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A general sense is one that is distributed throughout the body and has receptor cells within the structures of other organs purchase accutane 40 mg fast delivery. General senses often contribute to the sense of touch buy 10mg accutane amex, as described above purchase accutane 40mg visa, or to proprioception (body movement) and kinesthesia (body movement) cheap 20mg accutane amex, or to a visceral sense purchase 40 mg accutane free shipping, which is most important to autonomic functions. A special sense is one that has a specific organ devoted to it, namely the eye, inner ear, tongue, or nose. The general sense that is usually referred to as touch includes chemical sensation in the form of nociception, or pain. Pressure, vibration, muscle stretch, and the movement of hair by an external stimulus, are all sensed by mechanoreceptors. Listing all the different sensory modalities, which can number as many as 17, involves separating the five major senses into more specific categories, or submodalities, of the larger sense. For example, the general sense of touch, which is known as somatosensation, can be separated into light pressure, deep pressure, vibration, itch, pain, temperature, or hair movement. Research at the turn of the 20th century led to recognition of the fifth taste, umami, during the mid-1980s. The surface of the tongue, along with the rest of the oral cavity, is lined by a stratified squamous epithelium. Within the structure of the papillae are taste buds that contain specialized gustatory receptor cells for the transduction of taste stimuli. These receptor cells are sensitive to the chemicals contained within foods that are ingested, and they release neurotransmitters based on the amount of the chemical in the food. Neurotransmitters from the gustatory cells can activate sensory neurons in the facial, glossopharyngeal, and vagus cranial nerves. The taste buds contain specialized gustatory receptor cells that respond to chemical stimuli dissolved in the saliva. These receptor cells activate sensory neurons that are part of the facial and glossopharyngeal nerves. When you eat something salty, the salt crystals + – + dissociate into the component ions Na and Cl , which dissolve into the saliva in your mouth. The Na concentration becomes high outside the gustatory cells, creating a strong concentration gradient that drives the diffusion of the ion into the + cells. The entry of Na into these cells results in the depolarization of the cell membrane and the generation of a receptor potential. Just as with sodium ions in salty flavors, these hydrogen ions enter the cell and trigger depolarization. Increasing hydrogen ion concentrations in the saliva (lowering saliva pH) triggers progressively stronger graded potentials in the gustatory cells. For example, orange juice—which contains citric acid—will taste sour because it has a pH value of approximately 3. The sweet taste is the sensitivity of gustatory cells to the presence of glucose dissolved in the saliva. Other monosaccharides such as fructose, or artificial sweeteners such as aspartame (NutraSweet™), saccharine, or sucralose (Splenda™) also activate the sweet receptors. The affinity for each of these molecules varies, and some will taste sweeter than glucose because they bind to the G protein–coupled receptor differently. However, there are a number of different ways in which this can happen because there are a large diversity of bitter-tasting molecules. Likewise, some bitter molecules increase G protein activation within the gustatory cells, whereas other bitter molecules decrease G protein activation. The specific response 604 Chapter 14 | The Somatic Nervous System depends on which molecule is binding to the receptor. Alkaloids are nitrogen containing molecules that are commonly found in bitter-tasting plant products, such as coffee, hops (in beer), tannins (in wine), tea, and aspirin. By containing toxic alkaloids, the plant is less susceptible to microbe infection and less attractive to herbivores. Therefore, the function of bitter taste may primarily be related to stimulating the gag reflex to avoid ingesting poisons. Because of this, many bitter foods that are normally ingested are often combined with a sweet component to make them more palatable (cream and sugar in coffee, for example). The highest concentration of bitter receptors appear to be in the posterior tongue, where a gag reflex could still spit out poisonous food.

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Botox is normally given is currently recommended that as a 10 unit per m/L in 30 different further randomized trials must sites of the bladder discount 10mg accutane otc. It can be be done to determine the exact given under general order accutane 40 mg on-line, regional place for this treatment modality purchase accutane 30mg fast delivery. No clear It has been studied in neurogenic randomized study has been done bladders and compared to Botox to evaluate the specifc treatment but shown to be less effective discount accutane 5 mg overnight delivery. Botulinum toxin can also be used into the sphincter to Botulinum toxin A reduce the outfow resistance generic accutane 20 mg visa. Tamsulosin, alfuzosin, The side effect profle is extremely • Cholinergic - increases detrusor low and systemic complications contraction almost unheard of. Alpha-Adrenergic blockers: also effective with other possible Alpha-adreno receptors side effects, and different dosage have been reported to be regimens. Drugs to enhance sphincter Alpha-blockers can therefore be function used to lower the resistance of • Alpha -adrenergic agonists the bladder neck and urethra. Cholinergic: In general Betanecol Several drugs including Alpha- chloride seems to be of limited Adronergic agonists, Estrogens, beneft of detrusor arefexia Beta-adrenergic agonists, as well and for elevated residual urine. A noradrenaline serotonin re- Neuromodulation and electrical uptake inhibitor (duloxitene) has stimulation been well studied and will increase Sacral nerve neuro modulation urethral resistance. The side effect has been well proven to treat the of this is nausea and it is also used refractory overactive bladder as in the treatment of depression. It is essential Drugs to facilitate bladder that there be normal neural emptying connections for this modality 91 to be effective. The effcacy of Detrusor Myectomy: (auto- the sacral neuromodulation also augmentation) includes afferent stimulation and This will produce a diverticulum in therefore intact neuropathways the dome of the bladder if ±20% are necessary. If there is a more Enterocyctoplasty that 50% improvement in their It is the best reproducible symptoms, a permanent generator operation to enlarge bladder is implanted on the lateral aspect capacity and increase storage of the buttock. The This is not a technique that urotheluim can be left intact and will normally be done at the the bowel muscle used to cover urogynaecology clinic but is more it. This is an exciting New bladder can be preformed for development but not for discussion patients with severely contracted at this level. The majority of catheterization can also be used these patients will have to self- with the sphincter if she has catheterize. Procedures to enhance outfow Diversions resistance Continent urinary diversions: if Bulking agents can be used to the normal urinary tract cannot increase passive urethral closing be used for storage and emptying pressure. The result of bulking function, a continence pouch can agents is ± 60% in improving the be formed, through which the incontinence. The technique is fairly diffcult and the Mid-urethral slings complication rate in the long term Mid- urethral slings are classically is relatively high. Small or large Mid urethral slings can also be intestine can be used for the pouch used to obstruct the urethra in and a number of valve mechanism patients with a hypotonic urethra. The classic the outfow is obstructed and the Bricker Ileostomy is still used for storage function of the bladder is patients where no restoration of normal. It is opened using a special dilated urethra and incontinence, valve system and the patient can a bladder disconnection should void spontaneously if she has be considered, especially if the normal detrusor function. There is usually allergic response and hence a small bladder capacity and an antihistamine may prove rarely an area of ulceration of the benefcial. Endometriosis Bladder distention under Intravesical Potassium Test anaesthesia often gives good If instillation of a solution with temporary symptomatic relief high potassium concentration and can be repeated. Following novel anatomical insights occasioned by the cadaver dissections of Delancey How Common Is and Richardson before him, a Prolapse? Whilst 97 we suppose that the cystocoele “rectocoele”) is any descent of contains the bladder, a vault the posterior vaginal wall so that prolapse consists of the apex of the a midline point on the posterior vagina and a rectocoele contains vaginal wall 3cm above the level of part of the rectum, this is not the hymen or any posterior point always the case. Women with prolapse (cervix / uterus) or vault (cuff) after beyond the hymenal ring have a hysterectomy. In a general Anterior vaginal wall prolapse population of women between (previously termed a “cystocoele”) 20 – 59, the prevalence of prolapse is descent of the anterior vagina was 31%, whereas only 2% of all so the urethra – vesical junction (a women had prolapse that reached point 3cm proximal to the external the introitus. Some estimations urinary meatus) or any anterior suggest that a degree of prolapse point proximal to this, is less than is found in 50% of parous women, 3cm above the plane of the hymen. An estimated 5% of Prolapse of the apical segment all hysterectomies result in vaginal of the vagina (previously termed prolapse. They include: asymptomatic pelvic support defects appears to predispose • Pelvic pressure to accentuation of unrepaired • Vaginal heaviness defects and new symptoms.

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As the body ages discount accutane 30 mg otc, changes occur that affect the endocrine system purchase accutane 20 mg with mastercard, sometimes altering the production buy accutane 40mg low cost, secretion accutane 30mg with visa, and catabolism of hormones order 5 mg accutane. For example, the structure of the anterior pituitary gland changes as vascularization decreases and the connective tissue content increases with increasing age. For example, the amount of human growth hormone that is produced declines with age, resulting in the reduced muscle mass commonly observed in the elderly. The adrenal glands also undergo changes as the body ages; as fibrous tissue increases, the production of cortisol and aldosterone decreases. Interestingly, the production and secretion of epinephrine and norepinephrine remain normal throughout the aging process. A well-known example of the aging process affecting an endocrine gland is menopause and the decline of ovarian function. With increasing age, the ovaries decrease in both size and weight and become progressively less sensitive to gonadotropins. This gradually causes a decrease in estrogen and progesterone levels, leading to menopause and the inability to reproduce. Testosterone levels also decline with age, a condition called andropause (or viropause); however, this decline is much less dramatic than the decline of estrogens in women, and much more gradual, rarely affecting sperm production until very old age. Although this means that males maintain their ability to father children for decades longer than females, the quantity, quality, and motility of their sperm is often reduced. As the body ages, the thyroid gland produces less of the thyroid hormones, causing a gradual decrease in the basal metabolic rate. This may be because of reduced dietary calcium levels, causing a compensatory increase in parathyroid hormone. Increasing age also affects glucose metabolism, as blood glucose levels spike more rapidly and take longer to return to normal in the elderly. In addition, increasing glucose intolerance may occur because of a gradual decline in cellular insulin sensitivity. Neural communication includes both electrical and chemical signaling between neurons and target cells. Endocrine communication involves chemical signaling via the release of hormones into the extracellular fluid. From there, hormones diffuse into the bloodstream and may travel to distant body regions, where they elicit a response in target cells. Many organs of the body with other primary functions—such as the heart, stomach, and kidneys—also have hormone-secreting cells. Hydrophobic hormones are able to diffuse through the membrane and interact with an intracellular receptor. These are typically associated with a G protein, which becomes activated when the hormone binds the receptor. Second messenger systems greatly amplify the hormone signal, creating a broader, more efficient, and faster response. Hormonal stimuli are changes in hormone levels that initiate or inhibit the secretion of another hormone. Finally, a neural stimulus occurs when a nerve impulse prompts the secretion or inhibition of a hormone. The hypothalamus and the pituitary gland are connected by a structure called the infundibulum, which contains vasculature and nerve axons. The anterior lobe is connected to the hypothalamus by vasculature in the infundibulum and produces and secretes six hormones. They also contribute to protein synthesis and the normal growth and development of body tissues, including maturation of the nervous system, and they increase the body’s sensitivity to catecholamines. Insufficient amounts of iodine in the diet can lead3 4 to goiter, cretinism, and many other disorders. The adrenal cortex—the outer layer of the gland—produces mineralocorticoids, glucocorticoids, and androgens. A perceived threat results in the secretion of epinephrine and norepinephrine from the adrenal medulla, which mediate the fight-or-flight response. The mineralocorticoids, chiefly aldosterone, cause sodium and fluid retention, which increases blood volume and blood pressure. Jet lag, caused by traveling across several time zones, occurs because melatonin synthesis takes several days to readjust to the light-dark patterns in the new environment. Both of these hormones are important in the development and maintenance of the female reproductive system, as well as maintaining pregnancy. The placenta develops during early pregnancy, and secretes several hormones important for maintaining the pregnancy.

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Depending on the nature of response towards the pathogen discount accutane 30 mg without prescription, Immune system is broadly classifed into Natural and Acquired immunity accutane 20mg line. They developed from the bone marrow stem cells and give rise to two families of white blood cells namely the Myeloid cells (named after bone marrow) and the Lymphoid cells cheap 5mg accutane with mastercard, which take their name from the lymphatic system buy accutane 30mg online. The lymphoid cells include T and B lymphocytes which get their maturation in different lymphoid organs purchase accutane 30 mg on-line. B-cell maturation begins in the liver (fetal) and continues within the bone marrow as maturation progresses (adult) and T cells complete their maturation in the thymus. Mechanisms involved in Natural immunity Skin barrier The skin covers and protects the body as a barrier to prevent invading pathogens. Intact skin prevents the penetration of most pathogens, by secreting lactic acid and fatty acids which lower the skin pH. Mechanical barriers Mucous membranes form the external layer where body is not covered with skin and it plays an important role in the prevention of pathogen entrance by traping them. Movement of the mucociliary process in the upper respiratory tract, the cilia in the eyelids act as escalators to remove the pathogens. Phagocytosis The ingestion (endocytosis) and killing of microorganisms by specialized cells called as phagocytes. Opsonization -The process by which microbes are coated by a molecule called opsonin which aids attachment of microbes to the phagocytic cells which facilitates phagocytosis. Neutrophils constitutively express ligands and receptors (L-selectin) which interact with reciprocal receptors and ligands on endothelial cells (P- and E-selectin). Neutrophil responds and move towards a group of molecules called chemo-attractants (chemical mediators) 146 and this process is called chemotaxis (chemical attraction). The phagocytes make its way through intact capillary walls and into the surrounding tissue by a process called diapedesis (emigration of phagocytes into tissues). Chemo-attractants include complement protein C5a, bacterial products, cytokines, lipid mediators from injured tissue. Capillary Unstimulated Neutrophil Adhesion Molecule C b3 Tissue trauma C b3 Diapedesis Release Mediators Chemotaxis C b3 Opsonin Opsonized (1) Pathogen Lysozyme C,a Attached to (2) Pathogen Pseudopode like structure (3) Formation of Phagolysozyme Endothelium (4) Fig 10. Neutrophil has three types of granules namely Primary granules ( contain serine proteases, lysozyme and phospholipase A ) Secondary granules ( include perforrin, elastase and collagenase) and Tertiary 2 granules ( contain gelatinase). Apart from these granules the phagocytes also posses a variety of oxygen dependent killing mechanisms. Neutrophils contain an enzyme called as myeloperoxidase, which can convert superoxide into hypochlorite ion which has a strong bactericidal activity. The role of macrophage is consider as frst order defence mechanism, as it engulf and kill more pathogens effciently. Liver - Kupffer cells Brain - Microglial cells Kidney - Mesangial cells Spleen - Splenic macrophages Peritoneum - Peritoneal macrophages. Infammation A localized protective reaction produced in tissue response to any irritation, injury or infection is called as infammation. Usually, the name of the tissue, organ and the region which develops infammation is suffxed with ‘itis’ for example conjunctivitis, gastritis and pharyngitis respectively. The infammatory response helps to mobilize the nonspecifc defense forces to the tissue space where pathogen is present. The damaged cells release chemical mediators such as histamine from the mast cells, which dilate the near by blood vessels. They get activated due to the tissue damage and this process leads to “walling off” the area and this helps to prevent spreading of the infectious material. It attaches to the target and releases a lethal burst of chemicals called as perforins that penetrate the cell wall. Interferon Interferons are proteins produced by body cells when they are invaded by viruses, is released into the bloodstream or intercellular fuid, in order to induce healthy cells to manufacture an enzyme that block viral replication. The complement system is the part of innate immune system plays an important defense against microorganisms, especially gram-negative bacteria. The complement system consists of a set of over twenty serum proteins which are getting activated as follows. The pathways include the classic pathway (C1qrs, C2, C4), the alternative pathway (C3, factor B, properdin) and these two pathways converge at the component C3. Generally, they take part in differentiating self and non self antigens and the presentation of processed foreign antigen to activate the T cells. It has the special ability to keep memory of frst time exposure of an antigen (primary immune response) and mounts better response when there is second time exposure of same antigen (secondary immune response). Natural (Due to natural entry of pathogen) Actively acquired Artificial (Due to artificially introduced antigen like immunization process) Natural (Baby receives the antibody synthesized by the Passively mother through mother’s milk acquired Artificial (Antibodies are introduced artificially) 150 10.

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