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Early stage gastric cancer has not penetrated the major muscle layer of the stomach wall and is associated with a more favorable survival rate than seen in more advanced disease. Trabeculae are laid down in response to stress and are shaped Articular cartilage Epiphysis Epiphyseal line Spongy bone/cancellous (trabecular) bone Compact bone Medullary cavity Functional Properties Nutrient foramen Diaphysis Endosteum Periosteum Growth and Ossiication the process of longitudinal bone growth involves endochondral ossiication. Signiicant liver damage is rare if serum acetaminophen levels are less than 150 and 37 g/ml, respectively, 4 and 12 hours after ingestion. Surges of physiologic activation and physiologic instability are thought to be the hallmark neurobiological processes underlying panic anxiety disorder. Ureter One of a pair of ibromuscular, mucosalined narrow tubes that connect the kidneys to the bladder. The presence of an intact gastric mucosal barrier and the ability of the mucosa to renew its epithelium serve to protect it against injury. Thus the highly variable nature of pain expression among individuals makes accurate pain assessment dificult. During an attack of shingles, the reactivated virus travels from the ganglia to the skin of the corresponding dermatome. Increasing cognitive skill is necessary for the function of memory and the ability to learn and associate, to discriminate, to separate, and to categorize various stimuli. In an incomplete fracture, the cortex of the bone buckles or cracks; however, bone continuity is not disrupted. Complications from missed diaphragmatic rupture include bowel obstruction or infarction from herniation of the abdominal contents. Accompanying diseases Previous treatment Special history Lesion Descriptors After a skin lesion has been classiied as primary or secondary, other features should be noted, particularly size, symmetry of color and shape, and distribution if more than one lesion is present. Tapping the tendon produces a quick stretch in the muscle ibers of the quadriceps muscle and stimulates the muscle spindles. Hence, subcutaneous emphysema in one body region may occur from injury to another body region that might not be initially imaged. Axial contrast-enhanced T1-weighted image shows diffuse pachymeningeal enhancement and thickening. An elderly individual with good nutritional balance and protein intake combined with adequate active exercise maintains muscle function and strength. Cerebrovascular accidents (strokes) and tumors are responsible for most of these lesions. The American Cancer Society now recommends that all women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than 21 years of age. Obesity, with the accumulation of adipose tissue via net synthesis of lipids such as triacylglycerol, is a form of anabolism. This phenomenon, A = Complete: No motor or sensory function is preserved in the sacral segments S4 to S5. Autologous Pertaining to a tissue or structure occurring naturally and derived from the same individual such as blood donated by a patient before surgery to be returned to the patient. A seizure disorder can be acquired as a consequence of cerebral injury or other pathologic process, including structural lesions such as tumors, blood clots, or infection. At equilibrium, the electrical gradient pulling K+ in to the cell and the chemical gradient pulling it out are balanced. Secondary cerebral vasospasm, a pathologic narrowing of the major vessels around the area of rupture, typically occurs from day 4 to day 14. This iber is usually fatigue resistant and relies on oxidative phosphorylation for energy. As the disease progresses, the individual with dementia may have to be placed in an alternative living situation such as a nursing home or assisted-living program. Interstitial cystitis Inlammation of the bladder that is believed to be associated with an autoimmune or allergic response. Physical training and conditioning increase the cross-sectional area of muscle ibers.

Syndromes

• 4 months
• X-rays
• Infection in the intestines
• Lung crackles (a sign of fluid buildup), heart murmur, or other abnormal sounds
• Lung failure (See: Adult respiratory distress syndrome)
• Ringing in the ears (tinnitus)
• Transient ischemic attack (TIA)
• Look at your feet, including the soles and the space between your toes.

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Malaise, growth retardation or weight loss, low-grade fever, and anemia are other clinical manifestations. It is usually innervated by a single -motor neuron and has low fatigue resistance, low capillary density, low levels of aerobic enzymes, and low oxygen availability. Cardiac sources include thrombi formed in the cardiac chambers (mural thrombi) and thrombi or vegetations on valve lealets. Thrombi, emboli, vasospasm, neutrophil aggregation, and tissue edema may inhibit vasodilating autoregulatory mechanisms. The appendages, although originating from the epidermal layer, are anatomically located in both the epidermis and the dermis. Epidermis the epidermis shows a generalized thinning with advancing age, although there may be some thickening in sun-exposed areas. Some researchers believe that -amyloid may be responsible for lower choline levels in nerve cells and decreased acetylcholine levels. These mass lesions are often unilateral and may result in severe compression of vital brain structures. Typical clinical scenario Patients with extensive pneumomediastinum, sometimes due to positive pressure ventilation, may appear to have pneumoperitoneum, which is not suspected clinically. Blunt and penetrating trauma of the thoracic aorta and aortic arch branches: an autopsy study. As the length of healing time increases, so does the degree of scarring and depigmentation. Although esophagography remains the mainstay of diagnosis, this test may be falsely negative in as many as 10% of patients [7]. Should this trend continue unabated, worldwide the number of persons with diabetes will rise to 366 million by 2015. The clinical outcome of occult pulmonary contusion on multidetector-row computed tomography in blunt trauma patients. The mechanism is not clear, but because of a loss in normal proprioception and pain responses, damage occurs to the joint. Note how the gas only extends anteriorly as far as the gasfluid level, a clue suggestive of pseudopneumatosis. Lysozyme An enzyme secreted by macrophages and neutrophils to control foreign particle activity. Four million people work each day in an environment with damaging levels of noise, and in 2008 approximately 2 million employees were exposed to workplace noise levels that put them at risk for hearing loss. This may be due to the fact that there are fewer blood vessels and nerve cells around the glands that enable the body to respond to temperature changes. The sore begins as a reddening of the skin with unobservable necrosis in the deep underlying tissue. Angle-closure glaucoma occurs when the angle between the pupil and lateral aspect of the cornea is narrow and blocks outlow when the pupil is dilated. However, the appropriate treatment of intracerebral arterial embolism remains controversial [3]. The gonococcus then attaches to and penetrates columnar epithelium and produces a patchy inlammatory response in the submucosa. Its causes are poorly understood, but recent research has focused on genetic, environmental, and immunologic factors. In addition, the contention that women with dysmenorrhea tend to be neurotic has been refuted in well-designed psychiatric research studies. In other instances, when a rapid return to mobility is desired, surgical ixation may have an advantage over nonsurgical treatment. Many patients have residual or permanent deicits in motor, sensory, language, and cognitive functions that necessitate intensive strategies to maximize the likelihood of return to a productive life. Teaching point Early diagnosis of esophageal rupture is critical as a delay in diagnosis and repair of even just 24 hours results in a high mortality rate. Astrocytes also participate in nervous system signaling and have been shown to take up and release molecules, such as neurotransmitters and cotransmitters that modulate neurotransmission. Saturated fatty acid Having the maximal number of hydrogen atoms present so that only single bonds exist in the carbon chain, as in saturated fatty acids.

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As is the case for the transport of monosaccharides, brush border membrane carriers are involved in the transfer of amino acids across the intestinal epithelial cell; these carriers require energy and are coupled to the transport of sodium. Transcellular luid Body luid contained in special compartments, such as the synovial or cerebrospinal compartments; a component of extracellular luid. Non-thrombotic pulmonary emboli from embolized polymethylmethacrylate, mercury, and ethiodol can mimic calcified, chronic pulmonary emboli. The acidity is also too low to digest protein in the stomach via the enzyme pepsin. Antimicrobial therapy should be initiated promptly in suspected cases of spontaneous bacterial peritonitis pending culture results. Additional identiied risk factors include portal vein thrombosis, previous portosystemic shunt operations, current alcohol or drug addiction, a poor psychosocial support system, and psychological instability. An enlarged liver and elevated levels of transaminases in the newborn should necessitate a search for congenital infection. A primary concern both of health care providers and of individuals with diabetes is avoiding the acute and chronic complications of diabetes. Articular (hyaline) cartilage Connective tissue that forms a smooth, resilient, low-friction surface for articulation of two bones. Rods are important for nighttime and peripheral vision and outnumber cones by nearly 20 to 1. Dysmenorrhea Dysmenorrhea is menstruation that is painful enough to limit normal activity or to cause a woman to seek health care. Bile A substance produced by hepatocytes in the liver and stored in the gallbladder. Likewise, seizure activity increases neuronal metabolism and leads to worsening neurologic outcomes. Collagen ibers connect one lamella to another within the osteon and increase the mechanical strength of bone. Increased osmolality may cause cellular shrinkage with neurologic signs and symptoms. Clues to a familial syndrome include at least three close relatives with colorectal cancer, colorectal cancer involving at least two generations, and one or more cases of colorectal cancer occurring before age 50 years. Isolated systolic hypertension An elevation in systolic blood pressure greater than 140 mm Hg without an increase in diastolic blood pressure. The cerebellum serves to adjust the timing and intensity of movements to improve the similarity between the intended and actual movements. Radiographs may show minimal changes; however, some cases involve aggressive disease with bone erosion, luffy new bone formation (periostitis), and marked loss of joint spaces. Concern regarding weight can lead to omission of insulin injections or the manifestation of eating disorders. Buck fascia or fascia of Buck Thick ibrous envelope surrounding the tunica albuginea, which encloses each of the erectile bodies of the penis. In theory, natural light acts as a zeitgeber, or a biological clock synchronizer that is based on the 24-hour day-night cycle. Cell mass is redistributed in response to the stressor, with an increase in the production of acute-phase proteins. Mammography is an important clinical tool, and according to current screening guidelines, most women should have yearly mammograms beginning at age 40. One injection during infancy is followed by one booster dose when the child enters kindergarten or irst grade or when the child enters middle school or junior high school. These patients may also develop eye inlammation, but this is less likely than in the early-onset group. Topical lotions and orally administered antihistamines provide partial relief of symptoms, but tolerance to the drugs develops and patients often require a series of different medications over time. Improved outcomes have clearly been related to an improved understanding of the pathophysiologic mechanism of burns, advances in burn care management, and the development of a comprehensive, patient-centered, treatment-oriented approach. After about 5 years of continual pain, many patients note a decrease in the symptoms. Migraine headaches are caused by an interaction between neurotransmitters and cerebrovascular mechanisms and may be triggered by factors such as stress, foods, and sleep deprivation. With movement, capillarization occurs more rapidly and tensile strength improves more quickly. Obsessive thoughts manifest as ideas, images, and urges that dominate normal thinking and functioning.

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The current rarely produces direct visceral damage, but severe injuries to the extremities are common. Bradycardia occurs (secondary to the overriding parasympathetic inluence), and there is a loss of the cardiac accelerator relex. Ankle, tarsal, and knee joints are often affected, although attacks can occur in hands, wrists, and elbows. Vitiligo is a depigmented patch of skin that is most noticeable in dark-skinned individuals. Obstruction of the common bile duct can be managed with endoscopically placed biliary stents. The primary sites for assessing skin pallor are the nail beds, lips, and conjunctivae. Apraxia An inability to execute previously learned skills, usually following a stroke. If vital capacity and muscle strength fall below 50% of predicted norms, respiratory failure is probable owing to retention of carbon dioxide. Placenta previa is a condition in which the placenta is implanted abnormally over the internal cervical os. In the majority of cases, amenorrhea is due to an abnormal pattern of hormonal functioning that interrupts the normal sequence of events in which the endometrial tissue lining the uterus proliferates and then is sloughed. In both males and females, the vesicles, which are usually painless at irst, may rupture and develop in to extensive shallow, painful ulcers. A typical motor neuron receives hundreds of synaptic inputs, which summate to control the generation of action potentials. Meningoceles occur with equal frequency in the cervical, thoracic, and lumbar areas. This disease can also cause kidney dysfunction, lung or pleural involvement, and neurologic symptoms attributable to nerve compression. Standard measures, including gastric lavage, induced emesis, and activated charcoal, are used in cases of acute ingestive poisoning. The spinal cord mediates spinal relexes involved in maintenance of posture, protective responses to pain, urination, and muscle tone. Just the opposite condition (hypoactive brain circuits) is thought to be the fundamental basis of depressive disorders. As with other tissue of the musculoskeletal system, muscle atrophies in response to disuse and immobilization, and hypertrophies when subjected to increased stress. The nipple, located at the center of the adult female breast, is composed of bundles of smooth muscle ibers with erectile properties. In some cases, the obstructing clot is eficiently lysed by the endogenous ibrinolytic system before permanent tissue damage occurs. This response can occur when antigen and antibody react in blood vessels in the skin. Most often, osteosarcomas originate in the metaphyses of long bones, chondrosarcomas arise in the axial skeleton, Ewing sarcomas develop in the diaphyses of long bones, and giant cell tumors originate in the epiphyses of long bones. The zone of young proliferating cartilage demonstrates the most active cartilage cell growth. Corticated edges may be appreciated, depending on image quality, slice thickness, and plane of the axial image with respect to the vertebra. For example, in primary hypothyroidism, the thyroid fails to secrete thyroid hormones and serum levels of thyroxine (T4) become lower. As blood escapes from the engorged veins, signiicant loss of blood and plasma from the affected segment may result in the rapid development of shock. As a result, pull of any part of the muscle, instead of being limited to a tendon bundle, is spread widely through the tendon. Numerous proteolytic enzymes are involved in protein digestion, and each enzyme acts on a slightly different type of peptide linkage. These defects include diminished opsonic activity of the ascitic luid, diminished reticuloendothelial function, and transmigration of gut bacteria across the intestinal wall and in to the ascites.

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Lipohypertrophy is characterized by an increase in subcutaneous tissue because of insulin-stimulated growth of adipose tissue at the injection sites. Stomatitis An inlammation of the oral mucosa that may extend to the buccal mucosa, lips, and palate. An infectious agent has long been sought as a cause, but reproducible evidence of a particular bacterium or virus has not been found. Ossicle One of several small bones in the middle ear responsible for transmitting sound waves to the inner ear. This creates an increased osmotic load and a subsequent shift of water across the epithelium. After the skeletal epiphyses close, bony growth increases bone density and thickening of the short bones, such as the hands and feet. Recurrent lesions are common and may be precipitated by stress, sunlight exposure, menses, or injury. Swelling of the brain (cerebral edema) often develops in patients with grade 3 or 4 hepatic encephalopathy and results in an increase in intracranial pressure. This patient also had bilateral basilar pulmonary consolidation (asterisk) from aspiration. However, evaluation of coronal images and sagittal images will reveal the site of abnormality is located at the bifurcation of the pulmonary arteries. If a woman has had an early (younger than 12 years) onset of menses and a late (older than 55 years) menopause, her risk is increased. By remaining attached to thyroglobulin, T3 and T4 are trapped within the water-soluble colloid. Cerebral vessels respond to metabolic factors including pH, carbon dioxide concentration, and oxygen levels. Physical examination reveals a mass bulging in to the posterior of the vaginal introitus. Menopause A process by which the supply of ovarian follicles and estrogen hormones declines, usually beginning between the ages of 45 and 55 years. If the individual survives the initial extension of the tumor, the liver and lungs are the usual sites of distant metastasis. However, as a risk factor, hyperlipidemia poses less threat for coronary artery disease and atherosclerosis than aging alone. Corpus luteum Anatomic structure on the surface of the ovary that grows in the ruptured ovarian follicle following ovulation and acts as a temporary endocrine organ that secretes progesterone. Clinical symptoms become evident when a suficient number of neurons have been excited. Risk factors for otitis media include use of paciiers, second-hand cigarette smoke exposure, gastroesophageal relux, poor socioeconomic conditions, daycare attendance, and propped bottles. Obesity also creates challenges with activities of daily living from increased risk of osteoarthritis, chronic pain, gallbladder disease, sleep apnea, and psychosocial impairments. Systemic involvement may consist of lymphadenopathy, splenomegaly, hepatitis, nonproductive cough, testicular swelling, and conjunctivitis. Although many of the disorders described in the following section are not life threatening, they can affect the quality of life. Later in the progression of tumor growth, a sensation of rectal fullness and a dull ache may be felt in the rectum or sacral region. The caudate nucleus and putamen 863 Astrocyte Tight junctions Capillary Endothelial cell together are called the striatum. These disorders may be associated with hormonal imbalances or primary lesions of the reproductive tract. Moreover, any local skin disease that affects the epidermis may also affect the nail matrix (epidermal cells that give rise to the nail plate) and lead to an abnormal (dystrophic) nail. A major feature of the intestinal absorptive surface is the villus, the small ingerlike projection lined with epithelial cells that was described earlier in this chapter. During the routine right upper quadrant ultrasound, hepatic size, morphology, and echogenicity should be inspected, with careful attention to hepatic enlargement and hypoechogenicity that may reflect acute hepatitis, or a shrunken, nodular hepatic contour suggestive of cirrhosis. However, when a larger ovarian cyst ruptures, an ovarian vessel may tear, with variable amounts of intraperitoneal hemorrhage and abdominal pain.

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Eventually they may ind ways to minimize neuronal degeneration after injury and encourage repair or replacement. The typical presenting clinical scenario is chest pain radiating to the back, with hypertension being the most common predisposing factor. Lack of exercise, lack of dietary iber, slowed peristalsis, and pathologic conditions that alter motility. Thus, in the spinal cord, the epidural space is a true space, unlike its counterpart in the cranium, which is only a potential space. Basal ganglia Groups of cell bodies (nuclei) located deep within the cerebral hemispheres that help plan and execute motor activities, including the caudate, putamen, globus pallidus, substantia nigra, and subthalamus. Another facet of alcohol-associated chronic pancreatitis is its tendency to progress after alcohol consumption is stopped. In the United States, approximately 1% to 2% of the population is affected with a lower prevalence being reported in Asian countries. Liver transplantation is available for patients with irreversible cirrhosis whose heart involvement does not preclude surgery. Severe pancreatitis, particularly in the setting of acute necrotizing pancreatitis, may result in multisystem organ dysfunction, requiring aggressive support in the intensive care unit setting. Lubrication of cartilage from a combination of these two methods decreases friction in the joint. Hormone agonist A chemical that binds to a hormone receptor and initiates intracellular activities identical to those caused by hormones. Growth hormone increases peripheral insulin resistance and prevents insulin from suppressing hepatic glucose production. Arteriosclerosis Generalized term for pathologic conditions resulting in decreased distensibility of arteries; also known as hardening of the arteries. Clinical manifestations may appear gradually, especially if adrenal destruction is slow and incremental, such as in autoimmune adrenal insuficiency. Alterations in sensory function may be acute/short-term, chronic/ long-term, or progressive in nature. Other nonpharmacologic therapies for headache include resting in a quiet, darkened room or applying cold packs to the head and back of the neck. Thus, as the regional lymphadenitis progresses, complications such as perianal and rectovaginal istulas develop, along with strictures of the rectum. If synovitis of the hip becomes extensive, severe pain may be noted on evaluation. It is not a disease, but a radiographic finding that may be secondary to any one of many pathologic processes [1]. The worry is often about minor issues, where the person anticipates the worst possible outcome, and inds it dificult to control. Chondroma Also called enchondroma; a cartilage-forming tumor located within bone that accounts for about 15% of benign bone tumors. The brain parenchyma is divided in to compartments by the supporting structure of the dura. Postherpetic neuralgia is the most important complication occurring in people older than 50 years. Universal childhood vaccination is recommended in the United States and in many countries around the world. Both types of receptors phosphorylate their target proteins upon binding of the hormone to an external binding site. The greatest concern regarding body image is the appearance of the skin, which tends to look mottled and spotty. Arthritis Any inlammatory condition of the joints; characterized by pain, swelling, heat, redness, and limitation of movement. However, if it is not possible to determine cyanosis from the skin, close inspection of the nail beds, lips, palpebral conjunctiva, palms, and soles should show evidence of cyanosis. The eficacy of therapy can be assessed by monitoring blood glucose and HbA1c levels. In this type of injury a linear orbital floor fracture results in inferior bony displacement. Benign causes of mediastinal widening include atelectasis, inadequate inspiration, mediastinal lipomatosis, congenital vascular anomalies, tortuous vessels, and radiographic technique.

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Nociception Activation of nociceptors by potentially tissue-damaging stimuli, resulting in the perception of pain by the central nervous system. Immobility the main nutritional effect of immobility is loss of calcium from nonstressed bone, a process that can elevate serum calcium and phosphorus levels. As the ibers progress upward, they gradually move toward the midline, so that those corresponding to the lower extremities occupy the medial white column and those representing the arm are more lateral. The tympanic membrane is a thin, elastic membrane that is very sensitive to changes in pressure. In motivated patients, this is perhaps the most helpful intervention that can be undertaken. Because trauma is a sudden stress, catabolism is much greater than anabolism because the body has not had enough time to replenish the proteins lost. It is an intraduralextramedullary lesion commonly found in the distal cord or at the conus medullaris and is composed largely of distended intradural draining veins. Semen Male reproductive luid that contains spermatozoa; released with ejaculation. Condyloid joint A joint that permits lexion and extension at one axis and adduction and abduction around another axis, such as the metacarpophalangeal joint of the hand. If one contracts smooth muscle, the other relaxes it; if one stimulates glandular secretion, the other inhibits it; if one speeds up a process, the other slows it down. This is the typical appearance for archiform splenic enhancement and should not be confused with a laceration or contusion. A familiar example is the pain of myocardial infarction that is felt in the jaw or left arm. The cell bodies of sensory afferents collect together in the dorsal root ganglion. Spinal Nerves the 31 pairs of spinal nerves are named after the vertebral segments from which they emerge. Firm materials may be removed from the canal with loop or hook instruments, taking care not to push the object further in to the canal. Other symptoms include cyanosis from hypoxia, absent cough and gag relexes, restlessness, increased secretions and lacrimation, diaphoresis, decreased urine output, bowel and bladder incontinence, dysarthria, and respiratory distress. When the depressed person ruminates, everything is interpreted through a negative ilter. The resulting malabsorption of ingested nutrients may promote malnutrition and severe debilitation. Acute cholecystitis may necessitate intervention, but surgeons generally prefer to allow a "hot" gallbladder to "cool down" before performing surgery, particularly if the patient is considered a high surgical risk. However, scar tissue tends to develop altered contours; that is, the skin is no longer lat but becomes raised above the contour of the surrounding area (also known as hypertrophic scarring). Esophageal varix Abnormally dilated blood vessel lying immediately below the mucous membrane of the esophagus that connects the hypertensive portal system with the systemic circulation. The reactions leading to the assimilation of organic molecules are organized in to metabolic pathways. The loss of impulses from the temperature regulatory center in the brain prevents the ability to sweat below the level of injury. Islands of perfused parenchyma surrounded by hematoma will generally follow the enhancement pattern of normal parenchyma. Two types of disorders of malabsorption may occur after surgical intervention on the stomach or small bowel: dumping syndrome and short-bowel syndrome. The test should be done in the morning after an overnight fast of between 8 and 14 hours and after at least 3 days of unrestricted diet (150 g of carbohydrate per day) and unlimited physical activity. Systemic Steroids Administration of systemic steroids in dermatologic disease is usually oral. Note the sharp anterior contour to the pulmonary hemorrhage in the right middle lobe, consistent with a pneumothorax. The inner layer of the joint capsule is the entry point for nutrients and the exit point for waste material.

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Partial seizure A seizure in which part of the brain surface is involved in the seizure. If the stimulus is so great that the ability of the muscle to increase tension is exceeded, the muscle is said to be "in tetanus. Although its primary physiologic function is lactation (production of milk) to nourish the human infant, the signiicance of the breast as a symbol of feminine sexuality in contemporary Western culture must also be recognized. Desensitization the process of manipulating or "training" the hypothalamus to react less forcefully to a perceived threat or stressor. Multiple myelomas involve the calvaria, vertebrae, and ribs, but also other bones that contain hematopoietic bone marrow. In the United States, exogenous steroids used in the management of various diseases, such as allergic and autoimmune diseases, are the most common cause of Cushing syndrome. Chylothorax An accumulation of chylous luid attributable to leakage of chyle (lymph luid) from the thoracic duct or to rheumatoid pleural effusion or tuberculous pleuritis. Approximately 7 lb of this weight gain is the fetus; 4 lb of the increased weight is amniotic luid, placenta, and fetal membranes; 2 lb represents an increase in uterine tissue; and another 2 lb of the weight gain is an increase in breast tissue. Patients may complain of a heavy sensation in their face as well as a decreased sense of taste, but sensation of the face is generally intact. Laxity in the cervical region may also allow compression of the vertebral artery, leading to vertebrobasilar insuficiency. Strabismus An abnormal ocular condition in which the visual axes of the eyes are not directed at the same point. Not only do contractures develop in the skin, but also the underlying tissues such as ligaments and tendons have a tendency to shorten during the healing process. Metformin suppresses hepatic gluconeogenesis and enhances glucose uptake by peripheral tissue; thiazolidinediones enhance glucose uptake by peripheral tissue; and acarbose delays absorption of ingested carbohydrate. The exercise prescription is as essential in diabetes management as the medication or nutrition prescription. In children older than 2 years with milder symptoms, a "wait and see" approach may be used. Neuropsychological studies have shown that objects in the ield of neglect are usually ignored. Nutrition of the joint components stagnates, leading to degenerative changes in the joint that become permanent. Sonography of the gallbladder: significance of striated (layered) thickening of the gallbladder wall. In addition, other conditions in which the glycogen content of the vagina is enhanced may favor candidiasis, such as diabetes, pregnancy, and the use of oral contraceptives. Axial T2-weighted image shows a confluent area of hyperintensity in the left parietal subcortical white matter, in continuity with the spenium of the corpus callosum that is heterogeneous with high signal centrally and is associated with subcortical edema. Continued oil production and bacterial growth in this obstructed follicle may cause rupture of the wall or sebaceous gland and result in an inlamed lesion. Also notice the rounded configuration of the right inferior rectus muscle, indicating disruption of the fascial sling; compare with the normal contralateral side. Radical surgery, including pelvic exenteration, or removal of all the pelvic organs, can now be performed with limited morbidity. The inancial and legal ramiications of dementia can be devastating to patients and their families and caregivers. Any effusion in to the joint cavity may lead to stretching of the capsule and its associated ligaments. Blood glucose levels 6 to 10 times normal may occur with signiicant cortisol secretion. Leukotrienes A class of biologically active compounds produced by leukocytes that trigger allergic and inlammatory reactions similar to those of histamine. Salvaging the penumbra is the aim of early thrombolytic therapy; however, treatment must be instituted within 3 hours of stroke onset to be maximally effective. The genetic mutation leads to production of a reduced amount of an abnormal dystrophin protein and a slower muscular degeneration.

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Osteoarthritis A common degenerative joint disease characterized by progressive loss of articular cartilage and by formation of new bone from subchondral bone at joint margins. Autoregulation is inluenced by the partial pressures of carbon dioxide (Paco2) and oxygen (Pao2) in the arterial blood. In addition, these patients frequently suffer from a second autoimmune disease such as Hashimo to thyroiditis. Spina biida is a developmental anomaly characterized by defective closure of the bony encasement of the spinal cord (neural tube) through which the spinal cord and meninges may or may not protrude. Types of Muscle Contraction Electromyography is used to evaluate muscle contraction. Supericial partial-thickness burn Marked by destruction of the epidermis and dermis, a supericial partial-thickness burn is also a second-degree burn. Uncorrected obstruction may lead to intestinal wall edema, ischemia, and necrosis. At 757 the canalicular posthepatocytic level, many drugs such as the phenothiazines and the sex hormones may cause jaundice. The oxidation of branched-chain amino acids occurs for two reasons: to meet energy requirements and to provide the liver with amino acids for the synthesis of acute-phase proteins (C-reactive protein, mannose-binding protein, complement factors, ferritin, ceruloplasmin, amyloid A, and haptoglobin). Troponin A regulatory protein involved in regulation of actin-myosin cross-bridge formation. Transtentorial herniation can occur rapidly or slowly, depending on the type of lesion. A patent eustachian tube prevents membrane rupture and discomfort that marked pressure differences can produce. Cerebrospinal luid lows in the subarachnoid space and is reabsorbed by arachnoid villi within the dural sinuses. Schizoid Indifferent to social interaction and possessing a limited range of emotional experience and expression. Neural inluences from the sympathetic and parasympathetic nervous system are directly involved with carbohydrate metabolism and glucose utilization. Typical imaging findings include lack of normal enhancement within the sinus and convex bowing of the lateral margin [5]. Kept free from infection, a partial-thickness burn will heal from the edges and from below in a process that occurs over a 14- to 21-day period. A thorough health history and physical examination along with visual acuity testing and ophthalmoscopic examination will provide health care providers with the necessary information to appropriately treat or refer individuals with visual impairment. Along with the malabsorption of fat, the absorption of fat-soluble vitamins (A, D, E, and K) may be impaired, leading to such problems as coagulopathy and night vision impairment. Speciically, the reader must be able to compare and contrast the differences between benign breast disorders and carcinoma of the breast and discuss the meaning and importance of various risk factors for breast carcinoma in a knowledgeable way. Initially, affected muscles are laccid, with spasticity occurring after about 6 weeks. A diagnosis of noiseinduced hearing loss is made through careful history and audiometric testing. The fatigue can also make ordinary daily activities, once performed automatically, nearly impossible. Mucosal edema Swelling of the membranes of the respiratory, gastrointestinal, or urogenital systems; usually a consequence of inlammation. In addition, when compared with adults, children also need a larger percentage of their dietary intake of protein to contain essential amino acids. The pattern can change when the usual wake and sleep times are altered, for example, in night-shift workers. Topical Steroids Corticosteroids can also be applied topically to suppress inlammation. Bizarre lesions occur, such as long linear bands on extremities, "saber cut" lesions in the scalp, or lesions involving one side of the face or the body. Endometriomas are illed with brown blood debris; when they rupture, their contents spill on to the sensitive pelvic peritoneum.

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Hydrocephalus Increase in the amount of cerebrospinal luid attributable to blocked circulation or absorption and the consequent enlargement of the ventricles. If there is an external protrusion of the saclike structure, the condition is called spina biida cystica and is further classiied according to the extent of neural involvement. Wound management, nutritional support, and surgical grafting of full-thickness wounds are the priorities of treatment during the emergent phase. This accumulation is prevented by maintaining urine output at 100 to 200 ml/hr in adults and 2 ml/kg/hr in children until the urine clears. Neurotransmitters are either actively transported back in to the axon terminals for reuse or destroyed by enzyme activity. The pemphigus group disorders are characterized by bullous eruptions (blisters) thought to be caused by autoimmune reactions. Chronic bronchitis A condition characterized by excessive secretion of bronchial mucus and manifested by productive cough for 3 or more months in at least 2 consecutive years in the absence of any other disease process that may cause this symptom. It results from the stripping of the periosteum by the accumulation of pus within the bone, and new bone growing from the periosteum. Other features of foot involvement include swelling of joints, a cocking-up of the toes attributable to subluxation of the metatarsal heads (claw toes), and lateral deviation of the irst through fourth toes. Mechanisms of secondary injury are the subject of much interest because of the potential to effectively intervene to limit brain damage. These interrelated and dynamic reactions meet the unique requirements of each independent cellular activity. These medications have been shown to decrease bone resorption, stabilize the fragile bone lesions, and reduce pain and the risk of fractures. Stratum fibrosum Stratum synovium Adhesive Capsulitis An example of such a restriction is loss of function in the shoulder after even a minor injury, leading to a "frozen shoulder," also called adhesive capsulitis. Autonomic complications include gastrointestinal disturbances, bladder dysfunction, tachycardia, postural hypotension, and sexual dysfunction. Muscular decline rises with increasing age and usually occurs earlier in men; however, the extent of muscular system decline varies. Decompensation occurs as the impaired cells are unable to produce suficient insulin to overcome insulin resistance. Lau Differential diagnosis Gas trapped in skin folds can be mistaken for subcutaneous emphysema. Uric acid is a normal waste product of purine metabolism and therefore must be iltered primarily by the kidneys. Disorders of the gag relex such as stroke or neuropathy can lead to life-threatening obstruction or aspiration. Protein synthesis in the involved neurons is necessary to consolidate long-term changes in synaptic eficiency. Conversion of this dysrhythmia to normal sinus rhythm can sometimes be accomplished with antidysrhythmic agents or electrical cardioversion. The blue-colored amino acids represent the insulin that is released when the C-peptide segment is cleaved. Surgical treatment may include aspiration of lymph nodes as needed; rectal strictures and istulas may require surgical correction. The synovial sheath provides strength to the joint and, through its neural receptors, detects motion, compression, tension, vibration, and pain. The majority of pain sensations travel via C ibers and project to areas of the brain that evoke emotional responses such as displeasure and anxiety. They can be distinguished from acute fractures by the lack of inflammatory changes in the soft tissues and the lack of sharp fracture lines. Movement of the head causes movement of the endolymph contained in the semicircular canals.