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Types of Teeth During the course of your lifetime levitra extra dosage 40 mg on-line can you get erectile dysfunction young age, you have two sets of teeth (one set of teeth is a dentition) purchase levitra extra dosage 60 mg without a prescription impotence kegel. The third members of each set of three molars, top and bottom, are commonly referred to as the wisdom teeth, because their eruption is commonly delayed until early adulthood. Anatomy of a Tooth The teeth are secured in the alveolar processes (sockets) of the maxilla and the mandible. Gingivae (commonly called the gums) are soft tissues that line the alveolar processes and surround the necks of the teeth. The two main parts of a tooth are the crown, which is the portion projecting above the gum line, and the root, which is embedded within the maxilla and mandible. Both parts contain an inner pulp cavity, containing loose connective tissue through which run nerves and blood vessels. In the crown of each tooth, the dentin is covered by an outer layer of enamel, the hardest substance in the body (Figure 23. Although enamel protects the underlying dentin and pulp cavity, it is still nonetheless susceptible to mechanical and chemical erosion, or what is known as tooth decay. The most common form, dental caries (cavities) develops when colonies of bacteria feeding on sugars in the mouth release acids that cause soft tissue inflammation and degradation of the calcium crystals of the enamel. Digestive Functions of the Mouth Structure Action Outcome Lips and Confine food Food is chewed evenly during mastication cheeks between teeth Moisten and lubricate the lining of the mouth and pharynx Moisten, soften, and dissolve food Salivary Secrete saliva glands Clean the mouth and teeth Salivary amylase breaks down starch Manipulate food for chewing Tongue’s Move tongue extrinsic sideways, and in Shape food into a bolus muscles and out Manipulate food for swallowing Tongue’s Change tongue Manipulate food for swallowing intrinsic shape muscles Sense food in Nerve impulses from taste buds are conducted to salivary nuclei in the Taste buds mouth and sense brain stem and then to salivary glands, stimulating saliva secretion taste Activated in the stomach Lingual Secrete lingual glands lipase Break down triglycerides into fatty acids and diglycerides Shred and crush Break down solid food into smaller particles for deglutition Teeth food Table 23. It receives food and air from the mouth, and air from the 1104 Chapter 23 | The Digestive System nasal cavities. A short tube of skeletal muscle lined with a mucous membrane, the pharynx runs from the posterior oral and nasal cavities to the opening of the esophagus and larynx. The other two subdivisions, the oropharynx and the laryngopharynx, are used for both breathing and digestion. The oropharynx begins inferior to the nasopharynx and is continuous below with the laryngopharynx (Figure 23. The inferior border of the laryngopharynx connects to the esophagus, whereas the anterior portion connects to the larynx, allowing air to flow into the bronchial tree. During swallowing, the elevator skeletal muscles of the pharynx contract, raising and expanding the pharynx to receive the bolus of food. Once received, these muscles relax and the constrictor muscles of the pharynx contract, forcing the bolus into the esophagus and initiating peristalsis. Usually during swallowing, the soft palate and uvula rise reflexively to close off the entrance to the nasopharynx. At the same time, the larynx is pulled superiorly and the cartilaginous epiglottis, its most superior structure, folds inferiorly, covering the glottis (the opening to the larynx); this process effectively blocks access to the trachea and bronchi. When food enters the trachea, the reaction is to cough, which usually forces the food up and out of the trachea, and back into the pharynx. To enter the abdomen, the esophagus penetrates the diaphragm through an opening called the esophageal hiatus. The upper two-thirds of the esophagus consists of both smooth and skeletal muscle fibers, with the latter fading out in the bottom third of the esophagus. Rhythmic waves of peristalsis, which begin in the upper esophagus, propel the bolus of food toward the stomach. Food passes from the esophagus into the stomach at the lower esophageal sphincter (also called the gastroesophageal or cardiac sphincter). Recall that sphincters are muscles that surround tubes and serve as valves, closing the tube when the sphincters contract and opening it when they relax. The lower esophageal sphincter relaxes to let food pass into the stomach, and then contracts to prevent stomach acids from backing up into the esophagus. Surrounding this sphincter is the muscular diaphragm, which helps close off the sphincter when no food is being swallowed. Histology of the Esophagus The mucosa of the esophagus is made up of an epithelial lining that contains non-keratinized, stratified squamous epithelium, with a layer of basal and parabasal cells.

Today generic 60mg levitra extra dosage fast delivery erectile dysfunction nofap, poisoning (both accidental and intentional) buy levitra extra dosage 40mg with amex young husband erectile dysfunction, is a significant contributor to mortality and morbidity. It has been estimated that 7% of all emergency room visits are the result of toxic exposures. Household cleaner, over-the-counter 3 Toxicology and prescription drugs, cosmetics, and solvents comprise the most frequent human toxic exposures. Young children and elderly are most likely to be accidentally exposed to drugs or household chemicals at home. During adolescence and young adulthood the exposures are more likely to be intentional, either through suicide attempts or experimentation with drugs or alcohol. However, adult men have been reported to be more at risk of occupational exposures than adult woman. Route of entry of exposures reported was by mouth in most cases: 77% were the result of ingestion, 7. In general, nearly everyone is at risk of acute and chronic toxic exposures to hazardous substances in the ambient environment. Toxicologic terms and definitions A) Important toxicologic terms  Toxin- a poison of natural origin. It is a qualitative term which depends on the amount of chemical absorbed, severity of the exposure, dose & others. It can be acute (toxic event which occurs soon after acute or limited exposure), or chronic (apply to an event which occurs many weeks, months or years after exposure). B) Presence of mixtures Humans normally come in contact with several (or many) different chemicals concurrently or sequentially. The resulting biologic effect of combined exposure to several agents can be characterized as synergistic, additive, Potentiation & antagonistic Synergism-when the effect of two chemicals is greater than the effect of individual chemicals e. Antagonism -is the phenomenon of opposing actions of two chemicals on the same system e. Basic classification of toxicology Toxicology is broadly divided into different classes depending on research methodology, socio-medical & organ/specific effects. Descriptive toxicology Descriptive toxicology deals with toxicity tests on chemicals exposed to human beings and environment as a whole. Mechanistic toxicology Mechanistic toxicology deals with the mechanism of toxic effects of chemicals on living organisms. Instead of organophosphates, drugs which reversibly bind to cholinesterase would be preferable in therapeutics) 6 Toxicology C. Regulatory toxicology Regulatory toxicology studies whether the chemical substances has low risk to be used in living systems E. Predictive toxicology Predictive toxicology studies about the potential and actual risks of chemicals /drugs. Based on specific socio-medical issues A) Occupational toxicology Occupational toxicology Deals with chemical found in the workplace E. B) Environmental toxicology Environmental toxicology deals with the potentially deleterious impact of chemicals, present as pollutants of the environment, to living organisms. It is concerned with the toxic effects of chemical and physical agents on living organisms, especially in populations and communities with defined ecosystems. C) Clinical toxicology Clinical toxicology deals with diagnosis and treatment of the normal diseases or effects caused by toxic substances of exogenous origin i. D) Forensic toxicology Forensic toxicology closely related to clinical toxicology. It deals with the medical and legal aspects of the harmful effects of chemicals on man, often in post mortem material, for instance, where there is a suspicion of murder, attempted murder or suicide by poisoning. Toxicokinetics and Toxicodynamics - Toxicokinetics deals with absorption, distribution, biotransformation (biotransformation) and excretion of chemicals. Toxicokinetics i) Absorption Absorption is the process by which the chemical enters the body. It depends on the route of administration, dissociation (to become ionized), dissolution (ability of solid dosage form to become soluble), concentration, blood flow to the site, and the area of the absorptive site. Bioavailability is the fraction of unchanged drug reaching the systemic circulation following of non-vascular administration.

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Typically discount 40mg levitra extra dosage amex shakeology erectile dysfunction, these patients complain of When some pregnancy tissue has been vaginal bleeding and cramping which passed cheap 40mg levitra extra dosage fast delivery top rated erectile dysfunction pills, but more remains inside the leads to passage of tissue. The responsible bacteria are usually a mixed group of Bedrest for a day or two may be all that strep, coliforms and anaerobic is necessary to treat a complete abortion. Save in formalin any tissue which the Remember, though, that she has the patient has passed for pathology potential for becoming extremely ill very examination. If you can grab a portion of the placenta (assuming a part of it is or extruded through the cervix), you sometimes can tease the rest of the Cefoxitin 2. They typically involve a labor-type Third Trimester Delivery experience for the patient, with delivery Complications of a non-viable fetus. Cesarean Section After delivery of the fetus, be prepared to wait as long as several hours for the In the face of intractable hemorrhage in placenta (afterbirth) to separate and be an undelivered patient or totally delivered. While waiting, clamp and cut obstructed labor, emergency cesarean the umbilical cord and remove the fetus section will probably be life-saving. Manual Removal of the Placenta If the placenta remains inside longer than 6 hours, D&C is indicated to After delivery of the infant, the placenta remove it. Insert your hand through the Alternative diagnoses which can cause vagina into the uterus and grasp the similar symptoms include a corpus placenta. With This is generally caused by the uterus a threatened abortion, the pain is central failing to contract. After manually or suprapubic and the uterus itself may exploring the uterus to make sure no be tender. If she should suddenly rupture and go into Post Partum Hysterectomy shock, you can respond more quickly. Typically, this is a The vibration during a helicopter ride or supracervical hysterectomy (subtotal the jostling over rough roads in an hysterectomy) even in experienced ambulance or truck may provoke the hands because of the difficulty in easily actual rupture. A woman with an unruptured ectopic pregnancy may have the typical Ruptured Ectopic Pregnancy unilateral pain, vaginal bleeding, and adnexal mass described in textbooks. Women with a ruptured ectopic Alternatively, she may have minimal pregnancy will nearly always have pain, symptoms. If surgery is not an ultrasound scan to confirm the available option, stabilization and placement of the pregnancy. If abdominal surgery is not an available option, the outlook for a patient with a Ovarian Cyst ruptured ectopic pregnancy is not totally bleak. Aggressive fluid and blood These cysts are common and generally replacement, oxygen and complete cause no trouble. Each time a woman bedrest will result in about a 50/50 ovulates, she forms a small ovarian cyst chance of survival. If the pulse is >100 or urine Occasionally, ovarian cysts may cause a output <30, she needs more fluid. If she becomes short of breath Delaying menstruation and the lung sounds become Rupturing "crackly," slow down the fluids Twisting as she probably is becoming fluid Causing pain overloaded. If she becomes short of breath 95% of ovarian cysts disappear and the lungs sound dry, increase spontaneously, usually after the next the fluids and give blood as she menstrual flow. Those that remain and is probably anemic and in need those causing problems are often of more oxygen carrying removed surgically. If the This problem is often indistinguishable cyst is small, its rupture usually occurs clinically from a pelvic abscess or unnoticed. If large, or if there is appendicitis, although an ultrasound associated bleeding from the torn edges scan can be helpful. The pain is Treatment is surgery to remove the initially one-sided and then spreads to necrotic adnexa. Unruptured Ovarian Cyst Other surgical conditions which may While most of these cysts are without resemble a twisted ovarian cyst (such as symptoms, they can cause pain, bowel obstruction, appendicitis, ectopic particularly with strenuous physical pregnancy) may not have a good activity or intercourse. The cyst and ovary (and often a Gradual onset of mild bilateral pelvic portion of the fallopian tube) die and pain with purulent vaginal discharge is necrose. Since surgery may be required, Treatment consists of: transfer to a definitive surgical facility should be considered. In addition, they have palpable pelvic masses from dilated, abscessed Pregnancy-related problems fallopian tubes.

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It is non-specific and characteristically is the manifestation of end-stage gliosis order levitra extra dosage 60mg with visa erectile dysfunction etiology. Spongiform changes consist of the presence of small cheap 40 mg levitra extra dosage with amex best erectile dysfunction pills 2012, round, or ovoid, optically empty vacuoles within the neuropil (Fig. Optically empty vacuoles involving the neuropil in a variety of neurodegenerative diseases: A) Status spongiosus involving the subpial layer of the frontal lobe of a 70-year-old man with Pick disease. B) Spongiform changes involving the upper cortical layers of the temporal lobe of a 66-year-old woman with Alzheimer disease Lewy body variant. Symptoms usually begin in the 4th or 5th decades of life, and progress slowly but inexorably. Childhood patients tend to inherit the disease from their fathers and have an age of onset 8-10 years earlier than their fathers. Chorea is a rapid, involuntary, non- repetative or arrhythmic movement involving the face, trunk and limbs. Chorea may begin as “restlessness”, but invariably progresses to grossly evident choreaform movements. Symptoms begin insidiously, with death occurring 12-15 years from the time of symptomatic onset. The earliest cognitive changes often consist of irritablility, moodiness, and antisocial behavior. Dementia subsequently develops, with impairment of attention and executive function consistent with frontostriatal pathology. An expanded polyglutamine residue (polyQ) distinguishes the mutated huntingtin (with about 37 to 250 polyQ [mhtt]) from the wild type (with 8 to about 34 – 36 polyQ [whtt]). The disease occurs when the critical threshold of about 37 polyQ is exceeded (Fig. The lengths of the repeat correlates inversely with the age of onset, with younger affected patients bearing larger repeat lengths. The phenomenon of polyQ extension is observed in other less common inherited neurodegenerative diseases, collectively referred to as polyglutaminopathies. Other diseases include the genes underlying fragile x- syndrome, spino-bulbar muscular atrophy, spinocerebellar ataxia, and myotonic dystrophy. Patients with juvenile onset (about 6 percent of the patients, usually paternal transmission) have 70 or more polyQ. Degeneration initially involves the striatum, then the cerebral cortex, and eventually may appear throughout the brain as a constellation of the toxic effect of the mutation and the ensuing secondary changes. The striatal atrophy is prominent in 80 percent, mild in 15 percent, and subtle, if at all, in 5 percent of the brains. The striatum is probably the only site where neuronal loss and “active” reactive, fibrillary astrocytosis coexist. The tail of the caudate nucleus shows more degeneration than the body, which is more involved than the head. Similarly, the caudal portion of the putamen is more degenerated than the rostral portion. Along the coronal (or dorsoventral) axis of the neostriatum, the dorsal neostriatal regions are more involved than the ventral ones (Fig. Along the medio-lateral axis, the paraventricular half of the caudate nucleus is more involved than the paracapsular half. In essence, the dorsal third of the rostral neostriatum is especially prone to degenerate in contrast to the relatively preserved ventral third, including the nucleus accumbens (Fig. Microscopically, degeneration is manifested by neuronal loss and reactive gliosis (Figure 29). Fibrillary astrogliosis parallels the loss of neurons along the caudo-rostral and dorsoventral striatal gradients of decreasing severity. The dorsal, medial field of the normal head of the caudate nucleus is remarkable for the presence of scattered neurons dispersed within a smooth, homogeneous neuropil (top).

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