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Conditions Affecting the Brain 31 Atraumatic Brain Damage bral thrombosis buy cardura 2mg with visa. Formation of the thrombus blocks blood flow to an Atraumatic brain damage safe 1mg cardura, as just area of the brain order cardura 1mg amex. Because brain tissue explained, refers to conditions in which the needs the oxygen contained in blood brain has sustained damage due to condi- to survive, tissue that cannot obtain tions other than traumatic injury. This tissue death is called an or interference with blood and oxygen infarct. When a part pends on how large an area of the of the brain receives no oxygen (anoxia) brain has been deprived of blood sup- or too little oxygen (hypoxia), the tissue ply from the clot. Again, when the clot brain that then balloons out and can rup- occludes blood flow to a part of the ture), infections or inflammation of the brain, surrounding brain tissue dies. A third cause of stroke is hemorrhage, tions that deprive the brain of oxygen, which occurs because of rupture of a such as strangulation, near drowning, or blood vessel. When blood vessels are weakened because of dis- Stroke (Cerebral Vascular Accident) ease, such as with arteriosclerosis, or because of congenital weakness as Stroke, also known as cerebral vascular with an aneurysm, increased pressure accident, is a sudden alteration in brain may cause the blood vessel to burst. Stroke is usually the of oxygen, but also because the culmination of progressive disease that escaped blood compresses brain tis- has occurred over the course of many sue against the skull, causing further years. There are three as the result of stroke depends on: main causes of stroke: • the side of the brain affected 1. The most common cause is blocking • the specific area of the brain that has of a cerebral artery by a clot (throm- been damaged bus) that has formed inside the • the amount of damage that has artery, a condition referred to as cere- occurred 32 CHAPTER 2 CONDITIONS OF THE NERVOUS SYSTEM: PART I Often after stroke, in addition to the ini- tions. The organism recover, and function in these areas may also gains access to the cerebrospinal flu- be restored. Individuals with meningitis are usu- tions until months after the stroke as ally acutely ill, initially with fever and flu- occurred. Within a short period of At times, temporary blocking of the time they develop severe headache, neck cerebral arteries causes slight, temporary rigidity, and discomfort when exposed to neurological deficits. If the cause is bacterial in ori- are referred to as transient ischemic at- gin, prompt treatment with antibiotics tacks (TIAs). Although most individuals with meningitis recover Any infection of the brain or the mem- completely, some may have residual neu- branes that surround the brain and spinal rological deficits such as deafness, paraly- cord can cause serious neurological effects, sis, or cognitive difficulties. Meningitis refers to an mation of the brain due to direct invasion inflammation of the meninges (mem- of an organism. It may be caused by an branes surrounding the brain and spinal endemic virus, such as the West Nile virus, cord). It can be caused by bacteria, virus- a mosquito-borne virus (Huhn, Sejvar, es, or other organisms. The specific name giv- Gubler, 2001), or it may be secondary to en to the meningitis infection is frequent- another infection, such as measles or ly related to its cause or location. Some individuals with en- instance, cerebral meningitis refers to cephalitis may experience severe head- meningitis of the brain, whereas cere- ache, stiff neck, and coma. There is no brospinal meningitis refers to meningitis of adequate treatment for encephalitis, ex- both the brain and spinal cord. Menin- cept for maintaining comfort and prevent- gococcal meningitis (commonly known as ing complications. The symptoms can spinal meningitis) is caused by a bacterium subside in a few weeks, leaving no perma- that settles in the lining of the throat and nent damage; however, the condition can is spread easily through respiratory secre- also be life-threatening. Some individuals Conditions Affecting the Brain 33 develop irreversible neurological changes gunshot wound). At times, functional impair- with compromised immune systems, are ments in open head injury may be more often the most susceptible to more severe extensive if additional damage is sus- manifestations of these diseases. For example, in addition to the trauma to the brain itself, bone fragments Traumatic Brain Injury from the injury may also lacerate and injure the brain, blood vessels, or Traumatic brain injury is broadly defined meninges (lining surrounding the brain). It is not degenerative, cient force that the brain slams against the is not the result of a disease, and is not other side of the skull or twists within the congenital in origin. Damage to the brain skull, causing shearing of blood vessels or occurs from a blow to the head that is nerve fibers throughout the brain.

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At one point during the ited because its continued use has been shown to delay the work purchase cardura 2mg with mastercard, he jumped to the ground from a ladder leaning healing process cheap 1mg cardura overnight delivery, and it could also mask warning signs of against the tree buy 1mg cardura, a distance of about 4 feet. Clin Sports Med considerable discomfort, and the pain did not lessen 1997;16:419–434. Am J Sports Med Physical examination reveals a somewhat swollen as- 1996;24:S2–S8. The area is tender to the touch, but the pain does CASE STUDY FOR CHAPTER 10 not involve the knee joint. Using the left leg for compari- son, he is considerably impaired in his ability to extend Heart Failure the lower portion of his right leg and doing so causes A 50-year-old man consulted his family physician with great discomfort. He is given a few days’ supply of a non- and somewhat short of breath from walking from his car (continued) CHAPTER 10 Cardiac Muscle 189 to the office. Did the beneficial effects of his therapy relate more to formation: He has been a light smoker for most of his changes in contractility or to changes in the mechanical sit- adult life, although he has tried to quit; he attributes his uation of the heart muscle? What is the benefit of a drug that tends to relax both arterial while, to the smoking habit. At this stage of the patient’s disease, but is no longer taking his prescribed medication. Minor however, even the added muscle strength was not sufficient chest pain that he associates with heavy exertion quickly to handle the demands of the body during exercise. With a lowered systolic pressure, the afterload during short- Physical examination notes some swelling of his an- ening would be reduced. An examination of the length-ten- kles and feet, and palpation reveals a somewhat en- larged and tender liver. Distinct basilar rales (abnormal sion curve shows that more shortening would be possible, sounds that indicate pulmonary congestion) are heard and the force-velocity curve would predict that the contrac- during auscultation of the chest. The use of drugs such as digitalis could have relieved the ing (cardiomegaly) was apparent in an ultrasound exam- patient’s symptoms sooner, but the risks of such drugs ination. The diuretic therapy reduced the blood volume, which include a reduction in the amount of saturated fat and meant that the heart muscle was less distended at rest. He is advised that moderate exercise, such as lowered arterial volume would have also lowered the after- walking, would be beneficial if it is tolerated well. Thus, both aspects of the problem were referred to a support program to help him quit smoking. Because the cough went away soon after arising, it was in exercise tolerance is noted, and both systolic and dias- more likely a result of fluid accumulation in the lungs. His weight has de- increased heart rate and contractility of the muscle associ- creased somewhat. The abnormal lung sounds are ab- sent, and he has been able to quit smoking. The X-ray and ultrasound data show an increase in the tion in the skeletal muscle. If this was the case, why did the the weakened state of the heart muscle during contraction, patient suffer from the problems reported above? What effect would lowering the systolic blood pressure pumped with each beat. This patient was not treated with contractility-enhancing dressed the contractility of the muscle, the beneficial drugs. Did the result of the diuretic therapy relate most directly to duction of the preload and afterload on the muscle. Was the patient’s morning cough most likely a result of load and preload at the same time. Did the complaint of fatigue during exercise relate more Poole-Wilson PA, Colucci WS, Massie BM, Chatterjee K, Coats strongly to problems of the muscle at rest or during con- AJS. Blood and Cardiovascular PART IV Physiology CHAPTER Components, Immunity, and Hemostasis Denis English, Ph. Blood consists of erythrocytes, leukocytes, and platelets process of inflammation often results in the destruction of suspended within a solute-rich plasma. Platelets and plasma proteins control hemostasis, a tors, which promote wound healing, process that stops blood loss after injury and promotes 10. These cells, also known as leukocytes, exert their Bthat pulsates through the arteries to every part of the effects in conjunction with antibodies and protein cofactors body, interacts with individual cells via an extensive capil- in blood. In this chapter, we will see how certain leukocytes lary network, and returns to the heart through the venous act without prior sensitization to neutralize offending system. Many of the functions of blood are undertaken in pathogens, while others require a prior infectious insult to the capillaries, where the blood flow slows dramatically, al- deal with invaders.

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The parotid glands secrete saliva that is rich in wa- The intercalated ducts are lined with small cuboidal cells buy cardura 4 mg line. There are volved in the secretion of proteins generic 2mg cardura mastercard, since secretory granules also minor salivary glands located in the labial generic cardura 2 mg fast delivery, palatine, are occasionally observed in their cytoplasm. The striated duct is and are innervated by both the parasympathetic and sympa- lined with columnar cells. Its major function is to modify the thetic divisions of the autonomic nervous system. The large excretory ducts, hormones may modify the composition of saliva, their phys- lined with columnar cells, also play a role in modifying the iological role is questionable, and it is generally believed that ionic composition of saliva. Although most proteins are syn- salivary secretion is mainly under autonomic control. The Salivary Glands Consist of a Network of Acini and Ducts Saliva Contains Various Electrolytes and Proteins A diagram of the human submandibular gland is shown in Figure 27. The basic unit, the salivon, consists of the aci- The electrolyte composition of the primary secretion pro- nus, the intercalated duct, the striated duct, and the excre- duced by the acinar cells resembles that of plasma. Microp- CHAPTER 27 Gastrointestinal Secretion, Digestion, and Absorption 483 in place of two K ions taken up by the cell. The epithelial 240 lining of the duct is not permeable to water, so water does not follow the absorbed salt. Salivary -amylase (ptyalin) is produced predomi- nantly by the parotid glands and mucin is produced mainly by the sublingual and submandibular salivary glands. Amy- 80 lase catalyzes the hydrolysis of polysaccharides with -1,4- glycosidic linkages. It is synthesized by the rough ER + and transferred to the Golgi apparatus, where it is packaged Na into zymogen granules. The zymogen granules are stored 120 at the apical region of the acinar cells and released with ap- propriate stimuli. Because some time usually passes before Cl- acids in the stomach can inactivate the amylase, a substan- Na+ tial amount of the ingested carbohydrate can be digested 80 before reaching the duodenum. The term 40 describes a family of glycoproteins, each associated with HCO - 3 different amounts of different sugars. Also present in saliva are small 0 amounts of muramidase, a lysozyme that can lyse the mu- 0 3 4 5 Plasma Rate of secretion (mL/min) ramic acid of certain bacteria (e. However, samples from the excre- plays an important role in the general hygiene of the oral tory (collecting) ducts are hypotonic relative to plasma, in- cavity. The muramidase present in saliva combats bacteria dicating modification of the primary secretion in the striated by lysing the bacterial cell wall. It helps This is because Na is actively absorbed from the lumen by small food particles stick together to form a bolus, which the ductal cells, whereas K and HCO3 ions are actively secreted into the lumen. Saliva can dissolve flavor- in exchange for HCO3 ions or by passive diffusion along ful substances, stimulating the different taste buds located the electrochemical gradient created by Na absorption. Finally, saliva plays an important role in wa- rate of secretion (see Fig. As the secretion rate in- ter intake; the sensation of dryness of the mouth due to low creases, the electrolyte composition of saliva approaches salivary secretion urges a person to drink. At low secretion rates, the ductal epithe- Autonomic Nerves Are the Chief Modulators lium has more time to modify and, thus, reduce the osmo- of Saliva Output and Content lality of the primary secretion, so the saliva has a much lower osmolality than plasma. The opposite is true at high As mentioned, salivary secretion is predominantly under secretion rates. In the resting Although the absorption and secretion of ions may ex- state, salivary secretion is low, amounting to about 30 plain changes in the electrolyte composition of saliva, these mL/hr. The submandibular glands contribute about two processes do not explain why the osmolality of saliva is thirds to resting salivary secretion, the parotid glands about lower than that of the primary secretion of the acinar cells. Stim- Saliva is hypotonic to plasma because of a net absorption of ulation increases the rate of salivary secretion, most notably ions by the ductal epithelium, a result of the action of a in the parotid glands, up to 400 mL/hr. The stimuli for salivary secretion are acidic-tasting substances, Na /K -ATPase transports three Na ions out of the cell such as citric acid. Other types of stimuli that induce sali- 484 PART VII GASTROINTESTINAL PHYSIOLOGY vary secretion include the smell of food and chewing. Se- Effects of Parasympathetic and Sympa- cretion is inhibited by anxiety, fear, and dehydration. The parasympathetic nervous Responses Parasympathetic Sympathetic system plays an important role in controlling the secretion Saliva output Copious Scant of saliva. The centers involved are located in the medulla Temporal response Sustained Transient oblongata.

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