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Textbook of Medical Physiology, 11th edition

Chapter 60:
The Autonomic Nervous System (ANS); The Adrenal Medulla

By Dr. Mudassar Ali Roomi (MBBS, M.Phil)


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Effect of ANS on heart

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Sympathetic Distribution

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Parasympathetic Distribution

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Function of the Adrenal Medulla

Adrenal medulla is a large sympathetic ganglion when stimulated releases epinephrine (80%) and norepinephrine (20%) into the blood stream causes prolonged activity of the substances (2-4 minutes) helps the body deal with stress Difference b/w action of epinephrine and nor-epinephrine:
Epinephrine has greater effect on cardiac stimulation

epinephrine raises the arterial pressure to a lesser extent but increases the cardiac output more Epinephrine has 5 to 10 times as great a metabolic effect as norepinephrine

Importance of adrenal medulla: 1. the dual mechanism of sympathetic stimulation provides a safety factor, one mechanism substituting for the other if it is missing. 2. to stimulate structures of the body that are not innervated by direct sympathetic fibers

Sympathetic and Parasympathetic Tone

the basal rate of activity of each system Importance: this background activity allows for an increase or decrease in activity of an organ by a single system
sympathetic tone normally causes about a 50 % vasoconstriction (so, SANS has more effect on vessels) increasing or decreasing tone can change vessel diameter parasympathetic tone provides background G.I. activity (so, PANS has more effect on GIT) Mechanism of Denervation Supersensitivity: upregulation of the receptors

Autonomic Reflexes
Cardiovascular Autonomic Reflexes Gastrointestinal Autonomic Reflexes Other Autonomic Reflexes

Sympathetic System Often Responds by Mass Discharge Parasympathetic System Usually Causes Specific Localized Responses.

Stress Response (fight or flight response)

mass sympathetic discharge
increase in arterial pressure, heart rate and contractility, blood flow to muscles, blood glucose, metabolic rate, muscle strength, mental activity, blood coagulation

prepares the body for vigorous activity need to deal with a life-threatening situation 1. Increased arterial pressure 2. Increased blood flow to active muscles concurrent with decreased blood flow to organs such as the gastrointestinal tract and the kidneys that are not needed for rapid motor activity 3. Increased rates of cellular metabolism throughout the body 4. Increased blood glucose concentration 5. Increased glycolysis in the liver and in muscle 6. Increased muscle strength 7. Increased mental activity 8. Increased rate of blood coagulation

Pharmacology of the Sympathetic Nervous System

adrenergic or sympathomimetic drugs act like norepi and epi these drugs have an effect which is much more prolonged than that of either norepi or epi
phenylephrine stimulates alpha receptors isoproterenol stimulates both beta1 and beta2 receptors albuterol stimulates only beta2 receptors

some drugs act indirectly by increasing the release of norepi from its storage terminals
ephedrine, tyramine, and amphetamine

Pharmacology of the Sympathetic Nervous System

drugs that block the effect of norepi and epi synthesis and storage

release from the nerve terminal


alpha blockers
phentolamine and phenoxybenzamine

beta blockers
beta1 and 2 - propranolol, beta1 - metoprolol

ganglionic blockers

Pharmacology of the Parasympathetic Nervous System

parasympathomimetic drugs
nicotine activates nicotinic receptors (nicotinic agonist) pilocarpine and methacholine (muscarinic agonist) activates muscarinic receptors, cause profuse sweating

cholinesterase enzyme inhibitors

neostigmine, pyridostigmine,and ambenonium potentiates the effect of acetylcholine

antimuscarinic drugs
atropine and scopolamine (muscarinic antagonist) blocks the effect of acetylcholine on effector cells

Some Disorders of the Autonomic Nervous System

Horner syndrome : Chronic unilateral pupillary constriction (miosis), sagging of the eyelid (ptosis), withdrawal of the eye into the orbit, flushing of the skin, and lack of facial perspiration, resulting from lesions in the cervical ganglia, upper thoracic spinal cord, or brainstem that interrupt sympathetic innervation of the head. Raynaud disease : Intermittent attacks of paleness, cyanosis, and pain in the fingers and toes, caused when cold or emotional stress triggers excessive vasoconstriction in the digits; most common in young women. In extreme cases, causes gangrene and may require amputation. Sometimes treated by cutting sympathetic nerves to the affected regions.