OF

CHEST, ABDOMINAL & PELVIC

ORGANS
NERVOUS SYSTEM :
I.CENTRAL NERVOUS SYSTEM:
- ENCEPHALON
- MEDULLA SPINALIS
II. PERIPHERAL NERVOUS SYSTEM:
- SOMATIC NERVOUS SYSTEM
* CRANIAL NERVES : 12
* SPINAL NERVES : 31
- AUTONOMIC NERVOUS SYSTEM:
* SYMPATHETIC SYSTEM
* PARASYMPATHETIC SYSTEM
SNS, PNS, and ANS

􀂄 SNS and ANS are both part of the

peripheral nervous system (PNS).

􀂄 SNS operates under our conscious control.

􀂄 ANS functions are involuntary.

Comparison of SNS and ANS
􀂄 SNS uses both somatic sensory and somatic motor
neurons to conduct stimulus information from a
sensory receptor, such as a tactile receptor in the skin.
􀂄 Somatic motor neurons innervate skeletal muscle
fibers.
􀂄 ANS also utilizes sensory and motor neurons.
􀂄 Visceral sensory neurons provide input to activate the
ANS.
 Comparison of SNS and ANS
ANS
 Innervate the viscera ,smooth
muscle and glands
 Aferens fiber and its eferents
called viscero aferents and
viscero eferents
 Impulse delivered by more
than one neuron
 ANS functions are
involuntary.
SNS
 Innervate the skin,skeletal
muscle and joints
 Aferens fiber and its eferents
called somato aferents and
somato eferents
 Impulse delivered by single
neuron
 SNS operates under our
conscious control.
Divisions of the ANS
􀂄 ANS is subdivided into parasympathetic and sympathetic
divisions.

􀂄 Divisions are similar in that they both use a preganglionic

neuron and a ganglionic neuron to innervate muscles or
glands.

􀂄 Both contain the autonomic ganglia that house the

ganglionic neurons.

􀂄 Both are involuntary and are concerned with the body’s

internal environment.

􀂄 Divisions perform dramatically different functions.

 Divisions of the ANS
The Parasympathetic Division
􀂄 Also termed the craniosacral
division.
􀂄 Primarily concerned with
conserving energy and replenishing
nutrient stores.
􀂄 nicknamed the “rest-and-digest”
division
􀂄 Participates along with the
sympathetic division in
maintaining homeostasis (a
constant internal environment).
The Sympathetic Division
􀂄 Also termed the thoracolumbar
division.
􀂄 Primarily concerned with
preparing the body for
emergencies.
􀂄 referred to as the “fight-or-flight”
division
􀂄 Increased sympathetic activity
results in the increased alertness
and metabolic activity necessary for
these activities as well as in times of
fear.
Anatomic Differences
􀂄 Divisions are distinguished by several anatomic differences.

􀂄 Preganglionic neuron cell bodies are housed in different

regions of the CNS.

􀂄 Parasympathetic preganglionic neurons originate in either

the brainstem or the lateral gray matter of the S2–S4 spinal
cord regions.

􀂄 Sympathetic preganglionic neurons originate in the lateral

horns of the T1–L2 spinal cord regions
Parasympathetic division
 Anatomic Differences

􀂄 Parasympathetic division is structurally more simple than the

sympathetic division.
􀂄 Parasympathetic division is also termed the craniosacral division because
its preganglionic neurons are housed within nuclei in the brainstem and
within the lateral gray regions of the S2–S4 spinal cord segments.
􀂄 Ganglionic neurons in the parasympathetic division are found in
- either terminal ganglia, which are located close to the target
organ, or
- intramural ganglia, which are located within the wall of the
target organ
 Cranial Nerves
􀂄 Associated with the parasympathetic division are
the oculomotor (CN III), facial (CN VII),
glossopharyngeal (CN IX), and vagus (CN X)

􀂄 First three of these nerves convey parasympathetic

innervation to the head.

􀂄 Vagus nerve is the source of parasympathetic

stimulation for the thoracic and most abdominal organs.
Spinal Nerves
􀂄 Target organs innervated include:
the distal portion of the large intestine, the rectum,
most of the reproductive organs, the urinary bladder,
and the distal part of the ureter.

􀂄 Parasympathetic innervation causes

increased smooth muscle motility (muscle
contraction) and secretory activity in digestive tract
organs, contraction of smooth muscle in the bladder
wall, and erection of the female clitoris and the male
penis
Effects and General Functions of the Parasympathetic
Division

􀂄 Parasympathetic division is most active during times when

the body must process nutrients and conserve energy.

􀂄 Lack of extensive divergence in preganglionic axons prevents

the mass activation seen in the sympathetic division.

􀂄 Effects of the parasympathetic nervous system tend to be

discrete and localized.

􀂄 Parasympathetic activity can affect one group of organs

without necessarily having to “turn on” all other organs.
Sympathetic Division
Organization and Anatomy of the Sympathetic
Division

􀂄 Much more complex than the parasympathetic division,

both anatomically and functionally.

􀂄 Sympathetic preganglionic neuron cell bodies are

housed in the lateral horn of the T1–L2 regions of the
spinal cord.

􀂄 Preganglionic sympathetic axons remain with the spinal

nerve for merely a short distance before they branch off
and leave the spinal nerve.
Left and Right Sympathetic Trunks
􀂄 Immediately anterior to the paired spinal nerves are the left
and right sympathetic trunks.

􀂄 Each is located immediately lateral to the vertebral column.

􀂄 A sympathetic trunk looks much like a pearl necklace.

the “string” of the “necklace” is composed of bundles of axons

􀂄 the “pearls” are the sympathetic trunk (or paravertebral)

ganglia, which house sympathetic ganglionic neuron cell
bodies
􀂄 White Rami Connecting the spinal nerves to each
sympathetic trunk are rami communicantes.

􀂄 Gray Rami Carry postganglionic sympathetic axons

from the sympathetic trunk to the spinal nerve.
 Splanchnic Nerves
􀂄 Composed of preganglionic sympathetic axons.

􀂄 Run anteriorly from the sympathetic trunk to most of the viscera.

􀂄 Should not be confused with the pelvic splanchnic nerves

associated with the parasympathetic division.

Larger splanchnic nerves have specific names:

􀂄 greater thoracic splanchnic nerves

􀂄 lesser thoracic splanchnic nerves

􀂄 least thoracic splanchnic nerves

􀂄 lumbar splanchnic nerves

􀂄 sacral splanchnic nerves

 Splanchnic Nerves
􀂄 Terminate in prevertebral (or collateral) ganglia.

􀂄 Called “prevertebral” because they are immediately anterior to

the vertebral column on the anterolateral wall of the
abdominal aorta.

􀂄 Prevertebral ganglia typically cluster around the major

abdominal arteries and are named for these arteries.
Example: celiac ganglia cluster around the celiac trunk

􀂄 Sympathetic postganglionic axons extend away from the

ganglionic neuron cell bodies in these ganglia and innervate
many of the abdominal organs.
Dual Innervation by the Parasympathetic and
Sympathetic Divisions of the ANS

􀂄 Innervate organs through specific axon bundles called

autonomic plexuses.

􀂄 Communication by chemical messengers, called

neurotransmitters.

􀂄 specific in each division of the autonomic nervous system

􀂄 Usually all organs are innervated by both divisions of the

autonomic nervous system.

􀂄 Maintains homeostasis through autonomic reflexes that

occur in the innervated organs.
 Autonomic Plexuses
􀂄 Collections of sympathetic postganglionic axons and
parasympathetic preganglionic axons, as well as some
visceral sensory axons.

􀂄 Close to one another, but they do not interact or

synapse with one another.

􀂄 Provide a complex innervation pattern to their target

organs.
 Plexuses
􀂄 Cardiac plexus, increased sympathetic activity increases heart
rate and blood pressure, while increased parasympathetic
activity decreases heart rate
􀂄 Pulmonary Plexus, parasympathetic pathway causes
bronchoconstriction and increased secretion from mucous
glands of the bronchial tree, sympathetic innervation causes
bronchodilation
􀂄 Esophageal Plexus, parasympathetic axons control the
swallowing reflex
􀂄 Abdominal aortic plexus, consists of the celiac plexus,
superior mesenteric plexus, and inferior mesenteric plexus
􀂄 Hypogastric plexus
 Neurotransmitters and Receptors
􀂄 Two neurotransmitters are used in the ANS.

- acetylcholine (ACh)

- norepinephrine (NE)

􀂄 Neurotransmitters are released by the presynaptic cell.

􀂄 Bind to specific receptors in the postsynaptic cell membrane.

􀂄 Binding has either an excitatory or an inhibitory effect on the

effector, depending on the specific receptor.
Autonomic Fibers and Ganglia
Key
9. Celiac trunk and ganglion
10. Superior mesenteric artery and
ganglion
13. Superior hypogastric plexus and
ganglion
32. Lesser splanchnic nerve
33. Lumbar splanchnic nerves
34. Sacral splanchnic nerves
35. Inferior hypogastric ganglion and
plexus
37. Aorticorenal plexus and renal
artery
38. Ganglion impar
Innervation of the lungs
 Innervation is via the pulmonary plexuses located anterior and
posterior to the lung roots.
 The plexuses contain postganglionic sympathetic fibers from the
sympathetic trunks that innervate the smooth muscle of the bronchial
tree, pulmonary vessels, and glands of the bronchial tree.
 Sympathetic fibers are bronchodilators, vasoconstrictors, and inhibit
glandular secretion.
 The plexuses contain preganglionic parasympathetic fibers from the
vagus nerve (CN X), small parasympathetic ganglia, and postganglionic
parasympathetic nerves that innervate the smooth muscle of the
bronchial tree, pulmonary vessels, and glands of the bronchial tree.
 Parasympathetic fibers are bronchoconstrictors, vasodilators, and
secretomotor to the glands.
 Visceral afferent fibers carry information involved in cough reflexes,
stretch reception, blood pressure, chemoreception, and nociception
 INNERVATION OF HEART
Both divisions of the autonomic nervous system provide
fibers to the cardiac plexuses superficial and deep.

I. Sympathetic components :
1. N. CARDIACUS SYMPATHICUS CERVICALIS SUPERIOR
2. N. CARDIACUS SYMPHATICUS CERVICALIS MEDIUS
3. N. CARDIACUS SYMPATHICUS CERVICALIS INFERIOR
4. Nn. CARDIACI SYMPATHICI THORACII

II. Parasympathetic components :

1. N. CARDIACUS VAGALIS CERVICALIS SUPERIOR
2. N. CARDIACUS VAGALIS CERVICALIS INFERIOR
3. Nn. CARDIACI VAGALIS THORACICA.
Abdominal Organs
 Esophagus, Stomach
 Parasympathetic supply
 From anterior and posterior vagal trunks
 Increase peristalsis and relax pyloric sphincter

 Sympathetic supply
 From T6–T9 spinal cord segments via great splanchnic
nerve to celiac plexus
 Inhibit peristalsis and contract pyloric sphincter

 Nociception via greater splanchnic nerves (T5-9) for

stomach
 DUODENUM
 Parasympathetic supply from the vagus via celiac and
superior mesenteric plexuses
 Sympathetic supply via celiac and superior mesenteric
plexuses, traveling on pancreaticoduodenal arteries
 Nociception via greater splanchnic nerves (T5-9) for
proximal duodenum and T8-11 splanchnics for distal
duodenum
 JEJUNUM AND ILEUM
 Parasympathetic supply
 Preganglionic fibers from the posterior vagal trunks
 Synapse on postganglionic cells in myenteric and
submucosal plexuses in intestinal wall
 Sympathetic supply
 Preganglionic fibers from T5–T9 spinal cord segments
→ sympathetic trunks → greater and lesser
splanchnic nerves
 Synapse on postganglionic cells in celiac and superior
mesenteric ganglia
 Nociception via sympathetic afferents in splanchnic nerves to
superior mesenteric plexus T8-12
 LARGE INTESTINE
 CECUM: sympathetic and parasympathetic nerves from the
superior mesenteric plexus
 ASCENDING COLON : from the superior mesenteric plexus
 TRANVERSE COLON :
 Superior mesenteric plexus along right and middle colic arteries
 Inferior mesenteric plexus along left colic arteries
 DESCENDING COLON:
 Sympathetic fibers from the lumbar sympathetic trunk and
superior hypogastric plexus
 Parasympathetic fibers from the pelvic splanchnic nerves
 SIGMOID :
 Sympathetic fibers from the lumbar sympathetic trunk and
superior hypogastric plexus
 Parasympathetic fibers from the pelvic splanchnic nerves
Large intestine

 Nociception to transverse colon via sympathetic

afferents from T8-12 splanchnics to superior and
inferior mesenteric plexuses
 Descending and sigmoid colon via superior
hypogastric plexus and parasympathetic afferents
to the pelvic plexus at S2-S4
 Note that there are some nociceptive afferents with the
vagus
Diagrams of Innervation of Colon
 LIVER AND GALL BLADDER
 LIVER :
 Sympathetic fibers from celiac plexus
 Parasympathetic fibers from anterior and posterior vagal
trunks
 GALL BLADDER :
 Sympathetic from celiac plexus
 Parasympathetic from vagus
Liver and Biliary Tree
 Liver
 Hepatic Plexus - largest derivative of celiac plexus
 Biliary Ducts
 Nociception via sympathetic fibers and right splanchnic
nerves from T6-10
 Vagus nerve plays no role in pain transmission
 Inflammatory biliary disease stimulates afferent fibers of
the parietal peritoneum causing somatic pain in the T6-9
distribution (RUQ)
 Pancreas and Spleen
 Pancreas:
 From the vagus
 From thoracic
splanchnic nerves
 Nociception via
splanchnic nerves T5-9
through celiac plexus
 Vagal afferents do not
mediate pancreatic
pain
Spleen :
 Derived from the
celiac plexus
 Travels along
branches of splenic
artery
 Vasomotor function
 Kidneys and Ureters
 Kidneys
 Lesser and least splanchnic nerves
 Celiac plexus
 Aorticorenal plexus
 Adrenals
 Greater, lesser and least slanchnics
 Celiac plexus
 Ureters
 Nociceptive fibers with sympathetics in renal, aortic and
superior and inferior hypogastric plexuses
Pelvic Organs and Innervation
Pelvic Autonomics
 Superior hypogastric plexus (presacral nerve)
 Contains no parasympathetics
 Hypogastric nerve
 Inferior hypogastric plexus
 Contains parasympathetic fibers from the pelvic
splanchnics
 Ganglion impar
Innervation of the Bladder
 Sympathetics
 T12, L1, L2
 Parasympathetics
 Pelvic splanchnic nerves
 Nervi erigentes
 S 2, 3, 4
 Nociceptive afferents
 Sacral roots (S 2, 3, 4)
 Not sympathetics
 Innervation of Uterus, Cervix and Ovaries

 Uterovaginal plexus from superior and inferior

hypogastric plexuses
 Sympathetic, parasympathetic and somatic afferent
 Fundus and body (intraperitoneal) - Inferior and
superior hypogastric plexuses
 Cervix (subperitoneal)
 Inferior hypogastric plexus to pelvic (splanchnic)
nerves (S2-S4) (most texts)
 Bonica: LUS and CX same as fundus

 Ovaries - afferents with hypogastric plexuses

(T10-11)
 Innervation of the Vagina
 Superior 3/4ths
 Uterovaginal plexus
 Pelvic plexus (sacral fibers)
 Lower 1/4th
 Pudendal nerve via sacral fibers
 Perineum
 Pudendal nerve
Innervation of Prostate, Testes and Scrotum
 Prostate
 Prostatic plexus
 Inferior hypogastric plexus
 Testicle (T10)
 Vas deferens (T10-L1)
 Epididymis (T11-12)
 Prostate (Prostatic plexus; similar to bladder)
 Scrotum
 Ilioinguinal and genitofemoral
 Perineal nerve (branch of pudendal)
Rectum, Anus and Perineum
 Sympathetics
 Superior and inferior hypogastric plexuses
 Parasympathetics
 Pelvic splanchnic nerves
 Nociceptive afferents
 Pudendal nerve (somatic)
 Also with pelvic splanchnic nerves
 Anus
 Inferior rectal nerve via pudendal
 Perineum by pudendal and branches
Pudendal Nerve
 Supplies skin, organs and
muscles of perineum
 Distribution similar in
males and females
 Pudendal nerve blockade
 Medial to ishial tuberosity
at sacrospinous ligament
 Transvaginal
 Functions
 Micturation
 Defecation
 Erection
 Ejaculation
 Parturition
 THANK YOU
FOR YOUR ATTENTION