Sympathetic Nervous System Medical Editor: Jan Camille Santico
o Exit the ganglia and swirl around the internal carotid
OUTLINE artery, forming the carotid plexus
I) MAIN HEADING IN The carotid plexus branches into three to innervate:
II) CONTENT FORMATTING (1) Dilator pupillae III) APPENDIX IV) REVIEW QUESTIONS Causes pupillary dilation V) REFRENCES Allows for far vision (2) Ciliary muscle (ciliaris) Contracts to make the lens flat (accommodation) Assists in far vision (3) Salivary glands I) SYMPATHETIC NERVOUS SYSTEM The norepinephrine released by the post-ganglionic fibers The sympathetic nervous system is activated during “fight can act directly on: or flight” situations o Tunica media (of blood vessels) Location: Spinal Cord, T1 – L2 or L3 (thoracolumbar Constricts the tunica media, decreasing blood flow outflow) to the salivary glands and consequently Remember decreasing salivary output Ganglion – a group of cell bodies outside the CNS o Salivary glands Pre-ganglionic Fibers/Neurons – fibers which originate Increases mucin (a glycoprotein which thickens from the brain/spinal cord and synapse with a ganglion mucus) production, causing thick and viscous Post-ganglionic Fibers/Neurons – fibers which originate mucus from the ganglion and travel to a target/effector organ (4) Lacrimal glands The cell bodies of pre-ganglionic sympathetic neurons The norepinephrine released by the post-ganglionic fibers originate in the intermediate lateral grey horn of the spinal can act directly on: cord (from T1-L2) o Tunica media (of blood vessels) These pre-ganglionic neurons synapse with their Constricts the tunica media, decreasing blood flow postganglionic neurons at different locations: to the lacrimal glands and consequently o Chain/Paravertebral ganglia decreasing lacrimal output Bilateral chains of ganglia located ventral and o Lacrimal glands lateral to the spinal cord Decreases lacrimation o Prevertebral/Collateral ganglia Midline structures located anterior to the aorta and (B) MIDDLE AND INFERIOR CERVICAL GANGLIA spinal cord Pathway of Pre-ganglionic Fibers: Sympathetic fibers from the thoracic spinal cord pass through the chain II) CHAIN/PARAVERTEBRAL GANGLIA ganglia and extend superiorly to synapse with the middle Recall: Preganglionic fibers can synapse with ganglia and inferior cervical ganglia which are located superior or inferior to their central o Fibers from T1-T3 can contribute to the plexuses neuron (See Autonomic Nervous System lecture) o Fibers from T1-T5 can exit on their own as splanchnic Sympathetic fibers from the upper thoracic spinal cord nerves (within the spinal nerve) extend to the cervical region to Pathway of Post-ganglionic Fibers: synapse with the cervical ganglia: o The most important post-ganglionic branches from o Superior cervical ganglia innervate the heart, lungs, and esophagus o Middle cervical ganglia Cardiac plexus o Inferior cervical ganglia Esophageal plexus o Stellate ganglia Pulmonary plexus fusion of the inferior cervical and first thoracic o Recall: The superior cervical ganglia also give off sympathetic ganglia branches to innervate these organs; thus, it is These cervical ganglia provide sympathetic efferent sometimes called the superior-middle-inferior cardiac innervation to the face and head. nerve/plexus
(A) SUPERIOR CERVICAL GANGLIA (1) Cardiac Plexus (heart)
• Pathway of Pre-ganglionic Fibers: Sympathetic fibers Acts on nodal cells from T1-T3 pass through the chain ganglia then extend o Increase heart rate superiorly to synapse with the superior cervical ganglia o Positive chronotropic action Pathway of Post-ganglionic Fibers: Acts on myocardium/contractile muscle cells o Join/Contribute to spinal nerves to supply: o Increase contraction power increases cardiac Erector pili output increases BP Blood vessels (2) Esophageal Plexus (esophagus) Sudoriferous sweat glands o Contribute branches to the heart, lungs, and Decreases peristalsis of esophagus esophagus Decreases secretions from esophageal glands
Sympathetic Nervous System NEURO PHYSIOLOGY: Note #1. 1 of 4
(3) Pulmonary Plexus (lungs) ascending colon, and transverse colon (proximal 2/3s) Acts on bronchial smooth muscle o The post-ganglionic fibers inhibit the digestive o Control airway resistance/diameter process in the aforementioned organs by: Causes dilation of respiratory bronchioles Decreasing peristalsis Decreases secretions from glands Decreasing absorption (through vasoconstriction) Vasoconstricts the bronchial arteries (Recall: pulmonary Decreasing secretion arteries fall under the control of autoregulation) o If these vessels dilate, it will allow fluid to leak within (C) ADRENAL MEDULLA the lungs. Pathway of Pre-ganglionic Fibers: The greater splanchnic nerve synapses with the chromaffin cells of III) PREVERTEBRAL/COLLATERAL GANGLIA the adrenal medulla One of their functions is to divert blood flow away from o Example of an intramural ganglion the digestive and excretory organs so that blood can be o Exception to the usual two-neuron structure of the sent to the brain and muscles, which are more important sympathetic nervous system in “fight or flight” situations Pathway of Post-ganglionic Fibers o The chromaffin cells release norepinephrine and (A) CELIAC GANGLIA epinephrine to the general circulation, causing a • Pathway of Pre-ganglionic Fibers: diffuse, systemic effect o Sympathetic fibers from T5-T9 pass through the chain ganglia and exit as the greater splanchnic nerve o The greater splanchnic nerve synapses with the Summary celiac ganglia The greater splanchnic nerve synapses with the following: o Celiac Ganglia Pathway of Post-ganglionic Fibers: o Superior Mesenteric Ganglia o The post-ganglionic fibers branch out to innervate o Adrenal Medulla some abdominal organs (1) Stomach (D) AORTICORENAL GANGLIA Recall: There is less focus on digestion during “fight or flight” situations • Pathway of Pre-ganglionic Fibers: Inhibits peristalsis (via beta-2 adrenergic receptors) o Sympathetic fibers from T10-T11 pass through the o By constricting blood vessels to the stomach, chain ganglia and exit as the lesser splanchnic consequently decreasing blood flow nerve o The greater splanchnic nerve synapses with the Decreases absorption and secretion aorticorenal ganglia Constricts the pyloric sphincter (via alpha-1 receptors) o Prevents chyme from moving to the duodenum Pathway of Post-ganglionic Fibers: o The post-ganglionic fibers innervate the kidney and (2) Liver ureter Recall: The liver can break down glycogen into glucose Decrease urine production (by decreasing blood when blood sugar levels are low flow to the kidneys) Stimulates glycogenesis Juxtaglomerular cells release renin, which triggers the angiotensin II cascade to increases blood (3) Gall Bladder pressure Inhibits biliary tree contraction / decreases biliary tree flow (E) RENAL PLEXUS o To prevent the secretion of bile Pre-ganglionic Fibers: Sympathetic fibers from T12 (4) Pancreas pass through the chain ganglia and synapse with diffuse Recall: The beta cells produce insulin, while the alpha ganglion cells (renal plexus) cells produce glucagon Post-ganglionic Fibers: The post-ganglionic fibers enter Decreases insulin production the kidney to: o To prevent low blood sugar o Support the aorticorenal ganglion fibers in decreasing urine production in the kidney Increases glucagon production o Decrease peristalsis of the ureter (5) Spleen (F) INFERIOR MESENTERIC GANGLION Causes splenic contraction Pathway of Pre-ganglionic Fibers: (6) Duodenum (proximal half) o Sympathetic fibers from L1-L2 (sometimes L3) pass through the chain ganglia and exit as lumbar Recall: The celiac trunk (of the aorta) supplies this area splanchnic nerves Decrease peristalsis and secretion in this area o The lumbar splanchnic nerves innervate the inferior (B) SUPERIOR MESENTERIC GANGLIA mesenteric ganglion • Pathway of Pre-ganglionic Fibers: Pathway of Post-ganglionic Fibers: o Sympathetic fibers from T5-T9 pass through the chain o Recall: The inferior mesenteric artery supplies the ganglia and exit as the greater splanchnic nerve transverse colon (distal 1/3), descending colon, o The greater splanchnic nerve synapses with the sigmoid colon, and upper rectum celiac ganglia AND the superior mesenteric o These fibers innervate the aforementioned organs to: ganglia Decrease peristalsis Decrease defecation Pathway of Post-ganglionic Fibers: o Recall: The superior mesenteric artery supplies the duodenum (distal half), jejunum, ileum, cecum,
2 of 4 NEURO PHYSIOLOGY: Note #1. Sympathetic Nervous System
(G) SUPERIOR HYPOGASTRIC PLEXUS (H) INFERIOR HYPOGASTRIC PLEXUS Pathway of Pre-ganglionic Fibers: Sympathetic fibers Pathway of Pre-ganglionic Fibers: from T12-L3 (sometimes L3) pass through the chain o Sympathetic fibers from T10-L2 pass through the ganglia and synapse with the superior hypogastric chain ganglia and exit around the sacral region as the plexus sacral splanchnic nerves o The superior hypogastric plexus gives off the left and o The sacral splanchnic nerves synapse with the right hypogastric nerves, which also form the inferior inferior hypogastric plexus hypogastric plexus Recall: This plexus is made up of the left and right o These fibers can also synapse with the hypogastric nerves, which come from the superior intermesenteric plexus hypogastric plexus Located between the superior and inferior Pathway of Post-ganglionic Fibers: The post- mesenteric arteries ganglionic fibers of this plexus innervate the gonads The post-ganglionic fibers from this plexus can go in all directions (1) Males Pathway of Post-ganglionic Fibers: The post- The postganglionic fibers of the inferior hypogastric ganglionic fibers go to the internal urethral sphincter and plexus innervate the penis and scrotum detrusor o Initiate ejaculation Parasympathetic stimulation: erection (“point”) (1) Detrusor Sympathetic stimulation: ejaculation (“shoot”) Muscularis externa of the bladder o Stimulate prostate gland to produce seminal fluid Contain beta-2 and beta-3 adrenergic receptors (2) Females Sympathetic stimulation causes relaxation of this muscle to decrease micturition The postganglionic fibers innervate the uterus and vagina o Non-pregnant women: stimulate uterine contractions (2) Internal Urethral Sphincter o Pregnant women Contain alpha-1 adrenergic receptors There is a shift from alpha-1 to beta-2 adrenergic Sympathetic stimulation causes constriction of the receptors sphincter to prevent micturition Due to this shift, sympathetic fibers do not induce Recall: The external urethral sphincter is under voluntary uterine contractions in pregnant women somatic control IV) OTHER SYMPATHETIC CONTRIBUTIONS The sympathetic nervous system receives input from the hypothalamus, limbic nuclei, and in certain situations, the cortex o These sympathetic fibers can have higher brain control (e.g. we can control our heart rate to an extent)
Figure 1.Sympathetic Nervous System
Sympathetic Nervous System NEURO PHYSIOLOGY: Note #1. 3 of 4
V) REVIEW QUESTIONS
The following are innervated by the sympathetic
fibers of the superior cervical ganglion, EXCEPT? a. Dilator pupillae b. Levator palpebrae c. Ciliaris muscle d. Lacrimal glands
The greater splanchnic nerve originates from which
segments of the spinal cord? a. T1-T4 b. T5-T9 c. T10-T11 d. L1-L2
Which of the following is NOT a function of the
celiac ganglion? a. Decrease absorption in the stomach b. Stimulates glycogenesis in the liver c. Stimulates the production of insulin d. Decreases biliary tree flow
The internal urethral sphincter is innervated by
which sympathetic ganglia? a. Inferior cervical ganglia b. Inferior mesenteric ganglia c. Superior hypogastric ganglia d. Inferior hypogastric ganglia
Which of the following is an intramural ganglion?
a. Superior mesenteric ganglia b. Superior hypogastric ganglia c. Cardiac plexus d. Chromaffin cells
CHECK YOUR ANSWERS
VI) REFRENCES
4 of 4 NEURO PHYSIOLOGY: Note #1. Sympathetic Nervous System
