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How does the lower than normal arterial pressure buy lotrisone 10 mg amex, smaller than normal arterial pulse pressure 10mg lotrisone visa, and decreased blood During a routine health assessment generic lotrisone 10 mg without a prescription, a 52-year-old man flow to the hands and feet indicate impairment of the con- was found to have a blood pressure of 180/95 mm Hg generic lotrisone 10mg without a prescription. How did the streptokinase improve performance of the blood pressure has always been a little high. How is aspirin useful to protect the coronary vasculature the heart, eyes (including the blood vessels of the from occlusions by blood clots? How might lowering the low-density lipoproteins and rais- resting heart rate is 87 beats/min. Explain how drugs might lower the blood pressure by af- oxygen for the heart cells. Partially occluded arteries did not fecting 1-adrenergic receptors, 1-adrenergic receptors, in- provide sufficient blood flow to provide the needed oxygen travascular fluid volume, the renin-angiotensin-aldosterone and hypoxia resulted. Coronary artery problems leading to system, and intracellular calcium ion levels. Anything that increases cardiac output or SVR can cause an the pain extends into the left arm and hand, as well as neck increase in arterial blood pressure. Chronic hypertension can damage many organs and tis- mal electrical activity in the heart. The results can range sues, some of which may be detected by physical exami- from mild disturbances of conduction to rapidly lethal ven- nation. In addition, the longer cardiac cells are phy as a result of increased afterload. The blood vessels without adequate blood flow, the more damage is done to of the eye can become thickened and sclerotic. The sooner oxygenation is restored, the less repair hypertension can contribute to atherosclerosis, the pe- is needed in the heart tissue. When the contractile ability of the heart is compromised, such as the kidneys, may also be damaged by hyperten- the typical result is a reduced stroke volume, which would sion, but these abnormalities require specific laboratory explain the decreased pulse pressure. If cardiac output de- testing to evaluate and usually cannot be assessed by creases, in spite of an increased heart rate, then arterial physical examination. Streptokinase is a bacterial product that activates plasmino- lower SVR. Drugs that reduce intravascular fluid volume (di- gen, which leads to clot dissolution. Blood flow and oxygen uretics such furosemide or hydrochlorothiazide) reduce pre- supply to the downstream muscle will then be restored. If load and, thereby, lower cardiac output and arterial pres- the muscle cells are not seriously injured, they will show sure. With sure by preventing the vasoconstriction and sodium reten- aspirin present, platelets are far less likely to be activated, tion that would otherwise occur when the RAAS is acti- 308 PART IV BLOOD AND CARDIOVASCULAR PHYSIOLOGY vated. Calcium blockers diminish cardiac contractility (a de- References terminant of cardiac output) and vascular smooth muscle Izzo JL, Black HR, eds. In: Young JR, Olin JW, Bartholomew blocking either its entry or its release into the cytosol of car- JR, eds. CHAPTER Pulmonary Circulation and the Ventilation- Perfusion Ratio 2020 Rodney A. CHAPTER OUTLINEFUNCTIONAL ORGANIZATION OF THE PULMONARYBLOOD FLOW DISTRIBUTION IN THE LUNGS CIRCULATIONSHUNTS AND VENOUS ADMIXTUREPULMONARY VASCULAR RESISTANCETHE BRONCHIAL CIRCULATIONFLUID EXCHANGE IN PULMONARY CAPILLARIES KEY CONCEPTS 1. Gravity causes lung perfusion to be better at the base than and low-pressure system. A mismatch of ventilation and blood flow occurs at both pulmonary vascular resistance to fall with increased car- the base and the apex of the lungs. High pulmonary capillary hydrostatic pressure leads to pul- lation-perfusion ratio in the lungs. The bronchial circulation is part of the systemic circulation and does not participate in gas exchange. FUNCTIONAL ORGANIZATION OF THE mately equal to the stroke volume of the right ventricle PULMONARY CIRCULATION (about 80 mL) under most physiological conditions. The heart drives two separate and distinct circulatory sys- tems in the body: the pulmonary circulation and the sys- The Pulmonary Circulation Functions in Gas temic circulation. The pulmonary circulation is analogous Exchange and as a Filter, Metabolic Organ, and to the entire systemic circulation.

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What is the large dark mass (filling defect) seen in the urinary bladder (indicated with the letter B) on the IVU? On the CT generic 10mg lotrisone otc, white contrast fills the lumen of the urinary bladder (indicated with an arrow) buy cheap lotrisone 10 mg online. Synchronous tumors are tumors of the (a) same cell type occuring at the same time in separate locations order lotrisone 10 mg line. Urinary System © The McGraw−Hill Anatomy discount lotrisone 10 mg otc, 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. Each kidney is contained by a renal tubules are drained into papillary during ejaculation. The female capsule and divided into an outer renal ducts that extend through the renal urethra is much shorter than that of a cortex and an inner renal medulla. Micturition is controlled by reflex centers the minor calyces and then into the major calyces, which drain into the 1. Urine is channeled from the kidneys to in the second, third, and fourth sacral renal pelvis. From there, urine flows the urinary bladder by the ureters and segments of the spinal cord. Urinary System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 696 Unit 6 Maintenance of the Body Review Activities Objective Questions (c) the urinary bladder. Which of the following statements about development process lead to a better concave medial border of the kidney metanephric kidneys is true? List four common congenital (c) They are the third pair of kidneys to malformations of the urinary system. Essay Questions pyuria, oliguria, polyuria, uremia, and (d) adipose capsules. Describe the location of the kidneys in enters directly into relation to the abdominal cavity and the Critical-Thinking Questions (a) the renal calyces. Describe how the kidney is supported urinary system rather than the excretory against the posterior abdominal wall. Which of the following statements is this support related to the condition 2. Treatment with sulfa medications such as concerning the kidneys is false? Trace a drop of blood from an interlobular spectrum antibiotics such as tetracycline (b) They each contain 8 to 15 renal artery through a glomerulus and into an or ampicillin usually clear up the pyramids. What is (c) They each have two distinct vessels through which the blood passes. The neighborhood day-care center won’t third and fifth lumbar vertebrae. A renal stone (calculus), would most You’ve tried to toilet train your likely cause stagnation of urine in which 5. In a male, trace the path of urine from the site of filtration at the renal corpuscle to 15-month-old boy, but you haven’t made portion of the urinary system? List in order all the structures through which the urine your efforts, or would it be better to wait? What functions of a real kidney does an (d) the renal pelvis artificial kidney (dialysis machine) fail to (e) the urethra types of nephrons found in a kidney.

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For exam- ple buy generic lotrisone 10mg on-line, an individual can have a normal arterial PO2 and SaO2 but reduced oxygen content safe lotrisone 10 mg. This situation is seen in patients 0 20 40 60 80 100 120 140 who have anemia (a decreased number of circulating red cells) discount 10mg lotrisone. A patient with anemia who has a hemoglobin concen- PO2 (mm Hg) B tration half of normal (7 lotrisone 10 mg on line. A patient with anemia has a normal SaO2because that content and capacity are proportionally re- 80 duced. The usual oxyhemoglobin equilibrium curve does not show changes in blood oxygen content, since the vertical axis is saturation. If the vertical axis is changed to oxygen content 60 (mL O /dL blood), then changes in content are seen (Fig. The shape of the oxyhemoglobin equilibrium curve PCO2↑, pH↓ does not change, but the curve moves down to reflect the re- 40 duction in oxygen content. A good analogy for comparing an anemic patient with a normal patient is a bicycle tire and a 20 truck tire: both can have the same air pressure, but the amount of air each tire holds is different. Carbon monoxide interferes PO (mm Hg) with oxygen transport by competing for the same binding 2 sites on hemoglobin. Carbon monoxide binds to hemoglo- Hemoglobin (Hb) binding affinity for O2. B, An increase in temperature, [H ], or arte- 50 rial PCO2 causes a rightward shift of the oxyhemoglobin equilib- rium curve. A P increase indicates that binding affinity for oxy- 20 50 gen decreases, which favors the unloading of O2 from Hb at the tissue level. An increase in red cell levels of 2,3-diphosphoglycer- Normal blood ate (DPG) will also shift the curve to the right. Several factors affect the binding affinity of hemoglobin for Anemia O2, including temperature, arterial carbon dioxide tension, 5 (40% of normal) and arterial pH. A rise in PCO2, a fall in pH, and a rise in temperature all shift the curve to the right (see Fig. The effect of carbon dioxide and hydrogen ions on the affinity of hemoglobin for oxygen is known as the Bohr ef- 0 20 40 60 80 100 fect. A shift of the oxyhemoglobin equilibrium curve to the PO2 (mm Hg) right is physiologically advantageous at the tissue level be- cause the affinity is lowered (increased P ). Severe shift enhances the unloading of oxygen for a given PO2 in anemia can lower the O2 content to 40% of normal. The blood the tissue, and a leftward shift increases the affinity of he- O2 content of an individual exposed to CO is shown for compari- moglobin for oxygen, thereby, lowering the ability to re- son. When the blood is 60% saturated with carbon monoxide lease oxygen to the tissues. A simple way to remember the (HbCO), O2 content is reduced to about 8 mL/dL of blood. Note functional importance of these shifts is that an exercising the leftward shift of the oxyhemoglobin equilibrium curve when muscle is warm and acidic and produces large amounts of CO binds with hemoglobin. This means that breathing higher concentrations of • It has a strong binding affinity for hemoglobin. Breathing fresh air • As an odorless, colorless, and nonirritating gas, it is vir- will favor the reaction to the left, which will cause CO to tually undetectable. A striking feature of CO •PaO2 is normal, and there is no feedback mechanism to is a binding affinity about 210 times that of oxygen. For example, breathing normal air (21% blood is bright cherry red when CO binds with hemo- O2) contaminated with 0. Therefore, a person can be exposed to CO and have With the high affinity of hemoglobin for CO, breathing a oxygen content reduced to a level that becomes lethal, by small amount CO can result in the formation of large causing tissue anoxia, without the individual being aware of amounts of HbCO. The brain is one of the first organs affected by normal because the oxygen diffusion gradient has not lack of oxygen. However, oxygen content will be greatly reduced vision and, if severe enough, cause unconsciousness. This is seen in The best treatment for CO poisoning is breathing 100% Figure 21.

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In suggest that somatostatin may play a role in regulating both most cases lotrisone 10mg line, however buy generic lotrisone 10 mg line, these factors have the opposite effect glucagon and insulin secretion lotrisone 10mg. The initial gene product for glucagon generic 10 mg lotrisone, pre- proglucagon, is a much larger peptide. Like other peptide hormones, the “pre” piece is removed in the ER, and the pro- METABOLIC EFFECTS OF INSULIN hormone is converted into a mature hormone as it is pack- AND GLUCAGON aged and processed in secretory granules (see Chapter 31). The endocrine pancreas secretes hormones that direct the Secretion of Glucagon. The principal factors that influ- storage and use of fuels during times of nutrient abundance ence glucagon secretion are listed in Table 35. Insulin is se- exceptions, this table is nearly a mirror image of Table 35. These two decrease in blood glucose below about 100 mg/dL pro- hormones play an important role in directing the flow of motes glucagon secretion. CHAPTER 35 The Endocrine Pancreas 627 Insulin Affects the Metabolism of Carbohydrates, dient. The carriers shuttle glucose across the membrane Lipids, and Proteins in Liver, Muscle, and faster than would occur by diffusion alone. Considerable Adipose Tissues recent work has revealed not just one transporter, but a family of about seven different glucose transporters The primary targets for insulin are liver, skeletal muscle, and (GLUT), commonly called GLUT 1 to GLUT 7. Insulin has multiple individual actions in transporters are expressed in different tissues and, in some each of these tissues, the net result of which is fuel storage. GLUT 4, the insulin-stimulated glucose transporter, is Mechanism of Insulin Action. Although insulin was one of the primary form of the transporter present in skeletal mus- the first peptide hormones to be identified, isolated, and cle tissue and adipose tissue. It is present in plasma mem- characterized, its exact mechanism of action remains elusive. In tar- The insulin receptor is a heterotetramer, consisting of a pair get cells, the effect of insulin is to promote the of / subunit complexes held together by disulfide bonds translocation of GLUT 4 transporters from the intracellular (Fig. The subunit is an extracellular protein contain- pool into plasma membranes. As a result, more transporters ing the insulin-binding component of the receptor. The are available in the plasma membrane, and glucose uptake subunit is a transmembrane protein that couples the extra- by target cells is, thereby, increased. Activation of the subunit of the insulin receptor results Insulin and the Synthesis of Glycogen. Besides promot- in autophosphorylation, involving the phosphorylation of ing glucose uptake into target cells, insulin promotes its a few selected tyrosine residues in the intracellular portion storage. This event further activates the tyrosine ki- mary forms: as glycogen and (by metabolic conversion) as nase portion of the subunit, leading to tyrosine phospho- triglycerides. Glycogen is a short-term storage form that rylation of specific intracellular substrates. A cascade of plays an important role in maintaining normal blood glu- events follows, leading to the pleiotropic actions of insulin cose levels. While tyrosine phosphorylation events and skeletal muscle; other tissues, such as adipose tissue, appear to be the early steps in insulin action, serine/threo- also store glycogen but in quantitatively small amounts. In- nine phosphorylation or dephosphorylation is involved in sulin promotes glycogen storage primarily through two en- many of the final steps of insulin action. It activates glycogen synthase by pro- moting its dephosphorylation and concomitantly Insulin and Glucose Transport. Perhaps one of the most inactivates glycogen phosphorylase, also by promoting its important functions of insulin is to promote the uptake of dephosphorylation. A specific cell mem- brane carrier is involved but no energy is required, and the Insulin and Glycolysis. In adipose tissue and liver tissue, insulin promotes lipogenesis and in- hibits lipolysis (Fig.

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