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Clinical test: With one hand under the elbow back spasms 8 weeks pregnant buy imitrex 50 mg amex, flex the elbow slightly below spasms near kidney discount imitrex 50mg free shipping, or at, a right angle with the forearm supinated, and press against the forearm to extend the elbow. Triceps brachii ­ long head Starting posture: Seated on a chair; shoulder about 90° abducted; elbow flexed at a right angle; palm facing down. Electrode location: Midway along a line between the posterior crest of the acromion process and the olecranon process at two-finger widths medial to that line (Figure 6. Clinical test: Extend the elbow while applying pressure that would tend to flex it. Rectus femoris Starting posture: Seated on a table; knees slightly flexed; upper body slightly bent backwards. Electrode location: Midway along the line from the anterior superior iliac spine to the superior aspect of the patella (Figure 6. Clinical test: Extend the knee ­ with no rotation of the thigh ­ against pressure. Biceps femoris Starting posture: Lying prone with thighs on table; knees flexed by less than 90° from fully extended position; thigh and shank both slightly rotated externally. Electrode location: Midway along the line from the ischial tuberosity to the lateral epicondyle of the tibia (Figure 6. Reference electrode: On or around the ankle or on the spinous process of the seventh cervical vertebra. Clinical test: Extend the knee against pressure applied to the leg proximal to the ankle. They also recommend a clinical test for each individual muscle, performed from the starting posture, to ensure satisfactory signals; a few examples of these tests are shown in Box 6. First, to distinguish between artifacts and signal, it is essential that good recordings free from artifacts are obtained. The siting of electrodes, skin preparation and other factors can all affect the results. Even the activity or inactivity of one motor unit near the pick-up site can noticeably change the signal. Such epoch durations considerably exceed the durations of muscle activity in many fast sports movements. The last of these depends upon electrode position, muscle fibre conduction velocity, the geometry of the detecting electrode surfaces and the detection volume. It is considered to provide a measure of the number of recruited motor units during voluntary contractions where there is little correlation among motor units. This is a simple method of quantifying signal intensity and gives an output (Figure 6. The main issue with this estimator is the choice of the epoch duration, which, for this estimator, is related to the filter cut-off frequency (see also Chapter 4). Typical values of the cut-off frequency are around 2 Hz for slow movements such as walking, and around 6 Hz for faster movements such as running and jumping. A development of this approach is the use of an ensemble average calculated over several repetitions of the movement. This procedure theoretically ­ for physiologically identical movements ­ reduces the error in the amplitude estimation by a factor equal to the square root of the number of cycles. It is often used in clinical gait analysis but ignores the variability of movement patterns. Again, these epoch durations considerably exceed the durations of muscle activity in many fast sports movements. The central tendency and spread of the power spectrum are best expressed by the use of statistical parameters, which depend upon the distribution of the signal power over its constituent frequencies. Two statistical parameters are used to express the central tendency of the spectrum. For a spectrum of discrete frequencies, the mean frequency is obtained by dividing the sum of the products of the power at each frequency and the frequency, by the sum of all of the powers. The median frequency is the frequency that divides the spectrum into two parts of equal power ­ the areas under the power spectrum to the two sides of the median frequency are equal. The spread of the power spectrum can be expressed by the statistical bandwidth, which is calculated in the same way as a standard deviation. This is accompanied by a noticeable shift in the power spectrum towards lower frequencies (Figure 6. This results either from a lowering of the conduction velocity of all the action potentials or through faster, higher frequency motor units switching off while slower, lower frequency motor units remain active.

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It courses along the hyoid bone and anastomoses with the branch from the opposite side muscle relaxant succinylcholine imitrex 50 mg with mastercard. It penetrates the thyrohyoid membrane and lies beneath the mucosa of the piriform recess spasms hiccups buy imitrex 25 mg without a prescription. A 19 20 21 22 23 24 15 14 12 13 25 Arteries 195 20 18 1 2 3 19 17 11 13 12 9 10 7 8a 8 16 16a 4 5 6 7 8 9 10 14 15 6 11 12 5 13 14 15 2 1 1 4 16 17 18 19 20 21 22 23 A Arch of aorta and vessels of neck 24 25 a a a 196 Arteries 1 2 1 Lingual artery. It passes medial to the mastoid process at the occiput and anastomoses with the superficial temporal, vertebral, deep cervical and posterior auricular arteries. It passes beneath the sternocleidomastoid muscle and runs obliquely behind the pinna. Inconstant branch of the occipital artery that occasionally passes through the parietal foramen and supplies the dura mater. Usually very tortuous branches of occipital artery that penetrate the trapezius and supply the occiput. It lies under the parotid gland on the styloid process between the mastoid process and the ear. It courses with it through the stylomastoid foramen to the hiatus of the canal for the greater petrosal nerve, and then into the middle and inner ear. It anastomoses at the hyoid 15 bone with the infrahyoid branch and the branch from the opposite side. Arising at the anterior margin of the hyoglossus, it passes between the mylohyoid and the sublingual gland and extends up to the gingiva. As 17 the main branch of the lingual artery, it passes between the genioglossus and inferior longitudinal muscles of the tongue to the apex of the tongue and anastomoses with the artery from 18 the opposite side. It runs below the styloyoid muscle, first upward, then laterad, and crosses the mandible at the anterior margin of the masseter. Arising from the proximal portion of the facial artery, it passes medial to the styloglossus muscle at the lateral wall of the pharynx to supply the palatal arches and adjacent musculature, often also the tonsils from above. Branch frequently arising from the ascending palatine artery and supplying the palatine tonsils. It lies caudal to the mylohyoid muscle and supplies mainly this muscle and the submandibular gland. It anastomoses with the submental and mental arteries as well as the artery of the opposite side. It anastomoses with the transverse facial and infra-orbital arteries as well as the artery of the opposite side. C 5 10 11 12 13 14 15 16 17 10 9 8 7 20 21 22 23 18 19 11 24 20 21 22 25 12 Mastoid branches. It supplies the posterior side of the pinna with perforating branches as well as the anterior side and the small auricular muscles. Branch that courses above the mastoid process and anastomoses with the occipital artery. Branch that is covered by the parotid gland and passes below the zygomatic arch to the cheek. It anastomoses with its counterpart from the opposite side as well as with the supra-orbital and supratrochlear arteries from the internal carotid. It anastomoses with its counterpart from the opposite side as well as with the posterior auricular and occipital arteries. It arises beneath the temporomandibular joint, passes lateral or medial to the lateral pterygoid muscle and ramifies in the pterygopalatine fossa. It passes backward and upward to the temporomandibular joint, external acoustic meatus and tympanic membrane. Accompanied by the chorda tympani, it passes through the petrotympanic fissure into the tympanic cavity. It passes between the medial pterygoid muscle and mandibular ramus into the mandibular canal up to the mental foramen. It passes medial to the lateral pterygoid muscle and through the foramen spinosum into the middle cranial fossa where it ramifies. Accessory branch from the middle meningeal artery or from the maxillary artery that extends to the adjacent muscles, the auditory tube and through the foramen ovale to the dura up to the trigeminal (semilunar) ganglion.

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Relationship between Anatomy & Physiology Form is closely related to muscle relaxer 93 best 25 mg imitrex function in all living things spasms while high order 50 mg imitrex mastercard. For example, the thin flap of your eyelid can snap down to clear away dust particles and almost instantaneously slide back up to allow you to see again. At the microscopic level, the arrangement and function of the nerves and muscles that serve the eyelid allow for its quick action and retreat. At an even smaller level of analysis, the function of these nerves and muscles likewise relies on the interactions of specific molecules and ions. Your study of anatomy and physiology will make more sense if you relate the form of the structures you are studying to their function. In fact, it can be somewhat frustrating to attempt to study anatomy without an understanding of the physiology that a body structure supports. Imagine, for example, trying to appreciate the unique arrangement of the bones of the human hand if you had no conception of the function of the hand. Fortunately, your understanding of how the human hand manipulates tools-from pens to cell phones-helps you appreciate the unique alignment of the thumb in opposition to the four fingers, making your hand a structure that allows you to pinch and grasp objects and type text messages. Variation in Anatomy & Physiology While learning about the structure and function of the human body it is common to develop the misconception that all individuals are essentially the same. Human physiology can vary either within one individual or between different individuals due to differences in things like their genetic make-up, age, sex, and the environment. Textbooks and plastic models show common presentations of structures of the human body but there is more variation in human anatomy than you would likely imagine. Variation in structure can include the modification of an existing common structure, the complete absence of a common structure, or presence of an uncommon structure. A few select examples include: Palmaris longus ­ A muscle of the forearm that is one of the most variable muscles in the body. Dextrocardia ­ the heart is oriented to the right side of the body instead of the most common presentation where the apex is pointed to the left. This is sometimes accompanied by the transposition of other organs (ex: liver) with little or no functional effect on the individual. Parathyroid gland ­ Parathyroid glands vary both in location (can be found on or near the thyroid gland, trachea, and esophagus) and number (2-6). Most sources describe four parathyroid glands found on the posterior surface on the thyroid gland which likely occurs less than half of the time. Vertebral column ­ the most common description of the number of vertebrae in each section of the vertebral column is: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal vertebrae. However, this exact distribution is found is only about 20% of individuals with variation in both the total number of vertebrae (25-32) and how many are found in each section. Familiar examples of atoms include hydrogen, oxygen, carbon, nitrogen, calcium, and iron. Two or more atoms combine to form a molecule, which includes things like water molecules, proteins, and sugars found in living things. A cell is the smallest independently functioning unit of a living organism which can include independentlyliving single cell organisms like bacteria. All living structures within the human body contain cells, and almost all functions of human physiology are performed in cells or are initiated by cells. A human cell typically consists of flexible membranes that enclose cytoplasm, a water-based cellular fluid together with a variety of tiny functioning units called organelles. A tissue is a group of multiple similar cells (these cells can either be of the same cell type or can consist of a few related cell types) that work together to perform a specific function. An organ is an anatomically distinct structure of the body composed of two or more tissue types that performs one or more specific functions. An organ system is a group of organs that work together to perform major functions to meet physiological needs of the body. Throughout this course we will cover a subset of the organ systems found in the human body: the integumentary, skeletal, muscular, and nervous systems. Language of Anatomy Anatomists and health care providers use terminology to precisely talk about the anatomy of the human body that can seem overwhelming at first.

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Axon terminal Synaptic vesicle Neurotransmitter chemical Neurotransmitter receptors Presynaptic membrane Neural cleft Postsynaptic membrane Figure 9 muscle spasms 7 little words purchase imitrex 25 mg on-line. The time is consumed in (a) the release of the neurotransmitter spasms when excited buy cheap imitrex 25mg on line, (b) the diffusion of the neurotransmitter across the cleft, (c) the interaction of the neurotransmitter with receptors on the postsynaptic membrane, and (d) the initiation of the impulse in the postsynaptic neuron. With repetitive stimulation there is a progressive decline in synaptic transmission due to depletion of the store of neurotransmitter in the axon terminal. Most synapses conduct impulses in one direction only because the neurotransmitter is usually present only on one side of the synapse. During the time the membrane is hyperpolarized, the potential is farther below threshold, making it more difficult to generate an action potential. Some of these chemicals mimic neurotransmitters and stimulate the receptors on the postsynaptic membrane. Other chemicals bind to the receptors, blocking them from normal neurotransmitter binding and preventing synaptic activity. Still others prevent the normal mechanism of removing neurotransmitters from the synaptic gap, causing continuous nervous stimulation at the junction. Botulinum toxin can inhibit the release of the neurotransmitter acetylcholine from synaptic vesicles. Cholinergic drugs bind to receptors for acetylcholine, where they mimic the neurotransmitter. Symptoms include tremor of the hands; weakness; rigidity of the large joints, which causes a stooped fixed posture; and a shuffling gait. The symptoms can be partially treated with exercise, heat, massage, the use of anticholinergic drugs, antihistamines, and L-dopa (a precursor of dopamine that can cross the blood­brain barrier). The neuroglia that have functions similar to white blood cells are (a) oligodendrocytes, (b) astrocytes, (c) microglia, (d) ependymal cells, (e) lymphocytes. The speed of a nerve impulse is independent of (a) the diameter of the nerve fiber, (b) the physiological condition of the nerve, (c) the presence of myelin, (d) the length of the nerve fiber, (e) the presence of neurolemmocytes. The basic unit of the nervous system is (a) the axon, (b) the dendrite, (c) the neuron, (d) the cell body, (e) the synapse. Depolarization of the membrane of a nerve cell occurs by the rapid influx of (a) potassium ions, (b) chloride ions, (c) organic anions, (d) sodium ions. At a synapse, impulse conduction normally (a) occurs in both directions, (b) occurs in only one direction, (c) depends on acetylcholine, (d) depends on epinephrine. In a resting neuron, (a) the membrane is electrically permeable, (b) the outside of the membrane is positively charged, (c) the outside is negatively charged, (d) the potential difference across the membrane is zero. Dendrites carry nerve impulses (a) toward the cell body, (b) away from the cell body, (c) across the body of the nerve cell, (d) from one nerve cell to another. The transmitter substance in the presynaptic neuron is contained in (a) the synaptic cleft, (b) the neuron vesicle, (c) the synaptic gutter, (d) the mitochondria. The interior surface of the membrane of a nonconducting neuron differs from the exterior surface in that the former is (a) negatively charged and contains less sodium, (b) positively charged and contains less sodium, (c) negatively charged and contains more sodium, (d) positively charged and contains more sodium. The presence of myelin gives a nerve fiber its (a) gray color and degenerative abilities, (b) white color and increased rate of impulse transmission, (c) white color and decreased rate of impulse transmission, (d) gray color and increased rate of impulse transmission. During repolarization of the neuronal membrane, (a) sodium ions rapidly move to the inside of the cell, (b) sodium ions rapidly move to the outside of the cell, (c) potassium ions rapidly move to the outside of the cell, (d) potassium ions rapidly move to the inside of the cell. The arrival on a given neuron of a series of impulses from a series of terminal axons, thereupon producing an action potential, is an example of (a) temporal summation, (b) divergence, (c) generation potential, (d) spatial summation. Neural regulation differs from endocrine regulation in that the former (a) is quick, precise, and localized; (b) is slower and more pervasive; (c) does not require conscious activity; (d) has longer lasting effects. The gray matter of the brain consists mainly of neuron cell (a) axons, (b) dendrites, (c) secretions, (d) bodies. The tightly packed coil of the neurolemmocyte membrane that encircles certain kinds of axons is called (a) a myelin sheath, (b) a neurolemma, (c) a node, (d) gray matter. The interruptions occurring at regular intervals along a myelin-coated axon are (a) neurofibril nodes, (b) synapses, (c) synaptic clefts, (d) gap junctions. The junction between two neurons is called (a) a neurospace, (b) an axon, (c) a synapse, (d) a neural junction.

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Pruritus Opioid-induced pruritus (itch) commonly occurs following systemic administration and even more commonly following intrathecal/epidural opioid administration spasms near tailbone order imitrex 50 mg without prescription. Although pruritus may be due to infantile spasms 6 months old purchase 25mg imitrex a generalized histamine release following the application of morphine, it is also evoked by fentanyl, a poor histamine liberator. The main mechanism is thought to be centrally mediated in that inhibition of pain may unmask underlying activity of pruritoreceptive neurons. Opioid-induced pruritus can be successfully attenuated by naltrexone (6 mg orally) or with less impact on the analgesic effect by mixed agonists such as nalbuphine. Respiratory depression Respiratory depression is a common phenomenon of all -opioid agonists in clinical use. These drugs reduce the breathing rate, delay exhalation, and promote an irregular breathing rhythm. The fundamental drive for respiration is located in respiratory centers of the brainstem that consist of different groups of neuronal networks with a high density of -opioid receptors. Routes of opioid administration Oral the majority of opioids are easily absorbed from the gastrointestinal tract with an oral bioavailability of 35%. However, they undergo to a high degree (40­80%) immediate first-pass metabolism in the liver, where glucuronic acid binding makes the drug inactive and ready for renal excretion. Oral opioids are commonly available in two galenic preparations, an immediate-release formula (onset: within 30 min, duration: 4­6 hours) and an extended-release formula (onset: 30­60 min, duration: 8­12 hours). Antitussive effects In addition to respiratory depression, opioids suppress the coughing reflex, which is therapeutically produced by antitussive drugs like codeine, noscapine, and dextromethorphan. The main antitussive effect of opioids is regulated by opioid receptors within the medulla. Gastrointestinal effects Opioid side effects on the gastrointestinal system are well known. In general, opioids evoke nausea and vomiting, reduce gastrointestinal motility, increase circular contractions, decrease gastrointestinal mucus secretion, and increase fluid absorption, which eventually results in constipation. In addition, they cause smooth muscle spasms of the gallbladder, biliary tract, and urinary bladder, resulting in increased pressure and bile retention or urinary retention. These gastrointestinal effects of opioids are mainly due to the involvement of peripheral opioid receptors in the mesenteric and submucous plexus, and are due to a lesser extent to central opioid receptors. Therefore, titration with methylnaltrexone (100­150­300 mg orally), which does not penetrate into the central nervous system, successfully attenuates opioid-induced constipation. More common practice, however, is the coadministration of laxatives such as lactulose (3 Ч 10 mg Intravenous/intramuscular/subcutaneous these different forms of parenteral opioid application follow the same goals: a convenient and reliable way of application, a fast onset of analgesic effect, and bypass 42 of hepatic metabolism. While intravenous application gives immediate feedback about the analgesic effect, intramuscular and subcutaneous routes of administration have some delay (about 15­20 min) and should be given on a fixed schedule to avoid large fluctuations in plasma concentrations. The faster rise in opioid plasma concentration with parenteral versus enteral applications enables better and more direct control of opioid effects; however, it increases the risk of a sudden overdose with sedation, respiratory depression, hypotension, and cardiac arrest. After parenteral administration, a first phase of opioid distribution within the central nervous system, but also in other tissues such as fat and muscles, is followed by a second, slower phase of redistribution from fat and muscles into the circulation with the possibility of the re-occurrence of some opioid effects. Michael Schдfer Table 2 Equianalgesic doses of different routes of administrations of opioids Drug Morphine, oral Morphine, i. Morphine, epidural Morphine, intrathecal Oxycodone, oral Hydromorphone, oral Methadone, oral Tramadol, oral Tramadol, i. However, the duration of analgesia is much longer with buprenorphine (6­8 hours) than with fentanyl (15­45 min). Similar to the other parenteral applications, there is no hepatic first-pass metabolism. Its main indications of use are for postoperative and chronic malignant pain; however, it is also used for other severe pain conditions. In acute pain states, morphine can be quickly titrated to optimal pain relief by the parenteral route. In chronic pain conditions, daily morphine doses should be given in an extended-release formula, and breakthrough pain is best treated by administration of a fifth of the daily morphine dose in an immediate-release formula. Intrathecal/epidural Opioids administered intrathecally or epidurally penetrate into central nervous system structures depending on their chemical properties: less ionized, i.

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The catheters may even be advanced-always without resistance-up to quick spasms in lower abdomen generic 50mg imitrex fast delivery the thoracic segments in infants because their more compact and globular fat makes it easy to muscle relaxant during pregnancy discount 50 mg imitrex overnight delivery pass the catheter. Subcutaneous tunneling of the caudal catheter reduces the rate of bacterial contamination. Is there a maximum dose of local anesthetics that is safe when the drug is used for local anesthesia? No more than 4 mg/kg of lidocaine without epinephrine, or 7 mg/kg with epinephrine, should be used when infiltrating for local anesthesia. Bupivacaine should not exceed 2 mg/kg or 8 mg/day; it is commonly used in concentrations of 0. Maximum doses are generally an issue when suturing large wounds or when using higher concentrations of local anesthetics. Planning an analgesic strategy It is important to have a plan for pain relief from the beginning of the perioperative period until such time as the pediatric patient is pain free (see. Developmental age the chronologic and neurodevelopmental age of the patient should be considered. A premature or young infant who may have problems with central respiratory drive may benefit from techniques that minimize the use of opioids, which have central respiratory depressant drug effects. In older infants and toddlers, play therapy and the presence of parents have an important role in pain relief. Surgical considerations the degree of pain is often associated with the type of surgery. The type of surgery often is the deciding factor in choosing a particular pain relief measure. For surgeries in areas that are moved regularly, such as the chest and upper abdomen, the pain relief measure required would be intense. Compared to neuraxial blocks, peripheral nerve blocks with or without catheters have the least complications and are popular, especially the axillary, the femoral, and the three-in-one-block. Lumbar epidurals can be used for a single dose administration, especially when caudal block is contraindicated or when the volume needed for the caudal block would be close to toxic levels. A catheter placed in the epidural space can provide continuous analgesia for a long period of time (if tunneled for periods of more than 1 week). In children, often the caudal route is preferred because it is safest technically due to Educating nurses and parents A nurse is the first person who faces a child with pain. It is her responsibility to monitor and coordinate with the surgical and the anesthetic team. If trained nursing personnel is not available or a high-dependency area is not available, more aggressive methods of pain relief may not be safe. Parents provide emotional support to the child, and it is important to discuss the plan with the parents to elicit their support. Two hours after surgery, oral paracetamol 300 mg or a combination of paracetamol and ibuprofen (300 mg) is given 8-hourly until the pain score allows reduction or stopping of the medication. In such situations, the strategy should be to devise simple techniques, which do not require precision equipment and intensive monitoring in the postoperative period. Local anesthetics can be applied by wound infiltration, prior to incision, before closure, or continuously in the postoperative period. In single-injection regional nerve blocks, postoperative analgesia is limited to 12 hours or less. Continuous peripheral nerve blocks provide an effective, safe, and prolonged postoperative pain relief. If all patients received a regional block intraoperatively, that would obviate the need for potent parenteral opioids. The duration of analgesia provided by a caudal block can be prolonged by addition of other adjuvants. Plan 2 A newborn baby with an anorectal anomaly is scheduled for an emergency colostomy. The baby can be managed with a spinal subarachnoidal block with bupivacaine alone. For premature babies, opioids should be avoided due to immature respiratory function. Although ketamine is used in many places, there is no good evidence for the effectiveness and safety of this drug in neonates. Plan 3 A 5-year-old boy is admitted to the emergency ward with acute burns and severe pain.

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It appears thicker and more multi-layered when the bladder is empty muscle relaxant antagonist buy generic imitrex 50mg on-line, and more stretched out and less stratified when the bladder is full and distended spasms jerking limbs discount imitrex 25mg line. From the connective tissue sheath that surrounds muscle cells, to the tendons that attach muscles to bones, and to the skeleton that supports the positions of the body support is a critical function of connective tissues. Protection is another major function of connective tissue which includes bones that protect delicate organs and, of course, the skeletal system. In addition, specialized cells in connective tissue defend the body from microorganisms that enter the body. Transport of fluid, nutrients, waste, and chemical messengers is ensured by specialized fluid connective tissues, such as blood and lymph. Finally, adipose cells store surplus energy in the form of fat and contribute to the thermal insulation of the body. Unlike epithelial tissue, which is composed of cells closely packed with little or no extracellular space in between, connective tissue cells are dispersed in a matrix. The matrix usually includes a large amount of extracellular material produced by the connective tissue cells that are embedded within it and plays a major role in the function of the tissue. Connective tissues come in a vast variety of forms, yet they have three characteristic components in common: specialized cells, large amounts of ground substance, and extracellular protein fibers. The ground substance can vary from a watery fluid in blood, to a dense gel in cartilage, and even a mineralized matrix in bones. The amount and structure of each component correlates with the function of the tissue, from the rigid ground substance in bones supporting the body to the inclusion of specialized cells; for example, a phagocytic cell that engulfs pathogens and also rids tissue of cellular debris. The three broad categories of connective tissue are classified according to the characteristics of their ground substance and the types of fibers found within the matrix (Table 3. Both tissues have a variety of cell types (mesenchymal cells, fibroblasts, fibrocytes, adipocytes, macrophages, lymphocytes, and mast cells) and protein fibers (collagen, elastic, and reticular) suspended in a viscous ground substance. Dense connective tissue is reinforced by bundles of fibers that provide tensile strength, elasticity, and protection. In loose connective tissue, the fibers are loosely organized, leaving large spaces between structures. Loose Connective Tissue Loose connective tissue is found between many organs where it acts both to absorb shock and bind tissues together. It allows water, salts, and various nutrients to diffuse through to adjacent or embedded cells and tissues. It contains all the cell types and fibers previously listed and is distributed in a random, web-like fashion (Figure 3. It fills the spaces between muscle fibers, surrounds blood and lymph vessels, and supports organs in the abdominal cavity. Areolar tissue underlies most epithelia and represents the connective tissue component of epithelial membranes. A large number of capillaries allow rapid storage and mobilization of lipid molecules. White adipose tissue is most abundant and appears yellow due to carotene and related pigments from plant food. White fat contributes mostly to lipid storage and can serve as insulation from cold temperatures and mechanical injuries. White adipose tissue can be found protecting the kidneys and cushioning the back of the eye. Reticular cells produce the reticular fibers that form the network onto which other cells attach. Dense Regular Dense regular connective tissue primarily has collagen fibers that run parallel to each other which enhances tensile strength and resistance to stretching in the direction of the fiber orientations (Figure 3. Ligaments and muscle tendons are made of dense regular connective tissue, though in ligaments not all fibers run parallel. Some dense regular tissues include elastin fibers in addition to collagen fibers, which allows the ligament to return to its original length after stretching. The ligaments in the vocal folds and between the vertebrae in the vertebral column are often classified as elastic.

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Tenia of transverse colon located at the attachment of the greater omentum in the posteromedial part of the ascending and descending colon spasms with cerebral palsy generic 50mg imitrex with mastercard. Displaceable layer between the muscularis mucosa and the muscularis knee spasms pain buy 50 mg imitrex, consisting mainly of collagenous connective tissue containing nerves and blood vessels. Villus-free mucous coat of the colon comprised of simple, goblet-cell rich, columnar epithelium, connective tissue and lamina muscularis mucosae. Thin plate of smooth muscle extending from the 2nd to 3rd coccygeal vertebrae to the rectum. Smooth muscle fibers extending from the membranous part of the urethra to the rectum. The middle is the largest (Kohlrausch) and projects about 6 mm above the anus from the right side, the others from the left. Upper border of anal canal formed by the puborectal muscle at the level of the levator sling just above the anal columns. It is firmly connected with the underlying tissues by fibrous longitudinal muscles. Lower border of anal pecten at the level of the lower margin of the internal anal sphincter. Lower opening of anal canal surrounded by the subcutaneous and superficial parts of the external anal sphincter. Tenia-free segment, about 15 cm long, located between the sigmoid colon and the anus. Layer of longitudinally oriented muscle fibers distributed uniformly throughout the entire circumference of the rectum. Inner layer of circularly oriented muscle fibers of the tunica muscularis; no semilunar folds form in this part of the rectum. Organ 13-15 cm in length that lies 19 partly in the duodenal loop, partly behind the omental bursa at the level of L1-2. Additional excretory duct usually found draining into the minor duodenal papilla (p. Part of the pancreas consisting of about 1 million Langerhans` islets, which produce glucagon and insulin. It is divided into segments on the basis of the branchings of its blood vessels and biliary ducts. Groove between the uncinate process and the remaining part of the head of the pancreas. Superior margin of the pancreas located between the anterior and posterior surfaces. Anterior margin of the pancreas, which corresponds to the line of attachment of the transverse mesocolon (p. It also forms the lower boundary of the omental bursa at the posterior abdominal wall. Inferior margin of the pancreas situated between the lower anterior and posterior surfaces. Main excretory duct of the pancreas opening on the greater duodenal papilla together with the bile duct. Flat impression made by the heart on the left side of the liver in front of the inferior vena cava. Groove for the venous ligament extending from the liver hilum to the inferior vena cava between the caudate lobe and left lobe. C 25 12 13 14 15 11 10 26 27 28 29 16 17 18 13 12 30 31 19 20 21 22 23 24 18 16 17 14 15 25 Sphincter muscle of pancreatic duct. Fissure on the visceral surface of the liver that lodges the ligamentum teres hepatis. Fissure between the caudate and quadrate lobes in which run the hepatic artery proper, portal vein and hepatic duct. Bulge on the visceral surface of the left lobe to the left of the ligamentum venosum.


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