Professional Documents
Culture Documents
Somatic Visceral
Pain Non-pain
Sympathetic Parasympathetic
GRC
Ant. root
GRC WRC
Periarterial
plexus
Pre-lecture review
Visceral afferent innervation “rules”
Midgut
distal duodenum
jejunum MIDGUT Inferior
ileum
cecum mesenteric
appendix Artery (IMA)
ascending colon
proximal 2/3 of transverse colon
Sadler 82
Hindgut
distal 1/3 of transverse colon
descending colon
sigmoid colon
rectum HINDGUT Drake 295
proximal anus
Gray’s text 4.96
Pre-lecture review
Foregut innervation
Target Organs
Distal esophagus
Stomach
Proximal duodenum
N 298
Liver
Gall bladder
Pancreas
(Spleen)
N 299
N 301
Pre-lecture review
Midgut innervation
Target Organs
Distal duodenum
Jejunum
Ileum
Cecum
Appendix
Ascending colon
Proximal 2/3 of
transverse colon
N 301
N 302
Pre-lecture review
Hindgut innervation
Target Organs
Distal 1/3 of transverse
colon
Descending colon
Sigmoid colon
Upper rectum
N 302
Generalized comparison of abdominal sympathetic vs. parasympathetic systems
• Preganglion axons exit the sympathetic chain from the Ant. root
GRC WRC
T5–S4 chain ganglia and course along abdominopelvic
splanchnic nerves
Greater splanchnic n
T5-T9 spinal cord segment
Lesser splanchnic n
T10-T11 spinal cord segment
Least splanchnic n
T12 spinal cord segment
Lumbar splanchnic n
L1-L2 spinal cord segment
Sacral splanchnic n
L1-L2 spinal cord segment
N 206, 317
Prevertebral sympathetic ganglia
Celiac ganglia
base of celiac trunk
Aorticorenal ganglia
base of renal arteries
[more in unit 5]
N 297
Abdominal / Pelvic Visceral Plexuses
Celiac plexus
N 297
Abdominal / Pelvic Visceral Plexuses
Hypogastric nerves
connect superior hypogastric and
inferior hypogastric plexuses
-Efferents are primarily sympathetic
N 390
Sympathetic Summary
ORIGIN FROM
ABDOMINOPELVIC SPINAL CORD ORIGIN FROM TYPICAL
SPLANCHNIC N. SEGMENT (IMLCC) SYMPATHETIC CHAIN SYNAPSE TARGET
Greater Celiac
T5–T9 T5–T9 Foregut
splanchnic nerve ganglion
Superior
distribution to be expected
Lesser
T10–T11 T10–T11 mesenteric Midgut
splanchnic nerve
Continued Aortico-
Least T12
in Unit 5 T12 T12 renal Kidneys
splanchnic nerve
ganglion
Inferior
Lumbar Hindgut,
L1–L2 L1–L5 mesenteric
splanchnic nerve Pelvic organs
ganglion
(Inferior Hindgut
Continued Sacral
L1–L2 S1–S5 hypogastric (lower rectum),
in Unit 5 splanchnic nerve
plexus) Pelvic organs
Referred pain: Abdomen—the take home message
• FOREGUT pain tends to refer to EPIGASTRIC REGION
• MIDGUT pain tends to refer to UMBILICAL REGION
• HINDGUT pain tends to refer to HYPOGASTRIC REGION
• Pathology of liver, gallbladder, and duodenum can refer to shoulder due to irritation of the diaphragm
• Gall bladder has additional somatic sensory innervation from branch of phrenic nerve
• Irritation of parietal peritoneum (somatic innervation) causes acute, well-localized pain
•with reflexive “splinting” or “guarding” of abdominal wall musculature.
•Manifests clinically as “rebound tenderness”
MDA B2.12
Visceral pain pathway (retrograding along sympathetic pathway) is basis of referred pain
T1
T7
T10
L1
MDA B2.12
N162
MDA I.46
Autonomic Regulation of the GI Tract occurs via
interaction with the Enteric Nervous System
Sympathetic Parasympathetic
• Decrease blood flow to GI tract • Stimulate secretory cells of the GI
through vasoconstriction mucosa, and organ-specific cells (e.g.,
parietal cells in the stomach)
• Inhibit contraction of GI smooth • Stimulate contraction of GI smooth
muscle muscle
Clinical Correlation
Hirschsprung’s disease (congenital aganglionic megacolon)
• Failure of neural crest cells to migrate to distal GI tract.
• Affected (aganglionic) section of colon is paralyzed in constriction (arrows)
• Results in fecal accumulation proximal to the aganglionic portion.
• Correctable by surgical resection of affected colon.
Lukman O. Abdur-Rahman
Hypogastric nerves
Inferior hypogastric plexus
Rectal plexus -at rectum
Vesical plexus -at urinary bladder
Uterovaginal plexus (female)
N 390
• Inferior aspect of parietal peritoneum is the threshold determining course of visceral pain sensation
• Visceral pain sensations of structures…
• Above or in contact with the inferior peritoneum course via sympathetic-carrying splanchnic nerves (e.g.,
lumbar, greater, lesser, least)
• Below the inferior peritoneum course via parasympathetic-carrying pelvic splanchnic nerves
T9
T10 Celiac ganglion
T11
T12
MDA 2.87
Innervation of the Ureter
Innervation via nearest neighbor autonomic plexus
(e.g., renal, intermesenteric, superior & inferior hypogastric)
Density of innervation increases inferiorly
Ureters are primarily above the pelvic pain line
Proximal ureter
Pregangionic sympathetics viaT11-L2 spinal cord segments
What are the associated splanchnic nerves?
Postganglionic sympathetics via renal and intermesenteric plexuses
Function: control of vascular tone
Parasympathetic innervation via pelvic splanchnic nerves to intrinsic ganglia
Function: Promotes peristalsis
Visceral pain—most of ureter is above pelvic pain line, signals primarily
conveyed via sympathetic pathways to T11–L2 spinal cord segments
Visceral non-pain conveyed via pelvic splanchnic nerves
MDA 3.26
Innervation of the Ureter
Innervation via nearest neighbor autonomic plexus
(e.g., renal, intermesenteric, superior & inferior hypogastric)
Density of innervation increases inferiorly
Ureters are primarily above the pelvic pain line
Abdominal ureter
Pregangionic sympathetics viaT11-L2 spinal cord segments
What are the associated splanchnic nerves?
Postganglionic sympathetics via superior hypogastric plexus
Function: control of vascular tone
Parasympathetic innervation via pelvic splanchnic nerves to intrinsic ganglia
Function: Promotes peristalsis
Visceral pain—most of ureter is above pelvic pain line, signals primarily
conveyed via sympathetic pathways to T11–L2 spinal cord segments
Visceral non-pain conveyed via pelvic splanchnic nerves
MDA 3.26
Innervation of the Ureter
Innervation via nearest neighbor autonomic plexus
(e.g., renal, intermesenteric, superior & inferior hypogastric)
Density of innervation increases inferiorly
Ureters are primarily above the pelvic pain line
Pelvic ureter
Pregangionic sympathetics viaT11-L2 spinal cord segments
What are the associated splanchnic nerves?
Postganglionic sympathetics via inferior hypogastric plexus
Function: control of vascular tone
Parasympathetic innervation via pelvic splanchnic nerves to intrinsic ganglia
Function: Promotes peristalsis
Visceral pain—most of ureter is above pelvic pain line, signals primarily
conveyed via sympathetic pathways to T11–L2 spinal cord segments
Visceral non-pain conveyed via pelvic splanchnic nerves
MDA 3.26
MDA B2.12
Innervation of the urinary bladder
Lumbar splanchnics
Preganglionic sympathetics
-from L1-L2 spinal cord segments
L1 -course via lumbar & sacral splanchnic nerves
L2
-pass though inferior hypogastric plexus and synapse
in vesical plexus
Postganglionic sympathetics
-to urinary bladder via vesical plexus
Sacral splanchnics
Inferior
Hypogastric
Plexus
S2
S3
S4
Sacral splanchnics
Inferior
Hypogastric
Plexus
S2
S3
S4
Sacral splanchnics
Inferior
Hypogastric
Plexus
S2
S3
S4
Sacral splanchnics
Inferior
Hypogastric
Plexus
S2
S3
S4
YYT 19.10
Innervation of the rectum
Preganglionic sympathetics
-From L1–L2 spinal cord segments
-Course via lumbar splanchnic nerves
-Synapse in inferior mesenteric ganglion & within superior
hypogastric plexus
Postganglionic sympathetics
-Distributed to rectum via periarterial plexuses of IMA and superior
rectal artery (superior rectum) or rectal plexus (inferior rectum)
Preganglionic parasympathetics
-Via pelvic splanchnic nerves
-Pass through inferior hypogastric plexus and rectal plexus
-Synapse in intrinsic ganglia
Visceral afferents
-Rectum is below the pelvic pain line
-Both visceral pain & non-pain conveyed via pelvic splanchnic
nerves
MDA 3.33
Innervation of the anal canal
Superior to pectinate line—same as rectum
Sympathetics via lumbar/sacral splanchnics
Parasympathetics via pelvic splanchnics
Visceral pain/non-pain via pelvic splanchnics
Pectinate line
N 388
N 371 MDA 3.33
Autonomic & Somatic Control of Defecation
⎻ Stimulate peristalsis
⎻ Stimulate secretion of colorectal glands
⎻ Relax internal anal sphincter
⎻ Stimulate peristalsis of anal canal
Preganglionic sympathetics
⎻ Via lumbar splanchnic nerves
⎻ Synapse in inferior hypogastric plexus
Postganglionic sympathetics
⎻ Distributed via uterovaginal plexus
Preganglionic parasympathetics
⎻ Via pelvic splanchnic nerves
⎻ Pass through inferior hypogastric & uterovaginal plexuses
⎻ Synapse on intrinsic ganglia Pelvic pain
Visceral afferent line
⎻ Above pelvic pain line: pain via lumbar splanchnics
⎻ Below pelvic pain line: pain via pelvic splanchnics
⎻ All non-pain via pelvic splanchnics
N 393
Clinical Correlation: Anesthesia for Parturition (child birth)
Spinal anesthesia via lumbar puncture into subarachnoid space
⎻ Complete anesthesia of uterus, cervix, vagina, perineum,
lower extremities, and inferior abdominal wall
⎻ Most-common form of anesthesia for cesarean section
MDA B3.27
Innervation of Erectile Tissues
Parasympathetic innervation to erectile tissues Parasympathetic innervation to crura of clitoris and
via cavernous nerves from prostatic plexus bulb of vestibule via cavernous nerves from the
⎻ Facilitates (tumescence) penile erection uterovaginal plexus
⎻ Facilitates vaginal secretion, clitoral erection,
engorgement of bulbs of the vestibule
↓PSNS Tunica
⇟SNS albuginea
Fig. 21-22; Gartner & Hiatt, Color Textbook of Histology; 2nd edition
Autonomic Control of Sexual Function
Erection (male & female) mediated by PARASYMPATHETICS
Flaccid state:
⎻ Low/Absent parasympathetic activity
⎻ Tonic sympathetic activity
maintains arterio-venous (AV) shunt (helicine arteries)
most blood bypasses capillaries within erectile bodies
Tumescent state (erection):
⎻ Increased parasympatheic signal via cavernous nerves to
erectile tissues
closes the AV shunt
blood accumulates and engorges the erectile tissues
Swelling of erectile tissues compresses deep draining veins
against the ~inelastic tunica albuginea and Buck’s fascia
⎻ Additional contraction of the bulbospongiosus &
ischiocavernosus (somatic via pudendal nerve)
further impedes drainage of venous blood
Following ejaculation Tunica
Sympathetic activity re-establishes the AV shunt albuginea ↑PSNS
Flaccid state re-established ⇟SNS
Fig. 21-22; Gartner & Hiatt, Color Textbook of Histology; 2nd edition
Autonomic Control of Sexual Function
Emission is mediated by:
⎼ Sympathetics: Semen is delivered to the prostatic
urethra through the ejaculatory ducts
N 362
Clinical Correlation: Priapism / Clitorism
Prolonged erection of either the penis (priapism) [or the clitoris (clitorism)] prevents venous blood from
exiting the erectile bodies, and can cause ischemia of erectile tissues.
1. Low flow/ischemic priaprism—blood trapped within erectile tissues
Etiology not clear (sickle-cell, malaria, leukemia all increase risk)
2. High-flow/non-ischemic—more rare, less painful
Typically due to perineal injury rupturing arterial supply
Fig. 21-22; Gartner & Hiatt, Color Textbook of Histology; 2nd edition © 2016 Midwestern University
© 2016 Randall Nydam
Sympathetics to the Head
• Preganglionic cell bodies (“thoraco-lumbar”)
• lateral horn (IMLCC) from T1–L2
• Preganglionic axons
• ascend in the sympathetic chain and synapse on
postganglionic cell bodies in superior cervical ganglion
• Postganglionic axons
• carotid periarterial plexus
• travel on branches of external or internal carotid
• re-coalesce into a single nerve (e.g., deep petrosal nerve), or
may join (“hitch-hike”) on branches of CN V
• Primarily vasoconstriction
• Also superior tarsal and dilator pupillae muscle in orbit
MDA I.45
• Postganglionic axons
• Carried to target structures via “hitch-hiking”
(on branches of CN V)
Big picture: ganglia are NOT intrinsic and DO have names MDA I.48
46
Functional Components of
Cranial Nerves
CN I: VA
CN II: SA
: SE,
CN IV: SE
CN V: SA, SE
CN VI: SE
: SA, SE, , VA
CN VIII: SA
: SA, SE, , VA
: SA, SE, , VA
CN XI: SE
CN XII: SE
: iliary ganglion
: tic ganglion
: terygopalatine & ubmandibular ganglia
VE to submandibular
& sublingual glands
Ciliary ganglion
(CN III)
Pterygopalatine
SA from floor of oral ganglion
cavity, gingivae, & anterior (CN VII)
2/3 of tongue,
Otic
ganglion
VA from anterior (CN IX)
2/3 of tongue
Submandibular ganglion
(CN VII) 49
MDA 9.9
Autonomic Innervation of the Eye
Dilator pupillae
Sphincter pupillae
Ciliary muscle
N 89
MDA 7.51 50
Autonomic Innervation of the Eye
Ciliary ganglion
Short ciliary nn *Parasympathetic root of CG
CN III (from CN III)
Sphincter
* *Sympathetic root of CG
pupillae (from internal carotid
Dilator
* plexus)
pupillae
Internal carotid plexus
Long ciliary nn
Nasociliary n.
Superior cervical
ganglion IMLCC For additional review of these
pathways
Click here
&
Click here
&
Click here 51
N 133
Autonomic Innervation of the Parotid Gland
CN IX CN IX
MDA 9.13
Tympanic n.
N 132
(passing through tympanic
canaliculus)
Medial Wall
Lateral Wall
Tympanic
canaliculus
52
N 12 MDA 7.114
Autonomic Innervation of the Parotid Gland
Lesser petrosal n.
Medial Wall
Lateral Wall
MDA 7.114
N 13
53
N 50
Autonomic Innervation of the Parotid Gland
Lesser petrosal n.
Auriculotemporal n. (branch of N 50
Otic ganglion V3)
• Sympathetic
• Inhibits secretion
(vasoconstriction)
N 46
55
Autonomic Innervation of the Submandibular & Sublingual Glands
CN V
Submandibular
Ganglion
Chorda tympani
IMLCC
Lingual a.
Deep petrosal
n. Internal carotid plexus
57
Superior cervical ganglion For additional
IMLCC review of these
pathways
Click here & Click
N 53 here
Autonomic Innervation of Lacrimal Gland
Lacrimal n. (br.
of V1)
Zygomatic n.
Maxillary n.
V2
PterygopalatineGa
58
nglion N 52
For additional review of this
pathway
Click here
Autonomic Innervation of the Eye
Midbrain-Pons junction IMLCC
Sympathetic chain
CN III
Sup. cervical ganglion
Sup. orbital fissure
Ciliary ganglion no
synapse!
Short ciliary nerves (br. Long ciliary nerves Click to return
of V1) (br. of V1)
Short ciliary nerves (br. of
V1)
Long ciliary nn
(br. of V1) Short ciliary nn
(br. of V1)
Sympathetic root of CG Ciliary Ganglion
(from internal carotid Parasympathetic root of
plexus) CG (from CN III)
Nasociliary n. (br.
of V1) CN III
Click to return
Internal carotid plexus
V1 (Ophthalmic
Division of Trigeminal
Nerve)
60
N 88
Autonomic Innervation of the Eye
Nasociliary n. (br. N 88
of V1)
Click to return
61
MDA 7.58
Autonomic Innervation of the Parotid Gland
Lesser petrosal n.
Otic ganglion
62
Hiatus for lesser Click to return
Auriculotemporal n. petrosal n.
(branch of V3)
N 13
N 50
Autonomic Innervation of the Parotid Gland
N 46
Click to return
63
Autonomic Innervation of the Parotid Gland
Medulla IMLCC
CN IX
Jugular foramen
Sympathetic
chain
Tympanic n.
Tympanic canaliculus
Lesser petrosal n.
Hiatus for lesser petrosal n.
Foramen ovale
External
Otic Ganglion
carotid plexus
Click to return
CN VII
Medial Wall
Lateral Wall
Lingual n.
Petrotympanic
fissure
MDA 7.114
Click to return
Medial View
65
N 50
Autonomic Innervation of the Submandibular & Sublingual Glands
Lingual n.
Chorda tympani
N 50 66
Sublingual & Submandibular
Glands
Autonomic Innervation of the Submandibular & Sublingual Glands
Pons – Medulla junction IMLCC
CN VII Sympathetic
Chain
Internal acoustic meatus
Chorda tympani
Petrotympanic fissure Sup. Cervical Ganglion
Lingual n. (br. of V3)
Click to return
Lingual n. (br. of V3) Lingual a.
Submandibular & 67
Sublingual Gland Submandibular Gland
Sublingual Glands
Autonomic Innervation of the Nasal & Palatal Mucosa
Pterygopalatinega
nglion (Vidian) nerve of the
pterygoid canal
Greater petrosal n.
Posterior lateral nasal
nn. Deep petrosal n.
(branches of V2)
Pharyngeal branch
of V2
& Nasopalatine n.
(br. of V2) to nasal
N 39 Lateral wall of nasal cavity septum
68
Autonomic Innervation of the Nasal & Palatal Mucosa
Pons – Medulla junction IMLCC
Sympathetic chain
CN VII
Internal acoustic meatus Sup. Cervical Ganglion
Greater petrosal n.
Opening to pterygoid canal Internal carotid plexus
Carotid canal
Nerve of the pterygoid
canal (Vidian n.) Deep petrosal n.
Branches of V2
Branches of V2
Pterygopalatine
Pterygopalatine Ganglion (no synapse!)
Ganglion
Communicating Communicating
branch branch Click to return