The Autonomic

Nervous System
The autonomic nervous system and homeostasis
The autonomic nervous system contributes to homeostasis by responding to subconscious
visceral sensations and exciting or inhibiting smooth muscle, cardiac muscle, and glands.

As you learned in Chapter 12, the peripheral nervous system (PNS) includes cranial and spinal nerves and is divided into a
somatic nervous system (SNS) and autonomic nervous system (ANS). Like the somatic nervous system, the autonomic
nervous system (ANS) (aw⬘-tō-NOM-ik) operates via reflex arcs. (The derivation is auto- ⫽ self; -nomic ⫽ law.) Structurally,
the ANS includes autonomic sensory neurons, integrating centers in the central nervous system (CNS), autonomic motor
neurons, and the enteric division or enteric nervous system (ENS). A continual flow of nerve impulses from (1) autonomic
sensoryy neurons in visceral
vis organs and blood vessels propagate into (2) integrating
centers in the CNS. Then, impulses in (3) autonomic motor neurons
propagate to various effector tissues, thereby regulating the activity of
smooth muscle, cardiac muscle, and many glands. The enteric
division
divi is a part of the ANS that consists of a specialized
network
ne of nerves and ganglia, forming an independent nerve
network
n within the wall of the gastrointestinal (GI) tract. The
ANS
A usually operates without conscious control. However,
centers in the hypothalamus and brain stem do regulate ANS
reflexes. In this chapter, we compare structural and functional
features
f of the somatic and autonomic nervous systems. Then
we
w discuss the anatomy of the motor portion of the ANS and
compare
com the organization and actions of its two major parts, the
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Did you ever wonder how some blood pressure medications exert
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523
524 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM
15.1 Comparison of Somatic and
Autonomic Nervous Systems
OBJECTIVE
• Compare the structural and functional differences
between the somatic and autonomic parts of the nervous
system.
Somatic Nervous System
The somatic nervous system includes both sensory and motor
neurons. Sensory neurons convey input from receptors for somatic
senses (tactile, thermal, pain, and proprioceptive sensations; see
Chapter 16) and from receptors for the special senses (sight,
hearing, taste, smell, and equilibrium; see Chapter 17). All of these
sensations normally are consciously perceived. In turn, somatic
motor neurons innervate skeletal muscles—the effectors of the
somatic nervous system—and produce both reflexive and volun-
tary movements. When a somatic motor neuron stimulates the
muscle, it contracts; the effect always is excitation. If somatic
motor neurons cease to stimulate a muscle, the result is a para-
lyzed, limp muscle that has no muscle tone. Although we are
generally not conscious of breathing, the muscles that generate
respiratory movements are also skeletal muscles controlled by
somatic motor neurons. If the respiratory motor neurons become
inactive, breathing stops. A few skeletal muscles, such as those
in the middle ear, are controlled by reflexes and cannot be con-
tracted voluntarily.
Autonomic Nervous System
The main input to the ANS comes from autonomic (visceral)
sensory neurons. Mostly, these neurons are associated with
interoceptors (IN-ter-ō-sep⬘-tors), sensory receptors located in
blood vessels, visceral organs, muscles, and the nervous system
that monitor conditions in the internal environment. Examples of
interoceptors are chemoreceptors that monitor blood CO2 level
and mechanoreceptors that detect the degree of stretch in the
walls of organs or blood vessels. Unlike those triggered by a
flower’s perfume, a beautiful painting, or a delicious meal, these
sensory signals are not consciously perceived most of the time,
although intense activation of interoceptors may produce con-
scious sensations. Two examples of perceived visceral sensations
are pain sensations from damaged viscera and angina pectoris
(chest pain) from inadequate blood flow to the heart. Input that
influences the ANS also includes some sensations monitored by
somatic sensory and special sensory neurons. For example, pain
can produce dramatic changes in some autonomic activities.
Autonomic motor neurons regulate visceral activities by either
increasing (exciting) or decreasing (inhibiting) ongoing activities
in their effector tissues (cardiac muscle, smooth muscle, and glands).
Changes in the diameter of the pupils, dilation and constriction of
blood vessels, and adjustment of the rate and force of the heart-
beat are examples of autonomic motor responses. Unlike skeletal
muscle, tissues innervated by the ANS often function to some
extent even if their nerve supply is damaged. For example, the
heart continues to beat when it is removed for transplantation into
another person, smooth muscle in the lining of the gastrointestinal
tract contracts rhythmically on its own, and glands produce some
secretions in the absence of ANS control.
Most autonomic responses cannot be consciously altered to
any great degree. You probably cannot voluntarily slow your
heartbeat to half its normal rate. For this reason, some autonomic
responses are the basis for polygraph (“lie detector”) tests. How-
ever, practitioners of yoga or other techniques of meditation may
learn how to regulate at least some of their autonomic activities
through long practice. Biofeedback, in which monitoring
devices display information about a body function such as heart
rate or blood pressure, enhances the ability to learn such con-
scious control. (For more on biofeedback, see the Medical
Terminology section at the end of this chapter.) Signals from the
general somatic and special senses, acting via the limbic system,
also influence responses of autonomic motor neurons. Seeing a
bike about to hit you, hearing squealing brakes of a nearby car, or
being grabbed by an attacker would all increase the rate and
force of your heartbeat.
Comparison of Somatic and Autonomic
Motor Neurons
Recall from Chapter 10 that the axon of a single, myelinated so-
matic motor neuron extends from the central nervous system (CNS)
all the way to the skeletal muscle fibers in its motor unit (Figure
15.1a). By contrast, most autonomic motor pathways consist of two
motor neurons in series, that is, one following the other (Figure
15.1b). The first neuron (preganglionic neuron) has its cell body in
the CNS; its myelinated axon extends from the CNS to an auto-
nomic ganglion. (Recall that a ganglion is a collection of neuronal
cell bodies in the PNS.) The cell body of the second neuron (post-
ganglionic neuron) is also in that same autonomic ganglion; its
unmyelinated axon extends directly from the ganglion to the effec-
tor (smooth muscle, cardiac muscle, or a gland). Alternatively, in
some autonomic pathways, the first motor neuron extends to spe-
cialized cells called chromaffin cells in the adrenal medullae
(inner portions of the adrenal glands) rather than an autonomic
ganglion. Chromaffin cells secrete the neurotransmitters epineph-
rine and norepinephrine (NE). All somatic motor neurons release
only acetylcholine (ACh) as their neurotransmitter, but autonomic
motor neurons release either ACh or norepinephrine (NE).
Unlike somatic output (motor), the output part of the ANS has
two divisions: the sympathetic division and the parasympa-
thetic division. Most organs have dual innervation; that is, they
receive impulses from both sympathetic and parasympathetic
neurons. In some organs, nerve impulses from one division of the
ANS stimulate the organ to increase its activity (excitation), and
impulses from the other division decrease the organ’s activity (in-
hibition). For example, an increased rate of nerve impulses from
the sympathetic division increases heart rate, and an increased rate
of nerve impulses from the parasympathetic division decreases
heart rate. The sympathetic division is often called the fight-or-flight
division. Sympathetic activities result in increased alertness and
 15.1 COMPARISON OF SOMATIC AND AUTONOMIC NERVOUS SYSTEMS 525
Figure 15.1 Motor neuron pathways in the (a) somatic nervous system and (b) autonomic nervous system (ANS).
Note that autonomic motor neurons release either acetylcholine (ACh) or norepinephrine (NE); somatic motor
neurons release only ACh.

Somatic nervous system stimulation always excites its effectors (skeletal muscle fibers); stimulation by the autonomic nervous
system either excites or inhibits visceral effectors.

Somatic ACh
motor neuron
(myelinated)

Spinal cord
Effector: skeletal muscle

(a) Somatic nervous system

Autonomic NE
motor neurons
ACh

Sympathetic Sympathetic
Spinal cord preganglionic postganglionic Effectors: glands, cardiac
neuron Autonomic neuron muscle (in heart), and
(myelinated) ganglion (unmyelinated) smooth muscle (e.g., in

15
urinary bladder)

C H A P T E R
Adrenal cortex
Adrenal medulla Chromaffin cell Epinephrine
ACh and NE

Spinal cord Sympathetic Blood vessel

preganglionic
Adrenal medulla
neuron
(myelinated)

ACh
ACh

Spinal cord
Parasympathetic Autonomic Parasympathetic
Effectors: glands, cardiac
preganglionic ganglion postganglionic
muscle (in heart), and
neuron neuron
smooth muscle (e.g., in
(myelinated) (unmyelinated)
urinary bladder)
(b) Autonomic nervous system

What does dual innervation mean?

metabolic activities in order to prepare the body for an emergency
situation. Responses to such situations, which may occur during
physical activity or emotional stress, include a rapid heart rate,
faster breathing rate, dilation of the pupils, dry mouth, sweaty but
cool skin, dilation of blood vessels to organs involved in combat-
ing stress (such as the heart and skeletal muscles), constriction of
blood vessels to organs not involved in combating stress (for ex-
ample, the gastrointestinal tract and kidneys), and release of glu-
cose from the liver.
The parasympathetic division is often referred to as the rest-
and-digest division because its activities conserve and restore
body energy during times of rest or digesting a meal; the majority
of its output is directed to the smooth muscle and glandular tissue
of the gastrointestinal and respiratory tracts. The parasympathetic
526 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM

division conserves energy and replenishes nutrient stores. Although
both the sympathetic and parasympathetic divisions are concerned
with maintaining homeostasis, they do so in dramatically different
ways.
Table 15.1 compares the somatic and autonomic nervous
systems.
CHECKPOINT
1. How do the autonomic nervous system and somatic
nervous system compare in structure and function?
2. What are the main input and output components of the
autonomic nervous system?
preganglionic neuron (Figure 15.1b). Its cell body is in the brain
or spinal cord; its axon exits the CNS as part of a cranial or spinal
nerve. The axon of a preganglionic neuron is a small-diameter,
myelinated type B fiber that usually extends to an autonomic gan-
glion, where it synapses with a postganglionic neuron, the second
neuron in the autonomic motor pathway. Note that the postgangli-
onic neuron lies entirely outside the CNS in the PNS. Its cell body
and dendrites are located in an autonomic ganglion, where it
forms synapses with one or more preganglionic axons. The axon
of a postganglionic neuron is a small-diameter, unmyelinated
type C fiber that terminates in a visceral effector. Thus, pregangli-
onic neurons convey nerve impulses from the CNS to autonomic
ganglia, and postganglionic neurons relay the impulses from auto-
nomic ganglia to visceral effectors.

15.2 Anatomy of Autonomic Preganglionic Neurons

Motor Pathways
OBJECTIVES
• Describe preganglionic and postganglionic neurons of the
autonomic nervous system.
• Compare the anatomical components of the sympathetic
and parasympathetic divisions of the autonomic nervous
system.
Anatomical Components
Each division of the ANS has two motor neurons. The first of the
two motor neurons in any autonomic motor pathway is called a
In the sympathetic division, the preganglionic neurons have their
cell bodies in the lateral horns of the gray matter in the 12 thoracic
segments and the first two (and sometimes three) lumbar segments
of the spinal cord (Figure 15.2). For this reason, the sympathetic
division is also called the thoracolumbar division (thōr⬘-a-kō-
LUM-bar), and the axons of the sympathetic preganglionic
neurons are known as the thoracolumbar outflow.
Cell bodies of preganglionic neurons of the parasympathetic
division are located in the nuclei of four cranial nerves in the
brain stem (III, VII, IX, and X) and in the lateral gray matter of
the second through fourth sacral segments of the spinal cord
(Figure 15.3). Hence, the parasympathetic division is also known

TABLE 15.1

Comparison of the Somatic and Autonomic Nervous Systems

SOMATIC NERVOUS SYSTEM AUTONOMIC NERVOUS SYSTEM
Sensory input From somatic senses and special senses. Mainly from interoceptors; some from somatic senses and special
senses.
Control of motor output Voluntary control from cerebral cortex, with Involuntary control from hypothalamus, limbic system, brain stem,
contributions from basal ganglia, cerebellum, and spinal cord; limited control from cerebral cortex.
brain stem, and spinal cord.
Motor neuron pathway One-neuron pathway: Somatic motor neurons Usually two-neuron pathway: Preganglionic neurons extending from
extending from CNS synapse directly with effector. CNS synapse with postganglionic neurons in autonomic ganglion,
and postganglionic neurons extending from ganglion synapse with
visceral effector. Alternatively, preganglionic neurons may extend
from CNS to synapse with chromaffin cells of adrenal medullae.
Neurotransmitters All somatic motor neurons release only acetylcholine All sympathetic and parasympathetic preganglionic neurons release
and hormones (ACh). ACh. Most sympathetic postganglionic neurons release NE; those to
most sweat glands release ACh. All parasympathetic postganglionic
neurons release ACh. Chromaffin cells of adrenal medullae release
epinephrine and norepinephrine (NE).
Effectors Skeletal muscle. Smooth muscle, cardiac muscle, and glands.
Responses Contraction of skeletal muscle. Contraction or relaxation of smooth muscle; increased or decreased
rate and force of contraction of cardiac muscle; increased or
decreased secretions of glands.
 15.2 ANATOMY OF AUTONOMIC MOTOR PATHWAYS 527
Figure 15.2 Structure of the sympathetic division of the autonomic nervous system. Solid lines represent preganglionic axons;;
dashed lines represent postganglionic axons. Although the innervated structures are shown for only one side of the
body for diagrammatic purposes, the sympathetic division actually innervates tissues and organs on both sides.

Cell bodies of sympathetic preganglionic neurons are located in the lateral horns of gray matter in the 12 thoracic and first
two lumbar segments of the spinal cord.

SYMPATHETIC DIVISION
(thoracolumbar) Key: Distributed primarily to smooth muscle
Preganglionic neurons of blood vessels of these organs:
Postganglionic neurons

Eye Pineal gland

Lacrimal gland
Mucous membrane
Brain Sublingual and of nose and palate
submandibular Parotid gland
glands

Heart
Atrial muscle fibers
Spinal SA/AV nodes
cord
C1 Superior Ventricular
cervical muscle fibers
C2 ganglion
C3 Trachea
Cardiac plexus
C4
Middle Bronchi
C5 cervical

15
C6 ganglion

Inferior Lungs
C7
cervical

C H A P T E R
C8 ganglion

T1 Pulmonary
Skin plexus Liver,
T2 gallbladder,
and bile ducts
T3
Greater
T4 splanchnic
nerve Stomach
T5
Celiac Spleen
T6 ganglion Transverse
Pancreas
colon
T7 Aorticorenal
Sweat gland
T8 ganglion
Hair follicle
smooth muscle T9 Small
Lesser
intestine Descending
Blood vessels T10 splanchnic
(each sympathetic nerve Ascending colon
trunk innervates T11 Least colon Sigmoid
the skin and splanchnic colon
viscera) T12 nerve
Superior Rectum
L1 mesenteric Adrenal gland
L2 ganglion
Kidney
L3
L4 Renal Ureter
L5 ganglion

S1
Sympathetic
Lumbar
trunk ganglia S2 splanchnic Inferior
(on both sides) mesenteric
S3 nerve
ganglion
S4
S5 Prevertebral
ganglia
Coccygeal (fused together)
Urinary bladder External genitals Uterus

Hypogastric
plexus

Which division, sympathetic or parasympathetic, has longer preganglionic axons? Why?

528 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM

Figure 15.3 Structure of the parasympathetic division of the autonomic nervous system. Solid lines represent preganglionic
axons; dashed lines represent postganglionic axons. Although the innervated structures are shown only for one side of
the body for diagrammatic purposes, the parasympathetic division actually innervates tissues and organs on both sides.

Cell bodies of parasympathetic preganglionic neurons are located in brain stem nuclei and in the lateral gray matter in the
second through fourth sacral segments of the spinal cord.

PARASYMPATHETIC DIVISION Key:

(craniosacral) Preganglionic neurons
Distributed primarily to smooth muscle
Postganglionic neurons
Oculomotor (III) and glands of these organs:
nerve Terminal ganglia

Eye
Lacrimal gland
Brain Mucous membrane
Facial (VII) Ciliary of nose and palate
nerve ganglion
Sublingual and Parotid gland
submandibular
glands

Pterygopalatine
ganglion Atrial
Spinal muscle fibers
Heart
cord
C1 SA/AV nodes
Submandibular
C2 ganglion
C3 Larynx
Glossopharyngeal (IX)
nerve Trachea
C4
Bronchi
C5
Vagus (X)
C6 nerve
Otic Lungs
C7 ganglion

C8

T1
Liver,
T2 gallbladder,
and bile ducts
T3
T4
T5 Stomach
T6 Transverse Pancreas
colon
T7
T8
Small Descending
T9 intestine colon
Ascending
T10 colon
T11 Sigmoid
T12 colon
Rectum
L1
L2
L3 Ureter
Pelvic
L4
splanchnic
L5 nerves
S1
S2
S3
S4
S5
Coccygeal Urinary bladder External genitals Uterus

Which ganglia are associated with the parasympathetic division? Sympathetic division?

as the craniosacral division (krā⬘-nē-ō-SĀK-ral), and the axons
of the parasympathetic preganglionic neurons are referred to as
the craniosacral outflow.
Autonomic Ganglia
There are two major groups of autonomic ganglia: (1) sympa-
thetic ganglia, which are components of the sympathetic division
of the ANS, and (2) parasympathetic ganglia, which are compo-
nents of the parasympathetic division of the ANS.
Sympathetic Ganglia The sympathetic ganglia are the sites
of synapses between sympathetic preganglionic and postgangli-
onic neurons. There are two major types of sympathetic ganglia:
sympathetic trunk ganglia and prevertebral ganglia. Sympathetic
trunk ganglia (also called vertebral chain ganglia or paraverte-
bral ganglia) lie in a vertical row on either side of the vertebral
column. These ganglia extend from the base of the skull to the
coccyx (Figure 15.2). Postganglionic axons from sympathetic
trunk ganglia primarily innervate organs above the diaphragm,
such as the head, neck, shoulders, and heart. Sympathetic trunk
ganglia in the neck have specific names. They are the superior,
middle, and inferior cervical ganglia. The remaining sympa-
thetic trunk ganglia do not have individual names. Because the
sympathetic trunk ganglia are near the spinal cord, most sym-
pathetic preganglionic axons are short and most sympathetic
postganglionic axons are long.
The second group of sympathetic ganglia, the prevertebral
(collateral) ganglia, lies anterior to the vertebral column and
close to the large abdominal arteries. In general, postganglionic
axons from prevertebral ganglia innervate organs below the dia-
phragm. There are five major prevertebral ganglia (Figure 15.2;
see also Figure 15.5): (1) The celiac ganglion (SĒ-lē-ak) is on
either side of the celiac trunk, an artery that is just inferior to the
diaphragm. (2) The superior mesenteric ganglion (MEZ-en-
ter⬘-ik) is near the beginning of the superior mesenteric artery in
the upper abdomen. (3) The inferior mesenteric ganglion is
near the beginning of the inferior mesenteric artery in the middle of
the abdomen. (4) The aorticorenal ganglion (ā-or⬘-ti-kō-RĒ-nal)
and (5) the renal ganglion are near the renal artery of each
kidney.
Parasympathetic Ganglia Preganglionic axons of the
parasympathetic division synapse with postganglionic neurons
in terminal (intramural) ganglia. Most of these ganglia are
located close to or actually within the wall of a visceral organ.
Terminal ganglia in the head have specific names. They are the
ciliary ganglion, pterygopalatine ganglion (ter⬘-i-gō-PAL-a-
tı̄ n), submandibular ganglion, and otic ganglion (Figure 15.3).
The remaining terminal ganglia do not have specific names.
Because terminal ganglia are located either close to or in the wall
of the visceral organ, parasympathetic preganglionic axons are
long, in contrast to parasympathetic postganglionic axons, which
are short.
15.2 ANATOMY OF AUTONOMIC MOTOR PATHWAYS 529
Postganglionic Neurons
Once axons of sympathetic preganglionic neurons pass to sympa-
thetic trunk ganglia, they may connect with postganglionic neu-
rons in one of the following ways (Figure 15.4):
1 An axon may synapse with postganglionic neurons in the
ganglion it first reaches.
2 An axon may ascend or descend to a higher or lower ganglion
before synapsing with postganglionic neurons. The axons of
incoming sympathetic preganglionic neurons that pass up or
down the sympathetic trunk collectively form the sympa-
thetic chains, the fibers on which the ganglia are strung.
3 An axon may continue, without synapsing, through the sym-
pathetic trunk ganglion to end at a prevertebral ganglion and
synapse with postganglionic neurons there.
4 An axon may also pass, without synapsing, through the sym-
pathetic trunk ganglion and a prevertebral ganglion and then
extend to chromaffin cells of the adrenal medullae that are
functionally similar to sympathetic postganglionic neurons.
A single sympathetic preganglionic fiber has many axon collater-
als (branches) and may synapse with 20 or more postganglionic
neurons. This pattern of projection is an example of divergence
and helps explain why many sympathetic responses affect almost
15
the entire body simultaneously. After exiting their ganglia, the
postganglionic axons typically terminate in several visceral effec-
C H A P T E R
tors (see Figure 15.2).
Axons of preganglionic neurons of the parasympathetic divi-
sion pass to terminal ganglia near or within a visceral effector
(see Figure 15.3). In the ganglion, the presynaptic neuron usu-
ally synapses with only four or five postsynaptic neurons, all of
which supply a single visceral effector, allowing parasympathetic
responses to be localized to a single effector.
Autonomic Plexuses
In the thorax, abdomen, and pelvis, axons of both sympathetic and
parasympathetic neurons form tangled networks called autonomic
plexuses, many of which lie along major arteries. The autonomic
plexuses also may contain sympathetic ganglia and axons of auto-
nomic sensory neurons. The major plexuses in the thorax are the
cardiac plexus, which supplies the heart, and the pulmonary
plexus, which supplies the bronchial tree (Figure 15.5).
The abdomen and pelvis also contain major autonomic plexuses
(Figure 15.5), and often the plexuses are named after the artery
along which they are distributed. The celiac (solar) plexus is the
largest autonomic plexus and surrounds the celiac trunk. It con-
tains two large celiac ganglia, two aorticorenal ganglia, and a
dense network of autonomic axons and is distributed to the stom-
ach, spleen, pancreas, liver, gallbladder, kidneys, adrenal medul-
lae, testes, and ovaries. The superior mesenteric plexus contains
the superior mesenteric ganglion and supplies the small and large
intestines. The inferior mesenteric plexus contains the inferior
mesenteric ganglion, which innervates the large intestine. Axons
of some sympathetic postganglionic neurons from the inferior
mesenteric ganglion also extend through the hypogastric plexus,
530 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM

Figure 15.4 Types of connections between ganglia and postganglionic neurons in the sympathetic division of the ANS. Also
illustrated are the gray and white rami communicantes.

Sympathetic ganglia lie in two chains on either side of the vertebral column (sympathetic trunk ganglia) and near large
abdominal arteries anterior to the vertebral column (prevertebral ganglia).

Cephalic
periarterial
nerve Posterior ramus
of spinal nerve
Anterior ramus
of spinal nerve

Carotid artery
Visceral effectors: eyes, lacrimal glands,
salivary glands, pineal gland, nasal
mucosa, and sweat glands, blood vessels,
and arrector pili muscles of skin of face

Sympathetic nerve

Visceral effector: heart

Skin
Posterior horn Posterior root
Posterior
root
ganglion 2
Above T1
Lateral Sympathetic
horn chain

Visceral effectors:
sweat glands, blood
Spinal vessels, and arrector
Anterior nerve pili muscles of skin
horn of neck, trunk, and
Spinal cord Anterior root 1 limbs
(thoracic or upper Sympathetic
lumbar segment) trunk ganglion
Splanchnic
nerve Gray ramus
communicans
3
2

White ramus
Prevertebral communicans
ganglion
4 (celiac ganglion)
Visceral effector: stomach

Adrenal cortex
Adrenal medulla Chromaffin cell Below L2

Adrenal gland
Key:
Sympathetic preganglionic neurons
Sympathetic postganglionic neurons Anterior view
What is the significance of the sympathetic trunk ganglia?
 15.2 ANATOMY OF AUTONOMIC MOTOR PATHWAYS 531
Figure 15.5 Autonomic plexuses in the thorax, abdomen, and pelvis.
An autonomic plexus is a network of sympathetic and parasympathetic axons that sometimes also includes autonomic sensory
axons and sympathetic ganglia.

Trachea

Right vagus (X) nerve

Left vagus (X) nerve

Arch of aorta

CARDIAC PLEXUS

PULMONARY PLEXUS
Right primary bronchus
Esophagus

Right sympathetic
trunk ganglion

Thoracic aorta
Greater splanchnic nerve

15
Lesser splanchnic nerve ESOPHAGEAL PLEXUS

C H A P T E R
Inferior vena cava (cut)

Celiac trunk Diaphragm

(artery)

AORTICORENAL
GANGLION
CELIAC GANGLION AND PLEXUS

Right kidney SUPERIOR MESENTERIC

GANGLION AND PLEXUS

Superior mesenteric artery RENAL GANGLION

AND RENAL PLEXUS

INFERIOR MESENTERIC
GANGLION AND PLEXUS

Inferior mesenteric artery

Right sympathetic
trunk ganglion
HYPOGASTRIC PLEXUS

Anterior view

Which is the largest autonomic plexus?

532 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM
which is anterior to the fifth lumbar vertebra, to supply the pelvic
viscera. The renal plexus contains the renal ganglion and sup-
plies the renal arteries within the kidneys and ureters.
With this background in mind, we can now examine some of
the specific structural features of the sympathetic and parasympa-
thetic divisions of the ANS in more detail.
Structure of the Sympathetic Division
Pathway from Spinal Cord to Sympathetic Trunk Ganglia
Cell bodies of sympathetic preganglionic neurons are part of the
lateral gray horns of all thoracic segments and of the first two
lumbar segments of the spinal cord (see Figure 15.2). The pregan-
glionic axons leave the spinal cord along with the somatic motor
neurons at the same segmental level. After exiting through the
intervertebral foramina, the myelinated preganglionic sympa-
thetic axons pass into the anterior root of a spinal nerve and enter
a short pathway called a white ramus (RĀ-mus) before passing
to the nearest sympathetic trunk ganglion on the same side (see
Figure 15.4). Collectively, the white rami are called the white
rami communicantes (kō-mū-ni-KAN-tēz; singular is ramus
communicans). Thus, white rami communicantes are structures
containing sympathetic preganglionic axons that connect the
anterior ramus of the spinal nerve with the ganglia of the sympa-
thetic trunk. The “white” in their name indicates that they contain
myelinated axons. Only the thoracic and first two or three lumbar
nerves have white rami communicantes.
Organization of Sympathetic Trunk Ganglia
The paired sympathetic trunk ganglia are arranged anterior and
lateral to the vertebral column, one on either side. Typically, there
are 3 cervical, 11 or 12 thoracic, 4 or 5 lumbar, 4 or 5 sacral sym-
pathetic trunk ganglia, and 1 coccygeal ganglion. The right and
left coccygeal ganglia are fused together and usually lie at the
midline. Although the sympathetic trunk ganglia extend inferiorly
from the neck, chest, and abdomen to the coccyx, they receive
preganglionic axons only from the thoracic and lumbar segments
of the spinal cord (see Figure 15.2).
The cervical portion of each sympathetic trunk is located in the
neck and is subdivided into superior, middle, and inferior ganglia
(see Figure 15.2). Postganglionic neurons leaving the superior
cervical ganglion serve the head and heart. They are distributed to
the sweat glands, smooth muscle of the eye, blood vessels of the
face, lacrimal glands, pineal gland, nasal mucosa, salivary glands
(which include the submandibular, sublingual, and parotid glands),
and heart. Postganglionic neurons leaving the middle cervical
ganglion and the inferior cervical ganglion innervate the heart
and blood vessels of the neck, shoulder, and upper limb.
The thoracic portion of each sympathetic trunk lies anterior to
the necks of the corresponding ribs. This region of the sympa-
thetic trunk receives most of the sympathetic preganglionic axons.
Postganglionic neurons from the thoracic sympathetic trunk in-
nervate the heart, lungs, bronchi, and other thoracic viscera. In the
skin, these neurons also innervate sweat glands, blood vessels,
and arrector pili muscles of hair follicles. The lumbar portion of
each sympathetic trunk lies lateral to the corresponding lumbar
vertebrae. The sacral region of the sympathetic trunk lies in the
pelvic cavity on the medial side of the anterior sacral foramina.
Pathways from Sympathetic Trunk Ganglia
to Visceral Effectors
Axons leave the sympathetic trunk in four possible ways:
(1) They can enter spinal nerves; (2) they can form cephalic
periarterial nerves; (3) they can form sympathetic nerves; and
(4) they can form splanchnic nerves.
Spinal Nerves Recall that some of the incoming sympathetic
preganglionic neurons synapse with postganglionic neurons in
the sympathetic trunk, either in the ganglion at the level of entry
or in a ganglion farther up or down the sympathetic trunk. The
axons of some of these postganglionic neurons leave the sympa-
thetic trunk by entering a short pathway called a gray ramus and
then merge with the anterior ramus of a spinal nerve. Therefore,
gray rami communicantes are structures containing sympathetic
postganglionic axons that connect the ganglia of the sympathetic
trunk to spinal nerves (see Figure 15.4). The “gray” in their name
indicates that they contain unmyelinated axons. Gray rami com-
municantes outnumber the white rami because there is a gray
ramus leading to each of the 31 pairs of spinal nerves. The axons
of the postganglionic neurons that leave the sympathetic trunk to
enter spinal nerves provide sympathetic innervation to the vis-
ceral effectors in the skin of the neck, trunk, and limbs, including
sweat glands, smooth muscle in blood vessels, and arrector pili
muscles of hair follicles.
Cephalic Periarterial Nerves Some sympathetic pre-
ganglionic neurons that enter the sympathetic trunk ascend to the
superior cervical ganglion, where they synapse with postgangli-
onic neurons. The axons of some of these postganglionic neurons
leave the sympathetic trunk by forming cephalic periarterial
nerves (per⬘-ē-ar-TĒ-rē-al), nerves that extend to the head by
wrapping around and following the course of various arteries
(such as the carotid arteries) that pass from the neck to the head
(see Figure 15.4). Cephalic periarterial nerves provide sympa-
thetic innervation to visceral effectors in the skin of the face
(sweat glands, smooth muscle of blood vessels, and arrector pili
muscles of hair follicles), as well as other visceral effectors of the
head (smooth muscle of the eye, lacrimal glands, pineal gland,
nasal mucosa, and salivary glands).
Sympathetic Nerves Some of the incoming sympathetic
preganglionic neurons synapse with postganglionic neurons in
one or more ganglia of the sympathetic trunk. Then, the axons of
the postganglionic neurons leave the trunk by forming sympa-
thetic nerves that extend to visceral effectors in the thoracic
cavity (Figure 15.4). Sympathetic nerves provide sympathetic
innervation to the heart and lungs.
• Sympathetic nerves to the heart. Sympathetic innervation of
the heart consists of axons of preganglionic neurons that enter the
sympathetic trunk and then form synapses with postganglionic

neurons in the superior, middle, and inferior cervical ganglia and
first through fourth thoracic ganglia (T1–T4). From these gan-
glia, axons of postganglionic neurons exit the sympathetic trunk
by forming sympathetic nerves that enter the cardiac plexus to
supply the heart (see Figure 15.2).
• Sympathetic nerves to the lungs. Sympathetic innervation
of the lungs consists of axons of preganglionic neurons that
enter the sympathetic trunk and then form synapses with
postganglionic neurons in the second through fourth thoracic
ganglia (T2–T4). From these ganglia, axons of sympathetic
postganglionic neurons exit the trunk by forming sympa-
thetic nerves that enter the pulmonary plexus to supply the
smooth muscle of the bronchi and bronchioles of the lungs
(see Figure 15.2).
Splanchnic Nerves Recall that some sympathetic pregan-
glionic axons pass through the sympathetic trunk without termi-
nating in it. Beyond the trunk, they form nerves known as
splanchnic nerves (SPLANGK-nik; see Figures 15.2 and 15.4),
which extend to outlying prevertebral ganglia.
• Splanchnic nerves to abdominopelvic organs. Most sympa-
thetic preganglionic axons that enter splanchnic nerves
are destined to synapse with sympathetic postganglionic neu-
rons in the prevertebral ganglia that supply the organs of the
abdominopelvic cavity. Preganglionic axons from the fifth
through ninth or tenth thoracic ganglia (T5–T9 or T10) form
the greater splanchnic nerve. It pierces the diaphragm and
enters the celiac ganglion of the celiac plexus. From there,
postganglionic neurons follow and innervate blood vessels to
the stomach, spleen, liver, kidneys, and small intestine. Pre-
ganglionic axons from the tenth and eleventh thoracic gan-
glia (T10–T11) form the lesser splanchnic nerve. It pierces
the diaphragm and passes through the celiac plexus to enter
the aorticorenal ganglion and superior mesenteric ganglion
of the superior mesenteric plexus. Postganglionic neurons
from the superior mesenteric ganglion follow and innervate
blood vessels of the small intestine and proximal colon. The
least (lowest) splanchnic nerve, which is not always present,
is formed by preganglionic axons from the twelfth thoracic
ganglia (T12) or a branch of the lesser splanchnic nerve. It
pierces the diaphragm and enters the renal plexus near the
kidney. Postganglionic neurons from the renal plexus supply
kidney arterioles and the ureters. Preganglionic axons that
form the lumbar splanchnic nerve from the first through
fourth lumbar ganglia (L1–L4) enter the inferior mesenteric
plexus and terminate in the inferior mesenteric ganglion,
where they synapse with postganglionic neurons. Axons of
postganglionic neurons extend through the inferior mesen-
teric plexus to supply the distal colon and rectum; they also
extend through the hypogastric plexus to supply blood ves-
sels of the distal colon, rectum, urinary bladder, and genital
organs. Postganglionic axons leaving the prevertebral ganglia
follow the course of various arteries to abdominal and pelvic
visceral effectors.
15.2 ANATOMY OF AUTONOMIC MOTOR PATHWAYS 533
• Splanchnic nerves to the adrenal medulla. Some sympathetic
preganglionic axons pass, without synapsing, through the sym-
pathetic trunk, greater splanchnic nerves, and celiac ganglion,
and then extend to chromaffin cells in the adrenal medullae of
the adrenal glands (see Figures 15.2 and 15.4). Developmen-
tally, the adrenal medullae and sympathetic ganglia are derived
from the same tissue, the neural crest (see Figure 14.27). The
adrenal medullae are modified sympathetic ganglia, and the
chromaffin cells are similar to sympathetic postganglionic neu-
rons except they lack dendrites and axons. Rather than extend-
ing to another organ, however, these cells release hormones into
the blood. On stimulation by sympathetic preganglionic neu-
rons, the chromaffin cells of the adrenal medullae release a
mixture of catecholamine hormones—about 80% epinephrine,
20% norepinephrine, and a trace amount of dopamine. These
hormones circulate throughout the body and intensify responses
elicited by sympathetic postganglionic neurons.
CLINICAL CONNECTION | Horner’s Syndrome
In Horner’s syndrome, the sympathetic innervation to one
side of the face is lost due to an inherited mutation, an injury,
or a disease that affects sympathetic outflow through the supe-
15
rior cervical ganglion. Symptoms occur on the affected side and include
ptosis (drooping of the upper eyelid), miosis (constricted pupil), and
anhidrosis (lack of sweating). •
C H A P T E R
Structure of the Parasympathetic Division
Cell bodies of parasympathetic preganglionic neurons are found
in nuclei in the brain stem and in the lateral gray matter of the
second through fourth sacral segments of the spinal cord (see Fig-
ure 15.3). Their axons emerge as part of a cranial nerve or as part
of the anterior root of a spinal nerve. The cranial parasympathetic
outflow consists of preganglionic axons that extend from the
brain stem in four cranial nerves. The sacral parasympathetic
outflow consists of preganglionic axons in anterior roots of the
second through fourth sacral spinal nerves. The preganglionic
axons of both the cranial and sacral outflows end in terminal gan-
glia, where they synapse with postganglionic neurons.
The cranial outflow has four pairs of ganglia and the ganglia
associated with the vagus (X) nerve. The four pairs of cranial
parasympathetic ganglia innervate structures in the head and are
located close to the organs they innervate (see Figure 15.3).
1. The ciliary ganglia lie lateral to each optic (II) nerve near the
posterior aspect of the orbit. Preganglionic axons pass with the
oculomotor (III) nerves to the ciliary ganglia. Postganglionic
axons from the ganglia innervate smooth muscle fibers in the
eyeball.
2. The pterygopalatine ganglia are located lateral to the spheno-
palatine foramen, between the sphenoid and palatine bones.
They receive preganglionic axons from the facial (VII) nerve
and send postganglionic axons to the nasal mucosa, palate,
pharynx, and lacrimal glands.
534 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM

3. The submandibular ganglia are found near the ducts of the and generates regulatory output signals to motor neurons through-
submandibular salivary glands. They receive preganglionic out plexuses within the wall of the digestive organs. The motor
axons from the facial nerves and send postganglionic axons to neurons carry the output signals to the smooth muscle and glands
the submandibular and sublingual salivary glands. of the gastrointestinal tract to exert control over its motility and
4. The otic ganglia are situated just inferior to each foramen secretory activities.
ovale. They receive preganglionic axons from the glosso- Most of the nerve fibers that innervate the digestive organs
pharyngeal (IX) nerves and send postganglionic axons to the arise from two plexuses within the enteric division. The largest,
parotid salivary glands. the myenteric plexus (mı̄-en-TER-ik), is positioned between the
outer longitudinal and circular muscle layers from the upper
Preganglionic axons that leave the brain as part of the vagus esophagus to the anus. The myenteric plexus communicates exten-
(X) nerves carry nearly 80% of the total craniosacral outflow. sively with a somewhat smaller plexus, the submucosal plexus,
Vagal axons extend to many terminal ganglia in the thorax and which occupies the gut wall between the circular muscle layer
abdomen. As the vagus nerve passes through the thorax, it sends and the muscularis mucosae (see Section 24.3) and runs from the
axons to the heart and the airways of the lungs. In the abdomen, it stomach to the anus. Neurons emerge from the ganglia of these
supplies the liver, gallbladder, stomach, pancreas, small intestine, two plexuses to form smaller plexuses around blood vessels and
and part of the large intestine. within the muscle layers and mucosa of the gut wall. It is this
The sacral parasympathetic outflow consists of preganglionic
axons from the anterior roots of the second through fourth sacral
spinal nerves (S2–S4). As the preganglionic axons course through Figure 15.6 Pelvic splanchnic nerves.
the sacral spinal nerves, they branch off these nerves to form pelvic
splanchnic nerves (Figure 15.6). Pelvic splanchnic nerves syn- Through pelvic splanchnic nerves, axons of
apse with parasympathetic postganglionic neurons located in ter- parasympathetic preganglionic neurons extend to
parasympathetic postganglionic neurons in terminal
minal ganglia in the walls of the innervated viscera. From the
ganglia in the walls of the colon, ureters, urinary
terminal ganglia, parasympathetic postganglionic axons innervate
bladder, and reproductive organs.
smooth muscle and glands in the walls of the colon, ureters, uri-
nary bladder, and reproductive organs. Posterior horn Posterior root
Posterior
root
Structure of the Enteric Division ganglion
Posterior ramus
To understand and appreciate the enteric division (en-TER-ik) of spinal nerve
of the autonomic nervous system, also called the enteric ner-
vous system (ENS), it is important to realize that the gastrointes-
tinal tract, like the surface of the body, forms an extensive area of
contact with the environment. Although this gastrointestinal en-
Sacral spinal
vironment is inside the body, it is still considered part of the exter- nerve
nal environment. Just as the surface of the body must respond to Spinal cord
Anterior Anterior root
important environmental stimuli in order to function properly, horn (sacral segment) Anterior ramus
the surface of the gastrointestinal tract must respond to surround- of spinal nerve
Pelvic
ing stimuli to generate proper homeostatic controls. In fact, these splanchnic
responses and controls are so important that the gastrointestinal nerve
tract has its own nervous system with intrinsic input, processing,
and output. The enteric division can and does function indepen-
dently of central nervous system activity, but it can also receive
controlling input from the central nervous system.
The enteric division is the specialized collection of nerves and
ganglia forming a complex, integrated neuronal network within
Urinary bladder
the wall of the gastrointestinal tract, pancreas, and gallbladder.
This incredible nerve network contains in the neighborhood of
100 million neurons, approximately the same number as the spi-
nal cord, and is capable of continued function without input from
the central nervous system. The enteric network of nerves and
ganglia contains sensory neurons capable of monitoring tension
in the intestinal wall and accessing the composition of the intesti- Key: Visceral effector

nal contents. These sensory neurons relay their input signals to Parasympathetic preganglionic neuron
Parasympathetic postganglionic neuron
interneurons within the enteric ganglia. The interneurons estab-
lish an integrative network that processes the incoming signals Pelvic splanchnic nerves branch from which spinal nerves?
 15.3 ANS NEUROTRANSMITTERS AND RECEPTORS 535
system of nerves that makes possible the normal motility and se- Figure 15.7 Cholinergic neurons and adrenergic
cretory functions of the gastrointestinal tract. neurons in the sympathetic and
CHECKPOINT
parasympathetic divisions.
3. Why is the sympathetic division called the thoracolumbar Cholinergic neurons release acetylcholine; adrenergic
division even though its ganglia extend from the cervical neurons release norepinephrine. Cholinergic receptors
region to the sacral region? (nicotinic or muscarinic) and adrenergic receptors are
4. List the organs served by each sympathetic and integral membrane proteins located in the plasma
parasympathetic ganglion. membrane of a postsynaptic neuron or an effector cell.
5. Describe the locations of sympathetic trunk ganglia,
prevertebral ganglia, and terminal ganglia. Which types NICOTINIC Effector cell
of autonomic neurons synapse in each type of ganglion? RECEPTOR ADRENERGIC
6. Why does the sympathetic division produce simultane- ACh RECEPTOR
ous effects throughout the body, in contrast to para-
sympathetic effects, which typically are localized to
specific organs?
NE
7. What are the functions of the enteric division of the ANS?
Preganglionic neuron Postganglionic neuron
Ganglion
(a) Sympathetic division–innervation to most effector tissues
15.3 ANS Neurotransmitters
and Receptors
OBJECTIVE
MUSCARINIC
• Describe the neurotransmitters and receptors involved in NICOTINIC RECEPTOR
autonomic responses. RECEPTOR

15
Based on the neurotransmitter they produce and release, auto-

C H A P T E R
nomic neurons are classified as either cholinergic or adrenergic.
The receptors for the neurotransmitters are integral membrane
proteins located in the plasma membrane of the postsynaptic ACh
neuron or effector cell. ACh Cell of sweat gland
(b) Sympathetic division–innervation to most sweat glands

Cholinergic Neurons and Receptors

Cholinergic neurons (koˉ⬘-lin-ER-jik) release the neurotransmit-
ter acetylcholine (ACh). In the ANS, the cholinergic neurons MUSCARINIC
include (1) all sympathetic and parasympathetic preganglionic NICOTINIC RECEPTOR
RECEPTOR Effector cell
neurons, (2) sympathetic postganglionic neurons that innervate
most sweat glands, and (3) all parasympathetic postganglionic
neurons (Figure 15.7).
ACh is stored in synaptic vesicles and released by exocytosis.
It then diffuses across the synaptic cleft and binds with specific
cholinergic receptors, integral membrane proteins in the post- ACh
ACh
synaptic plasma membrane. The two types of cholinergic recep-
tors, both of which bind ACh, are nicotinic receptors and musca- (c) Parasympathetic division
rinic receptors. Nicotinic receptors (nik⬘-oˉ-TIN-ik) are present in
Which ANS neurons are adrenergic? What types of
the plasma membrane of dendrites and cell bodies of both sympa-
effector tissues contain muscarinic receptors?
thetic and parasympathetic postganglionic neurons (Figure 15.7a, b),
the plasma membranes of chromaffin cells of the adrenal medul-
lae, and in the motor end plate at the neuromuscular junction. They
are so named because nicotine mimics the action of ACh by bind- receive their innervation from cholinergic sympathetic postgan-
ing to these receptors. (Nicotine, a natural substance in tobacco glionic neurons and possess muscarinic receptors (see Figure 15.7b).
leaves, is not a naturally occurring substance in humans and is not These receptors are so named because a mushroom poison called
normally present in nonsmokers.) Muscarinic receptors (mus⬘- muscarine mimics the actions of ACh by binding to them. Nicotine
ka-RIN-ik) are present in the plasma membranes of all effectors does not activate muscarinic receptors, and muscarine does not
(smooth muscle, cardiac muscle, and glands) innervated by para- activate nicotinic receptors, but ACh does activate both types of
sympathetic postganglionic axons. In addition, most sweat glands cholinergic receptors.
536 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM
Activation of nicotinic receptors by ACh causes depolariza-
tion and thus excitation of the postsynaptic cell, which can be
a postganglionic neuron, an autonomic effector, or a skeletal
muscle fiber. Activation of muscarinic receptors by ACh some-
times causes depolarization (excitation) and sometimes causes
hyperpolarization (inhibition), depending on which particular
cell bears the muscarinic receptors. For example, binding of
ACh to muscarinic receptors inhibits (relaxes) smooth muscle
sphincters in the gastrointestinal tract. By contrast, ACh excites
muscarinic receptors in smooth muscle fibers in the circular
muscles of the iris of the eye, causing them to contract. Because
acetylcholine is quickly inactivated by the enzyme acetylcho-
linesterase (AChE), effects triggered by cholinergic neurons
are brief.
Adrenergic Neurons and Receptors
In the ANS, adrenergic neurons (ad⬘-ren-ER-jik) release nor-
epinephrine (NE), also known as noradrenalin (Figure 15.7a).
Most sympathetic postganglionic neurons are adrenergic. Like
ACh, NE is stored in synaptic vesicles and released by exocytosis.
Molecules of NE diffuse across the synaptic cleft and bind to spe-
cific adrenergic receptors on the postsynaptic membrane, causing
either excitation or inhibition of the effector cell.
Adrenergic receptors bind both norepinephrine and epineph-
rine. The norepinephrine can either be released as a neurotrans-
mitter by sympathetic postganglionic neurons or released as a
hormone into the blood by chromaffin cells of the adrenal medul-
lae; epinephrine is released as a hormone. The two main types of
adrenergic receptors are alpha (␣) receptors and beta (␤) recep-
tors, which are found on visceral effectors innervated by most
sympathetic postganglionic axons. These receptors are further
classified into subtypes—␣1, ␣2, ␤1, ␤2, and ␤3—based on the
specific responses they elicit and by their selective binding of
drugs that activate or block them. Although there are some ex-
ceptions, activation of ␣1 and ␤1 receptors generally produces
excitation, and activation of ␣2 and ␤2 receptors causes inhibition
of effector tissues. ␤3 receptors are present only on cells of brown
adipose tissue, where their activation causes thermogenesis (heat
production). Cells of most effectors contain either alpha or beta
receptors; some visceral effector cells contain both. Norepineph-
rine stimulates alpha receptors more strongly than beta recep-
tors; epinephrine is a potent stimulator of both alpha and beta
receptors.
The activity of norepinephrine at a synapse is terminated either
when the NE is taken up by the axon that released it or when the NE
is enzymatically inactivated by either catechol-O-methyltransfer-
ase (COMT) (kat⬘-e-kōl-ō-meth-il-TRANS-fer-ās) or monoamine
oxidase (MAO) (mon-ō-AM-ēn OK-si-dās). Compared to ACh,
norepinephrine lingers in the synaptic cleft for a longer time. Thus,
effects triggered by adrenergic neurons typically are longer lasting
than those triggered by cholinergic neurons.
Table 15.2 describes the locations of cholinergic and adrener-
gic receptors and summarizes the responses that occur when each
type of receptor is activated.
Receptor Agonists and Antagonists
A large variety of drugs and natural products can selectively acti-
vate or block specific cholinergic or adrenergic receptors. An
agonist (agon ⫽ a contest) is a substance that binds to and activates
a receptor, in the process mimicking the effect of a natural neuro-
transmitter or hormone. Phenylephrine, an adrenergic agonist at
␣1 receptors, is a common ingredient in cold and sinus medica-
tions. Because it constricts blood vessels in the nasal mucosa,
phenylephrine reduces production of mucus, thus relieving nasal
congestion. An antagonist (anti ⫽ against) is a substance that
binds to and blocks a receptor, thereby preventing a natural neuro-
transmitter or hormone from exerting its effect. For example, at-
ropine blocks muscarinic ACh receptors, dilates the pupils, re-
duces glandular secretions, and relaxes smooth muscle in the
gastrointestinal tract. As a result, it is used to dilate the pupils dur-
ing eye examinations, in the treatment of smooth muscle disor-
ders such as iritis and intestinal hypermotility, and as an antidote
for chemical warfare agents that inactivate acetylcholinesterase.
Propranolol (Inderal®) often is prescribed for patients with
hypertension (high blood pressure). It is a nonselective beta blocker,
meaning it binds to all types of beta receptors and prevents their
activation by epinephrine and norepinephrine. The desired effects
of propranolol are due to its blockade of ␤1 receptors—namely,
decreased heart rate and force of contraction and a consequent
decrease in blood pressure. Undesired effects due to blockade
of ␤2 receptors may include hypoglycemia (low blood glucose),
resulting from decreased glycogen breakdown and decreased
gluconeogenesis (the conversion of a noncarbohydrate into
glucose in the liver), and mild bronchoconstriction (narrowing of
the airways). If these side effects pose a threat to the patient, a
selective ␤1 blocker (which binds only to specific beta receptors)
such as metoprolol (Lopressor®) can be prescribed instead of
propranolol.
CHECKPOINT
8. Why are cholinergic and adrenergic neurons so named?
9. What neurotransmitters and hormones bind to adrenergic
receptors?
10. What do the terms agonist and antagonist mean?
15.4 Physiology of the ANS
OBJECTIVE
• Describe the major responses of the body to stimulation
by the sympathetic and parasympathetic divisions of
the ANS.
Autonomic Tone
As noted earlier, most body organs receive innervation from both
divisions of the ANS, which typically work in opposition to one
another. The balance between sympathetic and parasympathetic
activity, called autonomic tone, is regulated by the hypothala-
mus. Typically, the hypothalamus turns up sympathetic tone at the
 15.4 PHYSIOLOGY OF THE ANS 537

TABLE 15.2

Location and Responses of Adrenergic and Cholinergic Receptors

TYPE OF RECEPTOR MAJOR LOCATIONS EFFECTS OF RECEPTOR ACTIVATION

CHOLINERGIC Integral proteins in postsynaptic plasma membranes; activated by the

neurotransmitter acetylcholine.
Nicotinic Plasma membrane of postganglionic sympathetic and parasympathetic Excitation → impulses in postganglionic neurons.
neurons.
Chromaffin cells of adrenal medullae. Epinephrine and norepinephrine secretion.
Sarcolemma of skeletal muscle fibers (motor end plate). Excitation → contraction.
Muscarinic Effectors innervated by parasympathetic postganglionic neurons. In some receptors, excitation; in others, inhibition.
Sweat glands innervated by cholinergic sympathetic postganglionic Increased sweating.
neurons.
Skeletal muscle blood vessels innervated by cholinergic sympathetic Inhibition → relaxation → vasodilation.
postganglionic neurons.
ADRENERGIC Integral proteins in postsynaptic plasma membranes; activated by the
neurotransmitter norepinephrine and the hormones norepinephrine
and epinephrine.
␣1 Smooth muscle fibers in blood vessels that serve salivary glands, skin, Excitation → contraction, which causes
mucosal membranes, kidneys, and abdominal viscera; radial muscle in vasoconstriction, dilation of pupil, and closing of
iris of eye; sphincter muscles of stomach and urinary bladder. sphincters.
Salivary gland cells. Secretion of K⫹ and water.
Sweat glands on palms and soles. Increased sweating.

15
␣2 Smooth muscle fibers in some blood vessels. Inhibition → relaxation → vasodilation.
Cells of pancreatic islets that secrete the hormone insulin (beta cells). Decreased insulin secretion.

C H A P T E R
Pancreatic acinar cells. Inhibition of digestive enzyme secretion.
Platelets in blood. Aggregation to form platelet plug.
␤1 Cardiac muscle fibers. Excitation → increased force and rate of contraction.
Juxtaglomerular cells of kidneys. Renin secretion.
Posterior pituitary. Antidiuretic hormone (ADH) secretion.
Adipose cells. Breakdown of triglycerides → release of fatty acids
into blood.
␤2 Smooth muscle in walls of airways; in blood vessels that serve heart, Inhibition → relaxation, which causes dilation of
skeletal muscle, adipose tissue, and liver; and in walls of visceral airways, vasodilation, and relaxation of organ walls.
organs, such as urinary bladder.
Ciliary muscle in eye. Inhibition → relaxation.
Hepatocytes in liver. Glycogenolysis (breakdown of glycogen into
glucose).
␤3 Brown adipose tissue. Thermogenesis (heat production).

same time it turns down parasympathetic tone, and vice versa.
The two divisions can affect body organs differently because their
postganglionic neurons release different neurotransmitters and
because the effector organs possess different adrenergic and
cholinergic receptors. A few structures receive only sympathetic
innervation—sweat glands, arrector pili muscles attached to hair
follicles in the skin, the kidneys, the spleen, most blood vessels,
and the adrenal medullae (see Figure 15.2). In these structures
there is no opposition from the parasympathetic division. Still, an
increase in sympathetic tone has one effect, and a decrease in
sympathetic tone produces the opposite effect.
Sympathetic Responses
During physical or emotional stress, the sympathetic division
dominates the parasympathetic division. High sympathetic tone
favors body functions that can support vigorous physical activity
and rapid production of ATP. At the same time, the sympathetic
division reduces body functions that favor the storage of energy.
Besides physical exertion, various emotions—such as fear, em-
barrassment, or rage—stimulate the sympathetic division. Visua-
lizing body changes that occur during “E situations” such as
exercise, emergency, excitement, and embarrassment will help you
538 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM

remember most of the sympathetic responses. Activation of the
sympathetic division and release of hormones by the adrenal
medullae set in motion a series of physiological responses col-
lectively called the fight-or-flight response, which includes the
following effects:
• The pupils of the eyes dilate.
• Heart rate, force of heart contraction, and blood pressure increase.
• The airways dilate, allowing faster movement of air into and
out of the lungs.
• The blood vessels that supply the kidneys and gastrointestinal
tract constrict, which decreases blood flow through these tis-
sues. The result is a slowing of urine formation and digestive
activities, which are not essential during exercise.
• Blood vessels that supply organs involved in exercise or fight-
ing off danger—skeletal muscles, cardiac muscle, liver, and
adipose tissue—dilate, allowing greater blood flow through
these tissues.
• Liver cells perform glycogenolysis (breakdown of glycogen to
glucose), and adipose tissue cells perform lipolysis (break-
down of triglycerides to fatty acids and glycerol).
• Release of glucose by the liver increases blood glucose level.
• Processes that are not essential for meeting the stressful situation
are inhibited. For example, muscular movements of the gastroin-
testinal tract and digestive secretions slow down or even stop.
The effects of sympathetic stimulation are longer lasting and
more widespread than the effects of parasympathetic stimulation
for three reasons: (1) Sympathetic postganglionic axons diverge
more extensively; as a result, many tissues are activated simulta-
neously. (2) Acetylcholinesterase quickly inactivates acetyl-
choline, but norepinephrine lingers in the synaptic cleft for a lon-
ger period. (3) Epinephrine and norepinephrine secreted into the
blood from the adrenal medullae intensify and prolong the re-
sponses caused by NE liberated from sympathetic postganglionic
axons. These blood-borne hormones circulate throughout the
body, affecting all tissues that have alpha and beta receptors. In
time, blood-borne NE and epinephrine are destroyed by enzymes
in the liver.
Parasympathetic Responses
In contrast to the fight-or-flight activities of the sympathetic division,
the parasympathetic division enhances rest-and-digest activities.
Parasympathetic responses support body functions that conserve
and restore body energy during times of rest and recovery. In
the quiet intervals between periods of exercise, parasympathetic
impulses to the digestive glands and the smooth muscle of the
gastrointestinal tract predominate over sympathetic impulses.
This allows energy-supplying food to be digested and absorbed.
At the same time, parasympathetic responses reduce body func-
tions that support physical activity.

TABLE 15.3

Comparison of Sympathetic and Parasympathetic Divisions of the ANS

SYMPATHETIC (THORACOLUMBAR) PARASYMPATHETIC (CRANIOSACRAL)

Distribution
Location of preganglionic
neuron cell bodies and
site of outflow
Associated ganglia
Ganglia locations
Axon length and
divergence
White and gray rami
communicantes
Neurotransmitters
Physiological effects
Wide regions of body: skin, sweat glands, arrector
pili muscles of hair follicles, adipose tissue, smooth
muscle of blood vessels.
Lateral gray horns of spinal cord segments T1–L2.
Axons of preganglionic neurons constitute
thoracolumbar outflow.
Sympathetic trunk ganglia and prevertebral ganglia.
Close to CNS and distant from visceral effectors.
Preganglionic neurons with short axons synapse with
many postganglionic neurons with long axons that
pass to many visceral effectors.
Both present; white rami communicantes contain
myelinated preganglionic axons; gray rami
communicantes contain unmyelinated postganglionic
axons.
Preganglionic neurons release acetylcholine (ACh),
which is excitatory and stimulates postganglionic
neurons; most postganglionic neurons release
norepinephrine (NE); postganglionic neurons that
innervate most sweat glands and some blood vessels in
skeletal muscle release ACh.
Fight-or-flight responses.
Limited mainly to head and to viscera of thorax, abdomen, and
pelvis; some blood vessels.
Nuclei of cranial nerves III, VII, IX, and X and lateral gray matter
of spinal cord segments S2–S4. Axons of preganglionic neurons
constitute craniosacral outflow.
Terminal ganglia.
Typically near or within wall of visceral effectors.
Preganglionic neurons with long axons usually synapse with four
to five postganglionic neurons with short axons that pass to single
visceral effector.
Neither present.
Preganglionic neurons release ACh, which is excitatory and
stimulates postganglionic neurons; postganglionic neurons
release ACh.
Rest-and-digest activities.

The acronym SLUDD can be helpful in remembering five
parasympathetic responses. It stands for salivation (S), lacrima-
tion (L), urination (U), digestion (D), and defecation (D). All of
these activities are stimulated mainly by the parasympathetic di-
vision. In addition to the increasing SLUDD responses, other im-
portant parasympathetic responses are “three decreases”: decreased
heart rate, decreased diameter of airways (bronchoconstriction),
and decreased diameter (constriction) of the pupils.
Table 15.3 compares the structural and functional features
of the sympathetic and parasympathetic divisions of the ANS.
Table 15.4 lists the responses of glands, cardiac muscle, and
smooth muscle to stimulation by the sympathetic and parasympa-
thetic divisions of the ANS.
15.4 PHYSIOLOGY OF THE ANS 539
CHECKPOINT
11. Define autonomic tone.
12. What are some examples of the antagonistic effects of
the sympathetic and parasympathetic divisions of the
autonomic nervous system?
13. What happens during the fight-or-flight response?
14. Why is the parasympathetic division of the ANS called
an energy conservation/restoration system?
15. Describe the sympathetic response in a frightening
situation for each of the following body parts: hair
follicles, iris of eye, lungs, spleen, adrenal medullae,
urinary bladder, stomach, intestines, gallbladder, liver,
heart, arterioles of the abdominal viscera, and arterioles
of skeletal muscles.

TABLE 15.4

Effects of Sympathetic and Parasympathetic Divisions of the ANS

EFFECT OF SYMPATHETIC STIMULATION (␣ OR ␤ EFFECT OF PARASYMPATHETIC STIMULATION
VISCERAL EFFECTOR ADRENERGIC RECEPTORS, EXCEPT AS NOTED)* (MUSCARINIC ACh RECEPTORS)

GLANDS

15
Adrenal medullae Secretion of epinephrine and norepinephrine No innervation.
(nicotinic ACh receptors).

C H A P T E R
Lacrimal (tear) Slight secretion of tears (␣). Secretion of tears.
Pancreas Inhibits secretion of digestive enzymes and the Secretion of digestive enzymes and the
hormone insulin (␣2); promotes secretion of the hormone insulin.
hormone glucagon (␤2).
Posterior pituitary Secretion of antidiuretic hormone (ADH) (␤1). No innervation.
Pineal Increases synthesis and release of melatonin (␤). No innervation.
Sweat Increases sweating in most body regions (muscarinic No innervation.
ACh receptors); sweating on palms and soles (␣1).
Adipose tissue† Lipolysis (breakdown of triglycerides into fatty No innervation.
acids and glycerol) (␤1); release of fatty acids into
blood (␤1 and ␤3).
Liver† Glycogenolysis (conversion of glycogen into glucose); Glycogen synthesis; increased bile secretion.
gluconeogenesis (conversion of noncarbohydrates into
glucose); decreased bile secretion (␣ and ␤2).
Kidney, juxtaglomerular cells† Secretion of renin (␤1). No innervation.

CARDIAC (HEART) MUSCLE

Increased heart rate and force of atrial and Decreased heart rate; decreased force of atrial
ventricular contractions (␤1). contraction.

SMOOTH MUSCLE
Iris, radial muscle
Iris, circular muscle
Ciliary muscle of eye
Lungs, bronchial muscle
Gallbladder and ducts
Contraction → dilation of pupil (␣1).
No innervation.
Relaxation to adjust shape of lens for
distant vision (␤2).
Relaxation → airway dilation (␤2).
Relaxation to facilitate storage of bile in
the gallbladder (␤2).
No innervation.
Contraction → constriction of pupil.
Contraction for close vision.
Contraction → airway constriction.
Contraction → release of bile into small intestine.

TA B L E 15. 4 CONTINUES
540 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM

TABLE 15.4 CONTINUED

Effects of Sympathetic and Parasympathetic Divisions of the ANS

EFFECT OF SYMPATHETIC STIMULATION (␣ OR ␤ EFFECT OF PARASYMPATHETIC STIMULATION
VISCERAL EFFECTOR ADRENERGIC RECEPTORS, EXCEPT AS NOTED)* (MUSCARINIC ACh RECEPTORS)

Stomach and intestines Decreased motility and tone (␣1, ␣2, ␤2); Increased motility and tone; relaxation of sphincters.
contraction of sphincters (␣1).
Spleen Contraction and discharge of stored blood No innervation.
into general circulation (␣1).
Ureter Increases motility (␣1). Increases motility (?).
Urinary bladder Relaxation of muscular wall (␤2); contraction Contraction of muscular wall; relaxation of internal
of internal urethral sphincter (␣1). urethral sphincter.
Uterus Inhibits contraction in nonpregnant women (␤2); Minimal effect.
promotes contraction in pregnant women (␣1).
Sex organs In males: contraction of smooth muscle of ductus (vas) Vasodilation; erection of clitoris (females) and
deferens, prostate, and seminal vesicle resulting penis (males).
in ejaculation (␣1).
Hair follicles, arrector pili Contraction → erection of hairs resulting in No innervation.
muscle goose bumps (␣1).

VASCULAR SMOOTH MUSCLE

Salivary gland arterioles
Gastric gland arterioles
Intestinal gland arterioles
Coronary (heart) arterioles
Skin and mucosal arterioles
Skeletal muscle arterioles
Abdominal viscera arterioles
Brain arterioles
Kidney arterioles
Systemic veins
Vasoconstriction, which decreases secretion of saliva (␣1). Vasodilation, which increases secretion of saliva.
Vasoconstriction, which inhibits secretion (␣1). Secretion of gastric juice.
Vasoconstriction, which inhibits secretion (␣1). Secretion of intestinal juice.
Relaxation → vasodilation (␤2); Contraction → vasoconstriction.
contraction → vasoconstriction (␣1, ␣2);
contraction → vasoconstriction (muscarinic
ACh receptors).
Contraction → vasoconstriction (␣1). Vasodilation, which may not be physiologically
significant.
Contraction → vasoconstriction (␣1); No innervation.
relaxation → vasodilation (␤2);
relaxation → vasodilation (muscarinic
ACh receptors).
Contraction → vasoconstriction (␣1, ␤2). No innervation.
Slight contraction → vasoconstriction (␣1). No innervation.
Constriction of blood vessels → decreased No innervation.
urine volume (␣1).
Contraction → constriction (␣1); No innervation.
relaxation → dilation (␤2).

*Subcategories of ␣ and ␤ receptors are listed if known. †

Grouped with glands because they release substances into the blood.

15.5 Integration and Control of in regulating controlled conditions in the body, such as blood pres-
sure, by adjusting heart rate, force of ventricular contraction, and
Autonomic Functions blood vessel diameter; digestion, by adjusting the motility (move-
OBJECTIVES
ment) and muscle tone of the gastrointestinal tract; and defecation
• Describe the components of an autonomic reflex. and urination, by regulating the opening and closing of sphincters.
• Explain the relationship of the hypothalamus to the ANS. The components of an autonomic reflex arc are as follows:
• Receptor. Like the receptor in a somatic reflex arc (see Fig-
ure 13.14), the receptor in an autonomic reflex arc is the distal end
Autonomic Reflexes of a sensory neuron, which responds to a stimulus and produces a
Autonomic reflexes are responses that occur when nerve impulses change that will ultimately trigger nerve impulses. Autonomic
pass through an autonomic reflex arc. These reflexes play a key role sensory receptors are mostly associated with interoceptors.

• Sensory neuron. Conducts nerve impulses from receptors to
the CNS.
• Integrating center. Interneurons within the CNS relay signals
from sensory neurons to motor neurons. The main integrating
centers for most autonomic reflexes are located in the hypo-
thalamus and brain stem. Some autonomic reflexes, such as
those for urination and defecation, have integrating centers in
the spinal cord.
• Motor neurons. Nerve impulses triggered by the integrating
center propagate out of the CNS along motor neurons to an effec-
tor. In an autonomic reflex arc, two motor neurons connect the
CNS to an effector: The preganglionic neuron conducts motor
impulses from the CNS to an autonomic ganglion, and the
postganglionic neuron conducts motor impulses from an auto-
nomic ganglion to an effector (see Figure 15.1).
• Effector. In an autonomic reflex arc, the effectors are smooth
muscle, cardiac muscle, and glands, and the reflex is called an
autonomic reflex.
Autonomic Control by Higher Centers
Normally, we are not aware of muscular contractions of our
digestive organs, our heartbeat, changes in the diameter of our
blood vessels, and pupil dilation and constriction because the
integrating centers for these autonomic responses are in the spinal
cord or the lower regions of the brain. Somatic or autonomic
sensory neurons deliver input to these centers, and autonomic
motor neurons provide output that adjusts activity in the vis-
ceral effector, usually without our conscious perception.
The hypothalamus is the major control and integration center
of the ANS. The hypothalamus receives sensory input related to
visceral functions, olfaction (smell), and gustation (taste), as well
as changes in temperature, osmolarity, and levels of various sub-
D I S O R D E R S : H O M E O S TAT I C I M B A L A N C E S
Autonomic Dysreflexia
Autonomic dysreflexia (dis⬘-rē-FLEKS-sē-a) is an exaggerated re-
sponse of the sympathetic division of the ANS that occurs in about
85% of individuals with spinal cord injury at or above the level of T6.
The condition is seen after recovery from spinal shock (see Disorders:
Homeostatic Imbalances in Chapter 13) and occurs due to interrup-
tion of the control of ANS neurons by higher centers. When certain
sensory impulses, such as those resulting from stretching of a full
urinary bladder, are unable to ascend the spinal cord, mass stimula-
tion of the sympathetic nerves inferior to the level of injury occurs.
Other triggers include stimulation of pain receptors and the visceral
contractions resulting from sexual stimulation, labor/delivery, and
bowel stimulation. Among the effects of increased sympathetic activ-
ity is severe vasoconstriction, which elevates blood pressure. In response,
the cardiovascular center in the medulla oblongata (1) increases
parasympathetic output via the vagus (X) nerve, which decreases
heart rate, and (2) decreases sympathetic output, which causes dila-
tion of blood vessels superior to the level of the injury.
DISORDERS: HOMEOSTATIC IMBALANCES 541
stances in blood. It also receives input relating to emotions from
the limbic system. Output from the hypothalamus influences au-
tonomic centers in both the brain stem (such as the cardiovascu-
lar, salivation, swallowing, and vomiting centers) and the spinal
cord (such as the defecation and urination reflex centers in the
sacral spinal cord).
Anatomically, the hypothalamus is connected to both the sym-
pathetic and parasympathetic divisions of the ANS by axons of
neurons with dendrites and cell bodies in various hypothalamic
nuclei. The axons form tracts from the hypothalamus to parasym-
pathetic and sympathetic nuclei in the brain stem and spinal cord
through relays in the reticular formation. The posterior and lateral
parts of the hypothalamus control the sympathetic division. Stimu-
lation of these areas produces an increase in heart rate and force of
contraction, a rise in blood pressure due to constriction of blood
vessels, an increase in body temperature, dilation of the pupils,
and inhibition of the gastrointestinal tract. In contrast, the anterior
and medial parts of the hypothalamus control the parasympathetic
division. Stimulation of these areas results in a decrease in heart
rate, lowering of blood pressure, constriction of the pupils, and
increased secretion and motility of the gastrointestinal tract.
CHECKPOINT
16. Give three examples of controlled conditions in the
body that are kept in homeostatic balance by
15
autonomic reflexes.
17. How does an autonomic reflex arc differ from a somatic
C H A P T E R
reflex arc?
• • •
Now that we have discussed the structure and function of the
nervous system, you can appreciate the many ways that this sys-
tem contributes to homeostasis of other body systems by examin-
ing Focus on Homeostasis: Contributions of the Nervous System.
The condition is characterized by a pounding headache; hyperten-
sion; flushed, warm skin with profuse sweating above the injury
level; pale, cold, dry skin below the injury level; and anxiety. This
emergency condition requires immediate intervention. The first ap-
proach is to quickly identify and remove the problematic stimulus. If
this does not relieve the symptoms, an antihypertensive drug such as
clonidine or nitroglycerin can be administered. Untreated autonomic
dysreflexia can cause seizures, stroke, or heart attack.
Raynaud Phenomenon
In Raynaud phenomenon (rā-NŌ) the digits (fingers and toes) be-
come ischemic (lack blood) after exposure to cold or with emotional
stress. The condition is due to excessive sympathetic stimulation of
smooth muscle in the arterioles of the digits and a heightened response
to stimuli that cause vasoconstriction. When arterioles in the digits vaso-
constrict in response to sympathetic stimulation, blood flow is greatly
diminished. As a result, the digits may blanch (look white due to block-
age of blood flow) or become cyanotic (look blue due to deoxygenated
 FOCUS on HOMEOSTASIS
LYMPHATIC SYSTEM
and IMMUNITY
INTEGUMENTARY
SYSTEM Certain neurotransmitters help regulate
immune responses
Sympathetic nerves of the autonomic Activity in nervous system may increase
nervous system (ANS) control or decrease immune responses
contraction of smooth muscles attached
to hair follicles and secretion of
perspiration from sweat glands

RESPIRATORY
SYSTEM

SKELETAL Respiratory areas in brain stem control

SYSTEM breathing rate and depth
ANS helps regulate diameter of airways
Pain receptors in bone tissue warn of
bone trauma or damage

DIGESTIVE
SYSTEM
MUSCULAR
SYSTEM Enteric division of the ANS helps
regulate digestion
Somatic motor neurons receive instruc- Parasympathetic division of ANS
tions from motor areas of the brain
and stimulate contraction of skeletal CONTRIBUTIONS OF stimulates many digestive processes
muscles to bring about body movements
Basal nuclei and reticular formation set THE NERVOUS SYSTEM
level of muscle tone
Cerebellum coordinates skilled move- FOR ALL BODY SYSTEMS URINARY
ments SYSTEM
Together with hormones from the
endocrine system, nerve impulses ANS helps regulate blood flow to
provide communication and regulation kidneys, thereby influencing the rate of
of most body tissues urine formation
ENDOCRINE Brain and spinal cord centers govern
SYSTEM emptying of the urinary bladder

Hypothalamus regulates secretion of

hormones from anterior and posterior
pituitary
ANS regulates secretion of hormones
from adrenal medulla and pancreas REPRODUCTIVE
SYSTEMS
Hypothalamus and limbic system
govern a variety of sexual behaviors
CARDIOVASCULAR ANS brings about erection of penis in
SYSTEM males and clitoris in females and
ejaculation of semen in males
Cardiovascular center in the medulla Hypothalamus regulates release of
oblongata provides nerve impulses to anterior pituitary hormones that
ANS that govern heart rate and the control gonads (ovaries and testes)
forcefulness of the heartbeat Nerve impulses elicited by touch stimuli
Nerve impulses from ANS also regulate from suckling infant cause release of
blood pressure and blood flow oxytocin and milk ejection in nursing
through blood vessels mothers

542
 CHAPTER REVIEW AND RESOURCE SUMMARY 543

blood in capillaries). In extreme cases, the digits may become necrotic
from lack of oxygen and nutrients. With rewarming after cold expo-
sure, the arterioles may dilate, causing the fingers and toes to look red.
Many patients with Raynaud phenomenon have low blood pressure.
Some have increased numbers of alpha adrenergic receptors. Raynaud
is most common in young women and occurs more often in cold
climates. Patients with Raynaud phenomenon should avoid exposure to
cold, wear warm clothing, and keep the hands and feet warm. Drugs
used to treat Raynaud include nifedipine, a calcium channel blocker
that relaxes vascular smooth muscle, and prazosin, which relaxes
smooth muscle by blocking alpha receptors. Smoking and the use of
alcohol or illicit drugs can exacerbate the symptoms of this condition.

MEDICAL TERMINOLOGY

Autonomic nerve neuropathy (noo-ROP-a-thē) A neuropathy (disor-
der of a cranial or spinal nerve) that affects one or more auto-
nomic nerves, with multiple effects on the autonomic nervous
system, including constipation, urinary incontinence, impotence,
and fainting and low blood pressure when standing (orthostatic
hypotension) due to decreased sympathetic control of the cardio-
vascular system. Often caused by long-term diabetes mellitus (dia-
betic neuropathy).
Biofeedback A technique in which an individual is provided with in-
formation regarding an autonomic response such as heart rate,
blood pressure, or skin temperature. Various electronic monitor-
ing devices provide visual or auditory signals about the autonomic
responses. By concentrating on positive thoughts, individuals
learn to alter autonomic responses. For example, biofeedback has
visceral organ (such as the urinary bladder or colon) below the
level of the injury results in intense activation of autonomic and
somatic output from the spinal cord as reflex activity returns. The
exaggerated response occurs because there is no inhibitory input
from the brain. The mass reflex consists of flexor spasms of the
lower limbs, evacuation of the urinary bladder and colon, and
profuse sweating below the level of the lesion.
Megacolon (mega- ⫽ big) An abnormally large colon. In congenital
megacolon, parasympathetic nerves to the distal segment of the
colon do not develop properly. Loss of motor function in the seg-
ment causes massive dilation of the normal proximal colon. The
condition results in extreme constipation, abdominal distension,
and occasionally, vomiting. Surgical removal of the affected seg-
ment of the colon corrects the disorder.

15
been used to decrease heart rate and blood pressure and increase Reflex sympathetic dystrophy (RSD) A syndrome that includes spon-
skin temperature in order to decrease the severity of migraine taneous pain, painful hypersensitivity to stimuli such as light
headaches. touch, and excessive coldness and sweating in the involved body

Dysautonomia (dis-aw-tō-NŌ-mē-a; dys- ⫽ difficult; -autonomia ⫽
self-governing) An inherited disorder in which the autonomic
nervous system functions abnormally, resulting in reduced tear
gland secretions, poor vasomotor control, motor incoordination,
skin blotching, absence of pain sensation, difficulty in swallowing,
hyporeflexia, excessive vomiting, and emotional instability.
Hyperhidrosis (hı̄⬘-per-hı̄-DRŌ-sis; hyper- ⫽ above or too much;
-hidrosis ⫽ sweat) Excessive or profuse sweating due to intense
stimulation of sweat glands.
Mass reflex In cases of severe spinal cord injury above the level of the
sixth thoracic vertebra, stimulation of the skin or overfilling of a
C H A P T E R
part. The disorder frequently involves the forearms, hands, knees,
and feet. It appears that activation of the sympathetic division of
the autonomic nervous system due to traumatized nociceptors as
a result of trauma or surgery on bones or joints is involved.
Treatment consists of anesthetics and physical therapy. Recent
clinical studies also suggest that the drug baclofen can be used to
reduce pain and restore normal function to the affected body
part. Also called complex regional pain syndrome type 1.
Vagotomy (vā-GOT-ō-mē; -tome ⫽ incision) Cutting the vagus (X)
nerve. It is frequently done to decrease the production of hydro-
chloric acid in persons with ulcers.

C H A P T E R R E V I E W A N D R E S O U R C E S U M M A RY

Review Resource
15.1 Comparison of Somatic and Autonomic Nervous Systems Anatomy Overview - The Nervous
System: Overview
1. The somatic nervous system operates under conscious control; the ANS usually operates without con-
Anatomy Overview - Organization of
scious control. the ANS
2. Sensory input for the somatic nervous system is mainly from the somatic senses and special senses; Animation - Somatic Sensory and Motor
sensory input for the ANS is from interoceptors, in addition to somatic senses and special senses. Pathways
3. The axons of somatic motor neurons extend from the CNS and synapse directly with an effector. Figure 15.1 - Motor Neuron
Autonomic motor pathways consist of two motor neurons in series. The axon of the first motor neuron Pathways in the Somatic and
extends from the CNS and synapses in an autonomic ganglion with the second motor neuron; the second Autonomic Nervous Systems
Exercise - Assemble the
neuron synapses with an effector. Structure of the ANS
4. The output (motor) portion of the ANS has two major divisions: sympathetic and parasympathetic. Most Exercise - Sort ANS Functions
body organs receive dual innervation; usually one ANS division causes excitation and the other causes Exercise - What Is Your ANS Status?
inhibition. The enteric division consists of nerves and ganglia within the wall of the GI tract.
544 CHAPTER 15 • THE AUTONOMIC NERVOUS SYSTEM

Review Resource
5. Somatic nervous system effectors are skeletal muscles; ANS effectors include cardiac muscle, smooth
muscle, and glands.
6. Table 15.1 compares the somatic and autonomic nervous systems.

15.2 Anatomy of Autonomic Motor Pathways Animation - ANS: Motor Pathways

Anatomy Overview - Visceral Receptors
1. A preganglionic neuron is the first of the two motor neurons in any autonomic motor pathway; the axon
Anatomy Overview - Visceral Effectors
of the preganglionic neuron extends to an autonomic ganglion, where it synapses with a postganglionic Figure 15.2 - Structure of the
neuron, the second neuron in the autonomic motor pathway. Preganglionic neurons are myelinated; Sympathetic Division of the
postganglionic neurons are unmyelinated. Autonomic Nervous System
2. The cell bodies of sympathetic preganglionic neurons are in the lateral gray horns of the 12 thoracic Figure 15.3 - Structure of the
and the first two or three lumbar segments of the spinal cord; the cell bodies of parasympathetic pregan- Parasympathetic Division of
glionic neurons are in four cranial nerve nuclei (III, VII, IX, and X) in the brain stem and lateral gray the Autonomic Nervous Systemem
matter of the second through fourth sacral segments of the spinal cord.
3. There are two major groups of autonomic ganglia: sympathetic ganglia and parasympathetic ganglia.
Sympathetic ganglia include sympathetic trunk ganglia (on both sides of vertebral column) and prever-
tebral ganglia (anterior to vertebral column). Parasympathetic ganglia are known as terminal ganglia
(near or inside visceral effectors).
4. Sympathetic preganglionic neurons synapse with postganglionic neurons in ganglia of the sympathetic
trunk or in prevertebral ganglia; parasympathetic preganglionic neurons synapse with postganglionic
neurons in terminal ganglia.

15.3 ANS Neurotransmitters and Receptors Anatomy Overview - Neurotransmitters

Animation - The ANS: Types of
1. Cholinergic neurons release acetylcholine. In the ANS, cholinergic neurons include all sympathetic and Neurotransmitters and Neurons
ons
parasympathetic preganglionic neurons, sympathetic postganglionic neurons that innervate most sweat Figure 15.7 - Cholinergic
glands, and all parasympathetic postganglionic neurons. and Adrenergic Neurons
2. Acetylcholine binds to cholinergic receptors. The two types of cholinergic receptors, both of which bind in the Sympathetic and
acetylcholine, are nicotinic receptors and muscarinic receptors. Nicotinic receptors are present in the Parasympathetic
plasma membranes of dendrites and cell bodies of both sympathetic and parasympathetic postganglionic Divisions
neurons, in the plasma membranes of chromaffin cells of the adrenal medullae, and in the motor end
plate at the neuromuscular junction. Muscarinic receptors are present in the plasma membranes of all
effectors innervated by parasympathetic postganglionic neurons and in most sweat glands innervated by
cholinergic sympathetic postganglionic neurons.
3. In the ANS, adrenergic neurons release norepinephrine. Most sympathetic postganglionic neurons are
adrenergic.
4. Both epinephrine and norepinephrine bind to adrenergic receptors, which are found on visceral effectors
innervated by most sympathetic postganglionic neurons. The two main types of adrenergic receptors are
alpha receptors and beta receptors.
5. Table 15.2 summarizes the types of cholinergic and adrenergic receptors.
6. An agonist is a substance that binds to and activates a receptor, mimicking the effect of a natural neuro-
transmitter or hormone. An antagonist is a substance that binds to and blocks a receptor, thereby pre-
venting a natural neurotransmitter or hormone from exerting its effect.

15.4 Physiology of the ANS Anatomy Overview - Effectors

Animation - Physiological Effects of
1. The sympathetic division favors body functions that can support vigorous physical activity and rapid
the ANS
production of ATP (fight-or-flight response); the parasympathetic division regulates activities that con- Animation - The Alarm Reaction
serve and restore body energy.
2. The effects of sympathetic stimulation are longer lasting and more widespread than the effects of
parasympathetic stimulation.
3. Table 15.3 compares structural and functional features of the sympathetic and parasympathetic divisions.
4. Table 15.4 lists sympathetic and parasympathetic responses.

15.5 Integration and Control of Autonomic Functions Anatomy Overview - The ANS Control
Centers
1. An autonomic reflex adjusts the activities of smooth muscle, cardiac muscle, and glands.
Animation - Reflexes
2. An autonomic reflex arc consists of a receptor, a sensory neuron, an integrating center, two autonomic
motor neurons, and a visceral effector.
3. The hypothalamus is the major control and integration center of the ANS. It is connected to both the
sympathetic and the parasympathetic divisions.

CRITICAL THINKING QUESTIONS
1. You’ve been to the “all-you-can-eat” buffet and have consumed
large amounts of food. After returning home, you recline on the
couch to watch television. Which division of the nervous system
will be handling your body’s after-dinner activities? List several
organs involved, the major nerve supply to each organ, and the
effects of the nervous system on their functions.
2. Ciara is driving home from school, listening to her favorite music,
when a dog darts into the street in front of her car. She manages to
ANSWERS TO FIGURE QUESTIONS
15.1 Dual innervation means that a body organ receives neural in-
nervation from both sympathetic and parasympathetic neurons
of the ANS.
15.2 Most parasympathetic preganglionic axons are longer than most
sympathetic preganglionic axons because most parasympathetic
ganglia are in the walls of visceral organs, but most sympathetic
ganglia are close to the spinal cord in the sympathetic trunk.
15.3 Terminal ganglia are associated with the parasympathetic divi-
sion; sympathetic trunk and prevertebral ganglia are associated
with the sympathetic division.
15.4 Sympathetic trunk ganglia contain sympathetic postganglionic
neurons that lie in a vertical row on either side of the vertebral
column.
ANSWERS TO FIGURE QUESTIONS 545
swerve to avoid hitting the dog. As she continues on her way, she
notices her heart is racing, she has goose bumps, and her hands are
sweaty. Why is she experiencing these effects?
3. Mrs. Young is experiencing a bout of diarrhea that is keeping her
housebound. She would like to go to a birthday party for her
brother but is afraid to attend because of her diarrhea. What type
of drug, related to the autonomic nervous system function, could
she take to help relieve her diarrhea?
15.5 The largest autonomic plexus is the celiac (solar) plexus.
15.6 Pelvic splanchnic nerves branch from the second through fourth
sacral spinal nerves.
15.7 Most (but not all) sympathetic postganglionic neurons are adren-
ergic. Muscarinic receptors are present in the plasma membranes
of all effectors (smooth muscle, cardiac muscle, and glands)
innervated by parasympathetic postganglionic neurons and in
sweat glands innervated by cholinergic sympathetic postgan-
glionic neurons.
15
C H A P T E R