The Autonomic Nervous System

The autonomic nervous system has two branches: the sympathetic

nervous system, the parasympathetic nervous system. The
autonomic nervous system is unique in that it requires a sequential
two-neuron efferent pathway; the preganglionic neuron must first
synapse onto a postganglionic neuron before innervating the target
organ. The preganglionic, or first, neuron will begin at the
“outflow” and will synapse at the postganglionic, or second,
neuron’s cell body. The postganglionic neuron will then synapse at
the target organ. Within the brain, the autonomic nervous system is
regulated by the hypothalamus. Autonomic functions include
control of respiration, cardiac regulation (the cardiac control
center), vasomotor activity (the vasomotor center), and certain
reflex actions such as coughing, sneezing, swallowing and
vomiting. The hypothalamus, just above the brain stem, acts as an
integrator for autonomic functions. The sympathetic nervous
system is often considered the "fight or flight" system, while the
parasympathetic nervous system is often considered the "rest and
digest" or "feed and breed" system. In many cases, both of these
systems have "opposite" actions where one system activates a

physiological response and the other inhibits it. The function of the
sympathetic system is to prepare the body for an emergency. The
heart rate is increased, arterioles of the skin and intestine are
constricted, arterioles of skeletal muscle are dilated, and the blood
pressure is raised. In addition, the sympathetic nerves dilate the
pupils; inhibit smooth muscle of the bronchi, intestine, and bladder
wall; and close the sphincters.
Two major neurotransmitters in the ANS are
Acetylcholine: Fibers that secrete acetylcholine (cholinergic
fibers) include all preganglionic fibers, all postganglionic
parasympathetic fibers, and some postganglionic sympathetic
fibers (those that innervate pilo erectors, sweat glands, and blood
vessels).
Norepinephrine: Fibers that secrete norepinephrine(adrenergic
fibers) include most postganglionic sympathetic fibers. Sweat
glands on the palms and soles also respond to adrenergic
stimulation to some degree.
Sympathetic part
There are two kinds of neurons involved in the transmission of
any signal through the sympathetic system: pre-ganglionic and
post-ganglionic. The shorter preganglionic neurons originate from
the thoracolumbar region of the spinal cord specifically at T1 to
L2-L3, and travel to a ganglion often one of the paravertebral
ganglia, where they synapse with a postganglionic neuron. From
there, the long postganglionic neurons extend across most of the
body.
Sympathetic ganglia can be divided into two major groups,
paravertebral and prevertebral (or preaortic), on the basis of their
location within the body. Paravertebral ganglia generally are
located on each side of the vertebrae and are connected to form
the sympathetic chain, or trunk. There are usually 21 or 22 pairs
of these ganglia—3 in the cervical region, 10 or 11 in the thoracic
region, 4 in the lumbar region, and 4 in the sacral region—and a
single unpaired ganglion lying in front of the coccyx, called the
ganglion impar.

Cervical Part of the Sympathetic Trunk

The cervical part of the sympathetic trunk extends upward to the
base of the skull and below to the neck of the first rib, where it
becomes continuous with the thoracic part of the sympathetic
trunk. It lies directly behind the internal and common carotid
arteries (i.e., medial to the vagus) and is embedded in deep
fascia between the carotid sheath and the prevertebral layer of
deep fascia.
The sympathetic trunk possesses three ganglia: the superior,
middle, and inferior cervical ganglia:-

Superior Cervical Ganglion

The superior cervical ganglion lies immediately below the skull
Branches

 The internal carotid nerve, consisting of postganglionic

fibers, accompanies the internal carotid artery into the
carotid canal in the temporal bone. It divides into branches
around the artery to form the internal carotid plexus.
 Gray rami communicantes to the upper four anterior rami
of the cervical nerves
 Arterial branches to the common and external carotid
arteries. These branches form a plexus around the arteries
and are distributed along the branches of the external
carotid artery.
  Cranial nerve branches , which join the 9th, 10th, and
12th cranial nerves
 Pharyngeal branches, which unite with the pharyngeal
branches of the glossopharyngeal and vagus nerves to form
the pharyngeal plexus
 The superior cardiac branch, which descends in the neck
and ends in the cardiac plexus in the thorax

Middle Cervical Ganglion

The middle cervical ganglion lies at the level of the cricoid
cartilage Branches

 Gray rami communicantes to the anterior rami of the fifth

and sixth cervical nerves
 Thyroid branches, which pass along the inferior thyroid
artery to the thyroid gland
 The middle cardiac branch, which descends in the neck and
ends in the cardiac plexus in the thorax.
 Inferior Cervical Ganglion

The inferior cervical ganglion in most people is fused with the

first thoracic ganglion to form the stellate ganglion. It lies in
the interval between the transverse process of the seventh
cervical vertebra and the neck of the first rib, behind the
vertebral artery .
Branches

 Gray rami communicantes to the anterior rami of the

seventh and eighth cervical nerves
 Arterial branches to the subclavian and vertebral arteries
  The inferior cardiac branch, which descends to join the
cardiac plexus in the thorax .

The part of the sympathetic trunk connecting the middle cervical

ganglion to the inferior or stellate ganglion is represented by
two or more nerve bundles. The most anterior bundle crosses in
front of the first part of the subclavian artery and then turns
upward behind it. This anterior bundle is referred to as the ansa
subclavia .

Thoracic and abdominal part of the Sympathetic Trunk

Thoracic splanchnic nerves are splanchnic nerves that arise from

the sympathetic trunk in the thorax and travel inferiorly to
provide sympathetic innervation to the abdomen. The nerves
contain preganglionic sympathetic and general visceral afferent
fibers. There are three main thoracic splanchnic nerves: The
greater, lesser, and least splanchnic nerves provide the major
preganglionic contribution to the celiac plexus . The greater
splanchnic nerve has its origin from the T5-T10 spinal roots.
The nerve travels along the thoracic paravertebral border,
through the crus of the diaphragm, and into the abdominal
cavity, ending on the celiac ganglion. The lesser splanchnic
nerve arises from the T10-T11 roots and passes with the greater
nerve to end at the celiac ganglion then to superior mesenteric
ganglia. The least splanchnic nerve arises from the T12 spinal
roots and passes through the diaphragm to renal plexus and
inferior mesenteric ganglia. The inferior mesenteric ganglion
also receives fibers from L1 and L2 preganglionic neurons,
known as the lumbar splanchnic nerve. The large intestine and
kidney are the target organs from this ganglion, in addition to a
contribution to the pelvic plexus. This pelvic plexus also
contains parasympathetic nerves.
The three preaortic ganglia are the celiac, superior mesenteric,
and inferior mesenteric. Lying on the anterior surface of the
aorta, preaortic ganglia provide axons that are distributed with
the three major gastrointestinal arteries arising from the aorta.
Thus, the celiac ganglion innervates the stomach, liver,
pancreas, and the duodenum, the first part of the small intestine;
the superior mesenteric ganglion innervates the small intestine;
and the inferior mesenteric ganglion innervates the descending
colon, sigmoid colon, rectum, urinary bladder, and sexual
organs.

Parasympathetic Part
The cranial portion of the craniosacral outflow of the
parasympathetic part of the autonomic nervous system is located
in the nuclei of the oculomotor (3rd), facial (7th),
glossopharyngeal (9th), and vagus (10th) cranial nerves.
The parasympathetic nucleus of the oculomotor nerve is called
the Edinger-Westphal nucleus; those of the facial nerve the
lacrimatory and the superior salivary nuclei; that of the
glossopharyngeal nerve the inferior salivary nucleus; and that
of the vagus nerve the dorsal nucleus of the vagus . The axons
of these connector nerve cells are myelinated preganglionic
fibers that emerge from the brain within the cranial nerves.
These preganglionic fibers synapse in peripheral ganglia located
close to the viscera they innervate. The cranial parasympathetic
 ganglia are the ciliary, the pterygopalatine, the submandibular
and the otic.
The pelvic splanchnic nerves(S2-4), innervate the pelvic viscera.
The visceral tissues in the pelvis that the parasympathetic nerve pathway
controls include those of the urinary bladder, ureters, urinary sphincter, anal
sphincter, uterus, prostate, glands, vagina, and penis. Unconsciously, the
parasympathetic will cause peristaltic movements of the ureters and intestines,
moving urine from the kidneys into the bladder and food down the intestinal
tract and the parasympathetic will assist in excreting urine from the bladder or
defecation.