Anatomy of the Autonomic

System
Dr Arthur Saniotis
 AUTONOMIC SYSTEM

Regulates activity
1. smooth muscle
2. cardiac muscle
3. glands
Operates without
conscious control

Named autonomic
because was thought
to be AUTONOMUS
(working without
CNS)
But to operate it 1. Visceral organs
depends on
continuous flow of 2. Blood vessels (not consciously perceived) into INTEGRATING CENTERS IN THE CNS
sensory input from:
Structurally then ANS includes:
• Autonomic sensory neurons
• Integrating centers in the CNS (Hypothalamus and brain
stem)
• Autonomic motor neurons to smooth muscle, cardiac muscle
and glands

Structurally then ANS includes:

Comparing the ANS (autonomic SOMATIC
neurons) and Somatic NS (somatic
neurons)
• Somatic sensory neurons
• Integrating centers in the CNS
(Cortex)
• Somatic motor neurons to
skeletal muscles only AUTONOMIC

• Somatic- the effect of a motor

neuron is always excitation
• Autonomic- the effect of a motor
neuron is either excitatory or
inhibitory
• Makes all routine adjustments in
physiological systems
• The ANS pathway from the CNS
to the effector always involves 2
neurons synapsing in an
autonomic ganglion
• Preganglionic (neuron #1) –
cell body is in the CNS, axon
extends to the ganglion
outside the CNS
• Postganglionic (neuron #2) –
cell body is in the ganglion,
axon extends to the visceral
effector
 Preganglionic (neuron #1)
• Always myelinated
• Neurotransmitter is always ACh
Postganglionic (neuron #2)
• Always nonmyelinated
• Neurotransmitter is Ach or norepinephrine
 A neuron found in the
sympathetic nervous
system has:
SHORT myelinated axon –
> ganglion –> LONG
unmyelinated axon

A neuron found in the

parasympathetic nervous
system has:
LONG myelinated axon –>
ganglion –> SHORT
unmyelinated axon
 DIVISIONS OF ANS

ANS is composed of 2 sub-divisions:

1. SYMPATHETIC SYSTEM
2. PARASYMPATHETIC SYSTEM
• Each division has a different set of responses to smooth muscle,
cardiac muscle and glands

1. Sympathetic Division = Fight-or-flight

The body is activated in an excitatory mode

2. Parasympathetic Division = Rest-and-digest

The body is activated in an inhibitory mode
SYMPATETHIC PARASYMPATHETIC
1. Heart rate increased 1. Heart rate is slowed
2. Broncho-dilation 2. Broncho-constriction
3. Stimulates secretion 3. Stimulates salivation
of production
• Mineralcorticoids 4. Vasodilation
• Glutocorticoids 5. Stimulates digestion
• Epinephrine 6. Sphincters relaxed
• Norepinephrine 7. Stimulates erection
4. Increases sweat
production
5. Increases
gluconeogenesis
6. Vasoconstriction =
increase in blood
pressure
7. Inhibits GI system
8. Contraction of
sphincters
9. Stimulates ejaculation
 ANATOMY OF SYMPATHETHIC SYSTEM

Sympathetic division (thoracolumbar)

• Sympathetic division = Cell bodies of preganglionic sympathetic neurons are
located in the intermediolateral nucleus in the lateral horn from T1-L2
• Axons of these cells exit the spinal cord in the anterior root via the white
rami communicantes
• White rami communicantes are found from T1-L2 and are myelinated
• Preganglionic nerves travel to the paravertebral ganglia of the sympathetic
trunk
• Ganglia in the sympathetic chain are paired and extend either side of the
vertebral column from the cervical region to the coccyx
• This chain is also referred to as the paravertebral ganglion
• Carries preganglionic fibers and cell bodies of postganglionic neurons
Sympathetic division has 2 types of rami communicantes
which the spinal nerves connect to the sympathetic chain
• White rami communicantes = contain preganglionic nerve fibers
• Are only found in sympathetic ganglia between T1-L2 and are
myelinated
• Gray rami communicantes = contain postganglionic nerve fibers
• Are unmyelinated
• Gray rami communicantes are distributed in the branches of spinal
nerves to smooth muscles in blood vessels, sweat glands, and erector
muscles of the hair and skin
• Are found in all sympathetic ganglia
 3 pathways of the Sympathetic System

Number 1 pathway
• Cell bodies of preganglionic
sympathetic neuron lie in the
lateral gray horns of the spinal cord
• Preganglionic sympathetic fibers
leave the spinal cord via the ventral
root
• These axons pass to the spinal
nerve
• Axons leave the spinal nerve via
the white ramus communicantes)
• Synapse with the sympathetic
chain ganglia at the same level
• Postganglionic sympathetic fibers
exits at that level via the gray
ramus communicans, to the
visceral effector
Number 2 pathway
• Preganglionic
sympathetic fibers can
travel up or down the
sympathetic trunk where
it where it can synapse
with a postganglionic
sympathetic neuron
• Postganglionic
sympathetic fibers leaves
at that other level via the
gray ramus
communicantes, and exits
to the visceral effector
Number 3 pathway
Preganglionic sympathetic fibers passes
through the sympathetic trunk without
synapsing
Synapses in a collateral ganglion near a
major blood vessel near to the effector
These are referred to as splanchnic
nerves
Splanchnic nerves have
sympathetic preganglionic fibers which
are myelinated
Splanchnic nerves are paired visceral
nerves
Carry visceral efferent fibers (motor
fibers) and visceral afferent fibers
(sensory fibers)
Sympathetic splanchnic nerves
are divided into 3 types:
1. Greater splanchnic (T5-T9)
• Synapse at the celiac plexus,
renal plexus and suprarenal
medulla
1. Lesser splanchnic (T10-
T11)
• Synapse at lower part of
celiac plexus
1. Least splanchnic (T12)
Synapse at renal plexus
Superior Cervical Ganglion
Located posteriorly to the carotid artery,
and anterior to the C1-4 vertebrae
Located near the angle of the mandible
and bifurcation of the common carotid
artery
Internal carotid nerve
• Located along the internal carotid
artery, forming a network of nerves
(internal carotid plexus) to innervate
tarsal muscle of the eyelid
External carotid nerve – hitch-hikes along
the common and external carotid
arteries, forming a network of nerves
It innervates the smooth muscle of the
arteries
HORNER’S SYNDROME
Causes:
MIOSIS PTOSIS
1. Pancoast tumor – tumor in the apex of
lung which compressing against
superior cervical ganglion
Characterized by:
1. Miosis (a constricted pupil)
• Dilator pupilae muscle affected
• Innervated by internal carotid plexus from
the superior cervical ganglion
2. Partial ptosis (a weak, droopy eyelid)
tarsal muscle of the eyelid affected
3. Anhydrosis (decreased/loss of sweating)
Due to disruption of sympathetic nerves of
face/neck
4. Enophthalmos (inset eyeball due to
ptosis)
Possibly caused by affected orbitalis muscle
located at the posterior orbit which is
innervated by sympathetic nerves
Afferent sympathetic nerve fibers

These are myelinated nerve fibers

They do not have their cell bodies in sympathetic ganglia

They have their cell bodies in the posterior root ganglia of spinal nerves

The peripheral processes travel from the viscera through some plexus or subsidiary
ganglia with which the efferent fibers were involved

Then they enter sympathetic ganglia without synapsing

They pass to the spinal nerve via white rami communicantes and reach their cell
bodies in the posterior root ganglion of the corresponding somatic spinal nerve
• Visceral nerve afferents enter the posterior horn of spinal cord
• Share the same pain pathway as somatic spinal nerve afferents
• This is the reason for referred pain
• Because the message of somatic spinal nerve afferents is more powerful than
message of visceral nerve afferents the CNS perceives that the pain is coming
from area originating from the somatic spinal nerve afferent
• Adrenal gland (AG) is an endocrine organ
• It has the largest sympathetic ganglia
• Its cells are made of modified neurons that
have short axons and no nerve processes
1. AG outer layer = adrenal cortex
Secretes mineralcorticoids (i.e. aldesterone)
Secretes glutocorticoids (i.e. cortisol)
2. AG inner layer = adrenal medulla
Secretes norepinephrine
and epinephrine (adrenaline)
• When stimulated by preganglionic neurons
the cortex/medulla of AG secrete their
hormones into nearby capillaries and into
the bloodstream
• When these hormones are released in the
bloodstream they amplify fight/flight
response, giving more energy
NOTE: Sympathetic neuron to the renal
medulla does not synapse at the
sympathetic trunk but directly transmits to
the renal medulla where it causes the
secretion of epinephrine and
norephinephrine

A reason why the neuron to the renal

medulla bypasses the sympathetic trunk is
to increase response time in relation to a
fight/flight situation

This is similar to the superior/inferior

coliculli in the midbrain which bypass the
thalamus in order to increase response
time to a fight/flight situation
Common signs and symptoms
• Weight gain and fatty tissue deposits, particularly around the
midsection and upper back, in the face (moon face), and between the
shoulders (buffalo hump)
• Pink or purple stretch marks (striae) on the skin of the abdomen,
thighs, breasts and arms
• Thinning, fragile skin that bruises easily
• Slow healing of cuts, insect bites and infections
• Acne
• Depression, anxiety and irritability
• Bone loss, leading to fractures over time
• Severe fatigue
• Muscle weakness

Women with Cushing syndrome may experience:

• Thicker or more visible body and facial hair (hirsutism)
• Irregular or absent menstrual periods

Men with Cushing syndrome may experience:

• Decreased libido
• Decreased fertility
• Erectile dysfunction
Vagus nerve (CNX)
Has the longest course of all the cranial
nerves, extending from the head to the
abdomen. Its name is derived from the
Latin ‘vagary’ – meaning wandering
In the Head
• The vagus nerve originates from the
medulla of the brainstem. It exits the
cranium via the jugular foramen, with
the glossopharyngeal and accessory
nerves (CN IX and XI respectively).
• The left vagus nerve passes inferiorly
between the left common carotid and
left subclavian arteries, posterior to
the sternoclavicular joint, entering the
thorax
• The right vagus nerve passes anterior
to the subclavian artery and posterior
to the sternoclavicular joint, entering
the thorax
The Heart
• Cardiac branches arise in the thorax, conveying parasympathetic
innervation to the sino-atrial and atrio-ventricular nodes of the
heart
• These branches stimulate a reduction in the resting heart rate They
are constantly active, producing a rhythm of 60 – 80 beats per
minute
• If the vagus nerve was lesioned, the resting heart rate would be
around 100 beats per minute
Gastro-Intestinal System
• The vagus nerve provides parasympathetic innervation to the
majority of the abdominal organs
• It sends branches to the oesophagus, stomach and most of the
intestinal tract – up to the splenic flexure of the large colon
• The function of the vagus nerve is to stimulate smooth muscle
contraction and glandular secretions in these organs
• For example, in the stomach, the vagus nerve increases the rate of
gastric emptying, and stimulates acid production
• The right vagus nerve forms the posterior vagal trunk, and the left
forms the anterior vagal trunk
• Branches from the vagal trunks contribute to the formation of the
oesophageal plexus, which innervates the smooth muscle of the
oesophagus
Hypogastric plexuses
• (superior and inferior) are
networks of sympathetic and
visceral afferent nerve fibers
• Superior hypogastric plexus
caries fibres from the L3-L4 or
T12-L2 thoracolumbar
splanchnic nerves
• Superior hypogastric plexus
enters the pelvis, dividing into
right and left hypogastric
nerves, descends on the
anterior surface of the sacrum
and go along the common iliac
and internal iliac arteries to join
the inferior hypogastric plexus
• They join with parasympathetic
pelvic sphlanchnic nerves
descend lateral merge with
pelvic splanchnic nerves of the
inferior hypogastric plexus
Inferior hypogastric plexuses contain
both sympathetic and parasympathetic Sympathetic component
fibers • Inhibits peristaltic contraction of the
Hypogastric/pelvic system of plexuses, rectum
1. receive sympathetic fibers via thoraco • Stimulates contraction of the internal
lumbar splanchnic nerves (from genital organs producing orgasm and
right/left hypogastric nerves ejaculation in males
2. receive parasympathetic fibers via Parasympathetic component
pelvic splanchnic nerves (S2-S4),
innervate the pelvic viscera • Stimulate contraction of the rectum and
bladder for defecation and urination,
Pelvic splanchnic nerves respectively
Arise in the pelvis from the anterior rami of • Erection of penis
spinal nerves S2–S4 of the sacral plexus • Because the pelvis does not include a
• Convey presynaptic parasympathetic cutaneous area, pelvic sympathetic fibers
do not produce pilomotion or vasomotion
Fibers derived from the S2–S4 spinal cord function
segments, which make up the sacral
outflow of the parasympathetic (craniosa-
cral) nervous system, and visceral afferent
fibers from cell bodies in the spinal ganglia
of the corresponding spinal nerves