AUTONOMIC

NERVOUS
SYSTEM
I. SUMMARY
• The autonomic nervous system (ANS) is part of the peripheral
nervous system and regulates involuntary, visceral body
functions in different organ systems (e.g., the cardiovascular,
gastrointestinal, and genitourinary systems).
• It is divided into the sympathetic and parasympathetic nervous
systems.
• The sympathetic nervous system has a thoracolumbar outflow
and is activated during fight or flight response, while
the parasympathetic nervous system has a craniosacral outflow
and is activated during digestion and rest.
• The sympathetic and parasympathetic nervous systems consist
of preganglionic and postganglionic neurons.
• The preganglionic fibers of both ANS divisions and
the postganglionic fibers of the parasympathetic division are
cholinergic fibers (release acetylcholine) that act on cholinergic
receptors (nicotinic or muscarinic).
• All postganglionic fibers of the sympathetic division are adrenergic
fibers (release norepinephrine) that act on adrenergic alpha or beta
receptors for neurotransmission, with the exception of the fibers
innervating the sweat glands, which are cholinergic.
• The adrenal medulla does not have a postsynaptic neuron.
The sympathetic preganglionic fibers stimulate the chromaffin cells of
the adrenal medulla directly via acetylcholine on nicotinic receptors,
which results in the release of norephedrine and epinephrine mediating
the fight or flight response.
II. OVERVIEW
Function: controls unconscious, involuntary, and visceral body functions, i.e., the
cardiovascular, thermoregulatory, gastrointestinal, genitourinary,
and pupillary systems
Components
• Visceral motor
• Sympathetic
• Parasympathetic
• Visceral sensory
• Ganglia
• Nuclei
• Enteric nervous system
III. SYMPATHETIC NERVOUS SYSTEM
•Structure
• Descends from central nervous system to T1–
L2 (thoracolumbar outflow)
• Neuron cell bodies are located in the lateral horn of
the spinal cord.
•Preganglionic axons (short myelinated, cholinergic
fibers) exit the spinal cord through ventral roots, spinal
nerves, and white rami communicantes.
•Postganglionic axons (long unmyelinated, mostly
adrenergic fibers): leave the paravertebral or prevertebral
ganglia and innervate end organs
SYMPATHETIC
GANGLION
1. PARAVERTEBRAL
GANGLIA
• Structure: form a chain
of ganglia on each side
of the vertebral
column running from
the base of the skull to
the coccyx, which forms
the sympathetic trunk 
• All paravertebral ganglia: innervation of blood vessels, arrector pili muscles,
and sweat glands
• Superior cervical ganglion: innervates sublingual gland, submandibular
gland, parotid gland, carotid body, choroid plexus, dilator pupillae, and levator
palpebrae superioris
• Middle cervical ganglion: branches to thyroid gland, supplies heart
• Stellate ganglion: supplies head, neck, arms, heart, and lungs
• Thoracic sympathetic ganglia 
• Upper thoracic sympathetic trunk: forms the cardiac plexus, pulmonary plexus, aortic
plexus, and esophageal plexus, which supply the neck, upper limbs, and thorax
(i.e., heart, aorta, trachea, lungs, and esophagus)
• Lower thoracic sympathetic trunk (T5–T12): mainly gives preganglionic fibers that
form the splanchnic nerves, which go to the celiac and aorticorenal ganglion and
supply the abdominal viscera
• Lumbar and sacral sympathetic ganglia: innervate the pelvic floor and lower limbs
SYMPATHETIC
GANGLION
2. Prevertebral
ganglia (or preaortic ganglia)
Not part of the sympathetic trunk
Closely associated with the
major abdominal branches of the
aorta:
• Celiac ganglion 
• Aorticorenal ganglion 
• Superior mesenteric ganglion 
• Inferior mesenteric ganglion 
IV. PARASYMPATHETIC NERVOUS
SYSTEM
• Exits central nervous system (dorsal motor
nucleus) with cranial nerves CN III, CN VII, CN
IX, CN X and the sacral spinal roots
(craniosacral outflow)
• Preganglionic axons (long, myelinated
cholinergic fibers): synapse in ganglia close to
end organs
• Postganglionic axons (short, cholinergic fibers):
leave ganglia and innervate end organs
 CRANIAL OUTFLOW

The cranial outflow supplies visceral structures of the head, neck and face via CN III, CN VII, CN IX and
of the thorax and upper abdomen via CN X.
• Edinger – Westphal nucleus -> oculomotor nerve (CN III) -> ciliary ganglion ->
sphincter pupillae (miosis) and ciliary muscle (accommodation)
Superior salivatory nucleus -> facial nerve -> pterygopalatine ganglion and submandibular
ganglion -> lacrimal gland, glands of the mucosa of the oral and nasal cavity, pharynx, and
sinuses.
Inferior salivatory nucleus -> glossopharyngeal nerve -> otic ganglion ->
salivation of parotid gland
• Dorsal nucleus of the vagus
nerve -> CN X -> several
ganglia close to/or within the
walls of the gastrointestinal
tract and lungs.
 • Consist of S2-S4
• Pelvic splanchnic nerves → 
SACRAL postganglionic neurons (hypogastric plexus or walls of 
viscera)
OUTFLOW • Distal GIT (distal colon, sigmoid  colon, rectum)
• Urinary bladder (voiding) 
• Penis or clitoris (erection)
THANK YOU!
QUIZ

1. Which of the following consists of nerves that branch off the spinal
cord and then innervate a “trunk” (which parallels the spinal cord)
and then branch off the trunk?
2. Which of the following consists of nerves that primarily branch
from the brain area and the sacral area only?
3. Which of the following nerves generally “speed up” body activities?

A. Somatic
B. Sympathetic
C. Parasympathetic
• Autonomic nervous system: hệ thần kinh tự chủ
• Preganglionic/postganglionic neurons: sợi trước/sau hạch
• The adrenal medulla: tủy thượng thận
• Paravertebral ganglia: hạch cạnh sống
• Superior cervical ganglion: hạch cổ trên
• Middle cervical ganglion: hạch cổ giữa
• Stellate ganglion: hạch sao
• Thoracic sympathetic ganglia: hạch giao cảm ngực
• Upper thoracic sympathetic trunk: thân giao cảm ngực trên
• Lower thoracic sympathetic trunk (T5–T12): thân giao cảm ngực dưới
• Lumbar and sacral sympathetic ganglia: Các hạch giao cảm thắt lưng và
xương cùng
• Prevertebral ganglia: hạch trước sống
• ciliary ganglion: hạch thể mi
• Superior salivatory nucleus: nhân tuyến nước bọt trên
• Inferior salivatory nucleus: nhân tuyến nước bọt dưới
• otic ganglion: hạch mang tai