PHYSIOLOGY OF ANS(AUTONOMIC NERVOUS SYSTEM)
Sympathetic Responses
Parasympathetic Responses
Autonomic Interactions
Control of Autonomic Nervous System Function
PHYSIOLOGY OF ANS(AUTONOMIC NERVOUS SYSTEM)
Sympathetic Responses
Parasympathetic Responses
Autonomic Interactions
Control of Autonomic Nervous System Function
Introduction to Autonomic Nervous systemNaser Tadvi
Lecture intends to give a brief overview of autonomic nervous system.
it includes the anatomical distribution of ANS, Neurohumoral transmission, co-transmission, receptors for ANS and synthesis of the neurotransmitters, Acetylcholine and Catecholamines
what are neurotransmitter
adrenegic neurotransmittier, epinephrine and nor epinephrine , receptors of epinephrine and non epinepheine, cholinergic meurotransmitter, acetylecholine
The central nervous system (CNS) is the part of the nervous system consisting of the brain and spinal cord. The central nervous system is so named because it integrates information it receives from, and coordinates and influences the activity of, all parts of the bodies
Introduction to Autonomic Nervous systemNaser Tadvi
Lecture intends to give a brief overview of autonomic nervous system.
it includes the anatomical distribution of ANS, Neurohumoral transmission, co-transmission, receptors for ANS and synthesis of the neurotransmitters, Acetylcholine and Catecholamines
what are neurotransmitter
adrenegic neurotransmittier, epinephrine and nor epinephrine , receptors of epinephrine and non epinepheine, cholinergic meurotransmitter, acetylecholine
The central nervous system (CNS) is the part of the nervous system consisting of the brain and spinal cord. The central nervous system is so named because it integrates information it receives from, and coordinates and influences the activity of, all parts of the bodies
Autonomic nervous system: divisions
General organization of ANS Neurons of ANS
Physiological anatomy of sympathetic nervous system& parasympathetic nervous System
Autonomic neurotransmitters and receptors
Functions of ANS: effects of autonomic nerve impulses on effector organs
Differences between sympathetic and parasympathetic systems
APPLIED ASPECTS- Autonomic drugs, Autonomic failure, Autonomic function tests
Individualized Webcam facilitated and e-Classroom USMLE Step 1 Tutorials with Dr. Cray. For questions or more information.. drcray@imhotepvirtualmedsch.com
The Autonomic nervous system divided into two parts i.e sympathetic nervous system and parasympathetic nervous system.
ANS also consists cranial nerve and spinal nerve.
Introduction to nervous system
Contents :
Parts of nervous system
Parts of brain
Sagittal section of the brain
Basic functions of the brain
Parts and functions of Diancephalon
Structures and functions of brainstem
Spinal cord
Peripheral nervous system
Somatic nervous system
Autonomic nervous system
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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2. Central nervous system
• The nervous system with the endocrine
system controls and coordinates various
functions of the body.
• The body has to make adjustments
according to the changes in its internal
and external environments.
• These adjustments are essential for the
maintenance of homeostasis, as well as
for existence.
3. The nervous system can be classified:
• Anatomically, according to its
different structures,
• Physiologically, according to its
functions.
Anatomically nervous system formed of
(Somatic nervous system, autonomic
nervous system and integrative nervous
system).
4.
5. Peripheral Nervous System
• Handles the CNS’s input and output.
• Contains all the portions of the NS
outside the brain and spinal cord.
• Contains sensory nerves and motor
nerves
• Divided into autonomic nervous
system and somatic nervous
system.
6. Peripheral Nervous System
• Sensory Nerves
(to the brain)
Carry messages from
receptors in the skin,
muscles, and other
internal and external
sense organs to the
spinal cord and then
to the brain
• Motor Nerves
(from the brain)
Carry orders from CNS
to muscles, glands to
contract and produce
chemical
messengers
7. • The ANS is part of the peripheral nervous
system and it controls many organs and
muscles within the body.
• In most situations, we are unaware of the
workings of the ANS because it functions in
an involuntary, reflexive manner.
• For example, we do not notice when blood
vessels change size or when our heart beats
faster.
• However, some people can be trained to
control some functions of the ANS such as
heart rate or blood pressure.
8. The ANS is most important in two situations:
1- In emergencies that cause stress
and require us to "fight" or take
"flight" (run away).
2- In no emergencies that allow us
to "rest" and "digest".
9. • It is usual to divide the nervous
system into somatic, autonomic and
integrated systems.
• The somatic nervous system provides
voluntary motor control of skeletal
muscle.
• The autonomic nervous system
provides an involuntary control of
internal environment and the viscera.
10. • The two systems are
anatomically separated form
each other, but functionally
they cannot perform their
work independently, and
they work with each other in
an integrated manner
11. Peripheral Nervous System
• Somatic NS
Consists of nerves
connected to
sensory
receptors and
skeletal muscles
Permits voluntary
action (writing
your name)
• Autonomic NS
Permits the
Involuntary functions
of blood vessels,
Glands and
internal organs e.g.:-
the bladder
stomach
heart
12. Characteristic Somatic nervous
system
Autonomic N.
system
Effectors Voluntary muscle Cardiac muscle
glands, s. muscle
General functions Adjustment to
external environment
Adjustment within
internal environment
Numbers of neurons 1 2
Ganglia outside the
CNS
------------ Chain ganglia,
collateral ganglia or
terminal ganglia
Neurotransmitter acetylcholine Acetylcholine,
adrenaline,
noradrenaline
Center Anterior Horn cells Lateral Horn cells
13. Comparison of Autonomic and
Somatic Motor Systems
• Autonomic nervous system
– Chain of two motor neurons
• Preganglionic neuron
• Postganglionic neuron
– Conduction is slower due to thinly or
unmyelinated axons
Pre-ganglionic
Ganglion
Post-ganglionic
14. Sympathetic N.S. Parasympathetic N.S.
Like the accelerator of
your car
Like the brakes in your car
Slows the body down to
keep its rhythm
Mobilized the body for
action
Enables the body to
conserve and store energy
Preganglionic: short, synapse
within the lateral & collateral
ganglia
Preganglionic: long, synapse
within the terminal ganglia
Postganglionic: long Postganglionic: short
Has a wide distributions Has a restricted distributions
15. Autonomic Nervous System
• Often work in
opposition
• Cooperate to fine-
tune homeostasis
• Regulated by the
brain;
hypothalamus, pons
and medulla
• Can also be
regulated by spinal
reflexes; no higher
order input
• Pathways both
consist of a two
neuron system
Preganglionic neuron autonomic ganglion postganglionic neuron target
from CNS outside CNS
16. Fig. 45.34(TE Art)Hypothalamus activates
sympathetic division of
nervous system
Heart rate, blood pressure,
and respiration increase
Blood flow to
skeletal muscles
increases
Stomach
contractions
are inhibited
Adrenal medulla
secretes
epinephrine and
norepinephrine
17.
18. Sympathetic
Fight or Flight, Dealing
with stress,
thoracolumber,
intermediolateral
column, T1 -L2
Parasympathetic
Rest and Digest,
Vegging
Craniosacral S2-S4,
19. Sympathetic nerve endings also activate the release of NE and E from the adrenal
medulla
Enhances effects of NE from sympathetic nerve endings
Adds the effects of E to the overall arousal (“fight or flight”) pattern
21. Sympathetic
• Sometimes called the
“thoracolumbar” division
• Short preganglionic neurons;
long postganglionic neurons;
ganglia are called the chain
ganglia
• Preganglionic neurons secrete
Ach onto nicotinic receptors
• Postganglionic neurons
secrete NE on to α or β
receptors
• Target tissues are smooth
muscle, cardiac muscle,
endocrine glands, brown fat
22. Parasympathetic
•Sometimes called the
“cranio-sacral division
•Long preganglionic
neurons;
•short postganglionic
neurons (often in the
target organ)
•Preganglionic neurons
secrete Ach on to
nicotinic receptors
•Postganglionic neurons
secrete Ach on to
muscarinic receptors
•Target tissues are
smooth muscle,
cardiac muscle,
exocrine glands, brown
fat
25. Similarities between Sympathetic & ParasympatheticSimilarities between Sympathetic & Parasympathetic
• Both are efferent (motor) systems: “visceromotor”
• Both involve regulation of the “internal” environment
generally outside of our conscious control:
“autonomous”
• Both involve 2 neurons that synapse in a peripheral
ganglion and Innervate glands, smooth muscle,
cardiac muscle
CNS ganglion
preganglionic
neuron
postganglionic
neuron
glands
smooth
muscle
cardiac
muscle
26. Differences between Sympathetic & ParasympatheticDifferences between Sympathetic & Parasympathetic
Location of Preganglionic Cell Bodies
Thoracolumbar
T1 – L2/L3 levels
of the spinal cord
Craniosacral
Brain: CN III, VII, IX, X
Spinal cord: S2 – S4
Sympathetic Parasympathetic
27. Sympathetic
CNS ganglion
short preganglionic
neuron
long postganglionic
neuron
target
Parasympathetic
CNS ganglion
long preganglionic
neuron
target
short postganglionic
neuron
Differences between Sympathetic & ParasympatheticDifferences between Sympathetic & Parasympathetic
Relative Lengths of Neurons
28. Parasympathetic
Overview of the Autonomic Nervous SystemOverview of the Autonomic Nervous System
Differences between Sympathetic & ParasympatheticDifferences between Sympathetic & Parasympathetic
Neurotransmitters
ACh, +
NE (ACh at sweat glands),
+ / -, α & ß receptors
ACh, + / -
muscarinic receptors
• All preganglionics release acetylcholine (ACh) & are excitatory (+)
• Symp. postgangl. — norepinephrine (NE) & are excitatory (+) or inhibitory (-)
• Parasymp. postgangl. — ACh & are excitatory (+) or inhibitory (-)
Sympathetic
• Excitation or inhibition is a receptor-dependent & receptor-mediated response
ACh, +
29. Overview of the Autonomic Nervous SystemOverview of the Autonomic Nervous System
Differences between Sympathetic & ParasympatheticDifferences between Sympathetic & Parasympathetic
Target Tissues
ParasympatheticSympathetic
• Organs of head, neck,
trunk, & external genitalia
• Organs of head, neck,
trunk, & external genitalia
• Adrenal medulla
• Sweat glands in skin
• Arrector muscles of hair
• ALL vascular smooth muscle
» Sympathetic system is distributed to essentially all
tissues (because of vascular smooth muscle)
» Parasympathetic system never reaches limbs or
body wall (except for external genitalia)
30. Overview of ANSOverview of ANS
Functional Differences
Sympathetic
• “Fight or flight”
• Catabolic (expend energy)
Parasympathetic
• “Feed & breed”, “rest &
digest”
• Homeostasis
» Dual innervation of many
organs — having a brake
and an accelerator provides
more control
31.
32.
33. The reflex arc
The autonomic reflex
arc
The somatic reflex
arc
Origin Lateral horn cells Anterior horn cells
Efferent Relay in autonomic
ganglia outside the
CNS.
Supply the effector
organ directly.
Inter
neuron
------------------------ present
Effector
organs
Smooth , cardiac
muscles
skeletal
42. Sympathetic System: Postganglionic Cell BodiesSympathetic System: Postganglionic Cell Bodies
Paravertebral
ganglia
Prevertebral
ganglia
• celiac ganglion
• sup. mesent. g.
• inf. mesent. g.
aorta
sympathetic
trunk (chain)
1. Paravertebral ganglia
• Located along sides of vertebrae
• United by preganglionics into Sympathetic Trunk
• Preganglionic neurons are thoracolumbar (T1–L2/L3)
but postganglionic neurons are cervical to coccyx
• Some preganglionics ascend or descend in trunk
synapse at
same level
ascend to
synapse at
higher level
descend to
synapse at
lower level
43. Sympathetic System: Postganglionic Cell BodiesSympathetic System: Postganglionic Cell Bodies
Paravertebral
ganglia
Prevertebral
ganglia
• celiac ganglion
• sup. mesent. g.
• inf. mesent. g.
aorta
sympathetic
trunk (chain)
2. Prevertebral (preaortic) ganglia
• Located anterior to abdominal aorta, in plexuses
surrounding its major branches
• Preganglionics reach prevertebral ganglia via
abdominopelvic splanchnic nerves
abdominopelvic
splanchnic
nerve
45. Sympathetic System: SummarySympathetic System: Summary
T1
L2
4- somatic
tissues
(body wall, limbs)
visceral tissues
(organs)
postganglionics
via 31 spinal
nerves
to somatic tissues
of neck, body wall,
and limbs
sympathetic
trunk
prevertebral
ganglia
2- Cardiopulmonary
Splanchnics: postganglionic
fibers to thoracic viscera
3- Abdominopelvic
Splanchnics: preganglionic
fibers to prevertebral ganglia,
postganglionic fibers to
abdominopelvic viscera
1- Cervical division
46. 1- Cervical division
Origin: T1-2
Course: preganglionic fibres reach the sympathetic
chain and then ascend upwards to relay
in the superior cervical ganglion.
Postganglionic neuron: pass from ganglion
to the following organs:-
• EYE: pupil dilatation, widening of palpebral fissure, exophthalmos,
Vasoconstriction of eye b.v. and Relaxation of ciliary muscle.
• Salivary gland : trophic secretion, Vasoconstriction of its blood vessels and
Squeezing of salivary secretion.
• Lacrimal gland: Trophic secretion and Vasoconstriction.
• Face skin blood vessel: Vasoconstriction of (Pale color).
• Sweet secretion: copious secretion.
• Hair: erection due to contraction of erector pilae muscles..
• Cerebral vessels: Weak vasoconstriction
48. (2) Cardiopulmonary division
Origin: Lateral horn cells of upper 4-5 thoracic segments.
Course: Preganglionic neurons reach the sympathetic chain to
relay in the three cervical ganglion and upper four thoracic
ganglion.
The postganglionic arise from these ganglia supply the
following structures:-
• Heart: Increase all properties of cardiac muscle (contraction,
rhythmicity, excitability, conductivity.
• Coronary vessels, its sympathetic supply. At first it
causes vasoconstriction, and then it causes vasodilatation due
to accumulation of metabolites.
• Bronchi: Broncho dilation, decrease bronchial secretions and
vasoconstriction of pulmonary blood vessels.
50. 3- Splanchnic division
Origin: lateral horn cells of the lower six thoracic and upper four lumber segments.
Course: Preganglionic neurons originate from these segments reach the sympathetic
chain where they pass without relay, and then they divided into two branches:
(1) Greater splanchnic nerve
(2) Lesser splanchnic nerve.
Greater splanchnic nerve:
• Origin: Preganglionic nerves fibers emerge from lateral horn cells of lower six
thoracic segments and then relay in the collateral ganglion in the abdomen.
• Course: Postganglionic nerve fibers arise from these ganglia (celiac, superior
mesenteric and inferior mesenteric ganglia) and supply the abdominal organs
causing the following effects:
• Vasoconstriction: of most arteries of stomach, small intestine, proximal part of large
intestine, kidney, pancreas and liver.
• Relaxation of the musculature of: stomach, small intestine and proximal part of
large intestine.
• Contraction of sphincters: of the stomach and intestine leading to (food retention).
• Contraction of the capsule: of the spleen leading to evacuation of about 200 ml of
blood.
• Breakdown of the glucose in the liver: (glycogenolysis) leading to increase of
blood glucose level.
• Stimulation of adrenal medulla: Secrete adrenaline and noradrenalin.
54. Lesser splanchnic nerve
Origin: Preganglionic nerve fibers originate from the lateral horn
cells of the 12 thoracic and upper two lumber segments.
Course: 2 nerves from both sides unite together forming the
presacral nerve, which proceeds to pelvis and divided into two
branches (hypogastric nerves), then relay in the inferior
mesenteric ganglion.
Postganglionic nerve fiber supplies the following pelvic viscera:
Urinary bladder: Relaxation of its wall.
– Contraction of internal urethral sphincter.
– Leading to urine retention.
Rectum:
– Relaxation of the distal part of large intestine.
– Relaxation of the rectum wall.
– Contraction of the internal anal sphincter.
– Leading to feces retention.
55. Genital organs:
- Vasoconstriction of its blood vessels.
–Leading to shrinkage of penis and
clitoris.
Vas deferens:
- Contraction of its wall, and wall of
seminal vesicles, ejaculatory ducts and
prostate
- Leading to ejaculation.
57. (4) Somatic division
Origin: Preganglionic nerve fibers arise from all lateral
horn cells of all sympathetic segments, and then relay
in the cervical and sympathetic chain ganglia.
Course: Postganglionic nerve fibers emerge from these
ganglia proceeds outside the central nervous system
to return back to spinal cord to join the spinal nerve
when it comes out from the anterior horn cells, and
supply the following structures:
Skin:
• Vasoconstriction giving the pale color of the skin.
• Stimulation of the sweet glands, the eccrine glands give copious
secretion, while the apocrine glands give thick odoriferous secretion.
• Hair erection.
Skeletal muscle:
• Its blood vessels show vasodilatation (V.D.) due to cholinergic
effect or vasoconstriction (V.C.) due to a adrenergic effect.
• The type of stimulation depends upon the nature of stimulation.
• Muscles: its stimulation causing delayed fatigue and early recovery.
58. 4- somatic tissues
(body wall, limbs)
postganglionics
via 31 spinal nerves
to somatic tissues of neck,
body wall, and limbs
sympathetic
trunk
60. The Role of the Adrenal Medulla
in the Sympathetic Division
• Major organ of the sympathetic nervous
system
• Secretes great quantities epinephrine (a
little norepinephrine)
• Stimulated to secrete by preganglionic
sympathetic fibers
62. ParasympatheticParasympathetic
PathwaysPathways
Cranial outflow
• CN III, VII, IX, X
• Four ganglia in head
• Vagus nerve (CN X) is major
preganglionic parasymp.
supply to thorax & abdomen
• Synapse in ganglia within
wall of the target organs (e.g.,
enteric plexus of GI tract)
Sacral outflow
• S2–S4 via pelvic splanchnics
• Hindgut, pelvic viscera, and
external genitalia
Clinical Relevance
» Surgery for colorectal cancer
puts pelvic splanchnics at risk
» Damage causes bladder &
sexual dysfunction
63. The Parasympathetic Division
• Cranial outflow
– Comes from the brain
– Innervates organs of the head, neck, thorax,
and abdomen
• Sacral outflow
– Supplies remaining abdominal and pelvic
organs
65. Cranial Nerves
• Attach to the brain and pass through
foramina of the skull
• Numbered from I–XII
• Cranial nerves I and II attach to the
forebrain
– All others attach to the brain stem
• Primarily serve head and neck structures
– The vagus nerve (X) extends into the
abdomen
75. CN IX: Glossopharyngeal Nerve
• Sensory and motor innervation of structures
of the tongue and pharynx
• Taste
76. CN X: Vagus Nerve
• A mixed sensory and motor nerve
• Main parasympathetic nerve
– “Wanders” into thorax and abdomen
77. CN XI: Accessory Nerve
• An accessory part of the vagus nerve
• Somatic motor function of pharynx, larynx,
neck muscles
78. CN XII: Hypoglossal Nerve
• Runs inferior to the tongue
– Innervates the tongue muscles
79. Cranial Outflow
• Preganglionic fibers run via:
– Oculomotor nerve (III)
– Facial nerve (VII)
– Glossopharyngeal nerve (IX)
– Vagus nerve (X)
• Cell bodies located in cranial nerve nuclei
in the brain stem
80. CN III: Oculomotor Nerve
Origin: Edinger-Westphal nucleus at
midbrain.
Course:
preganglionic from E-W nucleus to
rely in the ciliary ganglion.
Postganglionic supply:
1- pupillconstrictor muscle
2- ciliary muscle.
3- four of the extrinsic eye
muscles.
Its stimulation leads to miosis,
accommodation to neat vision
and movements of the eye ball.
82. CN VII: Facial Nerve
Origin: The superior salivary nucleus which is a part of
facial nucleus in the lower part of pons.
Course: Preganglionic nerve fibers run in the chorda
tympani nerve which is a part of facial nerve and relay
in:-
- Submaxillary ganglion
- Sphenopalatine ganglion.
• Postganglionic nerve arises from Submaxillary ganglion
supply submandibular and sublingual salivary glands
and anterior 2/3 of the tongue.
• Postganglionic nerve arises from Sphenopalatine
ganglion supply the mucosa of the soft palate and
nasopharynx and Lacrimal glands.
• Its stimulation causes vasodilatation and secretion at
their effector organs.
83. CN VII: Facial Nerve
• Innervates muscles of facial expression
• Sensory innervation of face
• Taste
84. CN IX: Glossopharyngeal Nerve
Origin: Glossopharyngeal nerve nucleus in
the upper part of the medulla oblongata
called inferior salivary nucleus, and then
relay in the otic ganglion.
Course: Postganglionic nerve fibers arise
from otic ganglion supply the parotid
salivary gland and posterior 1/3 of the
tongue
Its stimulation causes vasodilatation and
secretion at their effector organs
85. CN IX: Glossopharyngeal Nerve
• Sensory and motor innervation of structures
of the tongue and pharynx
• Taste
86. CN X: Vagus Nerve
Origin: Dorsal vagus nucleus in medulla oblongata
Course: Postganglionic nerve fibers from the terminal
ganglia which supplied from dorsal vagus nucleus and
supply the following structures:
• HEART: The vagus nerve supplies the both auricles
and don't supply the ventricles (and this called vagus
escape phenomena).
• Its stimulation produces inhibition of all cardiac properties
(decrease heart rate, decrease contractility and decrease
conductivity).
• Its stimulation causes vasoconstriction of coronary
vessels and reduction of O2 consumption by cardiac
muscle.
• These responses lead to bradycardia.
87. • Lungs: Vagus stimulation causes:
• Bronchoconstriction.
• Increased bronchial secretion.
• Vasodilatation of pulmonary blood vessels.
• These responses lead to precipitation of asthma.
Gastrointestinal tract: Vagus stimulation causes:
• Contraction of walls of esophagus, stomach, small intestine and
proximal part of large intestine.
• Relaxation of their corresponding sphincter.
• These responses promote deglutition, increased secretion of GIT and
evacuation of foods.
• Gall bladder: Vagus stimulation causes:
• Contraction of the gall bladder wall.
• Relaxation of its sphincter.
• These responses lead to evacuation of the gall bladder.
89. Sacral Outflow
Origin: Preganglionic nerve fibers arise from the
lateral horn cells of the 2nd, 3rd and 4th sacral
segments.
Course: These preganglionic passes without relay,
then the right and left branches unit together to form
the pelvic nerve, the pelvic nerve relay in the
terminal ganglia, where the postganglionic nerve
fibers emerge and supply the following structures:-
Urinary bladder: parasympathetic stimulation
causes:
- Contraction of the bladder wall
- Relaxation of its sphincter.
- These responses lead to micturition.
90. Rectum and descending colon:
parasympathetic stimulation causes:
- Contraction of its wall.
- Relaxation of internal anal sphincter.
- These responses lead to defecation.
Seminal vesicles and prostate:
parasympathetic stimulation -causes:
- Secretion of these glands.
Erectile tissue: parasympathetic stimulation
causes:
- Vasodilatation which lead to erection.
91. Chemical transmission
The traveling of signal in the nervous system
between different neurons is mediated by the
effect of a chemical substance released at the
nerve terminal called chemical transmitter.
In the sympathetic nervous system the chemical
transmitter is adrenaline, noradrenaline or
sometimes acetylcholine.
When the chemical transmitter is adrenaline the
nerve fiber is called adrenergic, but when the
chemical transmitter is acetylcholine, the nerve
fiber is called cholinergic.
92. Nerves Contact Other Cells at Synapses
• The synapse is the relay point where information is
conveyed from neuron to neuron by chemical
transmitters.
• At a synapse the axon usually enlarges to from a
button ' which is the information delivering part of the
junction.
• The terminal button contains tiny spherical structures
called synaptic vesicles, each of which can hold
several thousand molecules of chemical transmitter.
• On the arrival of a nerve impulse at the terminal
button, some the vesicles discharge their contents into
the narrow cleft that separates the membrane of
another cell's dendrite, which is designated to receive
the chemical message.
93. • Chemical transmitters carry the signal
across synapses
• Chemical transmitters are made and
stored in the presynaptic terminal
• The transmitter diffuses across the
synaptic gap and binds to a receptor in the
postsynaptic membrane.
• Binding of the Transmitter Produces an
excitatory postsynaptic potential EPSP or
inhibitory postsynaptic potential IPSP
94. The Transmitter is Broken down and
Recycled
• Once the signal has been delivered the
transmitter must be removed so that new
signals may be received
• In some cases the transmitter is broken
down by an enzyme in the synapse
• In other cases the transmitter is recycled-
it is transported back into the presynaptic
nerve
• In still other cases these 2 methods are
combined
95. Acetylcholine
• Important neurotransmitter in central and
peripheral nervous systems.
• Acetylcholine is synthesized in the
nerve terminal.
1- Acetyl-coenzyme A (AcCoA) is
manufacured in mitochondria.
2- Choline is accumulated in the teminals
by active uptake from interstitial fluid.
3- AcCoA + choline = acetylcholine.
96. Acetylcholine storage
• Acetylcholine is stored in vesciles in the verve terminal
after its synthesis, each vesicle contains approximatly
104
Ach molecules, which are released as a single
packet.
Acetylcholine release
The arrival of the action potential to the nerve terminal, it
leads to increase in the permeability of the terminal to
Ca++ influx.
• Ca++ recat with synapsin that bind the vesciles, which
on its unbinding the vesciles sweeps to attach to the
presynaptic membrane.
• The vesciles rupture and the acetylcholine released to
the synaptic cleft.
• Acetylcholine act on its specific receptors on the
postsynaptic membrane.
97. Acetylcholine release sites
1-Preganglionic nerve fibres of both
sympathetic and parasympathetic
divisions of the autonomic nervous
system.
2-Postganglionic nerves of the
parasympathetic division.
3- The sympathetic innervation of sweet
glands.
4- Neuromuscular junction.
5- Autonomic ganglion to the adrenal gland.
99. Acetylcholine inactivation
In synaptic cleft, Acetylcholinesterase
breaks it down into acetate and choline.
50% of choline then re up taken into
presynaptic neuron.
100. Acetylcholine receptors
Acetylcholine effects on the tissue are the result of its
action on the receptor present in the membrane of
the effector cells.
Several types of Ach receptors have been
characterized by their sensetivity to agonists (which
mimic the action of Ach) or antagonists (which
specifically block the action of Ach).
• Two types of cholinergic receptors are well known:
• Nicotinic receptors which are easily activated by
agonist molocule such as nicotine and
• Muscarinic receptors: which are sensitive to
muscarine.
101. Cholinergic receptors
Nicotinic receptors
(Central)
Muscarinic receptors
(peripheral )
Types Two types:-
Ganglionic
Neruomuscular
M1, M2 (cardiac), M3
(glandular&smooth
muscle) M4
(brain).M5,M6 and M7.
Stimulated
by
Nicotine in small
doses, Ach,
metacholine
Muscarine, Ach,
carbarcholine
Blocked by Nicoitin in large doses-
decameyhonium
d-tubourarine-
Atropine
scopolamine
site Autonomic ganglia
M.E.P
Adrenal medulla
Preganglionic neuron.
Parasympathetic
(pre-postganglionic)
Sympathetic
postganglionic nerve
endings (sweat glands
& skeletal muscle).
102. Nicotinic Receptors
• Located in the ganglia of both the
PSNS and SNS
• Named “nicotinic” because can be
stimulated by the alkaloid nicotine
103. Muscarinic Receptors
• Located postsynaptically:
– Smooth muscle
– Cardiac muscle
– Glands of parasympathetic fibers
– Effector organs of cholinergic sympathetic
fibers
• Named “muscarinic” because can be
stimulated by the alkaloid muscarine
107. Drugs Affecting the
Autonomic Nervous System
Parasympathomimetic drugs:
These are drugs which exert an action similar
to acetylcholine and there are two types:-
- Drugs directly stimulate cholinergic receptors
- Drugs inhibit cholinesterase enzyme.
Parasympatholytic Drugs:
These drugs antagonize the action of
acetylcholine.
108. Cholinergic Agents
• Drugs that stimulate the parasympathetic
nervous system (PSNS).
• Drugs that mimic the effects of the PSNS
neurotransmitter
• Acetylcholine (ACh)
109. Parasympathomimetic drugs
These are drugs which exert an action similar to the action of
acetylcholine and it is divided into two groups:
(A) Drugs that directly stimulate the cholinergic receptors:
These include Ach derivatives that not hydrolyzed rapidly by
cholinesterase e.g. metacholine, carbachol, poiolocarpine and
muscarine.
(B) Drugs that inhibit the cholinesterase enzyme: These drugs
preserve the action of Ach by preventing the action of
cholinesterase enzyme and they are two types:-
(1) Drugs which has a reversible effect i.e. their action is temporary
e.g. eserine (phyostigmine) and prostigmine (neostigmine).
• - Eserine: is a generalized drugs which causes generalized blocking
allover the body, thus we use it locally as an eye drops in treatment of
glaucoma otherwise it will cause generalized parasympathetic effect.
• - Neostigmine:It was used in treatment of myasthenia gravis due to its
direct action on the motor end plate.
(2) Drugs which have irreversible effect i.e. their action are
prolonged e.g. parathion (an insecticide) and D.F.P.
(Diisopropyflurophosphate), which is a toxic nerve gas.
110. Parasympatholytic Drugs
• These drugs which antagonize the action
of Ach by one of the following
mechanisms:-
• Competitive inhibition: These drugs
occupy the Ach receptors and present its
action.
• Persistent depolarization: These drugs
cause prolonged depolarization of Ach
receptor thus they prevent the excitation of
the receptor by the released Ach.
111. Parasympatholytic drugs
Muscarinic like action
blockers
Ganglion blockers Neuromuscular blocker
These drugs block the
action of Ach at
cholinergic receptors by
blocking the action of
Ach at muscarinic
receptors
These drugs block the
action of Ach at nicotinic
recpotors
These drugs block the
nicotinic like action of Ach
at neuromuscular junction.
e.g.-
AtropineHomatropine
Hyoscine
e.g.
-Nicotine in large doses.
- Arfonad
- Hexamethonium
e.g.
- curare
Mechanism of action-
competitive inhibition
Competitive inhibition.
-Persistent depolarization
Competitive inhibition.
Clinical use:
Atropine used for:--
dilation of pupil- relive
spasm- prevent
bronchial secretion
- Ganglion blocker used
for blocking conduction in
sympathetic ganglion of
hypertension.
- Curare is used as a
muscle relaxant
113. DHBR
NADP+
NADPH
from phe, diet, or protein
breakdown
Tyrosine L-Dopa
H2OO2
Tyrosine hydroxylase
(rate-determining step)
BH2BH4
1
Dopa
decarboxylase
CO2
Dopamine
pyridoxal
phosphate
2
Dopamine hydroxylase
ascorbate
H2O
Norepinephrine
O2
3
PNMT
SAM SAH
Epinephrine
4
Biosynthesis of catecholamines. BH2/BH4, dihydro/tetrahydrobiopterin; DHBR,
dihydrobiopterin reductase; PNMT, phenylethanolamine N-CH3 transferase; SAH, S-
adenosylhomocysteine; SAM, S-adenosylmethionine
Parkinson’s disease: local
deficiency of dopamine
synthesis; L-dopa boosts
productionPNMT specific to
adrenal medulla
SAM from
metabolism of
Met
DPN OHase in neuro-
scretory granules
114. ........
acetylcholine
Adrenal Medulla
Chromaffin Cell
Neuron
Acute
regulation
Tyrosine
L-Dopa DPN
DPN
↓
NE
granule
induction
Chronic
regulation
Stress
Hypothalamus
ACTH
Cortisol
from adrenal
cortex via intra-
adrenal portal
system
Epinephrine
PNMT
NE
neuro-
secretory
granules
E E E
NE E
Regulation of the release of
catecholamines and synthesis of
epinephrine in the adrenal
medulla chromaffin cell.
promotes
exocytosis
⊕
................
E
EE
ENE
E
E E
NE
E
Ca2+
115. Norepinephrine
Epinephrine COMT + MAO
Vanillylmandelic acid
Degradation of epinephrine, norepinephrine and dopamine via
monoamine oxidase (MAO) and catechol O methyl-‑ ‑
transferase (COMT)
Neuronal re-uptake and degradation of catecholamines quickly
terminates hormonal or neurotransmitter activity.
Cocaine binds to dopamine receptor to block re-uptake of dopamine
Dopamine continues to stimulate receptors of the postsynaptic nerve.
Dopamine Homovanillic acid
COMT + MAO
116. Table 1. Classification of Adrenergic Hormone Receptors
Receptor Agonists
Second
Messenger
G protein
alpha1
(α1
) E>NE IP3
/Ca2+
; DAG Gq
alpha2
(α2
) NE>E ↓ cyclic AMP Gi
beta1
(β1
) E=NE ↑ cyclic AMP Gs
beta2
(β2
) E>>NE ↑ cyclic AMP Gs
E = epinephrine; NE = norepinephrine
Synthetic agonists:
isoproterenol binds to beta receptors
phenylephrine binds to alpha receptors (nose spray action)
Synthetic antagonists:
propranolol binds to beta receptors
phentolamine binds to alpha receptors
118. Table 2. Metabolic and muscle contraction responses to catecholamine binding to
various adrenergic receptors. Responses in italics indicate decreases of the indicated
process (i.e., decreased flux through a pathway or muscle relaxation)
Process
α1
-receptor
(IP3
, DAG)
α2
-
receptor
(↓ cAMP)
β1
-
receptor
(↑ cAMP)
β2
-receptor
(↑ cAMP)
Carbohydrat
e
metabolism
↑ liver
glycogenolysis
No effect No effect
↑liver/muscle
glycogenolysis;
↑ liver gluconeogenesis;
↓ glycogenesis
Fat
metabolism
No effect ↓ lipolysis ↑ lipolysis No effect
Hormone
secretion
No effect
↓ insulin
secretion
No effect
↑ insulin and glucagon
secretion
Muscle
contraction
Smooth
muscle - blood
vessels,
genitourinary
tract
Smooth
muscle -
some
vascular;
GI tract
relaxation
Myocardial
-↑ rate,
force
Smooth muscle
relaxation - bronchi,
blood vessels,
GI tract, genitourinary
tract
119. ⊕
β1 or β2
receptor
ATP cyclic AMP
Gs
β
γ
αs
β
γ
GTP
inactive
adenylyl
cyclase
γ
β
GTP
ACTIVE
adenylyl
cyclase
inactive
adenylyl
cyclase
α2 receptor
Figure 5. Mechanisms of β1, β2, and α2 agonist effects on adenylyl cyclase activity
Gi
β
γ
αi
GTP
αs
GTP
αi
X
120. "FIGHT OR FLIGHT" RESPONSE
epinephrine/ norepinephrine major elements in the "fight or flight" response
acute, integrated adjustment of many complex processes in organs vital to the
response (e.g., brain, muscles, cardiopulmonary system, liver)
occurs at the expense of other organs less immediately involved (e.g., skin, GI).
epinephrine:
rapidly mobilizes fatty acids as the primary fuel for muscle action
increases muscle glycogenolysis
mobilizes glucose for the brain by ↑ hepatic glycogenolysis/
gluconeogenesis
preserves glucose for CNS by ↓ insulin release leading to reduced glucose
uptake by muscle/ adipose
increases cardiac output
norepinephrine elicits responses of the CV system - ↑ blood flow and ↓ insulin
secretion.
121. OH OP
[2]
degradation
to VMA
insulin activation of protein
phosphatase to dephosphorylate
enzymes[7]
α
[5]
γ
β
GTPase
αGDP
epinephrine
phosphorylation
of β-receptor by
β-ARK decreases
activity even with
bound hormone
OH OH
[3]
OP OP
[4]
OPOP
binding of β-arrestin
further inactivates
receptor despite
bound hormone
AC
cAMPATP
activated PKA
phosphorylates
enzymes
[6]
AMP
phosphodiesterase
GTP
[1]
dissociation
Figure 6. Mechanisms for terminating the signal generated by epinephrine
binding to a β-adrenergic receptor
122. Β1 found on heart muscle and in certain cells of the kidney
B2 found in certain blood vessels, smooth muscle of airways; found where sympathetic
neurons ARE NOT
Α1 receptors are found most commonly in sympathetic target tissues
A2 receptors are found in the GI tract and pancreas (relaxation)