Parasympathetic nervous system

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Parasympathetic_nervous_system

 

Parasympathetic nervous system
Autonomic nervous system innervation, showing the parasympathetic (craniosacral) systems in blue.
Details
Identifiers
Latin	Pars parasympathica divisionis autonomici systematis
Acronym(s)	PSNS
MeSH	D010275
TA98	A14.3.02.001
TA2	6661
FMA	9907
Anatomical terminology

The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system, the others being the sympathetic nervous system and the enteric nervous system.

The autonomic nervous system is responsible for regulating the body's unconscious actions. 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 (tears), urination, digestion, and defecation. Its action is described as being complementary to that of the sympathetic nervous system, which is responsible for stimulating activities associated with the fight-or-flight response.

Nerve fibres of the parasympathetic nervous system arise from the central nervous system. Specific nerves include several cranial nerves, specifically the oculomotor nerve, facial nerve, glossopharyngeal nerve, and vagus nerve. Three spinal nerves in the sacrum (S2-4), commonly referred to as the pelvic splanchnic nerves, also act as parasympathetic nerves.

Owing to 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".

Structure

The parasympathetic nerves are autonomic or visceral branches of the peripheral nervous system (PNS). Parasympathetic nerve supply arises through three primary areas:

1. Certain cranial nerves in the cranium, namely the preganglionic parasympathetic nerves (CN III, CN VII, CN IX and CN X) usually arise from specific nuclei in the central nervous system (CNS) and synapse at one of four parasympathetic ganglia: ciliary, pterygopalatine, otic, or submandibular. From these four ganglia the parasympathetic nerves complete their journey to target tissues via trigeminal branches (ophthalmic nerve, maxillary nerve, mandibular nerve).
2. The vagus nerve does not participate in these cranial ganglia as most of its parasympathetic fibers are destined for a broad array of ganglia on or near thoracic viscera (esophagus, trachea, heart, lungs) and abdominal viscera (stomach, pancreas, liver, kidneys, small intestine, and about half of the large intestine). The vagus innervation ends at the junction between the midgut and hindgut, just before the splenic flexure of the transverse colon.
3. The pelvic splanchnic efferent preganglionic nerve cell bodies reside in the lateral gray horn of the spinal cord at the T12-L1 vertebral levels (the spinal cord terminates at the L1-L2 vertebrae with the conus medullaris), and their axons exit the vertebral column as S2-S4 spinal nerves through the sacral foramina. Their axons continue away from the CNS to synapse at an autonomic ganglion. The parasympathetic ganglion where these preganglionic neurons synapse will be close to the organ of innervation. This differs from the sympathetic nervous system, where synapses between pre- and post-ganglionic efferent nerves in general occur at ganglia that are farther away from the target organ.

As in the sympathetic nervous system, efferent parasympathetic nerve signals are carried from the central nervous system to their targets by a system of two neurons. The first neuron in this pathway is referred to as the preganglionic or presynaptic neuron. Its cell body sits in the central nervous system and its axon usually extends to synapse with the dendrites of a postganglionic neuron somewhere else in the body. The axons of presynaptic parasympathetic neurons are usually long, extending from the CNS into a ganglion that is either very close to or embedded in their target organ. As a result, the postsynaptic parasympathetic nerve fibers are very short.

Cranial nerves

The oculomotor nerve is responsible for a number of parasympathetic functions related to the eye. The oculomotor PNS fibers originate in the Edinger-Westphal nucleus in the central nervous system and travel through the superior orbital fissure to synapse in the ciliary ganglion located just behind the orbit (eye). From the ciliary ganglion the postganglionic parasympathetic fibers leave via short ciliary nerve fibers, a continuation of the nasociliary nerve (a branch of ophthalmic division of the trigeminal nerve (CN V₁)). The short ciliary nerves innervate the orbit to control the ciliary muscle (responsible for accommodation) and the iris sphincter muscle, which is responsible for miosis or constriction of the pupil (in response to light or accommodation). There are two motors that are part of the oculomotor nerve known as the somatic motor and visceral motor. The somatic motor is responsible for moving the eye in precise motions and for keeping the eye fixated on an object. The visceral motor helps constrict the pupil.

The parasympathetic aspect of the facial nerve controls secretion of the sublingual and submandibular salivary glands, the lacrimal gland, and the glands associated with the nasal cavity. The preganglionic fibers originate within the CNS in the superior salivatory nucleus and leave as the intermediate nerve (which some consider a separate cranial nerve altogether) to connect with the facial nerve just distal (further out) to it surfacing the central nervous system. Just after the facial nerve geniculate ganglion (general sensory ganglion) in the temporal bone, the facial nerve gives off two separate parasympathetic nerves. The first is the greater petrosal nerve and the second is the chorda tympani. The greater petrosal nerve travels through the middle ear and eventually combines with the deep petrosal nerve (sympathetic fibers) to form the nerve of the pterygoid canal. The parasympathetic fibers of the nerve of the pterygoid canal synapse at the pterygopalatine ganglion, which is closely associated with the maxillary division of the trigeminal nerve (CN V₂). The postganglionic parasympathetic fibers leave the pterygopalatine ganglion in several directions. One division leaves on the zygomatic division of CN V₂ and travels on a communicating branch to unite with the lacrimal nerve (branch of the ophthalmic nerve of CN V₁) before synapsing at the lacrimal gland. These parasympathetic to the lacrimal gland control tear production.

A separate group of parasympathetic leaving from the pterygopalatine ganglion are the descending palatine nerves (CN V₂ branch), which include the greater and lesser palatine nerves. The greater palatine parasympathetic synapse on the hard palate and regulate mucus glands located there. The lesser palatine nerve synapses at the soft palate and controls sparse taste receptors and mucus glands. Yet another set of divisions from the pterygopalatine ganglion are the posterior, superior, and inferior lateral nasal nerves; and the nasopalatine nerves (all branches of CN V₂, maxillary division of the trigeminal nerve) that bring parasympathetic innervation to glands of the nasal mucosa. The second parasympathetic branch that leaves the facial nerve is the chorda tympani. This nerve carries secretomotor fibers to the submandibular and sublingual glands. The chorda tympani travels through the middle ear and attaches to the lingual nerve (mandibular division of trigeminal, CN V₃). After joining the lingual nerve, the preganglionic fibers synapse at the submandibular ganglion and send postganglionic fibers to the sublingual and submandibular salivary glands.

The glossopharyngeal nerve has parasympathetic fibers that innervate the parotid salivary gland. The preganglionic fibers depart CN IX as the tympanic nerve and continue to the middle ear where they make up a tympanic plexus on the cochlear promontory of the mesotympanum. The tympanic plexus of nerves rejoin and form the lesser petrosal nerve and exit through the foramen ovale to synapse at the otic ganglion. From the otic ganglion postganglionic parasympathetic fibers travel with the auriculotemporal nerve (mandibular branch of trigeminal, CN V₃) to the parotid salivary gland.

Vagus nerve

The vagus nerve, named after the Latin word vagus (because the nerve controls such a broad range of target tissues – vagus in Latin literally means "wandering"), has parasympathetic functions that originate in the dorsal nucleus of the vagus nerve and the nucleus ambiguus in the CNS. The vagus nerve is an unusual cranial parasympathetic in that it doesn't join the trigeminal nerve in order to get to its target tissues. Another peculiarity is that the vagus has an autonomic ganglion associated with it at approximately the level of C1 vertebra. The vagus gives no parasympathetic to the cranium. The vagus nerve is hard to track definitively due to its ubiquitous nature in the thorax and abdomen so the major contributions will be discussed. Several parasympathetic nerves come off the vagus nerve as it enters the thorax. One nerve is the recurrent laryngeal nerve, which becomes the inferior laryngeal nerve. From the left vagus nerve the recurrent laryngeal nerve hooks around the aorta to travel back up to the larynx and proximal esophagus while, from the right vagus nerve, the recurrent laryngeal nerve hooks around the right subclavian artery to travel back up to the same location as its counterpart. These different paths are a direct result of embryological development of the circulatory system. Each recurrent laryngeal nerve supplies the trachea and the esophagus with parasympathetic secretomotor innervation for glands associated with them (and other fibers that are not PN).

Another nerve that comes off the vagus nerves approximately at the level of entering the thorax are the cardiac nerves. These cardiac nerves go on to form cardiac and pulmonary plexuses around the heart and lungs. As the main vagus nerves continue into the thorax they become intimately linked with the esophagus and sympathetic nerves from the sympathetic trunks to form the esophageal plexus. This is very efficient as the major function of the vagus nerve from there on will be control of the gut smooth muscles and glands. As the esophageal plexus enter the abdomen through the esophageal hiatus anterior and posterior vagus trunks form. The vagus trunks then join with preaortic sympathetic ganglion around the aorta to disperse with the blood vessels and sympathetic nerves throughout the abdomen. The extent of the parasympathetic in the abdomen include the pancreas, kidneys, liver, gall bladder, stomach and gut tube. The vagus contribution of parasympathetic continues down the gut tube until the end of the midgut. The midgut ends two thirds of the way across the transverse colon near the splenic flexure.

Pelvic splanchnic nerves

The pelvic splanchnic nerves, S2-4, work in tandem to innervate the pelvic viscera. Unlike in the cranium, where one parasympathetic is in charge of one particular tissue or region, for the most part the pelvic splanchnics each contribute fibers to pelvic viscera by traveling to one or more plexuses before being dispersed to the target tissue. These plexuses are composed of mixed autonomic nerve fibers (parasympathetic and sympathetic) and include the vesical, prostatic, rectal, uterovaginal, and inferior hypogastric plexuses. The preganglionic neurons in the pathway do not synapse in a ganglion as in the cranium but rather in the walls of the tissues or organs that they innervate. The fiber paths are variable and each individual's autonomic nervous system in the pelvis is unique. The visceral tissues in the pelvis that the parasympathetic nerve pathway controls include those of the urinary bladder, ureters, urinary sphincter, anal sphincter, uterus, prostate, glands, vagina, and penis. Unconsciously, the parasympathetic will cause peristaltic movements of the ureters and intestines, moving urine from the kidneys into the bladder and food down the intestinal tract and, upon necessity, the parasympathetic will assist in excreting urine from the bladder or defecation. Stimulation of the parasympathetic will cause the detrusor muscle (urinary bladder wall) to contract and simultaneously relax the internal sphincter muscle between the bladder and the urethra, allowing the bladder to void. Also, parasympathetic stimulation of the internal anal sphincter will relax this muscle to allow defecation. There are other skeletal muscles involved with these processes but the parasympathetic plays a huge role in continence and bowel retention.

A study published in 2016, suggests that all sacral autonomic output may be sympathetic; indicating that the rectum, bladder and reproductive organs may only be innervated by the sympathetic nervous system. This suggestion is based on detailed analysis of 15 phenotypic and ontogenetic factors differentiating sympathetic from parasympathetic neurons in the mouse. Assuming that the reported findings most likely applies to other mammals as well, this perspective suggests a simplified, bipartite architecture of the autonomic nervous system, in which the parasympathetic nervous system receives input from cranial nerves exclusively and the sympathetic nervous system from thoracic to sacral spinal nerves.

Autonomic nervous supply to organs in the human body

Organ	Nerves	Spinal column origin
stomach	PS: anterior and posterior vagal trunks S: greater splanchnic nerves	T5, T6, T7, T8, T9, sometimes T10
duodenum	PS: vagus nerves S: greater splanchnic nerves	T5, T6, T7, T8, T9, sometimes T10
jejunum and ileum	PS: posterior vagal trunks S: greater splanchnic nerves	T5, T6, T7, T8, T9
spleen	S: greater splanchnic nerves	T6, T7, T8
gallbladder and liver	PS: vagus nerve S: celiac plexus right phrenic nerve	T6, T7, T8, T9
colon	PS: vagus nerves and pelvic splanchnic nerves S: lesser and least splanchnic nerves	T10, T11, T12 (proximal colon) L1, L2, L3, (distal colon)
pancreatic head	PS: vagus nerves S: thoracic splanchnic nerves	T8, T9
appendix	nerves to superior mesenteric plexus	T10
kidneys and ureters	PS: vagus nerve S: thoracic and lumbar splanchnic nerves	T11, T12

Emerging evidence in mouse models is suggesting that the previously held notion of the sacral spinal nerves being parasympathetic is incorrect, and that they may actually be sympathetic.

Function

Sensation

The afferent fibers of the autonomic nervous system, which transmit sensory information from the internal organs of the body back to the central nervous system, are not divided into parasympathetic and sympathetic fibers as the efferent fibers are. Instead, autonomic sensory information is conducted by general visceral afferent fibers.

General visceral afferent sensations are mostly unconscious visceral motor reflex sensations from hollow organs and glands that are transmitted to the CNS. While the unconscious reflex arcs normally are undetectable, in certain instances they may send pain sensations to the CNS masked as referred pain. If the peritoneal cavity becomes inflamed or if the bowel is suddenly distended, the body will interpret the afferent pain stimulus as somatic in origin. This pain is usually non-localized. The pain is also usually referred to dermatomes that are at the same spinal nerve level as the visceral afferent synapse.

Vascular effects

Heart rate is largely controlled by the heart's internal pacemaker activity. Considering a healthy heart, the main pacemaker is a collection of cells on the border of the atria and vena cava called the sinoatrial node. Heart cells exhibit automaticity which is the ability to generate electrical activity independent of external stimulation. As a result, the cells of the node spontaneously generate electrical activity that is subsequently conducted throughout the heart, resulting in a regular heart rate.

In absence of any external stimuli, sinoatrial pacing contributes to maintain the heart rate in the range of 60-100 beats per minute (bpm). At the same time, the two branches of the autonomic nervous system act in a complementary way increasing or slowing the heart rate. In this context, the vagus nerve acts on sinoatrial node slowing its conduction thus actively modulating vagal tone accordingly. This modulation is mediated by the neurotransmitter acetylcholine and downstream changes to ionic currents and calcium of heart cells.

The vagus nerve plays a crucial role in heart rate regulation by modulating the response of sinoatrial node; vagal tone can be quantified by investigating heart rate modulation induced by vagal tone changes. As a general consideration, increased vagal tone (and thus vagal action) is associated with a diminished and more variable heart rate. The main mechanism by which the parasympathetic nervous system acts on vascular and cardiac control is the so-called respiratory sinus arrhythmia (RSA). RSA is described as the physiological and rhythmical fluctuation of heart rate at the respiration frequency, characterized by heart rate increase during inspiration and decrease during expiration.

Sexual activity

Another role that the parasympathetic nervous system plays is in sexual activity. In males, the cavernous nerves from the prostatic plexus stimulate smooth muscles in the fibrous trabeculae of the coiled helicine arteries of penis to relax and allow blood to fill the two corpora cavernosa and the corpus spongiosum of the penis, making it rigid to prepare for sexual activity. Upon emission of ejaculate, the sympathetics participate and cause peristalsis of the ductus deferens and closure of the internal urethral sphincter to prevent semen from entering the bladder. At the same time, parasympathetics cause peristalsis of the urethral muscle, and the pudendal nerve causes contraction of the bulbospongiosus (skeletal muscle is not via PN), to forcibly emit the semen. During remission the penis becomes flaccid again. In the female, there is erectile tissue analogous to the male yet less substantial that plays a large role in sexual stimulation. The PN cause release of secretions in the female that decrease friction. Also in the female, the parasympathetics innervate the fallopian tubes, which helps peristaltic contractions and movement of the oocyte to the uterus for implantation. The secretions from the female genital tract aid in sperm migration. The PN (and SN to a lesser extent) play a significant role in reproduction.

Receptors

The parasympathetic nervous system uses chiefly acetylcholine (ACh) as its neurotransmitter, although peptides (such as cholecystokinin) can be used. The ACh acts on two types of receptors, the muscarinic and nicotinic cholinergic receptors. Most transmissions occur in two stages: When stimulated, the preganglionic neuron releases ACh at the ganglion, which acts on nicotinic receptors of postganglionic neurons. The postganglionic neuron then releases ACh to stimulate the muscarinic receptors of the target organ.

Types of muscarinic receptors

The five main types of muscarinic receptors:

• The M1 muscarinic receptors (CHRM1) are located in the neural system.
• The M2 muscarinic receptors (CHRM2) are located in the heart, and act to bring the heart back to normal after the actions of the sympathetic nervous system: slowing down the heart rate, reducing contractile forces of the atrial cardiac muscle, and reducing conduction velocity of the sinoatrial node and atrioventricular node. They have a minimal effect on the contractile forces of the ventricular muscle due to sparse innervation of the ventricles from the parasympathetic nervous system.
• The M3 muscarinic receptors (CHRM3) are located at many places in the body, such as the endothelial cells of blood vessels, as well as the lungs causing bronchoconstriction. The net effect of innervated M3 receptors on blood vessels is vasodilation, as acetylcholine causes endothelial cells to produce nitric oxide, which diffuses to smooth muscle and results in vasodilation. They are also in the smooth muscles of the gastrointestinal tract, which help in increasing intestinal motility and dilating sphincters. The M3 receptors are also located in many glands that help to stimulate secretion in salivary glands and other glands of the body. They are also located on the detrusor muscle and urothelium of the bladder, causing contraction.
• The M4 muscarinic receptors: Postganglionic cholinergic nerves, possible CNS effects
• The M5 muscarinic receptors: Possible effects on the CNS

Types of nicotinic receptors

In vertebrates, nicotinic receptors are broadly classified into two subtypes based on their primary sites of expression: muscle-type nicotinic receptors (N1) primarily for somatic motor neurons; and neuronal-type nicotinic receptors (N2) primarily for autonomic nervous system.

Relationship to sympathetic nervous system

Sympathetic and parasympathetic divisions typically function in opposition to each other. The sympathetic division typically functions in actions requiring quick responses. The parasympathetic division functions with actions that do not require immediate reaction. A useful mnemonic to summarize the functions of the parasympathetic nervous system is SSLUDD (sexual arousal, salivation, lacrimation, urination, digestion and defecation).

Clinical significance

The functions promoted by activity in the parasympathetic nervous system are associated with our day-to-day living. The parasympathetic nervous system promotes digestion and the synthesis of glycogen, and allows for normal function and behavior.

Parasympathetic action helps in digestion and absorption of food by increasing the activity of the intestinal musculature, increasing gastric secretion, and relaxing the pyloric sphincter.It is called the “rest and digest” division of the ANS.

Boyesen, founder of Biodynamic Psychology, modeled a therapy based on a particular form of massage, which uses sounds coming from the intestine, auscultated with a stethoscope, as feedback to understand the moment of transition from sympathetic to parasympathetic nervous function.

History

The terminology ‘Parasympathetic nervous system’ was introduced by Langley in 1921. He was the first person who put forward the concept of PNS as the second division of the autonomic nervous system.

Sympathetic nervous system

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Sympathetic_nervous_system 

 

Sympathetic nervous system
Schematic illustration showing the sympathetic nervous system with sympathetic cord and target organs.
Details
Identifiers
Latin	pars sympathica divisionis autonomici systematis nervosi
Acronym(s)	SNS
MeSH	D013564
TA98	A14.3.01.001
TA2	6601
FMA	9906
Anatomical terminology

The sympathetic nervous system (SNS) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous system and the enteric nervous system.

The autonomic nervous system functions to regulate the body's unconscious actions. The sympathetic nervous system's primary process is to stimulate the body's fight or flight response. It is, however, constantly active at a basic level to maintain homeostasis. The sympathetic nervous system is described as being antagonistic to the parasympathetic nervous system which stimulates the body to "feed and breed" and to (then) "rest-and-digest".

Structure

There are two kinds of neurons involved in the transmission of any signal through the sympathetic system: pre-ganglionic and post-ganglionic. The shorter preganglionic neurons originate in the thoracolumbar division of the spinal cord specifically at T1 to L2~L3, and travel to a ganglion, often one of the paravertebral ganglia, where they synapse with a postganglionic neuron. From there, the long postganglionic neurons extend across most of the body.

At the synapses within the ganglia, preganglionic neurons release acetylcholine, a neurotransmitter that activates nicotinic acetylcholine receptors on postganglionic neurons. In response to this stimulus, the postganglionic neurons release norepinephrine, which activates adrenergic receptors that are present on the peripheral target tissues. The activation of target tissue receptors causes the effects associated with the sympathetic system. However, there are three important exceptions:

1. Postganglionic neurons of sweat glands release acetylcholine for the activation of muscarinic receptors, except for areas of thick skin, the palms and the plantar surfaces of the feet, where norepinephrine is released and acts on adrenergic receptors.
2. Chromaffin cells of the adrenal medulla are analogous to post-ganglionic neurons; the adrenal medulla develops in tandem with the sympathetic nervous system and acts as a modified sympathetic ganglion. Within this endocrine gland, pre-ganglionic neurons synapse with chromaffin cells, triggering the release of two transmitters: a small proportion of norepinephrine, and more substantially, epinephrine. The synthesis and release of epinephrine as opposed to norepinephrine is another distinguishing feature of chromaffin cells compared to postganglionic sympathetic neurons.
3. Postganglionic sympathetic nerves terminating in the kidney release dopamine, which acts on dopamine D1 receptors of blood vessels to control how much blood the kidney filters. Dopamine is the immediate metabolic precursor to norepinephrine, but is nonetheless a distinct signaling molecule.

Organization

The sympathetic nervous system extends from the thoracic to lumbar vertebrae and has connections with the thoracic, abdominal, and pelvic plexuses.

Sympathetic nerves arise from near the middle of the spinal cord in the intermediolateral nucleus of the lateral grey column, beginning at the first thoracic vertebra of the vertebral column and are thought to extend to the second or third lumbar vertebra. Because its cells begin in the thoracolumbar division – the thoracic and lumbar regions of the spinal cord - the sympathetic nervous system is said to have a thoracolumbar outflow. Axons of these nerves leave the spinal cord through the anterior 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 (so called from the shiny white sheaths of myelin around each axon) 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.

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.

Scheme showing structure of a typical spinal nerve. 1. Somatic efferent. 2. Somatic afferent. 3,4,5. Sympathetic efferent. 6,7. Sympathetic afferent.

Presynaptic nerves' axons terminate in either the paravertebral ganglia or prevertebral ganglia. There are four different paths an axon can take before reaching its terminal. In all cases, the axon enters the paravertebral ganglion at the level of its originating spinal nerve. After this, it can then either synapse in this ganglion, ascend to a more superior or descend to a more inferior paravertebral ganglion and synapse there, or it can descend to a prevertebral ganglion and synapse there with the postsynaptic cell.

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.

A notable exception to the routes mentioned above is the sympathetic innervation of the suprarenal (adrenal) medulla. In this case, 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 bloodstream.

In the sympathetic nervous system 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 sympathetic nervous system 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.

The ganglia include not just the sympathetic trunks but also the cervical ganglia (superior, middle and inferior), which send sympathetic nerve fibers to the head and thorax organs, and the celiac and mesenteric ganglia, which send sympathetic fibers to the gut.

Autonomic nervous supply to organs in the human body

Organ	Nerves	Spinal column origin
stomach	PS: anterior and posterior vagal trunks S: greater splanchnic nerves	T5, T6, T7, T8, T9, sometimes T10
duodenum	PS: vagus nerves S: greater splanchnic nerves	T5, T6, T7, T8, T9, sometimes T10
jejunum and ileum	PS: posterior vagal trunks S: greater splanchnic nerves	T5, T6, T7, T8, T9
spleen	S: greater splanchnic nerves	T6, T7, T8
gallbladder and liver	PS: vagus nerve S: celiac plexus right phrenic nerve	T6, T7, T8, T9
colon	PS: vagus nerves and pelvic splanchnic nerves S: lesser and least splanchnic nerves	T10, T11, T12 (proximal colon) L1, L2, L3, (distal colon)
pancreatic head	PS: vagus nerves S: thoracic splanchnic nerves	T8, T9
appendix	nerves to superior mesenteric plexus	T10
kidneys and ureters	PS: vagus nerve S: thoracic and lumbar splanchnic nerves	T11, T12

Information transmission

Sympathetic Nervous System - Information transmits through it affecting various organs.

Messages travel through the sympathetic nervous system in a bi-directional flow. Efferent messages can trigger changes in different parts of the body simultaneously. For example, the sympathetic nervous system can accelerate heart rate; widen bronchial passages; decrease motility (movement) of the large intestine; constrict blood vessels; increase peristalsis in the oesophagus; cause pupillary dilation, piloerection (goose bumps) and perspiration (sweating); and raise blood pressure. One exception is with certain blood vessels such as those in the cerebral and coronary arteries, which dilate (rather than constrict) with an increase in sympathetic tone. This is because of a proportional increase in the presence of β₂ adrenergic receptors rather than α₁ receptors. β₂ receptors promote vessel dilation instead of constriction like α1 receptors. An alternative explanation is that the primary (and direct) effect of sympathetic stimulation on coronary arteries is vasoconstriction followed by a secondary vasodilation caused by the release of vasodilatory metabolites due to the sympathetically increased cardiac inotropy and heart rate. This secondary vasodilation caused by the primary vasoconstriction is termed functional sympatholysis, the overall effect of which on coronary arteries is dilation.

The target synapse of the postganglionic neuron is mediated by adrenergic receptors and is activated by either norepinephrine (noradrenaline) or epinephrine (adrenaline).

Function

Examples of sympathetic system action on various organs except where otherwise indicated.

Organ	Effect
Eye	Dilates
Heart	Increases rate and force of contraction
Lungs	Dilates bronchioles via circulating adrenaline
Blood vessels	Dilate in skeletal muscle
Digestive system	Constricts in gastrointestinal organs
Sweat glands	Activates sweat secretion
Digestive tract	Inhibits peristalsis
Kidney	Increases renin secretion
Penis	Inhibits tumescence
Ductus deferens	Promotes emission prior to ejaculation

The sympathetic nervous system is responsible for up- and down-regulating many homeostatic mechanisms in living organisms. Fibers from the SNS innervate tissues in almost every organ system, providing at least some regulation of functions as diverse as pupil diameter, gut motility, and urinary system output and function. It is perhaps best known for mediating the neuronal and hormonal stress response commonly known as the fight-or-flight response. This response is also known as sympatho-adrenal response of the body, as the preganglionic sympathetic fibers that end in the adrenal medulla (but also all other sympathetic fibers) secrete acetylcholine, which activates the great secretion of adrenaline (epinephrine) and to a lesser extent noradrenaline (norepinephrine) from it. Therefore, this response that acts primarily on the cardiovascular system is mediated directly via impulses transmitted through the sympathetic nervous system and indirectly via catecholamines secreted from the adrenal medulla.

The sympathetic nervous system is responsible for priming the body for action, particularly in situations threatening survival. One example of this priming is in the moments before waking, in which sympathetic outflow spontaneously increases in preparation for action.

Sympathetic nervous system stimulation causes vasoconstriction of most blood vessels, including many of those in the skin, the digestive tract, and the kidneys. This occurs as a result of activation of alpha-1 adrenergic receptors by norepinephrine released by post-ganglionic sympathetic neurons. These receptors exist throughout the vasculature of the body but are inhibited and counterbalanced by beta-2 adrenergic receptors (stimulated by epinephrine release from the adrenal glands) in the skeletal muscles, the heart, the lungs, and the brain during a sympathoadrenal response. The net effect of this is a shunting of blood away from the organs not necessary to the immediate survival of the organism and an increase in blood flow to those organs involved in intense physical activity.

Sensation

The afferent fibers of the autonomic nervous system, which transmit sensory information from the internal organs of the body back to the central nervous system (or CNS), are not divided into parasympathetic and sympathetic fibers as the efferent fibers are. Instead, autonomic sensory information is conducted by general visceral afferent fibers.

General visceral afferent sensations are mostly unconscious visceral motor reflex sensations from hollow organs and glands that are transmitted to the CNS. While the unconscious reflex arcs normally are undetectable, in certain instances they may send pain sensations to the CNS masked as referred pain. If the peritoneal cavity becomes inflamed or if the bowel is suddenly distended, the body will interpret the afferent pain stimulus as somatic in origin. This pain is usually non-localized. The pain is also usually referred to dermatomes that are at the same spinal nerve level as the visceral afferent synapse.

Relationship with the parasympathetic nervous system

Together with the other component of the autonomic nervous system, the parasympathetic nervous system, the sympathetic nervous system aids in the control of most of the body's internal organs. Reaction to stress—as in the flight-or-fight response—is thought to counteract the parasympathetic system, which generally works to promote maintenance of the body at rest. The comprehensive functions of both the parasympathetic and sympathetic nervous systems are not so straightforward, but this is a useful rule of thumb.

Disorders

In heart failure, the sympathetic nervous system increases its activity, leading to increased force of muscular contractions that in turn increases the stroke volume, as well as peripheral vasoconstriction to maintain blood pressure. However, these effects accelerate disease progression, eventually increasing mortality in heart failure.

Sympathicotonia is a stimulated condition of the sympathetic nervous system, marked by vascular spasm, elevated blood pressure, and goose bumps. A recent study has shown the expansion of Foxp3+ natural Treg in the bone marrow of mice after brain ischemia and this myeloid Treg expansion is related to sympathetic stress signaling after brain ischemia.

History and etymology

The name of this system can be traced to the concept of sympathy, in the sense of "connection between parts", first used medically by Galen. In the 18th century, Jacob B. Winslow applied the term specifically to nerves.

Autonomic nervous system

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Autonomic_nervous_system 

 

Autonomic nervous system
Autonomic nervous system innervation.
Details
Identifiers
Latin	Autonomici systematis nervosi
MeSH	D001341
TA98	A14.3.00.001
TA2	6600
FMA	9905
Anatomical terminology

The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, and thus influences the function of internal organs. The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions, such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. This system is the primary mechanism in control of the fight-or-flight response.

The autonomic nervous system is regulated by integrated reflexes through the brainstem to the spinal cord and organs. Autonomic functions include control of respiration, cardiac regulation (the cardiac control center), vasomotor activity (the vasomotor center), and certain reflex actions such as coughing, sneezing, swallowing and vomiting. Those are then subdivided into other areas and are also linked to autonomic subsystems and the peripheral nervous system. The hypothalamus, just above the brain stem, acts as an integrator for autonomic functions, receiving autonomic regulatory input from the limbic system.

The autonomic nervous system has three branches: the sympathetic nervous system, the parasympathetic nervous system and the enteric nervous system. Some textbooks do not include the enteric nervous system as part of this system. The sympathetic nervous system is often considered the "fight or flight" system, while the parasympathetic nervous system is often considered the "rest and digest" or "feed and breed" system. In many cases, both of these systems have "opposite" actions where one system activates a physiological response and the other inhibits it. An older simplification of the sympathetic and parasympathetic nervous systems as "excitatory" and "inhibitory" was overturned due to the many exceptions found. A more modern characterization is that the sympathetic nervous system is a "quick response mobilizing system" and the parasympathetic is a "more slowly activated dampening system", but even this has exceptions, such as in sexual arousal and orgasm, wherein both play a role.

There are inhibitory and excitatory synapses between neurons. A third subsystem of neurons have been named as non-noradrenergic, non-cholinergic transmitters (because they use nitric oxide as a neurotransmitter) and are integral in autonomic function, in particular in the gut and the lungs.

Although the ANS is also known as the visceral nervous system, the ANS is only connected with the motor side. Most autonomous functions are involuntary but they can often work in conjunction with the somatic nervous system which provides voluntary control.

Structure

Autonomic nervous system, showing splanchnic nerves in middle, and the vagus nerve as "X" in blue. The heart and organs below in list to right are regarded as viscera.

The autonomic nervous system is divided into the sympathetic nervous system and parasympathetic nervous system. The sympathetic division emerges from the spinal cord in the thoracic and lumbar areas, terminating around L2-3. The parasympathetic division has craniosacral “outflow”, meaning that the neurons begin at the cranial nerves (specifically the oculomotor nerve, facial nerve, glossopharyngeal nerve and vagus nerve) and sacral (S2-S4) spinal cord.

The autonomic nervous system is unique in that it requires a sequential two-neuron efferent pathway; the preganglionic neuron must first synapse onto a postganglionic neuron before innervating the target organ. The preganglionic, or first, neuron will begin at the “outflow” and will synapse at the postganglionic, or second, neuron's cell body. The postganglionic neuron will then synapse at the target organ.

Sympathetic division

The sympathetic nervous system consists of cells with bodies in the lateral grey column from T1 to L2/3. These cell bodies are "GVE" (general visceral efferent) neurons and are the preganglionic neurons. There are several locations upon which preganglionic neurons can synapse for their postganglionic neurons:

• Paravertebral ganglia (3) of the sympathetic chain (these run on either side of the vertebral bodies)

1. cervical ganglia (3)
2. thoracic ganglia (12) and rostral lumbar ganglia (2 or 3)
3. caudal lumbar ganglia and sacral ganglia

• Prevertebral ganglia (celiac ganglion, aorticorenal ganglion, superior mesenteric ganglion, inferior mesenteric ganglion)
• Chromaffin cells of the adrenal medulla (this is the one exception to the two-neuron pathway rule: the synapse is directly efferent onto the target cell bodies)

These ganglia provide the postganglionic neurons from which innervation of target organs follows. Examples of splanchnic (visceral) nerves are:

• Cervical cardiac nerves and thoracic visceral nerves, which synapse in the sympathetic chain
• Thoracic splanchnic nerves (greater, lesser, least), which synapse in the prevertebral ganglia
• Lumbar splanchnic nerves, which synapse in the prevertebral ganglia
• Sacral splanchnic nerves, which synapse in the inferior hypogastric plexus

These all contain afferent (sensory) nerves as well, known as GVA (general visceral afferent) neurons.

Parasympathetic division

The parasympathetic nervous system consists of cells with bodies in one of two locations: the brainstem (Cranial Nerves III, VII, IX, X) or the sacral spinal cord (S2, S3, S4). These are the preganglionic neurons, which synapse with postganglionic neurons in these locations:

• Parasympathetic ganglia of the head: Ciliary (Cranial nerve III), Submandibular (Cranial nerve VII), Pterygopalatine (Cranial nerve VII), and Otic (Cranial nerve IX)
• In or near the wall of an organ innervated by the Vagus (Cranial nerve X) or Sacral nerves (S2, S3, S4)

These ganglia provide the postganglionic neurons from which innervations of target organs follows. Examples are:

• The postganglionic parasympathetic splanchnic (visceral) nerves
• The vagus nerve, which passes through the thorax and abdominal regions innervating, among other organs, the heart, lungs, liver and stomach

Sensory neurons

The sensory arm is composed of primary visceral sensory neurons found in the peripheral nervous system (PNS), in cranial sensory ganglia: the geniculate, petrosal and nodose ganglia, appended respectively to cranial nerves VII, IX and X. These sensory neurons monitor the levels of carbon dioxide, oxygen and sugar in the blood, arterial pressure and the chemical composition of the stomach and gut content. They also convey the sense of taste and smell, which, unlike most functions of the ANS, is a conscious perception. Blood oxygen and carbon dioxide are in fact directly sensed by the carotid body, a small collection of chemosensors at the bifurcation of the carotid artery, innervated by the petrosal (IXth) ganglion. Primary sensory neurons project (synapse) onto “second order” visceral sensory neurons located in the medulla oblongata, forming the nucleus of the solitary tract (nTS), that integrates all visceral information. The nTS also receives input from a nearby chemosensory center, the area postrema, that detects toxins in the blood and the cerebrospinal fluid and is essential for chemically induced vomiting or conditional taste aversion (the memory that ensures that an animal that has been poisoned by a food never touches it again). All this visceral sensory information constantly and unconsciously modulates the activity of the motor neurons of the ANS.

Innervation

Autonomic nerves travel to organs throughout the body. Most organs receive parasympathetic supply by the vagus nerve and sympathetic supply by splanchnic nerves. The sensory part of the latter reaches the spinal column at certain spinal segments. Pain in any internal organ is perceived as referred pain, more specifically as pain from the dermatome corresponding to the spinal segment.

Autonomic nervous supply to organs in the human body

Organ	Nerves	Spinal column origin
stomach	PS: anterior and posterior vagal trunks S: greater splanchnic nerves	T5, T6, T7, T8, T9, sometimes T10
duodenum	PS: vagus nerves S: greater splanchnic nerves	T5, T6, T7, T8, T9, sometimes T10
jejunum and ileum	PS: posterior vagal trunks S: greater splanchnic nerves	T5, T6, T7, T8, T9
spleen	S: greater splanchnic nerves	T6, T7, T8
gallbladder and liver	PS: vagus nerve S: celiac plexus right phrenic nerve	T6, T7, T8, T9
colon	PS: vagus nerves and pelvic splanchnic nerves S: lesser and least splanchnic nerves	T10, T11, T12 (proximal colon) L1, L2, L3, (distal colon)
pancreatic head	PS: vagus nerves S: thoracic splanchnic nerves	T8, T9
appendix	nerves to superior mesenteric plexus	T10
kidneys and ureters	PS: vagus nerve S: thoracic and lumbar splanchnic nerves	T11, T12

Motor neurons

Main article: Motor neuron

Motor neurons of the autonomic nervous system are found in ‘’autonomic ganglia’’. Those of the parasympathetic branch are located close to the target organ whilst the ganglia of the sympathetic branch are located close to the spinal cord.

The sympathetic ganglia here, are found in two chains: the pre-vertebral and pre-aortic chains. The activity of autonomic ganglionic neurons is modulated by “preganglionic neurons” located in the central nervous system. Preganglionic sympathetic neurons are located in the spinal cord, at the thorax and upper lumbar levels. Preganglionic parasympathetic neurons are found in the medulla oblongata where they form visceral motor nuclei; the dorsal motor nucleus of the vagus nerve; the nucleus ambiguus, the salivatory nuclei, and in the sacral region of the spinal cord.

Function

Function of the autonomic nervous system 

Sympathetic and parasympathetic divisions typically function in opposition to each other. But this opposition is better termed complementary in nature rather than antagonistic. For an analogy, one may think of the sympathetic division as the accelerator and the parasympathetic division as the brake. The sympathetic division typically functions in actions requiring quick responses. The parasympathetic division functions with actions that do not require immediate reaction. The sympathetic system is often considered the "fight or flight" system, while the parasympathetic system is often considered the "rest and digest" or "feed and breed" system.

However, many instances of sympathetic and parasympathetic activity cannot be ascribed to "fight" or "rest" situations. For example, standing up from a reclining or sitting position would entail an unsustainable drop in blood pressure if not for a compensatory increase in the arterial sympathetic tonus. Another example is the constant, second-to-second, modulation of heart rate by sympathetic and parasympathetic influences, as a function of the respiratory cycles. In general, these two systems should be seen as permanently modulating vital functions, in usually antagonistic fashion, to achieve homeostasis. Higher organisms maintain their integrity via homeostasis which relies on negative feedback regulation which, in turn, typically depends on the autonomic nervous system. Some typical actions of the sympathetic and parasympathetic nervous systems are listed below.

Target organ/system	Parasympathetic	Sympathetic
Digestive system	Increase peristalsis and amount of secretion by digestive glands	Decrease activity of digestive system
Liver	No effect	Causes glucose to be released to blood
Lungs	Constricts bronchioles	Dilates bronchioles
Urinary bladder/ Urethra	Relaxes sphincter	Constricts sphincter
Kidneys	No effects	Decrease urine output
Heart	Decreases rate	Increase rate
Blood vessels	No effect on most blood vessels	Constricts blood vessels in viscera; increase BP
Salivary and Lacrimal glands	Stimulates; increases production of saliva and tears	Inhibits; result in dry mouth and dry eyes
Eye (iris)	Stimulates constrictor muscles; constrict pupils	Stimulate dilator muscle; dilates pupils
Eye (ciliary muscles)	Stimulates to increase bulging of lens for close vision	Inhibits; decrease bulging of lens; prepares for distant vision
Adrenal Medulla	No effect	Stimulate medulla cells to secrete epinephrine and norepinephrine
Sweat gland of skin	No effect	Stimulate to produce perspiration

Sympathetic nervous system

Promotes a fight-or-flight response, corresponds with arousal and energy generation, and inhibits digestion

• Diverts blood flow away from the gastro-intestinal (GI) tract and skin via vasoconstriction
• Blood flow to skeletal muscles and the lungs is enhanced (by as much as 1200% in the case of skeletal muscles)
• Dilates bronchioles of the lung through circulating epinephrine, which allows for greater alveolar oxygen exchange
• Increases heart rate and the contractility of cardiac cells (myocytes), thereby providing a mechanism for enhanced blood flow to skeletal muscles
• Dilates pupils and relaxes the ciliary muscle to the lens, allowing more light to enter the eye and enhances far vision
• Provides vasodilation for the coronary vessels of the heart
• Constricts all the intestinal sphincters and the urinary sphincter
• Inhibits peristalsis
• Stimulates orgasm

Parasympathetic nervous system

Main article: Parasympathetic nervous system

The parasympathetic nervous system has been said to promote a "rest and digest" response, promotes calming of the nerves return to regular function, and enhancing digestion. Functions of nerves within the parasympathetic nervous system include:

• Dilating blood vessels leading to the GI tract, increasing the blood flow.
• Constricting the bronchiolar diameter when the need for oxygen has diminished
• Dedicated cardiac branches of the vagus and thoracic spinal accessory nerves impart parasympathetic control of the heart (myocardium)
• Constriction of the pupil and contraction of the ciliary muscles, facilitating accommodation and allowing for closer vision
• Stimulating salivary gland secretion, and accelerates peristalsis, mediating digestion of food and, indirectly, the absorption of nutrients
• Sexual. Nerves of the peripheral nervous system are involved in the erection of genital tissues via the pelvic splanchnic nerves 2–4. They are also responsible for stimulating sexual arousal.

Enteric nervous system

The enteric nervous system is the intrinsic nervous system of the gastrointestinal system. It has been described as "the Second Brain of the Human Body". Its functions include:

• Sensing chemical and mechanical changes in the gut
• Regulating secretions in the gut
• Controlling peristalsis and some other movements

Neurotransmitters

A flow diagram showing the process of stimulation of adrenal medulla that makes it release adrenaline, that further acts on adrenoreceptors, indirectly mediating or mimicking sympathetic activity.

At the effector organs, sympathetic ganglionic neurons release noradrenaline (norepinephrine), along with other cotransmitters such as ATP, to act on adrenergic receptors, with the exception of the sweat glands and the adrenal medulla:

• Acetylcholine is the preganglionic neurotransmitter for both divisions of the ANS, as well as the postganglionic neurotransmitter of parasympathetic neurons. Nerves that release acetylcholine are said to be cholinergic. In the parasympathetic system, ganglionic neurons use acetylcholine as a neurotransmitter to stimulate muscarinic receptors.
• At the adrenal medulla, there is no postsynaptic neuron. Instead the presynaptic neuron releases acetylcholine to act on nicotinic receptors. Stimulation of the adrenal medulla releases adrenaline (epinephrine) into the bloodstream, which acts on adrenoceptors, thereby indirectly mediating or mimicking sympathetic activity.

A full table is found at Table of neurotransmitter actions in the ANS.

History

The specialised system of the autonomic nervous system was recognised by Galen. In 1665, Willis used the terminology, and in 1900, Langley used the term, defining the two divisions as the sympathetic and parasympathetic nervous systems.

Caffeine effects

Caffeine is a bioactive ingredient found in commonly consumed beverages such as coffee, tea, and sodas. Short-term physiological effects of caffeine include increased blood pressure and sympathetic nerve outflow. Habitual consumption of caffeine may inhibit physiological short-term effects. Consumption of caffeinated espresso increases parasympathetic activity in habitual caffeine consumers; however, decaffeinated espresso inhibits parasympathetic activity in habitual caffeine consumers. It is possible that other bioactive ingredients in decaffeinated espresso may also contribute to the inhibition of parasympathetic activity in habitual caffeine consumers.

Caffeine is capable of increasing work capacity while individuals perform strenuous tasks. In one study, caffeine provoked a greater maximum heart rate while a strenuous task was being performed compared to a placebo. This tendency is likely due to caffeine's ability to increase sympathetic nerve outflow. Furthermore, this study found that recovery after intense exercise was slower when caffeine was consumed prior to exercise. This finding is indicative of caffeine's tendency to inhibit parasympathetic activity in non-habitual consumers. The caffeine-stimulated increase in nerve activity is likely to evoke other physiological effects as the body attempts to maintain homeostasis.

The effects of caffeine on parasympathetic activity may vary depending on the position of the individual when autonomic responses are measured. One study found that the seated position inhibited autonomic activity after caffeine consumption (75 mg); however, parasympathetic activity increased in the supine position. This finding may explain why some habitual caffeine consumers (75 mg or less) do not experience short-term effects of caffeine if their routine requires many hours in a seated position. It is important to note that the data supporting increased parasympathetic activity in the supine position was derived from an experiment involving participants between the ages of 25 and 30 who were considered healthy and sedentary. Caffeine may influence autonomic activity differently for individuals who are more active or elderly.