Lesson outcomes Autonomic Nervous System (ANS)

• State the divisions of the nervous systems. • The portion of the nervous system that controls most visceral functions
Autonomic Nervous System • Describe the parasympathetic and sympathetic outflows of the body is called the autonomic nervous system.
• including the spinal cord division of origin • control arterial pressure,
Teguh Haryo Sasongko • length of preganglionic and postganglionic neurons • gastrointestinal motility,
Associate Professor, MD, PhD
• neurotransmitters • gastrointestinal secretion,
Human Biology/Physiology
Email: teguhharyosasongko@imu.edu.my; Ext: 1342 • receptors at the ganglionic and target organ synapse • urinary bladder emptying,
• sweating,
• List the major central nervous system control centers of the ANS • body temperature,
Bachelor of Medicine and Bachelor of Surgery (2021)
Year 1 Semester 1 • State examples of the sympathetic and parasympathetic involvement • ….
Module: Cellular Response 2 • Describe effects of abnormal ANS activity or lack of activity
Key Clinical Problem: Response to Xenobiotics
Credit to Dr Brinnell Annette Caszo for creating the slides

The SNS and ANS share afferent neurons The ANS and somatic nervous system
Afferent
neurons
Sensory receptor Integrating center(s)
Efferent neurons

Autonomic
Somatic
nervous
nervous
system
system

RESPONSE

Autonomic nervous system

Sympathetic NS
Fight or flight system
(stimulate metabolism, increase alertness, and
prepares the body to deal with emergencies)
preganglionic fiber from thoracic and lumbar
segments of the spinal cord synapse in ganglia
near the spinal cord
Preganglionic fibers are short (cholinergic,
acetylcholine, always excitatory)
Postganglionic fibers are long (adrenergic,
norepinephrine, mostly excitatory)
Parasympathetic NS
Rest and digest
(it conserves energy and promotes sedentary
activities such as digestion)
Preganglionic fibers originate in the brain and
the sacral segments of the spinal cord. They
synapse on neuron in the terminal ganglia very
close to target organs or intramural ganglia
embedded within the target organ
Preganglionic fibers are long (cholinergic,
acetylcholine, always excitatory)
Postganglionic fibers are short (cholinergic,
excitatory/inhibitory)
Sympathetic nervous system
The Sympathetic Components:
nervous system
1. Preganglionic neuron located between segments T1 and L2 of the spinal cord.
• Neurons are situated in the lateral gray horn and their short axons enter the
ventral roots of these segments.
2. Ganglionic neurons located in TWO types of ganglia near the vertebral column .
• Paired sympathetic chain ganglia on either side of the vertebral column contain
neurons that control effectors in the body wall and thoracic cavity.
• Unpaired collateral ganglia, anterior to the vertebral column, contain ganglionic
• The postganglionic sympathetic nerve fibers neuron that innervate tissues and organs in the abdominal cavity.
to the sweat glands, to the piloerector muscles
of the hairs, and to a very few blood vessels are
cholinergic. 3. The adrenal medullae, is the modified sympathetic ganglion and its neurons have very
short axons.
 Sympathetic nervous system Sympathetic chain ganglia
The collateral ganglia of sympathetic NS
The abdominal pelvic tissues and organs receive sympathetic innervation over
preganglionic fibers from lower thoracic and upper lumbar segments that pass
through the sympathetic chain without synapsing and instead synapse within
three unpaired collateral ganglia (celiac, superior and inferior mesenteric
ganglion). The nerve travelling to the collateral ganglia are known as splanchnic
nerve. The postganglionic fibers leaving the collateral ganglia innervate organs
throughout the abdominal cavity.
To liver, spleen,
adrenal gland,
intestines, kidneys,
urinary bladder,
reproductive organ

Cardiovascular effects
Adrenal Medullae Sympathetic function
The sympathetic nerves + circulating catecholamines (adrenaline + noradrenaline) bring
about:
Øblood flow to exercising muscle
Øenergy available ØIncrease in heart rate
Øoxygen availability ØIncrease in stroke volume (SV)
Øpain threshold which increase cardiac output
Øalertness Øalpha sympathetic effect-splanchnic
Shunting of blood away from
Vasoconstriction (VC) viscera & skin, towards the
It does these by activating the SYMPATHOADRENAL AXIS exercising muscles
ØSympathetic cholinergic effect- vasodilation
(VD)

Sympathetic preganglionic fiber enters adrenal medullae and synapse with

modified neurons that perform an endocrine function
Fight or flight Increased blood flow to exercising muscle

Metabolic effects
Main effects: Test your knowledge!
The sympathetic nerves + circulating catecholamines bring about:
ØIncrease in respiratory rate Main actions of Sympathetic division: Evident in
ØIncrease in tidal volume which Emergencies (fight or flight)
increase in O2 availability Increased oxygen and
energy to exercising muscle
ØLipolysis CVS: dilation of coronary
Øglycogenolysis sweating arteries, increased cardiac
vasoconstriction output, blood pressure and
redistribution of cardiac output
ØAlertness
ØPupil dilation ( better visual acuity) GIT: Eyes:
ØIncreased pain threshold Peristalsis is reduced Pupil dilation
Sphincters is constricted (Mydriasis)
 Parasympathetic nervous system Parasympathetic nervous system
craniosacral division of the ANS Components: Parasympathetic function
1. Preganglionic neurons in the brain stem and in sacral segments of the spinal Rest and digest
cord.
• The midbrain, pons, and medulla oblongata for cranial nerve III, VII, IX & X.
*Cranial nerves:
• Lateral gray horns of spinal cord segments S2 to S4. Ø Imagine an old man sleeping
Nerve III: oculomotor
Nerve VII: facial
Nerve IX: glossopharyngeal
Ø after a good meal
2. Ganglionic neurons in peripheral ganglia within or adjacent to the target
Nerve X: Vagues
organs. Ø He is drooling
• Preganglionic fibers less divergent than sympathetic division, more localized
specific effects than those of the sympathetic division. Ø His breathing is noisy
* Parasympathetic nerve with sacral origin, Ø His stomach is rumbling
do not join the spinal nerve but instead
form the pelvic nerve which innervates
intramural ganglia in kidney, urinary Ø His heart is slow and
bladder, last segment of large intestine and
sex organ. Ø His BP is low

Parasympathetic function Neurotransmitters

Neurotransmitters in ANS
in ANS
ØAcetylcholine
ØNoradrenaline (NE)
ØDrooling & rumbling of stomach- Increase in motility ØDopamine
and secretion of the GI tract
(+ relaxation of sphincters)\ parasympathetic preganglionic postganglionic
ØBreathing noisy-bronchoconstriction ACh ACh
ØHeart rate and BP low- reduced HR,
SV(slightly),conduction rate sympathetic ACh NA

Sweat glands
adrenal Blood vessels of
medulla ACh skeletal muscles
Citation: Introduction to Autonomic Pharmacology, Katzung BG, Kruidering-Hall M, Trevor AJ. Katzung & Trevor's Pharmacology: Examination & Board Review, 12e; 2019.
Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=197942917&bookid=2465&Resultclick=2 Accessed: May 06, 2019
Copyright © 2019 McGraw-Hill Education. All rights reserved
ADR

Neurotransmitters in ANS Neurotransmitter release Neurotransmitter release in ANS

Cholinergic neurons (release acetylcholine):

(1)all preganglionic neurons, 4.Produce
(2)all parasympathetic postganglionic neurons, physiological
(3)sympathetic postganglionic neurons that innervate sweat glands, blood vessels in effects
some skeletal muscles and produce vasodilation when stimulated (sympathetic
vasodilator nerves). 1.Synthesised 2.Released on 5.metabolised by
arrival of 3.Bind with
Noradrenergic neurons (release norepinephrine): and stored in receptor
impulse enzyme at site of
(1)The adrenal medulla postganglionic neurons the nerve release
(2) Rest of the sympathetic postganglionic neurons
 Cholinergic receptors

*except for sweat glands, some

Nicotinic receptor blood vessels to skeletal muscles

subtypes Muscle type Ganglion type CNS types

Skeletal
Main synaptic neuromuscular Many brain regions: pre-
Autonomic ganglia
location junction: mainly and postsynaptic
postsynaptic

Acetylcholine function Radial

* 1- Ach is made of acetyl CoA
Circular ms ** and choline Phenylalanine tyrosine dopamine norepinephrine
1
Øskeletal muscles - contraction(nicotinic effect) Acetyl CoA +choline
Øsmooth muscles of GI tract- contraction(muscarinic) ➜Acetylcholine (Ach) 2- ACh is quickly broken down
P-NMT in adrenal medulla
Øradial smooth muscles of GI sphincters*-relaxation by acetylcholinesterase
Øsmooth muscles of bronchus (bronchoconstriction)
Øcircular smooth muscles of iris **( pupil constriction) (meiosis) Re-uptake

3- Choline re-uptake to the epinephrine

Choline
synapse terminal
ACh stimulates all muscles Ach
Acetate
EXCEPT those of the HEART and BLOOD VESSELS Organo Physiologic
Phosphates, MAO
effect

(monoamine oxidase)

Adrenergic receptors
Alpha (α) receptors: α1, α2 Beta (β) receptors: β1, β2
Usually excitatory except on the GI tract Usually inhibitory EXCEPT on the HEART

Norepinephrine mainly activate

alpha receptors, whereas
epinephrine equally activate both
receptors
Test your knowledge! The Hypothalamus and the ANS
Over activity of sympathetic and parasympathetic
SYMPATHETIC OVERACTIVITY
§Hypertension PARASYMPATHETIC OVERACTIVITY

“HEAD GANGLION OF THE ANS” §Excessive sweating §Gastric acidity

Cardio-pulmonary responses §Vasospasm (Raynaud’s §Irritable bowel syndrome

phenomenon)*
Emotions (Rage and pleasure) *excessively reduced blood flow in
response to cold or emotional stress,
causing discolouration of the fingers, toes,
and occasionally other areas

CORRECTION: CHEMICAL or SURGICAL

Autonomic neuropathy Testing the ANS References

Diabetes mellitus ( diabetic neuropathy) Orthostatic hypotension/postural
hypotension (BP falls on standing)
§Leprosy
Neurological symptoms like tingling and
§Syphilis
numbness
§Viral infection
Sexual dysfunction e.g erectile dysfunction
§Old age (Baroreceptor reflex inefficient) (ED)
§Valsalva manoeuvre ( expiration against a closed glottis; bradycardia when
released)
§E:I ratio ( Compare R-R interval from QRS complex in ECG during expiration and
inspiration;about 2 in young people because heart rate is increased during
inspiration)
§Tilt test for postural hypotension
§Supine and standing BP ( supine BP is lower in normal people; higher in people
with autonomic neuropathy)
§Postage stamp test for nocturnal erection
• Autonomic nervous system (Ch 17). Barrett K.E., & Barman S.M., &
Brooks H.L., & Yuan J.J.(Eds.), (2019). Ganong's Review of Medical
Physiology, 26e. McGraw-Hill. https://accessmedicine-mhmedical-
com.ezp2.imu.edu.my/content.aspx?bookid=2525&sectionid=204291750
• Autonomic nervous system, (Ch 60) Ed 11 Textbook of Medical
Physiology, Guyton and Hall