THE AUTONOMIC NERVOUS SYSTEM AND VISCERAL SENSORY NEURONS o Axons run in ventral roots to ventral rami, branch

n in ventral roots to ventral rami, branch out to form pelvic splanchnic

nerves run through
Autonomic Nervous System (Involuntary; General Motor Division)  Inferior hypogastric plexus/pelvis plexus (pelvic floor) – only some
- System of motor neurons that innervate the smooth muscle, cardiac muscle, and preganglionic neurons synapses, contains fibers from both divisions
glands of the body (effectors) of ANS [most synapse in intramural plexus]
- Regulates visceral functions such as heart rate, blood pressure, digestion, and
urination (important for homeostasis)
- Distinct from somatic motor division (skeletal muscles)

General Visceral Sensory System

- Monitors activities of visceral organs  autonomic motor neurons can make
adjustments as necessary to ensure optical performance of visceral functions

Enteric Nervous System

- Innervates smooth muscle and glands (w/in digestive tract)
- Regulates activities of digestive tract
- Functions completely independently of the CNS
- Relationship of ANS and ENS
o Autonomic neurons to digestive tract can influence enteric neurons by either
stimulating or inhibiting their activity
o ANS acts as a “volume control” rather than “on/off” switch

Definition of Terms
 Synapse – junction between 2 neurons that communicates the message from one
neuron (pre) to another (post)
 Pre-synaptic Neuron
 Postsynaptic Neuron
 Ganglion – cluster of neuronal cell bodies in the PNS

Divisions of the Autonomic Nervous System

PARASYMPATHETIC DIVISION

Cranial Outflow (CN III, VII, IX, X)

- Originates from the brain and innervates organs in the head, neck, thorax, and most of
abdomen
- Preganglionic axons run in Oculomotor (III), Facial (VII), Glossopharyngeal (IX), Vagus
(X) Nerves.
o Cell bodies located in motor cranial nerve nuclei in the gray matter of the brain
stem
Sacral Outflow (S2-S4)
- Supplies distal portions of digestive tract and pelvic organs
- Continuing where vagus ends, innervates organs in pelvis: distal half of LE, bladder,
and reproductive organs (uterus, erectile tissues of ext. genitalia)
- Parasympathetic effects: stimulation of defecation, voiding of urine, and erection
- Preganglionic cell bodies lie in the visceral motor region of the spinal gray matter
 Somatic Motor Autonomic Nervous System
System
Innervation Skeletal muscles Smooth muscle, cardiac muscle, glands
Motor Unit Single neuron + Peripheral Autonomic Ganglion
skeletal muscle cells (motor) – site where pre- neuron
(innervates) synapses w/ post- neuron; contain cell
bodies of motor neurons
*Dorsal Root Ganglia – sensory

Chain of 2 motor neurons:

Preganglionic Postganglionic
neuron neuron

Axons Thick, heavily Thin, lightly Thinner,

myelinated myelinated unmyelinated
Impulse
Fast Slow
Conduction

NERVE INNERVATION OF VM FUNCTION PREGANGLIONIC AXONS ORIGIN POSTGANGLIONIC AXONS ORIGIN/SYNAPSE

Constriction of pupil & lens of
smooth muscles in the eye to bulge: focus on close cell bodies in accessory oculomotor nucleus cell bodies in ciliary ganglion (posterior part of
Oculomotor Nerve (III)
eye objects orbit lateral to optic nerve)

Lacrimal (tear) gland

above eye and glands in
Secretion Lacrimal nucleus in the pons Pterygopalatine ganglion posterior to maxilla
nasal cavity (mucus)
Facial Nerve (VII)

Glossopharyngeal Nerve
(IX)
Vagus Nerve (X)
- 90% of preganglionic
sympathetic fibers in
body
Submandibular and
Sublingual glands
(salivary)
Parotid gland lies
anterior to ear
Visceral organs of thorax
and most of the
abdomen
*not include pelvic organs and
vagal innervation of digestive
tube ends halfway along LE
Secretion
Secretion
Digestion (secretion of
digestive glands and
increased motility of smooth
muscles of digestive tract)
Reduction in heart rate
Constriction of bronchi
Superior salivatory nucleus in the pons
Inferior salivatory nucleus in the medulla
Mostly in the dorsal motor nucleus of vagus
in the medulla
Submandibular ganglion deep to mandibular
angle
Otic ganglion inferior to ovale of skull
Runs through enter length of vagus nerve
Most confined w/in walls of organs being
innervated
Cell bodies form intramural ganglia
SYMPATHETIC DIVISION - main collateral ganglia lie w/in autonomic nerve plexuses of same names:
- exits the thoracic and superior lumbar part of the spinal cord (T1-L2) o celiac
- Preganglionic cell bodies lie in the visceral motor region of the spinal gray matter  o superior mesenteric
lateral gray horn o inferior mesenteric
- More complex than parasympathetic  innervates more organs o inferior hypogastric
- Supplies all visceral organs in internal body cavities + visceral structures in the
superficial regions of the body SYMPATHETIC PATHWAYS
o arrector pili muscles of skin, smooth musculature in walls of arteries and veins - preganglionic neurons in thoracolumbar spinal cord send motor axons through
(some exceptions) = only sympathetic innervation adjacent ventral root into the spinal nerve, white ramus communicans, associated trunk
- more ganglia, falling into 2 classes: ganglia
o sympathetic trunk ganglia 1. synapses w/ postganglionic neuron in the sympathetic trunk ganglion at the
o collateral ganglia same level and exits via the gray ramus communicans into the spinal nerve at
that level
SYMPATHETIC TRUNK GANGLIA (chain ganglia/paravertebral ganglia) 2. ascends/descends in the sympathetic trunk to synapse in another trunk
- located along both sides of vertebral column from neck to pelvis ganglion; postganglionic fiber exits via ray ramus communicans at level of
- linked by short nerves into long sympathetic trunks (sympathetic chains) resemble synapse
strings of beads 3. passes through sympathetic trunk, exits on splanchnic nerve, synapses in a
- joined to the ventral rami of nearby spinal nerves by white and gray communicantes collateral ganglion; postsynaptic fiber extends from collateral ganglion to the
(lie lateral to each other) visceral organ via autonomic nerve plexus
- approximately 1 sympathetic trunk ganglion:1 spinal nerve
o some fused during development PATHWAYS TO THE BODY PERIPHERY
 Neck region: 3 sympathetic trunk ganglia : 8 spinal nerves - innervate sweat glands, arrector pili muscles on skin, and peripheral blood vessels (1
 Superior ganglia & 2)
 Middle ganglia - preganglionic axons enter sympathetic trunk ganglia and synapse with ganglionic cell
 Inferior cervical ganglia bodies
o Usually fuses w/ 1st thoracic ganglion  stellate - sympathetic outflow from CNS occur only on thoracic and lumbar spinal nerves
ganglion (star-shaped) in superior thorax o some of preganglionic axons travel superiorly/inferiorly in sympathetic trunk to
- 22-24 sympathetic trunk ganglia per side synapse in regions outside the area of outflow  supplying head, pelvis, limbs
- Typical person have # ganglia: - from sympathetic trunk ganglion, the postganglionic axons travel to in a gray ramus
o 3 cervical – ant. to transverse processes of cervical vertebrae communicans to the spinal nerve
o 11 thoracic –heads of ribs - The axons follow branches of the dorsal and ventral rami of the spinal nerve to the
o 4 lumbar – anterolateral sides of vertebral bodies skin, where they supply arrector pili and sweat glands
o 4 sacral – medial to sacral foramina o Anywhere along this path, postganglionic axons can “jump onto” nearby blood
o 1 coccygeal – anterior to coccyx vessels – follow and innervate those vessels
- not confuse sympathetic trunk ganglia w/ dorsal root ganglia - White rami communicantes
o latter: sensory; lie along dorsal roots of spinal nerves in the intervertebral o Contain all preganglionic axons traveling to the sympathetic trunk ganglion
foramina o White: preganglionic axons are myelinated
o former: motor; anterior to ventral rami of spinal nerves o Occur only on the region of sympathetic outflow from spinal cord – on
sympathetic trunk ganglia between T1 and L2
- Gray rami communicantes
o Contain only postganglionic axons headed to peripheral structures
COLLATERAL GANGLIA (prevertebral ganglia) o Gray: postganglionic axons are unmyelinated
- differ w/ sympathetic trunk ganglia o Occur only on all sympathetic trunk ganglia because sweat glands, arrector
o not paired, not segmentally arranged pili, and blood vessels must be innervated in all body segments
o only in abdomen and pelvis
o lie anterior to vertebral column, mostly on abdominal aorta (large artery) PATHWAYS TO THE HEAD
 - Preganglionic axons originate in the 1st 4 thoracic segments (T1-T4)
- Axons ascend in the sympathetic trunk to synapse in the superior cervical ganglion
- Postganglionic axons associate with large arteries that carry them to glands, smooth
muscle, and vessels throughout the head
- Function:
o Inhibit lacrimal, nasal, and salivary glands (fear causes dry mouth)
o Stimulate muscle in iris that dilates pupils
o Stimulate superior tarsal muscle (smooth muscle in upper eyelid) prevents
drooping of eyelid; lifts eyelids to open eyes wider when frightened.
PATHWAYS TO THE THORACIC ORGANS
- Preganglionic axons originate at T1-T6
o Some synapse in nearest sympathetic trunk ganglion and postganglionic
axons run directly to the organ supplied
 Fibers to lungs and esophagus, some axons to heart
o Along the way postganglionic axons pass through pulmonary, esophageal,
and cardiac plexuses
- Many sympathetic fibers to heart take less direct path
o Preganglionic axons ascend in the sympathetic trunk to synapse in the cervical
ganglia of the sympathetic trunk
o Postganglionic axons descend through the cardiac plexus and into the heart
wall
 Many nerves in the heart arise from the neck because heart develops
in neck region of embryo
- Function:
o Thoracic sympathetic nerves increase heart rate and dilate blood vessels that
supply heart wall (heart muscle receives more blood)
o Dilate respiratory air tubes and inhibit muscle and glands in esophagus
PATHWAYS TO ABDOMINAL ORGANS
- Preganglionic axons originate from inferior half of thoracolumbar spinal cord T5-L2
- Axons pass through adjacent sympathetic trunk ganglia and travel in thoracic
splanchnic nerves (greater, lesser, least) to synapse in collateral ganglia in the large
plexuses on the abdominal aorta
o Celiac ganglia
o Superior mesenteric ganglia
o Along w/ some smaller ones
- Postganglionic axons from these ganglia follow main branches of aorta to stomach,
liver, kidney, spleen, and intestines (through proximal half of LE)
- Function:
o Mostly inhibit activity of muscles and glands in these visceral organs
PATHWAYS TO THE PELVIC ORGANS
- Preganglionic axons originate in the most inferior part of thoracolumbar spinal cord
(T10-L2)
- Descend in sympathetic trunk to the lumbar and sacral ganglia of the sympathetic trunk
o Some synapse, postganglionic axons run in lumbar and sacral splanchnic
nerves to plexuses on the lower aorta and in the pelvis
 Inferior mesenteric plexus
 Aortic plexus
 Hypogastric plexuses
o Others, pass directly to autonomic plexuses and synapse in collateral ganglia
 Inferior mesenteric ganglia
 Inferior hypogastric ganglia
- Postganglionic axons proceed from these plexuses to the pelvis organs (bladder,
reproductive organs, distal half of LE)
- Function:
o Inhibit urination and defecation, promote ejaculation
THE ROLE OF ADRENAL MEDULLA IN SYMPATHETIC DIVISION
- Adrenal medulla
o Internal portion of adrenal (suprarenal) gland [lies on the superior aspect of
each kidney]
o Major organ of sympathetic nervous system
o Specialized sympathetic ganglion containing a collection of modified
postganglionic neurons that completely lack nerve processes
o Neuron-derived cells secrete great quantity of 2 excitatory hormones into the
blood of nearby capillaries during fight/flight response
 Norepinephrine
 Epinephrine (adrenaline) – greater amount
o Hormones travel throughout body through the bloodstream producing
widespread excitatory effects  “surge of adrenaline”
o Cells are stimulated to secrete by preganglionic sympathetic fibers that arise
from cell bodies in T8-L1
o Run in the thoracic splanchnic nerves and pass through the celiac plexus
before reaching the adrenal medulla
o More concentrated sympathetic innervation than any other organ in the body
VISCERAL SENSORY NEURONS
- Monitor stretch, temperature, chemical changes, and irritation w/in visceral organs
- Brain interprets visceral information as feelings of hunger, fullness, pain, nausea
- Almost all receptors are for these visceral senses are free (nonencapsulated) nerve
endings widely scattered throughout visceral organs
- Visceral sensations difficult to localize w/ precision
o People cannot distinguish whether gas pains originate in the stomach, or in
the intestine, or whether pain came from lower abdomen or uterus
- Like somatic sensory neurons, cell bodies are located in the dorsal root ganglia and in
the sensory ganglia of cranial nerves
- Long peripheral processes of sensory neurons accompany the autonomic motor fibers
to visceral organs
o Many accompany parasympathetic fibers in the vagus nerve and monitor
visceral sensations in organs served by the nerve
- Others accompany sympathetic fibers
 o Running from visceral organs into autonomic plexuses, through splanchnic
nerves, sympathetic trunk, rami communicantes, spinal nerves, and dorsal
roots
 From dorsal roots, central processes of these neurons enter the spinal
cord
 Most visceral pain fibers follow this sympathetic route to CNS
- Pathways in the way visceral sensory information is relayed through spinal cord to the
cerebral cortex not yet fully understood
o Most visceral inputs travel along the spinothalamic (spinoreticular) pathways
to the thalamus
o Neurons in thalamus relay visceral sensory information to the visceral sensory
cortex in the insula lobe for conscious perception
o Visceral sensory information reaches and influences visceral control centers
in the hypothalamus and medulla oblongata
- Visceral pain often is not felt when a visceral organ is cut or scraped
- Visceral pain is manifested once there is chemical irritation/inflammation of visceral
organs
 From spasms of smooth muscle in these organs, from excessive
stretching of organ  sever pain
- Referred pain – people suffering from visceral pain often perceive the pain to be
somatic in origin (skin/outer body)
o Ex: heart attacks  pain in cutaneous areas of superior thoracic wall and
medial aspect of left arm
o Cause not yet fully understood
- Both affected organ and region of body wall who which pain is referred are innervated
by same spinal segments
o Ex: heart and skin heart pain projects innervated by sensory neurons from T1-
T5
- Referred pain may result to convergence of somatic and visceral sensory neurons on
the same second-order neurons in the dorsal horn of the spinal cord
VISCERAL REFLEXES
- Visceral reflex arcs
o Visceral sensory and autonomic neurons participate including defecation
reflex (rectum is stretched by feces and smooth muscle of LE responds by
contracting the micturition reflex [smooth muscle in urine-filled bladder
contracts])
- Many are simple spinal reflexes  sensory neurons activate spinal interneurons which
activate preganglionic autonomic neurons
- Others involve cranial nerves and are integrated in the brain stem
o Baroreceptor reflex: regulates blood pressure
o When blood pressure is elevated, baroreceptors in carotid sinus (located at
junction of internal and external carotid arteries) stimulate visceral sensory
neurons in glossopharyngeal nerve.
o Integration in the cardiac center in the medulla stimulates vagus nerve
o Vagal stimulation of heart  decreases heart rate; blood pressure falls
- Some strictly peripheral reflexes
o Some branches from visceral sensory fibers w/ postganglionic motor neurons
w/in sympathetic ganglia
o Complete three-neuron reflex arcs (small sensory, motor, intrinsic neurons)
exist entirely within the wall of digestive tube  enteric nervous system
o Carry out highly localized autonomic responses involving either small
segments of an organ or a few different visceral organs
o Enable peripheral part of visceral nervous system to control some of its own
activity
CENTRAL CONTROL OF AUTONOMIC NERVOUS SYSTEM
- ANS not under direct voluntary control
- Many of activities regulated by CNS
- Sources of central control:
Control by the Brain Stem and Spinal Cord
- Reticular formation of brain stem appears to exert most direct influence over autonomic
functions
- Centers in medulla oblongata: regulate heart rate (cardiac centers), diameter of blood
vessels (vasometer center), and many digestive activities
- Periaqueductal gray matter of midbrain: controls many autonomic functions 
sympathetic fear response on threatening encounter
- Control of autonomic functions at level of spinal cord  subject to conscious inhibition
from brain
o Enables conscious control when/where eliminate wastes
Control by the Hypothalamus and Amygdaloid Body
- Hypothalamus – main integration center of ANS
o Medial and anterior parts of hypothalamus direct parasympathetic functions
o Hypothalamic centers influence preganglionic autonomic neurons in spinal
cord and brain
 Direct connections and relays in the reticular formation and
periaqueductal gray matter
- Through ANS hypothalamus controls heart activity, blood pressure, body temperature,
and digestive functions
- Amygdaloid body – main limbic region for emotions (fear)
o Through communications with hypothalamus and periaqueductal gray matter,
it stimulates sympathetic activity esp. fear-related behavior
Control by the Cerebral Cortex
- People can exert some conscious control over some autonomic functions by
developing control over thoughts and emotions
o Feelings of extreme calm achieved through meditation
 Associated w/ cerebral cortex influence on parasympathetic centers in
hypothalamus via various limbic structures
 - Voluntary sympathetic activation occurs when people decide to recall a frightful
experience
o Cerebral cortex acts through the amygdaloid body
DISORDERS OF AUTONOMIC NERVOUS SYSTEM
- Far-reaching effects (impair elimination processes and blood delivery)
1. Raynaud’s Disease
a. Characterized by intermittent attacks wherein skin of fingers and toes becomes
pale then blue and painful
b. Attack ends, vessels dilate, fingers refill w/ blood and become red
c. Provoked by exposure to cold or emotional stress
d. Exaggerated sympathetic vasoconstriction response in affected body regions
e. Severity: ranges from discomfort to extreme constriction of vessels that
gangrene (tissue death)
f. Treatment: administering drugs inhibit vasoconstriction; severe cases 
remove ganglia/cut preganglionic sympathetic fibers serving affected region
g. Common among elderly: 9% of all elderly women & 3-5% of elderly men
2. Achalasia of the cardia (“failure to relax”)
a. Some defect in autonomic innervation of esophagus  loss if organ’s ability to
propel swallowed food inferiorly
b. Smooth muscle surrounding inferior end of esophagus (cardiac sphincter)
remains contracted, preventing passage of food to stomach
c. Accumulation of food stretches esophagus to enormous width, meals cannot
be kept down
d. Cause: (usually appears in young adults) not understood
e. Treatment: longitudinal surgical incision through the muscle at the inferior end
of esophagus
3. Congenital megacolon/Hirschsprung’s Disease
a. Birth defect w/c parasympathetic and enteric innervation of distal region of LE
fails to develop normally because migrating neural crest cells fail to reach the
region
b. Feces and gas accumulation proximal to bowel immobile bowel segment,
greatly distending this area (megacolon = enlarged LE)
c. Treatment: surgical removal of inactive part of infant’s intestine
THE AUTONOMIC NERVOUS SYSTEM THROUGHOUT LIFE
- Developmental origins of structures of PNS
o All neurons w/ cell bodies in the CNS derived from neural tube
o All neurons w/ cell bodies in PNS derived from neural crest
- Somatic motor neurons and preganglionic autonomic neurons form from neuroblasts
of basal plate of neural tube
- Development of sympathetic division
o Some cells migrate ventrally from neural crest to form collateral ganglia on
aorta and adrenal medulla
o Sympathetic trunk ganglia and collateral ganglia receive axons from spinal
preganglionic neurons, in turn send postganglionic axons to visceral organs
- Development of parasympathetic division
o Postganglionic neurons derived from neural crest and reach visceral organs
by migrating along growing preganglionic axons
- Youth: impairments of visceral nervous function usually due to injuries to spinal cord
or autonomic nerves
- Advancing age: efficiency of ANS begin to decline
o Elderly people commonly constipated  autonomically controlled motility of GI
tract reduced
o Frequent eye infections  diminished formation of tears (bactericidal
enzymes)
o Pupils cannot dilate as widely/quickly
o Whenever young and healthy person rises to standing position sympathetic
division induces bodywide vasoconstriction  raise blood pressure to be
pumped to head and brain
 Response sluggish as one ages  elderly may faint if stand up too
quickly (not life threatening, easily alleviated)
 Standing up slowly to give sympathetic NS time to adjust BP
 Eye drops for dry eyes
 Drinking ample fluid alleviate constipation
CLINICAL APPLICATIONS
 Autonomic Neuropathy
o Damage to autonomic nerves; may occur as complication of diabetes
o Results in inability to control heart rate, BP, and blood sugar levels
o Digestion, respiratory functions, urination, sexual response and vision affected
o May go untreated because symptoms widespread and associated w/ other
conditions
o Detected via noninvasive heart rate variability test (HRV)
 Horner’s Syndrome
o Follows a damage to sympathetic trunk in the inferior neck region on one side
of body
o Symptoms: occur on affected side only; result from a loss of sympathetic
innervation to head and dominance of parasympathetic effects
 Drooping of upper eyelid (ptosis), pupil constriction, flushing of face,
inability to sweat
o Indicate presence of disease/infection in neck
 Stress-Induced Hypertension
o Continual stress promote overactive sympathetic stimulation causing
vasoconstriction  hypertension/ high BP
o Circulatory condition w/ variety of contributing factors
 Increases workload on heart  precipitating heart disease
 Increases wear and tear on artery walls
o Treatment: drugs that prevent smooth muscle cells in walls of blood vessels
from binding norepinephrine and epinephrine
 Mass Reflex Reaction
o Affects quadriplegics and paraplegics w/ spina cord injuries above level of T6
o Cord injury followed by temporary loss of all reflexes inferior to level of injury
 o Reflex activity returns  exaggerated due to lack of inhibitory input from higher
(brain) centers
o Ensuing episodes: surges of visceral and somatic motor output from large
regions of spinal cord
o Trigger: strong stimulus to skin/overfilling of visceral organ (bladder)
o During episode, body goes into flexor spasms, limbs move wildly, colon and
bladder empty, and profuse sweating occurs
o Sympathetic activity raises BP to life-threatening levels

DEFINITION OF TERMS
 Atonic bladder
o Bladder becomes flaccid and overfills, allowing urine to dribble out
o Results from temporary loss of micturition reflex following injury to spinal cord
 Vagotomy
o cutting/severing a vagus nerve often decrease secretion of stomach acid and
other digestive juices that aggravate ulcers