By

DR. Khairun Nisa Berawi

Medical Faculty Universitas Lampung
 Specific Learning Objective
After attending the lesson of Autonomic Nervous System
Physiology, student will be able to illustrate the normal
function of the Autonomic Nervous System

Organization of Nervous System ……

 NERVOUS SYSTEM

PERIPHERAL CENTRAL
NERVOUS SYTEM NERVOUS SYETM

MOTOR SENSORY
DIVISION DIVISION BRAIN SPINAL
CORD
AUTONOMIC SOMATIC
SYSTEM SYSTEM

Sympathetic
Organization of
Parasympathetic Nervous System
 PERIPHERAL NERVOUS SYSTEM (PNS)

Sensory neuron Motor neuron

Somatic motor Autonomic motor

neuron neuron

Innervate skeletal Innervate smooth muscle,

muscle cardiac muscle, and gland
Anatomical diff …
 ORGANIZATION OF SNS AND ANS
Anterior horn

Somatic motor neuron

Skeletal muscle
Somatic motor
Spinal cord neuron

Lateral horn
Autonomic ganglion Autonomic motor neuron

Effector organ e.g. smooth

muscle, heart, or gland

Preganglionic
Spinal cord neuron
Postganglionic neuron PERIPHERAL …….
 SUBTOPICS OF AUTONOMIC NERVOUS SYSTEM
1. Contrasting the Somatic and Autonomic Nervous System
2. Anatomy of the Autonomic Nervous System
3. Physiology of the Autonomic Nervous System
4. Regulation of the Autonomic Nervous System
5. Functional Generalization About Autonomic Nervous System
 1. CONTRASTING THE SOMATIC AND THE
AUTONOMIC NERVEOUS SYSTEMS

Objective:
Compare the structure and functional differences between the somatic
and autonomic nervous system

Organization ………….
 Anatomical differences between Somatic Nervous System and
Autonomic Nervous Syatem

Somatic Nervous Autonomic Nervous

System System

Cell body
in CNS Preganglionic
neuron
Somatic Cell body
neuron (Ganglion)
out of CNS Postganglionic
neuron

Effectors
 Functional differences between Somatic Nervous System and
Autonomic Nervous System

Somatic Nervous System Autonomic Nervous System

1. Conscious 1. Unconscious
2. Always excitatory 2. Excitatory and inhibitory (during
meal ANS stimulate the stomach
activities, during exercise inhibit)

Summarizes of differences…………
 Comparison of the Somatic and Autonomic Nervous Systems
Feature SNS
Target tissues Skeletal muscle
Regulation Controls all conscious and
unconscious movement of
skeletal muscle
Response to stimulation Skeletal muscle contract
Neuron arrangement One neuron extends from the
CNS to skeletal muscle
Neuron cell body Neuron cell bodies are in motor
location nuclei of the cranial nerves and
in the ventral horn of the spinal
cord
ANS
Smooth, cardiac muscle, and glands
Unconscious regulation, although
influenced by conscious mental
function
Target tissues are stimulated or
inhibited
Two neuron in series, the preganglioni
from CNS to ganglion, postganglion
from ganglion to effectors
Pregangiolonic neuron cell bodies are
in autonomic nuclei of the cranial
nerves and in the lateral part of the
spinal cord; postganglionic neuron
cell bodies are in the autonomic
ganglia
Continued …………
 Comparison of the Somatic and Autonomic Nervous Systems
Feature SNS ANS
Number of synapses One synapse between the Two synapses; first in autonomic
somatic motor neuron and the ganglia; second is at the target tissues
skeletal muscle
Axon sheaths Myelinated Preganglionic are myelinated;
postganglionic are unmyelinated
Neurotransmitter Acetylcholine Acetylcholine is released by
substances preganglionic neurons; either
acetylcholine and norepinephrine is
released by postganglionic neurons

Receptor molecules Receptor molecules for In autonomic ganglia, receptor

acetylcholine are nicotinic molecules for acetylcholine are
nicotinic; in target tissues, receptor for
acetylcholine are muscarinic, for
norepinephrine are  or  - adrenergic

Organization of somatic and autonomic nervous syetem ……

Assignments
1. Contrast the SNS with ANS for each the following:
a. The number of neuron between the CNS and effector organ
b. The location of neuron cell bodies
c. The structure each innervatives
d. Inhibitory or excitatory effects
e. Conscious or unconscious control

2. Why are sensory neurons not classified as somatic or

autonomic?
3. Define the terms preganglionic neuron, postganglionic
neuron, and autonomic ganglia
2. ANATOMY OF THE AUTONOMIS NERVOUS
SYSTEM

Objective:
• Compare the structural differences between the sympathetic
and parasympathetic divisions
• Describe the structure of the enteric nervous system
• Describe how sympathetic and parasympathetic axons are
distributed to organs
 ANS

SYMPATHETIC PARASYMPATHETIC

ENTERIC NERVOUS SYSTEM

Complex network of neuron cell bodies and axons within the wall of
digestive tract that composed of sympathetic and parasympathetic
 SYMPATHETIC DIVISION

1. Neuron cell bodies located in the lateral horn spinal cord gray matter between
T1 and L2 segments  called thoracolumbar division
2. The preganglionic neuron project to autonomic ganglia (sympathetic chain
ganglia = paravertebral ganglia) on either side of vertebral column behind the
parietal pleural
3. The sympathetic chain extends into cervical and sacral regions but only ganglia
from T1 – L2 that receive preganglionic axons. The cervical and sacral regions
is associated with the nearly every pair of spinal nerves
4. The cervical ganglia fuse during fetal development  only two or three pairs
exist in the adult
5. The preganglionic neuron are small and myelinated
6. The short connection between spinal nerve and a ganglion called white ramus
communicants
 SYMPATHETIC
DIVISION

Preganglionic neuron cell

bodies in the lateral horn
between T1-S2 
Thoracolumbar divison

Sympathetic chain ganglia

= paravertebral ganglia
THE ROUTES TAKEN BY SYMPATHETIC AXONS

THE ROUTES TAKEN BY SYMPATHETIC AXONS……….

 III
PARASYMPATHETIC
VII
DIVISION

IX
The cell bodies are within the
brainstem and sacral region
X

Craniosacral division
 Comparison of the Sympathetic and Parasympathetic Division
Feature Sympathetic division
Location of preganglionic Lateral horns of spinal cord
cell Bodies gray matter (T1 – L2)
Outflow from the CNS Spinal nerves
Sympathetic nerves
Splanchnic nerves
Ganglia The chain along spinal cord
for spinal and sympathetic
nerves; collateral ganglia for
splanchnic nerves
Number of postganglionic Many (much divergence)
neurons for each
preganglionic neuron
Relative length of neuron Short preganglionic
Long postganglionic
Parasympathetic division
Brainstem and lateral parts of
spinal gray matter (S2 – S4)
Cranial nerves
Pelvic nerves
Terminal ganglia near or on
effector organ
Few (less divergence)
Long preganglionic
Short postganglionic
 ENTERIC NERVOUS SYSTEM

1. Consist of nerve plexuses within the wall of the digestive tract

2. The plexuses have contributions from three sources:
a. Sensory neurons that connect the digestive tract to the CNS
b. ANS motor neurons that connect the CNS to the digestive tract
c. Enteric neurons, which are confined to the enteric plexus
3. The CNS is capable of monitoring the digestive tract through sensory
neurons and controlling its smooth muscle and gland through ANS
motor neurons
 TYPE OF ENTERIC NEURON
1. Enteric sensory neurons, detect chemical composition and
wall stretching.
2. Enteric motor neurons, stimulate or inhibit smooth muscle
contraction and gland secretion
3. Enteric interneurons, connect sensory and motor neurons
to each other.
 THE DISTRIBUTION OF AUTONOMIC NERVE FIBERS
1. Sympathetic division
a. Sympathetic axons from ganglia to target tissues pass through spinal,
sympathetic, and splanchnic nerves, head and neck nerve plexuses, thoracic
nerve plexuses, and abdominopelvic nerve plexuses
b. Sympathetic and splanchnic nerves join  autonomic nerve plexus,
complex, interconnected neural network formed by neurons of sympathetic
and parasympathetic division. They are named according to organs they
supply (cardiac plexus) or to blood vessels along which they are found
(thoracic aortic plexus).

2. Parasympathetic division
a. Parasympathetic outflow is through cranial nerve (III, VII, IX, X), and
plexuses (vagus and thoracic nerve plexuses, abdominal nerve plexuses, and
plevic nerve and pelvic nerve plexuses
 SENSORY NEURONS IN AUTONOMIC PLEXUSES
a. Not strictly part of autonomic nervous system
b. Some are part of reflex arcs regulating organ activities.
c. Transmit pain and pressure sensations from organ to CNS
d. The cell bodies of these sensory neuron are found in the dorsal root
ganglia and in certain cranial nerve (which are swelling on nerves close
to their attachment to the brain)
Assignment:
1. Where is the enteric nervous system located?. Describe the types of
neurons found in it
2. Define autonomic nerve plexuses. How are they typically named?
3. Describe the four major ways by which sympathetic axons pass from
sympathetic chain ganglia to each organs. Name four thoracic and four
abdominopelvic autonomic nerve plexuses
4. List the four major means by which parasympathetic axons reach
organs. List the cranial nerves and ganglia that supply the head and
neck. What cranial nerve supplies the thoracic and abdominal nerve
plexuses? To what plexus do pelvic nerves contribute?
 3. PHYSIOLOGY OF THE ANS
Objective: describe the major neurotransmitters and receptors of the ANS

Neurotransmitters

Preganglion
Sympathetic (cholinergic) Parasympathetic

Acetylcholine

Ganglion

Postganglion
Postganglion (Cholinergic)
(adrenergic)
Norepinephrine
 Receptors

Cholinergic receptor Adrenergic receptor

(binds to acetylcholine)
Nicotinic
 Bind to nicotin (tobacco
alkaloid)
Muscarinic
 Bind to muscarine (alkaloid
poisonous mushroom)
(binds to norepinephrine)
Alpha receptor
1  stimulatory response
2  inhibitory response
Beta receptor
1  various response
2  various response

Nicotine does not bind the muscarinic receptor

Muscarine does not bind to nicotinic receptor
Actylcholine binds other the nicotinic or muscarinic receptor
 Location of ANS receptors

Sympathetic division
Most target tissues have adrenergic receptors
 Sympathetic division
Some target tissues have muscarinic receptor

Sweat gland
Parasympathetic division
Effects and receptor types of sympathetic and parasympathetic division
on various tissues
Organ Sympathetic effects and receptor types Parasympathetic
effects and receptors
types
Adipose tissue Fat breakdown release of fatty acids (2 and 1) None
Arrector pili muscle Contrastion (1) None

Blood (platelets) Increase coagulation None

Blood vessels (arterioles):

Digestive organ Constriction (1) None
Heart Dilatation (2), constriction (1) None
Kidneys Constriction (1 & 2); dilatation (1&2) None
Lungs Dilatation (2); constriction (1) None
Skeletal muscle Dilatation (2); constriction (1) None
Skin Constriction (1 & 2) None
Blood vessels (veins) Constriction (1 & 2); dilataion (2)

Effects ………………continue
Organ Sympathetic effects and receptor types Parasympathetic effects and
receptors types
Eye
Ciliary muscle Relaxation for far vision (2) Constriction for near vision (m)
Pupil Dilated (1) Constricted (m)
Gallbladder Relaxation (2) Constriction (m)
Glands
Adrenal Release of epinephrine & norepinephrin (n) None
Gastric Decrease gastric secretion (2) Increase gastric secretion (m)
Lacrimal Slight tear production () Increase tear secretion (m)
Pancreas Decrease insulin secretion (2) Increase insulin secretion (m)
Decrease exocrine secretion () Increase exocrine secretion (m)
Salivary Blood vessel constriction; produce thick and Blood vessels dilation ; produce
viscous saliva thin and copious saliva (m)
Sweat
• Apocrine Thick, organic secretion (m) None
• Merocrine Watery sweat from most of the skin (m); sweat None
from palms and soles (1)

Continue ………….
Organ Sympathetic effects and receptor types Parasympathetic effects and
receptors types
Heart Increases rate and force of contraction (2 & 2) Decreases rate (m)
Liver Glucose released into blood (1 & 2) None
Lungs Dilates air passageways (2) Constricts airpassageways (m)

Metabolism Increases up to 100% ( & ) None

Sex organs Ejacutaion (1); erection Erection (m)

Skeletal muscle Breakdown glycogen to glucose (2) None

Stomach and
intestines
•Wall Decreases tone (1, 2 & 2) Increases motility (m)
•Sphincter Increases tone (1) Decreases tone (m)
Urinary baldder
•Wall (detrusor) None Contraction (m)
•Neck of bladder Contraction (1) Relaxation (m)
•Internal urinary Contraction (1) Relaxation (m)
spihincter
Assignments:
1. Define cholinergic and adrenergic neurons. Which neurons of the ANS
are cholinergic and adrenergic
2. Name the two major subtypes of cholinergic receptors. Where are they
located? When acetylcholine bind to each subtype, does it result in an
excitatory or inhibitory cell responses?
3. Name the two major subtypes of adrenergic receptors. Where are they
located?
4. On what part of the cell are  and  - adrenergic receptors typically
found? How are they typically stimulated? What type of response is
generally produced when there are stimulated?
 4. REGULATION OF THE ANS
Objectives
• Expalin how autonomic and local reflexes help to maintain homeostais
• Describe the role of the hypothalamus in controlling the ANS

1. To maintain homeostasis, the structures innervated by ANS are

regulated through the autonomic reflexes
2. Input come from cerebrum, hypothalamus, and other area as
conscious thoughts and actions, emotions, and other CNS
activities
a. Parasympathetic reflex
b. Sympathetic reflex
c. Influence of higher part of the brain on autonomic functions

Thought and emotion influence

ANS through hypothalamus

ANS integrating center that

interact with cerebrum, limbic
system, brainstem, spinal cord;
also regulate the body temperature

ANS reflex centers for controlling

pupil size, accommodation, tear
production, salivation, coughing,
swallowing, digestive activities,
blood vessels diameter, and
respiration
ANS reflex centers for regulating
defecation, urination, penile and
clitoral erection, and ejaculation
Assignments:
1. Name the components of an autonomic reflex. Describe the
autonomic reflex that maintain blood pressure by altering heart rate
or the diameter of blood vessels
2. What part of the CNS stimulate ANS reflexes and integrates
thought and emotions to produce ANS responses?
3. Define a local reflex. Explain how the enteric nervous system
operates to produce local reflexes?
 5. FUNCTIONAL GENERALIZATION ABOUT THE ANS

Objective: Describe the generalizations that can be made about the ANS, and expalin the
limitation of these generalizations.

Stimulatory versus inhibitory effects

 One division of ANS can be as stimulatory and or inhibitory

Dual innervation
 Most organ innervated by both sympathetic and parasympathetic
 Dual innervation is not universal
 Structures receive dual innervation are not regulated equally by both division
 Opposite effects
 The two division that innervate a single structure always produce opposite effects
 The ANS can increase or decrease the activity of the structure
 In a few instances, the effects is not clearly opposite

Cooperative effects
 One autonomic division can coordinate the activities of a different structures
 Both division of ANS can act together to coordinate the activity of a different
structures
 General versus localized effects
 The sympathetic division has a more general and longer effects than the
parasympathetic division
 The sympathetic division diverges more than parasympathetic
 The sympathetic stimulation often activates many different kind of effector organs
at the same time as a result of CNS stimulation or norepinephrine/epinephrine
release from adrenal medulla
 Functions at rest versus activity
 Sympathetic division influences under active or stress condition referred to “flight –
or fight response”
 Parasympathetic division influences under resting condition

During exercise
1. Increases heart rate and force of contraction; increase blood pressure and
movement
2. Oxygen, nutrient consumption, waste product are increased
3. Blood flow into tissue increase; reduces blood flow into tissues not involve in
exercise by vasoconstriction making blood more available for the exercising tissues
4. Dilatation of air passageway
5. Increases the availability of energy sources. Muscle and liver stimulated to break
down glycogen into glucose
6. Exercising muscle generate heat, body temperature increase
7. The activity of organs not essential for exercise decrease
Assignments:
1. What kind of effects, excitatory or inhibitory, are produced by the
sympathetic and parasympathetic divisions?
2. Give two exceptions to the generalization that organs are innervated
by both division of ANS
3. When a single organ is innervated by both ANS divisions, do they
usually produce opposite effects?
4. Explain how the ANS coordinates the activities of a different organs
5. Which ANS division produces the most general effects? How does
this happens?
6. Explain the “fight – or – flight response”
 CRITICAL THINKING
1. When a person is startled or sees a “pleasurable” object, the pupil of the eyes may
dilate. What division of the ANS is involved in this reaction? Describe the nerve
pathway involved
2. Reduced secretion from salivary and lacrimal glands could indicate damage to
what nerve?
3. In patient with Reynaud’s disease, blood vessels in the skin of the hand may
become chronically constricted, thereby reducing blood flow and producing
gangrene. These vessels are supplied by nerves that originate at levels T2 and T3
of the spinal cord and eventually exit through the first thoracic and inferior
cervical sympathetic ganglia. Surgical treatment for Reynaud’s disease sever this
nerve supply. At which of the following location would you recommend that the
cut be made: white rami T2 – T3, gray rami of T2 – T3, spinal nerves, or spinal
nerves C1 – T1? Explain.
Critical thinking continued………
4. Patients with diabetes mellitus can develop neuropathy, which is damage to parts of the
autonomic nerves. Given the following part of the ANS – vagus nerve, splanchnic
nerve, pelvic nerve, cranial nerve, outflow of gray ramus – match the part with the
symptom it would produce if the part were damaged:
a. Impotence
b. Subnormal sweat production
c. Gastric atony and delayed emptying of the stomach
d. Diminished pupil reaction (constriction) to light
e. Bladder paralysis with urinary retention
Critical thinking continued ….
5. Explain why metacholine, a drug that act like acetylcholine, is effective for treating
tachycardia (heart rate faster than normal). Which of the following side effects would
you predict: increased salivation, dilatation of the pupil, sweating, and difficulty in
taking a deep breath?
6. A patient has been exposed to the organophosphate pesticide malathion, which
inactivates acetylcholinesterase. Which of the following symptoms would you
predict: blurring of vision, excess tear formation, frequent or involuntary urination,
pallor (pale skin), muscle twitching, or cramps? Would atropine be an effective drug
to treat the symptoms? Explain.
7. Epinephrine is routinely mixed with local anesthetic solution. Why?
Critical thinking continued ……….
8. A drug blocks the effect of the sympathetic division on the heart. Careful
investigation reveals that after administration of the drug, normal action potentials are
produced in sympathetic preganglionic and postganglionic neurons. Also, injection of
norepinephrine produces a normal response in the heart. Explain, in as many ways as
you can, the mode of action of the unknown drug.
9. A drug is known to decrease heart rate. After the cutting the white rami of T1 – T4,
the drug still causes heart rate to decline. After cutting the vagus nerves, the drug no
longer affects the heart rate. Which division of ANS does the drug affect? Does the
drug have its effect at the synapse between postganglionic neurons and effector
organs, or in the CNS? Is the effect of the drug excitatory or inhibitory?
10. Make a list of the responses controlled by ANS in (a) a person who is extremely angry
and (b) a person who has just finished eating and is relaxing.