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These small terminal branches penetrate the sarcolemma and form a special structure known as the motor end plate buy pyridium 200 mg without a prescription erythematous gastritis diet, or synapse generic pyridium 200 mg visa chronic gastritis stress. This neuromuscular unit consisting of one motor neuron and all the muscle fibers that it innervates is called the motor unit discount pyridium online visa chronic gastritis recovery time. Interference — either chemical or physical — with the nerve pathway can affect the action of the muscle or stop the action altogether, resulting in muscle paralysis. There also are afferent, or sensory, nerves that carry information about muscle condition to the brain. When an impulse moves through the synapse and the motor unit, it must arrive virtu- ally simultaneously at each of the individual sarcomeres to create an efficient contrac- tion. The fiber’s membrane forms deep invaginations, or inward-folding sheaths, at the Z-line of the myofibrils. The resulting inward-reaching tubules ensure that the sarcomeres are stimulated at nearly the same time. In other words, if a single muscle fiber is going to contract, it’s going to do so to its fullest extent. Following are some practice questions that deal with muscle anatomy and contraction: 13. False Pulling Together: Muscles as Organs A muscle organ has two parts: The belly, composed predominantly of muscle fibers The tendon, composed of fibrous, or collagenous, regular connective tissue. If the tendon is a flat, sheet-like structure attaching a wide muscle, it’s called an aponeurosis. Each muscle fiber outside of the sarcolemma is surrounded by areolar connective tissue called endomysium that binds the fibers together into bundles called fasciculi (see Figure 6-2). Each bundle, or fasciculus, is surrounded by areolar connective tissue called perimysium. All the fasciculi together make up the belly of the muscle, which is surrounded by areolar connective tissue called the epimysium. Blood vessels, lymph vessels, and nerves pass into the fasciculus through areolar connective tissue called the trabecula. These blood vessels in turn branch off into capillaries that surround the muscle fibers in the endomysium. Fasciculus Epimysium Muscle fiber (cell) (wrapped by perimysium) (deep fascia) Tendon Figure 6-2: Connective tissue in a Perimysium Bone muscle. Endomysium Blood vessel (between fibers) Illustration by Imagineering Media Services Inc. Nonetheless, it has been demonstrated that fewer action potentials — a weaker stimulus, as it were — causes fewer motor units to become involved in a contraction. So it’s true that a muscle organ can have varying degrees of contrac- tion depending on the level of stimulation. As for how this can be so, one theory pro- poses that individual fibers have specific thresholds of excitation; thus, those with higher thresholds only respond to stronger stimuli. The other theory holds that the deeper a fiber is buried in the muscle, the less accessible it is to incoming stimuli. Complete fatigue occurs when no more twitches can be elicited, even with increasing intensity of stimulation. The short lapse of time between the application of a stimulus and the beginning of muscular response is called the latent period. Two types of muscle contraction relate to tone: Isometric: Occurs when a contracting muscle is unable to move a load (or heft a piece of luggage or push a building to one side). Isotonic: Occurs when the resistance offered by the load (or the gardening hoe or the cold can of soda) is less than the tension developed, thus shortening the muscle and resulting in mechanical work. Each muscle depends upon compan- ions in a muscle group to assist in executing a particular movement. Prime movers: Just as it sounds, these muscles are the workhorses that produce movement. Fixators or fixation muscles: These muscles serve to steady a part while other muscles execute movement.

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Each tract is named according to its origin and the joint of synapse generic pyridium 200 mg on line gastritis caused by diet, such as the corti- cospinal and spinothalmic tracts order cheap pyridium gastritis diet treatment. Thirty-one pairs of spinal nerves arise from the sides of the spinal cord and leave the cord through the intervertebral foramina (spaces) to form the peripheral nervous Chapter 15: Feeling Jumpy: The Nervous System 245 system quality 200 mg pyridium erosive gastritis definition, which we discuss in the later section “Taking Side Streets: The Peripheral Nervous System. In this section, we review six major divisions of the brain from the bottom up (see Figure 15-3): medulla oblongata, pons, midbrain, cerebellum, diencephalon, and cerebrum. Medulla oblongata The spinal cord meets the brain at the medulla oblongata, or brainstem, just below the right and left cerebellar hemispheres of the brain. In fact, the medulla oblongata is con- tinuous with the spinal cord at its base (inferiorly) and back (dorsally) and located anteriorly and superiorly to the pons. All the afferent and efferent tracts of the cord can be found in the brainstem as part of two bulges of white matter forming an area referred to as the pyramids. Many of the tracts cross from one side to the other at the pyramids, which explains why the right side of the brain controls the left side of the body and vice versa. Along with the pons, the medulla oblongata also forms a network of gray and white matter called the reticular formation, the upper part of the so-called extrapyramidal pathway. With its capacity to arouse the brain to wakefulness, it keeps the brain alert, directs messages in the form of impulses, monitors stimuli entering the sense recep- tors (accepting some and rejecting others it deems to be irrelevant), refines body movements, and effects higher mental processes such as attention, introspection, and reasoning. Although the cortex of the cerebrum is the actual powerhouse of thought, it must be stimulated into action by signals from the reticular formation. Nerve cells in the brainstem are grouped together to form nerve centers (nuclei) that control bodily functions, including cardiac activities, and respiration as well as reflex activities such as sneezing, coughing, vomiting, and alimentary tract movements. The medulla oblongata affects these reactions through the vagus, also referred to as cra- nial nerve X or the 10th cranial nerve. Pons The pons (literally “bridge”) does exactly as its name implies: It connects the cerebel- lum through a structure called the middle peduncle, the cerebrum by the superior peduncle, and the medulla oblongata by the inferior peduncle. It also unites the cere- bellar hemispheres, coordinates muscles on both sides of the body, controls facial muscles (including those used to chew), and regulates the first stage of respiration. Midbrain Between the pons and the diencephalon lies the mesencephalon, or midbrain. It con- tains the corpora quadrigemina, which correlates optical and tactile impulses as well as regulates muscle tone, body posture, and equilibrium through reflex centers in the superior colliculus. The inferior colliculus contains auditory reflex centers and is believed to be responsible for the detection of musical pitch. The midbrain contains Part V: Mission Control: All Systems Go 246 the cerebral aqueduct, which connects the third ventricle of the thalamus with the fourth ventricle of the medulla oblongata (see the section “Ventricles” later in this chapter for more). The red nucleus that contains fibers of the rubrospinal tract, a motor tract that acts as a relay station for impulses from the cerebellum and higher brain centers, also lies within the midbrain, constitut- ing the superior cerebellar peduncle. The second-largest divi- sion of the brain, it’s just above and overhangs the medulla oblongata and lies just beneath the rear portion of the cerebrum. The cerebellar cortex or gray matter contains Purkinje neurons with pear-shaped cell bodies, a multitude of dendrites, and a single axon. It sends impulses to the white matter of the cerebellum and to other deeper nuclei in the cerebellum, and then to the brainstem. The cerebellar cortex has parallel ridges called the folia cerebelli, which are separated by deep sulci. Diencephalon The diencephalon, a region between the mesencephalon and the cerebrum, contains separate brain structures called the thalamus, epithalamus, subthalamus, and hypothal- amus. The region where the two sides of the thalami come in contact and join forces is called the intermediate mass. The thalamus is a primitive receptive center through which the sensory impulses travel on their way to the cerebral cortex. Here, nerve fibers from the spinal cord and lower parts of the brain synapse with neurons leading to the sensory areas of the cortex of the cerebrum. The thalamus is the great integrat- ing center of the brain with the ability to correlate the impulses from tactile, pain, olfactory, and gustatory (taste) senses with motor reactions.

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He should be followed up by an expert sickle team since this has been shown to reduce admissions and improve quality of care generic pyridium 200mg line gastritis diet ketosis. He may benefit from long-term hydroxyurea which raises the HbF level and reduces the number of crises discount pyridium 200 mg overnight delivery gastritis diet mayo clinic. She has had the occasional episode of acute cystitis purchase pyridium 200mg with mastercard gastritis lipase, approximately on a 2-yearly basis. Examination of the cardiovascular and respiratory systems is otherwise unremarkable. Acute appendicitis classically presents with a short his- tory of central abdominal pain which rapidly localizes to the right iliac fossa. There is guard- ing and ‘board-like’ rigidity and rebound tenderness in the right iliac fossa. Untreated, some cases will resolve spontaneously, whereas others will perforate leading to localized or gener- alized peritonitis. Rarely a delayed diagnosis may result in acute appendicitis progressing to an appendix mass consisting of a haemorrhagic oedematous mass in the ileocaecal region. The symptoms of loin pain and presence of blood and protein in the urine mimicking a urinary tract infection suggest the appen- dix may be retrocaecal. Patients with retro-ileal appendicitis often have little abdominal pain, but irritation of the ileum can lead to severe diarrhoea and vomiting. Patients may also present with subacute intestinal obstruction due to intestinal ileus, or urinary reten- tion due to pelvic peritonitis. Differential diagnosis of acute appendicitis • In young adults the differential diagnoses include irritable bowel syndrome, non- specific mesenteric adenitis, ruptured ectopic pregnancy, twisted or haemorrhagic ovarian cysts, infection of the Fallopian tubes and urinary tract infections. The treatment is appendicectomy as soon as urinary tract infection has been excluded. A 62-year-old lady had been admitted 10 days previously to have a right hemicolectomy performed for a cae- cal carcinoma. This was discovered on colonoscopy which was performed to investigate an iron-deficiency anaemia and change in bowel habit. The initial surgery was uneventful, and she was given cefuroxime and metronidazole as routine antibiotic prophy- laxis. Over the next 5 days the patient remained persistently febrile, with negative blood cultures. In the last 24 h, she has also become relatively hypotensive with her systolic blood pressure being about 95 mmHg despite intravenous colloids. Her pulse rate is 110/min regular, blood pressure 95/60 mmHg and jugular venous pressure is not raised. Her sepsis is due to an anastomotic leak with a localized peritonitis which has been partially controlled with antibiotics. Her sepsis syndrome is manifested by fever, tachycardia, hypotension, hypoglycaemia, metabolic acidosis (low bicarbonate) and oliguria. The low sodium and high potassium are common in this condition as cell membrane function becomes less effective. The elevated white count is a marker for bacterial infection and the low platelet count is part of the picture of disseminated intravas- cular coagulation. Jaundice and abnormal liver function tests are common features of intra- abdominal sepsis. Aminoglycosides (gentamicin, streptomycin, amikacin) cause auditory and vestibular dysfunction, as well as acute renal failure. Risk factors for aminoglycoside nephro- toxicity are higher doses and duration of treatment, increased age, pre-existing renal insuffi- ciency, hepatic failure and volume depletion. Monitoring of trough levels is important although an increase in the trough level generally indicates decreased excretion of the drug caused by a fall in the glomerular flow rate. She requires transfer to the intensive care unit where she will need invasive circulatory monitoring with an arterial line and central venous pres- sure line to allow accurate assessment of her colloid and inotrope requirements.

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