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- 1. 1 Autonomic nervous system Sympatheticnervous system Sympathetic nervous system Dr Swati Patil
- 2. 2 • Autonomic nervoussystem -History -Introduction -Types :- Sympathetic –Development -Introduction -Course -Types -Applied
- 3. 3 Autonomic Nervous System •Self regulating • History: – 1898 - J.N.Langley assigned the term Autonomic Nervous System – 1921 – subdivided ANS into • Sympathetic • Parasympathetic • Enteric
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- 5. 5 Autonomic Nervous System •Introduction – Visceral component of nervous system , function closely related to somatic nervous system – Visceral afferent pathways resemble somatic afferent – Peripheral processes – auotonomic ganglia – somatic nerves
- 6. 6 Visceral Afferents -Cell bodies–unipolar – present in cranial sensory or dorsal root ganglia -Central processes –with somatic afferents into CNS –establish connections
- 7. 7 Visceral Efferent • Visceralefferent pathways in ANS differ from their somatic equivalents • pre-ganglionic neurons: – Somata are located in • visceral efferent nuclei & • in lateral grey columns – axons are • myelinated , • pass to peripheral ganglia • synapse with postganglionic neurons
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- 9. 9 • Post-ganglionic neurons–axons are unmyelinated , more numerous
- 10. 10 Subdivisions of ANS •Sympathetic • Parasympathetic • Enteric
- 11. 11 • Sympathetic –mass response -Constriction of cutaneous arteries - Cardiac acceleration - Rise in blood pressure - Contraction of sphincters - Depression of peristalsis • Sympathetic: mobilization & increased metabolism “fight, flight or fright” or “fight, flight or freeze”
- 12. 12 Neurotransmitters: • pre-ganglionic neuronsof both are cholinergic • post-ganglionic – parasympathetic –cholinergic – sympathetic –nor-adrenergic • principal co-transmitters – ATP , Neuropeptide Y
- 13. 13 Sympathetic Nervous System •Development :- -During 5th week, neural crest cells migrate along sides of spinal cord ganglia - dorsolateral to aorta -Some neural crest cells migrate ventral to aorta pre-aortic ganglia – celiac & mesenteric ganglia
- 14. 14 • Other neuralcrest cells migrate to heart, lungs, GIT terminal ganglia • Axons of sympathetic neurones in intermediolateral cell column of thoracolumbar seg of spinal cord pass through ventral root of spinal nerve & white ramus communicans to reach paravertebral ganglia
- 15. 15 • Synapse withneurons – ascend / descend in sympathetic trunk • Other presynaptic fibers – pass through paravertebral ganglia without synapsing – splanchnic nerves to viscera • Post synaptic fibres –grey rami from sympathetic ganglion into spinal nerve • Sympathetic trunk – ascending & descending fibres
- 16. 16 Sympathetic Trunk • Twoganglionated nerve cords –either side of vertebral column • White & grey rami communicantes • Location –neck ,thorax, abdomen, pelvis
- 17. 17 Preganglionic neurones: • Cellbodies of preganglionic sympathetic neurons –in lateral horn • Axons –myelinated ,diam -1.5 - 4 microm • Leave cord in ventral nerve roots – pass into spinal nerves, soon leave in white rami communicants
- 18. 18 Behaviour of PreganglionicFibres • Synapse with neurons in nearest ganglion or may ascend or descend • Fibres terminate in single ganglion or through collateral branches – synapse • Fibres may ascend or descend without synapsing –emerge in branches of sympathetic trunk –synapse in ganglia of autonomic plexus
- 19. 19 Postganglionic Neurones ofSympathetic Nervous System • Somata of postganglionic neurons –in ganglia of sympathetic trunk • Axons –unmyelinated, return to spinal nerve through grey ramus just proximal to white ramus & then form dorsal & ventral ramus
- 20. 20 Cervical Sympathetic Trunk •B/w Carotid sheath and prevertebral muscles • Internal carotid nerve • Three cervical ganglia – Superior – Middle – Inferior
- 21. 21 Superior Cervical Ganglion •Largest ganglion • Lies in front of transverse processes of C2 and C3 vertebrae • Branches – Medial – Lateral
- 22. 22 Middle Cervical Ganglion •Smallest of the Cervical ganglion • Lies on the C6 vertebra in front or behind Inf. thyroid artery • Branches – grey rami communicantes – Cardiac branch – Vascular Branch
- 23. 23 Stellate Ganglion • Formedby the fusion of C7,C8 andT1ganglia • Lies b/w neck of 1st Rib and transverse process of C7 vertebra • Branches – Grey rami communicans – Vascular branches
- 24. 24 Sympathetic supply –Head and Neck • Preganglionic fibres – T1-T5 segments of Spinal Cord • Ascend in Sympathetic Trunk • Synapse in cervical ganglia
- 25. 25 Thoracic Sympathetic Trunk •Comprises of 11 ganglia • Ganglia lie against the heads of ribs • Branches – Grey rami communicans – Pul. And cardiac Plexus – Splanchnic Nerves
- 26. 26 Coeliac Plexus • Situatedaround the origin of coeliac artery • Formed by greater Splanchnic Nerves and Ist lumbar sympathetic nerves • Nerves from the plexus supply abdominal viscera via blood vessels
- 27. 27 Lumbar Sympathetic Trunk •Lies retroperitoneally on the anterolat. surface of lumbar vertebrae • Rt side – overlapped by IVC • Lt side – overlapped by Aorta • Branches – Splanchnic nerves – Grey rami communicantes
- 28. 28 Hypogastric Plexuses • Superiorhypogastric plexus:- -location -formation -branches • Inferior hypogastric plexus :- -location -formation -branches
- 29. 29 Adrenal Medulla • Neuralcrest cells – secretary cells of medulla • Sympathetic supply – preganglionic sympathetic neurons • Secretary cells – postganglionic sympathetic neurons –lack axons or dendrites • Larger secretory cells – secrete adrenaline & NA
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- 31. 31 Sympathetic Ganglion Histology : •Connective tissue, ganglion, capsule cells • Nerve cells –multipolar, smaller • Nucleolus –prominent eccentric
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- 33. 33 Enteric Nervous System •Myenteric (Auerbach’s) plexus & submucosal (Meissner) plexus • Plexus –small enteric ganglia –joined by thin nerves –unmyelinated • Avascular –nutrition by diffusion • Neurones –excitatory & inhibitory • Afferents to ENS -2 types – cholinergic & NA
- 34. 34 Pain Afferents • Sensoryneurones –pain in thoracic & abdominal organs • Cell bodies –dorsal root ganglia • Peripheral processes – white communicating rami –sympathetic trunk –viscera
- 35. 35 • Referred pain–diffuse localization & radiation • Zone of reference of pain from int organ coincides with part of body served by somatic sensory neurons assoc with same segment of spinal cord
- 36. 36 Referred Pain • Heart–middle & inferior cervical cardiac nerves, thoracic cardiac branches of left sympathetic chain • Gall bladder –greater splanchnic nerve , diaphragm –phrenic nerve
- 37. 37 • Stomach –epigastrium– Rt & Lt greater splanchnic nerves • Duodenal ulcer –AAW – T9 T10 • Appendix –lesser splanchnic nerves –T10 • Pelvis & ureter –least splanchnic nerves –loin & groin
- 38. 38 Surgical Sympathectomy • Indications –Peripheral vascular disease –sympathectomy –temporary vasodilatation –development of collaterals – Hyperhidrosis –sympathectomy –permanent relief – Relief of Pain –a) visceral pain –excision / destruction – coeliac ganglia –Ca pancreas, chronic pancreatits – b) causlgia –intense pain
- 39. 39 Upper Thoracic andCervical Sympathectomy • Upper limb -2 & 3 thoracic ganglia with rami & intervening part • 1st thoracic –not removed, preganglionic fibres not arise above T2 (removal – Horner’s syndrome)
- 40. 40 Kuntz Nerve • Communicatingbranch B/w T1and T2 nerves • Receives Grey rami from Stellate and T2 ganglia • Clinical relevance –failure to identify during thoracic sympathectomy
- 41. 41 Lumbar Sympathectomy • Gangliectomy-3 & 4 lumbar ganglia & intervening trunk • Removal of LIis harmful – interferes with ejaculation
- 42. 42 Horner’s Syndrome • Preganglionic–white ramus of T1 –sympathetic trunk – superior cervical ganglion – postganglionic fibres (ICA) – ophthalmic –nasociliary – long ciliary branches • Damage –vascular lesions of cortex / brainstem, cervical rib, Ca lung, thyroid, oesophagus
- 43. 43 Clinical features of Horner’ssyndrome: • Miosis –failure dilation – unopposed parasympathetic activity • Partial ptosis –paralysis of LPS • Anhydrosis –lesion of superior cervical ganglion
- 44. 44 Central Control ofSympathetic Nervous System • Hypothalamus –controlling &integrating center • Hypothalamus –autonomic nuclei –spinal cord – reticular formation • Posterior & lateral nuclei – noradrenergic response
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