Autonomic nervous system (ANS) Central and peripheral compartments Sympathetic part (pars sympathica) Parasympathetic part (pars parasympathica) Enteric system Innervation of ■ non-striated muscles ■ myocardium ■ glands

smooth muscle myocardium glands VM (GVE) neuron CNS PNS skeletal muscle SM (GSE) neuron autonomic ganglion In contrast to somatic motor system that has just one neuron connecting CNS with periphery, the ANS has a two-neuron linkage to peripheral effectors. The transmiter of all preganglionic fibers is acetylcholine, transmitter released by the postganglionic parasympathetic fibers is also acetylcholine. The transmitter released by the sympathetic postganglionic fibers is norepinephrine (noradrenalin). smooth muscle myocardium glands VM (GVE) neuron pregangl. fiber myelinated postgangl. fibers unmyelinated cholinergic cholinergic adrenergic 2

cranial parasympathetic part thoraco-lumbal (sympathetic) system sacral parasympathetic part paravertebral  prevertebral ganglia intramural ganglia

■ dilates coronary arteries ■ increases heart rate Sympathetic system Catabolic reaction (activities that are mobilized during emergency and stress situations, “fight, fright and flight” responses) ■ dilates coronary arteries ■ increases heart rate ■ increases cardiac output ■ dilates bronchi ■ inhibits GIT motility ■ dilates pupil (mydriasis) ■ stimulates sweat glands secretion ■ stimulates secretion of viscous saliva The sympathetic system stimulates those activities that are mobilized by the organism during stress situations. Zvýšená akce sympatiku a následné vyplavení adrenergních mediátorů připravuje organismus k obraně, útoku nebo útěku anatomie 4

Parasympathetic system Anabolic reactions (activities associated with conservation and restoration of body resources) ■ decreases heart rate ■ decreases cardiac output ■ constricts coronary arteries ■ constricts bronchi ■ constricts pupil (miosis) ■ accommodation (near vision) ■ increases GIT motility ■ stimulates secretion of watery saliva Parasympathetic system stimulates activities associated with conservation and restoration of body resources. 5

Sympathetic system Central part: ncl. intermediolateralis Ganglion The preganglionic sympathetic fibers pass through the ventral roots to spinal nerves, then white communicating branches to the sympathetic trunk. Most of preganglionic sympathetic neurons have relatively short axons, while postganglionic neurons have long axons. Ganglion Peripheral part: pregangl. fibres rr.com. albi postgangl. fibres Noradrenalin Acetylcholine 6

Parasympathetic system Central part: CN III, VII, IX, X ncl. intermediolat. S2-4 Preganglionic fibers are long, postganglionic short. Peripheral part: Ganglion postgangl. fibres pregangl. fibres Acetylcholine Acetylcholine 7

I. Pars sympathica

Paravertebral ganglia (ggl. trunci sympathici) cervical 3 thoracic 10 - 11 lumbar 4 - 5 sacral 4 - 5 ganglion impar Prevertebral ganglia coeliacum mesentericum sup. aorticorenale mesentericum inf. Tr. sympatikus – relay fibers for the head, trunk and limbs. 9

Ganglia tr. sympathici R. com. albus (T1 – L2) R. com. grisseus Grey com. branches go back to the branches of the spinal nerves and innervate smooth muscle and glands in the skin of the trunk and limbs. R. com. albus (T1 – L2) R. com. grisseus postgangl. f. pregangl. f. 10

rr. interganglionares Rr. interganglionares Jsou to podélné spojky mezi sousedními ggll.. Obsahují také pregangliová vlákna, která jsou na postgangliový neuron přepojena ve vyšším nebo nižším gangliu 11

rr. viscerales rr. vasculares Nn. cardiaci N. caroticus Vascular branches accompany vessels and form plexusses in their adventitia. They reach target organs along the vessels Visceral branches are fibers to viscera – e.g. nn. cardiaci fibers that do not synapse in the ganglia of the sympathetic trunk – nn. splanchnici To prevertebral plexuses nn. splanchnici 12

Ggl. cervicale sup. Horner’s sy ggl. cervicale sup. m. dilatator pupilae ggl. ciliare m. orbitalis, mm. tarsales rr. com. grisei C1-4 rr. orbitales n. jugularis ggl. pterygopal. ggl. inf. IX. gl. lacr. n. petros. prof. ggl. sup. X. nn. carotico- tymp. n. carot. int. n. carot. ext. ggl. oticum ggl. cervicale sup. ve výši 2.-4. krčního obratle rr. laryngo- pharyngei a.men.med. gl.parotis r. interganglionaris a. facialis ggl. cervicale med. ggl. submand. n. card. cerv. sup. ggl. cervicothorac. (stellatum) gl. subling. gl. submand.

Ggl. cervicale med. et stellatum ggl. cervicale sup. a. car. com. r. interganglionaris rr. com. grisei C5-6 ggl. cervicale med. n. card. cerv. med. gl. thyroid. ve výši 5. krčního obratle a. subclav. gl. parathyroid. ansa subclav. ggl. cervicothorac. (stellatum) plexus vertebr. n. card. cerv. inf. rr. com. grisei C7-8

Ganglion cervicale sup. et med. ggl. cervicale sup. ggl. cervicale med.

Ganglion cervicale med. et stellatum ggl. cervicale med. ggl. stellatum

Th1 Th6 Th9 rr. vasculares - from all ganglia nn. cardiaci th. PARAVERTEBRAL GANGLIA Th1 rr. vasculares - from all ganglia nn. cardiaci th. rr. pulmonares th. rr. oesophagei Th6 rr. comm. grisei - from all ganglia Th9 n. splanchnicus major n. splanchnicus minor ggl. coeliacum (prevertebral ggl.) n. splanchnicus imus (1/3)

Ganglia sacralia 4-5 Ganglion impar 1 Ganglia lumbalia 4-5 Ganglia sacralia 4-5 Ganglion impar 1 Ggl. lumbalia leží med. od m. psoas major Ggl. sacralia lež mediálně od foramina sacralia pelvina Pregangliová vlákna přichází jako rr. com. albi z L1-L3 ganglií Postgangliová - rr. comm. grisei jdou do všech lumbálních a sakrálních nervů pro sympatickou inervaci DK Nn. splanchnici lumbales – hlavně pregangliová vlákna, která se přepojí až v intramurálním systému orgánů. Jdou do plx. aorticus abdominalis - začíná těsně pod bránicí, opřádá celou břišní aortu, při bifurkaci aorty přechází na promontorium jako plx. hypogastricus sup. NN. splanchnici sacrales končí v plx. hypogastricus Rr. vasculares – vytváří pleteně na větvích a. iliaca int. Plx.ilacus dx. et sin. Pokračují podél cév DK jako plx. femoralis a navazující pleteně podél větví tepen DK To zn. že jak HK, tak DK má 2 cestay sympatické inervace: jednak přes rr. com. grisei, jednak přes pleteně kolem cév Rr. com. grisei (L1 – Co) Rr. vasculares (parietal aa.) Nn. splanch. lumb. (plx. aorticus abd.) Nn. splanch. sacrales (plx. hypogastr.) 18

Ganglion lumbale Nn. splanchnici lumbales Ganglion sacrale 19

Prevertebral ganglia Coeliacum Mesentericum sup. Aorticorenale Ggl. coeliacum Coeliacum Mesentericum sup. Aorticorenale Mesentericum inf. Ggl. mes. sup. Ggl. aorticor. Ggl. mes. inf. 20

Pars parasympathica

Ggl. ciliare N. nasociliaris Ggl.cervic.sup. CN III E-W Ggl. ciliare afferents Ggl.cervic.sup. m. dilat. pup. vessels CN III E-W m. sph. pup. m. ciliaris Ggl. ciliare 22

nasal, paranasal, pharyng., palatal glands Ggl. pterygop. Ggl. pterygopalat. Nn. pterygop. Ggl.cervic.sup. SS rr.orbitales taste n.petr. prof. gl. lacrim. CN VII ncl.sal. sup nasal, paranasal, pharyng., palatal glands n. petr. major Ggl. pterygop. Canalis pteryg. 23

afferents from 2/3 of tongue n. lingualis Ggl. submand. N. lingualis Ggl.cervic.sup. afferents from 2/3 of tongue n. lingualis taste from tongue CN VII ncl.sal. sup. lingual glands gl. submand. gl. subling. Chorda tymp. Ggl. submand. 24

Ggl. oticum N. auriculotemporalis Ggl. oticum CN IX ncl.sal. inf. Plx. tympanicus Gl. parotis n. petr. min. n. tymp. Ggl.cervic.sup. glands of cheeks 25

Ncl. p. CN X pharynx,oesophagus, trachea, bronchi, lungs, heart, stomach, liver, kidneys, intestine to flex. coli sin., genital glands 26

Ncl. intermediolat. Sacral parasympathetic s. pregangl. f. - nn. splanch. pelvici to plx. hypog. sup. et inf. - ganglia pelvica > postgangl. f. - effectors intestine from flexura coli sin. organs of pelvis (exept genital glands) erectile bodies of penis and clitoris 27

PREVERTEBRAL (AORTIC) PLEXUSES

ANS innervates organs of thorax, abdomen and pelvis through mixed autonomic plexuses Plx. card. superf. et prof. Plx. aorticus thoracicus Plx. pulmonalis Plx. eosophageus 29

INNERVATION OF THE HEART plexus cardiacus superf. plexus cardiacus prof.

Abdomen Plx. aorticus abdom. coeliacus ... hepaticus, gastrici, lienalis, pancreaticus renalis et suprarenalis testicularis / ovaricus uretericus mesent. sup. mesent. inf. Plexus aorticus abdominalis – odtud jdou pleteně podél cév – plx. coeliacus, gastricus, hepaticus, splenicus, duodenalis, pancreaticus, uretericus, testicularis/ovaricus, renalis, suprarenalis, dál podél větví a. mesenterica sup. et inf. až do plx. rectalis sup. 31

Pelvis * Plx. hypogastr. sup. ** N. hypogastr. dx. et sin. *** Plx. hypogastr. inf. * Plexus hypogastricus sup. – nepárová pleteň, pokračování plx. aorticus při bifurkaci aorty a přes promontorium do malé pánve jako n. presacralis (spodní část pleteně). V této pleteni již nejsou vlákna z n. vagus. Odtud jdou vlákna přímo k pánevním orgánům nebo do plexus hypogastricus inf. a odtud k pánevním orgánům Pokračuje jako n. hypogastricus dx et sin., z ní vychází - plexus hypogastricus inf. – párová pleteń uložená po obou stranách rekta. Pleteň vybíhá ke všem pánevním orgánům – plx. rectalis, prostaticus .... Ty jsou prostoupeny ganglii, ve kterých se přepojují pregangliová vlákna sympatická i parasympatická. > plexus: rectales medii et inferiores vesicales prostaticus deferentialis uterovaginalis cavernosi penis / clitoridis ** *** 32

33 Plx. hypogastr. sup. N. hypogastricus Plx. hypogastr. inf. Plx. vesicalis Plx. rectalis Plx. prostaticus 33

Enteric system ■ neurons and interneurons in the wall of digestive tube Plx. myentericus Auerbachi Plx. submucosus Meissneri ES carries out automatic functions. Neurons of ES release more than 20 different transmitters and modulators. ES coordinates the activity of all parts of the gut and related glands. It is formed by the network of preganglionic sympathetic and parasympathetic fibers, postganglionic parasymp. neurons, sensory neurons and interneurons. Motor neurons control the smooth muscle of the gut and local blood vessels, as well as secretion of the glandular cells of the mucosa. Plx. myentericus located between the inner circular and outer longitudinal muscle layers – controls motility of the gut Plx. submucosus located in the submucosa – controls secretory functions ■ plexuses contain small ganglia 34

■ ganglia receive signals: from receptors of GIT from CNS via symp. a parasymp. nerves ■ through interneurons ■ control activity of GIT through stimulation or inhibition of motoneurons of enteric system = controls tonus and motions of digestive tube and secretion of glands Funkce: - zajištění koordinovaných pohybů žaludku a střeva, které posunují obsah - regulace sekrece k. solné, enzymů a GI hormonů endokrinního systému trávicí trubice. Ganglia ES dostávají informace 1/ z CNS sy a parasy nervy ANS 2/ z receptorů ve stěně trávicí trubice. Tyto receptory jsou funkčně mechanoreceptory, chemoreceptory a termoreceptory a průběžně předávají informace o stavu trávicí trubice a jejího nitra. Signály jsou pak v gangliích ES převedeny dod sítí interneuronů – tyto pak kontrolují aktivitu enterických motoneuronů, jež jsou konečnými dráhami k výkonným orgánům - efektorům, které buď aktivují nebo inhibují. The myenteric plexus exerts (uplatňuje se) control primarily over digestive tract motility. The submucous plexus, Its principal role is in sensing the environment within the lumen, regulating gastrointestinal blood flow and controlling epithelial cell function. In regions where these functions are minimal, such as the esophagus, the submucous plexus is sparse and may actually be missing in sections. In addition to the two major enteric nerve plexuses, there are minor plexuses beneath the serosa, within the circular smooth muscle and in the mucosa. 35

stratum longitudinale l. muscularis mucosae Auerbach plexus Meissner plexus stratum circulare stratum longitudinale l. muscularis mucosae symp. and parasympath.f. The viscerosensory neurons have dendritic processes that begin in the mucosa and response to tension, tonicity and chemical environment of the gut. enteric VS neuron enteric interneuron enteric motor neuron 36

AFFERENT VISCERAL PATHWAYS both autonomic divisions hunger, nausea, sexual excitement, vesical distension, visceral pain referred pain CN X – reflexes, hunger, nausea CN IX – chemo- and pressoreceptors sympathetic - pain