CONTROL OF VISCERAL

ACTIVITY

PRESENTER:
YR1 MMED.
MODERATOR: DR. MURIITHI WARUINGI
SEN. LECTURER DEPT OF MEDICAL PHYSIOLOGY
 OUTLINE
•INTRODUCTION

•THE AUTONOMIC NERVOUS SYSTEM

•HIERARCHY OF CONTROL

•AUTONOMIC REFLEX ARCH

•CNS CENTERS ROLE IN CONTROL OF VISCERAL ACTIVITY

•ENTERIC NERVOUS SYSTEM

•SPECIAL VISCERAL FUNCTIONS

 INTRODUCTION

•VISCERAL ACTIVITY IS MODULATED BY THE AUTONOMIC ARM OF THE CNS AND BY THE NEURO ENDOCRINE

CONTROL OF PITUITARY GLAND SECRETIONS.

•CNS MODULATION OF VISCERAL ACTIVITY INVOLVES DYNAMIC AND RESPONSIVE NEURAL CIRCUITRY

WHICH PROVIDES REGULATORY OVERSIGHT OVER VISCERAL FUNCTIONS.

•AUTONOMIC CONTROL IS ACHIEVED IN A FLEXIBLE AND PRECISE MANNER BY COORDINATION, PROCESSING

AND INTEGRATION OF SENSORY FEEDBACK, EXTERNAL & INTERNAL STIMULI.

•TARGET SPECIFIC PATHWAYS (SYMPATHETIC AND PARASYMPATHETIC) ARE ACTIVATED OR INHIBITED WITH A

HIGH DEGREE OF PRECISION IN DIFFERENT PHYSIOLOGIC CIRCUMSTANCES.

 INTRODUCTION
•CHARACTERISTICS OF AUTONOMIC OUTFLOW DEMONSTRATE THE EFFECT OF MULTIPLE PATHWAYS

FEEDING INTO A HIGHLY ORGANIZED NETWORK OF AUTONOMIC MOTOR OUTPUT.

•THE AUTONOMIC VISCERAL SYSTEM EXHIBIT SUSTAINED TONIC PATTERNS OF ACTIVITY AND

OCCASIONALLY COORDINATES TARGETED SPECIFIC PHASIC ACTION IN RESPONSE TO STIMULUS.

•AUTONOMIC VISCERAL CONTROL ALSO EXHIBITS NEGATIVE AND POSITIVE FEEDBACK MECHANISMS AND

ADAPTIVE BEHAVIOR TO A DEGREE.

•THE SYMPATHETIC DIVISION MAIN ROLE IS GLOBAL ACTIVATION IN RESPONSE TO A BRAIN PERCEIVED

“LIFE-THREATENING” SITUATION. THE PARASYMPATHETIC DIVISION OPERATES MORE LOCALLY, TO RESTORE

ROUTINE VISCERAL FUNCTIONS.

 DISTINCTIVE FEATURES OF VISCERAL MOTOR
SYSTEM
• LOWER MOTOR NEURON CELL BODIES ARE LOCATED OUTSIDE OF CNS, NEARER THE TARGET TISSUE OR
WITHHIN ITS WALLS

• INTERACTION BETWEEN MOTOR NERVE TERMINAL AND VISCERA; HIGHLY BRANCHED MOTOR AXONS
WITH MANY SYNAPTIC TERMINALS ALONG TERMINATION OF NERVE FIBER. NEUROTRANSMITTER TRAVELS
GREATER DISTANCE TO REACH RECEPTOR

• ACTIVITY OF VISCERAL MOTOR SYSTEM ARE COORDINATED BY SET OF CORTICAL & SUBCORTICAL
STRUCTURES IN VENTRAL AND MEDIAL PARTS OF FOREBRAIN AND BRAINSTEM (CENTRAL AUTONOMIC
NETWORK)

• VISCERAL MOTOR TERMINALS RELEASE A VARIETY OF NEUROTRANSMITTERS, PLUS A VARIETY OF CO-

NEUROTRANSMITTERS.

• NEUROTRANSMITTERS INTERACT WITH A DIVERSE SET OF POSTSYNAPTIC RECEPTORS THAT MEDIATE

VARIED POSTSYNAPTIC EFFECTS IN SMOOTH & CARDIAC MUSCLE & GLANDS.
 THE AUTONOMIC NERVOUS SYSTEM

•THE AUTONOMIC OUTFLOW IS COMPOSED OF SYMPATHETIC (FIGHT, FLIGHT) AND PARASYMPATHETIC (REST&

DIGEST, FEED & BREED) COMPONENTS.

•PARASYMPATHETIC PREMOTOR NUCLEI ARE THE DMN OF VAGUS & NUCLEUS AMBIGUUS (CN10) SUPERIOR

SALIVATORY (CN7) INFERIOR SALIVATORY (CN9) EDINGER WESTPHAL, PRETECTAL (CN3) BARRINGTON/PMC (PELVIC)

•SYMPATHETIC PREMOTOR NUCLEI ARE THE PARAVENTRICULAR NUCLEUS (PVN) IN THE HYPOTHALAMUS, LOCUS

COERULEUS (LC) AND DORSAL RAPHE NUCLEUS (DRN) IN THE BRAINSTEM

•BOTH OUTFLOW PATHWAYS HAVE CHOLINERGIC PRE GANGLIONIC NEURONS WITH THE SYMPATHETIC PRE

GANGLIONIC NEURONS BEING RELATIVELY SHORTER. (RELATIVE DISTANCE OF GANGLIA FROM S.C.)

•SYMPATHETIC PRESYNAPTIC FIBERS EXIT AT T1-L3 WHILE PARASYMPATHETIC FIBERS EXIT AT OCULAR,

BULBAR & SACRAL SPINE LEVELS.

 DISTRIBUTION OF VISCERAL NEURONS IN
THORACIC AND SACRAL SPINAL SEGMENTS
SYMPATHETIC (T6) AND PARASYMPATHETIC (S2)

PREGANGLIONIC CELL BODIES ARE LOCATED IN SPINAL

INTERMEDIATE GRAY MATTER.

THE VISCERAL EFFERENT NEURONS ARE CONCENTRATED

LATERALLY (INTERMEDIOLATERAL NUCLEUS).

PARASYMPATHETIC PREGANGLIONIC NEURONS ARE

LOCATED IN THE SACRAL SPINAL CORD (INTERMEDIATE GRAY

MATTER) AND BRAINSTEM

SYMPATHETIC PREGANGLIONIC NEURONS ARE FOUND

PARTICULARLY WITHIN THE INTERMEDIOLATERAL NUCLEUS

IN THE LATERAL HORN OF THE THORACOLUMBAR SPINAL

CORD

VISCERAL AFFERENT NEURONS PRESENT ALONG THE

DORSAL HORN SURFACE (LAMINA I OR MARGINAL NUCLEUS)

AND AT THE BASE OF THE DORSAL HORN (LAMINA V).

•IN THE PARASYMPATHETIC DIVISION THERE’S A DIVERGENCE FACTOR OF ROUGHLY 1:4, IN THE SYMPATHETIC

DIVISION THERE CAN BE A DIVERGENCE OF UP TO 1:20

•PARASYMPATHETIC POSTGANGLIONIC EFFECTS ARE PRODUCED BY ACETYLCHOLINE WHICH BINDS MUSCARINIC

RECEPTORS, NO OR BOTH. ATP IS A CO TRANSMITTER.

•SYMPATHETIC POSTGANGLIONIC EFFECTS ARE PRODUCED BY RELEASE OF NOREPINEPHRINE WHICH BINDS TO

ALPHA- OR BETA-ADRENERGIC RECEPTORS LINKED TO G PROTEINS (EXCEPTION OF SUDOMOTOR & ERECTOR PILI

FIBERS).

•THE ALPHA-ADRENERGIC RECEPTORS ARE ASSOCIATED WITH VASOCONSTRICTION AND SPHINCTER CONTRACTION.

THE BETA-ADRENERGIC RECEPTORS ARE ASSOCIATED WITH SMOOTH MUSCLE RELAXATION

•POPULATIONS OF SYMPATHETIC NEURONS ALSO KNOWN TO EXPRESS NEUROPEPTIDES: NEUROPEPTIDE Y, GALANIN,

SOMATOSTATIN AND OPIOIDS .

•CELL BODIES OF GENERAL VISCERAL AFFERENT (GVA) PRIMARY AFFERENT NEURONS RESIDE IN SPINAL GANGLIA

AND IN THE DISTAL GANGLIA (PETROSAL & NODOSE) OF GLOSSOPHARYNGEAL AND VAGUS CRANIAL NERVES.

•VISCERAL AFFERENTS ARE CONVEYED VIA MIXED (BRANCHIOMERIC) NERVE FIBERS; CN 9, 10 & SPINAL NERVES.

GVA 10% OF TOTAL AFFERENT INPUT INTO CNS. SPINAL AFFERENTS TRAFFIC NOXIOUS & TEMPERATURE SIGNALS

WHILE CRANIAL AFFERENTS LARGELY SUBCONSCIOUS. PELVIC PAIN LINE (ABOVE SNS, BELOW PNS)

•CENTRAL BRANCHES OF GVA SYNAPSE WITHIN SENSORY NUCLEI IN THE SPINAL CORD & BRAINSTEM. THESE

CONTAIN INTERNEURONS (MEDIATE VISCERAL REFLEXES) AND PROJECTION NEURONS (FOR CONSCIOUS AND

SUBCONSCIOUS ASCENDING PATHWAYS).

•VISCERAL AFFERENT ENDINGS IN THE PERIPHERY AND SPINAL CORD EXPRESS SUBSTANCE P , CALCITONIN GENE

RELATED PEPTIDE AND OTHER NEUROPEPTIDES OF THE TACHYKININ FAMILY, SUCH AS NEUROKININ A AND B.
 CENTRAL AUTONOMIC NETWORK

BOTH THE SYMPATHETIC AND PARASYMPATHETIC SYSTEMS ARE ORGANIZED IN A HIERARCHICAL

FASHION, FROM THE PERIPHERY, ASCENDING THRU’ SPINAL CORD, BRAINSTEM, HYPOTHALAMUS AND
FINALLY CEREBRAL CORTEX

EXTENSIVE INTERCONNECTIONS OCCURS BETWEEN VARIOUS NUCLEI (CENTRAL AUTONOMIC NETWORK)

• BETWEEN SITES RECEIVING VISCERAL INPUTS AND THAT CONTROL AUTONOMIC EFFERENT OUTPUTS,

• BETWEEN SITES FOR THE CONTROL OF SYMPATHETIC VERSUS PARASYMPATHETIC NERVOUS SYSTEM
OUTPUT.

• BETWEEN SITES FOR AUTONOMIC CONTROL AND SOMATIC, ENDOCRINE AND LIMBIC CIRCUITRY.

NET RESULT OF THIS NETWORK IN FULL OPERATION IS THE INDUCTION OF AUTONOMIC RESPONSES TO
VISCERAL AND SOMATIC STRESS STIMULI (↑↑↑ HR AND BP WITH THE ONSET OF PAIN).
 CENTRAL AUTONOMIC NETWORK
HIERARCHY IN THE AUTONOMIC NETWORK RESULTS IN:

• LOOPS FROM THE BRAINSTEM TO SPINAL CORD BEING RESPONSIBLE FOR RAPID SHORT-TERM REGULATION

OF THE AUTONOMIC NERVOUS SYSTEM,

• HYPOTHALAMIC-BRAINSTEM-SPINAL CORD PATHWAYS SERVING LONGER-TERM, METABOLIC AND

REPRODUCTIVE REGULATION,

• LIMBIC SYSTEM-HYPOTHALAMIC-BRAINSTEM-SPINAL CORD LOOPS SERVING ANTICIPATORY AUTONOMIC

REGULATION.
 HIERARCHY; AUTONOMIC CONTROL
THERE ARE THREE LEVELS OF INTEGRATIVE PROCESSING OF VISCERAL AFFERENTS AND COORDINATION OF

AUTONOMIC OUTFLOW.

1. VISCERAL REFLEX CIRCUITS/ ARCS- MEDIATE MOMENT TO MOMENT ADJUSTMENTS IN THE ACTIVITY OF

SPECIFIC AUTONOMIC TARGETS I.E. .

• VISCERAL AFFERENTS- SUBCONSCIOUS SENSORY SIGNALS FROM VISCERAL ORGANS: TEMPERATURE, PH,

STRETCH, INFORMS REFLEXIVE SIGNALING TO AUTONOMIC TARGETS

• INTERNEURONS- INTEGRATION OF SENSORY IMPULSE AND MODULATION FOR APPROPRIATE RESPONSE

 HIERARCHY; AUTONOMIC CONTROL

2.AUTONOMIC CENTERS/ CELL GROUPS WITHIN THE BRAINSTEM THAT COORDINATE ACTIVITY OF

SPECIFIC AUTONOMIC TARGETS. RESPIRATORY CONTROL , VASOMOTOR & CARDIAC CENTRES IN

MEDULLA

NEIGHBOURING WELL CONNECTED NUCLEI INVOLVED IN THE CONTROL OF INTERDEPENDENT

VISCERAL FUNCTIONS IN AUTONOMIC TARGETS- BLOOD PRESSURE & HEART RATE.

•CONTAINS THE REFLEX CENTRES FOR SPECIAL VISCERAL FUNCTIONS; VOMITING, SNEEZING,

COUGHING AND SWALLOWING.

•INFLUENCED BY VISCERAL SENSORY INPUTS TO NEARBY NUCLEI I.E., NTS- SENSORY INPUT FROM

VISCERAL ORGANS, PARABRACHIAL SUBNUCLEI- INTEGRATIVE RELAY ZONE.

 HIERARCHY; AUTONOMIC CONTROL

3. CORTICAL LEVEL: HIGHER CENTERS THAT ORGANIZE AUTONOMIC RESPONSES AS PART OF

COMPLEX BEHAVIORAL & ENDOCRINE RESPONSE TO ENVIRONMENTAL AND PHYSIOLOGICAL

CHALLENGES.

• CENTRAL NUCLEUS OF AMYGDALA AND MEDIAL PREFRONTAL CORTEX- PARTS OF THE LIMBIC

SYSTEM.

•  CORTICAL PATHWAYS ARE RECRUITED DURING STRESS AS WELL AS IN INFLUENCE OF BLOOD

PRESSURE, SYMPATHETIC VASOMOTOR DRIVE, CARDIOVASCULAR REFLEX FUNCTION,

VASOPRESSIN SECRETION, GASTROINTESTINAL MOTOR FUNCTION, AND MICTURITION.

 THE AUTONOMIC REFLEX ARC

•PREGANGLIONIC NEURONS ARE ACTIVATED BY DESCENDING PATHWAYS FROM AUTONOMIC PREMOTOR

CENTERS AND BY LOCAL REFLEXES. (IN THE GUT, REFLEX ACTIVITY CAN TAKE PLACE IN AUTONOMIC
PLEXUSES AND GANGLIA.)

•VISCERAL ACTIVITIES CONTROLLED BY AUTONOMIC REFLEXES- VASCULAR TONE, SWEATING, ACTIVATION

OF STRETCH RECEPTORS OF THE STOMACH WILL DIRECTLY ACTIVATE THE SMOOTH MUSCLE FIBERS OF THE
STOMACH WALL TO INCREASE MOTILITY.

•SENSORY INPUT CAN STIMULATE EITHER A SHORT OR A LONG REFLEX. SENSORY NEURON CAN PROJECT TO
THE CNS OR TO AN AUTONOMIC GANGLION.

•THE SHORT REFLEX INVOLVES THE DIRECT STIMULATION OF A POSTGANGLIONIC FIBER BY THE SENSORY
NEURON, WHEREAS THE LONG REFLEX INVOLVES INTEGRATION IN THE SPINAL CORD OR BRAIN.

•TARGET, THE DIFFERENCE IN WHICH DIVISION OF THE AUTONOMIC NERVOUS SYSTEM IS EXERTING
CONTROL IS JUST IN WHAT CHEMICAL BINDS TO ITS RECEPTORS.
AUTONOMIC REFLEX ARCS 
 CNS AUTONOMIC CONTROL CENTERS
HYPOTHALAMUS

MOST IMPORTANT HYPOTHALAMIC NUCLEUS OF THE CENTRAL AUTONOMIC NETWORK IS THE

PARAVENTRICULAR NUCLEUS (PVN). LOCATED BILATERALLY AROUND THE 3RD VENTRICLE 

MAGNOCELLULAR (BIG) NEURONS. CONTAIN VASOPRESSIN AND OXYTOCIN AND PROJECT THEIR AXONS INTO

THE POSTERIOR PITUITARY 

THE PARVOCELLULAR PVN NEURONS INCLUDE A NEUROENDOCRINE FUNCTIONAL SUBSET; PROJECT TO THE

MEDIAN EMINENCE SECRETE RELEASING HORMONES INTO THE HPA MEDIATE CONTROL OF ANT PITUITARY

HORMONE SECRETION.

PRE-AUTONOMIC PARVOCELLULAR NEURONS PROJECT TO PREGANGLIONIC AUTONOMIC NEURONS IN DMN OF

VAGUS, AUTONOMIC RELAY NUCLEI OF THE BRAINSTEM (A5, ROSTRAL VENTRAL LATERAL MEDULLA) AND TO THE

INTERMEDIOLATERAL SPINAL COLUMNS. (DIRECT INFLUENCES BOTH SYMPATHETIC AND PARASYMPATHETIC)   

 HYPOTHALAMUS

• PRE AUTONOMIC PVN PROJECTIONS DESCEND IPSILATERALLY THROUGH THE BRAINSTEM AND SPINAL

CORD.

• FOUR POINTS OF DECUSSATION (SUPRAMAMMILLARY, PONTINE TEGMENTUM, COMMISSURAL PART OF THE

NUCLEUS OF THE SOLITARY TRACT (THE MAJOR ONE), LAMINA X OF THE SPINAL CORD)

• ULTIMATELY INNERVATION IS BILATERAL BUT WITH AN IPSILATERAL DOMINANCE.

• DMN OF VAGUS, CENTRAL GRAY MATTER, PARABRACHIAL NUCLEUS, NUCLEUS OF SOLITARY TRACT,

LATERAL & VENTRAL MEDULLA, THE INTERMEDIOLATERAL SPINAL COLUMNS PROJECT & RECEIVE

SIGNALS FROM PRE AUTONOMIC PVN.

 RVLM
• THE ROSTRAL VENTROLATERAL MEDULLA (RVLM) CONTROLS BLOOD PRESSURE BY REGULATING

VASOCONSTRICTION AND CARDIAC OUTPUT.

• IT RECEIVES INPUT FROM PERIPHERAL BARORECEPTORS & CHEMORECEPTORS AND SEVERAL BRAIN

SITES, INCLUDING THE PAG AND HYPOTHALAMUS.

• GLUTAMATERGIC NEURONS OF THE RVLM PROJECT DIRECTLY TO SYMPATHETIC PREGANGLIONIC

NEURONS IN THE SPINAL CORD CONTROLLING CARDIAC OUTPUT AND BLOOD PRESSURE.

• PROVIDES TONIC ACTIVATION AND MEDIATES ALL REFLEXES CONTROLLING ART’ B.P.; INCLUDING

BAROREFLEX, CARDIOPULMONARY REFLEXES, AND CHEMOREFLEXES.

•  HIGH DEGREE OF CONVERGENCE AND DIVERGENCE BETWEEN THE RVLM NEURONS AND THEIR

PREGANGLIONIC SYMPATHETIC TARGETS

 THE AMYGDALA
• THE AMYGDALA, A LIMBIC BASAL NUCLEUS OF THE RHINENCEPHALON, IS INVOLVED IN GENERATING VISCERAL

ACTIVITY. STIMULATION CAUSES INTENSE EMOTION, SUCH AS AGGRESSION OR FEAR

• RECEIVES SENSORY INPUT FROM THALAMUS AND ASSOCIATION CORTEX PER SENSORY MODALITY.

• AUTONOMIC INPUT ARRIVES FROM INSULAR CORTEX, HYPOTHALAMUS AND PARABRACHIAL NUCLEI. MEMORY RELATED

INPUT COMES FROM THE HIPPOCAMPUS AND ADJACENT NEOCORTEX.

• PATHWAYS FROM THE THALAMUS TO THE AMYGDALA ARE PARTICULARLY IMPORTANT IN EMOTIONAL LEARNING.

OUTPUT PATHWAYS FROM THE CENTRAL NUCLEUS OF THE AMYGDALA MAKE EXTENSIVE CONNECTIONS WITH THE

BRAIN STEM FOR EMOTIONAL RESPONSES AND EXTENSIVE CONNECTIONS WITH CORTICAL AREAS THROUGH THE

NUCLEUS BASALIS.

• CHOLINERGIC PROJECTIONS FROM THE NUCLEUS BASALIS TO THE CORTEX ARE THOUGHT TO AROUSE THE CORTEX.
EXPRESSION OF DIFFERENT EMOTIONAL RESPONSES BY THE AMYGDALA
 CNS AUTONOMIC CONTROL CENTERS

• MIDBRAIN PERIAQUEDUCTAL GRAY MATTER (PAG) SURROUNDS THE MESENCEPHALIC AQUEDUCT. RELAYS
VISCERAL CONTROL INFORMATION FROM THE HYPOTHALAMUS TO THE HINDBRAIN NUCLEI (E.G., PMC,
RVLM).

• VISCERAL AND OTHER RESPONSES VARY ACCORDING TO WHERE THE PAG IS STIMULATED. (THE
CAUDOLATERAL PAG CONTAINS A MICTURITION CENTER THAT RECEIVES ASCENDING PROJECTIONS FROM
THE SACRAL CORD, SENDS AXONS TO THE PMC, AND GENERATES BLADDER CONTRACTION WHEN
STIMULATED.)

• THE PONTINE MICTURITION CENTER (PMC) IS LOCATED DORSALLY IN THE PONS. GIVE RISE TO AXONS THAT
DESCEND TO THE SACRAL SPINE PREGANGLIONIC NEURONS WHICH STIMULATE DETRUSOR SMOOTH
MUSCLE AND INHIBIT NEURONS TO URINARY SPHINCTERS.

• THE PMC ALSO CONTROLS THE URINARY TRACT INDIRECTLY VIA INPUT TO MEDULLARY RETICULAR NUCLEI
THAT DISPATCH AXONS TO THE LUMBOSACRAL SPINAL CORD. THE PMC RECEIVES INPUT FROM THE
HYPOTHALAMUS, PAG, AND SPINAL CORD.
 CNS AUTONOMIC CONTROL CENTERS
•NUCLEUS OF TRACTUS SOLITARIUS IS THE MAIN VISCERAL SENSORY NUCLEUS IN THE BRAINSTEM.

RECEIVES GVA FROM CN 9 & 10 AND SENDS OUTPUT TO PARASYMPATHETIC PREGANGLIONIC NEURONS,

TO PREMOTOR AUTONOMIC CENTERS, AND TO THE THALAMUS AND LIMBIC SYSTEM. (ROSTRALLY THE

NST RECEIVES SVA TASTE FROM CRANIAL NERVES VII, IX & X.)

CEREBRAL CORTEX- INSULAR AREA IS A VISCERAL SENSORY AREA OF THE NEOCORTEX THAT

RECEIVES INPUT FROM THE THALAMUS (VENTRAL POSTERIOR NUCLEI). THE MEDIAL FRONTAL CORTEX

(ROSTROVENTRAL CINGULATE GYRUS) IS A VISCERAL MOTOR AREA OF NEOCORTEX. THE LIMBIC

CORTEX FUNCTIONS AS A CEREBRAL ASSOCIATION AREA FOR CONTROL OF BEHAVIOR AND LEARNING.
 THE ENTERIC NERVOUS SYSTEM

. WITHIN THE GUT WALL, AUTONOMIC NERVES ARE FOUND IN SUBMUCOSAL (MEISNER) PLEXUS; LOCATED

WITHIN THE SUBMUCOSA & THE MYENTERIC (AUERBACH) PLEXUS FOUND BETWEEN CIRCULAR &

LONGITUDINAL MUSCLE LAYERS.

EACH CONTAINS:

• PREGANGLIONIC AXONS FROM THE VAGUS NERVE;

• POSTGANGLIONIC NEURONS OF PARASYMPATHETIC TERMINAL GANGLIA;

• AXONS FROM POSTGANGLIONIC NEURONS LOCATED IN SYMPATHETIC PREVERTEBRAL GANGLIA; AND

• INNERVATION FROM THE PELVIC PLEXUS (FOR DESCENDING COLON, RECTUM, & ANAL CANAL)

• AXONS OF VISCERAL AFFERENT NEURONS (CONVEYING MECHANORECEPTOR & CHEMORECEPTOR ACTIVITY)

GUT REFLEX ACTIVITY OCCURS INDEPENDENTLY OF THE CNS.

VISCERAL AFFERENT NERVES CAN TRIGGER: LOCAL REFLEXES BY SYNAPSING ON

POSTGANGLIONIC NEURONS WITHIN SUBMUCOSAL OR MYENTERIC PLEXUSES OR REGIONAL

REFLEXES BY SYNAPSING ON POSTGANGLIONIC NEURONS IN PREVERTEBRAL AUTONOMIC

GANGLIA