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The volume Atrial Arterial elevated transmural pressure associated with standing causes pressure volume a myogenic response and decreases the number of open cap- illaries buy cialis soft 20mg low cost. With fewer open capillaries 20mg cialis soft free shipping, the filtration rate for a AVP ANP Medullary cardiovascular center: increased given capillary hydrostatic pressure imbalance is less 20 mg cialis soft amex. Blood loss in- fluences sodium and water excretion by the kidney via several pathways. All these pathways, combined with an increased intake of salt and water, restore the extracellular fluid FIGURE 18. These responses occur longed standing, capillary filtration reduces ve- later than those shown in Figures 18. Without the compensatory events that result in the pathways responsible for stimulating an increased intake of salt changes shown in small type, prolonged standing would in- and water are not shown. CHAPTER 18 Control Mechanisms in Circulatory Function 303 tended bed rest results in reduced activity of all of the path- Aldosterone acts on the distal nephron to cause in- ways that increase blood volume in response to standing. Aldosterone released from the adrenal cortex day and is quantitatively significant after a few days. Wa- point, standing becomes difficult because blood volume is ter intake is determined by thirst and the availability of not adequate to sustain a normal blood pressure. This Increased plasma osmolality, sensed by the hypothalamus, increase, proportioned between the extrathoracic and in- results in both thirst and increased AVP release. Thirst and trathoracic vessels, augments stroke volume during stand- AVP release are also increased by decreased stretch of ing. If blood volume is not maintained by intermittent erect baroreceptors and cardiopulmonary receptors. Renal arteriolar vasoconstric- The long-term regulation of blood volume is driven by tion associated with increased sympathetic nerve activ- changes in plasma volume accomplished by sympathetic ity produced by standing reduces the glomerular filtra- nervous system effects on the kidneys; hormonal changes, tion rate. This results in a decrease in filtered sodium and including RAAS, AVP, and ANP; and alterations in pressure tends to decrease sodium excretion. Regulation of the precise quantities of wa- control of extracellular fluid volume is determined by the bal- ter and sodium that are excreted maintains the correct ance between the intake and excretion of sodium and water. Sodium excre- The distribution of extracellular fluid between plasma tion is much more closely regulated than sodium intake. Ex- and interstitial compartments is determined by the balance cretion of sodium is determined by the glomerular filtration of hydrostatic and colloid osmotic forces across the capil- rate, the plasma concentrations of aldosterone and ANP, and lary wall. Retention of sodium and water tends to dilute a variety of other factors, including angiotensin II. However, as increased synthesis of ferent arteriolar) and postcapillary (efferent arteriolar) re- plasma proteins by the liver occurs, a portion of the re- sistance and arterial pressure. Decreased mean arterial pres- tained sodium and water contributes to an increase in sure and/or afferent arteriolar constriction tends to result in plasma volume. Changes in glomerular any change in total red cell volume) decreases hematocrit, capillary pressure are primarily the result of changes in which stimulates erythropoietin release and erythropoiesis. REVIEW QUESTIONS DIRECTIONS: Each of the numbered (B) High sensitivity of arterioles to (B) Lower the heart rate below its items or incomplete statements in this norepinephrine intrinsic rate section is followed by answers or by (C) High sensitivity of arterioles to (C) Raise and lower the heart completions of the statement. Select the nitric oxide rate above and below its intrinsic ONE lettered answer or completion that is (D) Low parasympathetic nerve rate BEST in each case. The cold pressor response is initiated because of excessively constricted 2. In the presence of a drug that blocks by stimulation of blood vessels in the skin. Which of all effects of norepinephrine and (A) Baroreceptors the following alterations in autonomic epinephrine on the heart, the (B) Cardiopulmonary receptors function is most likely to be involved? Which of the following occurs when heart accompanied by a withdrawal of (D) Lying down acetylcholine binds to muscarinic sympathetic tone to most of the blood (E) Living in a space station receptors? In: (C) Norepinephrine release from (C) Exercise Izzo JL, Black HR, eds.

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Answer B: All of the sensory deficits seen in this woman reflect a lesion in the medial lemniscus generic cialis soft 20mg otc, which is located in the medial 55 buy cheap cialis soft 20 mg online. Answer A: The anterolateral system is located just internal to medulla in the territory of the anterior spinal artery cialis soft 20 mg free shipping. The antero- the brachium of the inferior colliculus in the lateral portions of the lateral system and the spinal trigeminal tract convey pain and ther- midbrain tegmentum. This tract conveys pain and thermal sensa- mal sensations from the body (sans face) and face, respectively. The solitary tract is made up of the central processes of vis- Corticospinal fibers are located in the crus cerebri, the mesen- cerosensory fibers and the medial longitudinal fasciculus at this cephalic tract at the lateral edge of the periaqueductal (central) level contains descending fibers that influence spinal motor neu- grey, and the central tegmental tract is, as its name indicates, in rons. Oculomotor fibers within the midbrain leave the nucleus, arch through the tegmentum, and exit 61. A on the medial surface of the basis pedunculi into the interpedun- cavitation in this location may communicate with a cavity in cer- cular cistern. Hydromyelia refers to a cavity of the spinal cord that is lined with ependymal cells. Answer C: Fibers conveying discriminative touch, vibratory spinal cord that give rise to characteristic motor and sensory sensations, and proprioception are located in the lateral lemnis- losses. Answer A: The dentate nucleus appears as a long thin undulat- has difficulty walking due to a lesion of fibers conveying position ing line within the white matter core of the cerebellar hemisphere. Fibers of the an- a crumpled bag with its hilus (the opening of the bag) directed ros- terolateral system convey pain and thermal sensation. The other cerebellar nuclei (fastigial, globose, em- and corticospinal are motor in function; however this man has no boliform) are small clumps of cells, and the red nucleus is found weakness. Answer C: The inferior salivatory nucleus is located in the ros- tral medulla, medial to the solitary tract and nuclei and inferior to the medial vestibular nucleus. Preganglionic axons that orig- Review and Study Questions for inate from these cells distribute on branches of the glossopha- Chapter 6 ryngeal nerve. The dorsal motor nucleus is in the medulla, its ax- ons travel on the vagus nerve. Cells located in the lateral wall of the atrium of the lateral ventricle. Answer C: Weakness of the extremities accompanied by (D) Pulvinar nucleus paralysis of muscles on the contralateral side of the tongue (seen (E) Splenium of the corpus callosum as a deviation of the tongue to that side on protrusion) indicates a lesion in the medulla involving the corticospinal fibers in the 2. Which of the following structures is clearly seen in coronal and ax- pyramid and the exiting hypoglossal roots. This is an inferior al- ial brain slices, and in many MRIs, in planes extending from the ternating hemiplegia. Middle alternating hemiplegia refers to a midline laterally through the basal nuclei? Alternating (B) Column of the fornix (alternate) hemianesthesia and hemihypesthesia are sensory (C) Genu of the internal capsule losses. Which of the following nuclei is located within the internal disorders and with cognitive dysfunction shows a large anterior medullary lamina and may be visible in an axial MRI in either T1- horn of the lateral ventricle. A loss of which of the following structures would (B) Dorsomedial result in this portion of the ventricular system being enlarged? The sagittal MRI of a 23-year-old woman shows a mass in the right (E) Septum pellucidum and fornix interventricular foramen (possibly a colloid cyst); the right lateral ventricle is enlarged. The axial MRI of a 54-year-old man shows an arteriovenous mal- impinging on which of the following structures? Which of the following structures is probably most affected (B) Posterior limb of internal capsule by this malformation? The sagittal MRI of a 42-year-old woman taken adjacent to the (E) Posterior limb of the internal capsule midline shows a round structure immediately rostral to the in- terpeduncular fossa on the inferior surface of the hemisphere.

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During chronic by the blood-brain barrier (capillary endothelium) buy cialis soft 20 mg, acid-base disturbances buy discount cialis soft 20mg on line, the bicarbonate concentration of which has its own transport capability generic cialis soft 20mg online. CSF changes in the same direction as in blood, but the Because of the properties of the limiting membranes, changes may be unequal. In metabolic disturbances, the CSF is essentially protein-free, but it is not just a simple CSF bicarbonate changes are about 40% of those in blood ultrafiltrate of plasma. CSF differs most notably from an but, with respiratory disturbances, CSF and blood bicar- ultrafiltrate by its lower bicarbonate and higher sodium bonate changes are essentially the same. Potassium, magnesium, base disturbances are imposed, CSF bicarbonate changes and calcium ion concentrations also differ somewhat from more slowly than does blood bicarbonate, and it may not plasma; moreover they change little in response to reach a new steady state for hours or days. As already marked changes in plasma concentrations of these noted, the mechanism of bicarbonate regulation is unset- cations. Irrespective of how it occurs, the bicarbonate regula- in CSF, but the mechanism that controls bicarbonate con- tion that occurs with acid-base disturbances is important centration is controversial. Because of the relative imperme- Peripheral Chemoreceptors abilities of the choroidal epithelium and capillary endothe- Respond to PO2, PCO2, and pH lium to H , changes in H concentration of blood are poorly reflected in CSF. By contrast, molecular carbon diox- Peripheral chemoreceptors are located in the carotid and ide diffuses readily; therefore, blood PCO2 can influence the aortic bodies and detect changes in arterial blood PO2, PCO2, pH of CSF. Carotid bodies are small ( 2 mm wide) sensory bicarbonate concentration and PCO2. The relative ease of organs located bilaterally near the bifurcations of the com- movement of molecular carbon dioxide in contrast to hy- mon carotid arteries near the base of the skull. Aortic bodies are located along the as- other poisons of the metabolic respiratory chain. This effect is more within the peripheral chemoreceptors (glomus cells) is the prominent in aortic bodies than in carotid bodies. About 40% of the effect of activity of peripheral chemoreceptors is under some degree PaCO2 on ventilation is brought about by peripheral of efferent control capable of influencing responses by chemoreceptors, while central chemoreceptors bring about mechanisms that are not clear. Unlike the central sensor, peripheral chemorecep- chemoreceptors is also centrally modified in its effects by tors are sensitive to rising arterial blood H and falling PO2. Interactions than aortic chemoreceptors; because of this and their among chemoreflexes, however, are easily demonstrated. The discharge rate of carotid chemoreceptors (and the resulting minute ventilation) is approximately linearly re- Significant Interactions Occur lated to PaCO2. The linear behavior of the receptor is re- Among the Chemoresponses flected in the linear ventilatory response to carbon dioxide The effect of PO on the response to carbon dioxide and 2 illustrated in Figure 22. When expressed using pH, the re- the effect of carbon dioxide on the response to PO have al- 2 sponse curve is no longer linear but shows a progressively ready been noted. By virtue of this interdependence, a re- increasing effect as pH falls below normal. This occurs be- sponse to hypoxia is blunted by the subsequent increased cause pH is a logarithmic function of [H ], so the absolute ventilation, unless PaCO is somehow maintained, because 2 change in [H ] per unit change in pH is greater when PaCO ordinarily falls as ventilation is stimulated (see Fig 2 brought about at a lower pH. The stimulating effect of hypoxia is blunted mainly The response of peripheral chemoreceptors to oxygen by the central chemoreceptors, which respond more po- depends on arterial PaO2, and not oxygen content. For example, if 100% oxygen is given to the response curve is not linear; instead, hypoxia is of in- an individual newly arrived at high altitude, ventilation is creasing effectiveness as PO2 falls below about 90 mm Hg. During the next few The behavior of the receptors is reflected in the ventilatory days, ventilation in the absence of supplemental oxygen response to hypoxia illustrated in Figure 22. The shape of progressively rises further, but it is no longer restored to sea the curve relating ventilatory response to PO2 resembles level value by breathing oxygen. Rising ventilation while that of the oxyhemoglobin equilibrium curve when plotted acclimatizing to altitude could be explained by a reduction upside down (see Chapter 21). As a result, the ventilatory of blood and CSF bicarbonate concentrations. This would response is inversely related in an approximately linear reduce the initial increase in pH created by the increased fashion to arterial blood oxygen saturation.

Construct a sample table listing the location and function grows cheap cialis soft 20 mg online,the chondrocytes (cartilage cells) in the center of the shaft of each type of cell found within bone tissue hypertrophy purchase cialis soft 20 mg visa,and minerals are deposited within the matrix in a 10 purchase 20 mg cialis soft with amex. Define osteon and sketch the arrangement of osteons process called calcification (fig. At the same time,some cells of the perichondrium (dense regular con- nective tissue surrounding cartilage) differentiate into osteoblasts. Skeletal System: © The McGraw−Hill Anatomy, Sixth Edition Introduction and the Axial Companies, 2001 Skeleton Developmental Exposition certain bones of the cranium are formed this way. Sesamoid bones The Axial Skeleton are specialized intramembranous bones that develop in tendons. EXPLANATION DEVELOPMENT OF THE SKULL Development of Bone The formation of the skull is a complex process that begins dur- Bone formation, or ossification, begins at about the fourth week of ing the fourth week of embryonic development and continues embryonic development, but ossification centers cannot be read- well beyond the birth of the baby. Three aspects of the embry- ily observed until about the tenth week (exhibit I). Bone tissue onic skull are involved in this process: the chondrocranium, the derives from specialized migratory cells of mesoderm (see neurocranium, and the viscerocranium (exhibit II). The viscerocranium (splanchnocranium) is the through a hyaline cartilage stage and then it is ossified as bone. Skeletal System: © The McGraw−Hill Anatomy, Sixth Edition Introduction and the Axial Companies, 2001 Skeleton (continued) EXHIBIT II The embryonic skull at 12 weeks is composed of bony elements from three developmental sources: the chondrocranium (colored blue-gray), the neurocranium (colored light yellow), and the viscerocranium (colored salmon). As the perichondrium calcifies,it gives rise to Epiphyseal border a thin plate of compact bone called the periosteal bone collar. Reserve zone A periosteal bud, consisting of osteoblasts and blood ves- sels, invades the disintegrating center of the cartilage model from Proliferation the periosteum. Once in the center, the osteoblasts secrete os- zone teoid, and a primary ossification center is established. Ossifica- Chondrocytes tion then expands into the deteriorating cartilage. This process is Hypertrophic zone repeated in both the proximal and distal epiphyses, forming sec- Epiphyseal border ondary ossification centers where spongy bone develops. Resorption Once the secondary ossification centers have been formed, zone bone tissue totally replaces cartilage tissue, except at the articular ends of the bone and at the epiphyseal plates. The reserve zone Ossification (zone of resting cartilage) borders the epiphysis and consists of zone Red bone small chondrocytes irregularly dispersed throughout the intercel- marrow lular matrix. The chondrocytes in this zone anchor the epiphy- seal plate to the bony epiphysis. The proliferation zone (zone of Diaphyseal border proliferating cartilage) consists of larger, regularly arranged chon- FIGURE 6. Skeletal System: © The McGraw−Hill Anatomy, Sixth Edition Introduction and the Axial Companies, 2001 Skeleton Chapter 6 Skeletal System: Introduction and the Axial Skeleton 143 TABLE 6. The plates indicate that the bones are still that are arranged in columns. The resorption zone (zone of dechondrification) is the area where a change in mineral content is occurring. The os- sification zone (zone of calcified cartilage) is a region of transfor- mation from cartilage tissue to bone tissue. The chondrocytes within this zone die because the intercellular matrix surrounding them becomes calcified. Osteoclasts then break down the calci- fied matrix and the area is invaded by osteoblasts and capillaries from the bone tissue of the diaphysis. As the osteoblasts mature, osteoid is secreted and bone tissue is formed. The result of this process is a gradual increase in the length of the bone at the epiphyseal plates. The time at which epiphyseal plates ossify varies greatly from bone to bone, but it usually occurs between the ages of 18 and 20 within the long bones (table 6. Because ossification of the epiphyseal cartilages within each bone occurs at predictable times, Spongy bone radiologists can determine the ages of people who are still growing by examining radiographs of their bones (fig.

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