LECTURE No.

INTRODUCTION TO AUTONOMICS
 General Characteristics of ANS
INVOLUNTARY
EFFERENT (MOTOR) SYSTEM; ( Plus SENSORY hitchhikers)
VISCERAL - innervates 3 target tissues:
smooth muscle (GI tract, blood vessels, etc)
cardiac muscle (and pacemaker / conduction tissue)
glands (sweat, mucous, lacrimal, etc.)

TWO MAJOR COMPONENTS:

a) sympathetic (SNS = thoracolumbar)
b) parasympathetic (PSNS = craniosacral)
minor third component that is gut-related:
c) enteric
TWO NEURON SYSYEM from CNS to target structures:
a) preganglionic neuron (cell body in CNS)
b) postganglionic neuron (cell body in autonomic
ganglion)
 Somatic vs. Autonomic
Voluntary Involuntary
external environment internal environment

Body Wall & Limbs Visceral (glands, smooth

and cardiac muscle)

Parasympathetic Sympathetic
Rest / Digest Fight / Flight
Motor Sensory
Body Cavities Everywhere

Motor Motor
Sensory
Skeletal m. Pain Glands Glands
Pressure
Cardiac m. Cardiac m.
Proprio-
Smooth m. Smooth m.
ception
Temp
Touch Physiological Pain
(reflex)
Outflow of
autonomics
from CNS Sympathetic chain and
paravertebral (chain) ganglia
- cervical to sacral

SNS Pre-aortic
Thoraco- sympathetic
lumbar ganglia
(T1-L2)
(CN 3,7,9,10)
Cranio-
sacral PSNS
(S2-4)
 Parasympathetic - Craniosacral
Cranio - from the brain: preganglionic cell bodies in
brainstem nuclei associated with CN III, VII, IX, X
(Vagus)
Vagus is the only cranial parasympathetic cranial nerve functioning
in the cervical, thoracic and lumbar regions, serving parasympathetics
to visceral structures in the neck, thorax and abdomen

Sacral - sacral or pelvic region: preganglionic cell bodies

in spinal cord segments S2,3,4 - functioning in the pelvic
region (called pelvic splanchnic nerves)

There is NO PARASYMPATHETIC INNERVATION TO THE

BODY WALL OR LIMBS (therefore parasympathetic fibers
should only be found on nerves leaving the CNS - CN III,
VII, IX and X and S2-4, and then distributed in plexuses
around organs in the body cavities)
 Sympathetic – Thoraco-lumbar
1) Preganglionic cell bodies are located in lateral horn
of spinal cord segments T1 – L2
2) All preganglionic axons enter the sympathetic chain
through white rami communicans
3) From the above outflow into the sympathetic chain,
sympathetics are supplied to the entire body,
including the body wall/limbs as well as organs in body
cavities (therefore there must be routes from the chain
that lead to body cavities as well as the body wall)

Visceral afferents - sensory fibers that accompany

both sympathetic and parasympathetic fibers (these
visceral afferents are “hitch-hiking” with
sympathetics and parasympathetics and are not
technically part of the SNS or PSNS)
Autonomic Ganglia - collections of nerve cell
bodies outside the CNS are called ganglia –
autonomic ganglia contain postganglionic
sympathetic or parasympathetic nerve cell bodies
Sympathetic Ganglia
1) Sympathetic chain ganglia (paravertebral ganglia) –
chain ganglia are found at all levels of the spinal cord /
spinal nerves
2) Preaortic sympathetic ganglia (prevertebral ganglia) –
these are only located in the abdomen, associated
with major branches of the abdominal aorta

Parasympathetic Ganglia – discrete parasympathetic

ganglia are only found in the head; FOR THE REST OF
THE BODY, postganglionic parasympathetic cell bodies
are found scattered near or in the walls of target organs
 Autonomics Schematic
CNS PNS
Target:
Sympathetic Long
Short Smooth m.
Cardiac m.
Glands
Parasympathetic Short
Long Target:
Smooth m.
Cardiac m.
Cell bodies in CNS nuclei Cell bodies in PNS ganglia Glands
Spinal Cord - repeating similar units = cord segments
12 Thoracic
8 Cervical Segments 5 Lumbar 5 Sacral
Segments Segments Segments

…,
…,
1 Coccygeal
Segment
 Ventral Dorsal ramus
ramus Of spinal Dorsal root
of nerve Dorsal
spinal Spinal
Dorsal
nerve root nerve
ganglion

Gray ramus Ventral

communicans
(GRC) Ventral
root

Sympathetic chain
White ramus & ganglion
communicans
(WRC)
 Skin and muscles of the back

Dorsal
ramus
Ventral
ramus

SENSORY (PPPTT = pain, pressure, proprioception,

touch, temperature)

MOTOR Somatic Skin and muscles

innervation of of the body wall
the body wall and limbs
 Sympathetic
Sympathetics to Chain and
Body Wall Ganglia
(paravertebral)
For spinal nerves above
T1, preganglionic axons
ascend in the chain to
cervical chain ganglia ALL preganglionic
sympathetics have cell bodies
in the lateral horn of spinal
gray matter from T1-L2; axons
travel on spinal nerve ventral
roots and enter the
sympathetic chain via white
rami communicantes
For spinal nerves below
L2, preganglionic axons
descend in the chain to
lumbar
and sacral
chain ganglia
 Segments T1-L2

WRC

All preganglionic sympathetic cell bodies are located in the lateral

horn of spinal segments T1–L2: therefore, lateral horns are only
located from T1-L2 (although there is something similar in segments
S2-4)

All preganglionic sympathetic nerves enter the sympathetic chain via

WRCs: therefore WRCs are only found in association with spinal
nerves / chain ganglia T1–L2 (above T1 and below L2 there are only
GRCs)
 GRCs
Segments above T1
only
and below L2

Above T1 spinal cord segment and below L2 spinal cord segment,

there are no lateral horns (no preganglionic sympathetic outflow
above T1 or below L2)

There are no WRCs above T1 or below L2 for the same reason (no
preganglionic sympathetic outflow to enter the chain above T1 or
below L2)

GRCs are the “on-ramps” used by postganglionic sympathetics which

are destined for the body wall and limbs – GRCs ONLY lead to spinal
nerves, the nerves of the body wall and limbs
 Sympathetic fibers – routes from the chain

Segments T1-L2
WRC

ALL preganglionic sympathetics enter the chain via WRCs

From the chain, there are routes (everywhere):
1) To the body wall and limbs
2) To thoracic organs (heart, airways, thoracic esophagus)
3) To abdominal organs
4) To pelvic organs
5) To organs in the perineum
6) To organs/structures in the head
 Sympathetics to Body Wall and Limbs

Sympathetics to spinal
nerves T1–L2 
preganglionics with cell GRCs Segments above
bodies in lateral horn of only T1 (cervical cord)
spinal segments T1–L2
enter the sympathetic
chain via WRCs 
synapse in ganglia at the
same spinal level 
postganglionics exit the
WRCs Segments T1-L2
chain via gray rami 
spinal nerves T1–L2  and
dorsal and ventral GRCs
rami of these spinal nerves
 innervate sweat glands ,
arrector pili muscles and
vascular smooth muscle in
the body wall at T1 – L2 GRCs
Segments below L2
levels only
 Sympathetics to Body Wall and Limbs
Sympathetics to spinal
nerves above T1 
preganglionics with cell
bodies in lateral horn of GRCs Segments above
upper thoracic segments only T1 (cervical cord)
enter the chain via WRCs
 ascend in chain 
synapse in cervical chain
ganglia  postganglionics
exit chain via gray rami
communicans  spinal
Upper Thoracic
nerves C1-C8  dorsal WRCs Segments
and ventral rami of these and
spinal nerves  supply GRCs
neck / upper limbs above
T1 level

GRCs
Segments below L2
only
 Sympathetics to Body Wall and Limbs

GRCs Segments above

only T1 (cervical cord)
Sympathetics to spinal
nerves below L2 
preganglionics with cell
bodies in lateral horn of
upper lumbar spinal
segments enter the
sympathetic chain via Lower Thoracic,
WRCs
WRCs  descend in chain Segments, L1-L2
and
 synapse in lower lumbar
GRCs
and sacral chain ganglia 
postganglionics exit chain
via gray rami  spinal
nerves L3-S5  dorsal and
ventral rami of these spinal GRCs
nerves  Segments below L2
only
innervate body wall / lower
limbs below L2 level
What Targets Do Sympathetics Innervate In the
Body Wall and Limbs?

GRCs Segments above

only T1 (cervical cord)
There are only 3 types
of sympathetic targets
In the body wall and
limbs:
1) Sweat glands
2) Vascular smooth Segments T1-L2
muscle (vessels in WRCs
the skin, vessels in and
GRCs
the connective
tissues and vessels
in skeletal muscles)
3) Arrector pili muscles
GRCs
Segments below L2
only
Dorsal root is sensory only
(and so far we have only
seen somatic sensory
nerves coming from the
body wall and limbs via the
dorsal and ventral rami of
spinal nerves)
 Preganglionic

Somatic Motor

Ventral root is motor only,

both somatic motor and
preganglionic sympathetics
(visceral motor)
 Sensory

Postganglionic

Somatic Motor

Spinal nerve and its branches

(dorsal ramus
and ventral ramus) are mixed
nerves: somatic motor,
somatic (and visceral) sensory
and postganglionic
sympathetics (visceral motor)
 Sympathetic fibers – routes from the chain to
thoracic organs

Segments T1-T4

A) Preganglionic sympathetics with Cardiopulmonary

cell bodies in lateral horn from T1-T4 plexus

enter chain via WRCs, synapse in

chain ganglia, postganglionic axons
exit the chain “medially” and travel to Esophageal
the cardiopulmonary plexus plexus
Sympathetic fibers – routes from the chain to
thoracic organs
B) Other preganglionic
sympathetics with cell
bodies in lateral horn from
T1-T4 enter chain via WRCs,
Cervical cord / ascend in the chain and
sympathetic chain synapse in cervical chain
ganglia, postganglionic
axons exit the chain and
travel to the cardio-
pulmonary plexus

Segments T1-T4
Cardiopulmonary
plexus
Sympathetic fibers – routes from the chain to
thoracic organs
During development, the
heart descends through the
cervical region to the thorax,
picking up and carrying
Cervical cord / along some of its
sympathetic chain sympathetic innervation
from cervical chain ganglia
– the ORIGIN of
preganglionics is the same –
T1-4 lateral horns, etc.

Segments T1-T4
Cardiopulmonary
plexus
 Sympathetic fibers – routes from the chain to
abdominal organs
Preganglionic axons with cell bodies in the lateral horn from T5–L2
enter the chain, pass on through ganglia WITHOUT synapsing, then
the (still) preganglionic fibers leave the medial aspect of the chain
ganglia and travel to a sympathetic ganglion along the abdominal
aorta (preaortic = prevertebral ganglia) where they synapse;
postganglionic fibers then travel along arteries to the GI tract

Segments T5-L2 Preaortic

ganglia
GI

Examples – Thoracic and lumbar splanchnic nerves

 These sympathetics pass on
beyond the chain still as
preganglionics – therefore
T5-9 = Greater thoracic
splanchnic nerve
they have to synapse in pre-
aortic ganglia (variously
named, e.g. celiac ganglion -
the only other sympathetic
ganglia beyond the chain)
T10-11 = Lesser thoracic
splanchnic nerve
Preaortic
ganglia
GI

T12 = Least thoracic

splanchnic nerve
The post-ganglionic
fibers follow arteries to
the GI tract
L1-2 = Lumbar
splanchnic nerves
 VISCERAL SENSORY FIBERS
Target
(organs in Visceral afferent (1 neuron) CNS
cavities)
Postganglionic Preganglionic
Visceromotor (2 neuron chain)

Visceral sensations are generally unconscious except for those that

result in pain (which then becomes conscious).
Visceral sensory fibers traveling with sympathetics and
parasympathetics are called visceral afferents
Generally, visceral afferents traveling with parasympathetics mediate
unconscious sensations (such as atrial stretch or GI stretch) resulting
in involuntary physiological responses, eg. enhanced peristalsis,
decreased heart rate, etc.
Generally, visceral afferents traveling with sympathetics mediate
conscious sensations that are usually painful, eg. heart attack pain,
gas pains, appendicitis pain, gall bladder pain, etc. and are caused by
anoxia/ischemia, distension, inflammation, or spasmodic contraction
of smooth muscles.
 Visceral afferents for pain from
heart (via cardiopulmonary nerves)
Skin,
joints,
tendons,
etc.

WRC
Segments T1-T4 Somatic afferent

Visceral afferent

Preganglionic

Cardiopulmonary
plexus Postganglionic
 Visceral afferents from GI
tract – accompanying
thoracic splanchnic nerves

Skin,
joints,
tendons,
etc.
Segments T5-L2 WRC

Somatic afferent
Preaortic
ganglion Visceral afferent
GI
Preganglionic

Postganglionic
 Thoracic
Sympathetic Vagus n.
Chain (PSNS)

Intercostal nn.
Somatic  ventral Sympathetic
rami of thoracic spinal chain
nerves
White and gray rami
communicantes
Sympathetic
Esophageal plexus chain ganglia
(sympathetics, (paravertebral
parasympathetics, ganglia)
and accompanying
visceral afferents)
 Cervical part of
sympathetic chain

Gray rami
communicantes
– from cervical
chain/ganglia to
cervical spinal
nerves
 C
e
r
v
i
Heart c Vagus
a
(cardiopulmonary) l

autonomics c
h
a
T
i h
T1
n o
r
a
c
T4 i
c
WRC
c
h
a
i
n
 Greater thoracic
splanchnic nerve (T5-9)

Lesser thoracic
splanchnic nerve (T10-11)

Least thoracic
splanchnic nerve (T12)
 Chain
ganglia WRC
-T5-9

Greater thoracic
splanchnic nerve

Pre-
aortic
ganglion
(celiac)
 Intermesenteric Preaortic ganglia
plexus

Superior hypogastric
Sympathetic plexus
chain
(lumbar part)

Lumbar Sympathetic chain

splanchnic (what part?)
nerve
 Segments S2,3,4

Pel
v
ner ic spl
ve( a
s) nchni
c

Preganglionic parasympathetics with cell bodies in a small “lateral-

horn-like area” of sacral (S2-4) segments of the spinal cord – axons
travel on the ventral (motor) roots to spinal nerves and then ventral
rami of S2,3 and 4 – then “jump off” the ventral rami as Pelvic
Splanchnic Nerves to enter the inferior hypogastric (pelvic) plexus

Postganglionic parasympathetic nerves are located at or in the walls

of target organs in the pelvis (such as the urinary bladder)
Preaortic ganglia
Superior hypogastric plexus

Sacral sympathetic
chain

S2,3,4
(Parasympathetic –
Pelvic Splanchnic
Nerves)

Pelvic (Inferior
Hypogastric) Plexus
 SOME AXIOMS OF THE ANS
1. All sympathetic and parasympathetic fibers originate from the
CNS. Thus, these nerves must be preganglionic (presynaptic).

2. All preganglionic sympathetics must enter the sympathetic chain

from spinal nerves (or ventral rami of spinal nerves) via WRC.

3. All WRC are found only at spinal cord segments T1-L2. Thus,
there are no WRCs above T1 spinal nerve or below L2 spinal
nerve.

4. Some postganglionic sympathetics leave the sympathetic chain

via GRCs to enter somatic (spinal) nerves. Thus, post-ganglionic
sympathetic fibers traversing the GRC innervate body wall
structures.
 SOME AXIOMS OF THE ANS
5. ALL somatic nerves contain postganglionic sympathetics but NO
preganglionic sympathetics and NO parasympathetics. Thus, GRCs connect
the sympathetic chain to ALL spinal nerves (allowing for passage of
postganglionic sympathetic axons from the chain to the somatic nerves).

6. The term "splanchnic" only means visceral. Thus, the term splanchnic when
used in “thoracic splanchnics”, “lumbar splanchnics”, “sacral splanchnics”
and “pelvic splanchnics” only means that they are visceral nerves
innervating appropriate visceral structures (and doesn’t differentiate
sympathetic from parasympathetic or pre-ganglionic from post-ganglionic).

7. Splanchnic nerves that leave the sympathetic chain ganglia may leave as
pre- or post-ganglionic fibers, the preganglionics are destined for other
ganglia (pre-aortic).

8. Pelvic splanchnics are preganglionic parasympathetics originating from

spinal cord segments S2,3,4.