Juliana Chan, PharmD, FCCP, BCACP

• Clinical Associate Professor, Colleges of Pharmacy and Medicine, University of Illinois at Chicago
• Clinical Pharmacist�Gastroenterology/Hepatology, Illinois Department of Corrections Hepatology Telemedicine, Sections of Hepatology, Digestive Diseases and Nutrition, Chicago, Illinois

https://pharmacy.uic.edu/profiles/jchan/

Food and fluids in the stomach are turned into a pasty material called chyme that is moved into the small intestine gastritis symptoms upper right quadrant pain 150mg zantac mastercard. Chyme is mechanically churned and chemically altered gastritis hunger purchase zantac without prescription, enabling nutrients to be absorbed into the intestinal blood or lymph capillaries gastritis relieved by eating zantac 150 mg low price. The undigested chyme that is moved into the large intestine is turned into a dryer gastritis que es buy zantac american express, more solid mass called feces gastritis location order 300 mg zantac with amex. Water gastritis diet pdf 300mg zantac sale, electrolytes, and vitamin K are absorbed through the mucosa of the large intestine as feces are formed. Objective C To detail the structure of the serous membranes associated with the abdominal cavity and viscera. Su rvey and connective tissue membrane that lines body cavities and covers visceral organs within these Review problems 1. The serous membranes within the abdominal cavity are specifically referred to as the peritoneum. The peritoneal covering continues around the abdominal viscera as the visceral peritoneum. The falciform ligament attaches the liver to the diaphragm and anterior abdominal wall. The lesser omentum extends between the liver and the lesser curvature of the stomach. The greater omentum extends from the greater curvature of the stomach to the transverse colon, forming an apronlike structure over the small intestine. The omentum stores fat, cushions visceral organs, supports lymph nodes, and protects against the spread of infection. Being a doublefolded structure, the mesentery also encloses the vessels and nerves that go to and from the intestines. Peritonitis is an inflammation of the peritoneum caused by bacterial contamination of the peritoneal cavity. The submucosal plexus, or plexus of Meissner, provides autonomic innervation to the muscularis mucosae (a thin layer of smooth muscle of the tunica mucosa). The pharynx, which is posterior to the oral cavity, is a common passageway for the respiratory and digestive systems. The teeth present in both the upper and lower jaw are listed below, and their locations can be noted in fig. There are four upper and four lower chisel-shaped anteriormost incisors, adapted for cutting and shearing food. There are two upper and two lower cone-shaped canines (eye teeth), adapted for holding and tearing. There are four upper and four lower premolars (bicuspids) with roughened cusps, adapted for crushing and grinding food. There are six upper and six lower molars (the posteriormost four of which are the wisdom teeth); adapted for crushing and grinding food. An impacted tooth is one that cannot emerge through the gum, and so becomes rotated, displaced, or tilted. An impacted wisdom tooth is common because the jaws are formed and the other teeth are in place long before a wisdom tooth tries to emerge. Heterodontia refers to the differentiation of teeth for different tasks (see problem 19. Diphyodontia refers to the development of two sets of teeth in a lifetime; in humans, there are 20 deciduous (baby) teeth, or milk teeth, and 32 permanent teeth. The dentin provides structural support to the tooth; it surrounds the pulp, which contains nerves and blood and lymph vessels. A thin layer of cementum fastens the tooth to the periodontal ligament, which borders a tooth socket called a dental alveolus. A root canal, in each root, for passage of vessels and nerves communicates with the pulp cavity through an apical foramen. The gingiva, or gum, is the fleshy covering over the mandible and maxilla through which the teeth protrude into the oral cavity. The saliva cleanses the teeth, initiates carbohydrate digestion through the action of amylase (see table 19. The tongue moves food around in the mouth during mastication and assists in swallowing. The palate is the roof of the oral cavity, consisting anteriorly of the bony hard palate and posteriorly of the soft palate. Transverse ridges, called palatal rugae, are located along the mucous membranes of the hard palate, where they serve as friction bands against which the tongue is placed during swallowing. During swallowing, the soft palate and uvula are drawn upward, closing the nasopharynx and preventing food and fluid from entering the nasal cavity. It serves the digestive system (with the passage of food and fluid) and the respiratory system (with the passage of air). The upper third of the esophagus contains skeletal muscle, the middle third contains skeletal and smooth muscle, and the lower third contains smooth muscle only. This includes chewing of the food and the formation of a bolus that is forced against the soft palate with the elevated tongue. The second stage, the involuntary deglutition reflex, begins when pharyngeal sensory receptors are stimulated. During this stage, the uvula is elevated, sealing off the nasal cavity; the hyoid bone and larynx are elevated, so that food or fluid is less likely to enter the trachea; and the esophagus is opened. During the third stage, the bolus or fluid enters the esophagus and is transported to the stomach by peristalsis. Achalasia is a condition in which the lower portion of the esophagus (gastroesophageal sphincter) fails to relax. The causes of achalasia include abnormal parasympathetic stimulation, emotional stress, or excess gastric secretion. The convex lateral margin of the stomach is called the greater curvature, and the concave medial margin is known as the lesser curvature. The functions of the stomach are to store food as it is mechanically churned with gastric secretions (see problem 19. The tunics are stripped away to expose the gastric rugae bordering the lumen of the stomach. These three smooth muscle layers enable churning movements in the formation of chyme. Distention (stretching) is permitted by gastric rugae, which are longitudinal folds of the tunica mucosa. Gastric juice is the combined secretory product of the mucus and the chief, parietal, and argentaffin cells (table 19. Hormones secreted from G cells into the bloodstream are not part of the gastric juice. In response to sight, taste, smell, or even certain thoughts, parasympathetic impulses in the vagus nerves initiate the secretion of 50 to 150 mL of gastric juice. Food-induced distention of the tunica mucosa, along with the chemical breakdown of protein, stimulates the release of gastrin (see table 19. Chyme entering the duodenum stimulates the release of gastrin, which leads to the production of additional small quantities of gastric juice. Vomiting is the reflexive response of emptying the stomach through the esophagus, pharynx, and oral cavity. Excessive gastric acid secretion relative to the degree of protection afforded by the mucous barrier of the duodenum results in duodenal ulcers. Gastric ulcers, however, may not be due to excessive acid secretion, but rather to mechanisms that reduce the barriers of the gastric mucosa to self-digestion. The gastroesophageal sphincter (lower esophageal sphincter) is located at the junction of the esophagus and the stomach. It is a specialized portion of the circular layer of the tunica muscularis that constricts after food or fluid passes into the stomach. It is not a true sphincter, however, because during reflexive vomiting it opens to permit flow of the regurgitated matter into the esophagus toward the oral cavity. Located at the terminal part of the stomach, the pyloric sphincter is also a specialization of the circular layer of the tunica muscularis. Generally, it prohibits backflow of chyme into the stomach, but with prolonged and extremely forceful vomiting it may be forced open, permitting some bile to be regurgitated. Objective G Su To identify the regions of the small intestine and to discuss the process of food absorption. It is divided on the basis of histological structure and function into the duodenum, jejunum, and ileum. The small intestine receives chyme from the stomach, and bile and pancreatic secretions from the liver and pancreas, respectively. Chyme is broken down in the small intestine, nutrients are absorbed, and the remaining undigested material is transported to the large intestine. It receives bile secretions through the common bile duct from the liver and gallbladder, and pancreatic secretions through the pancreatic duct. It is characterized by deep folds called plicae circulares in the mucosa and submucosa (see problem 19. The 2 m (6 ft) ileum joins the cecum of the large intestine at the ileocecal valve. These folds, in turn, are covered by numerous fingerlike projections of the mucosa called villi. Absorption is accomplished as food molecules enter the minute vessels of the villi through microvilli, which are microprojections on the free surface of the cells lining the villi. Contractions of the longitudinal and circular muscles of the tunica muscularis produce three distinct types of movements. Churning movements that occur at a rate of about 12 to 16 per minute in the regions containing chyme. These movements mix the chyme with digestive juices and bring it into contact with the villi. Irregular constrictions that cause wavelike movements first in one direction, then back again. Rhythmic local contractions of smooth muscles that occur at a rate of 15 to 18 per minute. The large intestine is structurally divided into the cecum, colon, rectum, and anal canal. Other than absorbing water, electrolytes, and small amounts of vitamin K, the large intestine plays a minor digestive role. It receives chyme through the ileocecal valve, a fold of mucous membrane at the junction of the small intestine and large intestine that prohibits the backflow of chyme. Its position at the junction of the ileum and cecum predisposes it for occasional blockage by small particles suspended within the developing chime. Occasionally, as the blockages form, they compress the wall of the appendix, constricting blood flow toward the tip of this organ. Restricted blood flow may then result in necrosis of the tissue and subsequent infection of the organ (appendicitis). The colon consists of ascending, transverse, descending, and sigmoid portions (see fig. The ascending colon extends superiorly from the cecum to the level of the liver, where it bends sharply to the left at the hepatic flexure (right colic flexure) and transversely crosses the upper peritoneal cavity as the transverse colon. Here, another right-angle bend called the splenic flexure (left colic flexure) marks the beginning of the descending colon. In the pelvic region, the colon angles medially into an S-shaped bend known as the sigmoid colon. Folds in the mucosa of the anal canal called anal columns permit distenion during defecation. The internal anal sphincter of smooth muscle tissue and the external anal sphincter of skeletal muscle tissue guard the anus. Colitis is ulceration of the mucosal lining of the colon, especially in the descending and sigmoid portions. The symptoms include diarrhea (stools contain blood and mucus), loss of appetite, nausea, and abdominal tenderness. Treatment of colitis includes avoidance of milk products, nuts, certain fruits, and the use of anti-inflammatory drugs. The mucosa and submucosa of the large intestine lack plicae, but they do have sacculations, or haustra, along their length (see fig. The tunica muscularis consists of longitudinal bands of smooth muscle called taeniae coli. In the tunica adventitia, attached superficially to the taeniae coli, are fat-filled pouches called epiploic appendages. Only the peristaltic movements of the colon are similar to those of the small intestine, although they are usually more sluggish (3 to 12 per minute). Haustral churning is the contraction of a haustrum stimulated by the distended tunics. Mass movement (two or three times a day following meals) is gross motion of fecal material, brought on by contraction of the taeniae coli. Prolonged diarrhea is of serious concern, especially in children and elderly people. The loss of these body essentials causes homeostatic changes that result in death within hours or a few days. Objective I Su To describe the location, structure, and functions of the liver and gallbladder. The reddish brown liver is positioned beneath the diaphragm, in the epigastric and right rvey hypochondriac regions of the abdominal cavity.

Hypothalamus (f) responds to intense pain (g) secretes melatonin (h) monitors osmotic concentration of blood (i) produces cerebrospinal fluid (j) apneustic center 179 Answers and Explanations for Review Exercises Multiple Choice 1 gastritis diet peanut butter buy 300mg zantac with visa. False; vasoconstriction and vasodilation to maintain blood pressure are functions of the medulla oblongata gastritis in pregnancy zantac 150mg free shipping. False; the cerebral arterial circle provides a rich blood supply to the brain gastritis healing discount zantac 300mg fast delivery, especially the pituitary gland gastritis diet ��������� discount 300 mg zantac mastercard. False; the limbic system generates emotions; the reticular activating system stimulates (alerts) the brain gastritis cystica profunda order 150 mg zantac overnight delivery. Reference is frequently made to a somatic nervous system in connection with the innervation of skeletal muscles gastritis diet symptoms purchase zantac 150mg with amex, which have both voluntary and involuntary contraction. The designation visceral nervous system refers to the autonomic innervation of visceral organs (those organs within the thoracic and abdominopelvic cavities). Most peripheral nerves are composed of both motor and sensory neurons; they are thus mixed nerves. Some cranial nerves, however, are composed either of sensory neurons only or of motor neurons only. Sensory nerves serve the special senses (see chapter 12) of taste, smell, sight, hearing, and balance. Motor nerves conduct impulses to muscles, causing them to contract, or to glands, causing them to secrete. Ganglia are sites for possible synapses of neurons between organs and the spinal cord. A dermatome is the area of the skin innervated by all the cutaneous neurons of a given spinal or cranial nerve (fig. The pattern of dermatome innervation is established embryonically and is of clinical importance in anesthetizing a particular portion of the body. Abnormally functioning dermatomes also provide clues about injury to the spinal cord or to specific spinal nerves. Most are mixed rvey nerves, some are totally sensory nerves, and others are primarily motor nerves. The names of the cranial nerves indicate their primary functions or their general distribution. The cranial nerves are also identified by Roman numerals in order of appearance from front to back (see table 11. The cranial nerves emerge from the inferior surface of the brain and pass through foramina of the skull (see fig. The first two pairs of cranial nerves are attached to the forebrain; the remaining 10 pairs are attached to the brainstem. Sensory nerves originate in nerve trunks and sensory organs and terminate at brain nuclei: motor nerves originate at brain nuclei. The olfactory nerve consists of bipolar neurons that function as chemoreceptors and relay sensory impulses of smell from mucous membranes of the nasal cavity. The optic nerve conducts sensory impulses from the photoreceptors (rods and cones) in the retina of the eye. The vestibulocochlear nerve consists of a vestibular branch, arising from the vestibular organs of equilibrium and balance, and a cochlear branch, arising from the spiral organ of hearing. The oculomotor nerve innervates the superior, inferior, and medial recti muscles and the inferior oblique muscle (see fig. The abducens nerve innervates the lateral rectus muscle, and the trochlear nerve innervates the superior oblique muscle. In the event of a concussion or other head injury, part of a quick neurologic assessment for cranial nerve damange is to have the patient follow finger movements with the eyes. An inability to look cross-eyed may signal damage to the oculomotor nerve; problems with lateral eye movements, damage to the abducens nerve; and trouble looking downward, away from the midline, damage to the trochlear nerve. This paired cranial nerve conveys sensory information from the face, nasal area, tongue, teeth, and jaws; it supplies motor innervation to the muscles of mastication (see fig. The trigeminal nerve gives rise to three separate nerves that branch from the trigeminal ganglion (fig. The ophthalmic nerve conveys sensory innervation to the anterior scalp, skin of the forehead, upper eyelid, surface of the eyeball, lacrimal (tear) gland, side of the nose, and upper mucosa of the nasal cavity. The maxillary nerve conveys sensory innervation to the lower eyelid, lateral and inferior mucosa of the nasal cavity, palate and portions of the pharynx, teeth and gums of the upper jaw, upper lip, and skin of the cheek. The mandibular nerve conveys sensory innervation to the teeth and gums of the lower jaw, anterior two thirds of the tongue, mucosa of the mouth, auricle of the ear, and lower part of the face. It is the motor portion of the mandibular nerve that serves the muscles of mastication. Surface and bony landmarks of the oral cavity are invaluable to a dentist in administering an anesthetic prior to filling or extracting a particular tooth. Alveolar nerves can be desensitized by injections near the roots of specific teeth. A maxillary nerve block, performed by injecting near the sphenopalatine ganglion, desensitizes the teeth in the upper jaw. Tic douloureux, also called trigeminal neuralgia, is a disorder of the trigeminal nerve characterized by severe recurring pain in one side of the face. Because the pain cannot be treated with drugs on a long-term basis, denervation eventually may be required for the patient. Caution must then be exercised while eating, however, so as not to unknowingly chew the cheek. It also conducts sensory impulses from taste buds on the anterior two thirds of the tongue (see problem 12. The paired vagus nerves are the principal autonomic parasympathetic nerves that provide visceral innervation (fig. Autonomic impulses through the vagus nerves regulate digestive activities, including glandular secretions and peristalsis. Sensory fibers of the vagus nerves convey sensations of hunger (hunger pangs), abdominal distention, intestinal discomfort, and laryngeal movement. A blow to the head may cause trauma not only at the point of impact, but also at the opposite side of the skull, where the brain rebounds off the cranium. A below to the top of the head, for example (as in an automobile accident), may damage the cranial nerves from the rebound of the brain off the floor of the cranium. Neurologic examinations following traumatic head injuries routinely involve testing for dysfunctions of cranial nerves. The 31 pairs of spinal nerves are grouped as follows: 8 cervical nerves, 12 thoracic rvey nerves, 5 lumbar nerves, 5 sacral nerves, and 1 coccygeal nerve (fig. The first pair of cervical nerves (Cl) emerges between the occipital bone of the skull and the first cervical vertebra (the atlas). The rest of the spinal nerves exit the spinal cord and vertebral canal through intervertebral foramina (see problem 6. Each spinal nerve is a mixed nerve, attached to the spinal cord by a posterior (dorsal) root of sensory fibers and an anterior (ventral) root of motor fibers (fig. Upon emergence through the intervertebral foramina, the anterior roots (immediately) and the posterior roots (after swelling into posterior [dorsal] root ganglia, where the cell bodies of the sensory neurons are located) become, respectively, anterior and posterior rami (fig. Except in the thoracic nerves T2-T12, the anterior rami of different spinal nerves combine and then split again, forming a network known as a plexus. There are four plexuses of spinal nerves: the cervical plexus, brachial plexus, lumbar plexus, and sacral plexus (see fig. Nerves that emerge from a plexus no longer carry a spinal designation, but instead are named according to the structure or region they innervate. Of the hundreds of nerves in the body, several paired nerves stand out because of their size and broad area of innervation. The paired phrenic nerves arise from the cervical plexuses (right and left), travel through the thorax, and innervate the diaphragm. Impulses through these nerves cause contraction of the diaphragm and inspiration of air. The axillary, radial, musculocutaneous, ulnar, and median nerves arise from the brachial plexus and innervate the shoulder and upper extremity. When you hit you "funny bone" at the elbow, it is the ulnar nerve that is traumatized. The femoral, obturator, and saphenous nerves arise from the lumbar plexus and innervate portions of the hip and lower extremity. A herniated disc, pressure from the uterus during pregnancy, or an improperly administered injection into the buttock may damage the roots leading to the sciatic nerve or the nerve itself. Even a temporary compression of the sciatic nerve, for example, as you sit on a hard surface for a period of time may result in the perception of tingling in the limb as you stand up. Located within the skin, a tendon, a joint, or some other peripheral organ, a receptor consists of dendritic endings of a sensory neuron that responds to specific stimuli, such as sudden pressure or pain. Extending from the receptor through the posterior root, the sensory (afferent) neuron conveys stimuli to the posterior horn of the spinal cord. The axon of a sensory neuron synapses with an association neuron (also called an interneuron or internuncial neuron) within the center. Beginning at a synapse with the association neuron, the motor neuron conveys impulses from the anterior horn of the spinal cord, through the anterior root, to the effector organ. The effector is a muscle or gland that responds to a motor impulse by contracting or secreting, respectively. An example of a reflex arc in action is the rapid automatic pulling away of the hand as a hot object is touched. The "arc," or center portion, of the reflex arc connecting the sensory with the motor components is always located in the spinal cord or the brain. An example of a reflex arc involving the brain is the rapid jerking away of the head from a sudden loud noise. Recall from chapter 7 (Objective F) that a motor unit consists of a motor neuron coupled with the specific skeletal muscle fibers that it innervates. This means that the motor unit is represented by the motor neuron and a specific cluster of skeletal muscle fibers, as shown in fig. Deep tendon reflex testing provides information about the functioning of receptors, sensory nerves, synapses, and the spinal cord. The functioning of these structures may be altered by developmental problems, drugs, or certain diseases. For example, when a person steps on a piece of broken glass with a bare foot, the injured foot is reflexively pulled away from the harmful object. As the foot is pulled away, and in a near simultaneous movement, the arms are extended to maintain balance on one foot. Within milliseconds, a pain sensation is conveyed to the brain, and the person is aware of what has happened, and even the nature of the reflexive response. Tapping the patellar ligament with a rubber mallet causes the quadriceps femoris muscle to stretch, which provokes impulses from intrafusal spindle receptors at the tendinous attachment of the muscle. The impulses are conducted along the sensory neuron to the spinal cord, where the sensory neuron synapses directly with the motor neuron. When a painful stimulus contacts the skin- for example, a sharp or hot object-a sensory receptor is activated. Sensory impulses are transmitted through a sensory neuron to the spinal cord, where two or more association neurons are stimulated. One association neuron generates impulses to a motor neuron, which initiates a response such as foot or hand withdrawal; the other association neurons conduct impulses to the brain, so that the person becomes aware of the painful event. The autonomic and somatic components of the nervous system are compared in table 11. These centers integrate the sensory visceral input with input from higher brain centers (the cerebral cortex and limbic system). There are two types of sympathetic ganglia: sympathetic chain ganglia and collateral ganglia. There are 22 ganglia in each chain (3 cervical, 11 thoracic, 4 lumbar, and 4 sacral). Some of the postganglionic neurons travel back into spinal nerves via gray rami communicantes, and the rest pass directly to the viscera. Collateral, or prevertebral, ganglia are found outside the sympathetic chain, in the vicinity of the viscera and arteries. All parasympathetic ganglia are called terminal ganglia because they are located close to or in the target organ. Muscarinic receptors are located on effector cells innervated by postganglionic neurons of the parasympathetic division and on those effector cells innervated by postganglionic cholinergic neurons of the sympathetic division (see problem 11. Nicotinic receptors are located at the ganglia in both the sympathetic and parasympathetic divisions. There are two main types, called alpha receptors and beta receptors, each divided into two sublypes (table 11. Norepinephrine stimulates mainly alpha receptors: epinephrine stimulates both alpha and beta receptors approximately equally. The heart, as well as most smooth muscles and visceral organs of the body, is innervated by both the two divisions are usually activated reciprocally; that is, as the activity of one is enhanced, the activity of the other is diminished. To predict the effects of each division on a specific organ, use the following rule of thumb: Sympathetic stimulation activates the body in states of stress, fear, and rage (the "fight-or-flight" reaction) and during strenuous physical activity. Parasympathetic stimulation maintains body functions under quiet, day-to-day living conditions; it decreases heart rate and promotes digestion and absorption of food. These include epinephrine, norepinephrine, isoproterenol, ephedrine, and amphetamine. Prescribed to dilate bronchial tubes, treat cardiac arrest, dilate pupils, delay absorption of local anesthetics, elevate mood of patient. These include phentolamine, phenoxybenzamine, prazosin (alpha blockers); propranolol, timolol, nadolol (beta blockers). Prescribed to lower blood pressure in cases of pheochromocytoma (alpha blockers); lower blood pressure, reduce frequency of anginal episodes, treat heart arrhythmias, reduce intraocular pressure in cases of glaucoma (beta blockers). These include acetylcholine and its mimics-methacholine, carbachol, and bethanecol.

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The running speed gastritis symptoms deutsch best purchase for zantac, the inclination of the terrain gastritis ruq pain buy zantac 150mg visa, the overload body and other factors gastritis x estres 150 mg zantac overnight delivery, are in close relationship with the magnitude of these stresses gastritis diet honey buy generic zantac 300mg. A fast forward leg gastritis diet ��� order zantac online from canada, kicked forward hcg diet gastritis generic zantac 300 mg free shipping, if it is not limited and slowed dow it may causes trauma. This is the action that is potentially more detrimental fo hamstring during racing action, especially if the latter lack of elasticity. Extrinsic Causes Often become decisive in establishing the syndrome hamistring overuse. The run action is "harmonic", when the hamstring is tonic, not retracted and with a good neuromuscular coordination during the "pendulum" of the race. The functional imbalance of the power ratio between the hamstring and quadriceps muscle can lead to a functional overload and then to a trauma. The index of power developed between quadriceps and hamstring is 6 to 4 (physiological relationship). When the quadriceps has a variety of causes excessive growth or the hamstring has a weakness-retraction (post-traumatic, etc. Generally, the patient reports a feeling of discomfort at insertional proximal during testing of flexibility, although they may not show significant deficits. Depending on the degree level compression of the sciatic nerve patients may show a radicular symptoms more or less evident. In Puranen-Orawa Test the pati performs an active stretching of hamstring muscles in the upri position. Again the test is positive causes pain to the level elect proximal insertion of the flexor. In Bent-Knee stretch the the subject carries out with the a of a band or a rope stretchin active flexor muscle from th supine position. The test positive if it evokes pain electi at the insertion of the proxim hamstring. Clinical diagnosis Generally the activity of the race is not totally prevented but, in any case, greatly restricted. Usually the pain is exacerbated by running uphill, downhill and during the sprint, remaining instead quite content while running at low speed performed on flat ground. Prevalence of Different Pathologies Observed by X-ray Imaging in Patients Afflicted with Chronic Low Back Pain (694 Individuals) with 95% Confidence Interval in both women and men were significantly younger. Prevalence of spondylolysis in communities, ethnicities, age groups, and both sexes is different, and various studies have reported the prevalence as 5-20% (10). However in our study, radicular pain occurred in more than 60% of individuals, and the prevalence of spondylolysis was less common. This research realized that the prevalence of spondylolysis in both sexes were the same, while other studies (10,11,13) reported that the prevalence of this injury in men was more than that in women. The authors of the present work concluded that individuals with spondylolysis were significantly younger than individuals without it, confirming the findings of most of the prior researches. More importantly, there was a statistically significant relationship between age and spondylolisthesis in women. Furthermore, no significant relationship existed between spondylolysis and spondylolisthesis, and only 10% of the individuals suffering from spondylolisthesis had spondylolysis. In most of the studies like the present one, women are more involved than men, and prevalence of spondylolisthesis is associated with increasing age in females (18-20). The most common etiology of spondylolisthesis is degeneration of joint surface, and spondylolysis is less important to make spondylolisthesis. However, the prevalence of spondylolisthesis among women was significant and associated with increasing age. Low back pain in Iran: a growing need to adapt and implement evidence-based practice in developing countries. Prevalence of spondylolysis and its relationship with low Downloaded from back pain in selected population. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult communitybased population. Spondylolysis and isthmic spondylolisthesis: impact of vertebral hypoplasia on the use of the Meyerding classification. Lumbosacral Transitional Vertebrae and Its Prevalence in the Australian Population. Spondylolysis and spondylolisthesis: prevalence of different forms of instability and clinical implications. Isthmic spondylolisthesis among patients receiving disability pension under the diagnosis of chronic low back pain syndromes. Prevalence and risk factors of lumbar spondylolisthesis in elderly Chinese men and women. The association of mild-moderate isthmic lumbar spondylolisthesis and low back pain in middle-aged patients is weak and it only occurs in women. Incidence of Involved Levels of Lumbosacral Vertebrae Level of Involvement L2-L3 L3-L4 L4-L5 L5-S1 Multilevel Number 2 18 35 26 9 Percent (%) 0. Funding None Conflicts of Interest All authors of the study declare that they did not enjoy any potential or actual and material or spiritual benefits in doing the research. In this survey, 692 individuals were studied which makes it a unique work in this field and I could not find previous similar evaluation performed in Iran. Another issue worthy of attention is that the authors did not consider dynamic spondylolisthesis and did not use dynamic X-rays which is widely recognized as an effective method to detect the lumbar instability. The level of spondylolisthesis was reported and the most common level (L4-L5) was consistent with previous studies in degenerative spondylolisthesis. Although the authors did not mention the prevalence of each type of spondylolisthesis separately, it seems that most of the patients had a degenerative type. Current study made no attempt to correlate radiographic findings with clinical symptoms which should be sought in future efforts. In conclusion, to my knowledge, this is the first study that has assessed the prevalence of spondylolysis and spondylolisthesis in Iranian population. Although it has a few drawbacks, it can be a basis for additional research in this area. For this discussion a few comments related to the circumstances and actions around euthanasia are relevant. The greatest paradox of veterinary medicine is that the first concern of the veterinarian should be the best possible care in the interest of the animal, yet often circumstances dictate that the best care of the herd is euthanasia of selected individuals. On the surface, this paradox appears to have its root in the greatest bane of the profession, economics. Usually there are several conflicting circumstances affecting the unwell animal or herd. The importance of each circumstance carries different weight according to the situation. The economic and sentinel value of the animal, economic situation of both owner and veterinarian, degree of suffering of the animal, emotional makeup and outlook of both owner and veterinarian, attachment of owner or some family member to the animal, quality of service offered by the practice, emotional symbolism of the animal, and many other factors bear upon the decision to euthanatize an animal. Veterinarians must be aware of these factors when assisting a client in this decision. This is more difficult than it appears, because the individuals involved may not be aware of all the relevant factors, or may turn a psychological blind eye to them. The relative demand and importance of each Aimless cutting and hacking has no place in proper necropsy technique. The basic necropsy examination is organized in such a manner that all organ systems are first evaluated grossly. Once this basic examination has been completed, the pathologist may then proceed to focus on the specific abnormal organs or tissues, but this should only occur after a thorough stepwise initial examination. A standard procedure properly conducted requires the prosector to continuously search, look and be aware of what is seen. Necropsy technique should also be designed to yield the best specimens possible for any ancillary tests that may be necessary following gross examination. The same principles apply: specimens should represent cell morphology and function as closely as possible to that which was present at the time of death. The necropsy must be conducted to avoid any exposure to water, contamination with foreign compounds, organisms or other material that could affect the findings and interpretations of further tests. The verb for euthanasia is euthanatize, not the necropsy in veterinary medicine 6 methods of killing animals that cause the most rapid loss of consciousness with the least discomfort are considered the most humane. Safety of personnel involved in killing the animal is an important factor, especially if the animal is large, deranged, or vicious, if the area where the animal is to be killed has solid barriers to movement, an irregular floor surface or other dangerous features, or if there is some inherent danger in the method of euthanasia selected. The emotional effect of the procedure on the owner and other observers is an important, but secondary consideration to the two already mentioned, but must always be kept in mind. As a general policy, the author is of the opinion that owners should not be present when an animal is killed. If they wish assurance that the animal has been killed, they should be asked to sit in a waiting room during the procedure, and then invited to view the body when the animal is dead. This allows the veterinarian and staff to concentrate on the task, removes unnecessary pressure should the procedure not proceed smoothly, and allows time for the animal to be placed in a natural position following death prior to the owner viewing the body. Agonal reflex respiratory movements made by large animals following barbiturate injection are often misinterpreted by owners. If an owner does wish to witness the euthanasia of an animal, a brief explanation of what is going to occur and the reactions to be expected from the animal will help to reassure the owner and pre-empt any factor must be judged carefully when advising an owner in order to render the best advice. This is very much the case in diagnostic veterinary practice when the disease problems encountered are often curable. Often the need for a high quality sample of a tissue or organ, or an untreated animal showing typical signs of a disease is a major factor in the decision to euthanatize a specific animal. In such situations, euthanasia is seldom in the interest of the animal, but is very often in the interest of the surviving members of the herd or flock. Discussion here will be restricted to those most commonly encountered in diagnostic practice. Once the decision to kill an animal has been made, the most important factor should be to minimize the discomfort and stress to which the animal will be subjected during the procedure. The the necropsy in veterinary medicine 7 Alternatively, a shotgun blast from short range laterally to the neck aimed such that the carotid arteries, trachea, cervical nerves and other structures are simultaneously destroyed can be an effective, humane, and safe method of killing a restrained large animal or wildlife under field or emergency conditions. However, use of firearms can become both dangerous and a nightmare of cruelty if the operator does not know the landmarks used to target the brain, misses the shot, or if the animal moves prior to discharge of the firearm. As with captive bolt pistols and for the same reasons, firearms should not be used on animals with heavy frontal bones or large frontal sinuses. Firearm use is precluded inside enclosed structures because of the possibility of ricochets. Such changes may give clues to the nature of the underlying disease process, but just as often may result in alterations that potentially confuse the diagnosis and interpretation of post-mortem findings and must be understood in order to properly interpret observations. These include hypoxia/anoxia, responses to metabolic changes and aspiration of blood/rumen content into the lungs. Equally important is that new staff or students that are assisting or observing have the steps and events they see explained to them, especially if death of the animal is not as smooth and painless as anticipated. The veterinarian should never assume that paraveterinary staff know everything that is occurring, nor that they know how to respond in every situation. For new staff members, explanation can be given as the procedure is being carried out. At all times, the veterinarian has to work in a calm and methodical manner, and the worse the situation becomes the calmer and more methodical he/she has to be. Massive trauma to the central nervous system is an acceptable method of euthanasia, but carries some caveats. Captive bolt pistols produce instant unconsciousness, but can be both inhumane and dangerous in the hands of an inexperienced operator. They are of no use in older swine and bulls, both classes of animals having large frontal sinuses which prevent penetration of the brain by the bolt. There is a role for firearms in killing animals in certain field or emergency situations. A single, well aimed shot into the brain administered by an experienced individual to a well restrained animal causes sudden death and is humane. The necropsy in veterinary medicine 8 and fairly easy, to differentiate between material entering the respiratory tract at this time from material entering the respiratory tract that is responsible for pneumonia and ultimately death. There is no tissue reaction to gastric/rumen contents entering the respiratory tract immediately at or following death. Material that enters shortly prior to death will elicit some hyperemia and fibrin exudation from mucous membranes. A much more severe inflammatory response is seen if true, active aspiration has occurred as part of the disease process that led to death, either due to accidental inhalation of ingesta, or more commonly, due to inhalation occurring as a consequence of some other process affecting laryngeal reflexes such as nervous disease or toxicosis. This is an important differentiation to make, because appreciation of gastric/rumen contents cannot occur in the presence of normal laryngeal reflexes. Aspiration is therefore an indication of either nervous disease affecting reflexes, or some systemic condition that has altered nerve function.

Technically gastritis red wine purchase zantac 300mg on-line, bones do not articulate; rather gastritis onions generic zantac 150mg with amex, the articular cartilage of one bone articulates with the articular cartilage of another gastritis or ibs zantac 150 mg discount. Objective G To list the cranial and facial bones of the skull gastritis diet oatmeal cheap 150 mg zantac fast delivery, to describe their locations and structural characteristics gastritis and bloating discount zantac 150 mg fast delivery, and to identify the articulations that affix them together gastritis or pancreatic cancer zantac 300mg low cost. The bones of the skull are united by serrated immovable joints called sutures (see figs. The frontal bone is joined to the two parietal bones at the coronal suture; the parietal bones meet each other at the sagittal suture; the occipital bone meets the parietal bones at the lambdoid suture; and a parietal bone joins a temporal bone at the squamous suture. The cranial cavity is the largest cavity of the skull, with a capacity of 1300 to 1350 cm3. The nasal cavity is formed by both cranial and facial bones Four sets of paranasal sinuses are located within the bones surrounding the nasal area. What are the major foramina of the skull, where are they located, and what structures pass through them A foramen (plural foramina) is an opening through a bone for the passage of a vessel or a nerve. The frontal bone forms the anterior roof of the cranium, the roof of the nasal cavity, and the supraorbital margin over the orbit of each eye (figs. The supraorbital foramen along the supraorbital margin transmits the small supraorbital nerve and artery. There are four paranasal sinuses that lessen the weight of the skull and act as sound chambers for voice resonance. Sinusitis is an inflammation of the mucous membrane that lines the paranasal sinuses. Because these sinuses connect to the nasal cavity, they are vulnerable to infections that originate in the nasal mucosa. Blowing the nose too hard may force microorganisms into the moist, warm environment of a paranasal sinus. Each of the two temporal bones that form the lower sides of the cranium consists of four parts. The flattened squamous part of the temporal bone forms the posterior component of the zygomatic arch (see fig. The tympanic part of the temporal bone contains the external acoustic meatus (ear canal) and the styloid process. The mastoid part of the temporal bone consists of the mastoid process, which contains the mastoid and stylomastoid foramina. The mastoid process of the temporal bone can be easily palpated as a bony knob behind the earlobe. Although not present on a newborn, the mastoid process soon develops as the sternocleidomastoid muscle that attaches to it contracts, causing neck movement. As the process develops, a number of small air-filled spaces called mastoid cells form within the bone. These spaces are clinically important because they can become infected in mastoiditis. A tubular communication from the mastoid cells to the middle ear cavity may allow ear infections to spread to this region. The occipital bone forms the posterior and much of the inferior portion of the cranium. The sphenoid bone is the most frequently fractured bone of the cranium (the bones supporting and surrounding the brain). Its broad, thin, platelike extensions are perforated by several foramina, weakening the sphenoid bone structurally. A blow to almost any portion of the skull causes the buoyed, fluid-filled brain to rebound against this vulnerable bone, often causing it to fracture. Because the bone is tightly confined, however, the fractured parts usually are not severely displaced and readily heal with no complications. The perpendicular plate of the ethmoid bone forms part of the nasal septum, which divides the nasal cavity into two nasal fossae. The epithelium covering the scroll-shaped superior and middle nasal conchae warms and moistens inhaled air. The perforations in the cribriform plate of the ethmoid bone allow the passage of olfactory nerves. The hard palate is the bony partition between the nasal and oral cavities formed by the union of the palatine processes of the maxillae and the palatine bones. The structure, function, and replacement sequence of teeth are discussed in chapter 19. Each of the two middle ear chambers contains three small auditory ossicles-the malleus (hammer), incus (anvil), and stapes (stirrup) (fig. In the functioning ear, the auditory ossicles amplify and transmit sound from the outer ear to the inner ear. A more detailed discussion of the structure and function of the auditory ossicles is included in chapter 12. Instead, it is suspended from the styloid processes of the temporal bones by the stylohyoid ligaments. As part of the axial skeleton, the vertebral column (backbone) supports and permits movement tebral column) also support and protect the spinal cord and permit passage of spinal nerves. The vertebrae (bones of the ver- the vertebral column is composed of 33 individual vertebrae (singular vertebra). There are 7 cervical, 12 thoracic, 5 lumbar, 4 or 5 fused sacral, and 4 or 5 fused coccygeal vertebrae; thus, the vertebral column is composed of a total of 26 movable parts (fig. Vertebrae are separated by fibrocartilaginous intervertebral discs and are secured to one another by interlocking processes and binding ligaments. The structural arrangement of the vertebral column allows only limited movement between vertebrae but extensive movements of the vertebral column as a unit. Paired intervertebral foramina that permit passage of spinal nerves are formed laterally where intervertebrae notches of adjacent vertebrae align. The cervical, thoracic, and lumbar curves are designated by the type of vertebrae they include. The curves of the vertebral column play an important functional role in increasing the strength and maintaining the balance of the upper portion of the body; they also make possible a bipedal (two-footed) stance. Cervical vertebrae have transverse foramina for the passage of vessels to the brain. Thoracic vertebrae are characterized by the presence of facets for articulation with the heads of ribs. The sacrum consists of four or five fused sacral vertebrae and attaches to the pelvic girdle at the sacroiliac joint. The triangular coccyx ("tailbone") is composed of four or five fused coccygeal vertebrae. The drum-shaped body of a vertebra is in contact with the intervertebral discs on each end. The neural arch on the posterior surface of the body of the vertebra is composed of two supporting pedicles and two arched laminae. The hollow space formed by the vertebral arch and body is the vertebral foramen, or vertebral canal, that allows passage of the spinal cord. Other processes of most vertebrae include paired transverse processes, paired superior articular processes, and paired inferior articular processes. The letter indicates which region the vertebra is from: C cervical, T thoracic, L lumbar, S sacral. The number indicates which vertebrae within the given region; hence C1 indicates the first cervical vertebrae, T6 indicates the sixth thoracic, and so on. Objective I Su To describe the structures of the rib cage and state their functions. The sternum, costal cartilages, and ribs attached to the thoracic vertebrae form the rib cage, girdle and upper extremities, protects and supports the thoracic and upper abdominal viscera, provides an extensive surface area for muscle attachment, and plays a major role in respiration. The elongated and flattened sternum is a compound bone, consisting of an upper manubrium, a central body, and a lower xiphoid process (fig. On the lateral sides of the sternum are costal notches, where the costal cartilages attach. Only the first seven pairs, the true ribs, are anchored to the sternum by individual costal cartilages (fig. The remaining two paired false ribs do not attach to the sternum and are frequently referred to as the floating ribs. Each of the first 10 paired ribs has a head and tubercle for articulation with a vertebra (fig. Fractures of the ribs are relatively common injuries and most frequently occur between ribs 3 and 10. The first two pairs are protected by the clavicles, and the last two pairs move freely and will give with an impact. Little can be done to assist the healing of a broken rib other than binding it to restrict movement. A typical rib (b) has facets for attachment to the sternum and a broadly flattened and rounded shaft (body) for protection of thoracic viscera and muscle attachment. The two scapulae and the two clavicles make up the pectoral (shoulder) girdle that anchors the rvey bones of the upper extremity to the axial skeleton at the manubrium of the sternum. The pectoral girdle provides attachment for numerous muscles that move the brachium (arm) and antebrachium (forearm). Blows to the shoulder or an attempt to break a fall with an outstretched hand displaces the force to this long, delicate bone. Furthermore, the anterior border of the clavicle is directly subcutaneous and is not protected by fat or muscle. The flattened, triangular scapula (shoulder blade) has three borders, three angles, and three fossae (fig. The medial border (vertebral border) is nearest to the vertebral column, and the lateral border (axillary border) is directed toward the arm. The superior angle is located at the junction of the superior and medial borders, and the inferior angle is located at the junction of the medial and lateral borders. Along the superior border, a distinct depression called the scapular notch serves as a passageway for a nerve. The spine of the scapula is a diagonal bony ridge on the posterior surface that separates the supraspinous fossa from the infraspinous fossa. The glenoid cavity is a shallow depression into which the head of the humerus fits. On the anterior surface of the scapula is a slightly concave area known as the subscapular fossa. Su rvey which contains the radius and ulna: and the manus (hand), which contains 8 carpal bones, 5 the upper extremity is divided into the brachium, which contains the humerus; the antebrachium, metacarpal bones, and 14 phalanges (figs. The rounded, proximal head of the humerus articulates with the glenoid cavity of the scapula at the shoulder joint. The distal end of the humerus articulates with the radius and ulna at the elbow joint. The distal ends of the radius and ulna articulate with the proximal row of carpal bones in the wrist. Located within the brachium, the humerus has a number of diagnostic features (fig. The anatomical neck is an indented groove surrounding the margin of the head of the humerus. The lesser tubercle is slightly anterior to the greater tubercle and is separated from it by the intertubercular groove, through which passes the tendon of the biceps brachii muscle. The capitulum at the distal end of the humerus is the lateral rounded condyle that receives the radius. The coronoid fossa is a depression above the trochlea on the anterior surface, and the olecranon fossa is a depression on the distal posterior surface. The surgical neck is the region of the humerus just below the anatomical neck, where the shaft of the humerus begins to taper. The surgical neck is so named because of the frequency of traumainduced fractures that occur at this location. The lateral radius and the medial ulna both articulate proximally with the humerus and distally with the carpal bones. The radius is shorter and more robust than the ulna and has a rounded proximal head for articulation with the capitulum of the humerus. The radial tuberosity on the medial side of the radius is for attachment of the tendon of the biceps brachii muscle. It has a distinct depression called the trochlear notch that articulates with the trochlea of the humerus. The coronoid process forms the anterior lip of the trochlear notch, and the olecranon forms the posterior portion, or elbow. Lateral and inferior to the coronoid process is the radial notch, which accommodates the head of the radius. The 27 bones of the manus, or hand, are grouped into 8 carpal bones, 5 metacarpal bones, and 14 phalanges (fig. The articulations (joints) between the cube-shaped carpal bones permit movement in a confined area, and the elongated metacarpal bones and phalanges act as levers about their freely movable joints. The proximal row, naming from lateral (thumb) to medial, consists of the scaphoid bone, lunate bone, triquetral bone, and pisiform bone. The distal row, from lateral to medial, consists of the trapezium, trapezoid bone, capitate bone, and hamate bone. Each of the five metacarpal bones consists of a proximal base, a shaft (body), and a distal head that is rounded for articulation with the base of a proximal phalanx. The pelvic girdle, or pelvis, is formed by the two ossa coxae united anteriorly by the symphysis rvey pubis (fig. It is attached posteriorly to the sacrum of the vertebral column at the sacroiliac joints. The pelvic girdle and its associated ligaments support the weight of the body from the vertebral column.