By J. Jorn. Saint Mary-of-the-Woods College. 2018.

Explain what is meant by visual inspection and palpation buy cheap ditropan 5mg, gross anatomy order ditropan 5mg on line. Knowing where muscles and muscle groups are lo- and discuss the value of surface anatomy in locating inter- cated can be extremely important in maintaining physical fitness discount ditropan 2.5 mg without prescription. Why is a knowledge of surface anatomy important in a of a patient is of immeasurable value in diagnosis and treatment cheap 5mg ditropan. How does the hypodermis of the skin differ in males and fe- the functioning of internal organs generic ditropan 2.5mg free shipping, take radiographs, and perform males? Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 298 Unit 4 Support and Movement Clavicle Great Fibular saphenous vein Deltoid nerve muscle Pectoralis major Tibial muscle nerve Small saphenous vein Cephalic vein Gastrocnemius muscle Sural Basilic vein nerve Median nerve Biceps brachii muscle Median cubital vein Basilic vein Median vein of forearm Tendo calcaneus Cephalic vein Nelson (a) (b) FIGURE 10. SURFACE ANATOMY OF THE NEWBORN The surface anatomy of a newborn infant represents an early stage of human development; therefore, it differs from that of an adult. Certain aspects of the surface anatomy of a neonate are of clinical importance in ascertaining the degree of physical develop- ment, general health, and possible congenital abnormalities. Objective 4 Describe the surface anatomy of a normal, full- term neonate. Objective 5 List some of the internal structures that can be palpated in a neonate. The birth of a baby is the dramatic culmination of a 9-month gestation, during which the miraculous development of the fetus (a) (b) Creek prepares it for extrauterine life. Although the normal, full-term neonate is physiologically prepared for life, it is totally dependent on the care of others. There is significantly more adipose tissue in- terlaced in the fascia covering the muscles, vessels, and nerves in a female than in a male. The hypodermis layer of the skin is also ap- proximately 8% thicker in a female than in a male. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 299 TABLE 10. The surface anatomy of a neonate obviously differs from that of an adult because of the transitional stage of develop- ment from fetus to infant. Although the surface anatomy of a neonate is discussed at this point in the text, prenatal development and body growth with its accompanying physiological changes are discussed in de- tail in chapter 22. A summary of the surface anatomy of the neonate is presented in table 10. The neonate born vertex (head first) keeps the neck and vertebral column flexed, with the chin resting on the upper chest. The hands are clenched into fists, the elbow joints are flexed, and the arms are held to the chest. The knee and hip joints are flexed, drawing the thighs to- ward the abdomen. The skin is the one organ of the neonate that is completely visible and is therefore a source of considerable information con- cerning its state of development and clinical condition. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 300 Unit 4 Support and Movement The neck of a neonate is short, thick, and surrounded by neck folds. The chest is rounded in cross section, and the ab- domen is cylindrical. The abdomen may bulge in the upper right quadrant because of the large liver. It progressively shrivels and becomes greenish black prior to its falling off by the second week. The genitalia of both sexes may appear darkly pigmented because of maternal hormonal influences. The hymenal tag usually disappears by from footprints of two premature babies (a, b) and a full-term baby the end of the first month. Skin color depends on ge- pubic area is also palpated for an abnormally distended urinary netic background, although certain areas, such as the genitalia, bladder. The newborn should void urine within the first areola, and linea alba may appear darker than the rest of skin be- 24 hours after birth. If the neonate is small or premature, the testes of newborn Blacks, Asians, and American Indians. An examination for in- gray pigmented areas vary in size and are usually located in the guinal hernias is facilitated by the crying of an infant, which cre- lumbosacral region. Abnormal skin color is clinically important in the physical as- Knowledge Check sessment of the neonate. Describe the appearance of each of the following in a nor- oration) is usually due to a pulmonary disease (for example, atelectasis or pneumonia) or to congenital heart disease.

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The setting may not particularly suggest hy- may appear clinically dead generic 5mg ditropan with visa, but patients have been revived pothermia ditropan 5mg online, and when the patient comes to medical atten- from core temperatures as low as 17 C cheap ditropan 5 mg, so that “no one is tion 5mg ditropan mastercard, the diagnosis may easily be missed because standard dead until warm and dead buy 5 mg ditropan otc. Because of the depressant ef- Depression of renal tubular metabolism by cold impairs fect of hypothermia on the brain, the patient’s condition the reabsorption of sodium, causing a diuresis and leading may be misdiagnosed as cerebrovascular accident or other to dehydration and hypovolemia. Respiration and cardiac out- tion depends on the physician’s considering it when ex- put typically are depressed more than metabolic rate, and amining a cool patient whose mental status is impaired a mixed respiratory and metabolic acidosis results, be- and obtaining a true core temperature with a low-reading cause of CO2 retention and lactic acid accumulation and glass thermometer or other device. CHAPTER 29 The Regulation of Body Temperature 549 heatstroke but is now known to be a distinct disorder that Hypothermia Occurs When the Body’s Defenses occurs in people with a genetic predisposition. In 90% of Against Cold Are Disabled or Overwhelmed susceptible individuals, biopsied skeletal muscle tissue con- Hypothermia reduces metabolic rate via the Q10 effect and tracts on exposure to caffeine or halothane in concentra- tions having little effect on normal muscle. Susceptibility prolongs the time tissues can safely tolerate a loss of blood may be associated with any of several myopathies, but most flow. Since the brain is damaged by ischemia soon after cir- susceptible individuals have no other clinical manifesta- culatory arrest, controlled hypothermia is often used to tions. The control of free (unbound) calcium ion concen- protect the brain during surgical procedures in which its tration in skeletal muscle cytoplasm is severely impaired in circulation is occluded or the heart is stopped. Much of our susceptible individuals; and when an attack is triggered, knowledge about the physiological effects of hypothermia calcium concentration rises abnormally, activating myosin comes from observations of surgical patients. ATPase and leading to an uncontrolled hypermetabolic During the initial phases of cooling, stimulation of shiv- process that rapidly increases core temperature. Treatment ering through thermoregulatory reflexes overwhelms the with dantrolene sodium, which appears to act by reducing Q10 effect. Metabolic rate, therefore, increases, reaching a the release of calcium ions from the sarcoplasmic reticulum, peak at a core temperature of 30 to 33 C. At lower core has dramatically reduced the mortality rate of this disorder. Other velops, wherein a fall in core temperature depresses metab- than producing specific disorders, heat exposure aggravates olism and allows core temperature to fall further, so that at several other diseases. Epidemiological studies show that 17 C, the O2 consumption is about 15%, and cardiac out- during unusually hot weather, mortality may be 2 to 3 times put 10%, of precooling values. Deaths ascribed to specific heat disorders account poses is called accidental hypothermia (Clinical Focus Box for only a small fraction of the excess mortality (i. It occurs in individuals whose defenses are impaired crease above the expected mortality). Most of the excess by drugs (especially ethanol, in the United States), disease, mortality is accounted for by deaths from diabetes, various or other physical conditions and in healthy individuals who diseases of the cardiovascular system, and diseases of the are immersed in cold water or become exhausted working blood-forming organs. REVIEW QUESTIONS DIRECTIONS: Each of the numbered (D) Antipyretics increase skin blood Threshold for items or incomplete statements in this flow so as to dissipate more heat, Core Sweating Cutaneous Temperature Threshold Vasodilation section is followed by answers or by increasing circulatory strain during (A) Unchanged Higher Lower completions of the statement. Select the exercise (B) Unchanged Unchanged Unchanged ONE lettered answer or completion that is (E) The increased heat production (C) Higher Higher Higher BEST in each case. A surgical sympathectomy has person, one who is acclimatized to but they are not used to counteract the completely interrupted the cold has increase in core temperature that sympathetic nerve supply to a patient’s (A) Higher metabolic rate in the cold, occurs during exercise. How would one expect the to produce more heat following best explains why it is thermoregulatory skin blood flow and (B) Lower metabolic rate in the cold, inappropriate to use antipyretics for sweating responses on that arm to be to conserve metabolic energy this purpose? Which statement best describes how preventing it temperature is tested in the early the elevated core temperature during (C) Antipyretics are ineffective during morning at 4:00 AM, and again in the fever affects the outcome of most exercise because they act on a afternoon at 4:00 PM. Harrison’s Principles of Internal infection concentration and ECF volume after he Medicine. New York: Mc- (C) Fever is harmful because the has replaced all the water that he lost? Cytokines as endogenous reduces the availability of amino acids (mmol/L) ECF Volume (L) pyrogens. In: Braunwald E, Fauci AS, growth of the bacteria responsible for (D) 113. Our subject is bicycling on a long road New York: McGraw-Hill, 2001;91–94. A manual laborer moves in March from metabolic rate (M in the heat-balance heat biophysics and physiology. In: Canada to a hot, tropical country and equation) is 800 W (48 kJ/min). Handbook becomes acclimatized by working performs mechanical work (against of Physiology. New York: Oxford his responses on the first few days in at a rate of 140 W. Interaction of body temperatures activity level after acclimatization one transfer coefficient, is 15 W/(m2• C).

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Such conditions generic ditropan 5 mg on line, which can usually only be diag- malfunctions of the cardiac muscle itself generic ditropan 5mg amex. These condi- nosed by direct muscle biopsy ditropan 5mg mastercard, are difficult to treat effec- tions cheap ditropan 2.5 mg, called cardiomyopathy buy 2.5 mg ditropan mastercard, result in impaired heart tively, although spontaneous recovery can occur. In hypertrophic cardiomyopathy, trypanosome (Chagas’ disease) can produce chronic car- an enlargement of the cardiac muscle fibers occurs be- diomyopathy. The tick-borne spirochete infection called cause of a chronic overload, such as that caused by hyper- Lyme disease can cause heart muscle damage and lead tension or a defective heart valve. Such muscle may fail to heart block, a conduction disturbance (see Chapter 13). An acute ischemic episode may be fol- diac muscle so weakened that it cannot pump strongly lowed by a stunned myocardium, with reduced me- enough to empty the heart properly with each beat. Chronic ischemia can produce a hi- strictive cardiomyopathy, the muscle becomes so stiff- bernating myocardium, also with reduced mechanical ened and inextensible that the heart cannot fill properly be- performance. Chronic poisoning with heavy metals, such as dling, which can lead to destructively high levels of inter- cobalt or lead, can produce toxic cardiomyopathy. These conditions can be improved by reestab- skeletal muscle degeneration associated with muscular lishing an adequate oxygen supply (e. CHAPTER 10 Cardiac Muscle 187 REVIEW QUESTIONS DIRECTIONS: Each of the numbered (D) The electrical activity is conducted (A) The resting muscle length from which items or incomplete statements in this too slowly for tetanus to occur contraction begins section is followed by answers or 5. The contraction cycle for cardiac (B) The size of the preload, which sets completions of the statement. Select the muscle differs in significant ways from the initial length ONE lettered answer or completion that is that of skeletal muscle. Which of the following sets of attrib- (A) The cycle involves only isometric muscle shortens utes best characterizes cardiac muscle? The factor common to most changes in (A) Large cells, electrically isolated, (B) Isometric relaxation occurs at a cardiac muscle contractility is the neurally stimulated shorter length than isometric (A) Amplitude of the action potential (B) Small cells, electrically coupled, contraction (B) Availability of cellular ATP chemically stimulated (C) The muscle relaxes along the same (C) Cytoplasmic calcium (C) Small cells, electrically coupled, combination of lengths and forces that concentration spontaneously active it took during contraction (D) Rate of neural stimulation (D) Small cells, electrically isolated, (D) The complete cycle in cardiac 10. At a given muscle length, the velocity spontaneously active muscle is isotonic of contraction depends on 2. What is the physiological role of the (A) Only the afterload electrical and a mechanical syncytium. The regulation of contraction in preload SUGGESTED READING cardiac muscle is (D) It prevents a contraction from American Heart Association. Website: (A) Most like that of smooth muscle having an isometric phase at shorter http://www. Why does cardiac muscle shorten less Mechanisms of Contraction of the (i. Boston: Lit- (C) Independent of filament-related (A) Higher loads cause a reduction in tle, Brown, 1976. New York: McGraw-Hill, stimulation (B) Higher loads cause rapid fatigue, 1981. Carmel, IN: Biological Sci- (A) The rate of neural stimulation is premature relaxation ences Press-Cooper Group, 2000. Oxford: Oxford University potential lasts into the relaxation phase important limit to force production in Press, 1979. CASE STUDIES FOR PART III • • • CASE STUDY FOR CHAPTER 8 four limbs, but the woman does not complain of muscu- lar soreness. She is somewhat underweight, slightly Polymyositis in an Older Patient short of breath, and speaks in a low voice. Laboratory A 67-year-old woman consulted her physician because of tests show a moderately elevated creatine kinase level. She reported There is no family history of muscle problems, and she is difficulty in rising out of a chair and had intermittent diffi- not currently taking any medication. Physical examination reveals the Because of the symptoms present, no muscle biopsy presence of a light purple rash around her eyes and on or electromyographic study is carried out. Muscle weakness is noted in all agnosis of polymyositis/dermatomyositis was made. The (continued) 188 PART III MUSCLE PHYSIOLOGY woman is placed on high-dose prednisone, and arrange- steroidal drug to manage the pain and inflammation and ments are made for periodic tests for circulating muscle is told to lessen the pain by applying ice packs to the af- enzymes. He is advised to avoid stair climbing as specialist to screen for a possible underlying malig- much as possible during this time, but to begin walking nancy, and physical therapy is strongly recommended.

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The roots of teeth fit into sockets ditropan 2.5mg with amex, called den- tal alveoli discount ditropan 2.5mg online, in the alveolar processes of the mandible and maxil- and fasten the tooth in its dental alveolus buy 2.5 mg ditropan with amex. Each socket is lined with a connective tissue periosteum best 5mg ditropan, (gum) is the mucous membrane surrounding the alveolar specifically called the periodontal membrane ditropan 2.5 mg low cost. Digestive System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 18 Digestive System 645 can be tasted. Saliva also contains starch-digesting enzymes and Enamel lubricating mucus, which aids swallowing. Saliva is secreted con- tinuously, but usually only in sufficient amounts to keep the mu- cous membranes of the oral cavity moist. Dentin Numerous minor salivary glands are located in the mucous membranes of the palatal region of the oral cavity. However, Dental pulp three pairs of salivary glands that lie outside the oral cavity pro- (in pulp cavity) duce most of the saliva, which is transported to the oral cavity via salivary ducts. The three major pairs of extrinsic salivary glands Gingiva are the parotid, submandibular, and sublingual glands (fig. It is positioned below and in front of the auricle of the membrane ear, between the skin and the masseter muscle. Saliva produced in the parotid gland drains through the parotid (Stensen’s) duct. Root The parotid duct parallels the zygomatic arch across the masseter canal Dental alveolus muscle, pierces the buccinator muscle, and empties into the oral Cementum cavity opposite the second upper molar. It is the parotid gland that becomes infected and swollen with the mumps. Root The submandibular gland lies inferior to the body of the mandible, about midway along the inner side of the jaw. Each sublingual gland contains several small sublingual ducts (Rivinus’ ducts) that empty into the floor of the mouth in an area posterior to the papilla of the submandibular duct. Enamel is composed Two types of secretory cells, serous and mucous cells, are primarily of calcium phosphate and is the hardest substance in the found in all salivary glands in various proportions (fig. Serous cells produce a watery fluid containing digestive enzymes; The pulp cavity contains the pulp, which is composed of connec- mucous cells secrete a thick, stringy mucus. Cuboidal epithelial tive tissue with blood vessels, lymph vessels, and nerves. Sympathetic impulses stimulate the receives nourishment through vessels traversing the apical fora- secretion of small amounts of viscous saliva. Proper nourishment is particularly important during embry- stimulation causes the secretion of large volumes of watery saliva. The diet of the mother should contain an Physiological responses of this type occur whenever a person abundance of calcium and vitamin D during pregnancy to ensure sees, smells, tastes, or even thinks about desirable food. Refluxed stomach acids also destroy tooth enamel and con- Pharynx stant vomiting, as in the eating disorder bulimia nervosa, contributes to the development of dental caries. The rate of tooth decay decreases after age 35, but then ing the oral and nasal cavities to the esophagus and larynx. Periodontal diseases result from plaque or tartar buildup at the gum line. This buildup pulls the pharynx has both digestive and respiratory functions. The sup- gum away from the teeth, allowing bacterial infections to develop. Saliva functions as a solvent in Wharton’s duct: from Thomas Wharton, English physician, 1614–73 cleansing the teeth and dissolving food molecules so that they Rivinus’ ducts: from August Quirinus Rivinus, German anatomist, 1652–1723 Van De Graaff: Human VI. Digestive System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 646 Unit 6 Maintenance of the Body Accessory salivary gland Tongue Accessory salivary gland Lingual frenulum Parotid gland Opening of submandibular duct Sublingual ducts Parotid duct Masseter muscle Sublingual gland Submandibular Submandibular gland duct Mandible (cut) FIGURE 18. Mucous cells Intralobular parotid duct Lumen of Seromucous submandibular acini intralobular duct Serous cells (a) (b) Mucous cells Serous cells Intralobular (c) sublingual duct FIGURE 18. Digestive System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 18 Digestive System 647 TABLE 18. The right side has been cut away to illustrate the interior structures in the pharynx. The middle constrictor three regions: the nasopharynx, posterior to the nasal cavity; the muscle arises from the hyoid bone and stylohyoid ligament and oropharynx, posterior to the oral cavity; and the laryngopharynx, encircles the middle portion of the pharynx.

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