THE AUTONOMIC

NERVOUS SYSTEM
NERVOUS SYSTEM
Our nervous system is complex network that cordinate our body
Voluntary and involuntary actions and transmit signals between different parts of the
body
It is divided into two anotimical division
1- CNS which consist of brain and spinal cord and peripheral nervous

2- system which consist of all the nerves and neurons out side the CNS
The Autonomic Nervous System
The autonomic nervous system is the portion of the nervous system
that controls most visceral functions of the body. This system helps to
control arterial pressure, gastrointestinal motility, gastrointestinal
secretion, urinary bladder emptying, sweating, body temperature, and
many other activities, some of which are controlled almost entirely
and some only partially by the autonomic nervous system.
Spinal cord contain three types of neurons that are important for us for
understanding Autonomic Nervous System

1- AFFERENT NEURONS which carry signals from the sensory receptors

(Sensory receptors are dendrites of sensory neurons specialized for receiving
specific kinds of stimuli) To the CNS

2- EFFERENT NEURONS that carry signal from the CNS to effector organs such
as muscles

3- INTER NEURONS which are located between afferent and efferent neurons
and integrate information between the two

So for example we touch hot object sensory receptors in our fingers would
immediately initiate signal that travel through AFFERENT neurons to the spinal
cord and from the spinal cord a response signal would be initiated and that will
travel from spinal cord through EFFERENT NEURONS towards the muscle in our
hand which will result withdrawal of the hand
The autonomic nervous system also often operates through visceral reflexes. That
is, subconscious sensory signals from a visceral organ can enter the autonomic
ganglia, the brain stem, or the hypothalamus and then return subconscious reflex
responses directly back to the visceral organ to control its activities.
The efferent autonomic signals are transmitted to the various organs of the body
through two major subdivisions called the sympathetic nervous system and the
parasympathetic nervous system, the
characteristics and functions of which follow.
Functions of sympathetic nervous system and the parasympathetic
nervous system

Types of neurons in both of these divisions

1- Cholinergic neurons which use neurotransmitter acetyl choline to send messages
2- adrenergic neurons which use neurotransmitter norepinephrine and epinephrine
to send messages
Sympathetic Nervous System Physiology
The sympathetic nervous system is responsible for regulating many homeostatic
mechanisms in living organisms. Fibers from the SNS innervate tissues in almost
every organ system and provide physiological regulation over diverse body
processes including pupil diameter, gut motility (movement), and urinary
output.

The SNS is perhaps best known for mediating the neuronal and hormonal stress
response commonly known as the fight-or-flight response, also known as
sympatho-adrenal response of the body. This occurs as the preganglionic
sympathetic fibers that end in the adrenal medulla secrete acetylcholine, which
activates the secretion of adrenaline (epinephrine), and to a lesser extent
noradrenaline (norepinephrine)
Therefore, this response is mediated directly via impulses transmitted through the
sympathetic nervous system, and also indirectly via catecholamines that are
secreted from the adrenal medulla, and acts primarily on the cardiovascular system.
For example, the sympathetic nervous system can accelerate heart rate, widen
bronchial passages, decrease motility of the large intestine, constrict blood vessels,
decrease peristalsis in the esophagus, cause pupillary dilation, perspiration
(sweating), and raise blood pressure
The Fight-or-Flight Response
The fight-or-flight response was first described by Walter Bradford Cannon. His
theory states that animals react to threats with a general discharge of the
sympathetic nervous system, priming the animal for fighting or fleeing.

Catecholamine hormones, such as adrenaline or noradrenaline, facilitate the

immediate physical reactions associated with a preparation for violent muscular
action. These include the following:
 Acceleration of heart and lung action.
 Paling or flushing (light color skin or red or hot), or alternating between both.
 Inhibition of stomach and upper-intestinal action to the point where digestion
slows down or stops.
• Constriction of blood vessels in many parts of the body.
• Liberation of nutrients (particularly fat and glucose) for muscular action.
• Dilation of blood vessels for muscles.
• Inhibition of the lacrimal gland (responsible for tear production) and salivation.
• Dilation of pupil (mydriasis).
• Relaxation of bladder.
sympathetic nervous system (fight and flight response)
Neurons arises from the thoracic and lumber region of the spinal cord
1st we have preganglionic neurons which originate directly from spinal cord these
are short and they releases acetyl choline so these are cholinergic and they synapse
with post ganglionic neurons which are long and release norepinephrine so these
neurons are adrenergic
GANGLION: where a nerve cell synapse with an other, the nerve cell comes out
from the spinal cord and synapses in the ganglion to the new nerve cell and the new
nerve cell target the tissue, there is chain of synaptic connection of sympathetic
neurons that lies along side of spinal cord
Eeffect of norepinephrine and post ganglionic neurons of sympathetic nervous
system on different organs and body parts

1- EFFECT ON EYE, LACRIMAL GLAND AND SALIVARY GLAND

superior cervical ganglion
The superior cervical ganglion (SCG) is part of the autonomic nervous system
 (ANS), more specifically it is part of the sympathetic nervous system, a division
of the ANS most commonly associated with the fight or flight response. The ANS
is composed of pathways that lead to and from ganglia, groups of nerve cells. The
SCG is the only ganglion in the sympathetic nervous system that innervates the
head and neck. The SCG innervates many organs, and glands
How SNS effect on each part and organs of body
1- EYE
Mydriasis ( dilate the pupil for greater vision, the pupil dilates in the dark and 
constricts in the light  )
Iris contain two group of muscles sphincter muscle or dilator pupillae. if the
sphincter contract the iris decreases and constrict the size of pupil
The dilator pupillae innervated by sympathetic neurons and cause pupil to dilate
2- lacrimal glands
In human physiology, the lacrimal glands are paired, almond shaped 
exocrine glands, one for each eye, The lacrimal gland produces tears 
The postganglionic sympathetic arise from the superior cervical ganglion of
the sympathetic trunk and travel along with the parasympathetic fibers (without
synapsing in the pterygopalatine ganglion) to innervate the lacrimal gland.
Sympathetic nervous system decrease the lactrimation
3- Salivary gland

Saliva is produced by the salivary glands of body – the parotid, submandibular and
sublingual glands. Within the glands, the acinar cells are responsible for the volume
of saliva secreted, and the duct cells are responsible for the composition of saliva.
The sympathetic control of salivary production is via the superior cervical
ganglion. Sympathetic stimulation results in the release of noradrenaline, which acts
upon alpha- and beta-adrenergic receptors.
This results in the following effects:
 Decreased production of saliva by acinar cells
 Increased protein secretion
 Decreased blood flow to the glands
2- EFFECT ON HEART AND LUNGS ESOPHAGUS

preganglionic neurons start from the spinal cord and terminate in middle and inferior
cervical ganglion from here post ganglionic neurons initiate and innervate the
cardiac, esophagus and pulmonary cells by cardiac esophagus and pulmonary plexus
(nerve fibers )

 Effect on cardiac cells

 Positive chronotropic effect (increase heart rate )
 Positive ionotropic effect ( increase force of muscular contractions )
 Increase cardiac output
 Increase blood pressure
 Effect on esophagus
 Decrease peristalsis
 Effect on bronchial smooth muscle
 Dilate bronchioles
 Decrease secretion
 Vasoconstriction of bronchial arteries
3- EFFECT ON STOMACH, LIVER, and PANCREAS (greater splanchnic
nerve)

Various neurons initiated from T5 to T9 region of spinal cord and they all synapses
into a nerve called greater splanchnic nerve,
This nerve reaches to a ganglion called celiac ganglion and from here many nerve
reaches to stomach, liver, pancreas

 Effect on stomach
 Inhibit peristalsis
 Vasoconstriction of blood vessels of stomach
 Decrease absorption
 Decrease secretion
 Contraction of pyloric sphincter (The pyloric sphincter is a band of smooth
muscle at the junction between the pylorus of the stomach and the duodenum of
the small intestine)
 Effect on liver
 Glycogenolysis
 Effect on pancreas
 Decrease insulin
 Increase glucagon
4- EFFECT ON adrenal medulla

A branch of nerve from Greater splanchnic nerve reaches toward adrenal

medulla , there is no post ganglionic neurons in this case a preganglionic neurons
directly go towards adrenal medulla,
Adrenal medulla made up of Chromaffin cells that make epinephrine (adrenaline)
and norepinephrine (noradrenaline), here acetyl choline
Stimulate adrenal medulla cells because preganglionic fiber release acetyl choline
5- EFFECT ON LARGE INTESTINE and SMALL INTESTINE

Preganglionic Neurons arises from thoracic region of spinal cord synapses at

superior mesenteric ganglion from here a post ganglionic neurons travel towards
ascending colon, transverse colon , duodenum, jejunum, ileum. and cause
 Decrease peristalsis
 Decrease absorption
 Decrease secretion
6-EFFECT ON KIDNEY (LESSER SPLANCHNIC NERVE)

Lesser splanchnic nerve originates from thoracic region of spinal cord

Innervate to the kidney, a preganglionic neurons in lesser splanchnic nerve synapses
with post ganglionic neurons in inferior mesenteric ganglion and post ganglionic
neurons reaches towards kidney where it causes

 Decrease urine production

 Norepinephrine stimulate beta1 adrenergic receptors (The beta-1 adrenergic
receptor is a Gs-protein-coupled) juxtaglomerular cells to produce renin which
increase blood pressure
 Vasoconstriction and decrease blood flow to the kidney
8- EFFECT ON URINARY BLADDER AND GENITALS
Postganglionic neurons from inferior mesenteric ganglion cause it to relax so
inhibiting micturition as well as targeting genitals to causing orgasm
Neurotransmission process in adrenergic neurons

There are five main steps in adrenergic neurons transmission

First step
Amino acid tyrosine transported into the cell by Na-tyrosin transporter
Inside the neuron tyrosine hydroxylated by tyrosine hydoxylase into
L-dopa ( levo dopa ), next L-dopa is converted to dopamine by enzyme Aromatic
amino acid decarboxylase
2nd step
Dopamine is transported into synaptic vesicle where enzyme dopamine
betahydroxylase convert dopamine to norepinephrine
3rd step
Arrival of action potential trigger opening of Ca channel and thus influx of Ca into
the neuron the increase Ca causes synaptic vasicle to fuse with the membrane and
release its contents into the synapse
4rth step
N.E binds to post synaptic receptor of effector organ which trigger
Intracellular response
N.E also binds to presynaptic receptor which results to decrease in N.E
Release by negative feedback
5th step

N.E remove from synaptic space by diffusing out into systemic circulation and also
inactivated by enzyme
catechol-o-methyletransferase (COMT) and most of the N.E get transported back
into the neuron by Na dependent N.E transporter (NET) and from here N.E
transported back into the synaptic vesicle
For future use which basically means it get recycle or it can be broken down to
inactivate metabolite by mono amine oxidase (MAO)
ADRENERGIC RECEPTORS

Adrenergic receptor that are activated by epinephrine/norepinephrine and

adrenergic drugs
Ach released from preganglionic neurons in sympathetic nervous system and bind
to nicotinic receptors on post ganglionic agrenerigic
Neurons and nicotinic receptor on adrenal medulla.
Now adrenergic Neurons release N.E while adrenal gland release 20% N.E and
80% epinephrine at the end N.E and EPI bind to receptors on effector organ. These
receptors are called Alpha and Beta receptors
Mediated by increase
intracellular Ca

Diation of the pupil

 Adipose tissue

Skeletal muscle

Juxtaglomerular Smooth muscle

cell Of GIT
Parasympathetic nervous system

Parasympathetic nervous system is responsible for rest and digest response

parasympathetic. Parasympathetic neurons arise from cranial nerve 3,7,9 and 10
and sacral region of spinal cord S2 to S4
In contrast to sympathetic division parasympathetic preganglionic neurons are long
and postganglionic neurons are short and they both
Releases acetyl choline so activity of parasympathetic division would
Have opposite effect of the sympathetic division
Preganglionic neurons in PSNS is very close to the target organ some time with in
the target organ so called terminal or intramural (with in the organ)
Preganglionic sympathetic neurons are called cholinergic B/c release
Ach but post ganglionic are adrenergic b/c release N.E but in PSNS
Ach release from both preganglionic and postganglionic neurons
Certain cranial nerves in the cranium, namely the preganglionic parasympathetic
nerves (CN III, CN VII, and CN IX) usually arise from specific nuclei in the 
central nervous system (CNS) and synapse at one of four parasympathetic 
ganglia: ciliary, pterygopalatine, otic, or submandibular. From these four
ganglia the parasympathetic nerves complete their journey to target tissues
The parasympathetic system can also be referred to as the craniosacral system
(or outflow) because the preganglionic neurons are located in nuclei of the brain
stem and the lateral horn of the sacral spinal cord.
Edinger–Westphal nucleus
The Edinger–Westphal nucleus located at midbrain (accessory oculomotor nucleus)
is the parasympathetic pre-ganglionic nucleus that innervates the 
iris sphincter muscle and the ciliary muscle
The oculomotor nerve is the third cranial nerve (CN III) originate from
Edinger–Westphal nucleus The Edinger-Westphal nucleus supplies 
parasympathetic fibers to the eye via the ciliary ganglion, and thus controls the 
sphincter pupillae muscle (affecting pupil constriction) .Preganglionic neurons
fiber is long while post ganglionic is short and it causes constriction of the pupil
(miosis)
Superior salivatory nucleus

Located in pons of brainstem, The facial nerve is the seventh cranial nerve, or

simply CN VII. It emerges from Superior salivatory nucleus
 of the brainstem, Preganglionic parasympathetic fibers from the superior
salivary nucleus travel over the facial nerve, CN VII, to the submandibular
ganglion and then to secretory cells in the submandibular and sublingual glands.
Parasympathetic preganglionic fibers from the superior salivary nucleus travel
over a branch of the facial nerve (CN VII) to the submandibular ganglion where
they synapse onto postganglionic fibers that stimulate serous secretion (is any of
various body fluids resembling serum) of the sublingual and submandibular
salivary glands,and increased salivation
Some parasympathetic preganglionic neuron fibers also arises from facial nerve
(CN VII) and synapses in pterygopalatine ganglion from
Here a post ganglionic fiber innervate the lacrimal and nasal gland
These neurons releases Ach on the cells of lacrimal and nasal glands and increase
the secretions
So there is more tear production more nasal secretion and increased salivation
Inferior salivatory nucleus

The inferior salivatory nucleus (or nucleus salivatorius inferior) is a cluster of 

neurons in the pons of the brainstem
The glossopharyngeal nerve, known as the ninth cranial nerve (CN IX),
originate from Inferior salivatory nucleus this nerve contain parasympathetic
fiber, parasympatheic preganglionic fiber synapses
In the otic ganglion from here post synaptic parasympathetic fiber
Innervate last salivary gland called parotid gland and increase the secretion of
saliva, increase salivary amylase (is an enzyme in the mouth that initiates the
digestion of carbohydrates ) and watery secretion of saliva
Dorsal nucleus of vagus nerve

is a collection of neurons in the brain stem.  It mostly serves parasympathetic

 vagal functions in the gastrointestinal tract, lungs, and other thoracic and 
abdominal vagal innervations
It control the 90% response of the parasympathetic nervous system
The vagus nerve, historically cited as the pneumogastric nerve, is the tenth 
cranial nerve or CN X, and interfaces with the parasympathetic control of the 
heart, lungs, and digestive tract.
lungs
vagus nerve has many branches one of which (pulmonary plexus) goes to the
bronchioles in the lungs and overall effect on bronchioles is bronchoconstriction
and increase mucus secretion in the lungs
heart
Another branch called cardiac plexus goes toward heart in S.A node and A.V node
and it decreases the action potential of S.A and A.V node so overall effect is
slowdown the heart rate (negative chronotropic effect) , decrease blood pressure
Esophagus and stomach

Another branch called esophageal plexus innervate the esophagus

And it increases the peristalsis and motility
A branches of the neurons arises from esophageal plexus and supply to the
stomach and increase the tone and motility of stomach and it also effect on parietal
cell of stomach and causes it to produce more gastric juices so increase secretions
Kidney, large intestine a small intestine ,pancreas
Parasympathetic neurons arises from right vagus called celiac plexus
Innervate the kidney, blood vessels of kidney, ureter, ascending colon
Transverse colon , duodenum , jejunum and ileum , pancreas
In kidney it cause the contraction of ureter and play role in increase urine formation
In large intestine it increases motility but in small intestine it increases motility,
increase absorption , increase secretion
It act on pancreatic beta cells of pancreas and it stimulate the release of insulin
production
Liver
Another neurons fiber called hepatic plexus originate from left vagus nerve reaches
toward liver and cause glycogenesis (is the process of glycogen synthesis,)
Parasympathetic outflow from sacral region of spinal cord

A Nerve originate from sacral region of spinal cord called pelvic splanchnic nerve
and supply to gonads (an organ that produces gametes; a testis or ovary) ,detrusor
muscle of bladder, internal urinary sphincter (urethral sphincter muscle which
constricts the internal urethral orifice), internal anal sphincter , rectum,
descending colon , sigmoid colon ,
 It increase the motility ,secretion ,and absorption of descending colon and colon
 It cause the contraction of rectum and relax a smooth muscle in rectum called
internal anal sphincter (involuntary )
(note External anal sphincter is in voluntary controle)
 it increases bladder contraction by acting on the detrusor muscles
It also act on internal urethral sphincter and relax the sphincter to pass the
urine
(note External urinary sphincter is in voluntary controle)