By U. Peer. University of Texas Medical Branch. 2018.

Osmosis order 10mg zyprexa otc medicine hat horse, a special type of diffusion referring to the passage of water through a selectively permeable membrane from an area of high water concentration to lower water concentration buy generic zyprexa 5mg online ok05 0005 medications and flying. Filtration, small molecules pass through selectively permeable membrane in response to force of pressure. Active movements across membranes Substances move through a selectively permeable membrane from areas of low concentration on side of a membrane to an area of higher concentration on the other side. But if equilibrium reached and still more molecules are needed, they must be pumped 20 Human Anatomy and Physiology through the membrane against concentration gradient. It includes: Pinocytoss – cell drinking Receptor – mediated Endocytosis- Endocytosis with the help of receptor. It is thick semi transparent, elastic fluid containing suspended particles and a series of minute tubules and filaments that form cytoskeleton. The inorganic components exist as solutions 21 Human Anatomy and Physiology because they are soluble in water. In the nucleus a jelly like fluid that fill the nucleus is karylymph (neucleoplasm), which contain the genetic material called chromosome. They are site of protein synthesis 22 Human Anatomy and Physiology c) Endoplasmic reticulum is a double membrane channel. Various products are transported from one portion of the cell to another via the endoplasmic reticulum. Each mitochondria posses two membrane, one is smooth (upper) membrane and the other is arranged with series of folds called cristae. They contain powerful digestive (hydrolytic 23 Human Anatomy and Physiology enzyme capable of breaking down many kinds of molecules. The lysosomal enzyme believed to be synthesized in the granular endoplasmic reticulum and Golgi complex. Some of the risk factors for cancer occurrence are radiation, chemicals, extreme pressure and hormonal therapy. Tissue is a group of similar cell and their intercellular substance that have a similar embryological origin and function together to perform a specialized activity. The various tissues of the body are classified in to four principal parts according to their function & structure. They are subdivided in to: - Covering & lining epithelium - Glandular epithelium Covering and lining epithelium: it forms the outer covering of external body surface and outer covering of some internal organs. It lines body cavity, interior of respiratory & gastro intestinal tracts, blood vessels & ducts and make up along with the nervous tissue (the parts of sense organs for smell, 28 Human Anatomy and Physiology hearing, vision and touch). According to the arrangement of layers covering and lining epithelium is grouped in to: a) Simple epithelium: it is specialized for absorption, and filtration with minimal wear & tear. It is a single layered b) Stratified epithelium, it is many layered and found in an area with high degree of wear & tear. Based on the cell shape covering and lining epithelium is grouped in to: a) Squamous: - flattened & scale like b) Cuboidal: - cube shaped c) Columnar: - tall & cylindrical d) Transitional: - combination of cell shape found where there is a great degree of distention or expansion, these may be cuboidal to columnar, cuboidal to polyhydral and cuboidal to Squamous 29 Human Anatomy and Physiology Therefore considering the number of layers and cell shape we can classify covering and lining epithelium in to the following groups: Simple epithelium a) Simple – Squamous epithelium, contain single layer of flat, scale like resemble tiled floor. Stratified epithelium It is more durable, protects underlying tissues form external environment and from wear & tear. These are Non-Keratnized and Keratinized stratified squamous 30 Human Anatomy and Physiology epithelium. Non-Keratnized stratified squamous epithelium is found in wet surface that are subjected to considerable wear and tear. In Keratinized, stratified squamous epithelium the surface cell of this type forms a tough layer of material containing keratin. It is found in seat glands duct, conjunctiva of eye, and cavernous urethra of the male urogenital system, pharynx & epiglottis. Transitional epithelium The distinction is that cells of the outer layer in transitional epithelium tend to be large and rounded rather than flat. Exocrine: Those glands that empties their secretion in to ducts/tubes that empty at the surface of covering.

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However it is always helpful to find out some background information about the patient e order zyprexa 5 mg visa 400 medications. Such information will indicate what vision the patient needs for work and for personal satisfaction order 5mg zyprexa with visa medications zanaflex. Major symptom of eye disease given • Disturbances of vision • Discomfort or pain in the eye • Eye discharge A. Disturbances of vision • The most common visual symptom • Can be sudden or gradual ¾ Blurring or reduction of vision ¾ Dazzling/glare/ – difficulty of seeing in bright light, may be caused by opacities in the cornea or lens ¾ Diplopia/ double vision/ ¾ Decreased peripheral vision – may be caused by various disorders in the retina, optic nerve or visual pathway pathology up to the visual cortex. Visual field Visual field is that portion of one’s surroundings that is visible at one time during central vision Not a routine test in all patients ¾ Important to do in any patients with suspected glaucoma, diseases of the optic nerves in visual pathways, and certain retinal diseases Confrontation test - Simple and no need of special equipment - Will detect serious visual field defects. To examine the front of the eye, this requires both a good light illumination with bright light, torch and magnifying lens(loupe). Normal eye • Eye lids should open and close properly • Eye lashes should grow forward and out ward • white part of the eye should be white • Cornea should be clear and transparent • Pupil is black and reactive to light During Examination of the Eye One Has to Comment the Following Things 1. Examination of the front aspect of the eye Eye lids – ™ In growing eye lash, misdirected ™ Everted eyelid examinations; follicles, papillary reaction, foreign body, concretions ™ Any mass, ulcer, discharge • Characterize it ™ Opening and closing pattern and defect of eye lid • Lagophthamos – eye lid that can’t close • Ptosis – eye lid drooping Nasolacrimal apparatus ™ Punctum ™ Mass, Ulcer or discharge over the Nasolacrimal apparatus Conjunctiva ƒ Color ƒ Growth 22 ƒ Bleeding ƒ Foreign body ƒ Spot - white foamy ƒ Follicles, papillae, scarring Characterize each findings Limbus ƒ Herbert’s pit ƒ Ciliary /circumcorneal/ injection ƒ Arcus Cornea Color and transparency Size Ulcer, scar, infiltrates Foreign body Laceration, perforation Blood vessels growth Sensation to touch Iris /pupil • Color ƒ Defect ƒ Reaction to light ƒ Relation with adjacent parts ƒ Pupillary margin: shape, adhesion between lens , iris and cornea Lens ƒ Transparency ƒ Position, sublaxated or dislocated 23 Anterior chamber • look for clarity • Depth 2. Ophthalmoscope is a form of illumination, which allows the examiner to look down the same axis as the rays of light entering the patient’s eye. To see the fundus • Ocular media must be healthy and transparent • Dilate the pupil with mydriatic drops • With the ophthalmoscope it appears 15 times larger than its actual size • In myopic patient the magnification is greater, but in hypermetropic patient it is less. Select ‘’ O’’ on the illuminated lens dial of the ophthalmoscope and start with small aperture. Take the ophthalmoscope in the right hand and hold it vertically in front of your own right eye with the light beam directed toward the patient and place your right index finger on the edge of the lens dial so that you will be able to change lenses easily if necessary. Position the ophthalmoscope about 6 inches (15cm) in front and slightly 0 to the right(25 ) of the patient and direct the light beam into the pupil. Rest the left hand on the patient’s forehead and hold the upper lid of the eye near the eyelashes with the thumb. While the patient holds his fixation on the specified object, keep the ‘’ reflex’’ in view and slowly move toward the patient. The optic disc should come into view when you are about 1and1/2 to 2 inches (3-5cm) from the patient. If it is not focused clearly, rotate lenses into the aperture with your index finger until the optic disc is clearly visible as possible. The hyperopic, or far- sighted, eye requires more‘’ plus’’(black numbers)sphere for clear focus; the myopic, or near-sighted, eye requires ‘’ minus’’(red numbers) sphere for clear focus. Now examine the disc for clarity of outline, color, elevating and condition of the vessels. To locate the macula, focus on the disc, then move the light approximately 2 disc diameters temporally. You may also have the patient look at the light of the ophthalmoscope, which will automatically place the macula in full view. The red-free filter facilitates viewing of the center of the macula, or the fovea. To examine the left eye, repeat the procedure outlined above except that you hold the ophthalmoscope in the left hand, stand at the patient’s left side and use your left eye. If the patient has a refractive error, try dialing up plus or minus lenses in the ophthalmoscope to bring the fundus into focus. It is difficult to see the fundus clearly so use a strong minus lens in the ophthalmoscope. Seat the baby on his mother’s lap, so that her hands restrain his arms and steady his head 2. Wrap the baby in a sheet or blanket, with his head on the examiners lap, and continue what you are going to do 3. In very difficult cases, it may be necessary to apply a drop of local anesthetic, and use a speculum to hold open the eyelids. Intra ocular pressure ƒ Should be measured in any patient with suspected glaucoma. Ahmed 5- Albert and Jakoboiec Principle and practice of ophthalmology 6- Up to date - (C) 2001 - www.

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Secondary fibrinolysis A clinical condition characterized by excessive fibrinolytic activity in response to disseminated intravascular clotting generic zyprexa 5mg free shipping treatment deep vein thrombosis. Secondary hemostatic A primary platelet aggregate that has been plug stabilized by fibrin formation during secondary hemostasis zyprexa 10mg free shipping medicine 906. Secretion Energy dependent discharge or release of products usually from glands in the body but also pertaining to the contents of platelet granules that are released after stimulation of the platelets by agonists; also, the product that is discharged or released. They selectively hydrolyze arginine- or lysine- containing peptide bonds of other zymogens converting them to serine proteases. Shelf life The time period for which a reagent or control is stable given appropriate storage conditions. Shelf life will change once the reagent or control is reconsitituted if lypholyzed or opened if liquid. Sickle cell formation may be observed in wet preparations or in stained blood smears from patients with sickle-cell anemia. Sickle-cell anemia A genetically determined disorder in which hemoglobin S is inherited in the homozygous state. Sickle-cell trait A genetically determined disorder in which hemoglobin S is inherited in the heterozygous state. Increased numbers of smudge cells are observed in lymphoproliferative disorders like chronic lymphocytic leukemia. Spur cell anemia An acquired hemolytic condition associated with severe hepatocellular disease such as cirrhosis, in which there is an increase in serum lipoproteins, leading to excess of erythrocyte membrane cholesterol. Determining the stage of disease usually involves radiologic studies, peripheral blood examination, and bone marrow aspiration and biopsy. Starry sky Morphologic appearance characteristic of high- grade lymphoma produced by numerous tingible body macrophages (stars) and a diffuse sheet of neoplastic cells (sky). Streptokinase A bacterial enzyme derived from group C-beta hemolytic steptococci that activates plasminogen to plasmin and is used as a thrombolytic agent in the treatment of thrombosis. Stroma Extracellular matrix or microenvironment that supports hematopoietic cell proliferation in the bone marrow. Stromal cells Cellular elements of the hematopoietic microenvironment in the red portion of bone marrow. Submetacentric Chromosome that has the centromere positioned off-center so that the short arm is shorter than the long arm. Sucrose hemolysis test A screening test to identify erythrocytes that are abnormally sensitive to complement lysis. Supernatant Clear liquid remaining on top of a solution after centrifugation of the particulate matter. The cell appears as a target with a bull’s-eye center mass of hemoglobin surrounded by an achromic ring and an outer ring of hemoglobin. Teardrop (dacryocytes) Erythrocyte that is elongated at one end to form a teardrop or pear-shaped cell. A teardrop cell cannot return to its original shape because it has either been stretched beyond the limits of deformability of the membrane or has been in the abnormal shape for too long a time. Thrombocytopenia A decrease in the number of platelets in the peripheral blood below the reference range for an individual laboratory (usually below 150 X 109/L). Thrombocytosis An increase in the number of platelets in the peripheral blood above the reference range for an individual laboratory (usually over 440 X 109/ L). Thromboembolism Blockage of a small blood vessel by a blood clot that was formed in the heart, arteries, or veins, dislodged and moved through blood vessels until reaching a smaller vessel and blocking further blood flow. It forms a 1:1 complex with thrombin inhibiting thrombin’s ability to cleave fibrinogen to fibrin but enhances thrombin’s ability to activate protein C. Thrombophlebitis Thrombosis within a vein that is accompanied by an inflammatory response, pain and redness of the area. Thrombopoietin A humoral factor that regulates the maturation of megakaryocytes and the production of platelets. Thrombosis Formation of a blood clot or thrombus, usually considered to be under abnormal conditions within a blood vessel. Toxic granules Large, dark blue-black primary granules in the cytoplasm of neutrophils that are present in certain infectious states. There is a leukocytosis with relative lymphocytosis or rarely an absolute lymphocytosis and the presence of reactive lymphocytes. Trabecula Projection of calcified bone extending from cortical bone into the marrow space; provides support for marrow cells.

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Irrespective of whether the patient is breathing spontaneously or being ventilated discount zyprexa 2.5mg overnight delivery symptoms crohns disease, capnography Pulmonary artery catheter and cardiac will detect most of the common problems purchase 10 mg zyprexa fast delivery medications 4h2, for output example disconnection (loss of reading), inade- See page 126. In addition, when a patient is venti- Blood loss lated, airway pressures must be monitored to avoid Simple estimates of blood loss during surgery are excessive pressures being generated within the easily performed. Airway pressure monitoring can also be used wet, the increase in weight giving an indication of as a secondary indicator of inadequate ventilation the amount of blood they have absorbed. The vol- in ventilated patients; high pressures may be the ume of blood in the suction apparatus can be meas- result of obstruction (e. Such bronchospasm), and loss of pressure the result of a methods are only estimates, as blood may remain disconnection. The latter function may be specifi- in body cavities, be spilt on the floor and absorbed cally used as a ‘disconnection alarm’. In paediatric practice, where small volumes of blood loss are relatively more Many other physiological parameters can be, and important, all absorbent materials are washed to are, monitored during anaesthesia when appropri- remove the blood and the resultant solvent as- ate. Cephalic vein The anaesthetic record On every occasion an anaesthetic is administered, a comprehensive and legible record must be made. The details and method of recording will vary with each case, the type of chart used and the equip- Dorsal metacarpal veins ment available. Laterally these are joined by • fluids administered and lost: type and volume; veins from the thumb and continue up the radial • use of local or regional anaesthetic techniques; border of the forearm as the cephalic vein (Fig. These have the advantage of allowing the large vein in the middle of the ventral (anterior) anaesthetist to concentrate on caring for the pa- aspect of the forearm—the median vein of the tient, particularly during an emergency, rather forearm (Fig. The antecubital fossa The cephalic vein passes through the antecubital Intravenous cannulation and fluid fossa on the lateral side and the basilic vein enters administration the antecubital fossa very medially, just in front of Intravenous cannulation is used to allow: the medial epicondyle of the elbow. These veins are •drugs to be given to induce and maintain joined by the median cubital or antecubital vein (see anaesthesia; Fig. Veins in this region tend to be used • fluids to be given to maintain or restore the either in an emergency situation or when attempts patient’s circulating volume; to cannulate more peripheral veins have failed. Some de- proximity and easily damaged by needles or vices have flanges or ‘wings’ to facilitate attach- extravasated drugs. All cannulae have a standard Luer-lock fitting for attaching a giving set and some have a valved injection port through Equipment which drugs can be given (Fig. Devices of different lengths and diameters are • Seldinger type This is used predominantly to used; the term ‘cannula’ is used for those 7cm or achieve cannulation of the central veins (see less in length, and ‘catheter’ for those longer than below), but peripheral devices are available, de- 7cm. The main types of cannulae used are: Technique for cannulation of a • Cannula over needle The most popular device, peripheral vein available in a variety of sizes, most commonly 14 gauge (2. The other end of the relatively mobile and capable of considerable vari- needle is attached to a transparent ‘flashback ation in their diameters. This reduces pain, • The junction of two veins is often a good site and makes the patient less likely to move and less as the ‘target’ is relatively larger. Often a ture site to prevent bleeding, and made worse by slight loss of resistance is felt as the vein is entered forgetting to remove the tourniquet! This indicates that the tip of the The degree of damage to the overlying tissues needle is within the vein. This ensures that the first part of technique and lack of knowledge of the local the plastic cannula lies within the vein. However, a cannula may pre- •W ithdraw the needle 5–10mm into the cannula vent this and allow air to enter the circulation. Most likely following cannulation of a central vein As this is done, blood may be seen to flow between (see below). The safest action is to withdraw the whole • The cannula and needle should now be ad- cannula and re-attempt at another site. The needle is re- • Thrombophlebitis Related to the length of time tained within the cannula to provide support and the vein is in use and irritation caused by the sub- prevent kinking at the point of skin puncture (Fig. There are many different types of equipment and ap- Complications proaches to the central veins, and the following is Most are relatively minor but this must not be used intended as an outline. A flexible guidewire is then passed down Access to the central veins the needle into the vein and the needle carefully withdrawn, leaving the wire behind. The catheter The antecubital fossa is now passed over the wire into the vein, some- This route has a relatively low success rate, but times preceded by a dilator.

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