PHYSIOLOGY

THE AUTO
NERVOUS
 The nervous system is one of the most compli­
cated systems in the human body. Along with the
endocrine system, it controls many bodily activ­
ities. The nervous system senses changes both in
the internal and external environments, inter­
prets these changes, and then coordinates appro­
priate responses in order to maintain homeosta-
sis. 1 In response to changing conditions, the
autonomic nervous system (ANS) shunts blood
to more needy areas, speeds or slows heart and
respiratory rates, adjusts blood pressure and
body temperature, and increases or decreases
stomach secretions.2 Most of this fine-tuning
occurs without our conscious awareness or
attention, implying a certain amount of func­
tional independence. Hence the term autonomic
(auto=self; nom=govern).

ERIC J ZELINSKAS, CST, BA

ONOMIC
S SYSTEM
g
207 NOVEMBER 2001 CATEGORY 1

eneral organization Functionally, the PNS is subdivided into two

The nervous system includes the central nervous specialized systems: the somatic nervous system
system (CNS), consisting of the brain and spinal (SNS) and the autonomic nervous system
cord, and the peripheral nervous system (PNS), (ANS).1 The SNS primarily innervates skeletal
consisting of 12 pairs of cranial nerves (which muscle, producing consciously controlled, vol­
emerge from the base of the skull) and 31 pairs of untary movement (ie walking and talking). The
spinal nerves (which emerge from the spinal ANS primarily innervates glands, smooth muscle
cord). All of these nerves consist of fibers that and cardiac muscle. It’s responsible for control­
may be sensory or motor or a mixture of both.1 ling visceral functions and involuntary muscles in
Nerves composed of both sensory and motor the respiratory, circulatory, digestive and urogen­
fibers are called mixed nerves. For example, the ital systems, and in the skin6 that are essential for
facial nerve CN VII consists of motor fibers that the body to maintain homeostasis. The ANS oper­
control facial expressions (eg frowning and smil­ ates without conscious control. The autonomic
ing) and sensory fibers, which transmit taste sen­ nervous system is activated mainly by centers
sations from the tongue to the brain. located in the spinal cord, brain stem, and hypo-

Review of basic parts of the neuron

Dendrites

Cell body
Nucleus

Axon
Myelin sheath

Nerve impulse

Axon

Vesicle

Synaptic cleft
Direction of impulse

Neurotransmitters

Receptor molecules Dendrite of receiving neuron

Axon terminals
thalamus.3 Often the autonomic nervous system autonomic (terminal) ganglia that lie near or FIGURE 1
operates by means of autonomic reflexes. Senso­ within the walls of the organs innervated (Figure
ry signals from peripheral nerve receptors relay 1). Since the terminal ganglia are close to the The parasympa­
signals into the centers of the cord, brain stem, or innervated organs/structures, the axons of the
hypothalamus, and these in turn transmit appro­ postganglionic fibers are short. PaNS pregan­ thetic nervous
priate reflex responses back to the peripheral glionic neurons synapse with only a relatively few
organs or tissues to control their activities.4 postganglionic neurons. For this reason they are system.3
much more precise and localized in their effects.
Divisions of the autonomic nervous system Some effects of PaNS stimulation include:
The autonomic nervous system (ANS) is further
divided into two major subdivisions: the • constriction of pupils
parasympathetic nervous system (PaNS) and • contraction of smooth muscle of alimentary
sympathetic nervous system (SyNS). The two canal
divisions are physiological antagonists and are in • constriction of bronchioles
equilibrium with each other. Both divisions often • slowing of heart rate
innervate the same organ (eg iris of the eye and
the heart). Structurally, each division differs in the Ciliary ganglion
location of their preganglionic neuron cell bodies Ciliary muscles of the eye
within the CNS, the location of their autonomic III Pupillary sphincter
ganglion, the relative lengths of their preganglion­
ic and postganglionic axons, and the ratio of pre­ VII Sphenopalatine ganglion
ganglionic and postganglionic neurons. They IX V Lacrimal glands
both integrate and operate continuously with the Nasal glands
X
rest of the nervous system by responding in vary­
ing degrees to information provided by the senso­ Submaxillary ganglion
ry component of the nervous system. Submaxillary gland
The SyNS dominates during stressful or
physically strenuous situations. It sends impuls­ Otic ganglion
es that increase blood pressure, speed up rate and Parotid gland
force of the heartbeat, dilate bronchioles,
increase blood sugar concentration and reroute Heart
blood flow to skeletal muscle (fight or flight).
Conversely, the PaNS dominates during times of Stomach
emotional calm and/or physical rest. It sends Pylorus
impulses that decrease blood pressure, decrease
heart rate and stimulate gastrointestinal motility Colon
(digestion and rest).
Small intestine
Parasympathetic nervous system Sacral
The PaNS is the craniosacral division of the ANS. Ileocecal valve
Preganglionic fibers originate from nuclei in the
Pearson Education Inc.© 2001

1
midbrain, medulla and sacral portion of the 2
spinal cord. Neurons of the PaNS emerge from 3
4 Anal sphincter
the brainstem and pass through as part of the III, Bladder
ILLUSTRATION REPRINTED BY PERMISSION OF

VII, IX, and X cranial nerves, and 2nd, 3rd, and Detrusor
4th sacral nerves from the sacral region.4 They Trigone
synapse with postganglionic neurons located in
 receptor sites in the effector gland, organ or
muscle causing the desired effect (eg release of
Eye hormones, muscular contraction, etc). (Table 1)
The action of acetylcholine is relatively brief
and usually lasts for only a fraction of a second. It
Pilo-erector muscle B is rapidly broken down by the enzyme
Heart cholinesterase, which is present both in the ter­
T-1 minal nerve ending and on the surface of the
Sweat gland receptor organ. Acetylcholine (cholinergic)
receptor sites are classified as either nicotinic or
muscarinic. Nicotinic receptor sites for ACh
occur at the junction between the preganglionic
I2 Bronchi
fibers and postganglionic fibers in both the SyNS
Blood vessel and the PaNS divisions of the ANS. Muscarinic
Celiac ganglion receptor sites for ACh occur at the junction
between the postganglionic fibers and effector
Pylorus sites in the PaNS division of the ANS.
L-1
Adrenal
Sympathetic nervous system
5 The SyNS is the thoracolumbar division of the
medulla
ANS (Figure 2). Preganglionic fibers originate
Kidney from cell bodies in the lateral gray horn of all
Ureter thoracic and the first two or three lumbar seg­
5 ments of the spinal cord and leave the cord by
way of the of the anterior (ventral) spinal nerve
Pearson Education Inc. © 2001

Intestine roots (Figure 3). They pass through the inter­

Ileocecal valve vertebral foramina, enter a white rami commu­
nicans and connect with the ganglia of the par­
ILLUSTRATION REPRINTED BY PERMISSION OF

avertebral sympathetic chain, which are situated

Anal sphincter
Hypogastric plexus anterolaterally to the spinal cord. Each of these
Detrusor
Trigone paired chains is a series of 22 ganglia spanning
the length of the vertebral column.4 All pregan­
Transmission of an impulse between pregan­ glionic neurons in the SyNS are myelinated,
glionic and postganglionic fibers takes place at which gives them a white appearance. Most pre­
an electrochemical junction called a synapse. ganglionic neurons end within the paraverte­
FIGURE 2 Both pre- and postganglionic neurons of the bral sympathetic ganglia and synapse with post­
PaNS are cholinergic and utilize the neurotrans- ganglionic efferent neurons. Some of the
The sympathetic mitter acetylcholine (ACh). 4 When a nerve postganglionic neurons re-enter the spinal
impulse reaches the terminus of a preganglionic nerves via the grey rami communicans. They
nervous system.3 fiber, it causes the release of ACh, which migrates appear grey because postganglionic neurons are
across the synapse. The ACh combines with nonmyelinated. These neurons extend with
Dashed lines represent post- receptors on the synaptic membrane of the post­ other neurons in the spinal nerves, eventually
ganglionic fibers in the gray ganglionic fiber, causing depolarization and branch off and form visceral nerves that inner­
rami leading into the spinal continuing the impulse down the postganglion­ vate smooth muscle and sweat glands. Other
nerves for distribution to ic fiber. Once the impulse reaches the postgan­ preganglionic neurons pass through the paraver­
blood vessels, sweat glands, glionic terminus and depolarizes it, ACh tebral sympathetic ganglia to a second set of gan­
and pilo-erector muscles. migrates across the synapse and binds to specific glia called collateral ganglia located mainly in the
Table 1 ANS parasympathetic

preganglionic postganglionic effector organs,

fibers fibers glands or muscles

Table 2 ANS sympathetic

sweat glands,
preganglionic postganglionic
blood vessels (some),
fibers fibers
external genitalia

heart,
preganglionic postganglionic
blood vessels (most),
fibers fibers
smooth muscle in GI tract

preganglionic adrenal blood

fibers medulla stream

Table 3 Cholinergic and adrenergic receptors2

Neurotransmitter Receptor Type Major locations Effect of binding

Acetylcholine Cholinergic
Nicotinic All postganglionic neurons; adrenal Excitation
medullary cells (also neuromuscular junc­
tions of skeletal muscle)
Muscarinic All parasympathetic target organs Excitation in most cases; inhibition of car­
diac muscle
Selected sympathetic targets:
• Sweat glands Activation
• Blood vessels in skeletal muscles Inhibition (causes vasodilation)

Norepinephrine (and Adrenergic

epinephrine released β1 Heart, adipose tissue Increases heart rate and strength; stimu­
by adrenal medulla) lates lipolysis
β2 Kidneys, lungs, and most other sympathetic Stimulates secretion of renin; other effects
target organs; abundant on blood vessels mostly inhibitory; dilation of blood vessels
serving skeletal muscles and the heart and bronchioles; relaxes smooth muscle
walls of digestive and urinary visceral organs
α1 Most important blood vessels serving the Activation: constricts blood vessels and vis­
skin, mucosae, abdominal viscera, kidneys, ceral organ sphincters
and salivary glands; but virtually all sympa­
thetic target organs except heart
α2 Membrane of adrenergic axon terminals; Mediates inhibition of NE release from adren­
blood platelets ergic terminals; promotes blood clotting
 Paravertebral (sympathetic chain) ganglion
Dorsal root and dorsal root ganglion

Lateral horn of gray matter (visceral motor zone)

Sympathetic trunk
Ventral ramus of spinal nerve
Gray ramus communicans
White ramus communicans
Ventral root

{
To effector
Dorsal ramus of spinal nerve Blood vessels

Skin (arrector pili mus-

Splanchnic nerve cles and sweat glands)

Prevertebral (collateral) ganglion such as the celiac

WB Saunders Publishing Co.© 2001

Target organ (in abdomen)

ILLUSTRATION REPRINTED BY PERMISSION OF

FIGURE 3
abdomen close to the aorta and its major branch­ acetylcholine (ACh). They innervate the sweat
Sympathetic es (eg celiac, superior mesenteric and inferior glands of the skin, some blood vessels within the
mesenteric arteries). These bundles of collateral skeletal muscles and the external genitalia. But
pathways.2 ganglia are often called plexus. 4 The pregan­ by far, the majority of the sympathetic postgan­
glionic neurons synapse with nonmyelinated glionic nerves are adrenergic and utilize the neu­
synapse in a paraver­ neurons in the collateral ganglion. The postgan­ rotransmitter norepinephrine (NE).3 The affect
tebral (chain) gan­ glionic neurons branch off and innervate the of NE released at the effector site produces diff-
glion at the same level smooth muscles of the abdominal and pelvic vis­ erent results (excitation or inhibition) depend­
synapse in a paraver­ cera and the endocrine glands in that area. The ing on the receptor(s) to which it binds. (Table 2)
tebral ganglion at a effects of the SyNS are extremely widespread There are two major classes of adrenergic
different level rather than specific to one organ or muscle. (NE-binding) receptors: alpha (α) and beta (β).
synapse in a preverte­ Preganglionic neurons of the SyNS are Organs that respond to NE (or epinephrine,
bral (collateral) gan­ cholinergic and utilize the neurotransmitter EPI) display one or both types of receptors. In
glion anterior to the acetylcholine (ACh). A few of the postganglionic general, NE or epinephrine binding to alpha
vertebral column neurons of the SyNS are cholinergic and secrete receptors is stimulatory, while their binding to
beta receptors is inhibitory. However, there are Surgical removal of the parasympathetic supply
notable exceptions. For example, binding of NE to the gut by cutting the vagi can cause serious
to the beta receptors of cardiac muscle prods the and prolonged gastric and intestinal atony, thus
heart into more vigorous activity. These differ­ illustrating that in normal function the parasym­
ences reflect that both alpha and beta receptors pathetic tone to the gut is strong. This tone can be
have two receptor subclasses (alpha 1 and alpha decreased by the brain, thereby inhibiting gas­
2, beta 1 and beta 2). Each receptor type tends to trointestinal motility, or it can be increased,
predominate in certain target organs (Table 3). thereby promoting increased gastrointestinal
activity.5 The presence of dual innervation and
Adrenal medulla the possibility of either increasing or decreasing
Some preganglionic sympathetic (thoracic the tone permit a wide range of control.5
splanchnic) nerve fibers pass through the celiac
ganglion without synapsing and terminate by Conclusion
synapsing with hormone-producing medullary The art and science of medicine has changed very
cells (chromaffin cells) of the adrenal gland. rapidly over the last 10 years. The high cost of
When stimulated by the preganglionic fibers, the hospital care has created an impetus for surgical
chromaffin cells release large quantities of epi­ technologists to master the knowledge and
nephrine and norepinephrine directly into the advanced procedural skills necessary to meet the
blood stream. These hormones are then carried growing demands of an ever more complex sur­
to tissues throughout the body where they rein­ gical environment. It is my hope this article has
force the effects of the SyNS.4 provided a useful framework upon which surgi­
The epinephrine and norepinephrine released cal technologists can advance their knowledge
by the combined efforts of the SyNS and the and understanding of human physiology as it
adrenal glands is eventually dissipated either by relates to patient care, thus being better prepared
being taken back into the synaptic nerve endings to move into the realm of advanced practice.
or by action of the enzyme monoamine oxidase.4
References
Sympathetic and parasympathetic tone 1. Gylys BA, Wedding, ME. Medical Terminolo­
The autonomic system generally maintains a gy, A Systems Approach. 3ed. Philadelphia: FA
‘tone,’ a basal level of activity, which then may be Davis Company; 1995: 318.
either increased or decreased by central control.5 2. Marieb EN. Human Anatomy and Physiology.
The sympathetic and parasympathetic systems 2ed. Redwood City, CA: The Benjamin/Cum-
are continually active and the basal rates of stim­ mings Publishing Co, Inc; 1992: 457.
ulation are known, respectively, as sympathetic 3. Guyton AC. Human Physiology and Mecha­
tone and parasympathetic tone.5 The value of nisms of Disease. 3ed. Philadelphia: WB Saun­
tone is that it allows a single nervous system to ders Publishing Co; 1982:439.
increase or decrease the activity of an organ. For 4. The parasympathetic nervous system.
example, sympathetic tone normally keeps greenfield.fortunecity.com Accessed 8/00
almost all the blood vessels of the body con­ 5. Regulation of Visceral Function. In: Selkurt EE,
stricted to approximately half their maximum et al. Physiology 3ed., Selkurt EE, ed. Boston:
diameter. By increasing the degree of sympathet­ Little, Brown and Company; 1971: 179-180.
ic stimulation, the vessels can be constricted even 6. Autonomic Nervous System. Microsoft Encar­
more; but, on the other hand, by decreasing the ta Online Encyclopedia 2000. Microsoft Cor­
level of sympathetic stimulation, the vessels can poration. encarta.msn.com Accessed 8/24/00
be dilated.5 7. Dorland’s Pocket Medical Dictionary, 24th ed.
Another example of tone is that of the Anderson DM, ed. Philadelphia: WB Saun­
parasympathetics in the gastrointestinal tract. ders; 1989.
 CEExam
207 NOVEMBER 2001 CATEGORY 1
1. The nervous system along with the ____ 6. Both pre- and postganglionic neurons of the
system controls many bodily activities. parasympathetic nervous system (PaNS)
A. cardiovascular utilize the neurotransmitter ____.
B. respiratory A. epinephrine B. norepinephrine
CONTINUING EDUCATION EXAMINATION
C. endocrine C. cholinesterase D. acetylcholine
D. urogenital
7. When stimulated by preganglionic sympa­
2. The peripheral nervous system consists thetic (thoracic splanchnic) nerve fibers, the
of ____. chromaffin cells of the adrenal glands
A. 10 pairs of cranial nerves; 28 pairs of spinal nerves release large quantities of ____ directly
B. 11 pairs of cranial nerves; 29 pairs of spinal nerves into the blood stream.
C. 12 pairs of cranial nerves; 31 pairs of spinal nerves A. acetylcholine B. epinephrine
Autonomic D. 13 pairs of cranial nerves;32 pairs of cranial nerves C. norepinephrine D. both B and C

nervous system 3. The autonomic nervous system (ANS) pri- 8. Which of the following branches of the
marily innervates all of the following except aorta does not have a collateral ganglion
____. (plexus) located next to it?
Earn CE credit at home
A. glands A. celiac
You will be awarded one continuing education (CE) credit for
B. skeletal muscle B. renal
recertification after reading the designated article and complet-
C. smooth muscle C. superior mesenteric
ing the exam with a score of 70% or better.
D. cardiac muscle D. inferior mesenteric
If you are a current AST member and are certified, credit
earned through completion of the CE exam will automatically
4. The autonomic nervous system (ANS) is acti- 9. Preganglionic fibers originate from cell bod­
be recorded in your file—you do not have to submit a CE report-
vated mainly by centers located in all of the ies in the ____ gray horn of all the thoracic
ing form. A printout of all the CE credits you have earned, includ-
following except ____. and first two or three lumbar segments of
ing Journal CE credits, will be mailed to you in the first quarter
A. Cerebellum the spinal cord.
following the end of the calendar year. You may check the status
B. Hypothalamus A. anterior B. lateral
of your CE record with AST at any time.
C. Brain stem C. medial D. posterior
If you are not an AST member or not certified, you will be
D. Spinal cord
notified by mail when Journal credits are submitted, but your
10. ____ receptor sites for acetylcholine
credits will not be recorded in AST’s files.
5. Which of the following is not a response to (cholinergic) occur at the junction between
Detach or photocopy the answer block, include your check or
sympathetic nervous system (SyNS) impulses? preganglionic and postganglionic fibers of
money order made payable to AST and send it to the Accounting
A. increase blood pressure both the sympathetic and parasympathetic
Department, AST, 6 West Dry Creek Circle, Suite 200, Littleton, CO
B. speed up force/rate of heart beat divisions of the ANS.
80120-8031.
C. increase blood sugar concentration A. nicotinic B. muscarinic
Members: $6 per CE, nonmembers: $10 per CE D. constrict bronchioles C. adrenergic D. oxidase
207 NOVEMBER 2001 CATEGORY 1

Autonomic nervous system a b c d a b c d

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