Wathita phachonpai, Ph.D.

Department of Physiology,
Faculty of Medical Science.
: phachonpai@yahoo.com

Autonomic Nervous System

&
Reflex
› Compare autonomic with somatic nervous system

› Compare parasympathetic and sympathetic in ANS

› Compare cholinergic transmission with

adrenergic transmission in ANS

› Understand about the action of ANS drugs
› Describe the reflex arc

› Describe the mechanism of reflexes

› Describe the structure of muscle spindle
›Describe about clinical application of the
stretch reflex
 Nervous System

Central nervous system Peripheral nervous system

Brain Spinal cord

Afferent division Efferent division

(sensory input to CNS) (motor output to target
organ)

Somatic NS ANS
- Parasympathetic
- Sympathetic
Autonomic nervous system : ANS

....is the part of the peripheral nervous system

that controls visceral functions.

Characteristic of ANS
- Involuntary
- Continuously
- Maintaining homeostasis
- Control by reflexes
 Stimulator for ANS

1. Inner Environments (tension, pressure, etc.)

2. Outer Environments (pain, temperature, etc.)

3. Emotions (anxiety, exciting, etc.)

 Centers of ANS

1. Spinal cord : Urination, Defecation

2. Medulla oblongata : Centers of respiratory,

reproductive and digestive system

3. Hypothalamus (“the boss”) : Integrating & centers

: sweating, vasodilatation, heart rate, blood pressure

4. Limbic system
ANS regulates (target organs)

- Smooth muscles (Visceral organs)

- Cardiac muscles

- Glands
ANS + SNS
ต่ างกันอย่ างไร ?
 Comparison of Somatic &
Autonomic Nervous Systems

SNS ANS
Effectors Skeletal Smooth & cardiac
muscles muscles, glands

Control Voluntary Involuntary

Division 1. sympathetic
- 2. parasympathetic

Function Movement Maintain homeostasis

 Comparison of Somatic &
Autonomic Nervous Systems

ANS
SNS

Parasympathetic
Neurotransmitters Acetylcholine
(Ach)
Acetylcholine
(Ach)
Sympathetic

Norepinephrine
(NE)
 Comparison of Somatic &
Autonomic Nervous Systems

Somatic Autonomic
No. of neurons
from One Two
CNS to effector

Ganglion No Yes
 Autonomic Neurons
- 2 neuron in the efferent pathway

Preganglionic neuron Postganglionic neuron

- Cell body in brain or - Cell body lies outside the CNS

spinal cord (1 st neuron). in an autonomic ganglion

- First synapse at the postganglionic - Synapse at the target organ

( 2 nd neuron).
- Axon is unmyelinated
- Axon is myelinated type B fiber type C fiber that terminates
that extends to autonomic ganglion in a visceral effector
 Brain or spinal cord (CNS)

Preganglionic neuron ANS

(Presynaptic) ganglion

ANS
receptor
Postganglionic neuron
(Postsynaptic)

neurotransmitters

synapse
receptor

Effector organ, Target organ

Classification of ANS

- Sympathetic
- Parasympathetic
Parasym + Sym
(ใน ANS) ต่ างกันอย่ างไร ?
Anatomical of Sym - Parasym

1. Origin of preganglionic neuron in CNS

2. Location of ganglion

3. Type of NT that affect on target organ.

AUTONOMIC NERVOUS SYSTEM : ANS
Parasympathetic
- Craniosacral outflow
(preganglionic neurons begin
at the cranial nerves (3,7, 9, 10)
and sacral (S2-S4)
- Long preganglionic neuron
- Terminal ganglia is near or
in the wall of target organ
Sympathetic
- Thoracolumbar outflow
(preganglionic neurons begin
at the thoracic and lumbar
(T1-L2)
- Short preganglionic neuron
- Terminal ganglia is far from
the target organ
 Parasympathetic Sympathetic
- Each preganglionic cell - Each preganglionic cell
synapses on little postganglionic synapses on many
cells postganglionic cells

- Both pre & postganglionic หลัง% - Preganglionic หลัง% ACh

ACh (cholinergic neuron) (cholinergic neuron)
Pre Post
-Postganglionic ส่ วนใหญ่ หลัง% NE
ACh ACh (Adrenergic neuron),
(ยกเว้ น ต่ อมเหงื%อ, หลอดเลือดทีไ% ปเลีย: ง
Skeletal muscle) หลัง% ACh
Nicotinic R. Muscarinic R.
(Post) (target organs)
 Parasympathetic Nervous System (Craniosacral
Outflow)
Sphincter Muscle of Iris SA & AV Node Bronchi/Bronchial
Ciliary Muscle Glands

Stomach

Lacrimal Gland
Small Intestines

Bile Ducts
Submaxillary & Gallbladder
Sublingual
Glands Kidney

Large Intestines
Parotid Gland
Bladder

Genitalia
 Radial Muscle of
Sympathetic Nervous System Iris, Ciliary Muscle
(Thoracolumbar Outflow)
Sublingual/Submaxillary
& Parotid Gland
SA & AV Nodes
Pilomotor Muscles His-Purkinje System
Sweat Glands Myocardium
Bronchi/Bronchial
Glands
Stomach

Kidneys
Blood Vessels

Intestines

Paravertebral Ganglia Bladder//Genitalia

Prevertebral Ganglia
 MCMP 407

Parasympathetic Ganglionic Synapse

Ca 2+ Acetylcholinesterase

Na+

ACH

a ba
Action Potential
Nicotinic
Receptor
Na+

Preganglionic neuron Postganglionic neuron

 MCMP 407

Parasympathetic Organ Synapse

Acetylcholinesterase

Ca 2+
Effector
Organ
Na+
K+
G

Action Potential
ACH
Muscarinic
Receptor

Postganglionic neuron
 MCMP 407

Sympathetic Ganglionic Synapse

Ca 2+ Acetylcholinesterase

Na+

ACH

a ba
Action Potential
Nicotinic
Receptor
Na+

Preganglionic neuron Postganglionic neuron

 MCMP 407

Sympathetic Organ Synapse

Ca 2+
Effector
Organ
Na+
G

NE
Action Potential

Adrenergic
Receptor

Postganglionic neuron
 Adrenal medulla (ต#อมหมวกไตชั้นใน)

e rw Control by preganglionic fiber

e mb
m (No Postganglionic)
Re
ACh
chromaffin cells (in adrenal medulla)

adrenaline (Epinephrine: Epi)

Acting as sympathetic ganglia

 Parasympathetic Sympathetic

- “rest-and-digest” response - “flight or fight” response

-Help conserve and restore - Emotional stress or

body energy during times of rest alarm reaction

• SLUDD type responses – (4 E -situations)

(salivation, lacrimation, Emergency,
urination, digestion & defecation) Embarrassment,
and
Excitement,
w 3 “decreases”--- Exercise
decreased HR, diameter
of airways and diameter of pupil
 Compare the effect of sympathetic
and parasympathetic

Target organ Sympathetic Parasympathetic

Heart rate Heart rate

Pupil Dilate Constrict

Bronchial Dilate Constrict

Digestion
(GI tract) Inhibit Promote
Most organs receive dual sympathetic
and parasympathetic innervation.

However, some organs only receive

sympathetic innervation:
Spleen
Sweat Glands
Piloerector Muscles
Most Blood Vessels
 Can you tell me about the ....?

- Differences between somatic and ANS.

- Characteristic of ANS.
- ANS regulates _______.
- Stimulator for ANS.
- Centers of ANS.
- Characteristic of Autonomic neurons.
- Division of ANS and duty of each ANS.
- Effect of sym and parasympathetic
on effectors.
Neurotransmitters in ANS

v Acetylcholine (ACh)
v Norepinephrine (NE)
 Main process of transmitters

Neurotransmitters
1. การสั งเคราะห์ (synthesis): Precursor, enzymes
2. การเก็บ (storage): varicosity
3. การปล่ อย (release): Ca2+
4. การออกฤทธิ9 (action): excitation, inhibition
ligand gate ion channel Shot action
Binding receptors
G protein coupled Long action
5. การทําลาย (termination of action)
- reuptake
- metabolize by enzymes
- diffuse (destroy at liver and excrete with urine)
 Neurotransmitters (ANS)

ACh NE, Epi

Cholinergic Adrenergic
neuron neuron
(cholinoceptor) (Adrenoceptor)
Neurotransmitters (NT)

Parasympathetic NT
- ACh : Pre/Post

Sympathetic NT
- ACh : Pre
- NE : Post
 Acetylcholine (ACh)

Synthesis
Precurssors : Acetyl CoA + Choline

Enzyme : Acetylcholinetranferese (ChAT)

Receptors
Muscarinic & Nicotinic
Degradation
Enzyme : Acetylcholinesterase (AChE)
Action
Shot action: ACh- rapidly hydrolyzed
Step of ACh release
1. Synthesis of ACh
- Acetyl CoA + Choline
- ChAT enzyme

2. ACh=> package up inside

vesicle to be transferred release

3. Release ACh from terminal

- Membrane depolarized
- entry Ca++
- Release ACh

4. ACh binding receptors

- Muscarinic & Nicotinic

5. Nerve impluse
Step of ACh release

6. Degradation of ACh

- AChE enzyme (breakdown)

- Acetic acid
+ Choline
(reuptake into presynaptic cell))
 Catecholamines :(NE, Epinephrine, Dopamine)
Synthesis Receptors
Tyrosine (Precursor)
- Alpha; α
Dopa - Beta; β
Dopamine Degradation
NE 1. Monoamine oxidase (MAO)
: presynaptic membrane
Epinephrine
Action depend on receptors 2. Catechol O-methytransferase
(COMT)
α1, β1 α2, β2 : postsynaptic membrane

excitation inhibition
 ANS : RECEPTOR
Adrenergic receptors
cholinergic receptors
Adrenoceptor
Cholinoceptor
NE
ACh - Alpha receptor (α)
Muscarinic receptor (M)
1. Vein, Eyes
1 : Ganglia, gland
2. postganglionic neuron
2 : Cardiac M., smooth M.
3 : Smooth M., gland - Beta receptor (β)
4 : CNS 1 Cardiac M.
Nicotinic receptor (N)
2. Blood vessel, Bronchioles
: Ganglia of ANS Liver, Pancreas
: synapse of skeletal M. (NMJ)
3. Adipose tissue
 Nicotinic receptor

- ligand gate ion channel to

open (Na2+)

- Depolarization
activate+
w Substances Ni re
Excitatory
Acethycholine, Nicotine
inhibit -
w Substances Ni re

Curare, alpha bungalotoxin

 Muscarinic receptors

M1 M2 M3

Neural: (CNS) Glandular,

smooth muscle
G protein Cardiac
coupled receptors Increased IP3 Increased IP3
w Substances and DAG and DAG

activate +
Pilocarpine M re Increased potassuim efflux
(opened K channel)
inhibit -
w Substances M re

Atropine
 Adrenergic receptor

Alpha1 Vein Contraction

Eye Mydriasis
Alpha2 Nerve terminal NE release and synthesis

Beta1 Heart Increase HR & contraction

Beta2 Blood vessel Vasodilation

Bronchioles Dilation
Liver Glycogenolysis
Pancrease Insulin release
Beta3 Adipose Tissue Lipolysis
BREAKING TIME
 - Are basically the sudden responses of
our body (involuntary) to the stimuli
that acts to return the body to homeostasis.

Characteristic of reflex
- Automatic - Adequate stimulus
- Involuntary
- Stereotyped response
Subconscious
- Occur
Conscious
Functions
- Homeostasis
- Protect our body from the dangerous stimuli

Reflex arc : วงจรการเกิด reflex

1. Receptors
2. Sensory (afferent) fibers
3. Reflex center (brain & spinal cord)
4. Motor (efferent) fibers
5. Effector organs
 Classification of reflexes
1. Amount of synapse in the CNS
v monosynaptic reflex: (stretch reflex)
v disynaptic reflex: (Golgi tendon reflex)
v polysynaptic reflex: (withdrawal reflex)

2. Kind of nerve fiber

➣ somatic reflex (knee reflex, ankle reflex)
➣ autonomic reflex (autonomic nerve: pupillary light reflex)
3. Origin of nerve fiber
w Cranial reflex
w Spinal reflex
4. Based on timing
“ Inborn reflex (sucking reflex)
“ Acquired reflex (conditioned reflex: practice)

5. Location of receptors
♠ Superficial reflex: (withdrawal reflex)
♠ Deep reflex : (patellar reflex, ankle reflex)
♠ Visceral reflex: (reflex to control BP)

6. Pathological reflex: Babinski’s sign

(abnormal pattern)
 Structure of skeletal muscle (muscle spindle)

Extrafusal Intrafusal
muscle fiber muscle fiber

- จํานวนมากที*สดุ - รับข้อมูลเกี*ยวกับความยาวของกล้ามเนืA อ
- แข็งแรงที*สดุ (muscle length)
- ปลายยึดติดกับ - อัตราการเปลี*ยนแปลงความยาวของใย
tendon กล้ามเนืA อ (rate of change of
- α motor muscle length)
neuron - γ motor neuron
(movement) - ตรงกลาง: free actin &
myosin
 α, γ neurons
Ventral root (motor)
 Extrafusal muscle fiber

- support by α motor neurons

support
- 1 α motor neuron 3 - > 100 muscle fibers

- 1 motor unit
 Intratrafusal muscle fiber

- central region: no actin & myosin filaments

(except head and end plate)

γ motor neuron กระตุ้น

head and end plate หดตัว

central of intrafusal fiber ยืดออก

 Intrafusal muscle fiber

Nuclear bag Nuclear chain

-Nuclei รวมอยู่บริเวณตรงกลาง Nuclei เรียงต่ อกัน

- Ia afferent fiber - Ia afferent fiber
- II afferent fiber
Muscle spindle can be excited by

1. lengthening the whole muscle.

2. contraction of the end portions of the

intrafusal muscle fiber.
 Muscle sensory receptors

Muscle spindles Golgi tendon organs

: detect rate of change : tension on tendon

of muscle length
: stretch reflexes

Intrinsic muscle control

Anterior motor neuron

Anterior (ventral) gray horn

α motor neuron γ motor neuron

Efferents fibers (ventral root)

Skeletal muscle fibers

Patellar reflex sensory receptors at patellar
(i.e. muscle spindles)
impulse

sensory Ia-nerve fiber of

the femoral nerve (afferent nerve)
synapse

level of L4 in the spinal cord

impulse

alpha-motor neuron
(efferent nerve)

quadriceps femoris muscle

(contraction)
 Muscle tone normal situation
คลื่นประสาทน,อย ๆ
γ motor neuron intrafusal muscle fibers
คลื่นประสาท
α motor neuron

extrafusal muscle fibers

(หดตัวน้ อย ๆ ตลอดเวลา)
Muscle tone 3 type

Normotonic Hypertonic Hypotonic

muscle muscle muscle
Golgi tendon reflex
• Detect muscle tension (not muscle length or rate of
change of muscle length)

Useful

- To prevent tearing of muscle, tendon.

- To equalize the contractile force of muscle fibers

Clinical management & stretch reflex
 Grading of reflexes
Grade 0 = Areflexia = No response
- any lesion that interrupts the reflex arc, Spinal shock

Grade1 = Hyporeflexia.
A reflex may be depressed by any lesion that interrupts the
reflex arc.

Grade2 = Normal response.

Grade3 = Hyperreflexia with no pathology : normal,

excitation

Grade4 = Hyperreflexia with pathology (upper motor

neuron)
Reflex testing
is a standard, useful procedure in search of
neurological pathology.
However
Interpretation of reflex responses is often
subjective and requires considerable
experience on the part of diagnosis.
Moreover
Require the other neurological examination
(motor power, sensation, consciousness) are used
to make diagnosis.
Autonomic reflexs or Visceral Reflexes

• Unconscious sensations and responses

– Changes in blood pressure, digestive functions etc.

– Filling & emptying of bladder or defecation.

- Reflex ทางเพศ : erection, ejaculation.

I hope my exam .....don't activate your sympathetic.
Stimulate sympathetic activity

Increase Suppress parasympathetic

activity

pupils dilate

Bronchial dilate พารา ซึ ม

Inhibit GI tract movement Bladder dilate

THANK YOU
FOR
ATTENTION