Autonomic

Nervous System(ANS)

DR. ALHAJI GBLA

INTERNAL MEDICINE REGISTRAR

1
 The Nervous System

is divided into

Peripheral nervous
Central nervous
system
system

which consists of Sensory nerves

Motor nerves

that make up

Somatic nervous Autonomic nervous

system system

which is divided into

Sympathetic Parasympatheti Enteric nervous

nervous system c nervous system
system

2
 Autonomic nervous
system
• The autonomic nervous system is the subdivision of the
peripheral nervous system that regulates body activities that are
generally not under conscious control (or) responsible for
control of involuntary or visceral body functions.

• The A.N.S composed of efferent neurons that innervates smooth

muscle of the viscera, cardiac muscle ,vasculatures & the
exocrine gland ,cardiac output, blood flow & glandular
secretion.

3
 Autonomic nervous
system
Divisions of the autonomic nervous system:
• Parasympathetic division
• Sympathetic division
Serve most of the same organs but cause opposing or antagonistic
effects.
• Parasysmpathetic: routine maintenance “rest &digest”.

• Sympathetic: mobilization & increased metabolism “fight, flight or

fright”.

• Efferent (Motor) Nerve : Carry impulses from CNS (brain and spinal
cord) to muscle or organ (peripheral tissues).

• Afferent (Sensory)Nerve :Neuron which transmits impulses from

sense organs (bring information from periphery ) to CNS

4
 Introduction (efferent
neurons)
• Efferent (motor)neuron carries nerve impulse from CNS to the effector organ by
way of two types of efferent neurons.
• First nerve is called Preganglionic neuron
and its cell body is located in the CNS.
• Preganglionic neurons emerge in the brain stem or spinal cord and makes a
synaptic connection in the ganglia.
• The ganglia function as a relay station between a preganglionic neuron and
second
nerve cell (postganglionic neuron)
• The postganglionic neuron has a cell body originating in the ganglia and terminates
on effector organ.

5
 Introduction to somatic motor
neurons
• Somatic efferent neurons are involved in the voluntary contol of
function such as contraction of the skeletal muscle.

• Input from sense organs & out put to skeletal muscle.

6
 Autonomic and Somatic Motor
Systems
Autonomic motor system
Chain of two motor neurons
•Preganglionic neuron
•Postganglionic neuron
Conduction is slower due to
thinly or unmyelinated
axons
Somatic motor system
One motor neuron extends
from the CNS to skeletal
muscle
Axons are well myelinated,
conduct impulses rapidly

7
Differences Between somatic &
Autonomic Nervous System
Differences Somatic Autonomic
No of neurons in efferent path 1 2
way
Neurotransmitter / receptor Ach/nicotinic Ach/ Muscarinic (or) N.E/ Alpha
at neuron target synapse or beta
Target tissue Skeletal muscle Smooth & cardiac muscle, some
endocrine & exocrine
Glands , some adipose tissue.
Neurotransmitter released Axon terminals Varicosities & axon terminals
from
Effects on target tissue Excitatory only, Excitatory or inhibitory.
Muscle contracts.
Peripheral components found Axons only Preganglionic axons, ganglia,
outside the CNS postganglionic neurons.
Summary of functions Posture & movement Visceral functions , including
Movement in internal organs &
secretion , control of
metabolisium. 51
 Sympathetic Nervous
(fight, flight or fright)
•
system
Also called thoracolumbar system: all its neurons are in lateral horn of gray matter
from T1-L3.
• Preganglionic neuron of the sympathetic system comes from thoracic and lumbar region
of the spinal cord and they synapse in the two cord like chain of ganglia that run parallel
on each side of the spinal cord.
• Preganglionic neurons are short ,. Postganglionic neurons are long
• Axons of the postganglionic neuron extended from these ganglion to the tissue that they
innervate and regulate.
• The adrenal medulla (large synaptic ganglion receives preganglionic fiber from the
sympathetic system.
• The adrenal medulla in response to stimulation secretes epinephrine also known as
adrenaline, and lesser amount of norepinephrine into the blood.

9
 Somatic Motor Fiber Skeletal
Ach
Muscle
Ganglion Postganglionic
Adrenergic Fiber; Smooth
Sympathetic Ach NE Muscle
Cardiac Cells
Gland Cells
Sympathetic Ganglion
Sweat
Ach Ach Glands

Sympathetic
EPI/NE
Ach
Adrenal Gland
Para-
sympathetic Ganglion
Smooth
Ach Ach Muscle
Cardiac Cells
Neurotransmitter released by preganglionic axons Gland Cells
•Acetylcholine for both branches (cholinergic)
Neurotransmitter released by postganglionic axons
• Sympathetic – most release norepinephrine
(adrenergic) 9
• Parasympathetic – release acetylcholine
 Role of the Sympathetic
Division
• The sympathetic division is the “fight-or-flight” system
• Involves E activities – exercise, excitement, emergency,
and embarrassment
• Promotes adjustments during exercise – blood flow to
organs is reduced, flow to muscles is increased
• Its activity is illustrated by a person who is threatened
– Heart rate increases, and breathing is rapid and
deep
– The skin is cold and sweaty, and the pupils
dilate
Sympathetic Division of the
ANS
 The Role of the Adrenal Medulla in
the Sympathetic Division
•Adrenaline (also called epinephrine) is produced in
the medulla of the adrenal glands.

•The adrenal glands are located on the top of each

kidney.

•The sympathetic nervous system stimulates the

adrenal gland (an effector) to release the hormone
adrenaline or epinephrine into the bloodstream.

•Adrenaline is a modified amino acid hormone.

The target tissue for adrenaline is mainly
cardiac and skeletal muscle.

•Adrenaline increases heart rate and blood

pressure providing more oxygen to working
muscles.

• It also increases blood sugar levels providing

more energy to cardiac and skeletal muscles.
Role of the Parasympathetic
Division
• Concerned with keeping body energy use low
• Involves the D activities – digestion, defecation, and
diuresis
• Its activity is illustrated in a person who relaxes after
a meal
– Blood pressure, heart rate, and respiratory rates
are low
– Gastrointestinal tract activity is high
– The skin is warm and the pupils are constricted

Parasympathetic neurons
Allow body to function under Rest and digest
(Rest and Digest)
 Pre-ganglionic fiber rises from the cranium(cranium fibers)
[III , VII, IX, X]and from sacral region of the spinal cord and
synapse in ganglia near or on the effector organ.
 Cranial outflow
 III –oculomotor nerve(- pupils constrict)
 VII -facial nerve –( tears, nasal mucus
 IX -glossopharyngeal nerve(parotid salivary gland)
 X –vagus nerve(visceral organs of thorax & abdomen):
Stimulates digestive glands
Increases motility of smooth muscle of digestive tract
Decreases heart rate
Causes bronchial constriction
 Sacral outflow (S2-S4): form pelvic splanchnic nerves
 Innervates organs of the pelvis and lower abdomen
 Supply 2nd half of large intestine
 Supply all the pelvic (genitourinary) organs
 Preganglionic fibers are long
 Postganglionic fibers are short , with a
ganglia close or with in the organ.
Summary of parasympathetic neurons
and neurons
Preganglionic synapses
• Long
• Synapse with postganglionic neurons at ganglia.
• Release acetylcholine (ACH) to activate nicotinic receptors on postganglionic
neurons

Postganglionic neurons
• Short
• Synapse on the target organ
• Release acetylcholine (ACH) to activate muscarinic receptors on the target
organ
 INNERVATION BY THE
A.N.S
ORGAN RECIEVING ONLY
DUAL INNERVATION SYMPATHETIC INNERVATION

• Most organs in the body are • The adrenal medulla, pilomotor

innervated by both divisions of the muscle and sweat glands.
A.N.S.
• Despite this dual innervation one • The control of blood pressure is also
system usually predominates in mainly a sympathetic activity with
controlling the activity of a given essentially no participation by the
organ. parasympathetic system
Ex: In the heart vagus nerve is the
predominant factor for controlling
rate.
 Enteric
neurons
• It is third division of ANS
• It is collection of nerve fibers that innervates the GIT, Pancreas and Gall
Bladder
• This system function independently of the CNS and control the
motility, exocrine and endocrine secretion and micro-circulation of the
GIT.
• It is modulated by both sympathetic and parasympathetic nervous
system.
 Megacolon
• Hirschsprung disease – hereditary defect
causing absence of enteric nervous system
– no innervation in sigmoid colon and rectum
– constricts permanently and will not allow passage of
feces
– feces becomes impacted above constriction
– megacolon – massive dilation of bowel accompanied
by abdominal distension and chronic constipation
– maybe colonic gangrene, perforation of bowel, and
peritonitis
– usually evident in newborns who fail to have their first
bowel movement 15-25
Neurotransmitter in sympathetic
and parasympathetic nervous
system
 DIFFERENCES BETWEEN
SNS&PNS
SNS PNS

ORIGIN DORSO-LUMBAR(T1 TO L2 OR L3) CRANIOSACRAL(III,VII,IX,X AND

S2-S4)

DISTRIBUTION WIDE LIMITED

GANGLIA AWAY FROM ORGANS ON/ CLOSE TO THE ORGANS

POST GANGLIONIC FIBRES LONG SHORT

PRE:POST FIBRES RATIO 1:20 TO 1:100 1:1 TO 1:2

TRANSMITTER NE (MAJOR) Ach

Ach (MINOR)

STABILITY OF TRANSMITTER NA Ach (RAPIDLY DESTROYS)

STABLE

IMPORTANT TACKLING STRESS & ASSIMILATION OF FOOD

FUNCTION EMERGENCY ,CONSERVATION OF ENERGY
 Adrenergic
Receptors
 α1-receptors: vasoconstriction, relaxation
of gastrointestinal smooth muscle, salivary
secretion and hepatic glycogenolysis

 α2-receptors: inhibition of transmitter

release (including noradrenalin and
acetylcholine release from autonomic
nerves), platelet aggregation, contraction of
vascular smooth muscle, inhibition of insulin
release

 β1-receptors: increased cardiac rate and

force

 β2-receptors: bronchi dilatation,

vasodilatation, relaxation of visceral smooth
muscle, hepatic glycogenolysis and muscle
tremor

 β3-receptors: lipolysis. 23
 Cholinergic
Receptors
• The two types of receptors that bind ACh are nicotinic and muscarinic
• These are named after drugs that bind to them and mimic ACh effects.
Nicotinic receptor
• Nicotinic receptors are found on:
– Motor end plates (somatic targets)
– All ganglionic neurons of both sympathetic and parasympathetic divisions
– The hormone-producing cells of the adrenal medulla
• The effect of ACh binding to nicotinic receptors is always stimulatory.

Muscarinic receptor
• Muscarinic receptors occur on all effector cells stimulated by postganglionic
cholinergic fibers
• The effect of ACh binding:
– Can be either inhibitory or excitatory
– Depends on the receptor type of the target organ
 Regulation of
 Autonomic reflexesANS
control most of activity of visceral organs, glands,
and blood vessels.
 Autonomic reflex activity influenced by hypothalamus and higher
brain centers, but it is the hypothalamus that has overall control of
the ANS.
 Sympathetic and parasympathetic divisions influence activities of
enteric (gut) nervous system through autonomic reflexes. These
involve the CNS. But, the enteric nervous system can function
independently of CNS through local reflexes. E.g., when wall of
digestive tract is stretched, sensory neurons send information to
enteric plexus and then motor responses sent to smooth muscle of
gut wall and the muscle contracts.
• Centers of the hypothalamus control:
– Heart activity and blood pressure
– Body temperature, water balance, and endocrine activity
– Emotional stages (rage, pleasure) and biological drives (hunger,
thirst, sex)
– Reactions to fear and the “fight-or-flight” system 26
 Levels of ANS
Control
• The hypothalamus is the
main integration center of
ANS activity
• Subconscious cerebral input
via limbic lobe connections
influences hypothalamic
function
• Other controls come from
the cerebral cortex, the
reticular formation, and the
spinal cord
 synaps
e

• The junction between two neurons is called a synapse.

• An action potential cannot cross the synaptic cleft between neurons, and
instead the nerve impulse is carried by chemicals called
neurotransmitters.
• These chemicals are made by the cell that is sending the impulse (the pre-
synaptic neuron) and stored in synaptic vesicles at the end of the axon.
• The cell that is receiving the nerve impulse (the post-synaptic neuron) has
chemical-gated ion channels in its membrane, called neuroreceptors.
• These have specific binding sites for the neurotransmitters
1. At the end of the pre-synaptic neuron there are voltage-gated calcium channels. When an
action potential reaches the synapse these channels open, causing calcium ions to flow into
the cell.
2. These calcium ions cause the synaptic vesicles to fuse with the cell membrane, releasing
their contents (the neurotransmitter chemicals) by exocytosis.
3. The neurotransmitters diffuse across the synaptic cleft.

4. The neurotransmitter binds to the neuroreceptors in the post-synaptic membrane, causing the
channels to open. In the example shown these are sodium channels, so sodium ions flow in.
5. This causes a depolarisation of the post-synaptic cell membrane, which may initiate an action
potential.

6. The neurotransmitter is broken down by a specific enzyme in the synaptic cleft; for example the
enzyme acetylcholinesterase breaks down the neurotransmitter acetylcholine. The breakdown
products are absorbed by the pre-synaptic neuron by endocytosis and used to re-synthesis more
neurotransmitter, using energy from the mitochondria. This stops the synapse being permanently
on.
 General Features of Peripheral
Autonomic Neurotransmission
Nerve Impulse Depolarization of Postganglionic
Fiber or Response of
Effector Cell
Membrane Depolarization of
Pre- or Postganglionic Fiber
Activation of NT
Receptors
Calcium Entry into
Varicosity

Diffusion of NT Across
Exocytosis of NT Neuroeffector Junction
or Synapse
 SYNTHESIS OF
NOREPINEPHRINE
Norepinephrine (NE) is the primary
neurotransmitter
 For postganglionic sympathetic
adrenergic
nerve.
It is synthesized inside the nerve axon,
stored within vesicles, then released by the
nerve
when an action potential travels down
the
nerve.
Synthesis of NE:
The amino acid tyrosine is transported
into the sympathetic nerve axon.
Tyrosine (Tyr) is converted to DOPA
by tyrosine hydroxylase,
(rate-limiting step for NE synthesis).
DOPA is converted to dopamine (DA)
by DOPA decarboxylase.
Dopamine is transported into vesicles then
converted to norepinephrine (NE) by dopamine
β-hydroxylase (DBH); transport into the vesicle
An action potential traveling down the axon depolarizes the membrane and causes calcium
to enter the axon.

Increased intracellular calcium causes the vesicles to migrate to the axonal membrane and
fuse with the membrane, which permits the NE to diffuse out of the vesicle into the
extracellular (junctional) space. DBH, and depending on the nerve other secondary
neurotransmitters (e.g., ATP), is released along with the NE.

 The NE binds to the postjunctional receptor and stimulates the effector organ response
 Synthesis of
epinephrine

 Epinephrine is synthesized from norepinephrine within the adrenal medulla,

which are small glands associated with the kidneys.
 Preganglionic fibers sympathetic adrenergic nerves synapse within the
adrenals. Activation of these fibers releases acetylcholine, which binds to
postjunctional nicotinic receptors in the tissue.
 This leads to stimulation of NE synthesis within adenomedullary cells, but
unlike sympathetic neurons, there is an additional enzyme (phenyl
ethanolamine-N- methyltransferase ) that adds a methyl group to the NE
molecule to form epinephrine.
 The epinephrine is released into the blood perfusing the glands and
carried throughout the body.
 Synthesis of
acetylcholine
Acetylcholine Synthesis
• Acetyl-CoA is synthesized from
pyruvate by mitochondria within
cholinergic nerves.
• This acetyl-CoA combines with
choline that is transported into the
nerve axon to form acetylcholine
(ACh).
• The enzyme responsible for this is
choline acetyltransferase.
• The newly formed ACh is then
transported into vesicles for storage
and subsequent release similar to
what occurs for NE.
• After ACh is released, it is rapidly
degraded within the synapse by
acetylcholineesterase, to form
acetate and choline.
 COTRANSMISSION
Release of More Than One
Neurotransmitter from the Same
Nerve Terminal

Cotransmitter A Cotransmitter B

Synergistic or Opposite Actions

Many Examples of NANC
Neurotransmitters
Many Examples of NANC
Neurotransmitters
 Drugs and the Nervous System
• neuropharmacology – study of effects of drugs on the
nervous system
• sympathomimetics enhance sympathetic activity
– stimulate
•
receptors or increase norepinephrine release
cold medicines that dilate the bronchioles or constrict nasal blood vessels
• sympatholytics suppress sympathetic activity
– block receptors or inhibit norepinephrine release
• beta blockers reduce high BP interfering with effects of epinephrine/norepinephrine
on heart and blood vessels
• parasympathomimetics enhance activity while
parasympatholytics suppress activity
• many drugs also act on neurotransmitters in CNS
– Fluoxethine blocks reuptake of serotonin to prolong its mood-
elevating effect
• caffeine competes with adenosine (the presence of which
causes sleepiness) by binding to its receptors 15-38
 Adenosine and Caffeine
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

NH2
N O CH3
N
H3C
N N
N N
OH O N
O N

CH3

OH
OH
Caffeine
Figure 15.11 Adenosine 15-39
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