Anda di halaman 1dari 63

AUTONOMIC NERVOUS SYSTEM

Dr S S Ranasinghe CNTH - Ragama

Somatic

Nervous system

(reacts to external environment)

Autonomic

ANS

Part of the peripheral nervous system Autonomic nervous system supplies and influences virtually every organ in the body Autonomic nervous system controls the bodys involuntary (i.e. outside of consciousness) activities

Relationship between autonomic & somatic systems


1) Both work on the basis of a reflex arc
Afferent component Central integration Efferent component

ANS

Afferent signals from - different parts of the body


(eg:- baroreceptors in the carotid & aortic arch through 9th & 10th cranial Ns - receptors in the ht & lung - skin, muscles & viscera)

- neurones in the spinal cord - cerebral centres (mainly in the


hypothalamus , brain stem. Portions in cerebral cortex especially of the limbic cortex)

ANS cerebral centers

ANS cerebral involvement

Autonomic reflex arc Afferents

This is made of 1 ry visceral sensory neurons found in the peripheral nervous system and in cranial sensory ganglia (eg: geniculate, petrosal and nodosa ganglia appended respectively to cranial nerves VII, IX and X) Sensory nerves monitor CO2, O2 sugar, arterial pressure, chemical composition of gut content, taste

Autonomic reflex arc Afferents


Relay in Dorsal root ganglia or cranial nerve nuclei Go through spinothalamic tract to brain(hypothalamus, brain stem centers, cortex , limbic system) Afferents and efferents travel along same pathways

Relationship between autonomic & somatic systems


2) Autonomic fibers travel to peripheral structures in somatic peripheral and cranial nerves These two systems have a close linkage
3) Somatic afferents have components that relay on autonomic preganglionic cell bodies in spinal cord & brain

Relationship between autonomic & somatic systems


4) Major differences are in the efferent component

Somatic with lowest efferent relay in the CNS Autonomic with the lowest efferent relay outside CNS. The medullated pregang fiber always relay on post gang neuron cell bodies outside CNS

ANS Motor neurons

Located in the autonomic ganglia in the peripheral nervous system

ANS cerebral involvement

Autonomic reflex arc - Effernts


Pre ganglionic neurone Located in the visceral efferent intermediolaterl gray column Or homologus motor nuclei of the cranial nerve Axons are mostly myelinated, relatively slowly conducting beta fibers Synapse in ganglia on the cell bodies of postganglionjc neuron

Autonomic reflex arc - Effernts


Each pre ganglionic axons diverge on 8-9 post ganglionic neurones, the autonomic output is diffused. post ganglionic neurone Located in all cases out side the CNS Axons mostly unmyelinated & on the visceral effectors

Autonomic reflex arc - Effernts

2 sub types sympathetic (traditionally called the fight- or flight


response)

parasympathetic associated with maintenance of functions


of the body & conserves energy eg: digestive, GU

3rd sub type non adrenergic non cholinergic neurons found to be integral in autonomic function particularly in the gut and lung, - sometimes considered as an independent system

SYMPATHETIC SYSTEM Pre ganglionic neurone Axons start from the IML gray column & leave the spinal cord with the ventral roots of T 1 L 2 /3 spinal nerves They pass via the white rami communicantes to the para vertebral sympathetic ganglion chain ( 22 paired

ganglia)

Most of them end on the cell bodies of the post ganglionic neurone within the chain

SYMPATHETIC SYSTEM

SYMPATHETIC SYSTEM Pre ganglionic neurone


Some pre gang neu pass through the para vert sympathetic ganglion chain &end on post ganglionic nerve in - collateral ganglion close to viscera - or end in unpaired distal plexuses anterior to the vertebral column Eg: ceoliac, sup mesentric, aorticorenal, inferior mesentric Part of the uterus and male genitalia are innervated by a special short noradrenergic neurone (post ganglioic neurone)

SYMPATHETIC SYSTEM Post ganglionic neurone


Some axons pass to the viscera in various sympathetic nerves Others reenter the nerve via the gray rami communicants Post gang neu to the head originate in the superior, middle & stallate ganglia travel to the effectors with blood vessles Part of the uterus and male genitalia are innervated by a special short noradrenergic neurne (post gnglioic neurone)

SYMPATHETIC SYSTEM Post ganglionic neurone

Sympathetic postganglionic fibers innervate the trunk and limbs via the spinal nerves Sympathetic distribution to the head and neck, which enables and mediates vasomotor, pupillodilator, secretory and pilomotor function comes from those 3 cervical sym ganglion. Pregang fibers of these originate in the upper thoracic segments.

SYMPATHETIC SYSTEM

SYMPATHETIC SYSTEM
Allows an amplified and diffused discharge - Pregang sympath fibers may pass through multiple ganglia before synapsing -The terminal fibers of the pregang axons may contact large nos: of post gang nurones ( may synaps with >20 ganglia) - One cell may be supplied by several pregang fibers - -Pregang sym fibers not only synapse at the gang of the level of their origin in the spinal cord but can also course up and down the paired ganglia.

Parasympathetic system

Cranial component III, VII, IX, X Sacral component s2-s4 sacral plexus Pre gang nerve cell bodies in motor nuclei of cranial nerves, & lateral grey of sacral 2-4

Long medullated pre gang neurones Synapse in post gang cell bodies on or very close to viscera

Parasympathetic system

Short non medullated post gang neurone

Visceral effector Anatomical pathway is direct and non diffuse

Parasympathetic system - cranial


Preganglionic fibers arise from mid brain & medulla oblongata - Fibers arise in the Edinger- Westphal nucleus of the 3rd N (oculomotor) course in the midbrain to synapse in the ciliary ganglion. Then innervates the smooth muscles of the iris & the ciliary muscles - Parasympath components of the facial (lacrimatory nucleus), glossopharyngeal & vagus (dorsal nucleus) nerves lie in the medullaoblongata

Parasympathetic system - cranial


Facial N gives off parasymp fibers to the - Chorda tympani, subsequently synapses in the ganglia of submaxillary or sublingual glands. - Greater superficial petrosal nerve synapses in the sphenopalatine ganglion. Glossopharyngeal nerve synapses in the otic ganglian

Parasympathetic system

This location of ganglia close to vicera makes the parasympa system more targeted and less robust than the sympathetic system Parasympathetic nerves may synapse with a 1:1 ratio of nerve to effector cells. The vagal innervation of the Auerbach plexus may connect one nerve fiber to 8000 cells

Enteric Nervous System

Is the network of neurones & their supporting cells found within the walls of the GI Tract, pancreas & gall bladder. This contains as many nerve cells as the spinal cord does Derived from the neuroblasts of the neural crest that migrates to the GI tract along the vagus nerve

Enteric Nervous System contin

Has a high degree of local autonomy (unlike


sym & parasym systems which have a discrete function. Even after sympathetic cut off after spinal anaesthesia, digestion & peristalsis occurs although sphincter function is impaired)

Action depends on the geographic location. The combination of amines & peptides and their relative concentrations within the enteric neuron determine its function

Enteric Nervous System contin

Enteric neurones can be sensory (monitor


tension, the chemical content in the wall of the intestine)

act like interneurons, or motor ( may be


excitatory or inhibitory. Contract intestinal muscles, dilate vessels, or transport H2O & electrolytes)

Neurotransmitters- Ach, NE, NANC (NO, substance P, VAP, a variety of opiate peptides etc

Enteric Nervous System contin

2 plexuses Myenteric plexus also called the Auerbach plexus ( is a network of nerve strands & small ganglia
lying between external longitudinal & circular muscle coats of the intestine)

Meissner plexus ( consists of nerve cell bodies,


glial cells & glial & neuronal processes . No connective tissue or blood vessels. Situated in the submucousal layer)

ANS Electrical activity at Autonomic ganglia


Usually impulses along the preganglionic and post gang neurons are all or none action potentials But those at auto ganglia and other synapses are graded responses, stimuli may or may not be conducted. These graded responses regulate transmission at ganglia Transmission of electrical activity at these sites is chemically mediated.

Electrical activity at Autonomic ganglia

4 Types of graded responses at ganglia Action potential -Ach


mediator (Na influx)

Fast EPSP (30ms)

Slow EPSP(30s)

Sensitive post gang neuron to incoming impulses Ach mediator


( K+ conductunce)

Electrical activity at Autonomic ganglia


Slow IPSP (2 s) Inhibits post gang neuron to incoming impulses - Dopamine
( K + conductance)

Late Slow EPSP (4mts)

Sensitive - GnRH
(K + conductance)

ANS

ANS

Chemical transmission

Principal transmitters- Ach - NE - Dopamine is also secreted by interneurones in the sympathetic ganglia - GnRH is secreted by some pre ganglionic neurones. This mediates slow exitatory response

ANS

Chemical transmission

Co-transmitters eg: VIP is released with Ach ATP and neuropeptide Y with NE

ANS

Chemical transmission

Cholinergic Transmission All preganglionicneurons Para sympathetic post gang neurons Sympathetic post gang neurons to sweat glands and blood vessles to skeletal muscles Norepinephrine Transmission Remaining post ganglionic neurones 80% NE, 20% Epinephrine Alpha and beeta subtypes

Adrenal medulla:
Is a sympathetic ganglion. Post ganglionic cells have no axons and secrete NE, Epinephrine and some dopamine directly into blood stream. Usually NE spreads farther and has more prolonged action than Ach. Ach is short acting, metabolised by Ach esterase very fast.

Ach Receptors
Muscarinic Receptors Found on all effector cells stimulated by postgang parasymp neurons & on effector cells stimulated by postgang cholinergic sympa nurones 5 types ( M 1-5) encoded by 5 separate genes Exact status of M5 is uncertain

Ach Receptors Muscarinic Receptors contn

Others are serpentine , coupled with G protiene to adenylate cyclase, K+ channels or phospholipase C M1 in brain M2 in heart M4 in pancreatic acinar and islet cells M3 & M4 in smooth muscles

Ach Receptors
Nicotinic Receptors On N-M junctions , in autonomic ganglia and in CNS. Small amounts of Ach stimulates post ganglionic neurones Large amounts of Ach block impulses from pre to post ganglionic neurones. These actions are unaffected by atropine, mimicked y Nicotine.

Nicotinic Receptors

Consists of 5 subunits coming from a menu of 16 ubunit coded by 1 different genes. Skeletal muscles fetal 2 alpha1 + beeta1 + gama + delta adult 2 alpha 1 + beeta1 + epsilon + delta ( the channel open time, the conductance) In autonomic ganglia are heteromers. Usually contain alpha3 subunits and other subunits

Nicotinic Receptors

In the brain many located pre synaptically on glutamate secreting axon terminals Other post synaptic neurons. Some are on structures other than neurons Some seem to be free in intestinal fluid.

But in the brain both muscarinic and nicotinic receptors are found in large numbers.

Valsalva maneuver

F ile-V alsalv a3.jpg

Valsalva maneuver
1. Initial pressure rise application of expiratory force pressure rises inside the chest forcing blood out of the pulmonary circulation into the left atrium

Valsalva maneuver
2.Reduced venous return and compensation: The output of the heart is reduced and stroke volume falls. This occurs from 5 to about 14 seconds the cardiac output and blood flow to the body remains low. During this time the pulse rate increases.

Valsalva maneuver
3.Pressure release: Pulmonary vessels and the aorta to re-expand causing a further initial slight fall in stroke volume (20 to 23 seconds) due to decreased left ventricular return and increased aortic volume, respectively. Venous blood can once more enter the chest and the heart, cardiac output begins to increase.

Valsalva maneuver
4. Return of cardiac output: In 24 seconds the stroke volume usually rises above normal before returning to a normal level. With return of blood pressure, the pulse rate returns towards normal.

Excitatory & inhibitory actions of ANS

Sympathetic stimulation causes excitatory effects on some organs & inhibitory effects on others. Likewise parasymp stimulationn causes excitation in some but inhibition in some others. When sympathetic stimulation excites a particular organ parasymp sometimes inhibits it, demonstrating that the two systems occasionally act reciprocally to each other. But most organs are dominantly controlled by one or the other of the 2 systems There is no generalization one can use to explain those actions