1. AUTONOMIC NERVOUS SYSTEM PRESENTED BY: LAHARI PALADUGU PHARM D (09-10)

2. DEFINITION The autonomic nervous system (ANS or visceral nervous system or involuntary nervous system) is the part of the peripheral nervous system that acts as a control system, functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiratory rate, salivation, perspiration, pupillary dilation, micturition, and sexual arousal. Most autonomous functions are involuntary but a number of ANS actions can work alongside some degree of conscious control.

3. LOCATION medulla oblongata in the lower brainstem Within in the brain, the autonomic nervous system is located in the medulla oblongata in the lower brainstem. hypothalamus limbic system The hypothalamus, just above the brain stem, acts as an integrator for autonomic functions, receiving ANS regulatory input from the limbic system to do so.

4. DIVISIONS ANS Functional SympatheticParasympathetic Enteric Anatomical ThoracolumbarCraniosacral Chemical AdrenergicCholinergic Non-cholinergic, non-adrenergic

6. SYMPATHETIC NERVOUS SYSTEM It has: -A central controlling part lateral horn posterior hypothalamus -A peripheral portion which takes origin in the lateral horn of the spinal cord from T1 to L2. The main cerebral controlling center is the posterior hypothalamus. -The peripheral portions has: -Afferent fibers -Efferent fibers

7. (THORACOLUMBAR) OUTFLOW OF SYMPATHETIC FIBERS the lateral horn of the spinal cord T1 to L2/3. Consists of cell bodies in the lateral horn of the spinal cord (intermediolateral cell columns) from T1 to L2/3. thoracolumbar outflow Because its cells begin in the thoracic and lumbar regions of the spinal cord, the SNS is said to have a thoracolumbar outflow.

9. ORGANIZATION. T1L2 spinal cord anterior root Take origin from the lateral horn cells of T1 to L2 and come out of the spinal cord via the anterior root. Axons anterior rootlet/rootspinal (sensory) ganglionanterior rami white rami connectors paravertebral prevertebral ganglia Axons of these nerves leave the spinal cord through the anterior rootlet/root. They pass near the spinal (sensory) ganglion, where they enter the anterior rami of the spinal nerves. However, unlike somatic innervation, they quickly separate out through white rami connectors that connect to either the paravertebral (which lie near the vertebral column) or prevertebral (which lie near the aortic bifurcation) ganglia extending alongside the spinal column.

10. SYNAPTIC TRANSMISSION. synaptic transmission synapse neurotransmitter To reach target organs and glands, the axons must travel long distances in the body, and, to accomplish this, many axons relay their message to a second cell through synaptic transmission. The ends of the axons link across a space, the synapse, to the dendrites of the second cell. The first cell (the presynaptic cell) sends a neurotransmitter across the synaptic cleft where it activates the second cell (the postsynaptic cell). The message is then carried to the final destination.

11. SOME TERMS… ganglia preganglionic cell postganglionic cell. Postganglionic cells have their cell bodies in the ganglia and send their axons to target organs or glands. In the SNS and other components of the peripheral nervous system, these synapses are made at sites called ganglia. The cell that sends its fiber is called a preganglionic cell, while the cell whose fiber leaves the ganglion is called a postganglionic cell. As mentioned previously, the preganglionic cells of the SNS are located between the first thoracic segment and third lumbar segments of the spinal cord. Postganglionic cells have their cell bodies in the ganglia and send their axons to target organs or glands.

12. paravertebral ganglia prevertebral ganglia Presynaptic nerves' axons terminate in either the paravertebral ganglia or prevertebral ganglia. There are four different ways an axon can take before reaching its terminal: 1 Axon enters the paravertebral ganglion at level of its originating spinal nerve 2 Synapse in the ganglion, ascend to a more superior paravertebral ganglion 3 Descend to a more inferior paravertebral ganglion and synapse there 4 Or it can descent to a prevertebral ganglion and synapse there with a postsynaptic cell

13. The postsynaptic cell then goes on to innervate the targeted end effector (i.e. gland, smooth muscle, etc.). Because paravertebral and prevertebral ganglia are relatively close to the spinal cord, presynaptic neurons are generally much shorter than their postsynaptic counterparts, which must extend throughout the body to reach their destinations. The ganglia include not just the sympathetic trunks but also the cervical ganglia (superior, middle, and inferior), which sends sympathetic nerve fibers to the head and thorax organs, and the celiac and mesenteric ganglia (which send sympathetic fibers to the gut).

14. AN EXCEPTION… THE ADRENAL MEDULLA Specialized ganglion of the SNS. Presynaptic neurons pass through paravertebral ganglia, on through prevertebral ganglia and then synapse directly with suprarenal tissue. This tissue consists of cells that have pseudo- neuron like qualities in that when activated by the presynaptic neuron, they will release their neurotransmitter (epinephrine) directly into the blood stream. chromaffin cells adrenal medulla Preganglionic fibers synapse directly on chromaffin cells in the adrenal medulla. epinephrine and norepinephrine These chromaffin cells secrete epinephrine and norepinephrine into the circulation.

16. MECHANISM OF ACTION. Fight or flight reaction The SNS is designed for a quick immediate and massive action and in conjunction with adrenal medulla initiate reactions in conditions of stress… Fight or flight reaction.

17. MECHANISM… catecholamines Its effect is mediated by catecholamines through three types of receptors: α- receptorsβ-receptorsepinephrine and norepinephrine are mediated by α- receptors and β-receptors α 1 -receptorsα 1 -receptors α 2 -receptorsα 2 -receptors β 1 -receptorsβ 1 -receptors β 2 -receptorsβ 2 -receptors D receptorsdopamine action is mediated through D receptors

21. PARASYMPATHETIC NERVOUS SYSTEM (CRANIOSACRAL SYSTEM) "rest-and-digest" “feed and breed” The parasympathetic system is responsible for stimulation of "rest-and-digest" or “feed and breed” activities that occur when the body is at rest, especially after eating, including sexual arousal, salivation, lacrimation, urination, digestion, and defecation complementary to the sympathetic nervous system. Its action is described as being complementary to the sympathetic nervous system.

22. LOCATION. S2, S3, and S4 spinal nerves third, seventh, ninth, and tenth cranial nerves "craniosacral outflow", Parasympathetic nerve fibers arise from the central nervous system with the S2, S3, and S4 spinal nerves and from third, seventh, ninth, and tenth cranial nerves. Because of its location, the parasympathetic system is commonly referred to as having "craniosacral outflow", which stands in contrast to the sympathetic nervous system, which is said to have "thoracolumbar outflow". The parasympathetic nerves that arise from the S2, S3, and S4 spinal nerves are commonly referred to as the pelvic splanchnic nerves or the "nervi erigentes".

23. PATHWAYS. anterior hypothalamus The main controlling center is present in the anterior hypothalamus. The parasympathetic nervous system also has: 1) Afferent fibers 2) Efferent fibers afferent fibers detection of volume and pressure changes The afferent fibers are concerned with the detection of volume and pressure changes in the viscera. efferent fibers secretomotor activity The efferent fibers are concerned with secretomotor activity of the viscera.

24. OUTFLOW. The outflow has two divisions: 1) Cranial division 2) Sacral division

25. CRANIAL DIVISION. Preganglionic neurons Edinger- Westphal nucleus Inferior salivary nucleus Dorsal nucleus and nucleus ambiguous of the vagus Superior salivary nucleus

26. preganglionic nerve fibers The preganglionic nerve fibers of these neurons synapse in the appropriate ganglia. These ganglia are present near the target organ. Postganglionic nerve fibers Postganglionic nerve fibers starts from these ganglia and supply to the organ. Preganglionic fibers are longer and the postganglionic fibers are shorter.

27. CRANIAL DIVISION. The cranial outflow is through III, VII, IX, and X.  Occulomotor – III  Constrictor pupillae  Ciliaris  Facial – VII  Lacrimal gland  Submaxillary gland and sublingual gland  Glossopharyngeal – IX  Parotid gland  Vagus – X  CVS, RS, GIT, up to transverse colon.

28. SACRAL DIVISION the lateral horns of sacral segments (S2, S3, and S4). The preganglionic neurons are present in the lateral horns of sacral segments (S2, S3, and S4). anterior root nervi erigentis or pelvic nerve Preganglionic fibers come out through the anterior root and form nervi erigentis or pelvic nerve. target organ The postganglionic neurons are present in the target organ itself. descending colon, sigmoid colon, and rectumurinary bladder, erectile tissue of the penis and the uterus. Nervi erigentis supplies the descending colon, sigmoid colon, and rectum. It also supplies the urinary bladder, erectile tissue of the penis and the uterus.

30. RECEPTORS acetylcholine (ACh) neurotransmitterpeptides cholecystokinin The parasympathetic nervous system uses chiefly acetylcholine (ACh) as its neurotransmitter, although peptides (such as cholecystokinin) may act on the PSNS as a neurotransmitter. muscarnicnicotinic cholinergic The ACh acts on two types of receptors, the muscarnic and nicotinic cholinergic receptors. preganglionic nerve releases ACh at the ganglion nicotinic receptors of postganglionic neuronspostganglionic nerve then releases ACh to stimulate the muscarinic receptors of the target organ Most transmissions occur in two stages: When stimulated, the preganglionic nerve releases ACh at the ganglion, which acts on nicotinic receptors of postganglionic neurons. The postganglionic nerve then releases ACh to stimulate the muscarinic receptors of the target organ.

31. NICOTINIC RECEPTORS.

32. MUSCARNIC RECEPTORS.

33. INTERACTION OF THE TWO DIVISIONS… SNS & PSNS. Most of the organs receive dual nerve supply. Though the actions of these two systems appear to be opposed, they are in-fact complementary. Depending on the situation at one moment, the sympathetic dominates and the PSNS is inhibited and in the next moment, the PSNS dominates and the SNS is inhibited.

34. ENTERIC NERVOUS SYSTEM. Consists of intramural nerve plexesus: (a) myenteric plexus (b) Meissner’s plexus (b) Meissner’s plexus sensory, motor, and interneurons. These are present in the GIT and contain the sensory, motor, and interneurons. Their activity is modulated by the sympathetic and parasympathetic nerve fibers. Several neurotransmitters are associated with this system. They influence -Smooth muscle: peristalsis and villi movements -Gland secretion: of enzymes, electrolytes, and the mucous -Blood vessels: alter blood flow -APUD cells: release of various GIT hormones

35. CENTRAL CONTROL OF THE AUTONOMIC NERVOUS SYSTEM.

38. DISORDERS OF THE ANS. -Autoimmune autonomic gangliopathy -Congenital central hypoventilation syndrome -Familial dysautonomia -Holmes-Adie syndrome -Horner syndrome -Multiple system atrophy -Neurally mediated syncope -Orthostatic hypotension -Postural tachycardia syndrome -Striatonigral degeneration -Vasovagal syncope -Erectile dysfunction -Etc……

39. DRUGS AFFECTING AUTONOMIC ACTIVITY.

40. REFERENCES. 1)https://en.wikipedia.org/wiki/Sympathetic_nervous_syste mhttps://en.wikipedia.org/wiki/Sympathetic_nervous_syste m 2)https://en.wikipedia.org/wiki/Parasympathetic_nervous_s ystemhttps://en.wikipedia.org/wiki/Parasympathetic_nervous_s ystem 3)http://www.nlm.nih.gov/medlineplus/autonomicnervoussy stemdisorders.htmlhttp://www.nlm.nih.gov/medlineplus/autonomicnervoussy stemdisorders.html 4)http://www.dana.org/news/brainhealth/detail.aspx?id=978 0http://www.dana.org/news/brainhealth/detail.aspx?id=978 0 5)Fundamentals of Medical Physiology 4 th Edition – LPR 6)BRS Physiology 5 th edition - Costanzo