By N. Vandorn. Cumberland College.

The suddenness of may even preclude procedures such as the loss does not give individuals the cochlear implant that could improve the opportunity to adapt gradually as hearing ability to hear discount silagra 100 mg on line. Deaf individuals may diminishes; consequently generic 50mg silagra mastercard, they are unlike- believe that attempts to correct their hear- ly to have developed signing skills purchase silagra 100 mg visa. De- ing is an implication that they have a pression can also interfere with learning medical condition that needs a cure discount silagra 100 mg with amex, per- and using new communication skills buy 100mg silagra visa. Counselors trained in The Deaf culture does not exist in a vac- sign language may not be readily avail- uum. Individuals may be imbedded in the able, and the use of an interpreter for Deaf culture, but they are also imbued counseling sessions may increase the with values, attitudes, and behaviors that reluctance to participate or to disclose feel- are part of a larger national culture as well ings openly. This fact creates another experienced by the adult with hearing loss layer of diversity. Just as adults with hear- ing loss must work through their feelings Hearing loss is often associated with iso- to achieve a healthy adjustment, so must lation because of the very nature of the parents before they can be of optimal disability itself. The ed sounds, such as the voices of loved ones, development of additional medical condi- music, or the chirping of birds, may be a tions that threaten these resources is of difficult loss to accept. A visual impairment or Because hearing loss is an invisible dis- conditions that affect the hands, such as ability, denial is common, especially for rheumatoid arthritis, can seriously hamper those who acquire a hearing loss later in individuals’ accustomed means of commu- life. They may react with increased sensi- nication if they are using ASL or Signed tivity or irritability when they do not under- English, necessitating additional training in stand words. Psychosocial Issues in Hearing Loss 167 Lifestyle Issues in Hearing Loss individuals as an emotional loss. Indi- viduals who are single may have more dif- Many daily activities involve the sense ficulty meeting potential partners and of hearing. For individuals with hearing establishing communication that could loss, simple transactions, such as purchas- lead to a more intimate relationship. In some instances, use of a third The social environment of individuals party as an interpreter may be a solution; with hearing loss is profoundly altered however, individuals who are hard of hear- because of the need for alternate means of ing or deaf may resent the loss of privacy communication. Individuals who have or the sense of independence associated been deaf since birth or early childhood with the use of an interpreter. Special life, however, frequently do not join the devices are necessary to make daily envi- Deaf community and may feel more iso- ronmental sounds, such as a knock on the lated, feeling they fit neither into the Deaf door, known to individuals with hearing community nor into the hearing world. Technology and special aids become, Language plays an important role in reg- in many instances, a necessity. For instance, without awareness of hearing may have difficulty developing and sensitivity of other family members, cooperative play with hearing playmates. They may children and fostering a shared commu- also find themselves increasingly left out nication system that encourages social of family decision making and discussions. Hearing loss at an early age also Depending on the degree of hearing has implications for literacy. Individuals loss, special activities, such as watching who have been deaf from an early age usu- television or attending movies, plays, and ally have a literacy level of fourth to fifth concerts, may also be affected. Low vices mentioned previously may help in- literacy rates may be attributed to lack of dividuals participate more fully in such consensus on educational methods. In addition, television decoders phasis is often placed on techniques of that provide captioned programming may communication, with less emphasis on be available to enable individuals with content matter. Some people may feel social and cultural contacts with the hear- uncomfortable or impatient while attempt- ing world because they have grown up ing to communicate with individuals with with the language and culture of the hear- hearing loss; consequently, they may ing world. Some may con- were deaf from an early age and use ASL sider deafness a social stigma because of as their primary language feel part of the myths and misconceptions about hearing Deaf community, which has established a impairments. Such attitudes build a bar- culture in which there are, in addition to rier to acceptance by others and to inclu- language, specific norms and characteris- sion in the larger social community. Individuals in this culture identify Societal responses can create difficult and with the Deaf community and tend to stressful situations for individuals with a view deafness not as a disability but rather hearing impairment, discouraging further as an alternative culture and associated participation in social functions. Individuals who do not speak the ber of support groups directed toward language are frequently viewed as out- individuals with adult or late-onset hear- siders and are not readily integrated into ing loss are available. Self Help for Hard of Hearing People Individuals with hearing loss may lim- (SHHH). Another example of such a it social contacts to family members and group is the Association of Late Deafened a few close friends, or they may avoid Adults (ALDA). In addition to offering sup- social contacts altogether because of their port to individuals who are hard of hear- inability to understand what is being said. Lack of under- nities also have other types of support standing by others can contribute to social groups for people with hearing loss. New acquaintances, unfamiliar Although family members serve as a sup- with hearing loss or unaware of the indi- port group for individuals with hearing vidual’s inability to hear, may perceive loss, their attitudes may also impede indi- them as aloof or even rude because of their viduals’ acceptance of their condition and failure to respond to a friendly statement subsequent rehabilitation.

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Pyruvate can be derived from lactate and the glucose-6-phosphatase 50 mg silagra overnight delivery, which is present in the liver but metabolism of glucogenic amino acids—those that can not in muscle or brain trusted 50mg silagra, converts glucose 6-phosphate to contribute to the formation of glucose purchase 100mg silagra visa. This last reaction enables the liver to release glu- gans involved in the production of glucose from noncarbo- cose into the circulation generic silagra 50 mg. Glucose 6-phosphate is an impor- hydrate sources are the liver and the kidneys cheap silagra 100mg with visa. However, be- tant intermediate in carbohydrate metabolism because it cause of its size, the liver plays a far more important role can be channeled either to provide blood glucose or for than the kidney in the production of sugar from noncarbo- glycogen formation. Both glycogenolysis and glycogenesis are hormonally Gluconeogenesis is important in maintaining blood glu- regulated. The pancreas secretes insulin into the portal cose concentrations especially during fasting. Therefore, the liver is the first organ to respond to blood cells and renal medulla are totally dependent on changes in plasma insulin levels, to which it is extremely blood glucose for energy, and glucose is the preferred sub- sensitive. For instance, a doubling of portal insulin concen- strate for the brain. Most amino acids can contribute to the tration completely shuts down hepatic glucose production. Insulin tends to lower blood glucose gluconeogenesis is not the liver enzymes but the availabil- by stimulating glycogenesis and suppressing glycogenoly- ity of substrates. Glucagon, in contrast, stimulates nephrine and glucagon but greatly suppressed by insulin. Although one might expect patients with liver disease to have difficulty The Liver Plays an Important Role regulating blood glucose, this is usually not the case be- cause of the relatively large reserve of hepatic function. Some patients with advanced liver disease develop lipid and protein) from the plasma. Lipid is circulated in the portal hypertension, which induces the formation of por- plasma as lipoproteins because lipid and water are not mis- tosystemic shunting, resulting in elevated arterial blood levels of insulin and glucagon. Monosaccharides are first phosphorylated by a reaction catalyzed by the en- zyme hexokinase. In the liver (but not in the muscle), there is a specific enzyme (glucokinase) for the phosphorylation of glucose to form glucose 6-phosphate. Depending on the energy requirement, the glucose 6-phosphate is channeled to glycogen synthesis or used for energy production by the - glycolytic pathway. Fructose is taken up by the liver and phosphorylated by fructokinase to form fructose 1-phosphate. This molecule is either isomerized to form glucose 6-phosphate or metabo- lized by the glycolytic pathway. Fructose 1-phosphate is used by the glycolytic pathway more efficiently than glu- cose 6-phosphate. Galactose is an important sugar used not only to provide energy but also in the biosynthesis of glycoproteins and glycolipids. When galactose is taken up by the liver, it is phosphorylated to form galactose 1-phosphate, which then reacts with uridine diphosphate-glucose, or UDP-glucose, to form UDP-galactose and glucose 1-phosphate. The UDP-galactose can be used for glycoprotein and glycolipid biosynthesis or converted to UDP-glucose, which can then be recycled. Gluconeogenesis is the production of very low density lipoprotein; TG, triglycerides; TCA, tricar- glucose from noncarbohydrate sources such as fat, amino boxylic acid. CHAPTER 28 The Physiology of the Liver 519 cible; the lipid droplets coalesce in an aqueous medium. The human liver normally has a consider- lipoprotein particles stabilize the hydrophobic triglyceride able capacity to produce VLDLs, but in acute or chronic center of the particle. During fasting, fatty acids are mobilized from adipose Liver VLDLs are associated with an important class of tissue and are taken up by the liver. The two forms of circulating hepatocytes to provide energy via -oxidation, for the gen- apo B are B48 and B100. The human liver makes only apo eration of ketone bodies, and to synthesize the triglyceride B100, which has a molecular weight of about 500,000. After feeding, chylomi- B100 is important for the hepatic secretion of VLDL. In crons from the small intestine are metabolized peripherally, abetalipoproteinemia, apo B synthesis and, therefore, the and the chylomicron remnants formed are rapidly taken up secretion of VLDLs is blocked.

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The abdominal portion of the aorta has called erythropoiesis; leukocytes are because the pressure is greater in the the following branches: the inferior formed through leukopoiesis buy cheap silagra 50 mg on line. Closing of the AV valves causes the first renal order silagra 50mg online, suprarenal discount silagra 50mg amex, testicular (or ovarian) buy silagra 50mg otc, sac order silagra 100 mg fast delivery, liver, and spleen. In the adult, red sound (lub); closing of the pulmonary and and inferior mesenteric arteries. Heart murmurs are commonly internal and external iliac arteries, which caused by abnormal valves or by septal supply branches to the pelvis and lower Heart (pp. The wall of the heart consists of the conduction is called an electrocardiogram Principal Veins of the Body epicardium, myocardium, and (ECG or EKG). Blood from the head and neck is drained (a) The right atrium receives blood from Blood Vessels (pp. Arteries and veins have a tunica externa, blood from the brain is drained by the and the right ventricle pumps blood tunica media, and tunica interna. Arteries ventricle pumps blood into the transport blood away from the heart. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 600 Unit 6 Maintenance of the Body 3. In the thorax, the superior vena cava is oxygen and nutrients are obtained from 2. Lymphatic capillaries drain interstitial formed by the union of the two the placenta rather than from the fetal fluid, which is formed from blood plasma; brachiocephalic veins and also collects lungs and GI tract. Fully oxygenated blood is carried only in capillaries, it is called lymph. The lower extremity is drained by both the umbilical vein, which drains the 3. This blood is carried via the via two large lymph ducts—the thoracic the fifth lumbar vertebra, the right and ductus venosus to the inferior vena cava duct and the right lymphatic duct. Partially oxygenated blood is shunted contain phagocytic cells and lymphatic 5. Blood from capillaries in the GI tract is from the right to the left atrium via the nodules that produce lymphocytes. Lymphoid organs include the lymph (a) This venous blood then passes through trunk to the aorta via the ductus nodes, tonsils, spleen, and thymus. The lymphatic system returns excess characterized by two capillary beds in interstitial fluid to the venous system and a series is called a portal system. Structural adaptations in the fetal cardiovascular system reflect the fact that Review Activities Objective Questions (c) depolarization of the ventricles. Which of the following is not a formed (d) repolarization of the ventricles. Which of the following does not arise (a) the ductus arteriosus (a) a leukocyte (c) a fibrinogen from the aortic arch? An elevated white blood cell count is (b) the left coronary artery (d) the aorta referred to as (c) the left common carotid artery (a) leukocytosis. Explain how the development of the (c) the renal arteries (d) the basilar artery aortic arches contributes to the formation (d) the coronary arteries 9. The maxillary and superficial temporal of the major vessels associated with the 4. The first heart sound (lub) is produced by (a) the liver (c) both a and b cavity. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 601 7. Some passenger planes are now equipped arteries, capillaries, and veins. What symptoms would a patient display a thrombus (blood clot) in his lower thigh blood pressure? A low platelet patient’s physician explained that shoulder regions that are not symmetrical count?

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