Autonomic Nervous system -Dr Najeeb.

Also called General visceral efferent system. (has some sensory fibres as-well)

Supplies all Smooth muscles in the body, all glandular tissue in the body, myocardium. (involuntry)

ANS Innervates all innervated structures of the body, except NMJ (Neuromuscular junctions) of
Skeletal muscles.

Anteromedial part of Hypothalamus = Parasympathetic outflow.

Postero-lateral part of Hypothalamus = Sympathetic.

Limbic system = Emotions, short term memory, Smell, also concerned with species survival and
perpetuation. All parts of brain engage with Limbic system.
Limbic system alters Hypothalamus ANS.

Cranial Nerves 3, 7, 9, 10 have parasympathetic outflows

Sympathetic system
Hypothalamic nucleus stimulates pre-ganglionic sympathetic fibres from T1 to L2.
Therefore thoraco-lumbar outflow is considered sympathetic.

Interomedial horn (lateral horn) = pre ganglionic fibres come out bilaterally.

Small dopaminergic interneuron in Sympathetic ganglion’s.

All preganglionic neurons are cholinergic. (even motor neurons, going neuromuscular junctions)

Preganglionic Fibres are myelinated...?!

Sympathetic chain = paravertebral ganglia

Gray Rami communicants, connect paravertebral sympathetic ganglion with spinal nerves. White
matter connects sympathetic chain, only from T1- L3. (sweat glands, muscles .Body wall structures,
and limbs.)
also pre-vertebral glanglia goes directly to effecto organ. (; celiac ganglion; superior mesenteric
ganglion; or inferior mesenteric ganglion.hypogastric ganglion.). (do not make a chain); usually
these fibres go around blood vessels, and innervate viscera. Eg Splanchin nerves, or cardiac nerves.
Heart is supplied by sympathetic root values T1-T5 (you hold your heart in five fingers. The ascend
upward into cervical ganglia, and then makeup cardiac nerves.

Adrenal medulla is innervated by presynaptic sympathetic fibres. Consists of many sympathetic

ganglia. Post ganglionic fibres have degenrated their axons. Adrenal medulla, do not have no
postganglionic axons. So they pour out their substances, mainly NE, but also E.

All sympathetic Stimulated tissues in Fight or flight response, have Alpha1 adrenergic receptors,
except, Heart B1, Juxtaglomerular cells B1, in the kidney, and Lipocytes (have modified Beta
1(called Beta3). These tissues have Beta 1 adrenergic receptors rather.
All sympathetic inhibited tissues in fight or flight response should have, Beta 2 adrenrgic
receptors.except, presynaptic nerves with Alpha2, platelets with Alpha2, and some part of GIT with
Alpha 2.

Coronary and Cerebral circulation are regulated by auto-regulation, not left to mercies of
fluctuations of ANS, .... except Prinz-metal angina,.. over stimulation of sympathetic nervous
system..
Sympathetic overflow. (Freefatty acid must go up) from adipocytes; Glycogenesis is inhibited B2,
Lipogenesis is inhibited.
Glucose must increase... therefore insulin secretion must decrease, inhibited beta cells in pancreas
has alpha 2 receptors.

Why is potassium released from liver cells, because so much glucose is released. Skeletal muscles
are working very hard, also causes potassium to be pumped out. Sodium goes into muscles,
potassium is therefore coming out, and must be immediately be shifted. Sodium/potassium atpases
are present in every cell and are very sensitive to epinephrine. Therefore, the increased potassium is
pumped back esp in muscle cells. Muscle spindles = intrafusal fibres.
When muscle spindles are over stimulated by epinephrine become desynchronised and unstable.
CNS sees the muscles activity through muscle spindles, thereby imbalance between flexor and
extensor, therefore tremors. Muscle spindles contain Beta2 receptors. Therefore salbutamol, can
produce tremors, Hyperkalemia, and hyperglycemia.

Thyrotoxicosis: (remember, E, and NE cannot cross Blood brain barrier, because they are highly
polar.) T3 and T4 induce the formation of adrenergic receptors. Thereby more/ increased
Sympathetic response (experienced) sympathomimetic activity... tachycardia, anxiety, tremors...
Beta 1- Gs- Adenylyl cyclase, - Phosphokinase A- Cations flush in. Calcium enters excitable cell
making cell more excitable. Resting membrane potential will more easily achieved, therefore
making SA Node fire more rapidly.
SA node, has leaky membranes, always allowing calcium to enter. Resting membrane potential have
come near to threshold potential, and it increase the rate at which it achieves threshold. More
effectively conduct, contract, excite....

Ligand binding domain- acetylcholine

Gi- Ginhibitory – M2 receptor. Adenylyl cyclase decreased. Atp to Camp reduced, reduced
Phosphokinase A, decreased phosphorylation of calcium channel. Cationic loading is decreased.
S and PS antagonism
Sympathetic activity inhibits PS activity, alpha 2 presynaptically. And vagal inhibition of
Sympathetic nerve ending M2 receptor.
Also Gs and Gi antagonism
cyclic amp is constantly being broken down... =phosphodiesterase – can be inhibited by caffeine.
PS stimulates phosphosiesterase.
Dephosphorylates calcium channels. Reducing calcium ions.
PS stimulated causes potassium efflux. Causing decreased cations in cells. Because Beta inhibitory
and gamma inhibitory subunits under PS are effected....
 Parasympathetic Nervous system
Anteromedial aspect of Hypothalamus.
<Cranial sacral outflow.
Stimulate brain stem , pons and medullary centre.
Brainstem nucleus = Edinger westpal nucleus.- cilliary ganglion – short cilliary nerve. Ciliary
muscle, sphincter pupilae muscle.
Pons= Superior salivatory (Lacrimatroy) nucleus and. Go with 7th cranial nerve... go to pterygoid-
palatine ganglon. - Lacrimal glandand nasal and palatine galnds. + submandibular gland.
Inderior salivatory nucleus – takes sensory information from carotid body. ninthe cranial nerve- otic
ganglion – parotid gland (auriculotemporal nerve branch)
Medulla = Dorsal nucleus of vagus. Right vagus (Sa node) and left vagus (AV node). Vagus also
takes sensory information back from lungs, as to how full they are.- 10th nerve – 1) Pharynx, larynx,
eosophagus, heart, lungs, stomach, duodenum, jejunum, ileum, cecum, ascending and transverse
colon (up to splenic flexure) .... - intramural ganglion.
Sacral units (S2,3,4)- lower abdominal organs, and pelvic organs.sigmoid colon, rectum. Urinary
bladder and genitalia. Glands and smooth muscle. - Intramural ganglion.
Long preganglionic fibres. Short postganglionic fibres.
Why does sphincter pupillae contract under m3. Gq- phospholipase c – PIB (phosphatidyl ionsitol
diphosphate) to...diacetylglycerol, and IP3, Ca2+ increases- calcium loading mechanism; calcium-
calmodulin mechanism.... But different to the heart.
Does not stimulate Diffusely (like sympathetic) but rather stimulates discretely.
In the heart PS outflow, only affects SA and AV node, and does not affect Ionotropy or dronotropy,
like S system.
Part 5.
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