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PHYSIOLOGY

AUTONOMIC NERVOUS SYSTEM

Dr. Elinor G. Bartolome || 08/10/2017

OUTLINE B. NERVOUS SYSTEM ORGANIZATION

I. Introduction • Central Nervous System (CNS)
a. Terminologies → Brain and Spinal Cord
b. Nervous System Organization → Integrates information, coordinates and influences activity of
c. Somatic NS vs. Autonomic NS all parts of the body
II. Sympathetic and Parasympathetic Division → Contains majority of the nervous system
a. Anatomical Differences • Peripheral Nervous System (PNS)
b. Neurochemical/ Biochemical Differences → Cranial and Spinal nerves and ganglia outside of the CNS
c. Functional Differences → Through your PNS, your CNS is able to control different bodily
d. Physiological Differences functions
e. Pharmacological Difference § Somatic Nervous System (SNS)
III. Reflexes
− Skeletal muscles are the effector organs
a. Reflex Arc
§ Autonomic Nervous System (ANS)
b. Classification of Reflexes
− Also called visceral motor system
IV. Autonomic Control Centers in the Brain
V. Case studies − Previously called Involuntary Nervous System since
functions are uncontrollable
− Branch of the PNS that is further subdivided into
OBJECTIVES Sympathetic and Parasympathetic Division
− Maintains homeostasis together with the endocrine
• At the end of the lecture/ module, the 1st year medical student system
will be able to:
− Provides motor control of the viscera
→ Differentiate between Somatic and Autonomic Nervous o Effector organs: smooth and cardiac muscles, glands
System (ANS). (i.e. heart, lungs, gastrointestinal tract, genitalia, etc)
→ Diagram the organization of the ANS. § Enteric Nervous System (ENS)
→ Compare and contrast the anatomic, biochemical, and − Includes the neurons and nerve fibers in the myenteric
physiologic bases for division of the autonomic nervous (control GI tract) and submucosal plexuses (regulate
system into the sympathetic and parasympathetic. body fluid homeostasis)
→ Discuss the levels of control of the ANS. − Located in the walls of GI tract
→ Give examples of autonomic reflexes. − Controlled by Sympathetic and parasympathetic
→ Tabulate the pharmacologic classifications of the ANS divisions
§ Classify the fibers according to the neurotransmitter
secreted.
§ Classify the receptors of the ANS.
§ Designate the blocking agents of each receptor
→ Define reflexes
→ Describe the functional components of a typical reflex arc
→ Classify the different reflexes as to:
§ Location of the receptor
§ # of synaptic connections or complexity of circuit;
monosynaptic or polysynaptic (two to several hundred)
§ Destination of the interneuron in the spinal cord: ipsilateral,
contralateral
§ Processing site: Spinal or Cranial reflexes
§ Location of effector organ or motor responses: somatic or
visceral
§ Development: Innate or required

I. INTRODUCTION

A. TERMINOLOGIES
• Neuron – nerve fibers/cells
• Afferent/ Sensory Neuron – carries sensory nerve impulses
from receptors towards the CNS
• Efferent/ Motor Neuron – carries motor nerve impulses from
the spinal cord to receptors in effector organs
• Ganglion – cluster of nerve cell bodies; group of neurons
forming nerve center outside the brain
• Varicosities – swellings in neurons that communicate with Figure 1. A functional overview of the nervous system.
effectors; where synapses occur
• Effector Organs – a muscle or gland that contracts or
secretes, respectively, in direct response to nerve impulses
• Interoceptor– sensory receptor that detects stimulus within the
body (ex. gut and other internal organs)
Trans #5 Group 10 :Bassig, Batalla, Bautista, A., Bautista N., Bautista, T. 1 of 7



C. SOMATIC NS vs. AUTONOMIC NS

Table 1. Comparison between Somatic NS and Autonomic NS
Somatic NS Autonomic NS
Mainly from
Somatic and interceptors, with some
Sensory input
special senses from somatic and
special senses
Involuntary control from
Voluntary control hypothalamus, limbic
Control of motor mainly from system, brain stem,
output cerebral cortex, spinal cord;
with basal ganglia, Limited control from
cerebral cortex Figure 2. Motor Neuron pathways in the Somatic NS and ANS
Two-neuron pathway
Preganglionic: B type II. SYMPATHETIC (THORACOLUMBAR) AND
Motor Neuron One-neuron
neuron - myelinated PARASYMPATHETIC (CRANIOSACRAL) DIVISION
pathway pathway
Postganglionic: C type • There are two divisions of the autonomic nervous system: the
neuron – unmyelinated parasympathetic and sympathetic divisions
Acetylcholine (all
preganglionic neurons, A. ANATOMICAL DIFFERENCES
parasympathetic & Table 2. Anatomical Differences between Sympathetic and Parasympathetic
sympathetic Divisions of the ANS
postganglionic neurons Sympathetic Parasympathetic
Neurotransmitter CN 3 (Oculomotor),
to most sweat glands);
and hormones Acetylcholine Origin of 7 (Facial),9
Norepinephrine(mostly T1-T12
released
by sympathetic Preganglionic (Glossopharyngeal),
L1-L2
postganglionic neurons neuron 10 (Vagus)
and chromaffin cells); S2-S4
Epinephrine (by Preganglionic
Short Long
chromaffin cells) neuron
Innervates smooth Postganglionic
Long Short
Innervates muscle, cardiac neuron
Effectors
skeletal muscle muscle, and glands Near the origin or Near effector organs
Location of
(visceral) spinal cord (Reason (Reason why
peripheral
Always why preganglionic is postganglionic is
ganglia
stimulatory; Either stimulatory or shorter) shorter)
Responses
manifest as inhibitory Extensive branching
Limited branching
contraction Divergence at preganglionic
(except vagus nerve)
Typically with varicosity neuron
Varicosity in or bulbous swelling Present
Neuromuscular None between efferent Presence of (White Ramus –
Junction neuron and effector Rami myelinated; Absent
organ communicantes Gray Ramus – non-
Interrupted myelinated)
Efferent neuron to
Uninterrupted By a ganglion in
spinal cord
between
NTK (Nice to know):
Preganglionic neurons of the sympathetic nervous system are
shorter because they are often closer to the spinal cord, while
preganglionic neurons of the parasympathetic nervous system
tend to be longer because they project and synapse with the
postganglionic neuron close to the target organ

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• Homologous to postganglionic sympathetic neurons

• Releases catecholamines – epinephrine & norepinephrine – into
circulation (not into synapse as in most postganglionic neurons)
• Muscarinic receptors

Deactivation of Acetylcholine and Norepinephrine

• Enzymatic degradation
→ ACh is deactivated by Acetylcholinesterase
§ Also called true or specific cholinesterase
→ NE by monoamine oxidase (MAO) in nerve terminals and
catecholo-methyltransferase (COMT) in the liver
→ Occurs very rapidly
• Reuptake – most NE is deactivated by reuptake; occurs slowly
• Diffusion of NT away from synaptic cleft
Neurotransmitters
• Acetylcholine
→ Classic NT whether sympathetic or parasympathetic
→ Involves in cholinergic transmission
Figure 3.Projection of sympathetic preganglionic and postganglionic fibers → Two classes of Ach receptors in autonomic ganglia:
§ Nicotinic receptors
B. NEUROCHEMICAL/ BIOCHEMICAL DIFFERENCES − N1: All neuromuscular junctions in somatic nervous
Table 3. Neurochemical Differences between Sympathetic and system
Parasympathetic Divisions of the ANS − N2: All peripheral ganglia
Sympathetic Parasympathetic − Can be blocked by agents like curare or hexamethonium
Ganglionic NT Acetylcholine Acetylcholine § Muscarinic receptors
Ganglionic − All parasympathetic neuroeffector junctions
Nicotinic Nicotinic − Some sympathetic neuroeffector junctions particularly in
Receptor
sweat glands
Norepinephrine
Effector Organ − Can be blocked by atropine
(EXCEPT sweat glands Acetylcholine
NT → Both nicotinic and muscarinic receptors mediate EPSPs
– ACh), Epinephrine
• Norepinephrine (NE)
Effector Organ → Usually in sympathetic postganglionic neurons
α1, α2, β1, β2 Muscarinic
Receptor → Involves in Adrenergic transmission
→ Two receptors that may be on target cells
§ α –receptors
− α–1 receptors: in postsynaptic membrane
− α–2 receptors: autoreceptors; in presynaptic membrane
− stimulatory, except in GI tract smooth muscles, cause a
↓ motility and secretion
§ β – receptors
− inhibitory, except in heart and kidneys
• Epinephrine
→ Same structure as NE however it contains a methyl group
→ It has a greater affinity to α –receptors than norepinephrine

C. FUNCTIONAL DIFFERENCES

Table 4. Functional Differences between Sympathetic and Parasympathetic
Divisions of the ANS
Sympathetic Parasympathetic
“Fight or Flight” “Rest and Digest”
Cardioselective Vasoselective
Control body’s response to
Control body’s response at rest
stress
Catabolic Anabolic
Effects are diffused Effects are localized
Effects last longer * Effects last shorter **
* Epinephrine is secreted by adrenal medulla directly to the
bloodstream; usually takes a while before reuptake can happen
Figure 4.Biochemical Differences in ANS & Somatic NS ** Enzymatic degradation of acetylcholine is faster

Adrenal Medulla Parasympathetic Effects

• Inner portion of adrenal gland • Diarrhea • Emesis
• Considered a modified sympathetic ganglion • Urination • Lacrimation
• Innervated by sympathetic preganglionic neurons • Miosis • Salivation
• Excited by acetylcholine • Bradycardia • Sweating
• Secretes epinephrine • Bronchospasm
*Sympathetic Effects are the reverse of these effects
Chromaffin Cells
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Steps in Synaptic Transmission A. REFLEX ARC

1. Synthesis and storage of neurotransmitters • The basic circuit that underlies a reflex
2. Release of neurotransmitters • Components:
3. Binding of neurotransmitters to the receptors • Receptor Organ–generates receptor potential/ generator
4. Deactivation of neurotransmitter agents potential;
− distal end of an afferent neuron which responds to a
D. PHYSIOLOGICAL DIFFERENCES stimulus and trigger nerve impulses
Dual Innervations − (Ex. nociceptors for pain)
→ Antagonistic Dual Innervation – Opposition of effects • Afferent/Sensory Neuron – generates action potential(AP)
§ Sympathetic: Pupil dilates, and more light enters; − conducts nerve impulses from receptor to CNS
Bronchioles dilate; Decreased urine production • Integration Center – where AP is conducted synapse between
§ Parasympathetic: Pupil constricts, less light enters; afferent and efferent neurons
Bronchiole constricts, increased urine production − mainly in the hypothalamus and brain stem; some in
→ Complementary Dual Innervation – Parasympathetic and spinal cord
sympathetic act on different effector cells to produce − happens in pre-and postganglionic neurons
synergism • Synapse – EPSPs, IPSPs
§ Ex. Sympathetic: Ejaculation • Efferent Neuron−conducts impulse from CNS to effectors
Parasympathetic: Erection due to vasodilation of BVs − where action potential is generated if there is summation
of EPSPs
• Effector Organ−responds to the motor nerve impulse (smooth
• Unique roles of the Sympathetic division muscle, cardiac muscle and glands)
→ Thermoregulatory effects • End Plate Junction – end plate potential
→ Metabolic effects
→ Release of renin from kidneys
• Usually, organs have dual innervations but some organs have
only 1 innervation
§ Adipose tissues
§ Adrenal medulla
§ Erector pili muscle
§ Blood vessels
§ Kidneys and its juxtaglomerular (JG) apparatus
See appendix for the Effects of Parasympathetic and Sympathetic
Divisions on various organs

E. PHARMACOLOGICAL DIFFERENCES
Table 5. Pharmacological Characteristics of Sympathetic ANS
Sympathomimetic Sympatholytic
Drugs that mimic the sympathetic Drugs that inhibit/ lessen the
NS effects of sympathetic NS
Ex. β2 agonist (Salbutamol) used Figure 5. Example of Reflex arc
by patients with asthma à B. CLASSIFICATION OF REFLEXES
Ex. β2 blocker (-olols) 1. Motor responses
relaxed smooth muscle in
a. Somatic
airways à dilation of airways
b. Visceral reflexes
Table 6. Pharmacological Characteristics of Parasympathetic ANS 2. Complexity of circuit
Parasympathomimetic Parasympatholytic a. Monosynaptic
“cholinomimetic drugs” b. Polysynaptic
3. Processing site
Drugs that mimic the effects of Drugs that inhibit the effects of
a. Spinal reflexes
acetylcholine on receptors acetylcholine on receptors
b. Cranial reflexes
Ex. Betanechol given after Ex. Atropine (antimuscarinic 4. Receptor location
surgery when there is a decrease drug) à induces sympathetic a. Superficial
in patient’s intestinal motility effects b. Deep
See appendix for the Drug Classes that influence the ANS c. Visceral
5. Development
III. REFLEXES a. Innate
• Automatic, involuntary b. Acquired
• Stereotype response to a stimulus
• Fast response to a change (stimulus) in the internal or external
environment that attempts to restore homeostasis

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Figure 6.Different Ways of Classifying Reflexes
Autonomic Reflexes
• visceral reflexes mediated by control centers in the brain
(hypothalamus, brain stem, spinal cord)
• operate without conscious control
• generally involve cardiac muscle, smooth muscle or glands
• with automatic adjustment or negative feedback control (internal
homeostasis)
1. Pupillary Reflex
• The light that strikes the retina will be processed by retinal
circuits which results to excitation of W-type retinal ganglion
cells that will respond to diffuse illumination
• Some of the W cells will go through the optic nerve and tract
to the pretectal nucleus to elicit pupillary constriction via the
bilateral connections with parasympathetic preganglionic
neurons in Edinger-Westphal nucleus
2. Temperature Regulation
• Thermoreceptors in the skin provide information about
external temperature
• Increase in body temperature is sensed by the hypothalamic
center via sympathetic nerves to sweat glands
• Sweating lowers body temperature
3. Sexual Autonomic Reflex
• Initiated both by psychic stimuli from the brain and sex organs
• Impulses converge on sacral cord
4. Baroreceptors (Stretch Receptors)
• Aid in control of arterial blood pressure and heart rate
• Located in walls of internal carotid arteries and arch of aorta
• Receptors triggered (stretched) by high BP → signals
transmitted to medulla oblongata → inhibits sympathetic
impulses and increases parasympathetic stimulation (vagus
nerve) → decreased heart rate and vasodilation
5. Defecation Reflex
• Sensory signals from distension of the rectum by feces →
stimulate involuntary relaxation of internal anal sphincter
• Mediated by parasympathetic autonomic motor impulses
• The external anal sphincter is under voluntary control, and if
opened, allows feces to be expelled
6. Micturition Reflex
• Bladder fills with urine signals from stretch receptors → pelvic
nerves → sacral segments of spinal cord → parasympathetic
activation
• Relaxation of internal urethral sphincter and contraction of
detrusor muscle of the bladder result to urination
• If urination is inconvenient, midbrain and cerebral cortex can
inhibit the reflex via the pudendal nerve
IV. AUTONOMIC CONTROL CENTERS IN THE BRAIN
1. Hypothalamus
• Anterior portion: Sympathetic
• Posterior portion: Parasympathetic
PHYSIOLOGY Autonomic Nervous System
• Part of diencephalon
• Temperature regulation controlled by thermoreceptive
neurons
• Thirst and food intake regulation
2. Pons
• Pneumotaxic center (respiratory rate)
3. Midbrain
• Micturition
• Vasomotor center
• Respiration
• Swallowing, coughing, vomiting
4. Others
• Other regions of the forebrain: amygdala, bed nucleus of stria
terminalis, some areas of the cerebral cortex
• Utilize ascending system to relay information
V. CASE STUDIES
Case Study 1: Insecticide Poisoning
CD is a 44-year-old woman who had spent much of the day working
in her garden. A blustery wind caused her to unintentionally inhale
the insecticide that she was spraying throughout the garden. When
she began wheezing severely, she was taken to the emergency
room. The attending physician observed other symptoms including
constricted pupils and a slowed heart rate. CD was treated with the
intravenous administration sulfate.
ANSWER:
S/Sx: Constricted pupils and slowed heart rate
Tx: Sulfate IV administration
Rationale: S/Sx are both parasympathetic reactions. Atropine
(Sulfate Monohydrate) is an antagonist of muscarinic receptors.
Case Study 2: Pheochromocytoma
AF is a 55-year-old woman who had been experiencing heart
palpitation, a throbbing headache, sweating, pain in the abdomen,
nausea and vomiting. Because these symptoms had failed to
subside, she went to see her primary care physician. A urinalysis
revealed the presence of catecholamines and their metabolites,
including vanillylmandelicacid(VMA). A subsequent CT scan
confirmed the presence of a tumor in the adrenal medulla. Surgery
to remove the tumor was scheduled.
ANSWER:
S/Sx: Heart palpitations, throbbing headache, sweating, pain in the
abdomen, nausea and vomiting. All Sympathetic reactions.
Tx: Surgery
Rationale: The tumor causes the pressure on the adrenal medulla
causing the increased released of the catecholamine
REFERENCES
Berne, R., Koeppen, B., & Stanton, B. (2010). Berne & Levy
Physiology. Philadelphia: Mosby/Elsevier
Brooks, H. et al (2009) Ganong’s Review of Medical Physiology
Hall, J. E. (2016). Guyton and Hall Textbook of Medical Physiology.
Saunders, Elsevier Inc.
Batch 2020Transes
Katzung, B. (2012). Basic and Clinical Pharmacology (12th edition).
McGraw Hill Medical
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APPENDICES

Figure 7. Overview of the Sympathetic and Parasympathetic Divisions

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Table 6.Effects of the Parasympathetic and Sympathetic Divisions on Various Organs

Table 7.Drug Classes that influence the ANS

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