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By T. Mine-Boss. Wheaton College, Massachusetts.

An increased level in this enzyme in the blood indicates necrosis or disease in these tissues purchase avana 200mg. Its measurement is most commonly used as part of the differential diagnosis of liver disease and in the tracking of the course of the disease process order discount avana on line. Most alkaline phosphatase in normal serum is derived from the bone order generic avana from india, but the enzyme is produced also in the liver avana 200mg with visa, intestinal mucosa, placenta, breast, and other tissues. Levels are high in the first few months of life, again during bone growth in preadolescence, and then decrease in senility, anemia and malnutrition Alkalosis - an actual or relative increase in blood alkalinity due to an accumulation of alkalies or reduction of acids. An abnormal acid base condition in the body fluids, characterized by a tendency toward an increased pH, as from an excess of alkaline bicarbonate or a deficiency of acid. Respiratory alkalosis may be caused by hyperventilation, central nervous system disease, congestive heart failure, pulmonary embolism, or early salicylate intoxication. Amino acids are the building blocks of proteins and the end products of protein digestion. Approximately 80 amino acids are found in nature, but only 20 are necessary for human metabolism or growth. Of these, some can be produced by the liver, the rest, called the essential amino aids, must be supplied by food. These are histidine, isoleucine, leucine, lysine, methionine, cysteine, phenylalanine, tyrosine, threonine, tryptophan, and valine. The nonessential amino acids are alanine, aspartic acid, asginine, citrulline, glutamic acid, glycine, hydroxyglutamic acid, hydroxyproline, norleucine, praline, and serine. Oral preparations of amino acids may be used as dietary supplements Ammonia – a gas formed by decomposition of nitrogen containing substances such as proteins and amino acids. It will turn litmus paper blue Amphetamine – a central nervous stimulant, can be used in the treatment of alcoholism, narcolepsy (sleeping too much) and certain types of mental depression Amygdaloid – resembling the shape of an almond Amylase - a class of enzymes that split or hydrolyze starch. Those found in animals are called alpha amylases; those in plants are called beta amylases Analgesic – a medicine, which relieves pain Anaphylaxis – the reactions which cause anaphylactic shock occur suddenly (minutes to an hour), including increased irritability, shortness of breath, turning “blue”, sometimes convulsions, unconsciousness and death, death usually results from spasms of muscles or bronchioles 393 Anemia – a condition in which there is a reduction in number of circulating red blood cells (hemoglobin) may be caused from excessive blood loss, reduction in red blood cell formation Angina – pain around the heart can be radiating to shoulder, arm or hand, or occasionally to the stomach Angioedema – an allergic disorder characterized by swelling and a rash around the tissues Angioneurotic – a swelling characterized by development of local allergic rash (wheals) accompanied by swelling of the subcutaneous or submucous tissues. Acute cases require confinement due to the very contagious state in the respiratory system Anxiolytic – counteracting or relieving anxiety, a drug that relieves anxiety Apathy – indifference, without emotion, sluggish 394 Aphasia – inability to express oneself properly through speech, or loss of verbal comprehension, it is considered to be complete or total when both sensory and motor areas are involved Aplastic anemia – a defiency of all of the formed elements of the blood, representing a failure of the cell generating capacity of the bone marrow. It may be caused by neoplastic disease of the bone marrow, or more commonly by destruction of the bone marrow by exposure to toxic chemicals, ionizing radiation, or some antibiotics or other medications. Rarely, an idiopathic form of the disease occurs Apnea – temporary or permanent cessation of breathing and therefore, of the body’s intake of oxygen and release of carbon dioxide. It is a serious symptom, especially in patients with other potentially life threatening conditions Apoptosis - cell death as in what happens to the brains in Batten Disease Arrhythmia – irregular heart action caused by disturbances either physiological or pathological Arteriosclerosis – a disease of the arterial vessels marked by thickening, hardening, and loss of elasticity in the arterial walls. Three forms of arteriosclerosis are generally recognized: atherosclerosis, sclerosis of arterioles, and calcific sclerosis of the medial layer of arteries. An increased level in this enzyme in the blood indicates necrosis or disease in these tissues. The episodes may be precipitated by inhalation of allergens or pollutants, infection, vigorous exercise, or emotional stress. Treatment includes 395 elimination of the causative agent, hyposensitization, aerosol or oral bronchodilators, and short term use of corticosteroids. Repeated attacks often result in emphysema and permanent obstructive lung disease Ataxia – a disorder or irregularity, a muscular incoordination especially that manifested when voluntary muscular movements are attempted Atrial fibrillation – irregular and rapid contractions of the heart where the atria and the ventricles are working independently, heart rate can be slow (in the 30’s or very fast in the 200’s), seen when the heart muscle begins to deteriorate. Atropine – used to overcome spasm of involuntary muscles, to help decrease secretions, also used to dilate pupils before testing eyes for glasses to relieve muscle spasm, and to increase heart rate Atypical – deviating from the normal Auditory - pertaining to the sense of hearing Aura – the preepileptic phenomenon where one is aware of a seizure that will be occurring shortly Auscultation – listening for sounds within the body, especially, from the chest, neck, or abdomen. A stethoscope is used, applied to the patient’s skin surface gently but firmly, to eliminate any environmental noises that may be present. They contribute to some of the subconscious aspects of voluntary movement such as accessory movements and inhibiting tremor. They do not initiate movement but rather provide coordination of complex motor circuits. May produce inflammatory lesions of the skin (cutaneous form) or lungs or a generalized invasion of the skin, lungs, bones, central nervous system, kidneys, liver, and spleen Blepharoptosis – drooping of the upper eyelid Blepharospasm – a twitching or spasmodic contraction of the orbicularis oculi muscle due to tics, eyestrain, or nervous irritability Bone marrow – the soft tissue in the marrow cavities of the long bones (yellow marrow) and in the spaces between trabeculae (a cord of tissue) of spongy bone in the sternum and other flat and irregular bones (red marrow). Red marrow produces all the types of blood cells Bowel – the intestine, colon Bradycardia – a normal heart rhythm with a rate of 60 or below in an adult or 70 in a child Bradykinesia – extreme slowness of movement Brain stem – part of the brain at the base of the neck which includes center for regulating and coordinating body activities, perception, the seat of consciousness, thought, memory, reason, judgment and emotion, through reflex centers automatic 397 control of body activities are maintained most important being cardiac, vasomotor, and respiratory centers which regulate circulation and respiration Brompton’s Cocktail – a mixture of cocaine, morphine and antiemetics formerly used to alleviate pain and induce euphoria, especially in patients with cancer Bronchial – a primary division of the trachea, which extends into each lung Bronchitis – inflammation of the bronchial mucous membrane, which a bronchus splits off of the trachea and goes into each lung Bronchodilator – a drug that expand the bronchi by relaxing bronchial muscle. There are three classes of bronchodilators: B2adrenergic-receptor agonists, Methylxanthines and Anticholinergic agents; the B2 adrenergic receptor agonists produce the greatest bronchodilitation in patients with bronchial asthma. The beta2, adrenergic receptor agonists are the best drugs for patients with mild, intermittent asthma and for acute attacks of reactive airway disease Bronchopneumonia – a type of pneumonia marked by scattered consolidation (areas filled with inflammatory exudates) in one or more lobes of the lung. It occurs primarily in infants and in elderly persons, both of whom have decreased resistance to bacterial and viral infections. It is often a complication of bronchitis Broncho-spasm – spasm of the bronchus, which the trachea divides into 2 bronchi, which ends, one in each lung Bruxism – the grinding of the teeth in children especially during sleep. It is a constituent of some kidney stones Calculi – any abnormal concretion, commonly called a stone, within the animal body. A calculus is usually composed of mineral salts, and can be found in the gallbladder, kidneys, ureter, bladder, or urethra Candidiasis – infection of the skin or mucous membrane with any species of Candida. Candida grows in warm moist areas, causing superficial infections of the mouth, vagina, nails, and skin folds of healthy individuals. Sometimes very difficult to get rid of Cardiac arrest – heart stops due to many reasons with the main one being heart attacks Cardiomegaly – enlargement of the heart Cardiomyopathy – any disease that affects the heart muscle, diminishing heart performance Cardiovascular – pertaining to the heart and blood vessels Cardioversion – the restoration of normal sinus rhythm by chemical or electrical means. When preformed mechanically, the procedure relies on or the oral or intravenous administration of antiarrhythmic drugs. Electrical cardioversion relies instead on the delivery of synchronized shock of direct electrical current across the chest wall. It is used to terminate arrhythmias such as atrial fibrillation, atrial flutter, supraventricular tachycardia, and well tolerated ventricular tachycardia. Unlike defibrillation, which is an unsynchronized shock, applied during a dire emergency, electrical cardioversion is timed to avoid the T wave of cardiac repolarization to avoid triggering malignant arrhythmias. A patient will almost always require sedation and analgesia before the procedure Carnitine – a chemical important in metabolizing palmitic and stearic acids. It has been used therapeutically in treating myopathy due to carnitine deficiency. In children that are on Depakote, you need to have their Carnitine levels checked periodically due to the fact that Depakote pulls Carnitine from the body system Carpal tunnel – pain or numbness that affects some part of the median nerve distribution of the hand (the palmer side of the thumb, the index finger, the radial half of the ring finger, and the radial half of the palm) and may radiate to the arms. Patients may have a history of cumulative trauma to the wrist in carpenters, rowers, typists, computer users, or those who regularly use vibrating tools or machinery Cascara – It is the main ingredient in a laxative which is supposed to be fairly good 399 Cataplexy – a sudden brief loss of muscle control brought on by strong emotion or emotional response, such as a hearty laugh, excitement, surprise, or anger. Cataracts – opacity or cloudy looking of the lens of the eye or its capsule or both Catatonic – a phase of schizophrenia in which the patient is unresponsive, the tendency is to remain and assume in a fixed position, refusal to move or talk are characteristics Catecholamines – one of many biologically active amines, including Metanephrines, Dopamines, Epinephrine and Norepinephrine, derived from Amino and Tyrosine. It is composed primarily of secretions of the choroids plexi in the lateral ventricles and in the third and fourth ventricles in the brain. Openings in the roof of the fourth ventricle allow the fluid to flow into the subarachnoid spaces around the brain and the spinal cord. The flow of fluid is from the blood in the choroids plexi, through the ventricles, the central canal, the subarachnoid spaces, and back into the blood. Samples of the fluid may be removed by lumbar puncture Cerebrovascular – pertaining to the blood vessels of the brain especially to pathological changes Ceroids – morbid condition of membranes resembling wax-like scales 400 Cervical erosion – a wearing away of the cervix in the uterus of females Chemoreceptor trigger zone – a sense organ or sensory nerve ending that is stimulated by and reacts to certain chemical stimuli and that is located outside the central nervous system. The excess pigmentation often occurs in pregnant women, in women using oral contraceptives, or in patients with underlying liver disease. Sun exposure tends to worsen the condition Cholelithiasis - formation or presence of stones in the bladder or kidneys or bile- stones in the gallbladder or common duct Cholestatic – arrest of the flow of bile. This may be due to intrahepatic causes, obstruction of the bile duct by gallstones, or any process that blocks the bile duct Cholesterol – a sterol widely distributed in animal tissues. Found in egg yolks, various oils, fats, myelin in the brain, spinal cord and axons, liver, kidneys, and adrenal glands. It is synthesized in the liver and is a normal constituent of most gallstones and of atherosclerotic plaques found in arteries. Spores from the fungus circulate in the air, when the dirt is disturbed during construction, dust storms, or earthquakes. About 80% of those persons living in the southwest and western states have positive skin test, which identify those infected. Usually these infections are asymptomatic and require no treatment Cogwheel rigidity – an abnormal rigor in muscle tissue, characterized by jerky movements when the muscle is passively stretched. Synthetic derivatives of this agent are used medicinally to relax skeletal muscles during anesthesia and critical care Cyanosis – slightly bluish, grayish, slate like or dark purple discoloration of the skin due to presence of abnormal amounts of reduced hemoglobin in the blood Cycloplegia – paralysis of the ciliary muscle (eye). This can be an anticholenergic side effect of antipsychotic or antidepressant medications Cyst – a closed sac or pouch with a definite wall, which contains fluid, semi fluid or solid material, usually an abnormal structure resulting from developmental anomalies, obstruction of ducts, or parasitic infection, usually not cancerous Cystic Fibrosis – a potentially fatal autosomal recessive disease that manifests itself in multiple body systems including the lungs, the pancreas, the urogenital system, the skeleton, and the skin; it causes chronic obstructive pulmonary obstructive disease, frequent lung infections, deficient elaboration of pancreatic enzymes, osteoporosis, and an abnormal high electrolyte concentration in sweat. The street name for this is “speed” Diabetes Mellitus – a chronic metabolic disease marked by hyperglycemia (high sugar level).

The parents wish to know whether the current pregnancy will result in a child with the same rare condition asthe previous child who died cheap avana 50 mg with mastercard. In the direct test purchase avana australia, the mutation causing the disease is the same as the one that alters the restric- tion site order cheapest avana. There is no distance separating the mutations and no chance for recombination to occur buy avana 200 mg online, which might lead to an incorrect conclusion. In the indirect assay,the mutation in the restriction site (a marker) has occurred independently of the mutation causing the disease. Comparison of Direct and Indirect Genetic Diagnosis Direct genetic diagnosis is used whenever possible. Its major limitation is that the disease-pro- ducing mutation(s) must be known if one is to test for them. Key Features of Indirect and Direct Genetic Diagnosis Indirect Direct Diagnosis Diagnosis Family information needed Yes No I 1 Errors possible because of recombination Yes No I Markers may be uninformative Yes No I Multiple mutations can be assayed with a single test Yes No I Disease-causing mutation• itself _must______ be known. Carrier diagnosis in recessive diseases Presymptomatic diagnosis for late-onset diseases • Asymptomatic diagnosis for diseases with reduced penetrance Prenatal diagnosis. Diagnosis of a genetic disease in a fetus may aid in making an u;,formed decision regarding pregnancy ter- mination, and it often aids parents in preparing emotionally and medically for the birth of an affected child. Fetal cells are present in the amniotic fluid and can be used to diagnose single-gene disorders, chromosome abnormalities, and some biochemical disorders. The villi are of fetal origin and thus provide a large sampleof actively dividing fetal cells for diagnosis. This technique has the advantage of providing a diagnosis earlier in the pregnancy. Disadvantages are a higher fetal mortality rate than with amniocentesis (about 1/100) and a small possibility of diagnostic error because of placental mosaicism (i. Preimplantation diagnosis Embryos derived from in vitro fertilization can be diagnosed by removing a single cell, typically from the eight -cell stage (this does not harm the embryo). The pedigree below shows a family in which hemophilia A, an X-linked disorder, is seg- regating. A 22-year-old woman with Marfan syndrome, a dominant genetic disorder, is referred to a prenatal genetics clinic during her tenth week of pregnancy. The amplified product is treated with the restriction enzyme HindU and the fragments separated by I, agarose gel electrophoresis. A 66-year-old man (1-2) has recently been diagnosed with Huntington disease, a late- onset, autosomal dominant condition. She cannot be homozygous for the disease-producing allele (choice B) because her father is unaffected. Homozygosity for the normal allele (choice C) is inconsistent with the results shown on the gel. Note that her father is not affected, and the bottom band in his pattern is in linkage phase with the normal allele of the gene. Choice E is incorrect because Marfan is a dominant disease with no "carrier" status. The restriction site is 10 million bp upstream from the phenylalanine hydroxylase gene so there is a minimum chance of recombination of 10%. Heteroplasmy (choice B) is asso- ciated with mitochondrial pedigrees, and the phenylalanine hydroxylase gene is a nuclear one. The disease-producing allele of the gene is associated with the presence of the HindU site. All the males shown are hemizygous (choice B) for the dystrophin gene because they have only one copy. In an X-linked pattern, this would be characteristic of a female with two copies of the disease-producing allele and is very rarely seen. There is no information about which one is in linkage phase with his disease-producing huntingtin allele. Before her testing, he had a 50% chance of having the disease- producing huntingtin allele. Casey, Administrative Assistant production team who were responsible for this • Yvonne N. Gillam, Associate Developmental project: Editor • Kate Margeson, Illustrations Coordinator • Andy McPhee, Senior Acquisitions Editor, • Frank J. Musick, Developmental Editor, who provided the overall design and layout for Electronic Publishing the sixth edition. His vision and guidance • Bob Butler, Production Manager focused the authors at the onset of the project, • Carolyn O’Brien, Art and Design Manager and his support throughout this endeavor • David Orzechowski, Managing Editor provided cohesiveness. Mayer, Developmental Editor, Manager, Electronic Publishing whose careful and conscientious edits • Elizabeth Y. Her We also extend our sincerest appreciation to Neil enthusiasm and untiring assistance and K. Daluge, support during this project are deeply appre- Senior Regional Manager, and their staff of sales rep- ciated and the authors extend their sincerest resentatives whose continued efforts have undoubt- gratitude. This table well-established track record of presenting medical identifies the interrelationship among the body word-building principles based on competency- systems and helps put each of them into a clear based curricula. Systems is designed with the educational foun- Finally, pharmacology information has been edited dation of a textbook-workbook that complements to include drugs most commonly used in medical all teaching formats, including traditional lecture, treatment. This section continues to provide distance learning, and independent or self-paced generic and trade names, along with their thera- study. Although the study of medical terminology • Chapter 3 presents major prefixes of position, demands hard work and discipline, various self- number and measurement, direction, and other paced activities offer interest and variety to the parameters. A variety of activities and • Chapter 4 introduces anatomical, physiological, resources are available to adopters of the textbook and pathological terms. Illustrations to specific body systems and may be taught in augment course content in new and interesting ways any sequence. Medical dictionaries as well as the American terms; diagnostic and therapeutic procedures; Association for Medical Transcription and the pharmacology; abbreviations; learning activities; American Medical Association support these and medical record activities. The sixth edition contains a summary of self-assessment and evaluation of competency. New to • Appendix A: Answer Key contains answers to this edition is a summary of common symbols as each learning activity to validate proficiency and well as an updated list of “do-not-use” abbrevia- provide immediate feedback for student assess- tions. Educators and practitioners in various • Appendix B: Common Abbreviations and health care disciplines have offered many helpful Symbols includes an updated, comprehensive suggestions for this edition, which have been list of medical abbreviations and their mean- incorporated. A newly developed list of key ings and a new summary of common symbols anatomy and physiology terms, complete with as well as an updated list of “do-not-use” pronunciations and definitions, sets a solid base abbreviations. The sup- dix presents two methods for word-element plemental medical record activities have been indexing—first by medical word element, then updated and include student activities that com- by English term. In addition, each medical record highlights a • Appendix G: Index of Oncological Disorders lists specific body system and correlates it with a oncological disorders presented in the textbook. Medical records can be used for various activities, including oral reports, medical coding, medical transcribing, or indi- Instructor’s Resource Disk vidual assignments. These fun, educational activities many new, innovative instructional aids designed are included for each body system chapter. They to make teaching medical terminology easier and are designed to reinforce material covered in the more effective. The supplemental teaching aids can chapter and can be used individually or in groups. This key should prove helpful as you pre- a powerful, user-friendly test-generation program. The transparency pages offer large, clear, black-and-white anatomical Activity Pack illustrations perfect for making overhead trans- parencies and are provided for each body system. The Activity Pack has been expanded to meet today’s instructional needs and now includes: PowerPoint Presentations • Suggested Course Outlines. Course outlines are provided to help you plan the best method of This edition of Systems contains three powerful covering material presented in the textbook. Lecture newly designed course outline is provided for Notes provides an outline-based presentation for textbooks packaged with Term Plus, the com- each body system chapter.

Diagnosis relies on examination of biopsied lung tissue or bronchial Pneumonia washings (lavage) buy cheap avana 100mg on-line. Pneumonia is any inflammatory disease of the lungs that may be caused by bacteria order line avana, viruses purchase 200mg avana, or Cystic Fibrosis fungi discount 50mg avana free shipping. A type of pneumonia Cystic fibrosis is a hereditary disorder of the associated with influenza is sometimes fatal. This thickened from food or liquid inhalation (aspiration pneu- mucus clogs ducts of the pancreas and digestive monias). As a result, digestion is impaired and the the lung (lobar pneumonia), but some are more patient may suffer from malnutrition. Chest pain, muco- ducts of the sweat glands, causing the skin to purulent sputum, and spitting of blood (hemop- become highly “salty. Medication in and inflammatory debris, the lung tissue looses the form of mists (aerosols) along with postural its spongy texture and become swollen and drainage provide relief. Consolidation is asso- An important diagnostic test called the sweat ciated primarily with bacterial pneumonias, not test measures the amount of salt excreted in sweat. Recent evidence suggests that it is caused patient survival is approximately 30 years. It usually occurs as a result of very serious lung con- Oncology ditions, such as trauma, severe pneumonia, and other major infections that affect the entire body The most common form of lung cancer is bron- (systemic infections) or blood (sepsis). This cancer is usually associated inflammation, and then collapse, making oxygen with tobacco use. Mechanical ventilation is divide repeatedly until the entire epithelium is commonly required to save the life of the patient. It is most Bronchogenic carcinoma spreads (metastasizes) commonly seen in preterm infants or infants born rapidly to other areas of the body, including the to diabetic mothers. Only surfactant, a phospholipid substance that helps about 10% of lung cancers are found in the early keep alveoli open. Flaring of the nostrils (nares) depending on specific cell type, how far the disease and central cyanosis are typically present. Diagnostic, Symptomatic, and Related Terms This section introduces diagnostic, symptomatic, and related terms and their meanings. It is time to review pathological, diagnostic, symptomatic, and related terms by completing Learning Activity 7–3. Descriptions are provided as well as pronunciations and word analyses for selected terms. How- ever, the Mantoux test does not differentiate between active and inactive infection. Additional incisions may be made if nodes are removed or other diagnostic or therapeutic procedures are performed. Pathology 165 Diagnostic and Therapeutic Procedures—cont’d Procedure Descripton Viewing piece Bronchoscope Channel in the flexible tube to accommodate biopsy forceps and instruments Left bronchus Visual examination of left bronchus Figure 7-7. In some cases, small amounts of injected radionu- clide (tracer) are used to enhance images lung Nuclear scanning test primarily used to detect pulmonary emboli Lung scan is commonly performed to detect the presence of a blood clot that may be interfering with blood flow in or to the lung. Children and the elderly can use a spacer to synchronize inhalation with medication release. Another method infections, there are several classes of drugs that of delivering medications directly to the lungs is treat pulmonary disorders. They relax smooth muscles of the bronchi, tant in the control and management of many pul- thus increasing airflow. Pharmacological Serevent agents may be delivered by an inhaler either orally or intravenously. Robitussin, Organidin Pharmacology 171 Abbreviations This section introduces respiratory-related abbreviations and their meanings. Complete each activity and review your answers to evaluate your understanding of the chapter. Learning Activity 7-1 Identifying Respiratory Structures Label the following illustration using the terms listed below. Enhance your study and reinforcement of word elements with the power of DavisPlus. We recommend you complete the flash-card activity before completing activity 7–2 below. Correct Answers 5 % Score Learning Activities 175 Learning Activity 7-3 Matching Pathological, Diagnostic, Symptomatic, and Related Terms Match the following terms with the definitions in the numbered list. Complete the termi- nology and analysis sections for each activity to help you recognize and understand terms related to body structure. Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Then review the pronunciations for each term and practice by reading the medical record aloud. Patient was a heavy smoker and states that he quit smoking for a short while but now smokes 3-4 cigarettes a day. When compared with a portable chest film taken 22 months earlier, the current study most likely indicates interstitial vascular congestion. Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Then review the pronunciations for each term and practice by reading the medical record aloud. We do believe he would benefit from further diuresis, which was implemented by Dr. Should there continue to be concerns about his volume status or lack of response to Lasix therapy, then he might benefit from right heart catheterization. We plan no change in his pulmonary medication at this time and will see him in return visit in 4 months. Other than the respiratory system, what other body systems are identified in the history of present illness? Vascular System • Describe the functional relationship between the Arteries cardiovascular system and other body systems. Capillaries • Identify, pronounce, spell, and build words related Veins Heart to the cardiovascular system. Conduction System of the Heart • Describe pathological conditions, diagnostic and Blood Pressure therapeutic procedures, and other terms related Fetal Circulation to the cardiovascular system. Connecting Body Systems–Cardiovascular System • Explain pharmacology related to the treatment Medical Word Elements of cardiovascular disorders. Pathology • Demonstrate your knowledge of this chapter by Arteriosclerosis Coronary Artery Disease completing the learning and medical record Endocarditis activities. The heart is a hollow, lary, and (3) vein—carry blood throughout the muscular organ lying in the mediastinum, the body. The pumping action of the heart propels blood containing oxygen, nutrients, and other vital prod- Arteries ucts from the heart to body cells through a vast Arteries carry blood from the heart to all cells of network of blood vessels called arteries. Because blood is propelled thorough the branch into smaller vessels until they become arteries by the pumping action of the heart, the microscopic vessels called capillaries. It is at the walls of the arteries must be strong and flexible capillary level that exchange of products occurs enough to withstand the surge of blood that results between body cells and blood. When this transporta- (5) tunica media is the middle layer composed of tion system fails, life at the cellular level is not smooth muscle. Pronunciation Help Long Sound a—rate ¯ e—rebirth¯ ¯ı—isle o—over¯ u—unite¯ Short Sound a—alone˘ e—ever˘ ˘ı—it o—not˘ u—cut˘ Anatomy and Physiology 187 (7) Lumen (7) Lumen Endothelium Endothelium (10) Valve (6) Tunica Heart intima (6) Tunica intima Elastic layer (5) Tunica media (5) Tunica Vena cava media (4) Tunica Aorta (4) Tunica externa externa (3) Vein (1) Artery (9) Venule Precapillary sphincter Endothelial cell Smooth muscle (8) Arteriole (2) Capillary Figure 8-1. When it contracts, it causes vasocon- called (8) arterioles and, finally, to the smallest striction, resulting in decreased blood flow. The (6) tunica intima is the Capillaries thin, inner lining of the lumen of the vessel, com- Capillaries are microscopic vessels that join the posed of endothelial cells that provide a smooth arterial system with the venous system. Because capillary walls are composed of associated with the pumping action of the heart, a only a single layer of endothelial cells, they are very cut or severed artery may lead to profuse bleeding. This thinness enables the exchange of water, Arterial blood (except for that found in the pul- respiratory gases, macromolecules, metabolites, monary artery) contains a high concentration of and wastes between the blood and adjacent oxygen (oxygenated) and appears bright red in cells. The right lary system is partially regulated by the contraction ventricle pumps blood to the lungs (pulmonary of smooth muscle precapillary sphincters that lead circulation) for oxygenation, and the left ventricle into the capillary bed. When tissues require more pumps oxygenated blood to the entire body blood, these sphincters open; when less blood is (systemic circulation). Once the exchange of prod- Deoxygenated blood from the body returns to ucts is complete, blood enters the venous system the right atrium by way of two large veins: the for its return cycle to the heart. From the right atrium, blood passes from smaller vessels called (9) venules that devel- through the (7) tricuspid valve, consisting of three op from the union of capillaries.

This remedy has been recommended for almost every ill that flesh is heir to effective 200mg avana, and it is difficult to determine avana 100mg on line, from what has been written purchase 100 mg avana with mastercard, just what it is good for cheap 200 mg avana with amex. If I were giving the indications for it, I should say - a sallow, dirty skin, tissues full and expressionless, an expressionless face, a tongue the color of the skin, very unnatural and large, patient gloomy and despondent. I have used it with advantage in dyspepsia, torpidity of liver, enlarged spleen, enlarged mesenteric glands, and in some diseases of women, characterized by pelvic fullness and torpor. The remedy is a mild stimulant and tonic, and may be used to improve the appetite and digestion. It has been used as a prophylactic against intermittent fever, and to effect a cure when it has been broken by quinine. There is no doubt but benefit follows its use in appropriate cases, and sometimes the advantage is much greater than from the use of medicines. The principal indication for its use is where an exalted temperature is maintained at the expense of the tissues. I employ it in cases of tuberculosis, scrofula, and in many forms of chronic disease, when the above indications exist. Especial attention is called to its use in local disease, with cacoplastic or aplastic deposits. As the increased temperature is associated with increased frequency of pulse, we frequently associate it with veratrum viride. As a general rule the stomachic bitters are not advantageous when we give this remedy. Many physicians fail to obtain advantage from the use of Cod-oil because they give tonics in excess at the same time. It may be used in chronic cough, with profuse perspiration, in dyspepsia with slight diarrhœa, and in leucorrhœa. This agent is a stimulant diaphoretic, and influences the reproductive organs of the female. It has been used in the treatment of colds, and in suppressed menstruation from cold. I do not know that there is any advantage in taking a crude material that is scarce and high priced, when we can obtain its medicinal action from that which is common and cheap. This remedy has been but little used, yet the evidence is pretty conclusive that it possesses a marked influence upon the nervous system. It has been employed as an antispasmodic, and to relieve irritation of the nerve centers. We have laughed at the Chinese for their use of Ginseng, which we have deemed inert, but I am pretty well satisfied that in this, as in some other things, they have the advantage of us. A limited use of the article has given me a very favorable opinion of its influence. Its first use, and a very important one, is in the treatment of nervous dyspepsia. I have obtained more benefit from it in my own person, than from any other remedy, and I have employed it with others with equal advantage. It exerts a decidedly beneficial influence in exhaustion of the brain from over work, and it is probable that its influence is as much in this direction as upon the stomach. Preparations containing Pancreatic juice, or Pancreatin, may be used in cases of intestinal dyspepsia, attended with chylous feces, in fatty diarrhœa, where there is disease of the mesenteric glands, etc. It is only a temporary remedy, intended to tide the patient over, until by other means intestinal digestion is re-established. Before describing the action of Opium, I want to draw the attention of my readers to the importance of having it good, and of not using morphia as a substitute. Never buy Opium in powder, and in selecting the gum, take that which, when broken, gives the characteristic odor. Opium in medicinal doses is a cerebral stimulant, and we will find this its most important use. In less degree it is a stimulant to the spinal-cord, and increases functional activity of all parts supplied from it. Opium or its salts may be administered for the relief of pain, to produce sleep, or as a general stimulant to the vegetative processes, when the following conditions are present: A soft, open pulse, or where there is not the element of hardness and smallness; a soft (not dry) skin; a moist tongue; pallid face; and eyes dull, immobile or dilated pupils. It is contra-indicated, where there is a dry, contracted skin; small hard pulse; dry tongue; flushed face; bright eye, with contracted pupils. It has gained this extensive use because of the marked relief it gives from pain, and even though it fails so frequently, the successes are estimated, not the failures. I believe the reader, by carefully studying the above indications and contra-indications, will be enabled to use the remedy so as to obtain its full palliative and curative action; not having the unpleasantness of failure to accomplish the desired object, or injury to the patient, to regret. It has been extensively employed for the relief of pain, and many physicians would hardly practice medicine if forced to give up their hypodermic syringes. The advantages to be obtained from this use of Morphia has not been over-estimated. But every one who has employed it, will recollect cases of failure, sometimes of injury, which were very mortifying. The indications for the hypodermic use of Morphia are the same as those just given for Opium, and where there is present the contra-indications, the use will not give the expected results, and may prove injurious. Fortunately in the majority of cases of neuralgia, there is a soft, open pulse, the cool, pallid skin, and the evidence of an enfeebled cerebro-spinal circulation. In such cases, the hypodermic use of Morphia gives present relief, and from its topical stimulation, may effect a radical cure. We never employ the hypodermic injection of Morphia where there is a hard, small pulse, dryness and constriction of skin, dry tongue, flushed face, bright eyes and contracted pupils. In many cases of fever and inflammation, though the patient suffers pain, and the ordinary influence of Morphia in this way would be very desirable, we withhold it. It exerts an influence upon the kidneys, being strictly stimulant and tonic, and relieving irritation of the urinary passages. It has been but little used, but may be tried in cases of mental depression, especially when associated with dyspepsia. It relieves irritation of the nerve centers, and improves sympathetic innervation, improving circulation and nutrition. It may be used in torpidity of the bowels with hemorrhoids, and in congestion of ovaries and uterus. It will be noticed that it does not make the impression on the mouth of an astringent, but on examining the mucous membrane after its use, it will be seen that the color is freshened, and it looks clean. This remedy exerts a most marked influence upon mucous membranes, especially when they have been subject to chronic inflammation. It removes irritation, promotes normal functional activity, and brings the structures back to a healthy condition. It has proven the most certain remedy in pharyngitis that I have ever employed, and has given such marked benefit in disease of the superior pharynx, posterior nares, and eustachian tubes, that I should not like to treat these cases without it. I have also used it with the spray apparatus in nasal catarrh, with most excellent results. Preparations from the mucous membranes of the calf or hog, containing a percentage of this ferment, are in the market, and most of them are reliable, but possibly “Schaffer’s Pepsin” may be taken as the standard. This, it is claimed by the maker, will dissolve 1,500 times its weight of albumen, but possibly 100 to 200 times its weight would be as much as could be expected from good commercial Pepsin. It is a very great mistake to suppose that the administration of Pepsin is anything more than an aid to digestion, when the stomach is so feeble or impaired that it can not furnish this digestive ferment. It adds nothing to the stomach, though it impairs its condition by giving it rest (doing its work). It adds nothing to the body at large of itself, though in so far as it fits the food for blood making, it aids in furnishing tissue-making food. Pepsin may be given to aid digestion when the stomach is enfeebled, and can not furnish a sufficient amount of gastric juice. Water receives an additional equivalent of oxygen, when it is presented to it in a nascent state. This combining with the hydrogen forms a deutoxide (H O2) It was first brought to the notice of the profession by Dr.