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It passes through the tricuspid valve to enter the right ventricle and is pumped through the pulmonic valve and the pulmonary arteries to the lungs symptoms chlamydia betoptic 5 ml for sale. The oxygenated blood from the lungs is carried back to the heart via the four pulmonary veins and enters the left atrium. Blood passes through the mitral valve to enter the left ventricle, and is then pumped though the aortic valve and aorta to enter systemic circulation. The right atrium is the most right lateral border while the right ventricle makes up the majority of the anterior surface (the sternocostal surface). The left atrium is the posterior surface of the heart while the left ventricle comprises the diaphragmatic surface. The superior aspect of the anterior surface of the heart is notable for a visualization of the origins of the great vessels: superior vena cava, aorta, and pulmonary trunk. The superior aspect of the posterior surface, the left atrium, is notable for the visualization of the four pulmonary veins. The orientation of the chambers can be further achieved by following the sulci or grooves formed from fusion of the muscular walls during development. The coronary sulcus is the groove separating the atriums from ventricles and can be seen in slide 6 running between the right auricle and the right edge of the pulmonary trunk. The anterior interventricular sulcus is the groove separating the ventricles on the anterior surface while the posterior interventricular sulcus separates the ventricles on the diaphragmatic surface. This slide shows the anterior and posterior views of the great veins as they enter the heart. The venous flow from the lower limbs, abdomen, and pelvis returns through the inferior vena cava and enters the right atrium. Newly oxygenated blood returns to the left atrium via the right and left superior and inferior pulmonary veins. These veins are unique in that they carry oxygenated blood unlike other adult veins. This slide shows the anterior and posterior views of the great arteries of the heart. The deoxygenated blood leaves the heart and travels to the lungs via the pulmonary trunk and the right and left pulmonary arteries. These arteries are also unique as they are the only adult arteries carrying deoxygenated blood. The blood is returned to the systemic circulation via the aorta arch which gives rise to the brachiocephalic trunk, the left common carotid artery, and left subclavian artery. The brachiocephalic trunk supplies blood to the right upper limb and head via the right subclavian artery and right common carotid artery respectively. The left common carotid artery then supplies the left head and neck while the left subclavian artery supplies the left upper limb. The pericardium is a fibroserous sac containing the heart and the origins of the great vessels. It is made up of an outer wall and an inner wall separated by a pericardial cavity. The outer wall is composed of an outer connective tissue layer called fibrous pericardium fused with an inner serous layer called the parietal layer of serous pericardium. Serous tissue simply refers to a thin membrane lining a closed body cavity moistened with serous fluid. The closed body cavity in this case is the pericardial cavity separating the two fused outer wall layers with the inner wall called the visceral layer of serous pericardium. The parietal and visceral layers of serous pericardium meet and are continuous at the origins of the great vessels forming reflections. The reflections (meeting of the parietal and visceral pericardium) occurring on the aorta and pulmonary trunk form the transverse sinus. When the pericardium is opened anteriorly or with the heart removed a finger can be placed in the transverse sinus to separate the aorta and pulmonary artery from the superior vena cava. With a section of the pericardial sac removed, the relationships off the posterior surface of the heart (left atrium) can be visualized. The descending aorta, also called the thoracic aorta, has a smooth shiny reddish color and is found traveling just left of the muscular appearing esophagus. The left vagus nerve can be seen traveling with the descending aorta before it moves anterior to the esophagus to become the anterior vagal trunk. The meshwork of small nerves overlaying the esophagus is the esophageal nerve plexus. Note that this slide also allows a visual distinction between the fused outer fibrous pericardium in white with the inner parietal layer of serous pericardium in tan. Showed here are the diaphragmatic relationships of the heart at the T8/T9 vertebral level. Several structures pass through the diaphragm including the inferior vena cava as it returns blood from the liver and hepatic veins. To the right of the descending aorta is the thoracic duct allowing lymphatic drainage. The right atrium seen receives deoxygenated blood from three vessels: the superior vena cava, the inferior vena cava, and the coronary sinus. The free wall of the right atrium contains a conical muscular pouch called the right auricle. Anterior to this ridge begin fanlike projections in the wall called pectinate muscles. Within the interatrial septum is the fossa ovalis with its limbus rim which when open during development as the foramen ovale shunted blood from the right to left atrium bypassing the non-functioning fetal lungs. The right ventricular receives the blood from the right atrium through the tricuspid valve (anterior, posterior, and septal cusps).

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The infraduodenal portion of the common bile duct is joined by the major pancreatic duct to form the hepatopancreatic ampulla symptoms 7 days after ovulation 5 ml betoptic purchase with mastercard. The gastroduodenal artery branches off of the common hepatic artery and runs inferiorly. The gastroduodenal artrery runs posteriorly to the duodenum with the common bile duct. After the gastroduodenal artery branches off of the common hepatic artery, it continues toward the porta hepatis as the proper hepatic artery. The proper hepatic artery divides into the right and left hepatic arteries which supply the right and left functional lobes of the liver, respectively. The cystic artery, which supplies the gallbladder, is a usually a branch of the right hepatic artery within the cystic triangle of Calot. The cystic triangle of Calot has three borders: the liver (superiorly), the common hepatic duct (left), and the cystic duct (right). Blood drains from the portal system into the liver before returning to the inferior vena cava. This illustration demonstrates the direction of the flow of major fluids in relation to the liver. Blood from the liver drains into the hepatic veins and, eventually, the inferior vena cava. The liver and gallbladder share lymphatic drainage to the hepatic, celiac, and posterior mediastinal nodes. The superior mesenteric artery and vein are located anteriorly to the uncinate process and posterior to the neck of the pancreas. The pancreas is a glandular organ that functions as both an exocrine and an endocrine gland. Exocrine glands empty their products into ducts, whereas endocrine glands empty their products into the bloodstream. The digestive enzymes produced by the exocrine pancreas are dumped into the duodenum via pancreatic ducts. The ends of these ducts can be seen within the duodenum as greater and lesser duodenal papillae. Note the lesser and greater duodenal papillae formed where the minor and major pancreatic ducts empty the products of the exocrine pancreas into the duodenum. In this view, the common bile duct and major pancreatic duct come together to empty their contents into the duodenum (greater duodenal papilla). At the point where the two ducts become one, the structure is called the hepatopancreatic ampulla. The release of bile and digestive enzymes from these ducts is regulated by the smooth muscle sphincters: the bile duct sphincter, the pancreatic duct sphincter, and the sphincter of the hepatopancreatic ampulla (Sphincter of Oddi). The blood supply to the pancreas stems from two major arteries: the celiac artery and the superior mesenteric artery. The celiac artery gives rise to the splenic artery, whose characteristically tortuous path renders it easy to identify. The splenic artery runs from right to left along the superior border of the pancreas. The gastroduodenal artery runs posteriorly to the duodenum and gives rise to the superior pancreaticoduodenal artery. The superior mesenteric artery gives rise to the inferior pancreaticoduodenal artery. Please note that there are a number of anastomoses involving the arteries supplying the pancreas. This is a summary slide of the different paths of pancreatic blood supply that we just reviewed. Use this slide to review the path of blood from the celiac artery (or trunk) to the dorsal pancreatic artery. Note how the anterior and posterior branches of the superior and inferior pancreaticoduodenal arteries anastomose to form the anterior and posterior pancreaticoduodenal arcades. The superior mesenteric vein rises anteriorly to the uncinate process and joins the splenic vein. Inferior mesenteric vein drains into the splenic vein just before the splenic vein joins the superior mesenteric vein. The lymphatic drainage of the pancreas follows the arterial supply to the celiac and superior mesenteric nodes. The spleen is a mobile, ovoid organ situated in the upper left quadrant of the abdominal cavity. This intraperitoneal organ is found adjacent to the costodiaphragmatic recess, and it is protected by ribs 9-11. The visceral surface of the spleen is concave with impressions of different visceral organs evident (similarly to liver). Note the impressions made by the stomach (gastric), left kidney (renal), and colon (colic). This transverse section through the abdomen shows the position of the spleen relative to some other viscera. The gastrosplenic ligament travels from the posterior surface of the stomach to the spleen. The lymphatic drainage of the spleen follows the arterial supply to the celiac and superior mesenteric nodes. D Department of Regenerative Medicine and Cell Biology Center for Anatomical Studies and Education College of Medicine Medical University of South Carolina I.

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The muscles of the larynx are supplied by two pairs of nerves medicine 75 purchase betoptic 5 ml visa, both branches of the vagus (Xth cranial nerve), called the superior laryngeal and recurrent or infenor laryngeal nerves. The bronchi and alveoli the main bronchi branch inferiorly from the trachea, one entering each lung. Each bronchus branches into smaller tubes called bronchioli and finally ends in the terminai bronchioles. The respiratory bronchioles branch into alveolar ducts which lead to the alveolar sacs, where respiration takes place. These structures are bound together with connective tissue and are called the root of the lung. Apart from the blood vessels responsible for transporting gases to and from 30 Medical Terminology Course the lung, the lung tissue also requires a blood supply. The blood vessels supplying lung tissue are the bronchial arteries which branch off from the aorta carrying oxygenated blood, via the root of the lung. The bronchial veins drain into the innominate and axygos veins and eventually back to the superior vena cava, the pleural cavity is made up of two layers; it is a potential space only. The visceral layer of the pleura is the outermost covering of the lung and it reflects to adhere to the innermost part of the chest wall and diaphragm where it is called the parietal (L paries = wall) pleura. The entire pleural cavity contains only a small amount of serous fluid for lubrication purposes in health. Parasympathetic fibres cause constriction of smooth muscle tissue, while sympathetic fibres cause dilation. In normal breathing, the respiratory rate and rhythm are influenced rhythmically by the Hering-Breuer reflex without any conscious muscular exertion. The most important factor which regulates the activity of the respiratory centre is the level of carbon dioxide in the blood. An increase in the level will stimulate the respiratory rate; a decrease in in the blood will depress the respiratory centre in the medulla. Asthma paroxysmal dyspnoea accompanied by adventitious sounds caused by spasm of the bronchial tubes or swollen mucous membranes. Bronchogemc carcinoma malignancy believed to arise from bronchiai epithelial tissue and synonymous with carcinoma of lung. Common cold synonymous with coryza - an acute catarrhal inflammation of the nasal mucous membranes. Croup a disease characterized by suffocative and difficult breathing, laryngeal spasm and sometimes membrane formation. Results in dyspnoea, cough, expectoration characterized by short inspiration, prolonged expiration. Hamartoma a benign tumour due to new growth of blood vessels, may be found as a symptomless coin lesion in the lung. Hay fever an allergic disease of mucous passages of the nose and upper air passages induced by external irritation. Medical Terminology Course 31 Pleurisy inflammation of the pleura (synonym pleuritis). The function of the digestive system is to: ingest food and fluids; secrete enzymes which break large molecules into simpler units; digest or condense food by chemical and mechanical means; absorb soluble substances and water into the circulatory system; reject undigested particles (excretion). The surface of the tongue has tiny projections called papillae which contain nerve endings for taste sensation. The frenulum is a fold of mucous membrane which attaches the underside of the tongue to the floor of the mouth. The mouth is kept moist by secretions from the salivary glands, the parotid, submandibular, and sublingual glands. The two arches are the glossopalatine arch anteriorly and the pharyngopalatine arch posteriorly, known as the tonsillar fauces. Mastication is under voluntary control, salivation is controlled by the autonomic nervous system. Ptyalin is an enzyme which begins the process of splitting starch from dextrose to maltose (a simple sugar). Tuberculosis a specific inflammatory disease caused by the tubercle bacillus characterized by caseous granulomatous infiltration. The muscle coats of the oesophagus consist of an inner circular and an outer longitudinal coat. The middle 1/3 is mixed skeletal and smooth muscle, while the lower one third is smooth muscle. The outer wall of the stomach has three smooth muscle coats, longitudinal (outer), circular (medial) and oblique (internal). The strong muscular action of the stom(6) ach chums the food into a semi-liquid substance and forces it through the pyloric sphincter into the duodenum. The exocrine duct from the pancreas joins with the common bile duct to form the ampulla of Vatei- which empties into the duodenum through the sphincter of Oddi. The exocrine or pancreatic enzymes serve to: neutralize acid from the stomach (water a) and alkaline salts); split fats (lipase); b) split starch to maltose (amylose): C) split proteins (trypsinogen plus enterd) okinase; produces tiypsin for this purpose); complete protein digestion (peptidase). The hormones insulin and glucagon are absorbed by capillaries which carry these hormones to the blood stream for systemic circulation. A fissure of the liver, known as the porta hepatis permits hepatic arteries, the portai vein, the hepatic duct, nerves and lymphatics to enter and leave the liver.

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It passes posterior 17 to the lateral meniscus to the fibular surface of the medial femoral condyle behind the posterior cruciate ligament medications 2 purchase betoptic line. It passes from the inner surface of the lateral femoral condyle obliquely forward and inferomedially to the anterior intercondylar area. It prevents inward rotation and forward displacement of the tibia toward the femur. It passes from the inner surface of the medial femoral condyle to the posterior condylar area, stabilizes the joint when flexed, and prevents backward displacement of the tibia away from the femur. Deformable, paired bulges of the adipose body that fill empty spaces in the anterior part of the joint cavity. Lateral collateral ligament that extends from the lateral epicondyle to the head of the fibula independent of the capsule and meniscus. Ligament on the medial side of the ankle which consists of the four segments described below. Group of fibers connecting the medial malleolus to the dorsal and medial surfaces of the navicular bone. Segment of the deltoid ligament that connects the medial malleolus to the medial surface of the talus as far as the neck of the talus. Fibers extending posteriorly from the medial malleolus almost as far as the posterior process of the talus. It originates in the lateral malleolar fossa and inserts at the lateral tubercle of the posterior process of the talus. It passes obliquely and posteriorly from the apex of the alteral malleolus to the calcaneus. The anterior portion of the lower ankle joint in which the talus articulates with the calcaneus and navicular bones. Joint between the talus and calcaneus that represents the posterior part of the lower ankle joint. Ligament that passes from the trochlea of the talus to the lateral surface of the calcaneus. Ligament on the medial side of the foot that extends from the medial tubercle of the posterior process of the talus to the sustantaculum tali. The following three interosseous ligaments are present between the tarsal bones: 5 20 Interrosseous talocalcaneal ligament. Joint situated in front of the talus and calcaneus but proximal to the cuboid and navicular bones. Broad group of ligaments on the dorsum of the foot connecting the navicular bone with the three cuneiform bones. They are particularly important for the bracing of both plantar arches of the foot. It lies medial to the above-mentionend ligament and supports, according to more traditional view, the articular cavity for the head of the talus. Since the talar side of the ligament is quite loose and contains no fibrocartilage, this concept is questionable. Groups of ligaments that connect the navicular bone with the cuneiform bones lodged in front of it. A plantar ligament coursing somewhat obliquely to the axis of the foot connecting the cuboid and navicular bones. Fibrous bands lying on the plantar aspect of the foot between the cuneiform bones. Fibrous brace on the plantar aspect of the foot between the lateral cuneiform and cuboid bones. Ligaments located on the dorsum of the foot between the tarsal and metatarsal bones. Ligaments located on the plantar aspect of the foot between the tarsal and metatarsal bones. Perhaps untoward responses are a result of an incomplete understanding of the presence and function of H2 receptors in tissues other than the gastric mucosa. These are highly variable and range from minor symptoms (dizziness, lethargy, and fatigue) to more serious disturbances (mental confusion, delirium, focal twitching, hallucinations, and seizures). Cimetidine exerts many effects on endocrine function that are generally minor and reversible on cessation of therapy. Other complications include elevation of serum prolactin concentrations, galactorrhea, loss of libido, impotence, and reduction in sperm counts. Small but definite increases in serum creatinine concentrations occur in most patients treated with cimetidine. This effect is not associated with other changes in renal function and ceases when the drug is withdrawn. With cimetidine there is a transient leukopenia, granulocytopenia, and thrombocytopenia reported. It is difficult to implicate cimetidine as a direct bone marrow suppressant because the cases reported almost always involve the concomitant use of other drugs or the existence of other serious systemic diseases. Although cimetidine enhances cell-mediated immune reactions, no evidence suggests that this phenomenon is related to any of the observed clinical responses. Although cimetidine initially seemed to have no significant drug interactions, subsequent clinical reports and laboratory studies indicate that this is not the case. Cimetidine has been shown to increase blood concentrations of numerous drugs, including anticoagulants of the warfarin type, tricyclic antidepressants, various benzodiazepines, phenobarbital, theophylline, propranolol and other -adrenoceptor blockers, Ca2+ channel blockers, lidocaine, estradiol, and phenytoin, creating a risk of toxicity. The basis of these interactions is competitive inhibition by cimetidine of the hepatic mixed-function oxidase enzymes responsible for the metabolism of these drugs. Also, a cimetidine-induced decrease in hepatic blood flow may depress the entry of drugs into the liver and slow metabolism.

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The rectus sheath contains the superior epigastric artery (vein) symptoms precede an illness order genuine betoptic online, inferior epigastric artery, lower intercostal nerves (T7-T11), and subcostal nerve (T12). The superior epigastric artery is a terminal branch of the internal thoracic artery that enters the rectus sheath between the sternal and costal portions of the diaphragm and descends posteriorly to the rectus muscle along with the superior epigastric vein. The inferior epigastric artery is a branch of the external iliac artery that runs through the transversalis fascia to reach the rectus sheath at the level of the arcuate line. The external oblique, internal oblique, and transversus abdominis muscles are supplied by intercostal nerves 7-11, the subcostal nerve (T12), and the first lumbar nerve (L1). The rectus abdominis muscle is supplied by intercostal nerves 7-11 and the subcostal nerve. Relaxation of the abdominal muscles occurs during inspiration to allow downward movement of viscera. Abdominal muscles are contracted to increase intra-abdominal pressure during forced expiration, micturition, defecation, and parturition. The superior and inferior epigastric veins run alongside their arterial counterparts. Interestingly, the paraumbilical veins drain to the portal vein via the falciform ligament. Superficially, the anterior abdominal wall superior to the umbilicus drains to anterior axillary nodes. The deep lymphatic drainage of the anterior abdominal wall follows the deep arteries. The inguinal region (groin) is the area where the anterior abdominal wall and thighs meet. During development, the initial position of the testes/ovaries is high in the posterior abdominal wall. The processus vaginalis continues to push outward through several layers: transversalis fascia, internal oblique musculature, and the aponeurosis of the external oblique muscle. As the processus vaginalis continues to push through the abdominal wall, the inguinal canal is formed. The layer of transversalis fascia becomes the deepest layer, while the aponeurosis of the external oblique muscle remains the most superficial layer. The gubernaculum (directly posterior to the processus vaginalis) pulls the testes through the inguinal canal and into the scrotum, while ovaries remain in the pelvic cavity. As the testes move through the inguinal canal, their complement of vessels, nerves, and ducts acquire the same complement of layers as the inguinal canal. In females, the remnant of the gubernaculum (round ligament of the uterus) remains in the inguinal canal. Descent of the gonads is complete upon the obliteration of the processus vaginalis. If it remains patent, a weakening of the abdominal wall can occur, possibly resulting in a hernia. The canal is a tube formed during gonad development which spans the region between the deep and superficial inguinal rings. As previously described, this ring of the inguinal canal results from an evagination of the transversalis fascia, a contributor to the formation of the internal spermatic fascia in males. The superficial ring of the inguinal canal is found at the lower end of the canal. The lateral and medial crura (attaching to the pubic symphysis and pelvic tubercle, respectively) form the sides of the arch. These tendinous crura are joined at the apex of the arch by the intercrural fibers. In males it also contains the spermatic cord, whereas in females it contains the round ligament of the uterus. The spermatic cord begins at the deep inguinal ring, runs through the inguinal canal, exits the inguinal canal via the superficial inguinal ring, and ends in the scrotum. The three fascia coverings of the spermatic cord are derived from layers of the anterior abdominal wall. These layers were acquired during development with the descent of the processus vaginalis (now the tunica vaginalis within the scrotum) through the layers of the abdominal wall. The cremasteric muscle is innervated by the genital branch of the genitofemoral nerve (L1,2). The external spermatic fascia was derived from the external oblique aponeurosis and fascia. This table summarizes the relationship between layers of the abdominal wall and the fascia of the spermatic cord. Note that not all of the layers of the abdominal wall contribute to the spermatic cord, i. The vas deferens is the duct responsible for transporting sperm from the epididymis to the ejaculatory duct. The duct begins at the tail of the epididymis and passes up the spermatic cord through the inguinal canal, through the deep ring and lateral to the inferior epigastric vessels. A vasectomy is the ligation and cutting of the vas deferens within the spermatic cord inferior to the superficial inguinal ring (within the scrotum). It originates from the anterior surface of the abdominal aorta, just inferior to the origin of the renal arteries. As the testis descends retroperitoneally during development, is carries blood supply with it to the scrotum.

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The important muscles providing this dynamic stability are subscapularis symptoms 22 weeks pregnant purchase cheap betoptic line, supraspinatus, infraspinatus and teres minor (Dark et al. The synchronous contraction of these muscles creates a compressive force, enabling the humeral head to pivot and glide in the glenoid fossa. Clinically, it is important to consider the alignment of the shoulder complex in the patient who has decreased muscle activity around this area. Careful positioning and handling of the shoulder complex during both rest and personal care tasks, such as washing and dressing, helps maintain involvement of the upper limb and may prevent trauma to this vulnerable area (see Chapter 8). When a patient is positioned by stabilising the trunk, for example at rest in side lying, the upper limb is allowed to accept the support of the pillow and not the upper limb supporting an unstable trunk. Many authors support the theory that the scapula position on an upright trunk provides an upward, anterior, lateral-facing glenoid fossa which offers an automatic locking mechanism for the shoulder joint with the upper limb in adduction preventing downward subluxation of the glenohumeral joint (Basmajian 1981; 158 Recovery of Upper Limb Function. The posture of the cervical and thoracic spine has a strong influence on the position and mobility of the scapula and therefore the glenohumeral joint (Culham & Peat 1993; Magarey & Jones 2003). The clinical implications of decreased antigravity activity in the trunk include a loss of scapula alignment and instability of the glenohumeral joint. This also applies to positioning the patient in the acute and subacute stages and supporting the hypotonic upper limb, and more importantly, the trunk, with pillows and/or a table to reduce the traction on the soft tissue and muscles of the upper quadrant. Dysfunction, for example weakness in the scapula musculature, will result in an alteration in scapula stability leading to shoulder function becoming less efficient, reducing performance and pre-disposing the individual to injury (Voight & Thomson 2000). Stability at the scapulothoracic joint depends not only on the surrounding musculature (Mottram 1997; Voight & Thomson 2000), notably trapezius and serratus anterior, but also on rhomboid major and minor and levator scapulae. These stabilising muscles must be recruited prior to movement of the upper limb to anchor the scapula (Mottram 1997; Voight & Thomson 2000), and while maintaining dynamic stability, they must also provide controlled mobility. A lack of appropriate activation leads to an inability to achieve an efficient reach pattern. However, changing the direction of movement may allow for a more appropriate pattern of activity and is a useful assessment tool. The scapula is able to move in many directions on the thoracic cage, including elevation, depression, abduction, adduction and rotation (Mottram 1997; Voight & Thomson 2000) and this mobility is important for: improving the congruity of the glenohumeral joint during movement; allowing the acromial arch to elevate, so preventing impingement of the humeral tubercles during elevation of the upper limb; 160 Recovery of Upper Limb Function. The repeated use of compensatory movement strategies by the patient will affect the balance of muscle activity around the shoulder complex, and this will have an impact on functional recovery in the upper limb. This is an area which is particularly difficult to address due to the complex nature of the neurological damage to the systems involved in postural control and efficient coordination of the patterns of movement necessary for upper limb function. As mentioned previously in this chapter, it is important to consider the role of postural stability for mobility and the role of the scapula in achieving range and refinement of movement of the upper limb. Importantly, McQuade and Schmidt (1998) found that when the upper limb was loaded, the ratio changed to 4. The thoracic alignment must also be considered as the scapula must travel around the thoracic cage to allow greater range of movement in the shoulder complex. A kyphotic thoracic spine or broad posterior aspect of the thorax will affect this journey and therefore the dynamics of scapula stability. This is characterised by force couples of paired muscles that control the movement or position of a joint or body part (Kibler 1998; Voight & Thomson 2000), maintaining maximal congruency between the glenoid fossa and the humeral head. Scapular stabilisation requires a force couple between the upper and lower portions of trapezius and the rhomboids coupled with serratus anterior, and then as the upper limb is elevated, activity of the lower trapezius and serratus anterior muscles is coupled with upper trapezius and rhomboids. Functional reach Although there are occasions when the upper limb is taken away from the body with no direct goal of using the hand, for example to wash under your upper limb with your other hand, many upper limb movements are for the purpose of transporting 162 Recovery of Upper Limb Function. When the task is pointing, all segments of the upper limb are controlled as one unit (Shumway-Cook & Woollacott 2007); however, when the task is to reach and hold an object, the hand is controlled independently of the other upper limb segments. Therefore, reach to grasp can be divided into two components, the transportation phase and the grasp phase. These two components occur synchronously and appear to be controlled by different neural mechanisms. Some evidence suggests that the rubrospinal and reticulospinal pathways may control the more proximal movements involved in reaching, whereas the corticospinal pathways are necessary for the control of manipulation (Kandel et al. However, evidence suggests that activation of the wrist and metacarpophalangeal joint extension via the rubrospinal system has a key role to play in goal-orientated activities where reaching to grasp rather than reaching is involved (Van Kan & McCurdy 2000). It has also been shown that when grasp requires a greater degree of dexterity, the reflex connections from the hand and forearm to the shoulder musculature are evident (Alexander et al. Therefore, the choice of object to grasp is not just with the function in mind but with the specific muscle activation patterns. Target location Vision plays a crucial role in target location and the selection of the appropriate motor programme for reach to grasp. The effect of figure-ground is particularly significant because the clearer the parameters of the target, the more precise the hand pre-shaping. If the task involves reaching to an object in the central visual field where focusing is optimal, then movement of the eyes alone may locate the target. If the object is in the peripheral visual field, locating it will require head and eye movement to ensure accurate reaching. Therefore, if components of shoulder and neck movements are impaired, alternative strategies may be adopted to locate the target, for example, the trunk may turn to allow visual regard. Once the target has been located and the motor programme selected, vision is no longer essential for the performance of reach (Santello et al. However, in its absence, there will be a slower approach of the hand towards the object. If there are any limitations of movement within the segments of the upper limb, the straight path will be disrupted resulting in possible failure in completing the task, clumsy execution or the use of compensatory strategies. Careful assessment of all the joints of the upper limb including the elbow, and proximal and distal radio-ulnar joints is required. For reach, grasp and manipulation to be effective, the hand needs to be transported accurately to the target.

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General sensory impulses 7mm kidney stone treatment order generic betoptic, such as those for pain, touch, temperature, vibrations 3. Viscera motor impulses producing involuntary control of glands and involuntary muscles (cardiac and smooth muscle). These motor pathways are part pf the autonomic nervous system, parasympathetic division. The olfactory nerve they supply the olfactory mucous membrane in the upper part of the nasal cavity. The nerve fibres originate I the bipolar olfactory cells of the mucosa and join to form 15-20 olfactory bundles which pass through the cribiform plate of the ethmoid bone to reach the olfactory bulb. Its fibres originate in the ganglion layer and converge on the posterior part of the eye ball. The nerve passes backwards through the orbit and optic canal into the middle cranial fossa where it unites with the nerve of opposite side of the optic chiasma. The oculomotor nerve this nerve has somatic motor and general visceral (parasympathetic) motor fibres. The somatic fibres supply the bulbar muscles, except superior oblique and lateral rectus. The parasympathetic fibres synapse in the ciliary ganglion and supply the sphincter pupillae and ciliary muscle. The nuclei of the nerve are situated in the upper midbrain in the perri-aqueductal grey matter. The nerve fibres pass forwards through the midbrain and leave it between the cerebral peduncles. The nerve pass through the posterior andmiddle cranial fossae and divides into superior and inferior divisions near the superior orbital fissure. The trochlear nerve this is the somatic motor nerve 170 Human Anatomy and Physiology supply to the superior oblique. The fibres pass posteriorly and undergo a dorsal decussation with the nerve of the opposite side caudal to the inferior colliculi the nerve then passes forwards through the posterior and middle cranial fossae,enters the orbit through the superior orbital fissure and supplies superior oblique. The third branch is joined by motor fibers to the muscles of mastication (chewing). The nerve leaves the inferior border of the pons near the midline, passes forwards through the posterior and middle cranial fossae, the cavernous sinus and the orbit, and supplies lateral rectus. The vestibulocochlear nerve contains special sensory fibers for hearing as well as those for balance from the semi circular canals of the internal ear. The glossopharyngeal nerve contains general sensory fibers from the back of the tongue and the pharynx (throat). This nerve also contains sensory fibers for taste from the posterior third of the tongue, secretary fibers that supply the largest salivary gland (parotid), and motor nerve fibers to control the swallowing muscles in the pharynx. This nerve also contains motor fibers to the larynx (voice box) and pharynx, and to glands that produce digestive juices and other secretions. The accessory nerve (formerly called the spinal accessory nerve) is a motor nerve with two branches. The hypoglossal nerve, the last of the 12 cranial nerves, carries impulses controlling the muscles of the tongue. The roots are formed from a number of rootlets which emerge from the anterolateral and posterolateral sulci of the spinal cord. The ventral root carries efferent (motor) fibres from the cord and the dorsal root, afferent (sensory) fibres to the cord. The cell bodies of the sensory fibres are situated in a ganglion on the dorsal root. Each nerve leaves the vertebral canal through an intervertebral foramen and soon divides into a large ventral and smaller dorsal ramus (branch). The adjacent ventral rami of most regions communicate to form plexuses (cervical, brachial and lumbosacral) while those of the thoracic region become the intercostals and subcostal nerves. The dorsal rami pass backwards into the postvertebral muscles and divide into medial and lateral branches. These rami supply the muscles and skin over the posterior aspect of the body but give no branches to the limbs. The ventral rami 173 Human Anatomy and Physiology supply the anterior and lateral wall of the back and the lower limbs. Branches of the Spinal Nerves Each spinal nerve continues only a very short distance away from the spinal cord and then branches into small posterior divisions and rather large anterior divisions. The larger anterior branches interlace to form networks called plexuses, which then distribute branches to the body parts. The cervical plexuses supplies motor impulses to the muscles of the neck and receive sensory impulses from the neck and the back of the head. The brachial plexus sends numerous branches to the shoulder, arm, forearm, wrist, and hand. The largest of these branches is the sciatic nerve, which leaves the dorsal part of the pelvis, passes beneath the gluteus maximus muscle, and extends down the back of the thigh. At its beginning it is nearly 1 inch thick, but it soon branches to the thigh muscles; near the knee it forms two subdivisions that supply the leg and the foot. These afferent impulses from the viscera are translated into reflex responses without reaching the higher center of the brain; the sensory neurons from the organs are grouped with those that come from the skin and voluntary muscles.

Pyran, 48 years: The two major structural classes of proteins are integral proteins and peripheral proteins. The spiral organ lies on top of the basilar membrane, which is the side of the cochlear duct located between the spiral organ and the scala tympani. It is located below the root of the arch on the lower edge of the body of a vertebra.

Masil, 58 years: On the right it is roughly pyramidal in shape and is located more directly at the superior pole of the kidney. Doctors will meet patients with fibromyalgia in a variety of settings, and commonly so, as the prevalence is about 2% of the population. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome.

Jose, 63 years: Oxygen- from inhaled air diffuses into the blood through the thin lung membranes and is carried to all the tissue of the body. Neurological symptoms may be present and may indicate a true neurological deficit or, more frequently, neural irritation in association with a chronic soft-tissue injury. Also, a cimetidine-induced decrease in hepatic blood flow may depress the entry of drugs into the liver and slow metabolism.

Grok, 64 years: It is customary to subdivide the abdominal area into nine regions or more easily in to four quadrants. The parasympathetic supply of the pelvis is from the pelvic splanchnic nerves (S2S4). Blood drains from the portal system into the liver before returning to the inferior vena cava.

Kent, 45 years: Recall there are two C-shaped fibrocartilage structures, the medial and lateral menisci, which are responsible for absorbing the stress from the weight of the rest of the body that is placed on the lower leg. Both groups showed highly significant improvement in all four categories of life quality as well as in the back pain and leg pain index, as compared with preoperative status. Total Disc Arthroplasty Attempts to artificially replace the intervertebral discs were already made in the 1950s by Fernstrom [79].

Kan, 21 years: Magerl [180] developed the so-called translaminar screw fixation which crossed the facet more perpendicularly, increasing stability [126]. Although buttock pain may originate from the hip, the lumbar spine is the usual source. For oral cylophosphamide the white cell count should be checked weekly for one month, fortnightly for two months and then every month.

Murat, 51 years: In both males and females, the venous drainage is by the vesical venous plexus draining into the internal iliac vein through the superior and inferior vesical veins. Trabecular perforation occurs particularly in situations of increased bone turnover. The stapes vibrates the oval window which causes changes in pressure in the fluid of the cochlea cause fluid waves in the scala vestibuli and scala tympani.

Pavel, 25 years: This highlights the significance of learned non-use in both hemiparetic and non-hemiparetic sides and highlights further the need for an individualised, holistic approach to the treatment of patients with neurological dysfunction (Hachisuka et al. By Thierry Bacro Center for Anatomical Studies and Education Department of Regenerative Medicine and Cell Biology College of Medicine Medical University of South Carolina Slide 1. Additionally, the nucleus pulposus is sandwiched inferiorly and superiorly by a thin layer of hyaline cartilage, called the cartilage end-plates which help adhere the intervertebral disc to the vertebrae and hold the disc in place.

Rocko, 47 years: Patients with mild undifferentiated connective tissue disorders may have inflammatory arthritis, oedema of hands and acrosclerosis. Fear-avoidance beliefs and fingertipfloor distance were reduced more after non-operative treatment, and lower limb pain was reduced more after surgery. Synergists Adductor magnus, adductor longus, adductor brevis, and gracilis Antagonists Palpation and Massage this muscle lies right in the femoral triangle and thus is difficult to palpate or massage due to the femoral artery, vein, and nerve in this area.

Ernesto, 26 years: The lateral end of the radius has a pointed projection called the styloid process of the radius. Smooth muscle tissue of the intestines is part of the digestive system, whereas smooth muscle tissue of the urinary bladder is part of the urinary system and so on. It is macrocytic, hypercbromic with some megaloblasts, with a high degree of anisocytosis and poikilocytosis.

Jorn, 34 years: The "handle" of the malleus attaches to the inside of the tympanic membrane, and the "head" attaches to the incus. Nonspecific aches and pains are also a feature of idiopathic pain syndromes, which are mostly seen in older female children/adolescents; such patients are often markedly debilitated by their pain and fatigue-the pain can be incapacitating-but the child/adolescent is otherwise well, and physical examination is usually normal. These large, multipolar neurons have a corona of dendrites surrounding the cell body and an axon that extends out of the ventral horn.

Trompok, 60 years: In this lecture, we describe the essentials features of the organs found in the female pelvis as well as their blood supply, venous and lymphatic drainages. Motor Responses There are three different kinds of motor responses including reflexes, rhythmic movement, and voluntary movement. Check your understanding Lesson 16: the Upper Limb � Nerves Created by Gabriella Sandberg Introduction Motor nerves arise from the spinal cord to provide innervation to all muscles.

Rasul, 61 years: Hamartoma a benign tumour due to new growth of blood vessels, may be found as a symptomless coin lesion in the lung. Patients with these immunological abnormalities may benefit from special- Thrombosis the most common presentation of antiphospholipid syndrome is venous thrombosis in the arms or legs, which is often recurrent, multiple and bilateral, with a propensity for pulmonary embolism. The clitoris is similar to the penis in males, consisting of a glans, right and left crura, and bulb of vestibule.

Nerusul, 22 years: Exclusion or treatment of infection is essential in patients with these conditions. Flexion exercises strengthen the abdominal muscles and extension exercises the paraspinal muscles. Oculomotor X Lesson 24: Motor Control Created by Manashree Malpe Introduction In this lesson, you will learn the fundamental aspects of how the nervous system controls our voluntary body movements.

Killian, 32 years: The Thyroid Gland the hormones of the thyroid gland exert a wide spectrum of metabolic and physiologic actions that affect virtually every tissue in the body. Gigantism refers to abnormally large growth secondary to excessive production of growth hormone. The learning of skilled motor activities, producing smooth, coordinated patterns of movement, requires precise temporal coordination of muscles and joints which are practised many times over (Nudo 2007).

Oelk, 44 years: An increase in automaticity refers to an increase in the rate of impulse generation, and conversely, a decrease in automaticity refers to a decrease in the rate of impulse generation. Narcotic analgesics Comment Used to counteract depression Given for relief of pain without loss of consciousness Habit-forming analgesics Examples Amphetamines Morphine, Codeine, Demerol Darvon 2. Obturator Internus and Externus Origin: obturator foramen Insertion: greater trochanter Implications of Shortened and/or Lengthened/ Weak Muscle Shortened: the group of lateral rotators can cause a posture in which the toes point out to the sides.

Dolok, 36 years: Bronchoalveolar lavage is favoured in some centres and certainly correlates with the extent of disease, but not always with activity. Motor involvement and/or objective sensory loss warrant urgent referral for specialist assessment. It is more common in women than men, with on onset between 35 and 50 years of age.

Boss, 59 years: Use all of the directional terms provided in the table below in an accurate context by illustrating the terms on a skeleton or torso model. Walking must also be adaptable to meet the needs of the individual and the demands of the environment. Similarly, abduction and adduction at the wrist moves the hand away from or toward the midline of the body.

Orknarok, 38 years: The pulmonary veins then return the oxygenated blood to the left side of the heart. They include the iliac veins from near the groin, four pairs of lumbar veins from the dorsal part of the trunk and from the spinal cord, the testicular veins from the testes of the male and the ovarian veins fro m the ovaries of the female, the renal and suprarenal veins from the kidneys and adrenal glands near the kidneys, and finally the large hepatic veins from the liver. Physiotherapy comprising a combination of mobilization techniques and directed exercises designed to strengthen and stabilize the cuff and scapular muscles can be used alone or combined with other measures.