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METHODICAL GUIDANCE for the Lecture Academic Subject Human Ministry of Public Health of Ukraine Ukrainian Medical Stomatological Academy "Approved" at the meeting of the Department of Human Anatomy «29» 08 2020 Minutes № Head of the Department Professor O.O. Sherstjuk ________________________ METHODICAL GUIDANCE for the lecture Academic subject Human Anatomy Module No 3 "The heart. Vessels and nerves of the head, the neck, the trunk, extremities" Lecture No 15 Review of the autonomic nervous system, its central departments. The principles of the autonomic innervation of the organs Year of study ІI Faculty Foreign students' training faculty, specialty «Medicine» Number of 2 academic hours Poltava – 2020 1. Educational basis of the topic The autonomic division of peripheral nervous system regulates physiological processes of the human organism like blood circulation, respiration, digestion, excretion and general metabolism; also, it regulates tissue trophic processes. The autonomic division acts relatively independently from the cerebral cortex and the organs supplied act involuntarily as well. It is quite clear that that distinguishing of the somatic and the autonomic compartments is conditional and exact delimitation is not possible. Such impossibility appears due to common regulatory centers for both divisions and tight morphological and functional associations featured by them. The somatic neurons and the interneurons of PNS like those of CNS feature topographical and synaptic associations so a reflex arc may comprise both somatic (e.g. afferent) and autonomic neurons. Summarizing the aforesaid, the term ’autonomic nervous system’ will be applied to a specific compartment of PNS but not for a separate nervous system. 2. Learning objectives of the lecture: . to familiarize students with the autonomic division of CNS; . to specify classification and functional significance, evolutional features of the autonomic division of CNS; . to provide theoretical information on parts of the autonomic division of CNS; . discuss the chief function of the parasympathetic part of the autonomic division of CNS. 3. Objectives of developing the future specialist’s personality (educational aims and objectives): familiarization with axiological, ethical and deontological principles of medical profession. 4. Interdisciplinary integration The preceding The acquired knowledge subjects Biology What are the main functions of the nervous system. The reflex arc and its variations. Phylogeny of cranial nerves. Classification of the neuron. Histology Structure of nerve fibers. Neurology Topography of the cranial nerves. Physics Describe the mechanism of nerve impulse. Anatomy Types of receptors. Projection of the nuclei of the cranial nerve 5. The plan and organization of lecture structure No The main stages of the lecture and Type of lecture. Time their content Means of motivation. allocation Teaching materials The preparatory stage 5% 1. Determining the relevance of the pp. 1-2 topic, learning objectives and motivation. The main stage Introductory lecture 85% 2. Delivering the lecture material according to the plan: Feedback and questions 1. Where do the centers of the to students sympathetic part of autonomic division of CNS reside? What are PPT presentation with they represented with? diagrams and tables. 2. What are the compartments of the sympathetic trunk? 3. Name the chief function of the parasympathetic part of the autonomic division of CNS. 4. What branches of the vagus nerve supply the viscera? The final stage Human Anatomy. In three 10% 3. General conclusions to the lecture. volumes. Volume 3: Answers to possible questions. textbook / Edited by V.G. Tasks for students’ self-directed Koveshnikov. - Lugansk: work. LTD «Virtualnaya realnost», 2009. – 384p. 6.The lecture material. The autonomic nervous system The nervous system is divided into two great subgroups: the cerebrospinal system, made up of the brain, spinal cord and the peripheral cranial and spinal nerves, and the autonomic system (also termed the vegetative, visceral or involuntary system), comprising the autonomic ganglia and nerves. Broadly speaking, the cerebrospinal system is concerned with the responses of the body to the external environment. In contrast, the autonomic system is concerned with the control of the internal environment, exercised through the innervation of the non-skeletal muscle of the heart, blood vessels, bronchial tree, gut and the pupils and the secretomotor supply of many glands, including those of the alimentary tract and its outgrowths, the sweat glands, and, as a rather special example, the suprarenal medulla. The two systems should not be regarded as being independent of each other, for they are linked anatomically and functionally. Anatomically, autonomic nerve fibres are transmitted in all of the peripheral and some of the cranial nerves; moreover, the higher connections of the autonomic system are situated within the spinal cord and brain. Functionally, the two systems are closely linked within the brain and cord. The characteristic feature of the autonomic system is that its efferent nerves emerge as medullated fibres from the brain and spinal cord, are interrupted in their course by a synapse in a peripheral ganglion and are then relayed for distribution as fine non-medullated fibres. In this respect they differ from the cerebrospinal efferent nerves, which pass without interruption to their terminations. The autonomic system is subdivided into the sympathetic and parasympathetic systems on anatomical, functional, and to a considerable extent, pharmacological grounds. Anatomically, the sympathetic nervous system has its motor cell stations in the lateral grey column of the thoracic and upper two lumbar segments of the spinal cord. The parasympathetic system is less neatly defined anatomically since it is divided into a cranial outflow, which passes along the cranial nerves III, VII, IX and X, and a sacral outflow, with cell stations in the 2nd, 3rd and sometimes 4th sacral segments of the cord. Functionally, the sympathetic system is concerned principally with stress reactions of the body. When this system is stimulated, the pupils dilate, peripheral blood vessels constrict, the force, rate and oxygen consumption of the heart increase, the bronchial tree dilates, visceral activity is diminished by inhibition of peristalsis and increase of sphincter tone, glycogenolysis takes place in the liver, the supradrenal medulla is stimulated to secrete, and there is cutaneous sweating and pilo-erection. The sympathetic pelvic nerves inhibit bladder contraction and are motor to the internal vesical sphincter. Coronary blood flow is increased, partly by a direct sympathetic effect and partly produced by indirect factors, which include more vigorous cardiac contraction, reduced systole, relatively increased diastole and an increased concentration of vasodilator metabolites. The parasympathetic system tends to be antagonistic to the sympathetic system. Its stimulation results in constriction of the pupils, diminution in the rate, conduction and excitability of the heart, an increase in gut peristalisis with sphincter relaxation and enhanced alimentary glandular secretion. In addition, the pelvic parasympathetic nerves inhibit the vesical internal sphincter and are motor to the detrusor muscle of the bladder. Table. Summary of effects of sympathetic and parasympathetic stimulation. Sympathetic stimulation Parasympathetic stimulation Eye Pupil dilates Pupil constricts; accommodation of lens Lacrimal Vasoconstrictor Secretomotor gland Heart Increase in force, rate, Decrease in force, rate, conduction conduction and excitability and excitability Lung Bronchi dilate Bronchi constrict; secretomotor to mucous glands Skin Vasoconstrictor Pilo-erection — Secretomotor to sweat glands Salivary Vasoconstrictor Secretomotor glands Musculature Peristalsis inhibited Peristalsis activated; sphincters of relax alimentary canal Acid Secretomotor secretion of stomach Pancreas Secretomotor Liver Glycogenolysis Suprarenal Secretomotor Bladder Detrusor inhibited Detrusor stimulated Sphincter stimulated Sphincter inhibited Uterus Uterine contraction Vasodilatation Vasoconstriction The sympathetic system tends to have a ‘mass action’ effect; stimulation of any part of it results in a widespread response. In contrast, parasympathetic activity is usually discrete and localized. This difference can be explained, at least in part, by differences in anatomical peripheral connections of the two systems, as will be shown below. It is useful to think of the two systems as acting synergistically. For example, reflex slowing of the heart is effected partly from increased vagal and partly from decreased sympathetic stimulation. In addition, some organs receive their autonomic innervation from one system only; for example, the suprarenal medulla and the cutaneous arterioles receive only sympathetic fibres, whereas neurogenic gastric secretion is entirely under parasympathetic control via the vagus nerve. Pharmacologically, the sympathetic postganglionic terminals release adrenaline and noradrenaline, with the single exception of the terminals to the sweat glands which, in common with all the parasympathetic postganglionicterminations, release acetylcholine. Fig. The essential difference between the cerebrospinal and autonomic outflows: (a) the cerebrospinal system has its lowest efferent nerve cell stations within the c.n.s.; (b) the autonomic system has its lowest efferent cell stations in a peripheral ganglion (here illustrated by a typica sympathetic
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