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In the former antimuscarinic drugs appear to impair both the acquisition and retention of some learned tasks buy 160 mg super p-force oral jelly visa no xplode impotence, as in the Morris water maze generic super p-force oral jelly 160 mg otc erectile dysfunction doctor visit. This involves placinga rat in a circular tank of water containinga stand with a platform just below the surface but which is not clearly visible because the vessel walls or water have been made opaque. Generally the rat quickly learns (2±3 trials) to identify the position of and swims to the platform. That ability is impaired by pretreatment with antimuscarinics which increase the number of ACETYLCHOLINE 135 trials (possibly tenfold) required before the animal swims directly to the platform and can increase the time to achieve it if given after the task has been learnt. How cholinergic function can facilitate the memory process is uncertain. It is generally thought that the laying down of memory is in some way dependent on the high-frequency discharge of hippo- campal neurons in which long-term potentiation or LTP (the persisting potentiated response to a normal afferent input after a prior and short intense activation) plays an important part (see Chapter 18). Unfortunately while NMDA antagonists impair LTP, antimuscarinics do not. Of course, ACh will, by blockingK‡ efflux, increase the likelihood of neurons discharging repetitively. While it is the muscarinic receptor which is primarily concerned with the cognitive effects of ACh it has recently been shown that part of the cholinergic septal input to the hippocampus innervates excitatory nicotinic receptors on GABA interneurons. Since these appear to synchronise the activity of the main hippocampal glutamate neurons their stimulation could influence hippocampal function and memory process (see Jones, Sudweeks and Yakel 1999). The fact that there is a cholinergic projection from the pedunculo pontine tegmental nucleus to the dopomine neurons of the ventral tegmental area (VTA) and that its excitatory effect is mediated through nicotinic receptors could also implicate them and so ACh, in the reward process. This is thought to be mediated in part through the mesolimbic and mesocortical dopamine pathways arising from the VTA and may offer an explanation for the addictive nature of nicotine and smoking. REFERENCES AND FURTHER READING Brown, DA (1983) Slow cholinergic excitation Ð a mechanism for increasing neuronal excitability. Brown, DA, Gahwiler, BH, Marsh, SJ and Selyanko, AA (1986) Mechanisms of muscarinic excitatory synaptic transmission in ganglia and brain. Caulfield, MP and Birdsall, NMJ (1998) Classification of muscarinic acetylcholine receptors. Changeux, JP (1990) The nicotinic acetylcholine receptor: an allosteric protein prototype of ligand-gated ion channels. Changeux, JP, Bertrand, D, Corringer, PJ, Dehoene, S, Edelstein, S, Leno, C, Novere, N le, Marubio, L, Picciotto, M and Zoli, M (1998) Brain nicotinic receptors: structure and regulation, role in learning and reinforcement. Cole, AE and Nicoll, RA (1984) Characterization of a slow cholinergic post synaptic potential recorded in vitro from rat hippocampal pyramidal cells. Collier, B and Mitchell, JF (1967) Release of ACh duringconsciousness and after brain lesions. Cordero-Erausquin, M, Marubio, LM, Klink, R and Changeux JP (2000) Nicotinic receptor function: new perspectives from knockout mice. Eglen, RM and Watson, N (1996) Selective muscarinic receptor agonists and antagonists. Flentge, F, Venema, K, Koch, T and Korf, J (1997) An enzyme-reactor for electrochemical monitoringof choline and acetylcholine. Applications in high-performance liquid chromato- graphy, brain tissue, microdialysis and cerebral fluid. Greenfield, SA (1991) A noncholinergic action of acetylcholinesterase (AchE) in the brain. Hersch, SM, Guten Kunst, CA, Rees, HD, Heilman, CT and Levey, AJ (1994) Distribution of M1±M4 muscarinic receptor proteins in the rat striatum. Light and electron microscopic immunochemistry usingsubtype-specific antibodies. Hulme, EC, Birdsall, NJM and Buckley, NJ (1990) Muscarinic receptor subtypes. Jones, S, Sudweeks, S and Yakel, JL (1999) Nicotinic receptors in the brain: correlating physiology with function.

It often occurs in combination with Korsakoff’s syndrome Beriberi Heart Disease and buy 160 mg super p-force oral jelly overnight delivery erectile dysfunction nursing interventions, like Korsakoff’s syndrome super p-force oral jelly 160mg discount impotence at 46, is related A deficiency in thiamine is thought to to thiamine deficiency. Treatment consists contribute to the development of beriberi of the replacement of thiamine. Individuals with the condi- treatment is mandatory to prevent perma- tion have a high cardiac output, even at nent deficits. Prompt treatment resolves rest, because of the dilation of the periph- many of the symptoms. Beriberi heart dis- syndrome accompanies Wernicke’s en- ease responds well to the administration cephalopathy, however, memory deficits of supplemental thiamine. Alterations in Heart Rate and Rhythm Peripheral Neuropathy Alcohol can affect both the speed at Although there are many causes of which the heart beats and the rhythm that peripheral neuropathy, a number of indi- it maintains. The direct long-term effect viduals who chronically abuse alcohol on blood pressure is variable. Alcohol develop disorders of the peripheral nerves withdrawal can put a heavy load on the (see Chapter 3). Peripheral neuropathy heart, sometimes compromising cardiac associated with chronic alcohol abuse is function so severely during detoxification thought to be the result of inadequate that death can result. Consequently, nutrition, specifically inadequate amounts detoxification should be conducted under of thiamine and the other B vitamins. Good nutrition and the administra- Alcohol can have a direct and adverse tion of supplemental B vitamins can effect on the development of red blood bring about improvement, but the cells, white blood cells, and platelets, improvement may be slow. One of the mecha- toms of myopathy improve with the ces- nisms by which alcohol affects blood cell sation of alcohol abuse, but continued formation is by interfering with the use of alcohol abuse leads to continued deteri- folic acid, a nutritional substance that oration. Excessive alcohol consumption bone marrow requires to manufacture can also contribute to osteoporosis healthy cells effectively. Osteoporosis leukopenia (an abnormal decrease in the occurs not only because calcium intake is number of white blood cells) and throm- insufficient but also because alcohol in- bocytopenia (an abnormal decrease in the terferes with the absorption of calcium number of platelets) occurs frequently in from the intestine. In addition to the direct effect on the Treatment with the administration of sup- musculoskeletal system, alcohol can also plemental folate, proper nutrition, and contribute to major injury. Individuals abstinence from alcohol can generally under the influence of alcohol may have reverse these abnormalities. As a Respiratory System result, they may be injuried in falls, fires, or motor vehicle or pedestrian accidents. In combination with cigarette Gastrointestinal System smoking, a higher incidence of chronic obstructive pulmonary disease (see Chap- It is possible for alcohol to affect almost ter 12) can result from chronic alcohol every organ of the gastrointestinal tract. In addition, because chronic alco- Individuals who consume alcohol exces- hol abuse affects some of the lungs’ nat- sively have an increased incidence of can- ural defenses, individuals who abuse cer of the throat and esophagus (see alcohol have a greater tendency to devel- Chapter 16). Despite the fact that alcohol is hol has a direct toxic effect on skeletal considered a hepatotoxin (substance that muscle; destruction of muscle fibers leads is harmful to the liver), individuals who to weakness, pain, tenderness, and swel- chronically abuse alcohol differ widely in ling of affected muscles. The more common Esophagitis and Gastritis form is chronic alcoholic myopathy, which evolves over months to years. Pain may be Esophagitis is inflammation of the less severe in chronic myopathy, although esophagus. Both can occur with the muscles may atrophy (shrink or become acute and chronic abuse of alcohol. The 212 CHAPTER 7 CONDITIONS RELATED TO SUBSTANCE USE severity of these conditions depends on effects of both fatty liver and alcoholic the individual. Individuals who continue to ditions produce only a mild discomfort, abuse alcohol, however, have a high but in other instances, the irritation and chance of developing cirrhosis. Obviously, absti- nence from alcohol is a major treatment Cirrhosis is most frequently caused by objective. It Esophageal Varices involves the reaction of the liver to injury by hepatotoxins (substances that are Some individuals who abuse alcohol harmful to the liver), in this case, alcohol. Circulation within the Esophageal varices are usually a complica- liver becomes less efficient, resulting in tion of cirrhosis. Because of the fibrous Treatment is directed toward controlling changes that occur in the liver with cirrho- hemorrhage, usually by inserting a special sis, there is increased pressure in the por- tube (Sengstaken-Blakemore tube) into the tal vein, a condition known as portal esophagus. Backflow of blood results in inflated to exert pressure against the bleed- the enlargement of the spleen (splenom- ing vein. Because the esophagus needs rest egaly), accumulation of fluid in the in order to heal, other types of feeding abdominal cavity (ascites), and develop- may be instituted until the esophagus is ment of esophageal varices. Others experience Alcoholic Hepatitis weakness, nausea, loss of appetite (ano- rexia), and jaundice (yellow discoloration During alcohol metabolism, fat is de- of the skin and whites of the eyes due to posited in the liver.

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This procedure may be used to and promoting connective tissue formation diseases discount 160 mg super p-force oral jelly with amex erectile dysfunction treatment without side effects, and may occur during pregnancy discount 160mg super p-force oral jelly otc erectile dysfunction treatment testosterone replacement. It may result from improper hygiene, expulsion of gastric contents into the mouth. Digestive System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 18 Digestive System 673 Chapter Summary Introduction to the Digestive System 2. The incisors and canines have one root (b) The membrane of intestinal (pp. Movements of the small intestine include blood and lymph for use at the cellular called dental alveoli that are lined rhythmic segmentation, pendular level. The digestive system consists of a in the periodontal membrane insert gastrointestinal (GI) tract and accessory into the cementum covering the Large Intestine (pp. Peritoneal membranes line the abdominal (d) The interior of a tooth contains a wall and cover the visceral organs. The layers (tunics) of the abdominal GI passageway connecting the oral and nasal tract are, from the inside outward, the peristalsis, haustral churning, and mass cavities to the esophagus and larynx. The liver is divided into right, left, propria, and thin layers of smooth cavity, pharynx, and esophagus. Peristaltic waves of contraction push food contains liver lobules, the functional units mucosae. The stomach consists of a cardia, fundus, hepatic cells separated by modified muscularis consists of layers of body, and pylorus. The oral cavity is formed by the cheeks, the bile; it releases the bile through the Small Intestine (pp. The cystic duct and common bile duct into tongue and teeth are contained in the 1. The pancreas is both an exocrine and an (a) Lingual tonsils and papillae with common bile duct and pancreatic duct endocrine gland. Fingerlike extensions of mucosa, called the pancreatic islets, secretes the palatal folds, a cone-shaped intestinal villi, project into the lumen, hormones insulin and glucagon. Digestive System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 674 Unit 6 Maintenance of the Body Review Activities Objective Questions 10. Describe how the gallbladder is filled with (c) covered with peritoneal membranes. What is the (d) located within the thoracic and (d) It is mixed with blood from the function of bile? Which of the following types of teeth are What are the biomechanical movements found in the permanent but not in the Essay Questions of the large intestine that make these deciduous dentition? Distinguish between the gastrointestinal What are some of the causes of cirrhosis? The double layer of peritoneum that supports the GI tract is called tract, viscera, accessory digestive organs, and gut. The deciduous (milk) teeth don’t matter (d) the tunica muscularis in the wall of the GI tract. Which surgery do you think would have (a) the pancreas (c) the tongue the tunic layers. Define the terms dental formula, (a) removal of the stomach (gastrectomy), 6. The numerous small elevations on the diphyodont, deciduous teeth, permanent (b) removal of the pancreas surface of the tongue that support taste teeth, and wisdom teeth. How does the stomach protect itself from increasing the surface area for absorption (b) the stomach. Describe the kinds of movements in the food particles and digestive enzymes. Diagram an intestinal villus and explain surgeon elect to remove a healthy (a) transport of bile and pancreatic juice. Explain why a ruptured appendix may (c) passage of chyme into the small 12. What are the regions of the large result in peritonitis, while an inflamed intestine.

The rate of glucose reabsorption is determined from the differ- ence between the filtered load and the rate of excretion super p-force oral jelly 160 mg without a prescription impotence heart disease. At RENAL BLOOD FLOW normal plasma glucose levels (about 100 mg/dL) buy super p-force oral jelly 160mg on line erectile dysfunction treatment australia, all of the filtered glucose is reabsorbed and none is excreted. This allows them to the plasma [glucose] exceeds a certain value (about 200 filter the blood plasma at a high rate. Further elevations in plasma glucose lead to progressively more excreted glucose. Glucose ap- The Kidneys Have a High Blood Flow pears in the urine because the filtered amount of glucose ex- ceeds the capacity of the tubules to reabsorb it. At very In resting, healthy, young adult men, renal blood flow av- high filtered glucose loads, the rate of glucose reabsorption erages about 1. This is about 20% of the cardiac reaches a constant maximal value, called the tubular trans- output (5 to 6 L/min). Both kidneys together weigh about CHAPTER 23 Kidney Function 385 240 Cortex 4 5 200 160 Outer medulla 0. More PAH is excreted than is filtered; the difference rep- The Kidneys Autoregulate Their Blood Flow resents secreted PAH. Despite changes in mean arterial blood pressure (from 80 to 180 mm Hg), renal blood flow is kept at a relatively constant level, a process known as autoregulation (see Chapter 16). Autoregulation is an intrinsic property of the kidneys and is 300 g, so blood flow per gram of tissue averages about 4 observed even in an isolated, denervated, perfused kidney. This rate of perfusion exceeds that of all other GFR is also autoregulated (Fig. When the blood organs in the body, except the neurohypophysis and pressure is raised or lowered, vessels upstream of the carotid bodies. The high blood flow to the kidneys is nec- glomerulus (cortical radial arteries and afferent arterioles) essary for a high GFR and is not due to excessive meta- constrict or dilate, respectively, maintaining relatively con- bolic demands. Below or The kidneys use about 8% of total resting oxygen above the autoregulatory range of pressures, blood flow and consumption, but they receive much more oxygen than GFR change appreciably with arterial blood pressure. Consequently, renal extraction of oxygen is Two mechanisms account for renal autoregulation: the low, and renal venous blood has a bright red color (be- myogenic mechanism and the tubuloglomerular feedback cause of a high oxyhemoglobin content). In the myogenic mechanism, an increase in cal arrangement of the vessels in the kidney permits a pressure stretches blood vessel walls and opens stretch-ac- large fraction of the arterial oxygen to be shunted to the tivated cation channels in smooth muscle cells. Therefore, ing membrane depolarization opens voltage-dependent the oxygen tension in the tissue is not as high as one 2 2 Ca channels and intracellular [Ca ] rises, causing might think, and the kidneys are certainly sensitive to is- smooth muscle contraction. Blood Flow Is Higher in the Renal Cortex In the tubuloglomerular feedback mechanism, the transient increase in GFR resulting from an increase in and Lower in the Renal Medulla blood pressure leads to increased solute delivery to the Blood flow rates differ in different parts of the kidney (Fig. Blood flow is highest in the cortex, averaging 4 to tubular fluid [NaCl] at this site and increased NaCl reab- 5 mL/min per gram of tissue. By mechanisms that are permits a high rate of filtration in the glomeruli. Blood still uncertain, constriction of the nearby afferent arteriole flow (per gram of tissue) is about 0. The relatively low blood flow in the medulla feedback sensitivity varies directly with the local concen- helps maintain a hyperosmolar environment in this region tration of angiotensin II. The tubuloglomerular feedback 386 PART VI RENAL PHYSIOLOGY AND BODY FLUIDS mechanism is a negative-feedback system that stabilizes renal blood flow and GFR. Autoregulatory If NaCl delivery to the macula densa is increased exper- range imentally by perfusing the lumen of the loop of Henle, fil- 1. This sug- gests that the purpose of tubuloglomerular feedback may be to control the amount of Na presented to distal nephron segments. Regulation of Na delivery to distal Renal blood flow parts of the nephron is important because these segments have a limited capacity to reabsorb Na. Without renal autoregulation, increases in arterial blood pressure would lead to dramatic increases in GFR and potentially serious losses of NaCl and water from the ECF. Sympathetic nerve stimulation causes renal vasocon- 0 40 80 120 160 200 240 striction and a consequent decrease in renal blood flow. Mean arterial blood pressure (mm Hg) Renal sympathetic nerves are activated under stressful condi- Renal autoregulation, based on measure- tions, including cold temperatures, deep anesthesia, fearful FIGURE 23. In the autoregulatory range, renal blood flow and GFR conditions, the decrease in renal blood flow may be viewed stay relatively constant despite changes in arterial blood pressure.

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