Two of the early manifestations of diabetes are excessive urination and excessive thirst asthma treatment telugu generic fluticasone 250 mcg with mastercard. They demonstrate how the out-of-control levels of glucose in the blood affect kidney function asthma stepwise approach generic 250mcg fluticasone overnight delivery. Excessive blood glucose draws water into the urine, and as a result the person eliminates an abnormally large quantity of sweet urine. The use of body water to dilute the urine leaves the body dehydrated, and so the person is unusually and continually thirsty. The person may also experience persistent hunger because the body cells are unable to access the glucose in the bloodstream. Over time, persistently high levels of glucose in the blood injure tissues throughout the body, especially those of the blood vessels and nerves. Inflammation and injury of the lining of arteries lead to atherosclerosis and an increased risk of heart attack and stroke. Damage to the microscopic blood vessels of the kidney impairs kidney function and can lead to kidney failure. Blood vessel damage also reduces circulation to the limbs, whereas nerve damage leads to a loss of sensation, called neuropathy, particularly in the hands and feet. Together, these changes increase the risk of injury, infection, and tissue death (necrosis), contributing to a high rate of toe, foot, and lower leg amputations in people with diabetes. Uncontrolled diabetes can also lead to a dangerous form of metabolic acidosis called ketoacidosis. However, in a glucose-deficient state, the liver is forced to use an alternative lipid metabolism pathway that results in the increased production of ketone bodies (or ketones), which are acidic. The build-up of ketones in the blood causes ketoacidosis, which-if left untreated-may lead to a life-threatening "diabetic coma. Diabetes is diagnosed when lab tests reveal that blood glucose levels are higher than normal, a condition called hyperglycemia. The treatment of diabetes depends on the type, the severity of the condition, and the ability of the patient to make lifestyle changes. As noted earlier, moderate weight loss, regular physical activity, and consumption of a healthful diet can reduce blood glucose levels. Some patients with type 2 diabetes may be unable to control their disease with these lifestyle changes, and will require medication. Research advances have resulted in alternative options, including medications that enhance pancreatic function. Here, you will learn about the hormone-producing activities of the heart, gastrointestinal tract, kidneys, skeleton, adipose tissue, skin, and thymus. Some of these hormones are secreted in response to eating a meal and aid in digestion. An example of a hormone secreted by the stomach cells is gastrin, a peptide hormone secreted in response to stomach distention that stimulates the release of hydrochloric acid. Secretin is a peptide hormone secreted by the small intestine as acidic chyme (partially digested food and fluid) moves from the stomach. It stimulates the release of bicarbonate from the pancreas, which buffers the acidic chyme, and inhibits the further secretion of hydrochloric acid by the stomach. It promotes the secretion of pancreatic enzymes and the release of bile from the gallbladder, both of which facilitate digestion. Other hormones produced by the intestinal cells aid in glucose metabolism, such as by stimulating the pancreatic beta cells to secrete insulin, reducing glucagon secretion from the alpha cells, or enhancing cellular sensitivity to insulin. Kidneys the kidneys participate in several complex endocrine pathways and produce certain hormones. Skeleton Although bone has long been recognized as a target for hormones, only recently have researchers recognized that the skeleton itself produces at least two hormones. It triggers the kidneys to inhibit the formation of calcitriol from vitamin D3 and to increase phosphorus excretion. Osteocalcin, produced by osteoblasts, stimulates the pancreatic beta cells to increase insulin production.
Motor Neuron Disease: A clinical condition characterized by degeneration of motor nerve cells in the brain asthma icd 0 buy generic fluticasone 250 mcg line, brain stem asthma treatment kottayam buy fluticasone 500mcg on-line, and spinal cord. Primary lateral sclerosis occurs when degeneration affects mainly corticospinal tract motor fibers. Amyotrophic lateral sclerosis occurs when degeneration affects both corticospinal tracts and lower motor neurons. Motor Point: the site over a muscle where its contraction may be elicited by a minimal intensity short-duration electric stimulus. Motor Response: (1) the compound muscle action potential (M wave) recorded over a muscle in response to stimulation of the nerve to the muscle. Motor Unit: the anatomic element consisting of an anterior horn cell, its axon, the neuromuscular junctions, and all of the muscle fibers innervated by the axon. With voluntary muscle contraction, it is characterized by its consistent appearance and relationship to the force of the contraction. The following measures may be specified, quantitatively if possible, after the recording electrode is placed randomly within the muscle: 1. Recruitment characteristics (a) Threshold of activation (first recruited, low threshold, high threshold). A variety of methods, including spike-triggered averaging, incremental motor nerve stimulation, F-wave measurement, or a Poisson statistical technique can be used. Synonyms can include motor unit number estimation and motor unit number estimating. Motor Unit Territory: the area of a muscle cross section within which the muscle fibers belonging to an individual motor unit are distributed. Movement-Related Cortical Potential: Electroencephalogram activity associated with (before and after) a voluntary movement. There are several components including the Bereitschaftspotential before the movement and the motor potential at about the time of the movement. Multifocal Motor Neuropathy: A disease characterized by selective focal block of motor nerve conduction in multiple nerves. Motor nerve conduction studies may permit identification and localization of the segments of nerve affected by the underlying pathology. The arrangement of the bare tips relative to the axis of the cannula and the distance between each tip should be specified. Multiple Discharge: Four or more motor unit action potentials of the same form and nearly the same amplitude occurring consistently in the same relationship to one another and generated by the same axon. Muscle Action Potential: Term commonly used to refer to a compound muscle action potential. Muscle Atrophy: Decrease in size of a muscle that may be due to disease of nerve or muscle, or todisuse. Muscle Cramp: An involuntary, painful muscle contraction associated with electrical activity. Cramp discharges are most common, but other types of repetitive discharges can also be seen. Muscle Fiber Action Potential: Action potential recorded from a single muscle fiber. Muscle Fiber Conduction Velocity: the speed of propagation of a single muscle fiber action potential, usually expressed as meters per second. Usually less than most nerve conduction velocities, varies with the rate of discharge of the muscle fiber, and requires special techniques for measurement. Muscle Hypertrophy: Increase in the size of a muscle due to an increase in the size of the muscle fibers or replacement or displacement of muscle fibers by other tissues. The latter is also referred to by the term 856 Glossary of Electrophysiologic Terms pseudohypertrophy, because the muscle is enlarged but weak. Muscle fibers increase in size as a physiologic response to repetitive and forceful voluntary contraction or as a pathologic response to involuntary electric activity in a muscle, for example, myotonic discharges or complex repetitive discharges.
The chain then passes behind the common iliac vessels and enters the pelvis anterior to the ala of the sacrum; thence it descends medial to the anterior sacral foramina asthmatic bronchitis joke buy generic fluticasone 250mcg line. The sympathetic trunks end below by meeting each other at the ganglion impar on the anterior face of the coccyx asthma treatment in the 70s order fluticasone 250mcg without prescription. The sympathetic trunks bear a series of ganglia that contain motor cells with which preganglionic medullated fibres enter into synapse and from which non-medullated postganglionic axons originate. Developmentally, there was originally one ganglion for each peripheral nerve but by a process of fusion these have been reduced, in humans, to three cervical, 12 or less thoracic, two to four lumbar and four sacral ganglia. These may: (A) relay in their corresponding ganglion and pass to their corresponding spinal nerve for distribution; (B) ascend or descend in the sympathetic chain and relay in higher or lower ganglia; or (C) pass without synapse to a peripheral ganglion for relay. Still other preganglionic fibres pass through the ganglia intact and pass to peripheral visceral ganglia for relay. The branches from the sympathetic ganglionic chain are divided into somatic and visceral groups. Somatic Each spinal nerve receives one or more grey rami from a sympathetic ganglion. The grey rami carry postganglionic non-medullated fibres, which are distributed to the segmental skin area supplied by the spinal nerve. These fibres are vasoconstrictor to the skin arterioles, sudomotor to sweat glands and pilomotor to the erectores pilorum. Visceral Postganglionic fibres to the head and neck and to the thoracic viscera arise from the ganglion cells of the sympathetic chain. Those to the head ascend along the internal carotid and vertebral arteries; those to the thoracic organs descend to , and are distributed by, the cardiac, pulmonary and oesophageal plexuses. The abdominal and pelvic viscera, however, are supplied in quite a different manner by postganglionic fibres which have their cell stations in peripheral gangliaathe coeliac, hypogastric and pelvic plexusesawhich receive their preganglionic fibres from the splanchnic nerves. A rich plexus of preganglionic fibres passes without relay from the coeliac ganglion to the gland; the preganglionic terminals end in direct contact with the chromaffin medullary cells, and liberate acetylcholine (as at all autonomic ganglia), which stimulates the secretion of epinephrine and norepinephrine by the adrenal medulla. The chromaffin cells of the adrenal medulla may thus be regarded as sympathetic cells which have not developed postganglionic fibres; indeed, embryologically both the medulla and the sympathetic nerves have a common origin from the neural crest. These fibres are distributed either along the peripheral spinal nerves or as plexuses around the carotid artery and its branches and the vertebral artery. Its branches are distributed thus: 1 Grey rami communicantes pass to the upper four cervical nerves. The Sympathetic System 223 3 Fibres form a plexus on the external carotid artery and its branches along which they reach the submandibular ganglion (see p. The middle cervical ganglion is small and not always present; it lies at the level of the 6th cervical vertebra and represents the fused ganglia of C5 and 6. Its branches are: 1 grey rami, which join the anterior primary rami of C5 and 6; 2 a thyroid branch, which travels along the inferior thyroid artery to this gland; 3 the middle cardiac nerve, which descends to the deep cardiac plexus. The inferior cervical ganglion is connected with the middle ganglion not only by the sympathetic chain itself, but also by the ansa subclavia, which reaches the middle ganglion by looping around the inferior margin of the subclavian artery and then passing upwards in front of it. Its branches are: 1 grey rami to the 7th and 8th cervical nerves; 2 a plexus along the vertebral artery to the brain; 3 the inferior cardiac nerve, which descends to form part of the deep cardiac plexus. The thoracic ganglia (see Figs 48 & 49) are usually 12 in number, although this number may be decreased by fusion; the commonest example of this is the blending of T1 with the inferior cervical ganglion to form the stellate ganglion. Each ganglion is connected to its corresponding intercostal nerve by grey and white rami communicantes. It pierces the crus of the diaphragm to join the coeliac ganglion; (b) the lesser splanchnic nerve (T9 and 10 or T10 and 11) also pierces the crus and ends in the coeliac ganglion; (c) the lowest splanchnic nerve arises from the lowest available thoracic ganglion and either pierces the crus or passes behind the medial arcuate ligament to join the renal plexus. The branches are: 1 grey rami to the lumbar nerves; 2 branches to the aortic plexus; 3 fibres that descend over the common iliac vessels to the hypogastric plexus. The ganglia of the lumbar sympathetic chain lie on the antero-lateral surface of the bodies of the lumbar vertebrae in loose retroperitoneal areolar tissue separated from the vertebral bodies by the thick anterior ligament. They are overlapped by the aorta on the left and the inferior vena cava on the right. The Sympathetic System 225 Body of lumbar vertebra Lumbar ganglion Inferior vena cava. Aorta Lumbar sympathectomy Lumbar sympathectomy can be used to treat a number of conditions that include: circulatory insufficiency in the lower limb; urogenital pain; renal colic; complex regional pain syndromes; frostbite; stump pain; and phantom limb pain syndromes. The lumbar sympathetic chain can be blocked either temporarily with local anaesthetic or for a period of many months with phenol or alcohol.
A previously healthy 40-year-old man is brought to the emergency department because of constant substernal chest pain for 12 hours that is exacerbated by coughing and inspiration chronic asthmatic bronchitis icd 9 purchase fluticasone 500mcg fast delivery. The most likely cause of his condition is injury to which of the following tissues? A 17-year-old boy comes to the emergency department because of severe thirst and weakness and a 4-kg (8 can asthmatic bronchitis lead to pneumonia buy fluticasone 500mcg on line. He began having voluminous painless watery diarrhea on the airplane while returning from a trip to Thailand 36 hours ago. After being severely beaten and sustaining a gunshot wound to the abdomen, a 42-yearold woman undergoes resection of a perforated small bowel. During the operation, plastic reconstruction of facial fractures, and open reduction and internal fixation of the left femur are also done. She says that she needs the morphine to treat her pain, but she is worried that she is becoming addicted. A 22-year-old man comes to the emergency department because of the recent onset of torticollis and uncontrollable facial grimacing. She has taken large doses of combination over-the-counter analgesic preparations for 10 years due to a low back injury. A previously healthy 26-year-old patient develops shortness of breath over several hours during a mountain climb at 5000 m (16,404 ft). On examination, the point of cardiac apical impulse is not displaced and there are widespread crackles throughout both lung fields. A 35-year-old man comes to the physician because of pain and swelling of his right arm where he scraped it on a tree branch 2 days ago. Examination of the right forearm shows edema around a fluctuant erythematous lesion at the site of trauma. Which of the following is most likely the primary mechanism of the development of edema in this patient? This mutation is most likely to alter the amino acid sequence with which of the following changes? A 6-day-old breast-fed boy is brought to the emergency department by his mother because of poor weight gain and irritability since delivery, and a 2-hour history of vomiting. A reducing substance test result of the urine is positive, and a glucose oxidase test result is negative. The concentration of which of the following metabolites in liver is most likely increased in this patient? A 60-year-old woman with reflux esophagitis comes to the physician for a follow-up examination. She has been undergoing proton-pump inhibitor therapy for the past month and shows clinical improvement. A 40-year-old woman receives an intravenous infusion of drug X that selectively constricts the efferent arterioles in her kidneys. Following the infusion, total cardiac output and renal afferent arteriolar tone are unchanged, but renal efferent arteriolar tone and total renal vascular resistance have both increased. Which of the following sets of changes most likely occurred following the infusion of drug X? Glomerular Filtration Rate Filtration Fraction Renal Blood Flow (A) (B) (C) (D) (E) 105. A 28-year-old woman comes to the physician because of a 6-month history of intermittent feelings of progressive overwhelming fear and apprehension, restlessness, and palpitations. She says that she often feels tense, and she has difficulty concentrating because she is unable to stop thinking about the things that worry her. Laboratory studies include: Hemoglobin Hematocrit Erythrocyte count Mean corpuscular volume 11. The physician recommends a diet that will restrict her daily intake by 500 kilocalories. Which of the following processes is most likely to increase in this patient as a result of following this diet?
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