The Autonomic Nervous System

1. The Autonomic Nervous System

2. The autonomic nervous system is concerned with the innervation of viscera, glands, blood vessels & non striated muscle. • The peripheral autonomic nervous system is comprised of - sympathetic system(thoracolumbar outflow) - parasympathetic system (craniosacral outflow)

3. GENERAL ARRANGEMENT • EFFERENT AUTONOMIC NERVE FIBRES • All efferent fibres of the sympathetic & parasympathetic nervous system are interrupted in their course by a synapse in the peripheral ganglion. • The preganglionic fibres are medullated while the post ganglionic fibres are non medullated. • The preganglionic fibres synapse with the nerve cells in a) The paravertebral sympathetic trunk b) Prevertebral nerve plexuses c) Adrenal medulla

4. In the parasympathetic nervous system, the preganglionic cranial fibres arise from the Edinger-Westphal(IIIrd nerve), salivary (7th & 9th nerves)ambiguus & dorsal motor (10th nerve) nuclei in the brain stem. • The preganglionic sympathetic fibres are usually short & synapse with many post ganglionic nerves. In contrast poreganglionic parasympathetic fibres which are long & synapse with only few post ganglionic fibres

5. AFFERENT AUTONOMIC NERVE FIBRES • These fibres subserve the following functions- • Visceral reflexes which usually do not reach the level of consciousness like breathing • Vascular reflexes like carotid sinus reflex in response to arterial pressure • Organic visceral sensations such as hunger or visceral distension • Visceral pain which is poorly localised & described as dull but can be severe & varying in intensity

6. TRANSMITTER SUBSTANCES • SYMPATHETIC NERVOUS SYSTEM • Preganglionic nerve endings- Acetylcholine • Postganglionic nerve endings- Noradrenaline PARASYMPATHETIC NERVOUS SYSTEM Acetlycholine is the transmitter substance

7. THE SYMPATHETIC NERVOUS SYSTEM

8. Sympathetic nervous system“fight, flight or fright” • Also called thoracolumbar system: all its neurons are in lateral horn of gray matter from T1-L2 • Lead to every part of the body (unlike parasymp.) • Easy to remember that when nervous, you sweat; when afraid, hair stands on end; when excited blood pressure rises (vasoconstriction): these sympathetic only • Also causes: dry mouth, pupils to dilate, increased heart & respiratory rates to increase O2 to skeletal muscles, and liver to release glucose • Norepinephrine (aka noradrenaline) is neurotransmitter released by most postganglionic fibers (acetylcholine in preganglionic): “adrenergic”

9. Sympathetic nervous system continued • Regardless of target, all begin same • Preganglionic axons exit spinal cord through ventral root and enter spinal nerve • Exit spinal nerve via communicating ramus • Enter sympathetic trunk/chain where postganglionic neurons are • Has three options…

10. Options of preganglionic axons in sympathetic trunk (see next slides for drawing examples) • Synapse on postganglionic neuron in chain ganglion then return to spinal nerve and follow its branch to the skin • Ascend or descend within sympathetic trunk, synapse with a posganglionic neuron within a chain ganglion, and return to spinal nerve at that level and follow branches to skin • Enter sympathetic chain, pass through without synapsing, form a splanchnic nerve that passes toward thoracic or abdominal organs • These synapse in prevertebral ganglion in front of aorta • Postganglionic axons follow arteries to organs

11. Synapse in chain ganglia at same level or different level

12. Visceral sensory The Autonomic Nervous System & Visceral motor

13. Autonomic nervous system • The autonomic nervous system is the subdivision of the peripheral nervous system that regulates body activities that are generally not under conscious control • Visceral motor innervates non-skeletal (non-somatic) muscles • Visceral sensory will be covered later

14. To repeat… • ANS is the subdivision of the peripheral nervous system that regulates body activities that are generally not under conscious control • Visceral motor innervates non-skeletal (non-somatic) muscles • Composed of a special group of neurons serving: • Cardiac muscle (the heart) • Smooth muscle (walls of viscera and blood vessels) • Internal organs • Skin

15. Basic anatomical difference between the motor pathways of the voluntary somatic nervous system (to skeletal muscles) and those of the autonomic nervous system • Somatic division: • Cell bodies of motor neurons reside in CNS (brain or spinal cord) • Their axons (sheathed in spinal nerves) extend all the way to their skeletal muscles • Autonomic system: chains of two motor neurons • 1st = preganglionic neuron (in brain or cord) • 2nd = gangionic neuron (cell body in ganglion outside CNS) • Slower because lightly or unmyelinated (see next diagram)

16. Axon of 1st (preganglionic) neuron leaves CNS to synapse with the 2nd (ganglionic) neuron • Axon of 2nd (ganglionic) neuron extends to the organ it serves Diagram contrasts somatic (lower) and autonomic: autonomic this dorsal root ganglion is sensory somatic Note: the autonomic ganglion is motor

17. Divisions of the autonomic nervous system (visceral motor part of it) • Parasympathetic division • Sympathetic division

18. Divisions of the autonomic nervous system • Parasympathetic division • Sympathetic division Serve most of the same organs but cause opposing or antagonistic effects Parasysmpathetic: routine maintenance “rest &digest” Sympathetic: mobilization & increased metabolism “fight, flight or fright” or “fight, flight or freeze”

19. Where they come from Sympathetic: thoracolumbar Parasympathetic: craniosacral

20. Parasympathetic nervous system“rest & digest” • Also called the craniosacral system because all its preganglionic neurons are in the brain stem or sacral levels of the spinal cord • Cranial nerves III,VII, IX and X • In lateral horn of gray matter from S2-S4 • Only innervate internal organs (not skin) • Acetylcholine is neurotransmitter at end organ as well as at preganglionic synapse: “cholinergic”

21. Parasympathetic continued • Cranial outflow • III - pupils constrict • VII - tears, nasal mucus, saliva • IX – parotid salivary gland • X (Vagus n) – visceral organs of thorax & abdomen: • Stimulates digestive glands • Increases motility of smooth muscle of digestive tract • Decreases heart rate • Causes bronchial constriction • Sacral outflow (S2-4): form pelvic splanchnic nerves • Supply 2nd half of large intestine • Supply all the pelvic (genitourinary) organs

22. Parasympathetic (only look at this if it helps you)

23. Pass through ganglia and synapse in prevertebral ganglion

24. Sympathetic

25. Adrenal gland is exception On top of kidneys Adrenal medulla (inside part) is a major organ of the sympathetic nervous system

26. Adrenal gland is exception • Synapse in gland • Can cause body-wide release of epinephrine aka adrenaline and norepinephrine in an extreme emergency (adrenaline “rush” or surge)

27. Summary

28. Visceral sensory system Gives sensory input to autonomic nervous system

29. Visceral sensory neurons • Monitor temperature, pain, irritation, chemical changes and stretch in the visceral organs • Brain interprets as hunger, fullness, pain, nausea, well-being • Receptors widely scattered – localization poor (e.g. which part is giving you the gas pain?) • Visceral sensory fibers run within autonomic nerves, especially vagus and sympathetic nerves • Sympathetic nerves carry most pain fibers from visceral organs of body trunk • Simplified pathway: sensory neurons to spinothalamic tract to thalamus to cerebral cortex • Visceral pain is induced by stretching, infection and cramping of internal organs but seldom by cutting (e.g. cutting off a colon polyp) or scraping them

30. Referred pain: important to know Plus left shoulder, from spleen Pain in visceral organs is often perceived to be somatic in origin: referred to somatic regions of body that receive innervation from the same spinal cord segments Anterior skin areas to which pain is referred from certain visceral organs

31. Visceral sensory and autonomic neurons participate in visceral reflex arcs • Many are spinal reflexes such as defecation and micturition reflexes • Some only involve peripheral neurons: spinal cord not involved (not shown)* *e.g. “enteric” nervous system: 3 neuron reflex arcs entirely within the wall of the gut

32. Central control of the Autonomic NS Amygdala:main limbic region for emotions -Stimulates sympathetic activity, especially previously learned fear-related behavior -Can be voluntary when decide to recall frightful experience - cerebral cortex acts through amygdala -Some people can regulate some autonomic activities by gaining extraordinary control over their emotions Hypothalamus: main integration center Reticular formation: most direct influence over autonomic function

33. SURGICAL SYMPATHECTOMY

34. INDICATIONS • Peripheral vascular disease-It maybe be used in organic occlusion of arteries in which direct vascular surgery will not relieve obstruction.It is also used in certain vasospastic conditions like Raynauds disease • Hyperhidrosis- gross sweating of the hands, axillae & feet. Sympathectomy gives permanent relief • Relief of Pain – a)Visceral Pain: Excision of Coeliac ganglion or its destruction by injection of absolute alchohol or phenol has been used to relieve pain of pancreatic cancer or chronic pancreatitis b) Causalgia: Characterised by intense pain at the site pf previous injury or operation.

35. CERVICOTHORACIC SYMPATHECTOMY • It is the upper thoracic & cervical sympathectomy • Aim is to obtain sympathetic denervation of the upper limb without diving the occulopupillary fibres • The sympathetic supply to the upper limb comes from T2-T6. • This is achieved by either Ganglionectomy or Division of the rami

36. Ganglionectomy