Sympathetic system is the system of energy utilization.

At the time of activity, urgency, anxiety, emotion, excite-

ment and combating stressful situations, sympathetic sys-
tem is activated to provide energy to the body. Excessive
and chronic stimulation of this system leads to leanness,
degeneration ad decay, and underutilization of it leads to
lethargy and adiposity.

Cell bodies of preganglionic neurons of the sympathetic

division are located in the intermediolateral horn of the
thoracic (T1 to T12) and upper lumbar (L1 to L3) segments
of spinal cord. Hence, sympathetic division is known as
thoracolumbar outflow of ANS. The preganglionic neu-
rons come out of the spinal cord via ventral roots. After the
merger of dorsal and ventral roots, spinal nerve emerges.
Sympathetic preganglionic axons leave the spinal nerve via

the white rami communicantes and enter the paraverte-
paraverte
bral sympathetic ganglia, which is an interconnected chain
located on both sides of the vertebral column.
Preganglionic fibers have any of the following destina-
tions (refer to Fig. 30.4, Chapter 30):
1. Preganglionic fibers emerging from spinal cord syn-
apse with cell bodies of postganglionic neuron
located in the paravertebral sympathetic ganglion at
the same spinal cord level. The postganglionic sympa
sympa-
thetic axons then travel in the cervical and lumbosa-
cral spinal nerves. However, few fibers of sympathetic
ganglion chain extend above and below the spinal
level.
2. The chain of sympathetic ganglia extends above
and below the thoracolumbar spinal levels, in which
branches of preganglionic fibers ascend to the cervical
levels or descend to the sacral level. Thus, pregangli
pregangli-
onic axons may synapse with postganglionic neurons
in the paravertebral ganglion at the same level, or
ascend up or descend down to the several spinal seg-
ments and then synapse with the postganglionic neu-
ron (Fig. 31.1).
Preganglionic axons that ascend to cervical level
arise from T1 to T5 and form three major ganglia:
superior, middle and inferior cervical ganglia.
Preganglionic axons descend below L3, form two
additional lumbar and at least four sacral ganglia.
Preganglionic fibers synapse with postganglionic
neurons in these sympathetic ganglia that are
present beyond the thoracolumbar segments of
spinal cord.
3. The preganglionic axons may pass through the para-
vertebral ganglia en route without synapsing there to
terminate in a prevertebral ganglion (collateral gan-
glion),, which is located close to the organ.
Postganglionic neurons for somatic structures such as
sweat glands, piloerector muscles, cutaneous blood ves-
sels and blood vessels of skeletal muscles leave the para-
vertebral ganglion in the gray rami communicantes and
reenter the spinal nerve to supply the target tissues.
Postganglionic neurons to head, heart and lungs origi
origi-
nate in the cervical or upper thoracic paravertebral ganglia
and proceed to the organs as separate nerves, for example
the cardiac nerve to the heart, or as perivascular plexuses
of axons that accompany arteries.
Sympathetic ganglia are of three types: paravertebral,
prevertebral, and terminal.
There are two paravertebral chains of ganglia on either
side of the spinal cord. Each chain has 22 or 23 ganglia
(Fig. 31.2).
There are three cervical ganglia: superior, middle, and
inferior.
1. The superior cervical ganglion provides sympathetic
fibers that innervate the structures in the head. These
sympathetic fibers travel in the perivascular plexus
along the carotid arteries and innervate radial muscle
of the iris that causes dilation of the pupil, supply Mul-
ler’s muscle that assists in elevating the eyelid, and
innervate lacrimal and salivary glands. Therefore, dis dis-
eases involving this pathway produce prominent oph-
thalmic signs.
2. The middle and inferior cervical ganglia innervate
structures in the chest, including the trachea, esopha-
gus, heart and lungs. Often, inferior cervical ganglion
and first cervical ganglion fuse to form stellate ganglion.
There are about 12 thoracic ganglia. Fibers from these
ganglia supply mainly thoracic structures. Preganglionic
fibers from T1 and T2 supply structures in head and neck,
from T3 and T4 supply thoracic viscera, from T5 to T9 supply
structures in upper limb, and from T6 to T12 supply upper
abdominal viscera (Table 31.1).
There are three lumbar ganglia for three lumbar seg-
ments. However, there are two additional lumbar and at
 mesenteric (Fig. 31.2). They are so named as they overlie
Table 31.1:
the celiac, superior mesenteric and inferior mesenteric
arteries at their origin from the aorta respectively.
1. Celiac ganglion: The preganglionic axons for celiac
ganglion originate in the T5 to T12 spinal levels and pro
pro-
vide innervation to the stomach, small intestine, liver,
pancreas, gallbladder, spleen and kidneys.
2. Superior mesenteric ganglion: The preganglionic fibers
for superior mesenteric ganglion originate primarily in
T10 to T12 and innervate the small and large intestines.
3. Inferior mesenteric ganglion: The preganglionic fibers
for inferior mesenteric ganglion originate from L1 to L3
and innervate the lower part of colon, rectum, urinary
bladder, and reproductive organs.

least four sacral ganglia that are present below the lum- These are located in the organ innervated by sympathetic
bar segments. Preganglionic fibers from T10 to L2 supply fibers. Examples are adrenal medulla, heart, pancreas, and
structures in lower limbs, and from L1 and L2 supply lower urinary bladder.
abdominal viscera (Table 31.1).

Adrenal medulla is a neuroendocrine structure. It forms

Postsynaptic neurons for the abdominal and pelvic vis- the inner core of the adrenal gland.
ceral organs arise from the prevertebral ganglia. They are 1. Cells of the adrenal medulla are innervated by pregan-
also called collateral ganglia. There are three major pre- glionic sympathetic fibers originating in the lower tho-
vertebral ganglia: celiac, superior mesenteric, and inferior racic spinal segments that travel in lesser splanchnic
 nerve. Therefore, adrenal medulla is considered as a
modified sympathetic ganglion that contains postgan-
glionic cells.
2. Preganglionic fibers terminate on the chromaffin cells
that represent modified ganglion cells. Chromaffin cells
synthesize both epinephrine and norepinephrine. How
How-
ever, unlike neurons, these cells have no axons though
they function as neuroendocrine cells and release hor
hor-
mone in response to preganglionic neuron activation.
Some of the cells in heart, pancreas and urinary blad-
der are modified postganglionic cells. The postganglionic
cells in heart (intrinsic
( cardiac adrenergic cells)) influence
development of heart during fetal life.
All preganglionic fibers are cholinergic and sympathetic
postganglionic fibers are adrenergic that secrete either
noradrenaline or adrenaline (for details, refer previous
chapter). However, there are few sets of postganglionic
sympathetic cholinergic fibers. These are postganglionic
sympathetic fibers supplying sweat glands and blood ves-
sels of skeletal muscles.. Evidences suggest that blood ves
ves-
sels of heart, lungs, kidney and uterus also receive some
cholinergic innervation.
Sympathetic activities are broadly two types: basal level
activity at rest and widespread responses following activa-
tion.
The sympathetic fibers impart a basal influence on many
organs they innervate. This basal rate of discharge is called
basal sympathetic tone.
1. Usually, functions of many viscera can be altered by
changing the basal level of sympathetic discharge to
the organs. Many such changes occur during normal phy-
siological activities. For example, change in heart rate
and blood pressure in response to change in posture.
2. But, if situations warrant for greater changes, basal
firing rate in sympathetic nerves can be increased
or decreased profoundly to achieve the target mod-
ulation in function. For example, to achieve a target
increase in cardiac output during exercise, sympa-
thetic stimulation considerably increases heart rate
and myocardial contractility.
Another characteristic of sympathetic stimulation is that
it produces widespread organ responses. Example of a
widespread response is fight or flight reaction (see below).
The widespread response to sympathetic activation is due
to two fundamental properties
properties:: divergence of sympa-
sympa
thetic outflow and activation of adrenal medulla.
The number of postganglionic axons emerging from the
paravertebral chain of ganglia is greater than the num-
ber of preganglionic neurons originating from the spinal
cord, the ratio of postganglionic to preganglionic neurons
being 100:1. Therefore, effector tissues innervated by
sympathetic fibers are more.
1. This basic principle of divergence enables the sympa-
thetic system to produce widespread responses by
simultaneously modulating functions of many effector
organs.
2. The divergence is due to branching of the pregangli-
pregangli
onic sympathetic axons in the paravertebral chain of
ganglia that makes synaptic connections with multiple
postganglionic neurons both above and below their
original level of emergence from the spinal cord.
The adrenal medulla mediates many sympathetic res-
ponses. In addition to its anatomical divergence of post-
ganglionic neurons, sympathetic system activates hor-
monal mechanism to achieve its widespread responses.
These are mediated by catecholamine secreted from
adrenal medulla.
1. The adrenal medulla is a neuroendocrine gland
gland, which
is basically a modified sympathetic ganglion
ganglion.
2. The chromaffin cells of the adrenal medulla secrete
both epinephrine and norepinephrine in a ratio of
about 8:1 and store them in their secretory vesicles.
3. They release hormone directly into the bloodstream
in response to activation by sympathetic preganglionic
fibers. Catecholamines released from adrenal medulla
by sympathetic stimulation modulate many organ
functions and therefore, further promote sympathetic
effects.
4. Thus, adrenomedullary secretion by sympathetic acti-
acti
vation forms the physiological basis of divergence for
widespread sympathetic responses.
Circulating epinephrine plays a greater role than
norepinephrine in physiologically mediating widespread
responses for three reasons:
1. From adrenal medulla, epinephrine secretion is con-
Table 31.2:
siderably more than norepinephrine.
2. Norepinephrine secretion is limited only to the axon
terminals of sympathetic fibers, and therefore its
effects are restricted only to the postsynaptic recep
recep-
tors in the target tissues, whereas circulating epineph-
rine reaches almost all tissues of the body.
3. Epinephrine potentiates sympathetic effects with grea-
ter efficacy than norepinephrine as it is more effec-
tive in stimulating both
-
tor agonist and norepinephrine is a better receptor
agonist).

Effects of sympathetic stimulation are summarized in

Table 31.2. Effects are mediated by release of noradrena-
line from sympathetic nerve endings and adrenaline from
adrenal medulla.

Catecholamines elicit their effects by acting on adrenergic

receptors. Adrenergic receptors are broadly divided into
two types: receptor has two subtypes: 1
and 2 receptor 1 2 3.

and receptors to noradrenaline.

Ef 1 Stimulation: The 1 receptors are present

in vascular smooth muscles of cutaneous and splanchnic
circulation, sphincters of bladder and GI tract and radial
muscles of iris. Stimulation of these receptors causes con
con-
traction or constriction of the structures in which they
are present. They are equally sensitive to adrenaline and
noradrenaline. The effects are mediated by formation of
intracellular IP3.
2 Stimulation: 2 receptors are present in
presynaptic nerve endings, wall of GI tract, platelets and
adipocytes. Stimulation of these receptors often causes
relaxation or inhibition of the structure. The effects are
mediated by decreased formation of intracellular cAMP.

Effects of 1 Stimulation: 1 receptors are present in SA

node, AV node and ventricular muscle. Stimulation of
these receptors causes excitation of these structures. They
are more sensitive to adrenaline than noradrenaline. The
effects are mediated by increased formation of intracel-
lular cAMP.
Effects of 2 Stimulation: 2 receptors are present in
blood vessels of skeletal muscles, bronchial smooth muscles

and wall of GI tract. Stimulation of these receptors causes
relaxation of these structures. They are more sensitive to
adrenaline than noradrenaline. The effects are mediated
by change in the level of intracellular cAMP.
Effects of 3 Stimulation: 3 receptors are present in
adipose tissues. Stimulation of these receptors causes
lipolysis. The effect is mediated by increase in the level of
intracellular cAMP.
The fight-or-flight response is a typical widespread
response of sympathetic activation. This occurs in critical
situations of life when one has to either fight the situation
or flee from the situation. Though many components of
response are due to direct effects of sympathetic stimu-
lation, secretion of catecholamine from adrenal medulla
contributes considerably. The effects are as follows:
1. Sympathetic stimulation of CVS increases blood pres-
sure due to increased cardiac output and vasoconstric-
tion. Also, redistribution of the blood flow occurs to
skeletal muscles and heart from splanchnic and cuta-
neous territories so that performance enhances.
2. In lungs, increased exchange of blood gases occurs
due to stimulation of the respiratory rate and dilation
of bronchiolar tree.. This increases supply of oxygen to
the tissues.
3. Sympathetic stimulation to salivary gland decreases
salivary secretion
secretion. However, secretion of mucus
increases proportionately, permitting lubrication of
the mouth despite increased ventilation and reduced
salivation.
4. Supply of metabolic substrates increases, which is an
essential component of effective stress reaction. The
demand for increased supply of substrates like glu-
cose and fatty acids is met by the actions of circulating
epinephrine on hepatocytes and adipocytes. Glycog-
enolysis increases plasma glucose concentration and
lipolysis promotes plasma free fatty acid level.
5. Sympathetic stimulation to sweat glands causes
secretion of a watery fluid, and evaporation of body
heat. Cutaneous vasoconstriction with concurrent
sweat gland activation causes cold, clammy skin of a
frightened individual.
6. Activation of piloerector muscles of hair follicles
causes hair-standing-on the skin. The hair erection
helps in preservation of body temperature or gives a
ferocious appearance to threaten the enemy.
7. Pupillary dilation enhances visual acuity and percep
percep-
tion to make the individual environmentally maximal
alert.
8. Stimulation of brainstem reticular system makes the
individual maximally alert and mentally conscious to
take appropriate decisions in quick successions.
9. Activity of bowel and bladder temporarily ceases due
to constriction of sphincters.