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By T. Dennis. Olin College of Engineering.

Both the coronary arteries branch of into smaller vessels purchase hydrea 500mg on-line treatment zinc poisoning, which are distributed all over the surface of the heart 500mg hydrea visa medicine x ed. For efficient pumping, it is necessary for the heart to beat at a reasonable rate of 60 – 90 beats per minute, which is achieved through controlled electrical impulses (conductive system). Plasma is important for the life of the tissue cells, conveying to them water and nourishment, and carrying away their waste products. They are very tiny disc with no nucleus, and are filled with haemoglobin, which is made from iron and protein. They can change shape and squeeze through the small bood vessel walls in order to fight gems that have entered the tissues. In acute infection many more leucocytes are produced to help in the fight (leucocytosis) 2) Lymphocytes are produced in the spleen and lymph glands. They are found mainly grouped together in the neck, axilla, and groins and in the pelvic and abdominal cavities. Functions of Lymph: Lymph glands help to protect the body from infection by 1) Filtering the lymph to prevent germs from getting into the blood stream, and fighting to overcome them. Once the food is digested, it must be transferred to the blood stream and the process by which this transfer occurs is called absorption. The Alimentary Canal: The alimentary canal is a long muscular digestive tube extending through the body. Functions of Digestive System: 1) Break down the food substances into small particles 2) Digestion of food substances. The alimentary canal,which is a continuous, passage way beginning at the mouth, where the food is taken in and terminating at the anus where the solid products of digestion, which are not absorbed, are expelled from the body. The accessory organs – which are vitally necessary for the digestive process, do not happen to be the part of the alimentary canal. They are: 1) Mouth – with the help of saliva from three pairs of salivary glands, 2) Stomach – with the help of gastric juice from the stomach wall and 3) Small intestine – with the help of pancreatic juice from the pancreas bile juice from the liver and the intestinal juice from the small intestine. They are (1) Molars – 12 (2) Pre molars – 8 (3) Canines – 4 (4) Incisors – 8 The teeth help to break down the food substances into small particles. The tongue has on its surface a number of taste buds by means of which we can differentiate sensation of taste. Later by associating the sight and smell of food with its taste, the child learns that the food has certain qualities and these very qualities are after wards capable of eliciting salivary secretion. Digestion in the mouth The food is chewed; and saliva the first of the digestive juices acts on it, softens it so that it can be easily swallowed. Both ends of the stomach are guarded by valves which normally permit the passage of substances in only one direction. The proximal end is guarded by cardiac sphincter and the distal end of the stomach is guarded by pyloric sphincter. Digestion in the Stomach The food material after being broken down by mechanical grinding and having been converted into a bolus with the saliva reaches the stomach, which pours a large quantity of gastric juice every day. Bile Juice: 1) In the absence of bile, fats are not digested properly which results in fatty diarrhea. The bile is concentrated and sent to the duodenum through the cystic duct when chime from the stomach enters the duodenum. Due to liver damage or obstruction of the bile duct, bilirubin collects in excess quantities in bleed and changes the colour of the skin and the eyes. Besides these enzymes pancreatic juice contains large quantities of sodium bicarbonate which neutralizes the hydrochloric acid present in the gastric juice secreted by the stomach. The Spleen: This is a dark purple organ situated in the left side of the upper abdomen, behind the stomach. Small Intestine The small intestine is about 600cm long in adult extending from the pyloric sphincter of the stom­ ach to intestine. The first 25cm or 30cm of the small intestine is called the duodenum followed by the jejunum and the remainder is the ileum. Digestion in the Small Intestine: The food in the stomach is partially digested by the gastric juice, but the small intestine is the organ in which the completion of the digestion and absorption occurs.

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These bones tend to have more complex shapes generic 500 mg hydrea with amex treatment 001, like the vertebrae that support the spinal cord and protect it from compressive forces buy discount hydrea 500mg on line symptoms 10 weeks pregnant. Sesamoid Bones A sesamoid bone is a small, round bone that, as the name suggests, is shaped like a sesame seed. These bones form in tendons (the sheaths of tissue that connect bones to muscles) where a great deal of pressure is generated in a joint. Sesamoid bones vary in number and placement from person to person but are typically found in tendons associated with the feet, hands, and knees. Bone Classifications Bone Features Function(s) Examples classification Femur, tibia, fibula, metatarsals, Cylinder-like shape, longer Long Leverage humerus, ulna, radius, than it is wide metacarpals, phalanges Cube-like shape, Provide stability, support, Short approximately equal in while allowing for some Carpals, tarsals length, width, and thickness motion Points of attachment for Sternum, ribs, scapulae, cranial Flat Thin and curved muscles; protectors of bones internal organs Irregular Complex shape Protect internal organs Vertebrae, facial bones Small and round; embedded Protect tendons from Sesamoid Patellae in tendons compressive forces Table 6. Bone is hard and many of its functions depend on This OpenStax book is available for free at http://cnx. Later discussions in this chapter will show that bone is also dynamic in that its shape adjusts to accommodate stresses. Gross Anatomy of Bone The structure of a long bone allows for the best visualization of all of the parts of a bone (Figure 6. The hollow region in the diaphysis is called the medullary cavity, which is filled with yellow marrow. The wider section at each end of the bone is called the epiphysis (plural = epiphyses), which is filled with spongy bone. Each epiphysis meets the diaphysis at the metaphysis, the narrow area that contains the epiphyseal plate (growth plate), a layer of hyaline (transparent) cartilage in a growing bone. When the bone stops growing in early adulthood (approximately 18–21 years), the cartilage is replaced by osseous tissue and the epiphyseal plate becomes an epiphyseal line. The medullary cavity has a delicate membranous lining called the endosteum (end- = “inside”; oste- = “bone”), where bone growth, repair, and remodeling occur. The outer surface of the bone is covered with a fibrous membrane called the periosteum (peri- = “around” or “surrounding”). The periosteum covers the entire outer surface except where the epiphyses meet other bones to form joints (Figure 6. In this region, the epiphyses are covered 222 Chapter 6 | Bone Tissue and the Skeletal System with articular cartilage, a thin layer of cartilage that reduces friction and acts as a shock absorber. Flat bones, like those of the cranium, consist of a layer of diploë (spongy bone), lined on either side by a layer of compact bone (Figure 6. The two layers of compact bone and the interior spongy bone work together to protect the internal organs. If the outer layer of a cranial bone fractures, the brain is still protected by the intact inner layer. Bone Markings The surface features of bones vary considerably, depending on the function and location in the body. These surfaces tend to conform to one another, such as one being rounded and the other cupped, to facilitate the function of the articulation. In general, their size and shape is an indication of the forces exerted through the attachment to the bone. As with the other markings, their size and shape reflect the size of the vessels and nerves that penetrate the bone at these points. Bone Cells and Tissue Bone contains a relatively small number of cells entrenched in a matrix of collagen fibers that provide a surface for inorganic salt crystals to adhere. These salt crystals form when calcium phosphate and calcium carbonate combine to create hydroxyapatite, which incorporates other inorganic salts like magnesium hydroxide, fluoride, and sulfate as it crystallizes, or calcifies, on the collagen fibers. The hydroxyapatite crystals give bones their hardness and strength, while the collagen fibers give them flexibility so that they are not brittle. Although bone cells compose a small amount of the bone volume, they are crucial to the function of bones. Four types of cells are found within bone tissue: osteoblasts, osteocytes, osteogenic cells, and osteoclasts (Figure 6.

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The muscle has a frontal belly and an occipital (near the occipital bone on the posterior part of the skull) belly cheap hydrea 500 mg medications for depression. In other words buy hydrea 500mg fast delivery treatment example, there is a muscle on the forehead ( frontalis) and one on the back of the head ( occipitalis), but there is no muscle across the top of the head. Instead, the two bellies are connected by a broad tendon called the epicranial aponeurosis, or galea aponeurosis (galea = “apple”). There are several small facial muscles, one of which is the corrugator supercilii, which is the prime mover of the eyebrows. These muscles are located inside the eye socket and cannot be seen on any part of the visible eyeball (Figure 11. If you have ever been to a doctor who held up a finger and asked you to follow it up, down, and to both sides, he or she is checking to make sure your eye muscles are acting in a coordinated pattern. Muscles of the Eyes Target Prime Movement Target motion Origin Insertion mover direction Superior Common Moves eyes up and toward (elevates); Superior tendinous ring Superior surface of nose; rotates eyes from 1 Eyeballs medial rectus (ring attaches to eyeball o’clock to 3 o’clock (adducts) optic foramen) Inferior Common Moves eyes down and (depresses); Inferior tendinous ring Inferior surface of toward nose; rotates eyes Eyeballs medial rectus (ring attaches to eyeball from 6 o’clock to 3 o’clock (adducts) optic foramen) Common Moves eyes away from Lateral Lateral tendinous ring Lateral surface of Eyeballs nose (abducts) rectus (ring attaches to eyeball optic foramen) Common Medial Medial tendinous ring Medial surface of Moves eyes toward nose Eyeballs (adducts) rectus (ring attaches to eyeball optic foramen) Surface of eyeball Moves eyes up and away Superior Inferior Floor of orbit between inferior from nose; rotates eyeball Eyeballs (elevates); oblique (maxilla) rectus and lateral from 12 o’clock to 9 o’clock lateral (abducts) rectus Moves eyes down and Suface of eyeball Superior away from nose; rotates Superior between superior Eyeballs (elevates); Sphenoid bone eyeball from 6 o’clock to 9 oblique rectus and lateral lateral (abducts) o’clock rectus Table 11. Muscles involved in chewing must be able to exert enough pressure to bite through and then chew food before it is swallowed (Figure 11. The masseter muscle is the main muscle used for chewing because it elevates the mandible (lower jaw) to close the mouth, and it is assisted by the temporalis muscle, which retracts the mandible. Muscles of the Lower Jaw Target motion Prime Movement Target Origin Insertion direction mover Maxilla arch; zygomatic Closes mouth; aids chewing Mandible Superior (elevates) Masseter Mandible arch (for masseter) Table 11. Muscles That Move the Tongue Although the tongue is obviously important for tasting food, it is also necessary for mastication, deglutition (swallowing), and speech (Figure 11. Extrinsic tongue muscles insert into the tongue from outside origins, and the intrinsic tongue muscles insert into the tongue from origins within it. The extrinsic muscles move the whole tongue in different directions, whereas the intrinsic muscles allow the tongue to change its shape (such as, curling the tongue in a loop or flattening it). The extrinsic muscles all include the word root glossus (glossus = “tongue”), and the muscle names are derived from where the muscle originates. The genioglossus (genio = “chin”) originates on the mandible and allows the tongue to move downward and forward. The palatoglossus originates on the soft palate to elevate the back of the tongue, and the hyoglossus originates on the hyoid bone to move the tongue downward and flatten it. The normal homeostatic controls of the body are put “on hold” so that the patient can be prepped for surgery. Control of respiration must be switched from the patient’s homeostatic control to the control of the anesthesiologist. Among the muscles affected during general anesthesia are those that are necessary for breathing and moving the tongue. Under anesthesia, the tongue can relax and partially or fully block the airway, and the muscles of respiration may not move the diaphragm or chest wall. To avoid possible complications, the safest procedure to use on a patient is called endotracheal intubation. Placing a tube into the trachea allows the doctors to maintain a patient’s (open) airway to the lungs and seal the airway off from the oropharynx. Post-surgery, the anesthesiologist gradually changes the mixture of the gases that keep the patient unconscious, and when the muscles of respiration begin to function, the tube is removed. It still takes about 30 minutes for a patient to wake up, and for breathing muscles to regain control of respiration. Muscles of the Anterior Neck The muscles of the anterior neck assist in deglutition (swallowing) and speech by controlling the positions of the larynx (voice box), and the hyoid bone, a horseshoe-shaped bone that functions as a solid foundation on which the tongue can move. The muscles of the neck are categorized according to their position relative to the hyoid bone (Figure 11. The suprahyoid muscles raise the hyoid bone, the floor of the mouth, and the larynx during deglutition. These include the digastric muscle, which has anterior and posterior bellies that work to elevate the hyoid bone and larynx when one swallows; it also depresses the mandible. The stylohyoid muscle moves the hyoid bone posteriorly, elevating the larynx, and the mylohyoid muscle lifts it and helps press the tongue to the top of the mouth.

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Less severe manifestations include rhinitis quality 500 mg hydrea medicine used to induce labor, vaginitis generic hydrea 500mg on-line symptoms bone cancer, urethritis, Recommended Regimen and reinfection at sites of fetal monitoring. Gonococcal oph- newborns thalmia is strongly suspected when intracellular gram-negative Sepsis, arthritis, and meningitis (or any combination of diplococci are identifed in conjunctival exudate, justifying these conditions) are rare complications of neonatal gonococcal presumptive treatment for gonorrhea after appropriate cultures infection. A defni- aspirate provide a presumptive basis for initiating treatment tive diagnosis is vital because of the public health and social for N. Nongonococcal or presumptive identifcation of cultures should be confrmed causes of neonatal ophthalmia include Moraxella catarrhalis with defnitive tests on culture isolates. Prophylactic Treatment for Infants Whose Mothers Have Gonococcal Infection other Management Considerations Infants born to mothers who have untreated gonorrhea are Simultaneous infection with C. Both mother and infant should be tested for chlamydial infec- Recommended Regimen in the Absence of Signs of Gonococcal Infection tion at the same time that gonorrhea testing is conducted (see Ophthalmia Neonatorum Caused by C. Follow-Up other Management Considerations Infants who have gonococcal ophthalmia should be hospi- Both mother and infant should be tested for chlamydial talized and evaluated for signs of disseminated infection (e. Management of Mothers and Their Sex Partners Te mothers of infants who have gonococcal infection and the mothers’ sex partners should be evaluated and treated Vol. Te mothers of infants who have gonococcal infection other Management Considerations and the mothers’ sex partners should be evaluated and treated according to the recommendations for treatment of gonococcal Only parenteral cephalosporins (i. Gonococcal Infections Among All children found to have gonococcal infections should be Children evaluated for coinfection with syphilis and C. Among sexually abused children, lactic agent should be instilled into the eyes of all newborn anorectal and pharyngeal infections with N. However, the efcacy of these Diagnostic Considerations preparations in preventing chlamydial ophthalmia is less clear, Because of the legal implications of a diagnosis of and they do not eliminate nasopharyngeal colonization by C. Gram stains are inadequate for chlamydial infections in pregnant women is the best method evaluating prepubertal children for gonorrhea and should not for preventing neonatal gonococcal and chlamydial disease. Ocular prophylaxis is warranted for neonates, (see Sexual Assault or Abuse of Children) because it can prevent sight-threatening gonococcal ophthalmia and because it is safe, easy to administer, and inexpensive. Recommended Regimen for Children Who Weigh >45 kg Treat with one of the regimens recommended for adults (see Recommended Regimen Gonococcal Infections) Erythromycin (0. Erythromycin is the only antibiotic ointment recommended Recommended Regimen for Children Who Weigh >45 kg and for use in neonates. Obtaining a medical history alone has been shown to be Te presence of objective signs of vulvar infammation in the insufcient for accurate diagnosis of vaginitis and can lead to absence of vaginal pathogens after laboratory testing, along the inappropriate administration of medication. Terefore, with a minimal amount of discharge, suggests the possibil- a careful history, examination, and laboratory testing to ity of mechanical, chemical, allergic, or other noninfectious determine the etiology of vaginal complaints are warranted. Information on sexual behaviors and practices, gender of sex partners, menses, vaginal hygiene practices (such as douch- Bacterial Vaginosis ing), and other medications should be elicited. Cervicitis also can sometimes cause a vaginal microbial changes, whereas others experience them vaginal discharge. Clinical labora- partners, a new sex partner, douching, lack of condom use, tory testing can identify the cause of vaginitis in most women and lack of vaginal lactobacilli; women who have never been and is discussed in detail in the sections of this report dedi- sexually active can also be afected. Douching might increase the risk for three of the following symptoms or signs: relapse, and no data support the use of douching for treatment • homogeneous, thin, white discharge that smoothly coats or relief of symptoms. Additional for the detection of elevated pH and trimethylamine, it has low regimens include metronidazole (750-mg extended release sensitivity and specifcity and therefore is not recommended. However, efcacy of using intravaginal lactobacillus formulations to treat additional evaluations are needed to confrm these associations. Monthly oral metronidazole administered with fuconazole has also been Providers should consider patient preference, possible evaluated as suppressive therapy (337). Intravaginal clindamycin cream is preferred in case of allergy Similarly, data are inconsistent regarding whether the or intolerance to metronidazole or tinidazole. Several Treatment is recommended for all pregnant women with additional trials have shown that intravaginal clindamycin symptoms. Some women have symptoms between metronidazole use during pregnancy and teratogenic characterized by a difuse, malodorous, yellow-green vaginal or mutagenic efects in newborns (342,343). However, many women have the antimicrobial agent used to treat pregnant women, oral minimal or no symptoms.

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