary gland : trophic secretion, Vasoconstriction of its blood vessels and
Squeezing of salivary secretion.
Lacrimal gland: Trophic secretion and Vasoconstriction.

Face skin blood vessel: Vasoconstriction of (Pale color).

Sweet secretion: copious secretion.
Hair: erection due to contraction of erector pilae muscles..
Cerebral vessels: Weak vasoconstriction

Sympathetic Pathways to the Head

(2) Cardiopulmonary division

Origin: Lateral horn cells of upper 4-5 thoracic segments.

Course: Preganglionic neurons reach the sympathetic chain to relay in
the three cervical ganglion and upper four thoracic ganglion.
The postganglionic arise from these ganglia supply the following
structures:-

Heart: Increase all properties of cardiac muscle (contraction,

rhythmicity, excitability, conductivity.
Coronary vessels, its sympathetic supply. At first it causes
vasoconstriction, and then it causes vasodilatation due to
accumulation of metabolites.

Bronchi: Broncho dilation, decrease bronchial secretions and

vasoconstriction of pulmonary blood vessels.

Sympathetic Pathways to Thoracic Organs

3- Splanchnic division
Origin: lateral horn cells of the lower six thoracic and upper four lumber segments.
Course: Preganglionic neurons originate from these segments reach the sympathetic chain
where they pass without relay, and then they divided into two branches:
(1) Greater splanchnic nerve
(2) Lesser splanchnic nerve.
Greater splanchnic nerve:
Origin: Preganglionic nerves fibers emerge from lateral horn cells of lower six thoracic
segments and then relay in the collateral ganglion in the abdomen.
Course: Postganglionic nerve fibers arise from these ganglia (celiac, superior mesenteric and
inferior mesenteric ganglia) and supply the abdominal organs causing the following effects:
Vasoconstriction: of most arteries of stomach, small intestine, proximal part of large
intestine, kidney, pancreas and liver.
Relaxation of the musculature of: stomach, small intestine and proximal part of large
intestine.
Contraction of sphincters: of the stomach and intestine leading to (food retention).
Contraction of the capsule: of the spleen leading to evacuation of about 200 ml of blood.
Breakdown of the glucose in the liver: (glycogenolysis) leading to increase of blood glucose
level.
Stimulation of adrenal medulla: Secrete adrenaline and noradrenalin.

Sympathetic Pathways to the Abdominal Organs

Sympathetic Pathways to the Pelvic Organs

(4) Somatic division

Origin: Preganglionic nerve fibers arise from all lateral horn
cells of all sympathetic segments, and then relay in the
cervical and sympathetic chain ganglia.
Course: Postganglionic nerve fibers emerge from these
ganglia proceeds outside the central nervous system to
return back to spinal cord to join the spinal nerve when it
comes out from the anterior horn cells, and supply the
following structures:
Skin:
Vasoconstriction giving the pale color of the skin.
Stimulation of the sweet glands, the eccrine glands give copious secretion,
while the apocrine glands give thick odoriferous secretion.
Hair erection.

Skeletal muscle:
Its blood vessels show vasodilatation (V.D.) due to cholinergic effect or
vasoconstriction (V.C.) due to a adrenergic effect.
The type of stimulation depends upon the nature of stimulation.
Muscles: its stimulation causing delayed fatigue and early recovery.

4- somatic tissues
(body wall, limbs)

postganglionics
via 31 spinal nerves
to somatic tissues of neck, body
wall, and limbs
sympathetic
trunk

Sympathetic Pathways to Periphery

Figure 15.9

The Role of the Adrenal Medulla in the

Sympathetic Division
Major organ of the sympathetic nervous
system
Secretes great quantities epinephrine (a little
norepinephrine)
Stimulated to secrete by preganglionic
sympathetic fibers

The Adrenal Medulla

Parasympathetic
Pathways
Cranial outflow
CN III, VII, IX, X
Four ganglia in head
Vagus nerve (CN X) is major
preganglionic parasymp. supply
to thorax & abdomen
Synapse in ganglia within wall of
the target organs (e.g.,
enteric
plexus of GI tract)

Sacral outflow
S2S4 via pelvic splanchnics
Hindgut, pelvic viscera, and
external genitalia
Clinical Relevance
Surgery for colorectal cancer
puts pelvic splanchnics at risk
Damage causes bladder &
sexual dysfunction

The Parasympathetic Division

Cranial outflow
Comes from the brain
Innervates organs of the head, neck, thorax, and
abdomen

Sacral outflow
Supplies remaining abdominal and pelvic organs

The Parasympathetic Division

Cranial Nerves
Attach to the brain and pass through foramina
of the skull
Numbered from IXII
Cranial nerves I and II attach to the forebrain
All others attach to the brain stem

Primarily serve head and neck structures

The vagus nerve (X) extends into the abdomen

The 12 Pairs of Cranial Nerves

CN III: Oculomotor Nerve

Innervates four of the extrinsic eye muscles

CN VII: Facial Nerve

Innervates muscles of facial expression
Sensory innervation of face
Taste

CN IX: Glossopharyngeal Nerve

Sensory and motor innervation of structures of

the tongue and pharynx
Taste

CN X: Vagus Nerve
A mixed sensory and motor nerve
Main parasympathetic nerve
Wanders into thorax and abdomen

Cranial Outflow
Preganglionic fibers run via:
Oculomotor nerve (III)
Facial nerve (VII)
Glossopharyngeal nerve (IX)
Vagus nerve (X)

Cell bodies located in cranial nerve nuclei in

the brain stem

CN III: Oculomotor Nerve

Origin: Edinger-Westphal nucleus at
midbrain.
Course:
preganglionic from E-W nucleus to rely
in the ciliary ganglion.
Postganglionic supply:
1- pupillconstrictor muscle
2- ciliary muscle.
3- four of the extrinsic eye muscles.
Its stimulation leads to miosis,
accommodation to neat vision and
movements of the eye ball.

CN III: Oculomotor Nerve

Innervates four of the extrinsic eye muscles

CN VII: Facial Nerve

Origin: The superior salivary nucleus which is a part of facial
nucleus in the lower part of pons.
Course: Preganglionic nerve fibers run in the chorda tympani
nerve which is a part of facial nerve and relay in:- Submaxillary ganglion
- Sphenopalatine ganglion.
Postganglionic nerve arises from Submaxillary ganglion
supply submandibular and sublingual salivary glands and
anterior 2/3 of the tongue.
Postganglionic nerve arises from Sphenopalatine ganglion
supply the mucosa of the soft palate and nasopharynx and
Lacrimal glands.
Its stimulation causes vasodilatation and secretion at their
effector organs.

CN VII: Facial Nerve

Innervates muscles of facial expression
Sensory innervation of face
Taste

CN IX: Glossopharyngeal Nerve

Origin: Glossopharyngeal nerve nucleus in the
upper part of the medulla oblongata called
inferior salivary nucleus, and then relay in the
otic ganglion.
Course: Postganglionic nerve fibers arise from
otic ganglion supply the parotid salivary gland
and posterior 1/3 of the tongue
Its stimulation causes vasodilatation and
secretion at their effector organs

CN IX: Glossopharyngeal Nerve

Sensory and motor innervation of structures of
the tongue and pharynx
Taste

CN X: Vagus Nerve
Origin: Dorsal vagus nucleus in medulla oblongata
Course: Postganglionic nerve fibers from the terminal ganglia
which supplied from dorsal vagus nucleus and supply the
following structures:
HEART: The vagus nerve supplies the both auricles and
don't supply the ventricles (and this called vagus escape
phenomena).
Its stimulation produces inhibition of all cardiac properties
(decrease heart rate, decrease contractility and decrease
conductivity).
Its stimulation causes vasoconstriction of coronary vessels and
reduction of O2 consumption by cardiac muscle.
These responses lead to bradycardia.

 Lungs: Vagus stimulation causes:

Bronchoconstriction.
Increased bronchial secretion.
Vasodilatation of pulmonary blood vessels.
These responses lead to precipitation of asthma.

Gastrointestinal tract: Vagus stimulation causes:

Contraction of walls of esophagus, stomach, small intestine and proximal
part of large intestine.
Relaxation of their corresponding sphincter.
These responses promote deglutition, increased secretion of GIT and
evacuation of foods.

Gall bladder: Vagus stimulation causes:

Contraction of the gall bladder wall.
Relaxation of its sphincter.
These responses lead to evacuation of the gall bladder.

CN X: Vagus Nerve

Sacral Outflow
Origin: Preganglionic nerve fibers arise from the lateral
horn cells of the 2nd, 3rd and 4th sacral segments.
Course: These preganglionic passes without relay, then the
right and left branches unit together to form the pelvic
nerve, the pelvic nerve relay in the terminal ganglia,
where the postganglionic nerve fibers emerge and
supply the following structures:Urinary bladder: parasympathetic stimulation causes:
- Contraction of the bladder wall
- Relaxation of its sphincter.
- These responses lead to micturition.

Rectum and descending colon:

parasympathetic stimulation causes:
- Contraction of its wall.
- Relaxation of internal anal sphincter.
- These responses lead to defecation.
Seminal vesicles and prostate:
parasympathetic stimulation -causes:
- Secretion of these glands.
Erectile tissue: parasympathetic stimulation causes:
- Vasodilatation which lead to erection.

Neurotransmitter release sites

Acetylcholine receptors

Two types of cholinergic receptors are well known:

Nicotinic receptors which are easily activated by agonist
molocule such as nicotine and
Muscarinic receptors: which are sensitive to muscarine.

Cholinergic receptors
Nicotinic receptors
(Central)

Muscarinic receptors
(peripheral )

Types

Two types:Ganglionic
Neruomuscular

M1, M2 (cardiac), M3
(glandular&smooth
muscle) M4
(brain).M5,M6 and M7.

Stimulated
by

Nicotine in small
doses, Ach,
metacholine

Muscarine, Ach,
carbarcholine

Blocked by

Nicoitin in large doses- Atropine

decameyhonium
scopolamine
d-tubourarine-

site

Autonomic ganglia
M.E.P
Adrenal medulla
Preganglionic neuron.

Parasympathetic
(pre-postganglionic)
Sympathetic
postganglionic nerve
endings (sweat glands
& skeletal muscle).

Nicotinic Receptors
Located in the ganglia of both the
PSNS and SNS
Named nicotinic because can be stimulated
by the alkaloid nicotine

Muscarinic Receptors
Located postsynaptically:
Smooth muscle
Cardiac muscle
Glands of parasympathetic fibers
Effector organs of cholinergic sympathetic fibers

Named muscarinic because can be

stimulated by the alkaloid muscarine

Comparison of sympathetic and

Parasympathetic Pathways

Neurotransmitters
Receptors