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As a result buy 260 mg extra super avana mastercard, the symp- grab bars and a raised toilet seat quality 260mg extra super avana, in the tom may not be recognized as being home order extra super avana 260 mg line. Because most spinal cord injuries related to kidney infection and the kidney affect bladder and bowel function generic 260 mg extra super avana with amex, in- infection may not be immediately diag- structions in catheter care and bowel re- nosed and treated. Individuals with spinal cord injury are at risk of developing additional health problems that could result in a secondary Pressure Sores (Decubitus Ulcers) disability and consequently additional One of the most common complica- functional limitations. The extent of the tions associated with spinal cord injury is risk is related to the level of injury. In gen- pressure sores (decubitus ulcers), which eral, the higher the level of injury, the result from lack of blood supply to a body greater the risk of developing secondary pressure point, such as the buttocks, sac- disabling conditions. Pressure sores develop ative that individuals with spinal cord when continuous pressure is exerted to a injuries, family members, and profes- body part over time (Pires & Adkins, 1996; sionals working with them are aware of Woolsey & McGarry, 1991). Pressure on a the risk and use prevention strategies to body part interferes with blood supply, lessen the risk. Because individu- Altered Symptoms of Illness als with spinal cord injury are often immobile, areas of pressure on certain Because of the lack of sensation that bony prominences are more likely to accompanies most spinal cord injuries, as develop. Since these individuals usually well as the interruption to nerve path- have no sensation below the level of ways, symptoms of various conditions un- injury, they are unable to feel pressure, 82 CHAPTER 3 CONDITIONS OF THE NERVOUS SYSTEM: PART II and because of the paralysis they are urine and prevent incontinence. The unable to easily shift their weight to bladder and its contents normally contain relieve the pressure. Inadequate skin care, no pathologic organisms, but there is irritation, and nutritional deficiency can always the potential for the introduction further contribute to the development of of infectious organisms when a catheter is the problem. For individuals with spinal cord be small on the surface, but the depth of injury, urinary tract infections can be a the ulcer may be more extensive. Un- serious, debilitating, and, at times, life- treated pressure sores can progress from threatening problem. Untreated urinary redness to breakdown of the skin, infec- tract infection can lead to pyelonephri- tion, and eventually death (necrosis) of tis (infection of the kidney) and, in skin tissue, which could extend through severe cases, septicemia (infection in the the tissue all the way to the bone. As a consequence, the risk of de- must be aware of the risk of pressure sores veloping kidney stones (renal calculi) is and the importance of monitoring their increased. Education about the importance of ney itself or may lodge in the ureters decreasing the amount of pressure on (tubes leading from the kidney to the bony prominences by regularly changing bladder) so that they obstruct urine flow, position, maintaining good nutrition, causing urine to back up into the kidneys and following good skin care is an impor- (urinary reflux), and eventually causing tant part of the rehabilitation process. In addition to and how to decrease this risk is crucial to having the correct cushion prescribed, preventing secondary urinary tract com- individuals with spinal cord injury should plications. In addition, individuals with also be helped to learn how to position spinal cord injury should be made aware them properly. Urinary tract infections are the second Secondary conditions related to bowel highest reported complication of spinal elimination may also be problematic. Because the bladder is emp- continence of fecal material may not only tied in abnormal ways, it may not empty contribute to skin breakdown and urinary often enough or may not empty com- tract infection, but may result in social pletely. When this happens, the urine left isolation if individuals become concerned in the bladder acts as a reservoir for infec- about the probability that incontinence tion. Other problems may relate to injury are generally unable to control impaction (fecal matter that becomes their bladder, they may need to have a hardened and is unable to be evacuated) catheter inserted into the bladder to drain or in some instances to a condition called Conditions Affecting the Spinal Cord 83 paralytic ileus, in which the intestine times be violent and can occur with even ceases to function. Spasticity can be debil- Individuals can decrease the risk of itating, not only because it is disruptive these conditions by establishing a pattern and can potentially cause embarrassment of regular elimination, monitoring diet to the individual, but also because in and fluid intake, and learning specific some instances it can be so strong that it techniques for enhancing optimal bowel causes individuals to fall from their function. Although Contractures in some instances spasticity can be useful to help individuals perform certain func- Contractures (loss of range of motion, tions such as shifting position or stand- or fixed deformity of a joint) may occur in ing, more often it is a source of discom- paralyzed limbs if the joints are not moved fort. When spasticity is a cause of con- through their regular range of motion. If indi- medications may be used to reduce spas- viduals with paraplegia or quadriplegia ticity; however, generalized weakness, the develop contractures of the hip or knee, side effects of sedation, or other side it may be difficult to assume adequate posi- effects may make this treatment less tioning in a wheelchair. In severe cases when other the joints through the full range of mo- treatments are ineffective in controlling tion through passive exercises conducted spasticity, individuals may resort to sur- by another person, or by using special gery, such as rhizotomy (surgical resec- equipment, can prevent contractures from tion of a nerve root) to relieve spasticity. In addition, proper wheelchair seating as well as positioning of joints can Osteoporosis help reduce risk of contractures. Bone is a dynamic substance that is Spasticity continually depositing and reabsorbing calcium. The combined stress of weight Spasticity refers to the exaggerated bearing and muscle pull that occurs with involuntary movement of paralyzed mus- normal activity helps bones maintain cles.

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Because of the superficial position of the palmaris longus muscle trusted extra super avana 260 mg, to deep (figs 260mg extra super avana amex. Although four of the six arise from you can readily determine whether it is present in your own forearm the medial epicondyle of the humerus (see table 9 extra super avana 260mg visa. The brachioradialis buy extra super avana 260 mg with mastercard, al- and then examining for its tendon just proximal to the wrist (see ready described, is an obvious reference muscle for locating the figs. The flexor carpi ulnaris muscle is positioned on the me- The flexor carpi radialis muscle extends diagonally across dial anterior side of the forearm, where it assists in flexing the the anterior surface of the forearm, and its distal cordlike tendon wrist joints and adducting the hand. This muscle is an The broad superficial digital flexor (flexor digitorum super- important landmark for locating the radial artery, where the ficialis) muscle lies directly beneath the three flexor muscles just pulse is usually taken. It has an extensive origin, in- The narrow palmaris longus muscle is superficial in posi- volving the humerus, ulna, and radius (see table 9. It has a long, slender don at the distal end of this muscle is united across the wrist tendon that attaches to the palmar aponeurosis, where it assists in joint but then splits to attach to the middle phalanx of digits II flexing the wrist joints. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 270 Unit 4 Support and Movement Deltoid Coracobrachialis Pectoralis major Cephalic vein Biceps brachii Coracobrachialis Musculocutaneous nerve Cephalic vein Axillary artery Biceps brachii Subscapular artery Brachialis Lateral thoracic artery Long thoracic nerve Latissimus dorsi Ulnar nerve and Median nerve basilic vein Brachial artery and Ulnar nerve basilic vein Medial and long heads of triceps brachii Creek Humerus Radial nerve Lateral head of triceps brachii FIGURE 9. Brachioradialis Lateral supracondylar ridge of humerus Proximal to styloid Flexes elbow joint Radial n. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 9 Muscular System 271 FIGURE 9. The deep digital flexor (flexor digitorum profundus) muscle Extension of the Hand lies deep to the superficial digital flexor. It inserts on the distal pha- The muscles that extend the joints of the hand are located on langes two (II) through five (V). Most of the primary extensor of the wrist, hand, and the second, third, fourth, and fifth digits. It flexes the joints of the thumb, assisting the The long, tapered extensor carpi radialis longus muscle is grasping mechanism of the hand. It extends the carpal joint and The tendons of the muscles that flex the joints of the hand abducts the hand at the wrist. Immediately medial to the extensor can be seen on the wrist as a fist is made. These tendons are se- carpi radialis longus is the extensor carpi radialis brevis, which curely positioned by the flexor retinaculum (fig. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 272 Unit 4 Support and Movement FIGURE 9. The extensor digitorum communis muscle is positioned in The extensor pollicis longus muscle arises from the midul- the center of the forearm, along the posterior surface. It origi- nar region, crosses the lower two-thirds of the forearm, and in- nates on the lateral epicondyle of the humerus. Its tendon of in- serts on the base of the distal phalanx of the thumb (fig. It sertion divides at the wrist, beneath the extensor retinaculum, extends the joints of the thumb and abducts the hand. The ex- into four tendons that attach to the distal tip of the medial pha- tensor pollicis brevis muscle arises from the lower midportion of langes of digits II through V. The action of this muscle is similar to that of cated on the ulnar side of the extensor digitorum communis mus- the extensor pollicis longus. Its tendinous insertion fuses with the tendon of the extensor As its name implies, the abductor pollicis longus muscle digitorum communis going to the fifth digit. It originates on the The extensor carpi ulnaris is the most medial muscle on interosseous ligament, between the ulna and radius, and inserts the posterior surface of the forearm. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 9 Muscular System 273 TABLE 9. Pronator quadratus Distal fourth of ulna Distal fourth of radius Pronates forearm and hand Median n. Flexor carpi radialis Medial epicondyle of humerus Base of second and third Flexes and abducts hand at Median n. Flexor carpi ulnaris Medial epicondyle and Carpal and metacarpal bones Flexes and adducts wrist Ulnar n. The antebrachial muscles that flex these joints are larger and stronger than those that extend the joints.

At the 20- to 30-cell stage cheap 260 mg extra super avana, a fluid-filled cavity (blasto- coele) appears and enlarges until the embryo becomes a Implantation Requires the Interaction of hollow sphere buy extra super avana 260 mg line, the blastocyst purchase extra super avana 260mg. The cells of the blastocyst the Uterine Endometrium and the Embryo have undergone significant differentiation discount 260 mg extra super avana free shipping. A single outer Cell division of the fertilized egg occurs without growth. The embryonic cells continue to cleave centa and embryonic membranes, produce hCG, and pro- as the embryo moves from the ampulla toward the uterus vide nutrition to the embryo. Until implantation, the embryo is enclosed in located cells comprises the embryoblast or inner cell mass the zona pellucida. Retention of an intact zona is necessary and will give rise to the fetus. The morula reaches the uterus about 4 days after fertil- dometrial glandular and epithelial cells (Fig. It remains suspended in the uterine cavity for 2 to act embryonic signals that trigger this reaction are unclear, 3 days while developing into a blastocyst and is nourished but histamine, catechol estrogens, steroids, prostaglandins, by constituents of the uterine fluid during that time. Im- leukemia inhibitory factor, epidermal growth factor, trans- plantation of the blastocyst, which is attachment to the forming growth factor , platelet-derived growth factor, surface endometrial cells of the uterine wall, begins on days placental growth factor, and several other pregnancy-asso- 7 to 8 after fertilization and requires proper priming of the ciated proteins have been proposed. In preparing for im- Invasion of the endometrium is mediated by the release plantation, the blastocyst escapes from the zona pellucida. The denuded trophoblast cells become man conceptus has penetrated the uterine epithelium and is negatively charged and adhere to the endometrium via sur- embedded in the uterine stroma (see Fig. Microvilli from the trophoblast cells in- phoblast cells have differentiated into large polyhedral cy- terdigitate with and form junctional complexes with the totrophoblasts, surrounded by peripheral syncytiotro- uterine endometrial cells. Maternal blood In the presence of progesterone emanating from the cor- vessels in the endometrium dilate and spaces appear and pus luteum, the endometrium undergoes decidualization, fuse, forming blood-filled lacunae. Between weeks 2 and 3, which involves the hypertrophy of endometrial cells that villi, originating from the embryo, are formed that protrude contain large amounts of glycogen and lipid. In some cases, into the lacunae, establishing a functional communication the cells are multinucleated. This group of decidualized between the developing embryonic vascular system and the cells is called the decidua, which is the site of implantation maternal blood (see Fig. In the ab- oblast has differentiated into three layers: sence of progesterone, decidualization does not occur and • Ectoderm, destined to form the epidermis, its ap- implantation would fail. As the blastocyst implants into the pendages (nails and hair), and the entire nervous system decidualizing uterus, a decidual reaction occurs involving • Endoderm, which will give rise to the epithelial lining of the dilation of blood vessels, increased capillary permeabil- the digestive tract and associated structures ity, edema formation, and increased proliferation of en- • Mesoderm, which will form the bulk of the body, in- CHAPTER 39 Fertilization, Pregnancy, and Fetal Development 689 cluding connective tissue, muscle, bone, blood, and and maternal circulations do not mix. The chorionic villi aggregate into groups known as cotyle- PREGNANCY dons and are surrounded by blood from the maternal spiral arteries that course through the decidua. Pregnancy is maintained by protein and steroid hormones Major functions of the placenta are the delivery of nu- from the mother’s ovary and the placenta. The maternal en- trients to the fetus and the removal of its waste products. Oxygen diffuses from maternal blood to the fetal blood down an initial gradient of 60 to 70 mm Hg. The oxygen- transporting capacity of fetal blood is enhanced by fetal The Mother and Fetus Contribute to the Placenta hemoglobin, which has a high affinity for oxygen. The In the human placenta, the maternal and fetal components PCO2 of fetal arterial blood is 2 to 3 mm Hg higher than are interdigitated. The functional units of the placenta, the that of maternal blood, allowing the diffusion of carbon chorionic villi (see Fig. Other com- tend tissue projections into the maternal lacunae that form pounds, such as glucose, amino acids, free fatty acids, elec- from endometrial blood vessels immediately after implan- trolytes, vitamins, and some hormones, are transported by tation. By week 4, the villi are spread over the entire surface diffusion, facilitated diffusion, or pinocytosis. As the placenta matures, it becomes ucts, such as urea and creatinine, diffuse away from the fe- discoid in shape.

As the descent continues generic extra super avana 260mg visa, the tongue starts to de- The neuroectodermal cells that form the adrenal medulla are velop cheap extra super avana 260 mg visa, and the opening into the thyroglossal duct order 260 mg extra super avana mastercard, called the fora- derived from the neural crest of the neural tube generic extra super avana 260 mg without prescription. By adrenal medulla is gradually encapsulated by the adrenal cortex, a the seventh week, the thyroid gland occupies a position immedi- process that continues into the fetal stage. The formation of the ately inferior to the larynx, surrounding the front and lateral sides adrenal gland is not completed until the end of the third year of age. Notice that the adrenal gland, like the pituitary, has a dual origin; part is neural and part is not. Like the pituitary, the adrenal cortex and adrenal medulla are in fact two different endocrine tis- Rathke’s pouch: from Martin H. Although they are located in the same organ, they secrete dif- foreman cecum: L. The placenta is also an endocrine gland; it secretes summarized in table 14. Endocrine System © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 EXHIBIT II The embryonic development of the thyroid gland. Detection of hCG in urine is an indication of pregnancy and is the basis of home 22. Describe the location of the pineal gland and the action of pregnancy tests. Endocrine System © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 480 Unit 5 Integration and Coordination Basal metabolism rate (BMR) and thyroid scans (see CLINICAL CONSIDERATIONS fig. Radiographs and electrocardiograms also may be helpful system and the consequences of glandular dysfunctions. Hypersecretion of an endocrine gland is generally Disorders of the Pituitary Gland caused by hyperplasia (increase in size) of the gland, whereas The pituitary is a remarkable gland. It simultaneously carries out hyposecretion of hormones is the consequence of a damaged or several functions, yet more than 90% of the gland must be de- atrophied gland. The diagnosis and treatment of endocrine problems can be difficult because of three complex physiological effects of Panhypopituitarism hormones. Total pituitary impairment, termed panhypopitu- Thus, the clinical symptoms obscure the source of the prob- itarism, brings about a progressive and general loss of hormonal lem. For example, the gonads stop functioning and the per- bolic problems because the primary action of hormones is to son suffers from amenorrhea (lack of menstruation) or aspermia regulate metabolism. The Common diagnostic methods will be discussed in this sec- thyroid and adrenals also eventually stop functioning. People tion, along with the more important endocrine disorders that af- with this condition and those who have had their pituitary sur- fect the major endocrine glands. Diagnosis of Endocrine Disorders Certain endocrine disorders affect the patient’s physical appearance Abnormal Growth Hormone Secretion and behavior; therefore, observation is very important in diagnosis. Inadequate growth hormone secretion during childhood causes The patient’s clinical history is also important in evaluating the pituitary dwarfism (fig. Hyposecretion of growth hor- rate of progress and stage of development of an endocrine disorder. One of the symptoms tory tests, particularly of blood and urine samples. These samples of this disease is premature aging caused by tissue atrophy. By are important because hormones are distributed via the blood, contrast, oversecretion of growth hormone during childhood and urine is produced from the metabolic wastes filtered from the causes gigantism (fig. A radioimmunoassay (RIA) is a laboratory test to deter- length of long bones. Excessive growth hormone secretion in an mine the concentration of hormones in blood and urine. Other adult does not cause further growth in bone length because the blood tests include the protein-bound iodine (PBI) test to deter- epiphyseal plates have already ossified. A urinalysis can be important in the diagnosis of several en- docrine disorders. A high level of glucose in a fasting patient in- dicates diabetes mellitus. A patient who has diabetes insipidus will produce a large volume (5–10 L per day) of dilute urine of low specific gravity.

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