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By Y. Ben. Sweet Briar College.

Neutrophils do not arrive at sites of delayed- when hemoglobin binds carbon monoxide discount cefadroxil 250mg line. Eosinophils throcytes possess two distinct types of hemoglobin buy cefadroxil 250mg fast delivery, play a role in immediate hypersensitivity to many anti- HbA and HbA2. These hemoglobin molecules may be gens that cause symptoms of allergy, such as sneezing saturated with oxygen (HbO2) or reduced to Hb when and stuffy nose, but do not participate in the delayed oxygen is released to cells within tissues. Superoxide anion is generated when cells programmed to respond specifically to this anti- oxygen is reduced by cytoplasmic NADPH. The re- gen derived from the bacteria that cause tuberculosis, duction is carried out by the enzyme NADPH oxidase, and not by a metabolite of this protein. Antibody specificity is dictated by the APPENDIX A Answers to Review Questions 715 sequence of amino acids within the variable regions of R P/Q the light and heavy chains. The Fc region is a site for an- where Q 95 5 100 mL/min tibody docking to effector cells and does not play a role and P 75 25 50 mm Hg. The constant region has a similar structure in antibodies of widely divergent specificity R 50/100 0. Fc receptors are sites on immune effector cells that interact with the Fc region of the antibody molecule and do not define an Chapter 13 antibody’s specificity. Voltage-gated Na channels are re- secreted IgA molecules that allows the molecule to sponsible for phase 0 in ventricular muscle. The potassium channels mentioned do not activated when tissue thromboplastin (tissue factor) is play a role in mediating depolarization. The form of the QRS will be normal curs later and is a step involved in the activation of because electrical excitation of the ventricles occurs both the intrinsic and the extrinsic pathways. With complete bin to thrombin and conversion of fibrinogen to fibrin heart block, P waves and QRS complexes are com- are the final steps that lead to clot formation by either pletely independent of each other. There will not be a consistent ratio of P waves to QRS complexes Chapter 12 because the two are disassociated, but the average ra- tio would be 80/40 or 2:1. Changes be significantly different from normal because depolar- in transmural pressure can be caused by changes inside ization now originates in the right ventricle and prop- or outside of a vessel (see equation 5). Because the right side of blood does not directly affect transmural pressure. Re- the heart depolarizes before the left, the configuration sistance, not transmural pressure, is proportional to the of the QRS may resemble that seen with left bundle length of a tube.

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The parietal pericardium is actually The wall of the heart is composed of three distinct layers composed of an outer fibrous pericardium and an inner serous (table 16 order 250 mg cefadroxil. It is the serous pericardium that produces the lu- visceral pericardium buy cefadroxil 250 mg fast delivery. The space between this layer and the parietal bricating pericardial fluid that allows the heart to beat in a pericardium is the pericardial cavity, just described. It is composed of cardiac muscle tissue (see chapter 4) and arranged Pericarditis is an inflammation of the parietal pericardium in such a way that the contraction of the muscle bundles results that results in an increased secretion of fluid into the pericar- dial cavity. Because the tough, fibrous portion of the parietal peri- in squeezing or wringing of the heart chambers. The thickness of cardium is inelastic, an increase in fluid pressure impairs the the myocardium varies in accordance with the force needed to movement of blood into and out of the chambers of the heart. Thus, the thickest por- Some of the pericardial fluid may be withdrawn for analysis by in- tion of the myocardium surrounds the left ventricle and the atrial jecting a needle to the left of the xiphoid process to pierce the pari- etal pericardium. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 547 TABLE 16. In- separated from each other by the thin, muscular interatrial sep- flammation of the endocardium is called endocarditis. Atrioventricular valves (AV valves) lie between the atria and ventricles, and semilunar valves are located at the bases of the two large vessels leaving the heart. The atria contract and empty simultaneously into vessels that supply blood to the muscular wall of the heart. The most prominent groove is the coronary sulcus that encircles the walls of the atria are reinforced with latticelike pestinate mus- heart and marks the division between the atria and ventricles. Contraction of these modified cardiac muscles ejects blood The partition between the right and left ventricles is denoted by from the atria to the ventricles. Each atrium has an ear-shaped, two (anterior and posterior) interventricular sulci. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 548 Unit 6 Maintenance of the Body TABLE 16. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 549 Left common carotid artery Left subclavian artery Brachiocephalic trunk Aortic arch Superior vena cava Descending aorta Left pulmonary artery Azygos vein Branches of left Right pulmonary artery pulmonary artery Branches of right pulmonary artery Left pulmonary veins Left atrium Right pulmonary veins Posterior cardiac vein Right atrium Coronary sinus Inferior vena cava Left ventricle Right ventricle (b) Aortic arch Superior vena cava Left pulmonary artery Pulmonary trunk Right pulmonary veins Left pulmonary veins Left atrium Pulmonary valve Aortic valve Right atrium Left atrioventricular valve Right atrioventricular valve Papillary muscle Chordae tendineae Interventricular septum Left ventricle Inferior vena cava Trabeculae carneae Right ventricle (c) FIGURE 16. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 550 Unit 6 Maintenance of the Body The following discussion shows the sequence in which The walls of the left ventricle are thicker than those of blood flows through the atria, ventricles, and valves.

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Cardiac output will increase until it equals Blood is redistributed to the legs from the central blood the sum of the previous venous return to the heart plus the volume by the following sequence of events order cefadroxil 250mg otc. However cefadroxil 250 mg line, much of the blood reaching the legs remains in the veins as Central Blood Volume Is Influenced by they become passively stretched to their new size by the in- Total Blood Volume and Its Distribution. As cardiac output exceeds venous re- of the ventricles, and therefore, central blood volume is an turn for a few beats, the central blood volume falls (as does important influence on cardiac output. Central blood vol- the end-diastolic fiber length, stroke volume, and cardiac ume is altered by two events: changes in total blood volume output). Once the veins of the legs reach their new steady- and changes in the distribution of total blood volume be- state volume, the venous return again equals cardiac output. The equality between venous return and cardiac output is reestablished even though the central blood volume is re- Changes in Total Blood Volume. However, the new cardiac output and ve- blood volume can occur as a result of an infusion of fluid, nous return are decreased (relative to what they were before the retention of salt and water by the kidneys, or a shift in standing) because of the reduction in central blood volume. A decrease in Without compensation, the resulting decrease in systemic blood volume can occur as a result of hemorrhage, losses arterial pressure would cause a drop in brain blood flow and through sweat or other body fluids, or the transfer of fluid loss of consciousness. Compensatory events, including in- from plasma into the interstitial space. In the absence of creased activity of the sympathetic nervous system, to be compensatory events, changes in blood volume result in discussed in Chapter 18, are required to maintain arterial proportional changes in both central and extrathoracic pressure in the face of decreased cardiac output. For example, a moderate hemorrhage (10% When the smooth muscle of the systemic veins con- of blood volume) with no distribution shift would cause a tracts, the compliance of the systemic veins decreases. The reduced central results in a redistribution of blood volume toward the cen- blood volume would, in the absence of compensatory tral blood volume. Venoconstriction is an important com- events, lead to decreased filling of the ventricles and di- pensatory mechanism following hemorrhage. Central blood volume can be altered by a shift in blood volume to or away from the periphery. Shifts in the distribution of blood volume THE COUPLING OF VENOUS RETURN occur for two reasons: a change in transmural pressure or a AND CARDIAC OUTPUT change in venous compliance. Changes in the transmural pressure of vessels in the Because the blood moves in a closed circuit, venous re- chest or periphery enlarge or diminish their size. Because turn—the flow of blood from the periphery back to the there is a finite volume of blood, it shifts in response to right atrium—must equal cardiac output. The interplay be- changes in transmural pressure in one or the other of these tween venous return and cardiac output can be analyzed regions.

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During a corneal trans- plant generic 250mg cefadroxil with mastercard, the defective cornea is excised and replaced with a transplanted cornea that is sutured into place buy 250mg cefadroxil. It is considered to be the most successful type of homotransplant (between individuals of Conjunctiva the same species). Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 15 Sensory Organs 505 Superior rectus muscle Sclera Conjunctiva Choroid Ciliary body Retina Posterior chamber Anterior Anterior chamber cavity Fovea centralis Cornea Central artery Pupil Central vein Lens Iris Posterior chamber Zonular fibers of suspensory ligament Ora serrata Optic nerve Posterior cavity Inferior rectus muscle FIGURE 15. There is an opening in the choroid at the back regulates the diameter of the pupil (table 15. Contraction of the pupillary The ciliary body is the thickened anterior portion of the constrictor muscle of the iris, stimulated by bright light, con- vascular tunic that forms an internal muscular ring toward the stricts the pupil and diminishes the amount of light entering the front of the eyeball (fig. Contraction of the pupillary dilator mus- collectively called the ciliary muscles are found within the cil- cle, in response to dim light, enlarges the pupil and permits more iary body. The transparent lens consists of tight lay- folds of the iris, so that all newborn babies have blue eyes. A thin, few months, the melanin moves to the surface of the iris and gives clear lens capsule encloses the lens and provides attachment for the baby his or her permanent eye color, ranging from steel blue to dark brown. The arrangement of smooth muscle fibers of the iris presents a The shape of the lens determines the degree to which the unique pattern for each person that is a thousand times more distinc- light rays that pass through will be refracted. Contraction of the ciliary muscles relaxes the suspensory ligament and makes the lens more Internal Tunic (Retina) spherical. A flattened lens permits viewing of a distant contact with the choroid, and an inner nervous layer, or visual object,whereas a rounded lens permits viewing of a close object. The thick nervous layer of the retina ter- The iris is the anterior portion of the vascular tunic and is minates in a jagged margin near the ciliary body called the ora continuous with the choroid. The thin pigmented layer extends anteri- as the colored portion of the eyeball (figs. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 506 Unit 5 Integration and Coordination Lens within lens capsule Conjunctiva Iris Zonular fibers of suspensory ligament Cornea Sclera Creek Meridional fibers Ciliary muscle of ciliary body Circular fibers (a) Ciliary muscle of ciliary body Zonular fibers of suspensory ligament Lens (b) FIGURE 15. The pigmented layer and nervous layer of the retina are not at- ripheral parts of the retina, where they respond to dim light for tached to each other, except where they surround the optic black-and-white vision.

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If a second kidney is not present cheap 250 mg cefadroxil fast delivery, every effort should be made to correct the prob- lem without performing a nephrectomy cheap cefadroxil 250mg without a prescription, which would consign the pa- tient to chronic hemodialysis or kidney transplant. A routine urinalysis reveals red blood cells too numerous to count, no white blood cells, and no bacte- ria. You order an intravenous urogram (IVU) (a), which is an injection of intravenous con- trast material for an exam of the urinary sys- tem, and CT scan (b). What is the large dark mass (filling defect) seen in the urinary bladder (indicated with the letter B) on the IVU? On the CT, white contrast fills the lumen of the urinary bladder (indicated with an arrow). Synchronous tumors are tumors of the (a) same cell type occuring at the same time in separate locations. Urinary System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 19 Urinary System 695 CLINICAL PRACTICUM 19. She describes the pain as intermittent and crampy, but de- nies any fever or blood in her urine. Physical exam shows a nontender ab- domen and no evidence of costovertebral angle tenderness. Routine urinalysis shows minimal red blood cells, no white blood cells, and no bacteria. What effect does this have on the ureter as demonstrated by the postcontrast image? Precontrast image Postcontrast image Chapter Summary Introduction to the Urinary System 3. The end product of the deliver blood to peritubular capillaries which is folded into rugae. These urinary system is urine, which is voided surrounding the nephron tubules.

By Y. Ben. Sweet Briar College.

Neutrophils do not arrive at sites of delayed- when hemoglobin binds carbon monoxide discount cefadroxil 250mg line. Eosinophils throcytes possess two distinct types of hemoglobin buy cefadroxil 250mg fast delivery, play a role in immediate hypersensitivity to many anti- HbA and HbA2. These hemoglobin molecules may be gens that cause symptoms of allergy, such as sneezing saturated with oxygen (HbO2) or reduced to Hb when and stuffy nose, but do not participate in the delayed oxygen is released to cells within tissues. Superoxide anion is generated when cells programmed to respond specifically to this anti- oxygen is reduced by cytoplasmic NADPH. The re- gen derived from the bacteria that cause tuberculosis, duction is carried out by the enzyme NADPH oxidase, and not by a metabolite of this protein. Antibody specificity is dictated by the APPENDIX A Answers to Review Questions 715 sequence of amino acids within the variable regions of R P/Q the light and heavy chains. The Fc region is a site for an- where Q 95 5 100 mL/min tibody docking to effector cells and does not play a role and P 75 25 50 mm Hg. The constant region has a similar structure in antibodies of widely divergent specificity R 50/100 0. Fc receptors are sites on immune effector cells that interact with the Fc region of the antibody molecule and do not define an Chapter 13 antibody’s specificity. Voltage-gated Na channels are re- secreted IgA molecules that allows the molecule to sponsible for phase 0 in ventricular muscle. The potassium channels mentioned do not activated when tissue thromboplastin (tissue factor) is play a role in mediating depolarization. The form of the QRS will be normal curs later and is a step involved in the activation of because electrical excitation of the ventricles occurs both the intrinsic and the extrinsic pathways. With complete bin to thrombin and conversion of fibrinogen to fibrin heart block, P waves and QRS complexes are com- are the final steps that lead to clot formation by either pletely independent of each other. There will not be a consistent ratio of P waves to QRS complexes Chapter 12 because the two are disassociated, but the average ra- tio would be 80/40 or 2:1. Changes be significantly different from normal because depolar- in transmural pressure can be caused by changes inside ization now originates in the right ventricle and prop- or outside of a vessel (see equation 5). Because the right side of blood does not directly affect transmural pressure. Re- the heart depolarizes before the left, the configuration sistance, not transmural pressure, is proportional to the of the QRS may resemble that seen with left bundle length of a tube.

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The parietal pericardium is actually The wall of the heart is composed of three distinct layers composed of an outer fibrous pericardium and an inner serous (table 16 order 250 mg cefadroxil. It is the serous pericardium that produces the lu- visceral pericardium buy cefadroxil 250 mg fast delivery. The space between this layer and the parietal bricating pericardial fluid that allows the heart to beat in a pericardium is the pericardial cavity, just described. It is composed of cardiac muscle tissue (see chapter 4) and arranged Pericarditis is an inflammation of the parietal pericardium in such a way that the contraction of the muscle bundles results that results in an increased secretion of fluid into the pericar- dial cavity. Because the tough, fibrous portion of the parietal peri- in squeezing or wringing of the heart chambers. The thickness of cardium is inelastic, an increase in fluid pressure impairs the the myocardium varies in accordance with the force needed to movement of blood into and out of the chambers of the heart. Thus, the thickest por- Some of the pericardial fluid may be withdrawn for analysis by in- tion of the myocardium surrounds the left ventricle and the atrial jecting a needle to the left of the xiphoid process to pierce the pari- etal pericardium. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 547 TABLE 16. In- separated from each other by the thin, muscular interatrial sep- flammation of the endocardium is called endocarditis. Atrioventricular valves (AV valves) lie between the atria and ventricles, and semilunar valves are located at the bases of the two large vessels leaving the heart. The atria contract and empty simultaneously into vessels that supply blood to the muscular wall of the heart. The most prominent groove is the coronary sulcus that encircles the walls of the atria are reinforced with latticelike pestinate mus- heart and marks the division between the atria and ventricles. Contraction of these modified cardiac muscles ejects blood The partition between the right and left ventricles is denoted by from the atria to the ventricles. Each atrium has an ear-shaped, two (anterior and posterior) interventricular sulci. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 548 Unit 6 Maintenance of the Body TABLE 16. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 549 Left common carotid artery Left subclavian artery Brachiocephalic trunk Aortic arch Superior vena cava Descending aorta Left pulmonary artery Azygos vein Branches of left Right pulmonary artery pulmonary artery Branches of right pulmonary artery Left pulmonary veins Left atrium Right pulmonary veins Posterior cardiac vein Right atrium Coronary sinus Inferior vena cava Left ventricle Right ventricle (b) Aortic arch Superior vena cava Left pulmonary artery Pulmonary trunk Right pulmonary veins Left pulmonary veins Left atrium Pulmonary valve Aortic valve Right atrium Left atrioventricular valve Right atrioventricular valve Papillary muscle Chordae tendineae Interventricular septum Left ventricle Inferior vena cava Trabeculae carneae Right ventricle (c) FIGURE 16. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 550 Unit 6 Maintenance of the Body The following discussion shows the sequence in which The walls of the left ventricle are thicker than those of blood flows through the atria, ventricles, and valves.

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Cardiac output will increase until it equals Blood is redistributed to the legs from the central blood the sum of the previous venous return to the heart plus the volume by the following sequence of events order cefadroxil 250mg otc. However cefadroxil 250 mg line, much of the blood reaching the legs remains in the veins as Central Blood Volume Is Influenced by they become passively stretched to their new size by the in- Total Blood Volume and Its Distribution. As cardiac output exceeds venous re- of the ventricles, and therefore, central blood volume is an turn for a few beats, the central blood volume falls (as does important influence on cardiac output. Central blood vol- the end-diastolic fiber length, stroke volume, and cardiac ume is altered by two events: changes in total blood volume output). Once the veins of the legs reach their new steady- and changes in the distribution of total blood volume be- state volume, the venous return again equals cardiac output. The equality between venous return and cardiac output is reestablished even though the central blood volume is re- Changes in Total Blood Volume. However, the new cardiac output and ve- blood volume can occur as a result of an infusion of fluid, nous return are decreased (relative to what they were before the retention of salt and water by the kidneys, or a shift in standing) because of the reduction in central blood volume. A decrease in Without compensation, the resulting decrease in systemic blood volume can occur as a result of hemorrhage, losses arterial pressure would cause a drop in brain blood flow and through sweat or other body fluids, or the transfer of fluid loss of consciousness. Compensatory events, including in- from plasma into the interstitial space. In the absence of creased activity of the sympathetic nervous system, to be compensatory events, changes in blood volume result in discussed in Chapter 18, are required to maintain arterial proportional changes in both central and extrathoracic pressure in the face of decreased cardiac output. For example, a moderate hemorrhage (10% When the smooth muscle of the systemic veins con- of blood volume) with no distribution shift would cause a tracts, the compliance of the systemic veins decreases. The reduced central results in a redistribution of blood volume toward the cen- blood volume would, in the absence of compensatory tral blood volume. Venoconstriction is an important com- events, lead to decreased filling of the ventricles and di- pensatory mechanism following hemorrhage. Central blood volume can be altered by a shift in blood volume to or away from the periphery. Shifts in the distribution of blood volume THE COUPLING OF VENOUS RETURN occur for two reasons: a change in transmural pressure or a AND CARDIAC OUTPUT change in venous compliance. Changes in the transmural pressure of vessels in the Because the blood moves in a closed circuit, venous re- chest or periphery enlarge or diminish their size. Because turn—the flow of blood from the periphery back to the there is a finite volume of blood, it shifts in response to right atrium—must equal cardiac output. The interplay be- changes in transmural pressure in one or the other of these tween venous return and cardiac output can be analyzed regions.

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During a corneal trans- plant generic 250mg cefadroxil with mastercard, the defective cornea is excised and replaced with a transplanted cornea that is sutured into place buy 250mg cefadroxil. It is considered to be the most successful type of homotransplant (between individuals of Conjunctiva the same species). Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 15 Sensory Organs 505 Superior rectus muscle Sclera Conjunctiva Choroid Ciliary body Retina Posterior chamber Anterior Anterior chamber cavity Fovea centralis Cornea Central artery Pupil Central vein Lens Iris Posterior chamber Zonular fibers of suspensory ligament Ora serrata Optic nerve Posterior cavity Inferior rectus muscle FIGURE 15. There is an opening in the choroid at the back regulates the diameter of the pupil (table 15. Contraction of the pupillary The ciliary body is the thickened anterior portion of the constrictor muscle of the iris, stimulated by bright light, con- vascular tunic that forms an internal muscular ring toward the stricts the pupil and diminishes the amount of light entering the front of the eyeball (fig. Contraction of the pupillary dilator mus- collectively called the ciliary muscles are found within the cil- cle, in response to dim light, enlarges the pupil and permits more iary body. The transparent lens consists of tight lay- folds of the iris, so that all newborn babies have blue eyes. A thin, few months, the melanin moves to the surface of the iris and gives clear lens capsule encloses the lens and provides attachment for the baby his or her permanent eye color, ranging from steel blue to dark brown. The arrangement of smooth muscle fibers of the iris presents a The shape of the lens determines the degree to which the unique pattern for each person that is a thousand times more distinc- light rays that pass through will be refracted. Contraction of the ciliary muscles relaxes the suspensory ligament and makes the lens more Internal Tunic (Retina) spherical. A flattened lens permits viewing of a distant contact with the choroid, and an inner nervous layer, or visual object,whereas a rounded lens permits viewing of a close object. The thick nervous layer of the retina ter- The iris is the anterior portion of the vascular tunic and is minates in a jagged margin near the ciliary body called the ora continuous with the choroid. The thin pigmented layer extends anteri- as the colored portion of the eyeball (figs. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 506 Unit 5 Integration and Coordination Lens within lens capsule Conjunctiva Iris Zonular fibers of suspensory ligament Cornea Sclera Creek Meridional fibers Ciliary muscle of ciliary body Circular fibers (a) Ciliary muscle of ciliary body Zonular fibers of suspensory ligament Lens (b) FIGURE 15. The pigmented layer and nervous layer of the retina are not at- ripheral parts of the retina, where they respond to dim light for tached to each other, except where they surround the optic black-and-white vision.

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If a second kidney is not present cheap 250 mg cefadroxil fast delivery, every effort should be made to correct the prob- lem without performing a nephrectomy cheap cefadroxil 250mg without a prescription, which would consign the pa- tient to chronic hemodialysis or kidney transplant. A routine urinalysis reveals red blood cells too numerous to count, no white blood cells, and no bacte- ria. You order an intravenous urogram (IVU) (a), which is an injection of intravenous con- trast material for an exam of the urinary sys- tem, and CT scan (b). What is the large dark mass (filling defect) seen in the urinary bladder (indicated with the letter B) on the IVU? On the CT, white contrast fills the lumen of the urinary bladder (indicated with an arrow). Synchronous tumors are tumors of the (a) same cell type occuring at the same time in separate locations. Urinary System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 19 Urinary System 695 CLINICAL PRACTICUM 19. She describes the pain as intermittent and crampy, but de- nies any fever or blood in her urine. Physical exam shows a nontender ab- domen and no evidence of costovertebral angle tenderness. Routine urinalysis shows minimal red blood cells, no white blood cells, and no bacteria. What effect does this have on the ureter as demonstrated by the postcontrast image? Precontrast image Postcontrast image Chapter Summary Introduction to the Urinary System 3. The end product of the deliver blood to peritubular capillaries which is folded into rugae. These urinary system is urine, which is voided surrounding the nephron tubules.