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You are in Home >> Exams >> Mitchell Anaesthetic Notes

Thoracic anatomy

Created: 6/9/2006
Updated: 8/1/2007

Autonomic nervous system 

  • Division by direction
    • Visceral efferent
      • Preganglionic myelinated, postganglionic unmyelinated
      • Synapse in ganglia
    • Visceral afferent
      • Similar to somatic afferent
      • Cell body in CNS, peripheral processes travel with autonomic and somatic fibres
  • Division by outflow
    • Sympathetic
      • Thoracolumbar outflow: T1-L3
      • Synapse in sympathetic trunk ganglia or other ganglia near CNS
      • Preganglionic cholinergic, postganglionic predominantly noradrenergic (also adrenergic, cholinergic sudomotor and purinergic)
    • Parasympathetic
      • Craniosacral outflow: III, VII, IX, X, S2-4
      • Synapse adjacent to end-organs
        • Cranial nerve parasympathetic ganglia are traversed by other fibres but contain only parasympathetic synapses
  • Parasympathetic anatomy
    • III
      • Edinger-Westphal nuclei --> oculomotor n. --> n. to inferior oblique --> ciliary ganglion --> short ciliary nn. --> ciliary muscle and sphincter pupillae
    • VII
      • Superior salivatory nucleus --> nervus intermedius --> facial n. --> chorda tympani --> lingual n. --> submandibular ganglion --> submandibular and sublingual glands
      • Geniculate ganglion --> greater petrosal n. --> pterygopalatine ganglion --> zygomatic and lacrimal nerves to lacrimal gland and nasal and palatine branches to nasal mucosa
    • XI
      • Inferior salivatory nucleus --> glossopharyngeal nerve --> tympanic plexus --> lesser petrosal n. --> otic ganglion --> auriculotemporal n. --> parotid gland and oral mucosa
    • X
      • Dorsal nucleus of vagus --> vagus n. --> minute ganglia in respiratory tract, heart, kidneys and gastrointestinal viscera from oesophagus to mid transverse colon. Most vagal fibres are afferent, there is a very large ratio of postganglionic to preganglionic efferent fibres.
    • S2-4
      • Anterior rami --> sacral spinal nerves --> pelvic viscera and pelvic plexus --> bladder, erectile tissue, gonads, uterus and uterine tubes, hindgut from mid transverse colon to rectum
  • Sympathetic anatomy
    • Preganglionic efferent
      • Lateral column cell body --> ventral root --> white ramus communicans --> sympathetic trunk --> synapse in trunk or other ganglia or adrenal
    • Postganglionic
      • May ascend or descend in the trunk, rejoin all spinal nerves via grey rami communicantes or leave in direct branches to vessels or viscera
    • Distribution
      • Cranial
        • Internal carotid plexus arises from superior cervical ganglion and accompanies carotid into the cranium and along anterior and middle cerebral arteries and ophthalmic artery
      • Cervical
        • Sympathetic chain condenses usually into three ganglia on each side: superior (C2-3), middle (C6) and cervicothoracic (stellate, T1) cervical ganglia
      • Cardiac plexus
        • Derived from T1-4 (and X) via cervical and thoracic ganglia
        • Surrounds heart, great vessels and coronaries
      • Pulmonary plexuses
      • Coeliac plexus
        • Two ganglia opposite T12-L1 with large condensation of autonomic fibres
        • Gives rise to phrenic, splenic, hepatic, left gastric, intermesenteric, suprarenal, renal, gonadal, superior and inferior mesenteric plexuses which accompany arteries to their target organs
      • Superior hypogastric plexus
      • Inferior hypogastric plexus
        • Supplies hindgut, ureter, bladder, gonads, sex organs

Somatic levels of visceral afferents

Organ Sympathetic Parasympathetic
Heart T1-5 X
Lungs T2-4 X
Oesophagus T5-6 X
Stomach T6-10 X
Liver, gallbladder T6-10 X
Pancreas, spleen T6-10 X
Small bowel T9-10 X
Large bowel T11-12 X to mid transverse
Kidney, ureter T10-L2 X, S2-4
Adrenal T8-L1 None
Gonads T10-11 S2-4
Bladder T11-L2 S2-4
Prostate T11-L1 S2-4
Uterus T10-L1 S2-4


Kindly provided by Dr James Mitchell from his pharmacodynamics series

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