Autonomic Nervous System

A. Structure/function of ANS
- Operation of ANS occurs subconsciously (aka automatically)
- It is considered to be primarily MOTOR
- There are two functional components of the ANS: GVE & GVA
- There are 3 parts to the ANS
• Enteric NS
o Innervates GI tract
o Although PNS & SNS regulate activity of enteric system – the gut can move w/out their
input
 Recall that Auerbach’s & Meissner’s Plexuses are in the walls of the GI tract
 Congenital absence of those plexuses is called Hirschsprung’s Disease
• Sympathetic NS: “fight or flight”
o Affects almost all parts of the body
o Antagonistic w/ PNS
• Parasympathetic NS: “rest & digest”
o Does NOT innervate skin, body wall, muscles, or joints
o Antagonistic w/ SNS

B. Compare structure & function of parasympathetic & sympathetic NS

Features common to PNS & SNS
• Primarily 2 neuron motor system
• Cell body of 1st motor neuron lies in nucleus of brainstem or spinal cord (ie the preganglionic
nerve)
o Pregang neuron = small diameter, myelinated motor neuron (B fiber)
• Cell body of 2nd motor lies in ganglia of peripheral nervous sytem (ie the postganglionic nerve)
o Postgag neuron = small diameter UNmyelinated motor neuron (C fiber)
• Preganglionic neurotransmitter for both is Ach

SNS: “thoracolumbar efferent outflow”

• Things that it does:
o Dialates pupils
o Increases heart rate
o Increases skin sweating
o Inhibits GI movement
o Contracts vesical & anal sphincters
o Blood diverted from skin & GI tract to skeletal muscles
• Preganglionics are found from T1-L2/3 in the intermediolateral cell column
• Pathway:
o Axons exit spinal cord via Anterior root & pass via white ramus communicans to
paravertebral ganglion
 Paravertebral ganglion found in sympathetic chain that lies next to vertebral
column
 Fibers of white ramus are B fibers
o Then, the preganglionic fiber can:
 Terminate on postganglionic sympathetic neuron in the ganglion
 Pass thru the sympathetic ganglia & ascend/descend in order to terminate on
another sympathetic ganglia
• Recall sympathetic trunk extends along length of the vertebral column
  Pass thru sympathetic ganglia to a prevertebral ganglia & terminate on a
postganglionic neuron there
• Examples of prevertebral ganglia: celiac, inferior/superior mesenteric
ganglia
 Pass thru sympathetic ganglia to adrenal medulla
• Recall adrenal medulla & autonomic ganglia are made from neural
crest cells
• Innerve of adrenal medulla is by preganglionics
• Cells of adrenal medulla act like postganlionics & release contents (epi)
into blood cirq
o Postganglionic neurons leave ganglia & rejoin spinal nerve via gray ramus communicans
 Fibers of gray ramus are C fibers
o From there, it will follow spinal nerve to its target
• Note on cervical part of sympathetic chain
o 3 named ganglia – inferior, middle & superior
 sometimes middle is abscent
 sometimes inferior fuses w/ 1st thoracic ganglion; may also be called stellate or
cervicothoracic ganglion
o Cervical postganglionic neurons innervate targets in the head, neck, upper limbs & heart

PNS: “craniosacral efferent outflow”

• Things that it does:
o Manages digestion
o Manages reproductive behavior
o Returns body to baseline levels
o Slows the heart
o Enhances peristalsis
o Relaxes vesicle & anal sphincters
• The nuclei of the PNS are:
o Edingwer-westphal (CN III) of midbrain
 Preganglionics travel w/ occulomotor
 Postganglionic neurons in ciliary ganglion
• Innervate constrictor muscle of pupil (spincter pupillae) & ciliary
muscle
• Constrict ciliary m: increases lens curvature when looking at near
objects (accommodation)
• Constrict spinchter pupillae: lowers amount of light reaching retina
o Superior salivatory & lacrimal (CN VII) of pons
 Preganglionics travel to sphenopalantine & submandibular ganglion via nervus
intermedius of VII
• They must travel thru pterygopantine to get to their respective ganglia
 Postganglionics innervate lacrimal gland & nasal mucosal glands
• Nasal mucosal glands: submandibular, sublingual, mucous glands of
oral mucosa

o Inferior salivatory (CN IX) of pons

 Preganglionics travel to otic ganglia via glossopharyngeal nerve
 Postganglionics innervate parotid gland
o Dorsal motor nucleus of vagus (CN X) of medulla
 Preganglionics travel to various visceral ganglia of thoracis & upper abdominal
cavities via vagus nerve
 Postganglionics innervate heart, GI tract, etc…
 • Parasympathetics for pelvis & lower abdominal come from lateral horns of S2-S4
o S2-S4 neurons send axons to visceral ganglia near their target organ
• NOTE: cranial nerve visceral afferents project ot causdal part of solitary nucleus
o Solitary nucleus, in combo w/ adj. reticular formation & autonomic motor nuclei control
respiration & circulation

C. Contrast structure & function of parasympathetic & sympathetic NS

Feature SNS PNS

Function Activate body Prepare body for rest
Location Thoracolumbar (T1-L2/3) Cranio-sacral (III, VII, IX, X & S2-4)
Neurons Short preganglionic Long preganglionic
Long postganglionic Short postganglionic
Response Global Discrete/local
Neurotransmitter NE (except sweat gland = Ach) Ach

D. Define referred pain & explain its clinical significance

General Info:
Information on Afferents (GVA) from viscera:
• Usually follow sympathetic nerves
• Have cell bodies in DRG
• Enter spinal cord via posterior root
• Some are important in visceral reflexes
o These synapse on preganglionic neurons of lateral horn

Referred Pain:
Pain associated w/ viscera is often mistaken as somatic pain
Is generally referred to the dermatome of the same spinal segment the visceral afferent centers
• Possible cause: sympathetic afferents synapsing w/ elements of pain pathways used for synaptic
transmission of somatic pain
• Examples:
o Cardiac Pain: chest & left side of arm (dermatome T1-T4)
o Gallbladder: right upper abdomen & scapula (dermatomes T6-T8)
o Stomach: dermatomes T7-T8
o Appendix – dermatome T10 w/ shift to lower right quadrant if peritoneum is involved

Causalgia:
• Sympathetic efferents may irritate injured area – leading to potential severe chronic pain
• Relief may be obtained via nerve block (ie lidocaine injections) or surgical removal
• Note: interruption of sympathetic innervation of superficial bv & sweat glands can cause
vasodilation & loss of sweating ability
o Affected area would be red, warm & dry
• Note: increased sympathetic innervation to superficial bv & sweat gland result in cold, pale,
clammy skin

E. Horner’s Syndrome: anatomical substrates for the syndrome, clinical signs &
symptoms
Cause of Horner’s
• Lesion of SNS in descending pathway b/w T1-T5
 • Damage to superior cervical ganglia

Signs/Symptoms of Horner’s
• Miosis – constriction of pupil due to lack of SNS innervation of dilator pupillae
o Pupil constricts b/c there is nothing to counteract PSNS-controlled sphincter pupillae
muscles
• Ptosis – drooping of upper eyelid due to inactivity of SNS innervation of superior tarsal muscle
(smooth muscle)
o Also seen in Myasthenia Gravis (ie you would have ptosis, but NO miosis)
o Could also occur b/c of lesion to CN III – GSE component
 But would get more pronounced eyelid drop
• Anhidrosis – lack of facial sweating
o It would be apparent if lesion occurs before branching of sympathetics in the periphery
 Branch to facial sweat glands follows ECA
 Branch to eye follows ICA
• Enophthalmos – sinking of one eye w/in the orbit (possibly due to inactivity of smooth muscle)

F. Describe somatic and autonomic innervation of the bladder. Discuss function

implications of damage to the NS on the bladder

Innervation of Bladder:
• SNS – retention of urine (GVE)
o Clinically less important than PSNS
o From L1/L2 intermediolateral cell column
o Innervates blood vessels
• PSNS – voiding of bladder (GVE)
o From S2-S4
o Preganglionics synapse on postganglionic on/in bladder
o Activation of bladder parasympathetics causes detrusor muscle of bladder to contract (ie
empty bladder)
• Sensory afferents involved in micturition enter spinal cord (GVA/GSA)
o Some participate in spinal reflexes
o Others terminate in paracentral lobule of cerebral cortex which has the cortical
representation of the bladder
• Somatic motor fibers of peripheral nerves participate in voluntary control over urination (GSE)
o They also originate from S2-S4 region
o They innervate external sphincter muscles

Lesions & bladder

• In spinal cord ABOVE S2-S4: interrupts regulation of normal bladder function by affecting
descending control of spinal reflex
o Result: automatic reflex bladder (similar to a baby) or “spastic bladder”
 Once bladder is full, it stimulates reflex circuitry  uncontrolled urination
follows
• Spinal cord AT S2-S4 or nerves of cauda equina: autonomous neurogenic bladder or “flaccid
bladder”
o Reflex circuitry NOT intact
o Only control is smooth muscle of bladder wall
o Bladder fills to capacity, then dribbles continuously
o Bladder can be emptied by manual compression of lower abdominal wall
 PNS damage causes sensation from skin through a peripheral nerve or myotome distribution to be
altered. You will get FLACCID paralysis with HYPOACTIVE reflexes.
CNS damage causes the reflexes to remain in tact so you have SPASTIC paralysis and
HYPERACTIVE reflexes. These lesions can cause bowel and bladder control issues.

If the lesion is between C3 and C5 there is a good chance that breathing will be affected
(due to phrenic nerve disruption from C3,4 and 5).

If the lesion is at C3 or ABOVE…you will need mechanical ventilation because the

phrenic nerve will be completely disrupted.

G. Vocab
• All covered above