Autonomic Nervous System

First year
(Medicine College –University of Tobruk )

Prof. Dr.
Elsayed Emara
Faculty of Medicine
2020
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Introduction 1
Learning Objectives
Upon completion of this chapter, the student should be able to answer
the following questions:
1) Distinguish between the central and peripheral nervous systems, and
between somatic and visceral divisions of the sensory and motor systems.
2) What is another name for the visceral motor nervous system? What are
its two subdivisions? What are their functions?
3) How does a somatic reflex arc differ from an autonomic reflex arc?
4) Describe the types & function of autonomic ganglia.
5) Differentiate between sensory nuclei & motor nuclei in the spinal cord.
6) A person with polio has lost the use of his leg muscles. In which area
of his spinal cord would you expect the virus-infected motor neurons to
be?
7) A disease that damages myelin sheaths would affect which portion of
the spinal cord?

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The nervous system

-The nervous system serves as the body’s primary communication and

control system. It provides a rapid means of integrating and regulating
body functions through electrical signals transmitted along specialized
nervous tissue cells called neurons.
 Functions of the nervous system:
-The nervous system has three overlapping functions, illustrated by the
example of a thirsty person seeing and then lifting a glass of water:
1) Sensory function.
-The nervous system uses its millions of sensory receptors to monitor
changes occurring both inside and outside the body. The gathered
information is called sensory input.
2) Integrative function.
-The nervous system processes and interprets sensory input and decides
what should be done at each moment—a process called integration.
3) Motor function.
-The nervous system activates effector organs—the muscles and glands—
to cause a response, called motor output.
Here’s another example: You are driving and see a red light ahead (sensory
input). Your nervous system integrates this information (red light means
“stop”), and your foot hits the brake (motor output).

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 Nervous tissue:
-Nervous tissue is composed of two main cell types: (1) neurons and (2)
glial cells. Neurons are the electrically excitable cells of the nervous
system. Glial cells are supportive cells that serve many functions for the
neurons.
Neuron Structure
-Neurons come in many shapes and sizes, but they typically share certain
basic structural features that include a cell body, dendrites, and an axon.
-The dendrites and axon are cellular extensions that project from the
spherically shaped cell body—with the axon extending from the
triangular, cone-shaped region of the cell body called the axon hillock.

-The neuron cell body (or soma) contains both the nucleus and the
cytoplasm. The nucleus contains chromatin and a prominent nucleolus,
which synthesizes the cell body’s large number of ribosomes. The

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cytoplasm within the cell body, which is more specifically called the
perikaryon, is composed of the typical cellular organelles such as the
endoplasmic reticulum, Golgi apparatus, ribosomes, and mitochondria.

-The cytoplasm within an axon is called axoplasm, and the plasma

membrane of an axon is called an axolemma.
-Axons (nerve fibers) may be insulated with a myelin sheath, which is
formed by a certain type of glial cells (either neurolemmocytes (Schwann
cells) or oligodendrocytes). Neurofibril nodes (nodes of Ranvier) are the
uninsulated regions of the axon between the myelin sheaths.

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 Structural Classification of neurons:

-Neurons are classified structurally based upon the number of processes
(i.e., axon or dendrites) extending from the cell body.
1) Multipolar neurons:
- These have many dendrites and a single axon that extends from the cell
body.
- All motor neurons; most interneurons.
2) Bipolar neurons:
- These have two processes that extend from the cell body—one dendrite
and one axon.
- Some special sense neurons (e.g., retina of eye, inner ear, nose)
3) Unipolar neurons:
- These neurons have only one process extending from the cell body,
which then branches into a central branch that functions as an axon and
peripheral branch that functions as a dendrite.
- Most sensory neurons are unipolar neurons.
4) Anaxonic neurons:
- These have only dendrites and no axons.
- Most interneurons are anaxonic neurons.

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 Functional Classification of neurons:

- Neurons are classified functionally according to the direction in which
nerve signals (action potentials) are propagated relative to the CNS.
- The three categories are sensory neurons, motor neurons, and
interneurons.
1) Sensory neurons (also known as afferent neurons):
- These are the neurons of the sensory nervous system.
- They are responsible for conducting sensory input from both somatic
sensory (e.g., touch receptors) and visceral sensory receptors (e.g., stretch
receptors within the urinary bladder) to the CNS.
- Most sensory neurons are unipolar. There is bipolar neurons for smell and
vision.

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2) Motor neurons (also known as efferent neurons):

- These are the neurons of the motor nervous system.
- They are responsible for conducting motor output from the CNS to both
somatic effectors (i.e., skeletal muscle) and autonomic effectors (i.e.,
cardiac muscle, smooth muscle, and glands).
- All motor neurons are multipolar.
3) Interneurons (also known as association neurons):
- These lie entirely within the CNS.
- They receive stimulation from many other neurons and carry out the
integrative function of the nervous system—that is, they receive, process,
and store information and “decide” how the body responds to stimuli.
- Interneurons facilitate communication between sensory and motor
neurons.
- Interneurons are either multipolar neurons or anaxonic neurons.

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 Myelination of neurons:
- It is the process by which part of an axon is wrapped with myelin.
- Myelin is the insulating covering around the axon that consists of
repeating concentric layers of plasma membrane of glial cells.
Myelination is completed by neurolemmocytes (Schwann cells) in the
PNS and by oligodendrocytes in the CNS.
- The high lipid content of the myelin gives an axon a distinct, glossy-white
appearance.
Myelination of a PNS axon:
- The neurolemmocyte starts to encircle a 1-millimeter portion of an axon.
- As the neurolemmocyte continues to wrap around the axon, the
cytoplasm and nucleus of the neurolemmocyte are squeezed to the
periphery of the neurolemmocyte (the outside edge).
- The overlapping inner layers of the plasma membrane form the myelin
sheath. The outer nucleated cytoplasmic layer of the Schwann cell,
which encloses the myelin sheath, is the neurolemma.

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- A neurolemmocyte in the PNS can myelinate only a 1- millimeter portion

of a single axon while an oligodendrocyte in the CNS, in comparison,
can myelinate a 1-millimeter portion of multiple axons and not just one
- Because the nucleus and cytoplasm of the oligodendrocyte remain in a
centralized location, no neurolemma is found in the CNS.

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NB:
- Not all axons are myelinated. Unmyelinated axons in the PNS are also
associated with neurolemmocytes, which help to protect and support the
axon. However, no myelin sheath covers them. Thus, the axon merely
rests in a depressed portion of the neurolemmocyte, but its plasma
membrane does not form repeated layers around the axon. In the CNS,
unmyelinated axons are not associated with oligodendrocytes.

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Anatomy of the nervous system

- The nervous system consists of two anatomic divisions: the central

nervous system (CNS) and the peripheral nervous system (PNS).
- These two systems communicate with each other and with the body to
maintain homeostasis.

[I] Central nervous system (CNS):

- It is the part of nervous system which is protected by bone cavities (the
skull and vertebral column).
- The CNS is the integrating and control center of the nervous system.
- It consists of the brain & spinal cord.
A) Brain:
- Lies inside the skull.
- Formed of:
1- Cerebrum (forebrain) consists of:
a) Telencephalon: includes the cerebral cortex and the basal ganglia.
b) Diencephalon: the thalamus and hypothalamus.

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2- Cerebellum.
2- Brain stem:
 Mid-brain.
 Pons.
 Medulla oblongata.
B) Spinal cord: (31 segments)
- Lies inside the vertebral column.
- Is divided into the following regions:
1- Cervical region (8 segments).
2- Thoracic region (12 segments).
3- Lumbar region (5 segments).
4- Sacral region (5 segments).
5- Coccygeal region (1 segment).

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[II] The peripheral nervous system (PNS):

- It is the part of the nervous system outside the CNS.
- The PNS consists mainly of nerves (bundles of axons) that extend from
the brain and spinal cord, and ganglia (collections of neuron cell bodies),
and sensory receptors.
A) Cranial nerves (CNs):
- Extend from the brain.
- Carry impulses to and from the brain.
- 12 pairs of cranial nerves.
- Cranial nerves are designated by either CN followed by a roman numeral
(e.g., CN I, CN II) or a specific name (e.g., olfactory nerve, optic nerve).
B) Spinal nerves:
- Extend from the spinal cord.
- Carry impulses to and from the spinal cord.
- 31 Pairs of spinal nerves.

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- Each spinal nerve is typically identified by the first letter of the spinal
cord part to which it attaches, followed by a number. Thus, each side of
the spinal cord contains 8 cervical nerves (called C1–C8), 12 thoracic
nerves (T1–T12), 5 lumbar nerves (L1– L5), 5 sacral nerves (S1–S5), and
1 coccygeal nerve (Co1).
 Functional subdivisions of the PNS:
A) Sensory (afferent) division:
- It consists of nerve fibers (axons) that carry impulses to the CNS from
sensory receptors located throughout the body.
- The sensory division keeps the CNS constantly informed of events going
on both inside and outside the body.
- The sensory division has two main parts:
● Somatic sensory division:
- This carries impulses from the skin, skeletal muscles, and joints.
● Visceral sensory division:
- This carries signals mainly from the viscera of the thoracic and abdominal
cavities, such as the heart, lungs, stomach, and urinary bladder.
B) Motor (efferent) division:
- It consists of nerve fibers (axons) that carry impulses from the CNS to
effector organs, which are the muscles and glands. These impulses
activate muscles to contract and glands to secrete.
- The motor division has two main parts:
■ Somatic (voluntary) nervous system (SNS):
- This is composed of somatic motor nerve fibers that conduct impulses
from the CNS to skeletal muscles.
■ Autonomic (involuntary) nervous system (ANS):
- This is composed of visceral motor nerve fibers that regulate the activity
of smooth muscles, cardiac muscles, and glands.
- The ANS has two further divisions:
1) The sympathetic division readies the body for physical activity, and is
called the fight or flight division.
2) The parasympathetic division regulates resting functions, such as
digesting food or slowing the heart rate, and is called the rest-and-digest
division.

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Gross anatomy of a spinal nerve

- Each spinal nerve anchors to the spinal cord by two roots, a posterior
(dorsal) root and an anterior (ventral) root, and each of these roots is
composed of multiple rootlets.
 The posterior root:
- The posterior (dorsal) root contains sensory neurons that relay nerve
signals from the sensory receptors to the spinal cord.
- These sensory neurons are unipolar neurons.
- These sensory neurons include somatic sensory neurons, which relay
nerve signals from somatic sensory receptors, and visceral sensory
neurons, which relay nerve signals from visceral sensory receptors.
- Both types of sensory neurons synapse with interneurons within the gray
matter of the posterior horns.
- The cell bodies of these sensory neurons are located external to the spinal
cord and form the posterior (dorsal) root ganglion.

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 The anterior root:

- The anterior (ventral) root contains motor neurons that relay nerve signals
from the spinal cord to the somatic and visceral effectors (muscle or
glands).
- The motor neurons are multipolar neurons.
- These motor neurons include somatic motor neurons, which extend to
skeletal muscle, and autonomic (or visceral) motor neurons, which
extend to autonomic effectors (cardiac muscle, smooth muscle, and
glands).
NB:
- Each spinal nerve forms where the dorsal (posterior) root (containing
sensory neurons) and the ventral (anterior) root (containing motor
neurons) join. Thus, both sensory and motor neurons compose each
spinal nerve, and it is classified as a mixed nerve.

If you compare a spinal nerve to a cable composed of multiple wires, the

“wires” within a spinal nerve are the sensory and motor axons, and each
“wire” transmits signals in one direction only.

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Sectional anatomy of the spinal cord

- The spinal cord is partitioned into two areas: an inner gray matter region
and an outer white matter region.
A) Gray matter of spinal cord:
- Gray matter within the spinal cord is centrally located, and its shape
resembles a letter H or a butterfly.
- Gray matter consists primarily of dendrites and cell bodies of neurons
that serve as processing, or “decision-making,” areas.
- The gray matter is subdivided into the following components on each side
of the spinal cord: a posterior horn, a lateral horn, an anterior horn.
1) Posterior horns:
- Posterior horns are both the left and right posterior masses of gray matter.
- The gray matter of the posterior horns is due to the presence of the
dendrites and cell bodies of interneurons.
- Sensory neurons extend through the posterior root of the spinal nerves
and synapse with the dendrites and cell bodies of the interneurons within
the posterior horn.
- The posterior horn contains somatic and visceral sensory nuclei.
2) Anterior horns:
- Anterior horns are both the left and right anterior masses of gray matter.
- The gray matter of the anterior horns is due to the presence of the
dendrites and cell bodies of somatic motor neurons. Collectively, they
form the somatic motor nuclei.
- The axons of somatic motor neurons extend through the anterior root of
the spinal nerves and innervate a somatic effectors that are controlled
consciously or voluntarily (i.e., skeletal muscles).

Note: A type of virus that specifically targets somatic motor neurons

within the spinal cord and potentially result in muscle paralysis is the
poliovirus “Poliomyelitis”.

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3) Lateral horns:
- Lateral horns are both the left and right lateral masses of gray matter.
- They are located only within the T1–L2 parts of the spinal cord, not the
entire length of the spinal cord.
- The gray matter of the lateral horns is due to the presence of the dendrites
and cell bodies of autonomic motor neurons. Collectively, they form the
autonomic motor nuclei.
- The axons of autonomic motor neurons extend through the anterior root
of the spinal nerves and innervate autonomic (or visceral) effectors that
are not controlled consciously or voluntarily (i.e., cardiac muscle, smooth
muscle, and glands).

NB:
- The cell bodies of neurons in the gray matter of the spinal cord are
organized into functional groups called nuclei.
B) White matter of spinal cord:
- White matter consists of bundles of nerve fibers called tracts that travel
up and down the spinal cord, between brain and cord.
- Many fibers of these tracts are myelinated; myelin gives the white matter
a glistening, white color.
- The white matter of the spinal cord is external to the gray matter and on
each side of the cord is partitioned into three distinct anatomic structural

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regions. Each of these regions is called a funiculus (formerly called

column).
1) The posterior funiculus:
- It is the white matter that lies between the posterior gray horn and the
posterior median sulcus (a shallow groove on the posterior (dorsal)
surface of the spinal cord).
2) The lateral funiculus:
- It is the white matter on the lateral side of the spinal cord, between the
anterior and posterior funiculi (columns).
3) The anterior funiculus:
- It is the white matter that occupies the space between anterior gray horn
and the anterior median fissure (a deep groove along the anterior surface).
NB:
- These funiculi (columns) contain tracts. A tract is a bundle of axons in
the CNS.
- All fibers in one tract have a similar origin, destination, and function.
Ascending tracts carry sensory information toward the brain, and
descending tracts carry motor commands to the spinal cord.

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Structural unit & Functional unit of nervous system

1- Structural unit is the nerve cell (neuron).

2- Functional unit is the reflex action.

Reflex action

 Definition: (Stimulus  Response)

- It is an unavoidable beneficial inborn response brought about by a
stimulus (a sudden change of the external or internal environment).
 Types:
1) Somatic reflex action:
- If the responding structure is skeletal muscle.
2) Autonomic reflex action:
- If the responding structure is cardiac muscle, smooth muscle or gland.

Components of reflex arc

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1- Receptor:
- Specialized structure sensitive to minor changes outside or inside the
body i.e. is sensitive to stimuli.
2- Afferent neuron:
- Carries impulses from a receptor to the CNS.
3- Integration center:
- Present inside CNS (chains of interneurons).
4- Efferent neuron:
- It carries impulses from CNS to effector organ.
5- Effector organ:
- It is the structure which produce the response.
- It may be gland, skeletal, smooth or cardiac muscle.

Differences between Somatic

& Autonomic reflex arcs

Somatic reflex arc Autonomic reflex arc

 Receptors: - Mainly in skin & subcutaneous - Mainly in the viscera.
tissue.
 Afferent: 1- Carry afferent impulses of somatic Carry afferent impulses of autonomic
reflexes which control the activity reflexes which control the activity of
of skeletal muscles (e.g. the viscera (e.g. micturition reflex).
withdrawal reflex).
 Efferent: - Innervate skeletal muscle. 9- Innervate smooth muscles, cardiac
1- muscles & glands.
2- - Usually voluntary: under control 10- Usually involuntary: not under control
of our will of our will
3- - Arise from somatic motor nuclei 11- Arise from autonomic motor nuclei in
in anterior horn of gray matter of lateral horn of gray matter of spinal
spinal cord. cord & cranial nuclei in brain stem.
4-
5- - Only one neuron. 12- Two neurons: preganglionic & post
ganglionic.

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6- - Thick myelinated fibers (type A).13- Preganglionic fibers are thin

7- -Its cutting  paralysis & atrophy.14- Its cutting  target cells show
8- -Neurotransmitter at effector
Organs  only Acetyl choline
(ACh).
- Its stimulation  excitation
(contraction) of skeletal
muscles.
myelinated (type B) & Postganglionic
fibers are very thin non myelinated
(type C).
denervation hypersensitivity.
15- May be ACh (parasympathetic
terminals) or NE (sympathetic
terminals)
16- Its stimulation  excitation or
inhibition of effector organ.
[Depending on neurotransmitter
and receptors on effector organs]

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Autonomic ganglia

 Definition:
 Collection of nerve cells outside the CNS where the preganglionic fibers
relay with the postganglionic autonomic efferent fibers.
 They are the site of synapses between pre- & postganglionic fibers.

 Types: According to their situation, the ganglia are classified into:

[1] Lateral (paravertebral) ganglia:
 This consists of 23-25 ganglia on both sides of the vertebral column
which form a sympathetic chain.
 3 Cervical (superior, middle & inferior), 10 –12 thoracic, 5 lumbar,
5 sacral & 1 coccygeal.
 They are for relay of sympathetic fibers only.
[2] Collateral (prevertebral) ganglia:
 Theses lie between the sympathetic chain and the organ of supply.
 Present in the abdomen near the abdomenal aorta at the region of big
arterial branches of aorta & named after them: coeliac, superior
mesentric, renal & hypogastric ganglia.
 Collateral ganglia exist also in head & neck e.g. otic & ciliary ganglia.
 They are for relay of sympathetic & parasympathetic fibers.
[3] Terminal ganglia:
 These are present near or in the wall of the effector organs.
 They are for relay of parasympathetic fibers only.

NB: The Chemical transmitter inside autonomic ganglia:

- Acetyl choline (Ach) is liberated at all preganglionic endings
“sympathetic & parasympathetic”.
- It is responsible for transmission or nerve impulse from preganglionic to
postganglionic neurons.

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Spinal cord S.C.G.

Aorta
M.C.G.
I.C.G.

Coeliac

10-12 Thoracic
Superior
mesentric Renal

Inferior
mesentric
5 lumbar
Viscus
5 sacral

1 coccygeal
Symp. chain

Lateral ganglia Collateral ganglia Terminal ganglia

 Functions of autonomic ganglia: [Distributing centers]:

 The preganganglionic fibers are few in numbers & arise from limited
regions in CNS.
Through divergence, one preganglionic fiber gives several postganglionic
fibers that distribute the autonomic impulses to many organs.
 The ratio of preganglionic fibers to postganglionic fibers:
- Sympathetic  1: 20 or more  generalized sympathetic effects.
- Parasympathetic  1: 2  localized parasympathetic effects.

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Autonomic Nervous System

2
Learning Objectives

Upon completion of this chapter, the student should be able to answer

the following questions:
1- What are the actions of the sympathetic and parasympathetic
innervation of the eye, and what symptoms arise when the sympathetic
or parasympathetic innervation is lost?
2- Where are the cell bodies of the postganglionic sympathetic neurons that
supply the head? Describe the effect of their damage.
3- Indicate the results of sympathetic activation of the following structures:
sweat glands, eye pupils, adrenal medullae, heart, bronchioles of the
lungs, liver, blood vessels of vigorously working skeletal muscles,
blood vessels of digestive viscera, salivary glands. Identify the types of
adrenergic or cholinergic receptors involved.
4- Describe the sympathetic response in a frightening situation for each of
the following body parts: brain, eye, lungs, urinary bladder, stomach,
intestines, heart, liver, adipose tissue, arterioles of the abdominal
viscera, and arterioles of skeletal muscles.
5- Compare the effects of adrenergic and cholinergic stimulation on the
following organs: eye, hear, bronchi, liver, penis & clitoris.
6- Describe the autonomic functions of the vagus & pelvic nerves.
7- Distinguish between the sympathetic and parasympathetic divisions of
the ANS in terms of structure, function, and neurotransmitters.

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Origin of the ANS

(I) Sympathetic system:

 It arises from the autonomic motor nuclei in the lateral horn of grey
matter of all thoracic & upper 2 lumbar segments of the spinal cord
(thoraco-lumbar outflow).

(II) Parasympathetic system:

 It arises from the nuclei of the 3rd, 7th, 9th & 10th cranial nerves & the
autonomic motor nuclei in grey matter of 2, 3, 4 sacral segments (cranio-
sacral outflow).

Interaction between sympathetic

& parasympathetic innervations

1- Reciprocal action:
 When one system is stimulated  the other system is inhibited.
2- Antagonistic action:
 Both systems are usually antagonistic in function.
 Sympathetic stimulation  pupillary dilatation (Mydraisis).
 Parasympathetic stimulation  pupillary constriction (Miosis).
3-Co-operative action:
 The sympathetic & parasympathetic stimulation produce different
effects that work together to produce desired effect. e.g. in the genital
system during sexual intercourse (coitus): erection
(parasympathetic) while ejaculation (sympathetic).
4- Complementary action:
 The sympathetic & parasympathetic produce the same action in some
organs as in salivary secretion.
 The parasympathetic produce excessive watery salivary secretion rich
in electrolytes while the sympathetic produce viscid salivary
secretion of small amount and rich in enzymes.

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5- Single innervation:
a) Structures supplied by Sympathetic only:
 Dilator pupillae muscle.
 Erector pillae muscle of the hair.
 Muscle of ventricles of heart.
 Blood vessels of skeletal muscle & skin.
 Suprarenal medulla (adrenal medulla).
 Sweat glands.
 Adipose tissue.
b) Structures supplied by Parasympathetic only:
 Constrictor pupillae muscle.
 Glands of the stomach & pancreas.

Functional anatomy of the sympathetic nervous system

- The sympathetic nerves originate from the autonomic motor nuclei in the
lateral horn of all thoracic & upper 2 lumbar segments of the spinal cord
(thoraco-lumbar outflow).
- The preganglionic sympathetic fibers leave the spinal cord with the
ventral roots of the corresponding spinal nerves. Then, they pass via the
white ramus comunicans into the ganglia of the paravertebral
sympathetic chain.
- Then the course of the fibers can be one of the following three ways:
1- It can synapse with postganaglionic neurons in the ganglion that
enters,
2- It can pass upward or downward in the chain and synapse in one of
the other ganglia of the chain,
3- It can pass through the chain without relay to a collateral ganglion.
- Postganglionic sympathetic fibers are either:
1- Join the spinal nerves in grey ramus comunicans to supply skin
structures as blood vessels and sweat glands, or
2- DO not join spinal nerves but go directly to the viscera along their
arterial blood supply.

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Functions of sympathetic nervous system

[I] Sympathetic to the head & neck

 Origin:
 The autonomic motor nuclei in the lateral horn of grey matter of upper
2 thoracic segments of the spinal cord (T1-2).
 Relay:
 Superior cervical ganglion (SCG).

 Functions:
(1) Eye:
a- Contraction of radial (dilator pupillae) muscle  pupil dilatation =
mydriasis.
b- Contraction of superior & inferior tarsal muscles  widening of
palpebral fissure.
c- Contraction of Muller’s muscle of the orbit  exophthalmos. (i.e.
forward protrusion of the eye forwards in animal).
d- Relaxation of the ciliary muscle  accommodation for far vision.

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(2) Skin:
a- Vasoconstriction (VC) of skin blood vessels.
b- Secretory to the sweat glands   sweating.
c- Contraction of erector pillae muscle  hair erection.
(3) Salivary glands:
a- Trophic secretion of saliva ( amounts, viscid,  enzymes).
b- Contraction of myoepithelial cells surrounding salivary acini 
squeezing of saliva.

Horner’s syndrome
 Cause:
1) Injury to cervical sympathetic nerve fibers in SCG.
2) Injury to upper 2 thoracic segments.

 Manifestations: (on the same side of lesion)

1) Miosis: Constriction of eye pupil due to paralysis of dilator pupillae
muscles.
2) Ptosis: Dropping of upper eye lid due to paralysis of superior tarsal
muscles.
3) Enophthalmos: Backward retraction of the eye in the orbit (sunken
eyeball) due to paralysis of Muller’s muscle in the
orbit.

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4) Anhydrosis: Loss of sweating due to paralysis of sympathetic nerve

supplying sweat glands.
5) Vasodilatation (VD) of skin vessels: Skin becomes warm & red.

[II] Sympathetic to the thoracic viscera

 Origin:
 The autonomic motor nuclei in the lateral horn of grey matter of upper
4 thoracic segments of the spinal cord (T1-4).
 Relay:
 3 Cervical & upper 4 thoracic ganglia.

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 Functions:
(1) Heart:
 Stimulation of all cardiac properties   contractility, rhythmicity,
excitability & conductivity.
 VD of coronary blood vessels   blood supply to cardiac muscle.
(2) Lung:
 Inhibitory to the plain muscles of bronchi  bronchodilatation.

[III] Sympathetic to the abdominal viscera

 Origin:
 The autonomic motor nuclei in the lateral horn of grey matter of 5–9
thoracic segments of the spinal cord (T5-9)  greater thoracic
splanchnic nerve (GTSN).
 The autonomic motor nuclei in the lateral horn of grey matter of 10–12
thoracic segments of the spinal cord (T10-12)  lesser thoracic
splanchnic nerve (LTSN).
 Relay:
 Greater thoracic splanchnic nerve (GTSN)  Coeliac ganglia.
 Lesser thoracic splanchnic nerve (LTSN)  superior mesentric & renal
ganglia.

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 Functions:
(1) Gastrointestinal tract (GIT):
 Inhibitory to plain muscles of stomach, small intestine & proximal half
of large intestine but motor to their sphincters
  Evacuation of stomach & intestine (food retention).
  Motility (peristalsis).
(2) Liver:
 Stimulation of glycogenolysis   blood glucose level.
 Relaxation of the wall of gall bladder & motor to its sphincter 
 Evacuation of bile (bile retention).
(3) Spleen:
 Contraction of the splenic capsule  ejection of its stored blood 
 Blood volume.
(4) Kidneys:
 Stimulation of juxtaglomerular cells leading to increased renin
secretion.
(5) Adrenal medulla:
 Secretion of two hormones (adrenaline 80% & noradrenaline 20%).
(6) Blood vessels:
 Vasoconstriction (VC) to the blood vessels of the viscera.
NB:
■ Pheochromocytoma is a tumor of the adrenal medulla that secretes
excessive amounts of catecholamines (adrenaline and noradrenaline).

[IV] Sympathetic to the pelvic viscera

 Origin:
 The autonomic motor nuclei in the lateral horn of grey matter of the
upper 2 lumbar segments of the spinal cord (L1- 2)  Lumbar
splanchnic nerve.
 Relay:
 Inferior mesentric ganglia.

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 Functions:
(1) GIT:
 Inhibitory to plain muscle of distal part of large intestine & the wall
of the rectum but motor to internal anal sphincter  retention of
feces.
(2) Urinary bladder (UB):
 Inhibitory to the wall of UB (detrusor muscle) but motor to internal
urethral sphincter  retention of urine.
(3) Blood vessels:
 VC of blood vessels of pelvic viscera  shrinkage of penis & clitoris.
(4) Genital system:
a- Male: Contraction of vas deferns, seminal vesicle & prostatic plain
muscles  ejaculation of semen.
b- Female: Motor (nonpregnant) & inhibitory (pregnant) fibers to the
uterus.

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[V] Sympathetic to the limbs, thoracic

& abdominal walls
 Functions:
1- VC of skin blood vessels (which limits bleeding from wounds).
2- VD of skeletal blood vessels.
3- Motor to the erector pilae muscle  hair erection.
4- Secretory to the sweat glands.

Effects of generalized sympathetic stimulation

- In energy conditions e.g. in cases of fight, flight, muscle exercise,

emotions, pain or cold  generalized sympathetic stimulation occurs
(alarm response, stress response, or mass discharge) that helps the
person to face emergency with better performance.

I) Sympathetic stimulation provide more energy substrates (O2,

glucose & fatty acids) to the body:
1- Lung: bronchodilatation  better lung ventilation  provides more O2
to the body.
2- Liver: glycogenolysis   blood glucose level.
3- Adipose tissue: lipolysis   free fatty acids (FFAs) in blood.

II) Sympathetic stimulation to the eye:

-  Field of vision &  amount of light entering the eye through:
a) Pupillary dilatation.
b) Elevation of eye lids.
c) Exophthalmus.

III) Sympathetic effects on CVS:

1- Heart:  HR & force of myocardial contraction &  ABP  better
perfusion of the vital organs & muscles.
2- Blood: shift from inactive organs (skin & splanchnic area) by VC to
active organs (heart & skeletal muscles).

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3- Spleen: contraction of splenic capsule  ejection of blood (1/2 L) rich

in RBCs   blood volume &  O2 carrying capacity of the blood.
4- Blood vesses: VC of blood vessels of skin (which limit bleeding if
wounded).

IV) Sympathetic stimulation to skeletal muscle:

-  Strength of muscle contraction & delay the onset of fatigue (Orbelli
phenomenon).

V) Stimulation of adrenal medulla to secrete adrenaline (80%) &

noradrenaline (20%) which:
1- Potentiate sympathetic activity.
2-  Metabolic rate all over the body.
3-  Mental activity & alertness (= aroused state) by central action of
catecholamines on the reticular formation in the brain.

VI) Sympathetic stimulation to sweat glands:

-  Sweating (which gets rid of the excessive heat produced during
exercise as a result of increased metabolism).

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The main effects of the sympathetic nervous system on

target structures.

Target Action Receptor

Eye Mydriasis α1
Blood vessels VC α1
Blood vessels of VD β2
skeletal muscles Muscarinic
Heart Increases heart rate & β1
force of contraction
Bronchioles Bronchodilatation β2
GIT Retention of food
•  Motility (peristalsis).
GB Retention of bile
UB Retention of urine
Colon Retention of feces
•Wall --------- Wall (β2)
•Sphincter ++++ Sphincter (α1)

Liver Glycogenolysis β2
Spleen Contraction of splenic α1
capsule
Kidney Increase renin secretion β1
Adrenal medulla Adrenaline 80% & Nicotinic
noradrenaline 20%
secretion
Genital system Ejaculation α1
Sweat gland Increases sweating Muscarinic
Erector pili muscle Hair erection α1
Adipose tissue Lipolysis β3

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The parasympathetic nervous system

 Functional anatomy:
• As in the sympathetic nervous system, parasympathetic pathways are
composed of preganglionic and postganglionic neurons.
• The preganglionic nerve fibers originate in cranial nerve nuclei in the
brainstem and in the lateral horn of the spinal cord between cord
segments S2 and S4 (craniosacral origin).
• These fibers pass uninterrupted all the way to the effector organ.
• In the wall of the effector organ, the preganglionic fibers synapse with
very short postganglionic fibers, which in turn affect the function of the
organ.

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Functions of parasympathetic nervous system

[I] Oculomotor (3rd cranial) nerve

 Origin:
 Edinger –Westphal nucleus in mid brain.
 Relay:
 The ciliary ganglion.
 Functions:
1) Motor to the constrictor pupillae muscle  Pupil constriction (miosis).
2) Motor to the ciliary muscle  accommodation for near vision.

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[II] Facial (7th carnial) nerve

 Origin:
1) Superior salivary nucleus (SSN) in lower part of pons  Chorda
tympani.
2) Lacrimal center close to SSN  Greater superficial petrosal nerve.
 Relay:
1) Chorda tympani  (the submandibular ganglion).
2) Greater superficial petrosal nerve  (the pterygopalatine ganglion).
 Functions:
(I) Chorda tympani:
1) Secretory & VD to the submandibular & sublingual salivary glands 
large amount of watery saliva poor in enzymes.
2) VD to blood vessels of the anterior 2/3 of tongue.
(II) Greater superficial petrosal nerve:
 Secretory & VD to lacrimal & nasal glands.

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[III] The glossopharyngeal (9th carnial) nerve

 Origin:
 Inferior salivary nucleus (ISN) in medulla oblongata.
 Relay:
 The otic ganglion.
 Functions:
1) Secretory & VD to parotid salivary gland  large amount of watery
saliva poor in enzymes.
2) VD to blood vessels of the posterior 1/3 of the tongue.

[IV] The vagus (10th carnial) nerve

 Origin:
 Dorsal vagal nucleus in medulla oblongata.
 Relay:
 The terminal ganglia in the organs which it supplies.
 Functions:
(1) Heart:
 Inhibition all cardiac properties;  contractility (-ve inotropic), 
excitability,  rhythmicity (-ve chronotropic), conductivity (-ve
dromotropic).
(2) Lungs:
 Bronchoconstriction.
  Bronchial mucous secretion.
(3) GIT:
a- Motor to plain muscles in wall of esophagus, stomach, small intestine
& proximal large intestine but inhibitory to their sphincters:
  Evacuation of food from GIT.
  Motility (peristalsis).
b- Secretory to glands of stomach, intestine, pancreas & liver.
(4) Gall bladder (GB):
 Motor to GB wall & inhibitory to sphincter of oddi  evacuation of GB.

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[V] The sacral autonomic = pelvic nerve

 Origin:
 The autonomic motor nuclei in sacral spinal cord segments (S2-4).
 Relay:
 The terminal ganglia in organs of supply.
 Functions:
(1) Defecation: (nerve of defecation)
 Constriction of the wall of the distal part of large intestine & rectum &
relaxation of internal anal sphincter.
(2) Micturition: (nerve of micturition)
 Contraction of the wall of the urinary bladder (detrusor muscle) &
relaxation of internal urethral sphincter.
(3) Erection: (nerve of erection = nervous erigentes)
 VD of the blood vessels of the pelvic viscera & the external genetalia 
erection of penis & clitoris.
(4) Secretion:
 Secretory to seminal vesicles & prostate.

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Anatomical & physiological Differences between the

sympathetic & parasympathetic division

Feature Sympathetic division Parasympathetic

Division
General effect Prepares body for activity; Conserves & stores
[Functional role] “fight or flight” energy; “rest and digest.”
Energy Expends energy Conserves energy
Origin Thoraco-lumbar outfow Cranio-sacral outflow
Rami Gray and white; the white None
communicantes rami contain myelinated
preganglionic fibers and the
gray contain unmyelinated
postganglionic fibers
Ganglia Lateral, or paravertebral Terminal ganglia
ganglia) & collateral, or
prevertebral, ganglia.
Divergence Great. [a preganglionic fiber Little. [a preganglionic
synapses with several fiber synapses with few
postganglionic fibers] postganglionic fibers]
Extent of effect Generalized. Localized.
Preganglionic Short long
fibers
Postganglionic long Short
fibers
Neurotransmitters All preganglionic fibers All preganglionic and
postganglionic fibers
release ACh. Most
release ACh (cholinergic
postganglionic fibers release fibers).
norepinephrine (adrenergic
fibers). Postganglionic fibers
serving sweat glands release
ACh.

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The main effects of the SNS & PNS on target structures

Target Sympathetic effect Parasympath. effect

Eye
Iris (+) DPM mydriasis (+) CPM miosis
Ciliary muscle (-) ciliary muscle  (+) ciliary muscle 
accommodation to far accommodation to near
vision vision
Blood vessels VC VD via nitric oxide (NO)
Blood vessels of VD No effect (no
heart & sk.m. innervation)
Heart Increases heart rate & Decreases heart rate &
force of contraction force of contraction
Lung Bronchodilatation Bronchoconstriction
GIT •Retention of food •Evacuation of food
•Decreases intestinal •Increases intestinal
motility (peristalsis) motility (peristalsis)
GB -Retention of bile -Evacuation of bile
UB -Retention of urine -Evacuation of urine
Colon -Retention of feces -Evacuation of feces
•Wall --------- •Wall ++++++
•Sphincter ++++ •Sphincter--------

Liver Glycogenolysis Increases bile secretion

Glands (nasal, Inhibits secretory activity; Stimulates secretory
activity
lacrimal, gastric, constricts blood vessels
pancreas) supplying the glands
Salivary glands Stimulates secretion of Stimulates secretion of
thick, viscous saliva watery saliva
Sweat glands Increases sweating No effect (no
innervation)
Genital system Ejaculation Erection (VD)

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Chemical transmission 3
Learning Objectives
Upon completion of this chapter, the student should be able to answer
the following questions:
1- Describe the sites of release of acetyl choline.
2- Name the neurotransmitters or hormones that are secreted by each of the
following:
a. Preganglionic autonomic neurons.
b. Postganglionic sympathetic neurons innervating intestine.
c. Postganglionic sympathetic neurons innervating sweat glands
d. Postganglionic parasympathetic neurons.
e. Adrenal medullary cells.
3- Explain what is meant by cholinergic fibers and describe where these
fibers are located in the body.
4- Which ANS fibers release acetylcholine? Which release
norepinephrine?
5- Explain what is meant by cholinergic receptors and describe where these
receptors are located in the body.
6- Describe the actions of acetyl choline.
7- Describe the clinical importance of drugs that mimic cholinergic effects.
8- Describe the clinical importance of drugs that inhibit cholinergic effects.

9- Hweedy, a 21-year-old college student, is having trouble sleeping, cries

frequently, and has recurrent thoughts of suicide An antidepressant is
prescribed. Like many such drugs, this antidepressant has
anticholinergic side effects. What side effects might Hweedy experience
in the first week of treat1nent?

10- Mr. Smeeda suffers from urinary retention and a hypoactive urinary
bladder. Bethanechol, a drug that mimics acetylcholine's autonomic
effects, is prescribed to manage his problem. First explain the rationale
for prescribing bethanechol, and then predict which of the following

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side effects Mr. Smeeda might experience while taking this drug (select
all that apply): low blood pressure, bradycardia, deficient tear
formation, wheezing due to bronchoconstriction, increased mucus
production in bronchi, deficient salivation, diarrhea, cramping (colic),
excessive sweating, undesirable erection of penis.

11- Distinguish between the different types of adrenergic receptors and

state where these receptors are located in the body.

12- Define denervation hypersensitivity & discuss its mechanism.

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Chemical transmission

 Transmission of nerve impulse in the autonomic ganglia between

preganglionic & postganglionic neurons & between postganglionic
neurons & the effector organs is chemically mediated i.e. it occurs
through release of chemical substance (transmitter) from the stimulated
nerve endings.

 The chemical transmitters in the ANS are:

- Acetyl choline (A Ch)  which is mainly a parasympathetic
transmitter.
- Noradrenaline (NA)  Which is the sympathetic transmitter.
The autonomic fibers are classified into:
a) Cholinergic fibers:
- The fibers that secrete acetylcholine at their terminations.

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b) Adreneric fibers:
- The fibers that secrete noradrenaline at their terminations.

Acetyl choline (ACh)

 Synthesis of ACh:
- ACh is synthesized in the terminal ending of cholinergic nerve fibers.

Choline acetyl transferase (CAT)

 Acetyl Co A + Choline Acetyl choline + Co A

 Release of acetylcholine:
A) Mechanism of release of A Ch:
- When an action potential (nerve impulse) spreads over the terminal fibers
 the depolarization process  the permeability of the fiber membrane
to Ca++ ions   Ca++ influx into the nerve terminals.
- Ca++ interact with the vesicle that are adjacent to the membrane causing
them to fuse with the membrane and to empty their contents to the
exterior. This process is known as exocytosis.

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B) Sites of release of ACh:

1) All Preganglionic autonomic fibers:
- All preganglionic parasympathetic fibers.
- All preganglionic sympathetic fibers.
- Preganglionic sympathetic fibers to adrenal medulla.
2) All postganglionic parasympathetic fibers.
3) Some postganglionic sympathetic fibers.
- Secretory fibers to sweat glands.
- Vasodilator fibers to blood vessels of skeletal muscles.
4) Somatic motor nerve fibers to skeletal muscles (Neuromuscular
junction).

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 Destruction of ACh.
 The secreted ACh is hydrolyzed rapidly by an enzyme called
Acetylcholinesterase (AChE).

AChE
 ACh Choline + acetic acid.

 Value of cholinesterase:
- Is to keep the action of ACh localized in the place of liberation,
otherwise it may accumulate & pass to blood & produce generalized
parasympathetic effects which are: undesirable as excessive salivation,
erection & micturition & dangerous due to decreased heart rate
(bradycardia) & decreased blood pressure (hypotension).

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Cholinergic fibers
 Defintion:
 There are fibers secreting ACh at their endings.
 Types:
1) Central cholinergic fibers :( arising from CNS.)
a- Pregangaglionic fibers to autonomic ganglia.
b- Preganganglionic fibers to adrenal medulla.
c- Somatic motor fibers to skeletal muscles.
2) Peripheral cholinergic fibers: (arising from autonomic ganglia.)
a- Postganganglionic parasympathetic fibers.
b- Postganganglionic sympathetic fibers to sweat glands & blood
vessels of skeletal muscles.

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Cholinergic receptors

 Definition:
 These are receptors responding to ACh.
 Types:
1) Central cholinergic receptors: (Nicotinic receptors)
 Can be activated by ACh or small dose of nicotine.
 Present in:
A- Autonomic ganglia (all postganglionic neurons [cell bodies and
dendrites], both sympathetic and parasympathetic).
B- Adrenal medulla (the hormone-producing cells of the adrenal
medulla).
C- Motor end plate (the sarcolemma of skeletal muscle cells at
neuromuscular junctions).
2) Peripheral cholinergic receptors: (muscarinic receptors)
 Can be activated by ACh or the mushroom poison muscarine.
 Present on:
A- The effector cells supplied by all postganganglionic parasympathetic
fibers.
B- Sweat glands & blood vessels of skeletal muscles.

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Actions of ACh

I] Nicotine like actions

1) Stimulation of autonomic ganglia.
2) Secretion of adrenaline & noradrenaline from adrenal medulla.
3) Contraction of skeletal muscles.

II] Muscarine like actions

(1) CVS:
a- Heart:  inhibition of all cardiac properties   contractility (atria),
rhythmicity, conductivity & excitability.
b- BVs:  VD [via release of EDRF = nitric oxide (NO)].
c- ABP:   arterial blood pressure (ABP) by direct VD &  HR.
(2) Respiratory system:
 Bronchoconstriction  wheezing.
(3) GIT:
  Motility.
 Motor to wall.
Evacuation of food & feces.
 Inhibitory to sphincters.
(4) GB:
 Motor to wall.
Evacuation of bile.
 Inhibitor to sphincter of Oddi.
(5) UB:
 Motor to wall (detrusor muscle).
Evacuation of urine.
 Inhibitory to int. urethral sphincter.
(6) Exocrine glands:
  Secretion of:
- Lacrimal gland - Salivary gland. - Bronchial gland.
- Gastric gland. - Pancreatic gland. - Sweat gland.
(7) Eye:
 Miosis due to contraction of constrictor pupillae muscles.
 Accomodation for near vision due to contraction of ciliary muscles.

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Parasympathomimetic drugs
 Definition:
 These are drugs which produce actions similar to parasympathetic
stimulation.
 Types:
(I) Direct:
 Drugs acting directly on muscarinic cholinergic receptors e.g.
a) Pilocarpine: Used as eye drops  miosis for treatment of glaucoma.
b) Bethanechol: treatment of post-operative urinary retention.
(II) Indirect:
 Drugs which inhibit AChE enzyme thus preserving ACh whose
action become prolonged & marked e.g. Anti ChE.

Anticholinestrases
 Definition:
 These are substances which combine with ChE preventing its
destructive effect on ACh Thus indirectly causing parasympathetic
effects by preserving released ACh.

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 Types:
(I) Reversible Anti-ChE: (short acting)
 Their actions are temporarly  several hours ex.:
a- Eserine: (physostigmine) used as eye drops  miosis for treatment of
glaucoma.
b- Prostigmine: (Neostigmine) used for treatment of:
- Myasthenia gravis.
- Paralytic ileus.
- Urine retention.
(II) Irreversible Anti-ChE: (long acting)
 Their actions are prolonged  several weeks ex.:
- Organophosphorous compounds:
a- Insecticides: Parathione & malathione.
b- Nerve = war gases: Sarin & soman.

Ach Antagonists = Blockers

 Definition:
 They block the function but not the secretion of ACh.
 Types of acetyl choline antagonists:
[I] Muscarinic blockers
 Drugs block the function of ACh on postganglionic cholinergic receptors
(muscarinic receptors) by competitive inhibition i.e. they compete with
ACh for the same site on the receptors.
 Ex.: Atropine, Homatropine, Scopolamine.

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Dr-Emara ANS

 Uses of atropine:
a) Dilate the pupil for fundus examination.
b) Relax smooth muscle spasm in renal or intestinal colic.
c) Treatment of poisoning with organophosphorous compounds as
malathione poisoning.
d) Block the muscarinic receptors before anaesthesia & surgical
operations in order to:
- Prevent cardiac arrest: which may occur due to reflex vagal
stimulation during tracheal intubation or surgery.
- Prevent salivary & bronchial secretions: these secretions may block
the air passages.

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[II] Nicotinic blockers

 Drugs block the nicotinic like action of ACh.
 These are divided into:
A) Ganglion blockers: (GB)
 These are drugs block the nicotinic receptors at autonomic ganglia.
1- Competitive GB:  acting by competitive inhibition.
- ex.: Hexamethonium, Trimetaphan & Pempidine.
2- Depolarization GB:  acting by persistant depolarization.
- ex.: Nicotine in large dose.
Uses of ganglion blockers:
 In the treatment of hypertension. These drugs blocks the conduction in
sympathetic ganglia.   Release of noradrenaline   VC   arterial
blood pressure (ABP).

B) Neuromuscular blockers: (NMB)

 These are drugs block the nicotinic receptors at the NMJ.
1- Competitive NMB:  acting by competitive inhibition.
- ex.: Curare, Galamine & Pancronium.
2- Depolarizing NMB:  acting by persistant depolarization.
- ex.: Succinylcholine & Decamethonium.
Uses of NMB:
 Muscle relaxants during surgical operations.

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Catecholamines
 These are:
1) Adrenaline (Epinephrine).
2) Noradrenaline (Norepinephrine).
3) Dopamine.
 Biosynthesis of epinephrine & Norepinephrine:

NB: N-methyltransferase present in adrenal medulla but not in

sympathetic postganglionic adrenergic neurons.
 Fate or inactivation of adrenaline & Noradrenaline:
- After secretion of norepinephrine by the terminal nerve endings, it is
removed from the secretory site in three ways:
1) Reuptake into the adrenergic nerve endings themselves by an active
transport process— accounting for removal of 50 to 80 per cent of the
secreted norepinephrine.

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Dr-Emara ANS
2) Diffusion away from the nerve endings into the surrounding body fluids
and then into the blood—accounting for removal of most of the remaining
norepinephrine.
3) Destruction of small amounts by tissue enzymes (one of these enzymes
is monoamine oxidase (MAO), which is found in the nerve endings, and
another is catechol-O-methyl transferase (COMT), which is present
diffusely in all tissues).

Adrenergic fibers

 These are fibers secreting noradrenaline at their endings.

 They are the postganglionic sympathetic fibers (except those supplying
the skeletal muscle & the eccrine sweat glands).

Adrenergic receptors

 Definition:
These are receptors present on the effector cells facing all postganglionic
sympathetic fibers (except those of sweat glands).
 Types & actions:
[I] -receptors
1- 1-receptors:
 Actions:
1- VC of skin & mucous membrane blood vessels.
2- Contraction of dilator pupillae muscles.
3- Contraction of erector pillae muscles.
4- Contraction of sphincters of GIT &UB.
5- Contraction of splenic capsule.
6- Contraction of the non-pregnant uterus.
7- Contraction of smooth muscle of the vas deferens  Ejaculation.
2- 2-receptors:
a- Inhibitory presynaptic receptors.
 Action:  release of noradrenaline.
b- Inhibitory postsynaptic receptors:
 Action:
-  Release of insulin.
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[II] -receptors
1- 1-receptors:
 Actions:
1-  Cardiac properties.
2-  Renin release from kidney.
3-  Lipolysis (increases fat breakdown).
2- 2-receptors:
 Actions:
1- VD of skeletal & coronary blood vessels.
2- Bronchodilatation.
3- Glycogenolysis.
4- Relaxation of wall of GIT & UB.
5- Relaxation of pregnant uterus.
4- 3-receptors:
 Actions:
1- Present in adipose tissue  lipolysis (increases fat breakdown).
2- Smooth muscle relaxation of the wall of urinary bladder and prevention
of urination.

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Adrenergic stimulants & blockers

Adrenrgic stimulants
Adrenergic blockers
(Sympathomimetic drugs)
 Drugs when injected in the body  Drugs which block or depress the
effects similar to sympathetic actions of sympathetic nerves.
stimulation.
1) Drugs stim. sympathetic ganglia: 1) Ganglion blockers:
 Small dose of nicotine.  Large dose of nicotine.
 Acetyl choline.  Hexamethonium.
2) Drugs  release NE: 2) Drugs prevent synthesis, storage &
 Tyramine. release of NA:
 Amphetamine.   Methyl dopa.
Sympatholytic
 Ephedrine.  Reserpine. drugs
 Guanethidine.
3) Drugs stim. -receptors: 3) -blockers:
 NE & epinephrine.  Phenoxybenzamine.
 Phenylephrine (stim. 1 only).  Prazosin (block 1 only).
 Clonidine (stim. 2 only).  Yohimbine (block 2 only).

4) Drugs stim. -receptors: 4) -blockers:

 Epinephrine.  Propranolol.
 Dobutamine (stim. 1 only).  Atenolol. (block 1 only).
 Albuterol (stim.2 only).  Butaxamine (block 2 only).

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Denervation of organs from the autonomic supply

 Sympathectomy:
- Removal of symp. innervations may be done in the following cases:
1) Vascular disorders associated with severe vasospam in vessels may
lead to gangrene as in Berger's disease.
2) Excessive sweating (hyperhydrosis).
 Parasympathectomy:
- Vagotomy may be done in cases of peptic ulcer to diminish gastric HCl
secretion by the parietal cells.
NB:
 The preganglionic (not postganglionic fibers) should be sectioned in
order to avoid denervation hypersensitivity i.e.  in the sensitivity of the
denervated organs to adrenaline & noradrenaline.

Denervation hypersensitivity

 Definition:
 After cutting of autonomic nerve, the denervated organ becomes more
sensitive to the injected catecholamine or A.Ch.
 Mechanisms:
A) In sympathetic:
1- Destruction of the nerve endings  prevents removal of catecholamines
by the process of reuptake into the nerve ending.
2- The monoamine oxidase (MAO) that is found in the nerve endings is
not available for the destruction of catecholamines.
3- Adrenergic receptors  in number after denervation (up-regulation of
receptors).
B) In parasympathetic:
1- Loss of true ChE in the nerve endings  absence of inactivation of ACh.
2- Cholinergic receptors  in number after denervation (up-regulation of
receptors).

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Central control of ANS 4

Central control of ANS

 The autonomic reflexes are controlled by centers present at various levels

in CNS.
[I] Spinal cord:
- LHCs can act as lower autonomic centers after separation of spinal
cord from higher centers in brain.
- Autonomic reflexes, such as micturition (urination), defecation,
erection, and ejaculation are integrated in the spinal cord
[II] Brian stem:
(1) M.O.: Contain important centres controlling H.R., A.B.P., digestive
secretion, movements, swalling, respiration, ….etc.
(2) Pons: Contains a part of respiratory center.
(3) Mid brain: Contains centers for accommodation & pupillary light
reflex.
[III] Higher control:
(1) Hypothalamus:
a- Anterior hypothalamic nuclei  control the parasympathetic
functions.
b- Posterior hypothalamic nuclei  control the sympathetic functions.
-Artificial stimulation of different regions of the hypothalamus
can activate the fight or flight response typical of the sympathetic
nervous system or have the calming effects typical of the
parasympathetic.
(2) Cerebral cortex:
- It controls the ANS directly & through centers e.g. the hypothalamus.
- The limbic system, an ancient part of the cerebral cortex, is involved
in many emotional responses and has extensive connections with the
hypothalamus, a site of several nuclei of autonomic control.

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