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Master Class:

Master Class:. Autonomic Nervous System. Robert Fisk, Ph.D., James Nemitz, Ph.D., John Nolte, Ph.D., Britt Sanford, M.D. Thoracolumbar Outflow: Sympathetic Ganglia and Attendant Pathways. James W. Nemitz, Ph.D. April 1, 2006 American Association of Anatomists.

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Master Class:

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  1. Master Class: Autonomic Nervous System Robert Fisk, Ph.D., James Nemitz, Ph.D., John Nolte, Ph.D., Britt Sanford, M.D.

  2. Thoracolumbar Outflow: Sympathetic Ganglia and Attendant Pathways James W. Nemitz, Ph.D. April 1, 2006 American Association of Anatomists Images used in this presentation are taken from Clinically Oriented Anatomy, 5th Ed.,Moore and Dalley, with permission from the publisher Lippincott Williams & Wilkins.

  3. Thoracolumbar ANS = Sympathetic Nervous System Postsynaptic (Postganglionic) Sympathetic Neurons = Paravertebral and Prevertebral (Preaortic/Collateral) Ganglia Presynaptic (Preganglionic) Sympathetic Neurons = Intermediolateral cell column (IML) Images taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott, Williams & Wilkins, 2006.

  4. Presynaptic Sympathetic Neurons Intermediolateral Cell Column (IML) • Location of ALL Presynaptic Sympathetic Cell Bodies • Lateral Horn of Spinal Cord Gray Matter • Spinal Cord Segments: T1 -> L2,3 IML Somatotopically Organized Image taken from Clinically Oriented Anatomy Image, 5th Ed., Moore & Dalley, Lippincott Williams & Wilkins, 2006.

  5. Postsynaptic Sympathetic Neurons Paravertebral vs. Prevertebral Ganglia Sympathetic Ganglia • Paravertebral Ganglia • Sympathetic Chain of Ganglia • Ganglia (Postsynaptic Neurons) • Sympathetic Trunks (Axons) • Somatic and Thoracic Pathways • Prevertebral Ganglia • Preaortic/Collateral Ganglia (Postsynaptic Neurons) • Abdominal/Pelvic Pathways Image taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott Williams & Wilkins, 2006. Image taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott Williams & Wilkins, 2006.

  6. Sympathetic Pathways: Presynaptic Presynaptic Axons • Ventral Roots and Rami: T1-L2,3 • White Rami Communicantes: T1-L2,3 • All Presynaptic Axons Enter the Chain • Synapse Within Sympathetic Chain (Paravertebral Ganglia) • At Entrance Level • Higher Level • Lower Level • Synapse Outside Sympathetic Chain (Prevertebral/Preaortic Ganglia) Image taken from Clinically Oriented Anatomy Image Collection, 4th Ed., Moore & Dalley, Lippincott Williams & Wilkins, 2000.

  7. Postsynaptic Pathways: Parietal Somatic Pathways • Presynaptic: IML (T1 – L2,3)->Ventral Roots/Rami->White Rami Communicans ->Sympathetic Chain • Postsynaptic: Paravertebral Ganglia -> Grey Rami Communicans -> Ventral and Dorsal Rami of Spinal Nerves (C1 -Coccygeal) • End Organs in Somatic Structures • Blood Vessels • Sweat Glands • Erector Pilae MM • Perineal Structures Image taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott Williams & Wilkins, 2006.

  8. Postsynaptic Pathways: Head and Neck • Head Pathway • IML (T1-5) • Superior Cervical Ganglion • Periarterial plexus • End Organs • Dilator pupillae m. • Superior tarsal m. • Blood vessels • Sweat glands • Neck Pathway • IML (T1-5) • Superior, Middle and Inferior Cervical Ganglia • Grey Rami Communicans • Cervical Spinal Nerves (C1-C4) • End Organs • Blood vessels • Sweat glands Image taken from Clinically Oriented Anatomy, 5th Ed., Moore and Dalley, Lippincott Williams & Wilkins, 2006.

  9. Postsynaptic Pathways: Visceral • Visceral Pathways • Input: White Rami Communicantes • T1-L2,3 • Output: Splanchnic Nerves • Cardiopulmonary (Paravertebral Gang.) • Abdominopelvic (Prevertebral Gang.) • End Organs • Visceral Organs Image taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott Williams & Wilkins, 2006.

  10. Sympathetic Innervation of Thoracic Organs • Thoracic Pathways • IML (T4-6) Presynaptic neurons • Ventral roots and rami • White rami communicans • Paravertebral ganglia Postsynaptic neurons • Cardiopulmonary Splanchnic nerves • Thoracic Plexi • Cardiac • Pulmonary • Esophageal Image taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott Williams & Wilkins, 2006.

  11. Sympathetic Innervation of Abdominal Organs • Abdominal Pathways • IML (T7-11) presynaptic • Ventral Roots and Rami • White Rami Communicans • Abdominopelvic Splanchnic Nerves (presynaptic axons) • Thoracic • Lumbar • Prevertebral Ganglia (postsynaptic neurons) • Celiac • Aorticorenal • Mesenteric • Postsynaptic axons • Abdominal Vessels Image taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott, Williams & Wilkins, 2006.

  12. Suprarenal Gland Image taken from Clinically Oriented Anatomy, 5th Ed., Moore and Dalley, Lippincott Williams & Wilkins, 2006.

  13. Sympathetic Innervation of Pelvic Organs • Pelvic Pathways • IML (T12-L2,3) presynaptic neurons • Ventral roots and rami • White rami communicans • Lumbar Splanchnic Nerves (presynaptic axons) • Prevertebral ganglia (postsynaptic neurons) • Inferior Mesenteric • Hypogastric • Pelvic • Postsynaptic axons • Abdominal vessels • Pelvic vessels Image taken from Clinically Oriented Anatomy, 5th Ed., Moore and Dalley, Lippincott Williams & Wilkins, 2006.

  14. Splanchnic Nerves/Prevertebral Ganglia • Abdominopelvic Splanchnic Nerves (Presynaptic Axons) • Thoracic • Greater: T5-T9 • Lesser: T10-T11 • Least: T12 • Lumbar: L1-L2 • Prevertebral Ganglia (Postsynaptic Neurons) • Celiac • Aorticorenal • Superior mesenteric • Inferior mesenteric • Plexi ganglia Image taken from Clinically Oriented Anatomy, 5th Ed., Moore and Dalley, Lippincott Williams & Wilkins, 2006.

  15. Splanchnic Nerves/Prevertebral Ganglia/Plexi

  16. Abdominal/Pelvic Plexi • Celiac Plexus: Stomach, Liver, Duodenum, Pancreas, Spleen • Aorticorenal Plexus: Kidneys, Suprarenal glands • Mesenteric Plexi • Superior: Small and Large intestine to splenic flexure • Inferior: Large intestine distal to splenic flexure • Hypogastric/Pelvic Plexi • Superior: Pelvic organs • Inferior: Pelvic organs Images taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott, Williams & Wilkins, 2006.

  17. Abdominal/Pelvic Plexi Axonal Components • Axonal Components • Sympathetic • Presynaptic • Postsynaptic • Parasympathetic • Presynaptic • Visceral Afferents Image taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott, Williams & Wilkins, 2006.

  18. Referred Pain: Abdominal/Pelvic Organs • Referred Pain Pathway • Visceral Afferents in Abdominopelvic Splanchnic Nerves • Dorsal Root Ganglia: Sensory Cell Bodies • Spinal Cord Segments and Ganglia Levels Image taken from Clinically Oriented Anatomy, 5th Ed., Moore and Dalley, Lippincott Williams & Wilkins, 2006.

  19. Visceral Afferents • General Visceral Afferents (GVA) • Found in sympathetic nerves • Cell bodies located in Dorsal Root Ganglia • Synapse in Spinal Cord: Dorsal Gray • Referred Pain • Viscerosomatic Reflexes Image taken from Clinically Oriented Anatomy, 5th Ed., Moore & Dalley, Lippincott Williams & Wilkins, 2006.

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