St. Luke’s College of Medicine – William H.

Quasha Memorial
PHYSIOLOGY BLOCK 1

Lecture: 9 – Autonomic Nervous System Date: August 17, 2015

Lecturer: Dr. Arlene R. Ng, M.D., Ph.D. Trans Team: Capinpin, Capistrano, Caseñas,
Cayetano

Topic Outline
I. General Organization of the Autonomic Nervous
System
A. Sympathetic Nervous System Subconscious
B. Parasympathetic Nervous System sensory signals
C. Enteric Nervous System
II. Characteristics of the Sympathetic and
Parasympathetic Function
A. Response
B. Neurotransmitters
C. Receptors
III. Autonomic Effects on Various Organs of the Body
IV. Autonomic Reflexes Subconscious
V. Sympathetic and Parasympathetic Tone reflex responses
VI. Mass Discharge of the Sympathetic Nervous System
VII. Specific Localized Responses from the
Parasympathetic System Figure 2.Process of eliciting a response in the ANS.
VIII. Medullary, Pontine, Mesenteric Control of the ANS
IX. Pharmacology of the Autonomic Nervous System  Two major subdivisions
LEGEND A. Sympathetic Nervous System
PPT Trans Audio Trans Book Trans B. Parasympathetic Nervous System

A. Sympathetic Nervous System

I. General Organization of the Autonomic Nervous
System
Autonomic Nervous System
 Portion of the nervous system that controls most visceral
functions of the body
 Functions on its own automatically
 Helps to control arterial pressure, gastrointestinal motility,
gastrointestinal secretion, urinary bladder emptying,
sweating, body temperature, etc.
 In coordination with higher centers of the brain
 Rapidity and intensity with which it can change visceral
functions
 Activated mainly by centers located in the spinal cord, brain
stem, and hypothalamus(major control center)
 The sympathetic nerve fibers originate in the spinal cord
along with the spinal nerves between cord segments T1
and L2 and pass first in to the sympathetic chain and then
to the tissues and organs that are stimulated by the
sympathetic nerves
 Thoracolumbar outlflow (T1 to L2)
 Sympathetic Chain – ganglia located just beside the spinal
cord; axons of the SNS synapse here before going to the
different organ systems
 Two main ganglion to be remembered are the (1) celiac
ganglion and (2) hypogastric plexus
 For every sympathetic nerve that innervates an organ there is
usually a corresponding parasympathetic innervation.

Figure 1. Location of the autonomic control centers in the brain,

(1) Brain Stem (mid-brain, pons and medulla), (2) Hypothalamus,
(3) Spinal Cord.

Limbic Cortex
 portion of the Cerebral Cortex
 controls emotion
o when scared, anxious, angry, the autonomic system reacts
accordingly
o example: going to the toilet before exams, increase of cardiac
rate, sweating and turning red when mad, turning red at the
mention of something or someone
 can transmit signals to the lower centers and in this way
influence autonomic control
 automatic and subconscious

Visceral Reflex
 The autonomic nervous system often operates through this
o Subconscious signals from visceral organs can enter the
autonomic ganglia, the brain stem, or the hypothalamus and
then return the subconscious reflex response directly back to
the visceral organs to control their activities
 All autonomic reflexes are polysynaptic with at least one
synapse in the CNS and another in the autonomic
ganglion. Figure 3.The Sympathetic Nervous System.

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 2 portions of the Autonomic Nervous System:
i. Preganglionic Portion
ii. Postganglionic Portion
 The ganglia are located outside the spinal cord
Table 1. Difference between the Innervation of Skeletal Muscles
and Innervation of the Autonomic Nervous System
Innervation of Innervation of the Autonomic
Skeletal Nervous System
Muscles
Number of Single neuron in Two neurons: a pre-ganglionic
neurons the skeletal and a post-ganglionic neuron
motor pathway
Spinal cord Nerve cells in Axon fibers pass through the
exit the spinal cord anterior root of the spinal cord
exit anteriorly into the corresponding spinal
(anterior /motor nerve. After the spinal nerve
root of the passes through the spinal canal,
spinal cord) the pre-ganglionic fibers leave
the spinal nerve and pass
through the white ramus (aka
white ramus communicans) of
one of the ganglia of the
sympathetic chain
Formation No Yes
of Synapse In the sympathetic chain: fate
outside the number 1 and 2
spinal cord Before the target organ: fate
number 3
Pathway Goes directly to In the sympathetic chain, the
the muscle that fate of the pre-ganglionic fiber
it innervates – can be one of the following:
to the 1. It can synapse with post-
neuromuscular ganglionic neurons of the
junction then ganglion that it entered
the muscle itself 2. It can pass upward or
downward in the chain and
synapse with another
ganglion of the sympathetic
chain
3. It can pass through the chain
and exit through one of the
sympathetic nerves radiating
outward from the chain and
synapse in a peripheral
sympathetic ganglion
The post-ganglionic
sympathetic neurons thus
originate either from one of the
sympathetic chain ganglia OR
from one of the peripheral
sympathetic ganglia. From
either of the two sources, the
post-ganglionic fibers travel to
their target organs.
Figure 4. Comparison of ANS and Somatic Nervous System
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BLOCK 1
 Some of the postganglionic fibers pass back from the
sympathetic chain into the spinal nerves through the gray
rami at all levels of the cord
 Theses sympathetic fibers are all very small type C fibers,
and they extend to all parts of the body by way of the
skeletal nerves
 Type C fibers
o Thinly, if not unmyelinated nerve fibers
o They control the blood vessels, sweat glands, and the
pilo-erector muscles of the hairs
 Segmental Distribution of the Sympathetic Nerve Fibers
(not necessarily distributed to the same part of the body as
the somatic spinal nerve fibers from the same segments)
 T1 : head
 T2 : neck
 T3 to T6 : thorax
 T7 to T11 : abdomen
 T12, L1, L2 : legs
 The distribution of sympathetic nerves to each organ is
determined partly by the locus in the embryo by which
the organ originated
 Adrenal Medullae
 Located on top of the kidneys
 Innervated by sympathetic fibers
 Secretory cells embryologically derived from nervous
tissue and are actually postganglionic neurons; the
endings of these fibers secrete the adrenal hormones
epinephrine and norepinephrine
B. Parasympathetic Nervous System
 Fibers leave the central nervous system through cranial
nerves III, VII, IX, and X; additional parasympathetic fibers
leave the lowermost part of the spinal cord through the
second and third sacral spinal nerves and occasionally the
first and fourth sacral nerves
 Craniosacral outflow
 Parasympathetic ganglia are located near the end organs.
The presynaptic fiber is very long, the postsynaptic axon is
relatively short.
 Vagus Nerve (CN X)
o Heart, lungs, esophagus, stomach, entire small
intestine, proximal half of colon, liver, GB, pancreas,
kidneys, upper portion of the uterus
o Almost all the visceral organs
 Cranial Nerve III
o Pupillary sphincter and ciliary muscle of the eye
 Cranial Nerve VII
o Lacrimal, nasal, and submandibular glands
 Cranial Nerve IX
o Parotid gland
 Sacral Fibers (Pelvic Nerves)
o Pass through spinal nerve sacral plexus at S2 and S3
levels
o Descending colon, rectum, urinary bladder, lower
portions of the ureters, external genitalia
 Preganglionic fibers pass uninterrupted all the way to the
organ that is to be controlled and synapse with
postganglionic neurons in the wall of the organ
 PHYSIOLOGY BLOCK 1

II. Characteristics of the Sympathetic and

Parasympathetic Function
A. Responses
a. Sympathetic response – Stress; flight or fight
b. Parasympathetic response – Peace; rest and digest

B. Neurotransmitters
 Normally, neurotransmitters are present for a short period of
time and then broken down but in the adrenal medulla,
neurotransmitters last a little longer than normal for them to
have their effect in the other organs

Table 2. Neurotransmitters of the ANS

Sympathetic Parasympathetic
Nervous System Nervous System
Pre- Cholinergic Cholinergic
ganglionic (Acetylcholine) (Acetylcholine)
Neurons
Post- Mostly adrenergic Cholinergic
ganglionic (Norepinephrine) (Acetylcholine)
Neurons Occasionally
acetylcholine

Figure 5. The Parasympathetic Nervous System
C. Enteric Nervous System (ENS)
 Controls function of the gastrointestinal tract, pancreas,
and gallbladder
 Contains local sensory, motor and inter-neurons
 Responsible for:
o Alteration in the gut walls
o Changes in the chemical environment of the gut
 Control smooth muscles of the gut, local blood vessels,
secretion of mucosa
 Has 80 to 100 million neurons
 Two major plexus:
1. Myenteric (Auchbach’s) plexus
 Between the outer longitudinal and inner circular
muscle layer
 Controls gut motility
2. Submucous (Meissner’s) plexus
 Between the circular muscle layer and mucosa
 Controls secretory function (regulates fluid
homeostasis)
 Connected with ANS, but functions separately
 Relatively independent of the CNS
 With inputs from ANS
 Controls the peristalsis of the gastrointestinal tract
 ANS influence on ENS
 The parasympathetic nervous system stimulates gut motility
 The sympathetic nervous system decreases gut motility
a. Acetylcholine
o Produced in the pre-synaptic terminal button
o Cholinergic neurons in the sympathetic nervous system: found
in sweat glands, pilo-erector muscles and some blood vessels;
use acetylcholine as their neurotransmitter to subserve the
sympathethic function of these cells
o Degradation: acetylcholinesterase
b. Norepinephrine
o Produced in the proximal area of the neuron before it
ends up in vesicles
o Postganglionic in SNS Adrenergic
o Removal of norepinephrine
a. Reuptake
b. Diffusion at the synaptic cleft and into the surrounding
body fluids then into the blood
c. Destruction using enzymes
i. Catechol-O-methyl transferase (COMT)
ii. Monoamine oxidase
C. Receptors
- Binding of neurotransmitters cause:
o Change in cell permeability to one or more ions
o Activation or inactivation of an enzyme attached to the
other end of the receptor protein
- 2nd messenger systems
-Acetylcholine receptors
o Muscarinic – found on all effector cells (except NMJ)
that are stimulated by the postganglionic cholinergic
neurons of either the parasympathetic nervous system
or the sympathetic system
o Nicotinic – Found in the autonomic ganglia at the
synapses between the preganglionic and postganglionic
neurons of both the sympathetic and parasympathetic
systems
- More proximal than the muscarinic receptors
- Also present at many non-autonomic nerve endings
(e. g. neuro-muscular junctions in skeletal muscle)

Muscarinic
Receptors

M1 M2 M3 M4 M5

Smooth
CNS Heart CNS CNS
Muscle

Nicotinic Receptors

N1 N2

Neuromuscular Autonomic ganglia, CNS

Junction and adrenal medulla
Mainly post-ganglionic
Pre-ganglionic Figure 7. Types of acetylcholine receptors and their locations
Figure 6. Enteric and Autonomic Nervous System

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-Adrenergic receptors (Sympathetic Nervous System only) - tone can be affected by removal or denervation so that there would
o Alpha receptors be hypersensitivity to certain stimuli when the tone is removed
- α1 Denervation supersensitivity
- α2 - Upregulation of receptors
o Beta receptors - Effect of norepinephrine: decreases blood flow due to
- β1 vasoconstriction
- β2 - Giving a test dose of norepinephrine decreases blood pressure
- β3 - Stellate ganglionectomy: loss of normal sympathetic tone
- If stellate ganglion is removed, there would be an increase in
o Norepinephrine blood flow in the arm (action of the sympathetic nervous system is
- Excites mainly alpha receptors but excites the beta vasoconstriction so if the tone is removed, there would be increase
receptors to a lesser extent as well in blood flow due to vasodilation)
- More specific; if you want to give a medication that - Blood flow would eventually go down but not necessarily
targets alpha receptors, give norepinephrine instead of normalize
epinephrine - A test dose of norepinephrine after ganglionectomy will cause a
o Epinephrine greater than the effect than the test dose given before the
- Excites both types of receptors equally procedure because of the upregulation of receptors that happened
with denervation during ganglionectomy
Table 3. Function of Adrenergic Receptors
Alpha Receptors Beta receptors
Vasoconstriction Vasodilation (β2)
Iris dilation Cardioacceleration (β1)
Intestinal relaxation Increased myocardial strength
(β1)
Intestinal sphincter Intestinal relaxation (β2)
contraction Uterus relaxation (β2)
Pilomotor contraction Bronchodilation (β2)
Bladder sphincter contraction Calorigenesis (β2)
Inhibits neurotransmitter Glycogenolysis (β2)
release (α2) Lipolysis (β1)
Bladder wall relaxation (β2)
Thermogenesis (β3) Figure 9. Effect of sympathectomy on blood flow in the arm, and
effect of a test dose of norepinephrine before and after
sympathectomy, showing supersensitization of the vasculature to
norepinephrine

V. Autonomic reflexes
- Cardiovascular autonomic reflexes
o Baroreceptor reflex
If there is a decrease in blood flow, pressure receptors in the
carotid bodies and the aorta will notice it and the SNS can
constrict the blood vessels to increase blood pressure
Can also send signals to the cardiovascular center in the
medulla so that it will send signal to the spinal cord to increase
cardiac output through sympathetic stimulation to bring back
the blood pressure (NOT parasympathetic because it decreases
blood pressure)
- Gastrointestinal autonomic reflexes
o food in mouth
Signals to vagal, glossopharyngeal and salivatory nuclei of
brainstem  parasympathetic transmission to secretory
glands of mouth and stomach  increase secretion of
digestive juices
o fecal matter in rectum
Stretching of rectumsacral spinal cordreflex signal
through parasympathetics to distal colonstrong
peristaltic contractionsdefecation
- Urinary reflex
Bladder stretchsacral cordreflex bladder contraction
and urinary sphincter relaxationurination
- Sexual reflex (initiated by psychic stimuli from the brain and
stimuli from the sexual organs) converge on sacral cord
a. Erection (parasympathetic)
b. Ejaculation (partially sympathetic)

VI. Mass Discharge of the Sympathetic System

Figure 8. Location of Muscarinic and Nicotinic Receptors
III. Autonomic Effects on Various Organs of the Body
Please see Appendix 1.
Advice from Dr. Ng: REMEMBER THE TABLE
IV. Sympathetic and Parasympathetic “Tone”
- tone allows a single nervous system to both increase and
decrease the activity of a stimulated organ
- when parts of the SNS and PNS function, they do not start from
zero (it has an underlying tone) so that minute corrections in the
function can happen
- effect of sympathetic tone on systemic arterioles
o denervation effects
- Intrinsic tone tends to restore normal function
o chemical adaptation
- Happens when there is an intense stimuli (eg. fight or flight
condition)
- All portions of the sympathetic nervous system discharge
simultaneously
- Alarm or stress response
 Hypothalamic activation by fright or severe pain
 Widespread reaction throughout the body
“Alarm” or “Stress” Response of the Sympathetic Nervous
System
- Mass discharge increases ability of the body to perform
vigorous muscle activity
o Increased arterial pressure
o Increased blood flow to active muscles concurrent with
decreased blood flow to organs such as the
gastrointestinal tract and the kidneys that are not needed
for rapid motor activity
o Increased rates of cellular metabolism throughout the
body
o Increased blood glucose concentration

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o Increased glycolysis in the liver and in the muscle
o Increased muscle strength
o Increased mental activity
o Increased rate of blood coagulation
- Happens in highly emotional states
o Rage
Hypertensionbrainstem ret formation spinal cord 
massive sympathetic discharge
- Sympathetic alarm reaction (fight or flight)
- Heat regulation: control of sweating and blood flow
o Plexus beneath the skin is composed of blood vessels that
would control loss of heat via constriction
- Local reflexes affecting sensory afferent fibers
o Heating the skin
VII. Specific Localized Responses from the
Parasympathetic System
- Cardiovascular reflexes
- Secretion of mouth and stomach glands
- Rectal emptying
VIII. Medullary, Pontine, Mesencephalic Control of the
Autonomic Nervous System
- All ANS activities are made possible by the control of the
higher centers and the hypothalamus
- will be discussed separately in another block :)
- Include intravenous norepinephrine, epinephrine and
methoxamine
- In contrast, alpha and beta receptor blockers can block
andrenergic activity
Parasympathomimetic drugs
- Also called cholinergic drugs
- Stimulate parasympathetic effector organs
- In contrast, cholinergic activities can be blocked with anti-
acetylcholinesterase drugs (same as those discussed in NMJ
lecture)
X. References
 Dr. Ng’s lecture
 Textbook of Medical Physiology 12th edition by Guyton
 Figure 1. Location of the autonomic control centers in the
brain:
http://www2.estrellamountain.edu/faculty/farabee/biobk/biob
ooknerv.html
 Figure 4. Comparison of ANS and Somatic Nervous System:
http://antranik.org/the-autonomic-nervous-system/
 Figure 6. Enteric and Autonomic Nervous System:
https://upload.wikimedia.org/wikipedia/commons/2/29/Neural
_control_gut.png
 Figure 8. Location of Muscarinic and Nicotinic Receptors:
http://higheredbcs.wiley.com/legacy/college/tortora/0470565
101/hearthis_ill/pap13e_ch15_illustr_audio_mp3_am/simulat
ions/hear/neuron_chol_adre.html

Figure 10. Autonomic Control Centers in the Brain Stem
and the Hypothalamus
V. QUIZ
1. This neurotransmitter is released from the axon terminal of
pre-ganglionic fibers.
2. Post-ganglionic sympathetic neurons release the following
neurotransmitter(s):
a. Ach c. Epinephrine e. a, b and c
b. NEpinephrine d. a and b only
3. Which of the ff is true about ENS?
a. Connected with ANS, but functions separately
b. Not connected with ANS, and functions separately
c. Connected with ANS, but has no influence on it
d. Influenced and controlled by ANS
4. True or False: Norepinephrine can leak into the bloodstream.
5. What compensates for the removal of tone caused by
denervation?

IX. Pharmacology of the ANS Answers:

Sympathomimetic drugs 1. Ach
- Also called andrenergic drugs 2. e
3. a
- Stimulate sympathetic effector organs 4. True
5. Progressive increase/decrease of intrinsic tone

Appendix 1. Autonomic Effects on Various Organs of the Body

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