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Treatment and Management of Addison’s Disease Diabetes Mellitus Although Addison’s disease was once Deﬁning Diabetes Mellitus fatal cheap 200mg acivir pills overnight delivery, replacement therapy with synthet- ic corticosteroids now enables individuals A chronic, incurable disorder of carbo- to live full, normal lives. Replacement hydrate metabolism, diabetes mellitus medication must be taken daily, howev- involves an imbalance of the supply of er. Careful monitoring for the develop- and demand for insulin and is the most 264 CHAPTER 9 ENDOCRINE CONDITIONS common of all endocrine conditions • destruction of insulin before it can be (Olefsky, 2001). The impact of • inability of body tissues to use the diabetes is immense. Over the last two insulin that is present decades the prevalence of diabetes in the United States has doubled (Centers for When there is insufﬁcient insulin, cells Disease Control, 2002). This in the United States have diabetes (Ameri- condition is known as hyperglycemia. Diabetes As blood is ﬁltered by the kidney, glu- mellitus is a leading cause of heart disease, cose is normally channeled back into the stroke, hypertension, blindness, kidney blood. Because individuals with diabetes disease, amputation, and nervous system mellitus have such a large amount of glu- damage (American Diabetes Association, cose in the blood, however, some glucose 2004a; Taylor, 2004). Be- The cause of diabetes mellitus is un- cause of the large concentration of glucose known, but there may be a familial ten- in the urine, the kidney excretes large dency to develop the disease. Obesity also quantities of water, a symptom called greatly increases the risk of diabetes polyuria. Diabetes drink large quantities of water to replace mellitus can also occur as a complication the excess ﬂuid lost (polydipsia). The of other conditions, such as pancreatitis body’s inability to use glucose means that (inﬂammation of the pancreas) or tumors the food or energy available to body tis- of the pancreas; as a side effect of medica- sues is inadequate. To compensate, indi- tions that cause an abnormal tolerance to viduals with diabetes increase food intake glucose (sugar); or as a result of speciﬁc dramatically (polyphagia). Despite this conditions that increase the body’s increased food intake, however, lack of demand for insulin, such as gestational insulin prevents the body from using food diabetes (diabetes that occurs during as an energy source. In these cases, the correction viduals begin to lose weight and become of the underlying cause may reverse the increasingly weak. Because the body’s Mechanisms of Diabetes Mellitus need for energy remains unmet, it metab- olizes its own stores of fat and proteins for Food that is ingested is eventually con- energy.
Starting with “S” for soft tissues will keep one from for- “D” refers to the distribution of abnormalities purchase 200 mg acivir pills mastercard. Recognizing soft-tissue most vividly exemplified by the distribution of erosions, (“S”) abnormalities will point to an area of major abnor- as may be seen distally in psoriasis and more proximally mality and should trigger a second or third look at the in rheumatoid arthritis. The soft tissues dor- lelism, (2) overlapping articular surfaces, and (3) three sally over the carpal bones are normally concave. All three can be especially applied to the the soft tissues over the dorsum of the wrist are straight carpal bones. Parallelism refers to the fact that any anatomic line volar to the distal radius suggests deep swelling when structure that normally articulates with an adjacent anatom- it is convex outward, as normally it should be straight or ic structure should show parallelism between the articular concave. Soft-tissue swelling along the radial and ul- cortices of those adjacent bones. This is exactly how jigsaw nar styloids may be seen in synovitis or trauma. If there is a piece of a jigsaw puzzle out of along the radial or ulnar side of a finger joint can indi- place, then that piece loses its parallelism to adjacent cate collateral ligament injury. Anatomically, this would cause overlapping articu- ment exist along the radial side of the index finger and lar surfaces. Therefore, the concepts of parallelism and the ulnar side of the small finger. If there is overlap ferentially around one interphalangeal or metacarpopha- of normally articulating surfaces, there should be disloca- langeal joint is highly suggestive of capsular or joint tion or subluxation at the site of those overlapping surfaces. Gilula This does not apply if one bone is foreshortened or bent, as Trauma with overlapping phalanges on a PA view of a flexed fin- ger. In that situation, one phalanx would overlap the adja- Traumatic conditions of the wrist basically can be classi- cent phalanx, but in the flexed PA position one would not fied as fractures, fracture-dislocations, and soft-tissue ab- normally see parallel articular surfaces at that joint. The third alignment concept refers to the fact that three Analysis of the carpal arcs, overlapping articular sur- carpal arcs can be drawn in any normal wrist when the wrist faces, and parallelism will help determine what exact and hand are in a neutral position, i. Arc I is a smooth curve along the bones normally parallel each other also identifies which proximal convex surfaces of the scaphoid, lunate and tri- bones have moved together as a unit away from a bone quetrum. Arc II is a smooth arc drawn along the distal con- that has overlapping adjacent surfaces.
Large- amplitude muscle contractions are associated with each slow Slow waves 1 buy cheap acivir pills 200 mg on-line. Electrical slow waves trigger action potentials, and action potentials trigger con- tractions. Level 5 includes higher brain centers that provide in- Autonomic Parasympathetic Neurons Project to put for integrative functions at levels 3 and 4. Projections to the digestive tract from tramural control networks that make up the intrinsic these regions of the CNS are preganglionic efferents. The parasympa- thetic and sympathetic subdivisions are identified by the positions of the ganglia containing the cell bodies of the postganglionic neurons and by the point of outflow from 5 the CNS. Comprehensive autonomic innervation of the di- Higher brain centers 4 3 Central parasympathetic Central sympathetic centers centers ICC network 2 Prevertebral sympathetic ganglia 1 GI muscle Enteric nervous system FIGURE 26. Gastrointestinal, esophageal, and biliary tract Electrical slow waves originate in the networks of ICCs. ICCs are musculature and mucosa the generators (pacemaker sites) of the slow waves. Signals from parasympathetic centers in the CNS are trans- mitted to the enteric nervous system by the vagus and pelvic Vago-Vagal Reflex Circuits Consist of Sensory nerves. These signals may result in contraction ( ) or relaxation ( ) of the digestive tract musculature. Afferents, Second-Order Interneurons, and Efferent Neurons A reflex circuit known as the vago-vagal reflex underlies moment-to-moment adjustments required for optimal di- ronal cell bodies in the dorsal motor nucleus in the medulla gestive function in the upper digestive tract (see Clinical oblongata project in the vagus nerves, and those in the Focus Box 26. The afferent side of the reflex arc consists sacral region of the spinal cord project in the pelvic nerves of vagal afferent neurons connected with a variety of sen- to the large intestine. Efferent fibers in the pelvic nerves sory receptors specialized for the detection and signaling of make synaptic contact with neurons in ganglia located on mechanical parameters, such as muscle tension and mucosal the serosal surface of the colon and in ganglia of the ENS brushing, or luminal chemical parameters, including glu- deeper within the large intestinal wall. Cell bodies of the synapse with neurons of the ENS in the esophagus, stom- vagal afferents are in the nodose ganglia. The afferent neu- ach, small intestine, and colon, as well as in the gallbladder rons are synaptically connected with neurons in the dorsal and pancreas.
The cranial nerves that have nuclei within the pons include the trigeminal (V) cheap 200 mg acivir pills otc, which trans- Objective 19 Describe the location and structure of the mits impulses for chewing and sensory sensations from the head; pons and cerebellum and list their functions. Two vital structures of the metencephalon vestibular branches of the vestibulocochlear (VIII), which main- are the pons and cerebellum. The two respiratory centers of the pons are called the apneustic and pneumotaxic areas (fig. It is located in the metencephalon and occupies the inferior and posterior aspect of the cranial cavity. The cerebel- lum is separated from the overlying cerebrum by a transverse fis- sure. A portion of the meninges called the tentorium cerebelli extends into the transverse fissure. The cerebellum consists of two hemispheres and a central constricted area called the vermis (fig. The falx cerebelli is the portion of the meninges that partially extends between the hemispheres. Like the cerebrum, the cerebellum has a thin outer layer of gray matter, the cerebellar cortex, and a thick, deeper layer of white matter. Three paired bundles of nerve fibers called cerebellar pe- duncles support the cerebellum and provide it with tracts for communicating with the rest of the brain (fig. The fibers within these peduncles origi- nate primarily from specialized dentate nuclei within the cerebellum and pass through the red nucleus to the thala- mus, and then to the motor areas of the cerebral cortex. Impulses through the fibers of these peduncles provide feedback to the cerebrum. Middle cerebellar peduncles convey impulses of voluntary movement from the cerebrum through the pons and to the cerebellum.