Anda di halaman 1dari 40

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 (PNS = 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.

Voluntary
external environment

AUTONOMIC

Involuntary
internal environment

Body Wall & Limbs


Visceral (glands, smooth
and cardiac muscle)
Parasympathetic
Motor Sensory

Rest / Digest

Fight / Flight

Body Cavities

Skeletal m. Pain
Pressure
Proprioception
Temp
Touch

Motor
Glands
Cardiac m.
Smooth m.

Sympathetic
Everywhere

Motor
Sensory

Physiological
(reflex)

Glands
Cardiac m.
Smooth m.

Pain

Outflow of
autonomics
from CNS

SNS
Thoracolumbar
(T1-L2)
(CN 3,7,9,10)
Craniosacral PSNS
(S2-4)

Sympathetic chain and


paravertebral (chain) ganglia
- cervical to sacral
Pre-aortic
sympathetic
ganglia

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,

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 - 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

Sympathetic

Short

Parasympathetic

Cell bodies in CNS nuclei

Long

Target:
Smooth m.
Cardiac m.
Glands

Long

Short

Cell bodies in PNS ganglia

Target:
Smooth m.
Cardiac m.
Glands

Spinal Cord - repeating similar units = cord segments


8 Cervical
Segments

12 Thoracic
Segments

5 Lumbar
Segments

1 Coccygeal
Segment

5 Sacral
Segments

Ventral
ramus
of
spinal
nerve

Dorsal ramus
Of spinal
nerve

Dorsal root
Dorsal
Dorsal
root
ganglion

Gray ramus Ventral


communicans
Ventral
(GRC)
root

White ramus
communicans
(WRC)

Sympathetic chain
& ganglion

Spinal
nerve

Skin and muscles of the back


Dorsal
ramus
Ventral
ramus

SENSORY (PPPTT = pain, pressure, proprioception,


touch, temperature)
MOTOR

Somatic
innervation of
the body wall

Skin and muscles


of the body wall
and limbs

Sympathetics to
Body Wall
For spinal nerves above
T1, preganglionic axons
ascend in the chain to
cervical chain ganglia

For spinal nerves below


L2, preganglionic axons
descend in the chain to
lumbar
and sacral
chain ganglia

Sympathetic
Chain and
Ganglia
(paravertebral)

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

Segments T1-L2
WRC

All preganglionic sympathetic cell bodies are located in the lateral


horn of spinal segments T1L2: 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 T1L2 (above T1 and below L2 there are only
GRCs)

GRCs
only

Segments above T1
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 T1L2
preganglionics with cell
bodies in lateral horn of
spinal segments T1L2
enter the sympathetic
chain via WRCs
synapse in ganglia at the
same spinal level
postganglionics exit the
chain via gray rami
spinal nerves T1L2
dorsal and ventral
rami of these spinal nerves
innervate sweat glands ,
arrector pili muscles and
vascular smooth muscle in
the body wall at T1 L2
levels

GRCs
only

WRCs
and
GRCs

GRCs
only

Segments above
T1 (cervical cord)

Segments T1-L2

Segments below L2

Sympathetics to Body Wall and Limbs


Sympathetics to spinal
nerves above T1
preganglionics with cell
bodies in lateral horn of
upper thoracic segments
enter the chain via WRCs
ascend in chain
synapse in cervical chain
ganglia postganglionics
exit chain via gray rami
communicans spinal
nerves C1-C8 dorsal
and ventral rami of these
spinal nerves supply
neck / upper limbs above
T1 level

GRCs
only

WRCs
and
GRCs

GRCs
only

Segments above
T1 (cervical cord)

Upper Thoracic
Segments

Segments below L2

Sympathetics to Body Wall and Limbs

Sympathetics to spinal
nerves below L2
preganglionics with cell
bodies in lateral horn of
upper lumbar spinal
segments enter the
sympathetic chain via
WRCs descend in chain
synapse in lower lumbar
and sacral chain ganglia
postganglionics exit chain
via gray rami spinal
nerves L3-S5 dorsal and
ventral rami of these spinal
nerves
innervate body wall / lower
limbs below L2 level

GRCs
only

WRCs
and
GRCs

GRCs
only

Segments above
T1 (cervical cord)

Lower Thoracic,
Segments, L1-L2

Segments below L2

What Targets Do Sympathetics Innervate In the


Body Wall and Limbs?

There are only 3 types


of sympathetic targets
In the body wall and
limbs:
1) Sweat glands
2) Vascular smooth
muscle (vessels in
the skin, vessels in
the connective
tissues and vessels
in skeletal muscles)
3) Arrector pili muscles

GRCs
only

WRCs
and
GRCs

GRCs
only

Segments above
T1 (cervical cord)

Segments T1-L2

Segments below L2

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


cell bodies in lateral horn from T1-T4
enter chain via WRCs, synapse in
chain ganglia, postganglionic axons
exit the chain medially and travel to
the cardiopulmonary plexus

Cardiopulmonary
plexus

Esophageal
plexus

Sympathetic fibers routes from the chain to


thoracic organs

Cervical cord /
sympathetic chain

B) Other preganglionic
sympathetics with cell
bodies in lateral horn from
T1-T4 enter chain via WRCs,
ascend in the chain and
synapse in cervical chain
ganglia, postganglionic
axons exit the chain and
travel to the cardiopulmonary plexus

Segments T1-T4
Cardiopulmonary
plexus

Sympathetic fibers routes from the chain to


thoracic organs

Cervical cord /
sympathetic chain

During development, the


heart descends through the
cervical region to the thorax,
picking up and carrying
along some of its
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 T5L2
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

T5-9 = Greater thoracic


splanchnic nerve

T10-11 = Lesser thoracic


splanchnic nerve

These sympathetics pass on


beyond the chain still as
preganglionics therefore
they have to synapse in preaortic ganglia (variously
named, e.g. celiac ganglion the only other sympathetic
ganglia beyond the chain)
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
cavities)

Visceral afferent (1 neuron)

CNS

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

GI

Preaortic
ganglion

Visceral afferent
Preganglionic
Postganglionic

Thoracic
Sympathetic
Chain
Intercostal nn.
Somatic ventral
rami of thoracic spinal
nerves

Vagus n.
(PSNS)

Sympathetic
chain

White and gray rami


communicantes
Esophageal plexus
(sympathetics,
parasympathetics,
and accompanying
visceral afferents)

Sympathetic
chain ganglia
(paravertebral
ganglia)

Cervical part of
sympathetic chain

Gray rami
communicantes
from cervical
chain/ganglia to
cervical spinal
nerves

Heart
(cardiopulmonary)
autonomics

C
e
r
v
i
c
a
l
c
h
a
i
n

Vagus

T1

T4

WRC

T
h
o
r
a
c
i
c
c
h
a
i
n

Greater thoracic
splanchnic nerve (T5-9)
Lesser thoracic
splanchnic nerve (T10-11)
Least thoracic
splanchnic nerve (T12)

Chain
ganglia
-T5-9

WRC

Greater thoracic
splanchnic nerve
Preaortic
ganglion
(celiac)

Intermesenteric
plexus

Sympathetic
chain
(lumbar part)
Lumbar
splanchnic
nerve

Preaortic ganglia

Superior hypogastric
plexus

Sympathetic chain
(what part?)

Segments S2,3,4
Pel
v
ner ic spl
a
ve(
s) nchni
c

Preganglionic parasympathetics with cell bodies in a small lateralhorn-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

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
doesnt differentiate sympathetic from
parasympathetic or pre-ganglionic from postganglionic).
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-