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It is also the place to apply pressure in case mary gland purchase 25mg clozaril, which is positioned on the pectoralis major mus- of severe arterial hemorrhage in the forearm or hand clozaril 100 mg low price. The medial and lateral epicondyles are phatic drainage pathway is toward the axilla (see fig buy discount clozaril 25 mg on-line. When the elbow is extended buy generic clozaril 50mg line, these promi- nences lie on the same transverse plane; when the elbow is flexed, they form a triangle. The ulnar nerve can be palpated in the ulnar sulcus (groove) posterior to the medial epicondyle (see fig. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 320 Unit 4 Support and Movement Deltoid m. The cubital fossa is the depression on the anterior surface Antebrachium of the elbow region, where the median cubital vein links the Contained within the antebrachium (forearm) are two parallel cephalic and basilic veins. These veins are subcutaneous and be- bones (the ulna and radius) and the muscles that control the come more conspicuous when a proximal compression is applied. The muscles of the forearm taper dis- For this reason, they are an important location (particularly the tally over the wrist, where their tendons attach to various bones median cubital) for the removal of venous blood for analyses and of the hand. Several muscles of the forearm can be identified as transfusions or for intravenous therapy (fig. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 321 Triceps brachii m. The ulna can be palpated along its entire length from Tendon of palmaris longus m. Nerves, tendons, and vessels are close to the surface at the Styloid process of ulna wrist, making cuts to this area potentially dangerous. Tendons Thenar eminence from four flexor muscles can be observed as surface features if Hypothenar eminence the anterior forearm muscles are strongly contracted while mak- ing a fist. The tendons that can be observed along this surface, from lateral to medial, are from the following muscles: flexor carpi radialis, palmaris longus, superficial digital flexor, and flexor carpi ulnaris. The median nerve going to the hand is located under the tendon of the palmaris longus muscle (see FIGURE 10. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 322 Unit 4 Support and Movement Tendon of extensor Nail pollicis brevis m. Distal Styloid process interphalangeal of ulna joints Anatomical Proximal snuffbox interphalangeal Tendon of extensor joints pollicis longus m. The radial artery lies along the Hand surface of the radius, immediately lateral to the tendon of the Much of the surface anatomy of the hand, such as flexion creases, flexor carpi radialis muscle. This is the artery commonly used fingerprints, and fingernails, involves features of the skin discussed when monitoring the pulse. Other surface features are the extensor tendons from also be detected in the ulnar artery, lateral to the tendon of the the extensor digitorum muscle, which can be seen going to each of flexor carpi ulnaris. The knuckles of the hand are the distal ends of the posterior surface of the wrist as the thumb is extended the second through the fifth metacarpal bones. The tendon of the extensor pollicis brevis muscle of the fingers and the individual phalanges can be palpated. The depression created between these two tendons as they are pulled taut is referred to as the anatomical snuffbox. Pulsations of the radial artery can be detected in Internal Anatomy this depression. The internal anatomy of the shoulder and upper extremity in- The median nerve, which serves the opponens pollicis muscle cludes the structures of the shoulder, brachium, cubitus (elbow), of the thumb, is the nerve most commonly injured by stab antebrachium, and hand. The principal structures of these re- wounds or the penetration of glass into the wrist or hand. Severing of this nerve paralyzes a major muscle of the thumb; it wastes away, re- gions are shown in the cadaver dissections in figures 10. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 323 Flexion creases Tendon of superficial on digits digital flexor m. Hypothenar eminence Thenar eminence Tendon of flexor carpi Flexion creases ulnaris m.

Mature males Two pairs of strong connective tissue bands are stretched generally have thicker and longer vocal folds than females; therefore cheap 25 mg clozaril overnight delivery, across the upper opening of the larynx from the thyroid cartilage the vocal folds of males vibrate more slowly and produce lower anteriorly to the paired arytenoid cartilages posteriorly cheap clozaril 50 mg on-line. The loudness of vocal sound is determined by the force of the vocal folds (true vocal cords) and the vestibular folds (false the air passed over the vocal folds and the amount of vibration discount clozaril 50 mg on-line. The vestibular folds support the vocal vocal folds do not vibrate when a person whispers purchase 25mg clozaril mastercard. The vestibular folds are not essary to convert sound into recognizable speech. Vowel sounds, used in sound production, but rather the vocal folds vibrate to for example, are produced by constriction of the walls of the phar- produce sound. The pharynx, paranasal sinuses, and oral and nasal cavities folds, whereas the rest of the larynx is lined with pseudostratified act as resonating chambers. This is an important anatomical complished through movements of the tongue and lips. Respiratory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 610 Unit 6 Maintenance of the Body Thyroid cartilage Larynx Cricoid cartilage Tracheal cartilage Trachea Carina Left principal (primary) bronchus Right principal (primary) bronchus Lobar (secondary) bronchus Segmental (tertiary) bronchus FIGURE 17. It is positioned anterior tube into the trachea to permit breathing and to keep the passage- to the esophagus as it extends into the thoracic cavity. A tracheotomy should be performed only by a competent physician as there is a great risk of cutting a recurrent la- of 16 to 20 C-shaped hyaline cartilages form the supporting walls ryngeal nerve or the common carotid artery. These tracheal cartilages ensure that the airway will always remain open. The open part of each of these cartilages faces the esophagus and permits the esophagus to Bronchial Tree expand slightly into the trachea during swallowing. The mucosa (surface lining the lumen) consists of pseudostratified ciliated The bronchial tree is so named because it is composed of a series columnar epithelium containing numerous mucus-secreting gob- of respiratory tubes that branch into progressively narrower tubes let cells (see figs. The trachea bifurcates against dust and other particles as the membrane lining the nasal into right and left principal (primary) bronchi at the level of the cavity and larynx. Medial to the lungs, the trachea splits to form sternal angle behind the manubrium. Because of the more vertical position of the right principal bronchus, foreign particles If the trachea becomes occluded through inflammation, exces- are more likely to lodge here than in the left principal bronchus. A tracheotomy is the procedure of surgi- lobar (secondary) bronchi and segmental (tertiary) bronchi (see cally opening the trachea, and a tracheostomy involves inserting a figs. Respiratory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 17 Respiratory System 611 Lumen of Tracheal esophagus epithelium Trachealis Tracheal muscle cartilage Lumen of trachea Tracheal epithelium Tracheal Thyroid cartilage gland Tracheal cartilage Adventitia (a) (b) FIGURE 17. There is connect to respiratory bronchioles that lead into alveolar ducts, little cartilage in the bronchioles. The conduction por- encircles their lumina can constrict or dilate these airways. Bron- tion of the respiratory system ends at the terminal bronchioles, chioles provide the greatest resistance to air flow in the conduct- and the respiratory portion begins at the respiratory bronchioles. During an asthma attack, there is a spasm of chioles rather than the pseudostratified columnar epithelium that the smooth muscles in the respiratory bronchioles. Numerous terminal bronchioles absence of cartilage at this level, the air passageways constrict. Respiratory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 612 Unit 6 Maintenance of the Body Trachea Left principal bronchus Right principal bronchus Bronchioles FIGURE 17. A fluoroscopic examination of the bronchi using a radiopaque medium for contrast is called bronchography. This technique enables the physician to visualize the bronchial tree on a bron- chogram (fig. Objective 11 Discuss the structural arrangement of the thoracic serous membranes and explain the functions of Knowledge Check these membranes. List in order the types of epithelia through which inspired air would pass in traveling through the nasal cavity to the Pulmonary Alveoli alveolar sacs of the lungs. Describe the location of the nasopharynx and list the exchange occurs across the walls of the tiny pulmonary alveoli; structures within this organ. List the paired and unpaired cartilages of the larynx and the functional units of the respiratory system. Describe the structure of the conducting airways from the surface area (60–80 square meters, or 760 square feet) for the diffu- trachea to the terminal bronchioles.

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These fatty acids provide an related forms of catecholamine receptors cheap clozaril 25 mg overnight delivery, all of which are alternative substrate for energy metabolism in other tissues generic 100mg clozaril overnight delivery, transmembrane proteins: 1 order 50mg clozaril visa, 2 proven clozaril 50 mg, 1, and 2. All can bind primarily skeletal muscle, and block the phosphorylation epinephrine or NE, to varying extents (see Chapter 3). During profound hypoglycemia, the rapid rise in blood Fight-or-Flight Response. Epinephrine and NE produce catecholamine levels triggers some of the same metabolic widespread effects on the cardiovascular system, muscular adjustments that occur more slowly during fasting. During system, and carbohydrate and lipid metabolism in liver, fasting, these adjustments are triggered mainly in response muscle, and adipose tissues. In response to a sudden rise in to the gradual rise in the ratio of glucagon to insulin in the catecholamines in the blood, the heart rate accelerates, blood. The ratio also rises during profound hypoglycemia, coronary blood vessels dilate, and blood flow to the skele- reinforcing the actions of the catecholamines on tal muscles is increased as a result of vasodilation (but vaso- glycogenolysis, gluconeogenesis, and lipolysis. Smooth muscles in the air- cholamines released during hypoglycemia are thought to ways of the lungs, gastrointestinal tract, and urinary be partly responsible for the rise in the glucagon-to-insulin bladder relax. Muscles in the hair follicles contract, causing ratio by directly influencing the secretion of these hor- piloerection. Catecholamines stimulate the se- action to the sudden release of catecholamines is known as cretion of glucagon by the alpha cells and inhibit the se- the fight-or-flight response (see Chapter 6). These catecholamine-mediated responses to hypoglycemia are Catecholamines and the Metabolic Response to Hypo- summarized in Table 34. Catecholamines secreted by the adrenal medulla and NE released from sympathetic postganglionic nerve terminals are key agents in the body’s defense against hypoglycemia. Catecholamine release usually Catecholamine-Mediated Responses starts when the blood glucose concentration falls to the TABLE 34. A fur- ther decline in blood glucose concentration into the hy- Liver Stimulation of glycogenolysis poglycemic range produces marked catecholamine release. Stimulation of gluconeogenesis Hypoglycemia can result from a variety of situations, such Skeletal muscle Simulation of glycogenolysis as insulin overdosing, catecholamine antagonists, or drugs Adipose tissue Simulation of glycogenolysis that block fatty acid oxidation. Hypoglycemia is always a Stimulation of triglyceride lipolysis Pancreatic islets Inhibition of insulin secretion by beta cells dangerous condition because the CNS will die of ATP Stimulation of glucagon secretion by alpha cells deprivation in extended cases. The length of time pro- CHAPTER 34 The Adrenal Gland 621 REVIEW QUESTIONS DIRECTIONS: Each of the numbered (F) Defects in aldosterone synthase (C) Cholesterol side-chain cleavage items or incomplete statements in this 4. What is the mechanism through which enzyme section is followed by answers or by catecholamines stabilize blood glucose (D) 11 -Hydroxylase completions of the statement. Select the concentration in response to (E) 3-Hydroxy-3-methylglutaryl CoA ONE lettered answer or completion that is hypoglycemia? Which of the following sources of muscle weakness and fatigue, anorexia, and cholesterol is most important for (B) Catecholamines inhibit weight loss associated with sustaining adrenal steroidogenesis glycogenolysis in the liver gastrointestinal symptoms (nausea, when it occurs at a high rate for a long (C) Catecholamines stimulate the vomiting). A patient receiving long-term (D) Congenital adrenal hyperplasia (E) Cholesterol from the endoplasmic glucocorticoid therapy plans to (E) Hypopituitarism reticulum undergo hip replacement surgery. A 7-year-old boy comes to the (A) Glucocorticoids should be glucocorticoids accelerate pediatric endocrine unit for evaluation decreased to prevent serious gluconeogenesis during fasting? Review of his hypoglycemia during recovery (A) Glucocorticoids stimulate the growth charts indicates substantial (B) Glucocorticoids should be secretion of insulin, which activates weight gain over the previous 3 years increased to stimulate immune function gluconeogenic enzymes in the liver but little increase in height. To and prevent possible infection (B) Glucocorticoids inhibit the use of differentiate between the development (C) Glucocorticoids should be glucose by skeletal muscle of obesity and Cushing’s disease, blood decreased to minimize potential (C) Glucocorticoids maintain the and urine samples are taken. Which of interactions with anesthetics vascular response to norepinephrine the following would be most (D) Glucocorticoids should be (D) Glucocorticoids inhibit diagnostic of Cushing’s disease? Adrenocorticotropin serum cortisol, and decreased serum to result in a decreased rate of (ACTH)- and non-ACTH-mediated insulin aldosterone release? J Clin Endocrinol serum cortisol, and decreased urinary the kidney Metab 1999;84:1729–1736. Congenital adrenal hyperplasia is most concentration at the macula densa DHEA. Baillieres Clin Endocrinol likely a result of (E) An increase in renal sympathetic Metab 1998;12:67–81.

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