By W. Aldo. Westwood College California.

The digestive system mechanically andchemically breaks down food to forms (a) Humans are diphyodont; they have mucosa increases the absorptive that can be absorbed through the (b)deciduous and permanent sets of teeth generic 50mg penegra overnight delivery mens health xmas gift guide. Movements of the small intestine includerhythmic segmentation quality 50mg penegra man health about inguinal hernia men, pendular level. The digestive system consists of a into the cementum covering thein the periodontal membrane insert gastrointestinal (GI) tract and accessory roots, firmly anchoring the teeth in Large Intestine (pp. The large intestine absorbs water and Serous Membranes and Tunics of the (c) Enamel forms the outer layer of the fecal material out of the body through theelectrolytes from the chyme and passes Gastrointestinal Tract (pp. Peritoneal membranes line the abdominal (d) The interior of a tooth contains a 2. The large intestine is divided into thececum, colon, rectum, and anal canal. TheGI tract is supported by a double layer of pulp cavity, which is continuous (a) Theappendixisattachedtothe peritoneum called the mesentery. The layers (tunics) of the abdominal GI passageway connecting the oral and nasal 3. Movements of the large intestine includeperistalsis, haustral churning, and mass mucosa, submucosa, tunica muscularis,tract are, from the inside outward, the cavities to the esophagus and larynx. Draw a labeled diagram of a Liver, Gallbladder, and Pancreas questions at the end of each chapter allow (a)(b) concerned with digestion. Swallowing (deglutition) occurs in threephases and involves structures of the oral (pp. The liver is divided into right, left, you to test the depth of your understanding (d) located within the thoracic and (d) It is mixed with blood from themuscle called the muscularisfunction of bile? Peristaltic waves of contraction push food contains liver lobules, the functional unitsquadrate, and caudate lobes. Which of the following types of teeth are Essay Questions (b) The submucosa is composed ofof the large intestine that make theseWhat are the biomechanical movementsinto the stomach. It displays greater and hepatic cells separated by modified to the objective questions are given (a)deciduous dentition? Definecirrhosisand explain why thislesser curvatures, and contains a pyloric capillaries called sinusoids. Distinguish between the gastrointestinalcovered with the visceral peritoneum. The gallbladder stores and concentrates (a) the submucosa cavity classified and what are theirfunctions? The oral cavity is formed by the cheeks,company interested in preparing a newSmall Intestine (pp. Describe the structures of the four tunicslips, and hard palate and soft palate. Regions of the small intestine include theduodenum, jejunum, and ileum; the the duodenum. The endocrine portion, consisting of considered a part of the digestive system? Fingerlike extensions of mucosa, called the pancreatic islets, secretes the (b) the spleen (d) the gallbladder 7. The numerous small elevations on the diphyodont, deciduous teeth, permanentprojection called the palatine uvula,(b) removal of the pancreas(a) removal of the stomach (gastrectomy),and at the bases of the intestinal villi the (b) The exocrine acini of the pancreas surface of the tongue that support taste teeth,andwisdom teeth. Most digestion occurs in palate and soft palate, pharynx, and hyoidbone perform in deglutition? How does the stomach protect itself from increasing the surface area for absorptionthat make it more efficient by either (c)(b) the small intestine. Describe the kinds of movements in thesmall intestine and explain what they food particles and digestive enzymes. During surgery to determine the cause ofan intestinal obstruction, why might the (a)ampulla (of Oddi) would interfere withtransport of bile and pancreatic juice. Diagram an intestinal villus and explainwhy intestinal villi are considered the surgeon elect to remove a healthy (b) secretion of mucus. In what portion of the result in peritonitis, while an inflamed (d) peristalsis. This online resource offers an extensive array of learning tools that are tailored to coincide with each chapter of the text. Learning Activities Among the activities awaiting you at the OLC are chapter quizzes, crossword puzzles, art labeling exercises, vocabulary flashcards, and animation-based activities.

Renal autoregulation (B) Gitelman’s syndrome kidney: GFR buy cheap penegra 100 mg prostate cancer stages, 42 nL/min; glomerular (A) Is associated with increased renal (C) Liddle’s syndrome capillary hydrostatic pressure buy discount penegra 100 mg on-line prostate oncology jonesboro, 50 mm vascular resistance when arterial blood (D) Nephrogenic diabetes insipidus Hg; hydrostatic pressure in Bowman’s pressure is lowered from 100 to 80 mm (E) Renal glucosuria space, 12 mm Hg; average glomerular Hg 14. In a person with severe central diabetes capillary colloid osmotic pressure, 24 (B) Mainly involves changes in the insipidus (deficient production or mm Hg. What is the glomerular caliber of efferent arterioles release of AVP), urine osmolality and ultrafiltration coefficient? Refresher osmolality of 1,200 mOsm/kg H2O, (A) Creatinine course for teaching renal physiology. Molecu- is about (D) Na lar physiology of renal p-aminohippu- (A) 100 mOsm/kg H2O (E) Urea rate secretion. Total body water is distributed in two major compart- filtration rate, angiotensin II and aldosterone, intrarenal ments: intracellular water and extracellular water. In an av- physical forces, natriuretic hormones and factors such as erage young adult man, total body water, intracellular wa- atrial natriuretic peptide, and renal sympathetic nerves. The corresponding figures for cretion in response to excess Na or Na depletion. Estro- an average young adult woman are 50%, 30%, and 20% of gens, glucocorticoids, osmotic diuretics, poorly reabsorbed body weight. The effective arterial blood volume (EABV) depends on the Volume Amount of indicator Concentration of indicator degree of filling of the arterial system and determines the at equilibrium. Electrical neutrality is present in solutions of electrolytes; to Na retention by the kidneys and contributes to the de- that is, the sum of the cations is equal to the sum of the an- velopment of generalized edema in pathophysiological ions (both expressed in milliequivalents). Cells are the loop of Henle and is secreted by cortical collecting duct typically in osmotic equilibrium with their external environ- principal cells. The amount of water in (and, hence, the volume of) perkalemia and excessive K excretion produces hy- cells depends on the amount of K they contain and, simi- pokalemia. Calcium balance is regulated on both input and output the ECF is determined by its Na content. Plasma osmolality is closely regulated by arginine vaso- controlled by 1,25(OH)2 vitamin D3, and the excretion of pressin (AVP), which governs renal excretion of water, and Ca2 by the kidneys is controlled by parathyroid hormone by habit and thirst, which govern water intake. Magnesium in the body is mostly in bone, but it is also an posterior pituitary gland, and acts on the collecting ducts important intracellular ion. The kidneys regulate the of the kidney to increase their water permeability. Filtered phosphate usually exceeds the maximal reabsorp- tive plasma osmolality (detected by osmoreceptors in the tive capacity of the kidney tubules for phosphate (TmPO4), anterior hypothalamus) and a decrease in blood volume and about 5 to 20% of filtered phosphate is usually ex- (detected by stretch receptors in the left atrium, carotid si- creted. Phosphate reabsorption occurs mainly in the proxi- nuses, and aortic arch). The kidneys are the primary site of control of Na excre- portant pH buffer in the urine. Only a small percentage (usually about 1%) of the fil- significant problem in chronic renal failure. The urinary bladder stores urine until it can be conve- critical importance in overall Na balance. Multiple factors affect Na excretion, including glomerular both autonomic and somatic nerves. The and lymph water (15% body fluid surrounding our body cells (the ECF) is constantly re- Intracellular water weight; 10. In this chapter, we begin with a discussion of the fluid compartments of the body—their location, magnitude, and composition. Then we consider water, sodium, potassium, calcium, magne- sium, and phosphate balance, with special emphasis on the role of the kidneys in maintaining our fluid and electrolyte balance. Finally, we consider the role of the ureters, urinary bladder, and urethra in the transport, storage, and elimina- tion of urine. Extracellular water (20% body weight; 14 L) FLUID COMPARTMENTS OF THE BODY Total body water (60% body weight; 42 L) Water is the major constituent of all body fluid compart- FIGURE 24. Total body water averages about 60% of body gram is for an average young adult man weigh- weight in young adult men and about 50% of body weight ing 70 kg. In an average young adult woman, total body water is in young adult women (Table 24. The percentage of 50% of body weight, intracellular water is 30% of body weight, body weight water occupies depends on the amount of adi- and extracellular water is 20% of body weight. A lean person has a high per- centage and an obese individual a low percentage of body weight that is water because adipose tissue contains a low ter is in the ICF, and one third is in the ECF (Fig.

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Circulatory System © The McGraw−Hill Anatomy order penegra 100 mg visa mens health ebook, Sixth Edition Body Companies cheap penegra 50mg radiation oncology prostate wikibooks, 2001 578 Unit 6 Maintenance of the Body Inferior vena cava Right common iliac v. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 579 The superficial veins of the lower extremity are the small soids). The right and left hepatic veins that drain the venous and great saphenous veins. The small saphenous vein arises blood from the liver and empty it into the inferior vena cava from the lateral side of the foot and ascends deep to the skin (fig. As a consequence of the hepatic portal system, the along the posterior aspect of the leg. It empties into the popliteal absorbed products of digestion must first pass through the liver vein, posterior to the knee. The great saphenous vein is the before entering the general circulation. It originates from the medial side of The hepatic portal vein is the large vessel that receives the foot and ascends along the medial aspect of the leg and thigh blood from the digestive organs. The great saphenous vein superior mesenteric vein, which drains nutrient-rich blood from is frequently excised and used as a coronary bypass vessel. If a su- the small intestine, and the splenic vein, which drains the perficial vein is removed, the venous return of blood from the ap- spleen. The splenic vein is enlarged because of a convergence of pendage is through the remaining deep veins. The right gastroepiploic vein, also from the stomach, drains directly into the superior mesenteric vein. The inferior vena cava parallels the abdominal aorta on the Three additional veins empty into the hepatic portal vein. As the inferior vena cava ascends through the abdomi- stances, such as alcohol, that are absorbed into the blood from the small intestine. However, excessive quantities of alcohol nal cavity, it receives tributaries from veins that correspond in cannot be processed during a single pass through the liver, and so a name and position to arteries previously described. Eventually, the liver is able to process Four paired lumbar veins (not shown) drain the posterior the alcohol as the circulating blood is repeatedly exposed to the liver abdominal wall, the vertebral column, and the spinal cord. Alcoholics may eventually suffer from cirrhosis of the liver as the normal liver tissue is destroyed. The right testicular vein in males (or the right In summary, it is important to note that the sinusoids of the ovarian vein in females) drains the corresponding gonads, and liver receive blood from two sources. The hepatic artery supplies the right suprarenal vein drains the right adrenal gland. These oxygen-rich blood to the liver, whereas the hepatic portal vein veins empty into the inferior vena cava. The left testicular vein transports nutrient-rich blood from the small intestine for process- (or left ovarian vein) and the left suprarenal vein, by contrast, ing. The inferior phrenic veins re- Liver cells exposed to this blood obtain nourishment from it and ceive blood from the inferior side of the diaphragm and empty are uniquely qualified (because of their anatomical position and into the inferior vena cava. Right and left hepatic veins origi- enzymatic ability) to modify the chemical nature of the venous nate from the capillary sinusoids of the liver and empty into the blood that enters the general circulation from the GI tract. Note that the inferior vena cava does not receive blood Knowledge Check directly from the GI tract, pancreas, or spleen. Instead, the ve- nous outflow from these organs first passes through capillaries in 21. Point out the vein that may bulge in the side of the neck when a person performs Valsalva’s maneuver and the vein that is com- Hepatic Portal System monly used as a site for venipuncture. Describe the positions, sources, and drainages of the small A portal system is a pattern of circulation in which the vessels and great saphenous veins. Describe the hepatic portal system and comment on the group of capillaries, which in turn are drained by more usual sys- functional importance of this system. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 580 Unit 6 Maintenance of the Body FIGURE 16. The umbilical cord is the connection between the pla- FETAL CIRCULATION centa and the fetal umbilicus. It includes one umbilical vein and two umbilical arteries, surrounded by a gelatinous substance.

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Present in about 3% of the popu- the normal development of the male fetus trusted penegra 100 mg prostate cancer xenograft, the testes will be in lation discount 100mg penegra otc prostate oil, a Meckel’s diverticulum consists of a pouch, approxi- scrotal position by the twenty-eighth week of gestation. Like the appendix, a Meckel’s diverticulum is prone to infec- tions; it may become inflamed, producing symptoms similar to Trauma to the Abdomen appendicitis. For this reason, it is usually removed as a precau- The rib cage, the omentum (see fig. The connection from the ileum of the small intestine to the However, puncture wounds, compression, and severe blows to outside sometimes is patent at the time of birth; this condition is the abdomen may result in serious abdominal injury. It permits the passage of fecal material through The large and dense liver, located in the upper right quad- the umbilicus and must be surgically corrected in a newborn. In pyloric stenosis, there is a narrowing of the liver is extremely serious because of the possibility of internal pyloric orifice of the stomach resulting from hypertrophy of the hemorrhage from such a vascular organ. This condition is more The spleen is another highly vascular organ that is fre- common in males than in females, and the symptoms usually ap- quently injured,especially from blunt abdominal trauma. The constricted opening interferes with the tured spleen causes severe internal hemorrhage and shock. Its Meckel’s diverticulum: from Johann Friedrich Meckel,German anatomist,1724–74 Hirschsprung’s disease: from Harold Hirschsprung, Danish physician, 1830–1916 Van De Graaff: Human IV. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 337 prompt removal (splenectomy) is necessary to keep the patient in gastric juice. The spleen may also rupture sponta- stomach, including alcohol and aspirin, and hypersecretion of neously because of infectious diseases that cause it to hypertrophy. The danger of a ruptured pancreas is the flow of pancre- Enteritis, or inflammation of the intestinal mucosa, is atic juice into the peritoneal cavity, the subsequent digestive ac- frequently referred to as intestinal flu. Diarrhea is symptomatic of inflamma- blow to one side propagates through the kidney and may possibly tion, stress, and other body dysfunctions. In children, it is of rupture the renal pelvis or the proximal portion of the ureter. Trauma to the external genitalia of both males and females is a relatively common occurrence. The pendant position of the Shoulder and Upper Extremity penis and scrotum makes them vulnerable to compression forces. For example, if a construction worker were to slip and land astride a steel beam, his external genitalia would be compressed Developmental Conditions between the beam and his pubic bone. In this type of accident, Twenty-eight days after conception, a limb bud appears on the the penis (including the urethra) might split open, and one or upper lateral side of the embryo, which eventually becomes a both testes might be crushed. Three weeks later (7 weeks Trauma to the female genitalia usually results from sexual after conception) the shoulder and upper extremity are present abuse. Vaginal tearing and a displaced uterus are common in in the form of mesenchymal primordium of bone and muscle. The physical and mental consequences are gener- is during this crucial 3 weeks of development that malformations ally severe. If a pregnant woman uses certain teratogenic drugs or is exposed to certain diseases (Rubella virus, for example) during Diseases of the Abdomen development of the embryo, there is a strong likelihood that Any of the abdominal organs may be afflicted by an array of dis- the appendage will be incompletely developed. It is beyond the scope of this text to cover all of these dis- ber of limb deformities occurred between 1957 and 1962 as a eases; instead, an overview of some general conditions will be result of women ingesting the sedative thalidomide during presented. It is estimated Knowledge of the clinical regions of the abdomen (see that 7,000 infants were malformed by this drug. Also important are the locations of the linea Although genetic deformities of the shoulder and upper ex- alba, extending from the xiphoid process to the symphysis pubis, tremity are numerous, only a few are relatively common. Spren- the umbilicus, the inguinal ligament, the bones and processes gel’s deformity affects the development of one or both scapulae. In this condition, the scapula is smaller than normal and is posi- Peritonitis is of major clinical concern. As a result, abduction of the arm is the serous membrane of the abdominal cavity. It lines the abdom- not possible beyond a right angle to the plane of the body. Peritonitis results from any type of contamination of extra digit is incompletely formed and nonfunctional.

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Ruffini of pressure buy generic penegra 100mg online mens health questionnaire, vibration cheap penegra 50 mg mastercard prostate cancer check, heat, or cold, the distribution of cu- endings (located in the dermis) are also slowly adapting re- taneous receptors over the skin can be mapped. Merkel’s disks in areas of hairy skin are grouped areas of skin used in tasks requiring a high degree of spatial into tactile disks. Nonmyelinated nerve endings, also usually specific receptors, and these areas are correspondingly well found in hairy skin, appear to have a limited tactile function represented in the somatosensory areas of the cerebral cor- and may sense pain. Several receptor types serve the sensa- warm and cold represent values along a temperature contin- tions of touch in the skin (Fig. In regions of hairless uum and do not differ fundamentally except in the amount skin (e. However, the familiar subjec- Meissner’s corpuscles, and pacinian corpuscles. Merkel’s tive differentiation of the temperature sense into “warm” and disks are intensity receptors (located in the lowest layers of “cold” reflects the underlying physiology of the two popula- the epidermis) that show slow adaptation and respond to tions of receptors responsible for thermal sensation. Meissner’s corpuscles adapt more rapidly Temperature receptors (thermoreceptors) appear to be to the same stimuli and serve as velocity receptors. The naked nerve endings supplied by either thin myelinated Pacinian corpuscles are very rapidly adapting (accelera- fibers (cold receptors) or nonmyelinated fibers (warm re- tion) receptors. They are most sensitive to fast-changing ceptors) with low conduction velocity. In regions of hairy skin, small form a population with a broad response peak at about 70 PART II NEUROPHYSIOLOGY range, steady temperature sensation depends on the ambi- ent (skin) temperature. At skin temperatures lower than Hairless skin Hairy skin 17 C, cold pain is sensed, but this sensation arises from pain receptors, not cold receptors. At very high skin tem- Horny peratures (above 45 C), there is a sensation of paradoxical layer cold, caused by activation of a part of the cold receptor Epidermis population. Temperature perception is subject to considerable pro- cessing by higher centers. While the perceived sensations reflect the activity of specific receptors, the phasic compo- nent of temperature perception may take many minutes to Dermis be completed, whereas the adaptation of the receptors is complete within seconds. The familiar sensation of pain is not limited to cu- Subcutaneous taneous sensation; pain coming from stimulation of the tissue body surface is called superficial pain, while that arising from within muscles, joints, bones, and connective tissue is called deep pain. Visceral pain arises from internal organs and is often due to strong contractions of visceral muscle or its forcible deformation. Pain is sensed by a population of specific receptors Meissner’s called nociceptors. In the skin, these are the free endings of Hair-follicle Merkel’s corpuscle receptor disks thin myelinated and nonmyelinated fibers with characteris- tically low conduction velocities. They typically have a high threshold for mechanical, chemical, or thermal stimuli (or a combination) of intensity sufficient to cause tissue de- struction. The skin has many more points at which pain can be elicited than it has mechanically or thermally sensitive Tactile Pacinian Ruffini sites. Because of the high threshold of pain receptors (com- disks corpuscle ending pared with that of other cutaneous receptors), we are usu- Tactile receptors in the skin. Both sets of receptors share some common mediated by different nerve fiber endings. In addition to features: • They are sensitive only to thermal stimulation. The density of temperature receptors differs at different places on the body surface. They are present in much lower numbers than cutaneous mechanoreceptors, and there are many more cold receptors than warm receptors. The perception of temperature stimuli is closely related to the properties of the receptors. The phasic component of the response is apparent in our adaptation to sudden im- mersion in, for example, a warm bath.

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