Introduction to the somatic and autonomic nervous systems

Last updated: November 01, 2022

Introduction to the somatic and autonomic nervous systems

CCRN Prep Total

CCRN Prep Total

Anatomic and physiologic dead space
Ventilation
Ventilation-perfusion ratios and V/Q mismatch
Gas exchange in the lungs, blood and tissues
Approach to a cough (pediatrics): Clinical sciences
Reading a chest X-ray
Approach to respiratory distress (newborn): Clinical sciences
Approach to chest pain: Clinical sciences
Acute respiratory distress syndrome
Respiratory distress syndrome: Pathology review
Respiratory failure (pediatrics): Clinical sciences
Acute respiratory distress syndrome: Clinical sciences
Approach to postoperative respiratory distress: Clinical sciences
Approach to dyspnea: Clinical sciences
Upper respiratory tract infection
Apnea of prematurity
Approach to complications of prematurity (early): Clinical sciences
Apnea, hypoventilation and pulmonary hypertension: Pathology review
Hospital-acquired and ventilator-associated pneumonia: Clinical sciences
Acid-base map and compensatory mechanisms
Respiratory acidosis
Approach to respiratory alkalosis: Clinical sciences
Approach to lower airway obstruction (pediatrics): Clinical sciences
Approach to upper airway obstruction (pediatrics): Clinical sciences
Croup and epiglottitis: Clinical sciences
Croup
Pharyngitis, peritonsillar abscess, and retropharyngeal abscess (pediatrics): Clinical sciences
Asthma: Clinical sciences
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Pneumonia: Pathology review
Pneumothorax
Pneumothorax: Clinical sciences
Pleural effusion, pneumothorax, hemothorax and atelectasis: Pathology review
Atelectasis: Clinical sciences
Approach to penetrating chest injury: Clinical sciences
Pulmonary embolism
Pulmonary embolism: Clinical sciences
Pulmonary shunts
Pulmonary hypertension
Pulmonary hypertension: Clinical sciences
Hypertension
Hypertensive emergency
Hypertension: Pathology review
Tracheoesophageal fistula
Esophageal atresia and tracheoesophageal fistula: Year of the Zebra
Bronchiolitis: Clinical sciences
Blood transfusion reactions and transplant rejection: Pathology review
Spinal fractures: Clinical sciences
Anatomy of the descending spinal cord pathways
Approach to differentiating lesions (spinal cord): Clinical sciences
Brain death: Clinical sciences
Pneumonia (pediatrics): Clinical sciences
Brain herniation
Pediatric brain tumors
Delirium
Delirium: Clinical sciences
Approach to encephalopathy (acute and subacute): Clinical sciences
Encephalitis
Approach to altered mental status: Clinical sciences
Approach to traumatic brain injury: Clinical sciences
Approach to traumatic brain injury (pediatrics): Clinical sciences
Traumatic brain injury: Pathology review
Epidural hematoma
Approach to trauma (pediatrics): Clinical sciences
Concussion and traumatic brain injury
Subarachnoid hemorrhage: Clinical sciences
Normal pressure hydrocephalus
Intracerebral hemorrhage
Approach to increased intracranial pressure: Clinical sciences
Subarachnoid hemorrhage
Neurogenic shock: Clinical sciences
Approach to shock (pediatrics): Clinical sciences
Shock: Pathology review
Shock
Approach to shock: Clinical sciences
Ischemic stroke
Acute stroke (ischemic or hemorrhagic) or TIA: Clinical sciences
Cerebral vascular disease: Pathology review
Arteriovenous malformation
Meningitis
Pelvic fractures: Clinical sciences
Subdural hematoma
Community-acquired pneumonia: Clinical sciences
Meningitis (pediatrics): Clinical sciences
Meningitis and brain abscess: Clinical sciences
Central nervous system infections: Pathology review
Syndrome of inappropriate antidiuretic hormone secretion: Clinical sciences
Approach to convulsive status epilepticus: Clinical sciences
Seizures and epilepsy
Approach to epilepsy: Clinical sciences
Approach to altered mental status (pediatrics): Clinical sciences
Nonbenzodiazepine anticonvulsants
Seizures: Pathology review
Spina bifida
Congenital neurological disorders: Pathology review
Electrolyte disturbances: Pathology review
Hyperosmolar hyperglycemic state: Clinical sciences
Compartment syndrome: Clinical sciences
Renal system anatomy and physiology
Intrinsic acute kidney injury (glomerular causes): Clinical sciences
Prerenal acute kidney injury: Clinical sciences
Prerenal azotemia
Intrinsic acute kidney injury (non-glomerular causes): Clinical sciences
Postrenal acute kidney injury: Clinical sciences
Approach to acute kidney injury: Clinical sciences
Approach to postoperative acute kidney injury: Clinical sciences
Renal failure: Pathology review
Chronic kidney disease
Chronic kidney disease: Clinical sciences
Nephrotic syndromes: Pathology review
Approach to hyperkalemia: Clinical sciences
Transplant rejection
Nephritic syndromes (pediatrics): Clinical sciences
The role of the kidney in acid-base balance
Urinary tract infections and kidney stones in pregnancy: Clinical sciences
Hemolytic-uremic syndrome
Approach to bleeding disorders (thrombocytopenia): Clinical sciences
Extrinsic hemolytic normocytic anemia: Pathology review
Thrombotic microangiopathy: Clinical sciences
Platelet disorders: Pathology review
Approach to blunt and penetrating abdominal injury: Clinical sciences
Approach to postoperative abdominal pain: Clinical sciences
Approach to acute abdominal pain (pediatrics): Clinical sciences
Non-accidental trauma and neglect (pediatrics): Clinical sciences
Small bowel ischemia and infarction
Bowel obstruction
Large bowel obstruction: Clinical sciences
Small bowel obstruction: Clinical sciences
Short bowel syndrome: Clinical sciences
Gastrointestinal bleeding: Pathology review
Hypovolemic shock: Clinical sciences
Congenital gastrointestinal disorders: Pathology review
Approach to bleeding disorders (platelet dysfunction): Clinical sciences
Cholestatic liver disease
Non-alcoholic fatty liver disease
Post-transplant lymphoproliferative disorders (NORD)
Transposition of the great vessels
Intussusception
Intussusception: Clinical sciences
Approach to the acute abdomen (pediatrics): Clinical sciences
Vasculitis: Pathology review
Necrotizing enterocolitis: Clinical sciences
Necrotizing enterocolitis: Year of the Zebra 2024
Guillain-Barré syndrome: Clinical sciences
Disseminated intravascular coagulation: Clinical sciences
Disseminated intravascular coagulation
Consumptive coagulopathy from massive transfusion: Clinical sciences
Sepsis: Clinical sciences
Approach to leukemia: Clinical sciences
Thrombosis syndromes (hypercoagulability): Pathology review
Malignant hyperthermia: Clinical sciences
Acute pancreatitis
Adrenal insufficiency: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Immune thrombocytopenia
Immune thrombocytopenia: Clinical sciences
Hematopoietic medications
Glucocorticoids
Sickle cell disease: Clinical sciences
Anatomy clinical correlates: Spinal cord pathways
Acute coronary syndrome: Clinical sciences
Antidiuretic hormone
Diabetes insipidus and SIADH: Pathology review
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Hyponatremia
Approach to hyponatremia: Clinical sciences
Approach to hyponatremia (pediatrics): Clinical sciences
Diabetes insipidus
Diabetes insipidus: Clinical sciences
Approach to hypoglycemia: Clinical sciences
Approach to hypoglycemia (pediatrics): Clinical sciences
Diabetic ketoacidosis: Clinical sciences
Diabetes mellitus (pediatrics): Clinical sciences
Diabetes mellitus: Pathology review
Pulmonary edema
Cerebral palsy
Hepatic encephalopathy: Clinical sciences
Approach to common musculoskeletal injuries (pediatrics): Clinical sciences
Approach to blunt chest injury: Clinical sciences
Pediatric musculoskeletal disorders: Pathology review
Approach to extremity injury: Clinical sciences
Neuroblastoma
Childhood and early-onset psychological disorders: Pathology review
Approach to trauma: Clinical sciences
Anatomy clinical correlates: Skull, face and scalp
Rhabdomyolysis
Compartment syndrome
Hypocalcemia
Hyperphosphatemia
Hyperkalemia
Sepsis (pediatrics): Clinical sciences
Sepsis
Neonatal sepsis
Empyema: Clinical sciences
Necrotizing soft tissue infections: Clinical sciences
Pressure-induced skin and soft tissue injury: Clinical sciences
Diffusion-limited and perfusion-limited gas exchange
Approach to acid-base disorders: Clinical sciences
Definitions of acids and bases
Acid-base disturbances: Pathology review
Catheter-associated urinary tract infection: Clinical sciences
Central line-associated bloodstream infection: Clinical sciences
Approach to medication exposure (pediatrics): Clinical sciences
Approach to household substance exposure (pediatrics): Clinical sciences
Approach to recreational substance exposure (pediatrics): Clinical sciences
Myocarditis: Clinical sciences
Pharmacodynamics: Drug-receptor interactions
Medication overdoses and toxicities: Pathology review
Opioid intoxication and overdose: Clinical sciences
Approach to stimulant use, intoxication, and overdose: Clinical sciences
Approach to hallucinogen, inhalant, and cannabis use, intoxication, and overdose: Clinical sciences
Cholinomimetics: Indirect agonists (anticholinesterases)
Suicide
Burns
Burns: Clinical sciences
Multiple organ dysfunction syndrome (MODS): Clinical sciences
Kawasaki disease
Approach to hypernatremia (pediatrics): Clinical sciences
Approach to a postoperative fever: Clinical sciences
Supraventricular arrhythmias: Pathology review
Aspiration pneumonia and pneumonitis: Clinical sciences
Cardiac preload
Cardiac cycle
Cardiac tumors
Cardiac work
Cardiac tamponade
Cardiac tamponade: Clinical sciences
Cardiac conduction velocity
Cardiac afterload
Cardiac contractility
ECG cardiac hypertrophy and enlargement
Ventricular tachycardia: Clinical sciences
Ventricular arrhythmias: Pathology review
ECG cardiac infarction and ischemia
Approach to tachycardia: Clinical sciences
Stroke volume, ejection fraction, and cardiac output
Dilated cardiomyopathy
Supraventricular tachycardia: Clinical sciences
Class IV antiarrhythmics: Calcium channel blockers and others
Atrial fibrillation and atrial flutter: Clinical sciences
Positive inotropic medications
Class I antiarrhythmics: Sodium channel blockers
Cardiomyopathies: Pathology review
Class III antiarrhythmics: Potassium channel blockers
Hypertrophic cardiomyopathy
Ventricular fibrillation
Aortic stenosis: Clinical sciences
Myocarditis
Brief, resolved, unexplained event (BRUE): Clinical sciences
Mitral stenosis: Clinical sciences
Congestive heart failure: Clinical sciences
Atrial flutter
Pressures in the cardiovascular system
Cardiovascular system anatomy and physiology
Restrictive cardiomyopathy
Airflow, pressure, and resistance
Total anomalous pulmonary venous return
Atrial fibrillation
Hypertrophic cardiomyopathy: Clinical sciences
Hypothermia: Clinical sciences
Hemothorax: Clinical sciences
Anaphylaxis: Clinical sciences
Abdominal aortic aneurysm: Clinical sciences
Muscarinic antagonists
Selective serotonin reuptake inhibitors
General anesthetics
Neuromuscular blockers
Right heart failure: Clinical sciences
Heart failure: Pathology review
Mitral valve disease
Approach to a murmur (pediatrics): Clinical sciences
Tricuspid valve disease
ACE inhibitors, ARBs and direct renin inhibitors
Patent ductus arteriosus
Adrenergic antagonists: Beta blockers
Pheochromocytoma
cGMP mediated smooth muscle vasodilators
Cardiac conduction system
Hypoplastic left heart syndrome
Hypoplastic left heart syndrome: Year of the Zebra 2024
Heart blocks: Pathology review
Rheumatic heart disease
Abnormal heart sounds
Valvular heart disease: Pathology review
Coronary artery disease: Pathology review
Pericarditis: Clinical sciences
Approach to hypertension: Clinical sciences
Deep vein thrombosis
Deep vein thrombosis: Clinical sciences
Approach to a fever: Clinical sciences
Anticoagulants: Heparin
Approach to hypercoagulable disorders: Clinical sciences
Heparin-induced thrombocytopenia
Thrombolytics
Atrial septal defect
Superior vena cava syndrome
Introduction to the somatic and autonomic nervous systems
Anticonvulsants and anxiolytics: Benzodiazepines
Anticonvulsants and anxiolytics: Barbiturates
Approach to congenital heart diseases (acyanotic): Clinical sciences
Tetralogy of Fallot
Cyanotic congenital heart defects: Pathology review
Approach to congenital heart diseases (cyanotic): Clinical sciences
Ventricular septal defect
Aortic valve disease
Pyloric stenosis
Aortic dissection
Pneumonia
Aortic dissection: Clinical sciences
Aortic dissections and aneurysms: Pathology review
Coarctation of the aorta
Acyanotic congenital heart defects: Pathology review
Pulmonary valve disease
Pulmonary chemoreceptors and mechanoreceptors
Zones of pulmonary blood flow
Carotid artery stenosis screening: Clinical sciences
Endocarditis
Endocarditis: Pathology review
Valvular insufficiency (regurgitation): Clinical sciences
Infectious endocarditis: Clinical sciences
Choanal atresia
Tetralogy of Fallot: Year of the Zebra
Mycoplasma pneumoniae
Measles virus
Respiratory alkalosis
Metabolic alkalosis
Approach to metabolic alkalosis: Clinical sciences
Approach to respiratory acidosis: Clinical sciences
Metabolic acidosis
Approach to metabolic acidosis: Clinical sciences
Pericardial disease: Pathology review
Atherosclerosis and arteriosclerosis: Pathology review
Cardiac and vascular tumors: Pathology review
Peripheral artery disease: Pathology review

Transcript

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Whether you’re playing volleyball with friends or just watching TV, your nervous system is always operating, making sure that the right organs function at the right time. The nervous system is structurally divided into two regions, called the central nervous system, or CNS, and the peripheral nervous system, or PNS. The peripheral nervous system can be further subdivided functionally into the somatic nervous system, and the autonomic nervous system.

Okay, let’s start with the somatic nervous system, which describes a set of nerve fibers that control voluntary actions and convey sensory information from the skin, skeletal muscles and joints. Somatic sensory fibers allow transmission of sensory information such as touch, pain, temperature, and proprioception. For example, somatic sensory fibers inform our CNS that our cup of coffee is too hot. Then there are somatic motor fibers, which only innervate skeletal muscle and control voluntary actions of the body, like putting the coffee cup back on the table until it cools down.

On the flip side, the autonomic nervous system controls the involuntary activities within the body. This system consists of visceral motor fibers that carry motor signals to smooth muscle, such as that found in the intestinal walls that allow for peristalsis to occur, as well as cardiac muscle, and glandular tissue.

We also have visceral sensory fibers, which are not typically defined as part of the autonomic nervous system, but they act in conjunction with the visceral motor fibers of the autonomic nervous system to control visceral function. Visceral sensory fibers travel with the visceral motor fibers carrying sensory information from the viscera back to the CNS, where visceral motor fibers will act in response to this sensory information. For example, they provide information about things such as the amount of oxygen in your blood, your arterial blood pressure, and the level of distention of your stomach after that big meal! This visceral sensory information is continuously regulating the activity of the visceral motor neurons of the autonomic nervous system - even while you sit here and watch this osmosis video!

Now, there is also a unique set of sensory neurons we want to mention called special sensory fibers, which relay sensory information related to our special senses, such as smell, sight, taste, hearing and balance back to the CNS for interpretation. These fibers are not really classified as part of the somatic or autonomic nervous system. However this information can modulate the activity of the somatic motor system, such as sending signals to skeletal muscles to turn your head in response to a sound, or the autonomic nervous system, such as stimulating salivary glands in response to the smell of a freshly baked apple pie!

Okay, now, let’s dive a bit more into the autonomic nervous system - or ANS. The ANS has two major subdivisions: the sympathetic nervous system – or SNS - and the parasympathetic nervous system - or PSNS. In addition, some classify the enteric nervous system – which is the intrinsic nervous system of the GI tract - as the third subdivision of the ANS. Now let’s start by discussing the SNS and PSNS, which, for the most part, have opposite effects in the body.

All right, now you’ve probably heard about the ‘fight or flight’ response, which kicks in when one encounters an alarming situation, like seeing a bear on your hike, or before taking an exam. These situations activate the SNS, which prepares the body to respond to extreme or stressful situations. For example, the sympathetic nervous system will cause dilation of the pupils to improve vision, increased heart rate and blood pressure, and diversion of blood flow to the organs that will help with our fight or flight response, like skeletal muscles and the brain. On the flip side, organs that are not urgently needed to address the immediately stressful situation, like the kidneys and the gastrointestinal tract, are toned down.

Ok, so once that bear is gone, or the exam is over, the parasympathetic nervous system kicks in to calm things down. It does so by decreasing your heart rate and blood pressure, increasing gut motility and digestive secretions and by allowing blood to flow back to the organ systems that have been put on hold by the sympathetic nervous system, like the digestive system. These effects can be summarized as the body’s ‘rest and digest’ response. In a nutshell, you can think of these two divisions of the ANS like a seesaw, where they work together to balance each other out.

Alright, as a quick break, let’s see if you can answer the following questions: What are the main divisions of the peripheral nervous system? How about the different components of the autonomic nervous system?

Ok, now, let’s discuss how information from the sympathetic and parasympathetic nervous systems communicate through the central nervous system. Remember that a group of cell bodies in the central nervous system is called a nucleus, while a group of cell bodies in the peripheral nervous system is called a ganglion.

Now, information that’s conveyed in the autonomic nervous system passes from the CNS, to its target organ through a two neuron system. The first neuron sending a signal from the central nervous system is called a preganglionic - or presynaptic - neuron, and the second neuron that the preganglionic neuron synapses with is called a postganglionic - or postsynaptic - neuron. This second neuron is usually the effector neuron, meaning that it then directly synapses on the organ that it acts on.

Now, there are other differences between the sympathetic or parasympathetic divisions of the ANS based on the location of the preganglionic neuron cell bodies and the route that the pre- and postganglionic neurons take to reach their effector organs. Let’s start by talking about the neurons of the sympathetic nervous system. So, the cell bodies of the preganglionic neurons of the sympathetic division are located in the intermediolateral nuclei which make up the lateral horns of the spinal cord’s gray matter in the thoracolumbar spinal cord segments.Specifically, the preganglionic neurons arise from the T1-L3 spinal cord segments.

Now, let’s follow the path of the preganglionic neurons more closely. So, from the intermediolateral nucleus, all of the preganglionic sympathetic fibers exit the spinal cord via the anterior root and enter the anterior rami of spinal nerves T1-L3. Shortly after, these fibers leave the anterior rami to enter the sympathetic chain via the white rami communicantes. The sympathetic chain - or trunk - is a paired structure that runs parallel on either side of the spinal cord, and it resembles an interconnected string of pearls. The sympathetic chain consists of a bundle of nerve fibers and neuron cell bodies. The neuron cell bodies within the sympathetic chain form the paravertebral ganglia.

Now, when the preganglionic fibers enter the sympathetic chain there are 4 possible routes for these fibers to take to synapse with their postganglionic counterparts. First, a preganglionic fiber can enter and immediately synapse with the postganglionic cell body in the paravertebral ganglion at its respective vertebral level. Second, it can also pass through the paravertebral ganglion to ascend, or, third, to descend the sympathetic chain before synapsing at a paravertebral ganglia at another vertebral level.

Fourth and finally, the preganglionic fibers can pass through the paravertebral ganglia without synapsing and instead, they continue via splanchnic nerves to one of a number of prevertebral ganglia, located anterior to the aorta, and synapse there. These ganglia are named according to the main aortic branch that they’re positioned near. The most superior are the paired celiac ganglia, found around the celiac trunk, just below are one or more superior mesenteric ganglia, followed by the inferior mesenteric ganglion.

Key Takeaways

The somatic nervous system is the part of the peripheral nervous system associated with voluntary body movements. It consists of nerve fibers that control voluntary actions and convey sensory information input from the skin, skeletal muscles, and joints.

On the other hand, the autonomic nervous system controls all the involuntary processes in the body, like heart rate, digestion, and breathing. It's made up of two parts: the sympathetic nervous system and the parasympathetic nervous system.

The sympathetic nervous system is responsible for the "fight or flight" response. It's activated when we're in danger or under stress, and it causes all of the body's systems to work faster so that we can either fight or run away.

The parasympathetic nervous system is responsible for "rest and digest" mode. It's activated when we're relaxed and not in danger, and it causes all of the body's systems to work more slowly so that we can rest and digest food.

Sources

  1. "Introduction to the Nervous System" Clinical Anatomy of the Cranial Nerves (2014)
  2. "Peripheral Nervous System" Netter's Atlas of Neuroscience (2016)
  3. "Enteric nervous system" Scholarpedia (2007)
  4. "Diagnostic and Statistical Manual of Mental Disorders" (2013)
  5. "Integrative Action of the Autonomic Nervous System" Cambridge University Press (2008)
  6. "Physiology" Mosby Incorporated (2004)
  7. "Dorland's Illustrated Medical Dictionary" Elsevier Health Sciences (2011)
  8. "The Central Nervous System" Oxford University Press (2004)
  9. "Life" Macmillan (2008)