Exchange of Respiratory Gases between Fetal Blood and Maternal Blood Exchange of respiratory gases between fetal blood and maternal blood occurs mainly because of pressure gradient cholesterol levels us vs canada order prazosin 2.5 mg with visa. This pressure gradient of 20 mm Hg causes the diffusion of oxygen into the fetal blood cholesterol levels uk vs usa purchase prazosin 2.5 mg otc. This pressure gradient is very low cholesterol count chart buy discount prazosin 5mg on line, compared to the gradient existing between partial pressure of oxygen in arterial blood and alveoli in adults cholesterol levels variation buy prazosin mastercard. The concentration of hemoglobin is about 50% more in fetal blood than in adult blood. Bohr effect and Double Bohr effect Bohr effect is the decrease in the affinity of hemoglobin for oxygen due to increased carbon dioxide tension. When carbon dioxide tension decreases, the affinity of hemoglobin for oxygen is increased. All the metabolic end products including carbon dioxide are completely excreted from fetus into the maternal blood. Double Bohr effect is the operation of Bohr effect in both fetal blood and maternal blood. Progesterone and estrogen secreted by corpus luteum are essential for the maintenance of pregnancy. It stimulates the interstitial cells of Leydig and causes secretion of testosterone. Estrogen Placental estrogen is similar to ovarian estrogen in structure and function. On uterus: Causes enlargement of the uterus so that, the growing fetus can be accommodated. On breasts: Responsible for the enlargement of the breasts and growth of the duct system in the breasts. It facilitates the passage of the fetus through the birth canal at the time of labor. Progesterone Placental progesterone is similar to ovarian progesterone in structure and function. On endometrium of uterus: Accelerates the proliferation and development of decidual cells in the endometrium of uterus. The decidual cells are responsible for the supply of nutrition to the embryo in the early stage. On the movements of uterus: Inhibits the contraction of muscles in the pregnant uterus. It is an important function of progesterone as it prevents expulsion of fetus during pregnancy. On breasts: Causes enlargement of breasts and growth of duct system of the breasts. Progesterone is responsible for further development and preparation of mammary glands for lactation. So, it is believed to act on mammary glands and to enhance the growth of fetus by influencing the metabolic activities. It increases the amount of glucose and lipids in the maternal blood, which are transferred to fetus. However, the action of this hormone on the breasts of pregnant women is not known. It causes anabolism of proteins and accumulation of proteins in the fetal tissues. On carbohydrate metabolism: It reduces the peripheral utilization of glucose in the mother leading to availability of large quantity of glucose to the growing fetus. It is also secreted in large quantity by placenta and mammary glands at the time of labor (Refer Chapter 84). Due to this interaction during synthesis of steroid hormones, fetus and placenta are together called fetoplacental unit (Fig. Pregnenolone from placenta and fetal liver forms the substrate for the formation of two substances in the adrenal gland of the fetus: i. From this progesterone, cortisol and corticosterone are synthesized in fetal adrenal glands. The interaction between fetus and placenta occurs because some of the enzymes involved in steroid synthesis present in fetus are absent in placenta and those enzymes, which are absent in fetus are present in placenta. If the urine is injected intraperitoneally, the ovarian changes can be observed within 2 hours.
They are caused either by adrenocortical adenoma/carcinoma cholesterol ratio calculator 2015 discount prazosin 2.5mg online, which produces androgens kaiser cholesterol levels generic prazosin 2.5 mg, or by congenital adrenal hyperplasia cholesterol and foods to eat purchase 2.5 mg prazosin mastercard, a cluster of autosomal recessive enzyme defects (most common is 21-hydroxylase deficiency) does cholesterol medication help weight loss order prazosin. Patients present with gradual onset of weakness, skin hyperpigmentation, hypotension, hypoglycemia, poor response to stress, and loss of libido. It can present with sustained or episodic hypertension and associated severe headache, tachycardia, palpitations, diaphoresis, and anxiety. Microscopically, the tumor shows nests of cells (Zellballen) with abundant cytoplasm. Microscopically, lymphocytic inflammation involves the islets of Langerhans (insulitis), leading to loss of cells and fibrosis of the islets. T2D is often asymptomatic, but it can present with either polydipsia, polyuria, and polyphagia, or with hyperosmolar nonketotic diabetic coma. Microscopically, the changes are nonspecific, and can include focal atrophy and amyloid deposition in islets (hyalinization). Treatment is diet/weight loss, oral antidiabetic drugs, and insulin as needed (more common in long-standing cases). The vascular disease can lead to atrophy of skin and loss of hair of the lower extremities, claudication, nonhealing ulcers, and gangrene of lower extremities. Diabetic nephropathy includes glomerular lesions, arteriolosclerosis, and pyelonephritis (see Renal chapter). Nonproliferative retinopathy is characterized by microaneurysms, retinal hemorrhages, and retinal exudates. Diabetic neuropathy can cause peripheral neuropathy, neurogenic bladder, and sexual impotence. Bone remodeling occurs throughout life and is necessary to maintain healthy bones. Bone resorption by osteoclasts is tightly balanced with bone formation by osteoblasts. Long bones may have broadened metaphyses, causing an "Erlenmeyer flask"-shaped deformity. Cranial nerve compression due to narrowing of cranial foramina may result in blindness, deafness, and facial nerve palsies. Lab studies show highly elevated serum alkaline phosphatase and increased levels of urinary hydroxyproline. Complications include arteriovenous shunts within marrow, which may result in high-output cardiac failure and an increased incidence of osteosarcoma and other sarcomas. Microscopically, there is a haphazard arrangement of cement lines, creating a "mosaic pattern" of lamellar bone. Skull involvement leads to increased head size and foraminal narrowing that can impinge on cranial nerves, often leading to deafness. Lab studies may show normal serum calcium, phosphorus, and alkaline phosphatase, but the diagnosis is not based on labs. Treatment can include estrogen replacement therapy (controversial; not recommended currently); weight-bearing exercise; calcium and vitamin D; bisphosphonate (alendronate); and calcitonin. Specific causes include dietary deficiency of vitamin D, intestinal malabsorption, lack of sunlight, and renal and liver disease. Note Rickets and osteomalacia are disorders of osteoid mineralization; osteoid is produced in normal amounts but is not calcified properly. The patient may present clinically with bone pain or fractures (vertebrae, hips, and wrist). Lab studies show low serum calcium, low serum phosphorus, and high alkaline phosphatase. Osteomalacia (adults) is due to impaired mineralization of the osteoid matrix Rickets (children) occurs in children prior to closure of the epiphyses. Both remodeled bone and bone formed at the epiphyseal growth plate are undermineralized.
If medical management fails cholesterol levels chart south africa discount prazosin 2.5 mg free shipping, pancreatography followed by surgery should be performed cholesterol levels shrimp purchase prazosin 2.5mg without prescription. Etiology Chronic alcoholism is most frequent cause of pancreatic exocrine insufficiency in U xanthoma cholesterol spots trusted 2.5 mg prazosin. The bentiromide test cholesterol values normal best 5 mg prazosin, a simple, effective test of pancreatic exocrine function, may be helpful. Secretin stimulation test is a relatively sensitive test for pancreatic exocrine deficiency. Differential Diagnosis Important to distinguish from pancreatic carcinoma; may require radiographically guided biopsy. Patients unable to maintain adequate hydration should be hospitalized, while those with milder symptoms can be managed on an ambulatory basis. Subtotal pancreatectomy may also control pain but at the cost of exocrine insufficiency and diabetes. Because pancreatic enzymes are inactivated by acid, agents that reduce acid production. Complications Vitamin B12 malabsorption in 40% of alcohol-induced and all cystic fibrosis cases. Epidemiology Fecal-oral transmission; endemic in underdeveloped countries; food-borne and waterborne epidemics; outbreaks in day-care centers, residential institutions. Endemic in sub-Saharan Africa and Southeast Asia, where up to 20% of population acquire infection, usually early in life. Clinical Course Often clinically mild and marked by fluctuating elevations of serum aminotransferase levels; >50% likelihood of chronicity, leading to cirrhosis in >20%. Idiosyncratic Variable dose and time of onset; small number of exposed persons affected; may be associated with fever, rash, arthralgias, eosinophilia. In many cases, mechanism may actually involve toxic metabolite, possibly determined on genetic basis-e. Toxic and Drug-Induced Hepatitis Supportive as for viral hepatitis; withdraw suspected agent, and include use of gastric lavage and oral administration of charcoal or cholestyramine. In acetaminophen overdose, more specific therapy is available in the form of sulfhydryl compounds. These agents appear to act by providing a reservoir of sulfhydryl groups to bind the toxic metabolites or by stimulating synthesis of hepatic glutathione. The grade is a histologic assessment of necrosis and inflammatory activity and is based on examination of the liver biopsy. The stage of chronic hepatitis reflects the level of disease progression and is based on the degree of fibrosis (see Table 300-2, p. Presentation Wide clinical spectrum ranging from asymptomatic serum aminotransferase elevations to apparently acute, even fulminant, hepatitis. With rare exception, these comparisons are not based on head-to-head testing of these drugs, hence relative advantages and disadvantages should be interpreted cautiously. Some pts may present with complications of cirrhosis: ascites, variceal bleeding, encephalopathy, coagulopathy, and hypersplenism. Lamivudine monotherapy is not an attractive choice because of its resistance profile. Because the emergence of resistance can lead to loss of antiviral benefit and further deterioration in decompensated cirrhosis, some authorities recommend combination therapy. Clinically mild, often waxing and waning aminotransferase elevations; mild chronic hepatitis on liver biopsy. Extrahepatic manifestations include cryoglobulinemia, porphyria cutanea tarda, membranoproliferative glomerulonephritis, and lymphocytic sialadenitis. The current consensus view is that therapy can be stopped if an early virologic response is not achieved; however, some experts feel that histologic benefit may occur even in the absence of a virologic response.
Chemical Factors Chemical factors which increase the blood flow to liver by vasodilatation are: i cholesterol risk chart purchase prazosin 2.5mg with visa. Nervous Factors Sympathetic fibers to liver cause vasoconstriction in liver and decrease the blood flow cholesterol diet chart in hindi buy prazosin 5mg fast delivery. Sympathetic fibers to liver and other portions of splanchnic circulation pass through splanchnic nerve cholesterol medical term definition purchase prazosin 2.5 mg with amex. Study of Capillary Circulation Blood flow through capillaries is studied by focusing the capillaries under dissecting microscope lowering cholesterol without medication uk discount prazosin 2.5mg without prescription. Capillaries arise from arterioles and form the actual functional area of circulatory system, i. Each capillary lies in a very close proximity to the cells of the tissues at a distance of about 20 to 30 mm. This enables easy and rapid exchange of substances between blood and the tissues through interstitial fluid. Pericytes are also involved in regulation of blood flow through endothelial junctions particularly in conditions such as inflammation. After arising from meta-arterioles, these capillaries form a network and finally join the venules. Preferential channels or continuous capillaries have same diameter as meta-arterioles. Precapillary Sphincter Beginning of true capillaries is encircled by smooth muscle fibers. Yet, these blood vessels actively modify their own diameter in response to nervous, hormonal, chemical and physical stimuli. Endothelial cells themselves alter the diameter of capillaries by swelling or shrinking. In most of the capillaries, adjacent endothelial cells leave a cleft called fenestra through which several substances may traverse the endothelium by means of transcytosis (Fig. However, in cerebral capillaries the fenestra are absent because the endothelial cells fuse to each other by tight junctions (Chapter 163). It is also known as mural cell or Rouget cell (named after the discoverer Charles Rouget). Pericytes extend long cytoplasmic processes, which wrap around the endothelial cells. Non-nutritional blood flow occurs in many tissues of the body particularly during resting conditions when metabolic activities are low. Physiological Shunt Physiological shunt is the link between arterial and venous side of circulation provided by meta-arteriole. However, the meta-arteriole in these tissues acts as the physiological shunt between arterial and venous sides of the circulation. Non-nutritional blood flow occurs through physiological shunt under resting conditions. Shunt in Capillaries Vs Shunt in Heart Physiological shunt in capillaries is different from physiological shunt in heart. But in heart, the deoxygenated blood flows towards the oxygenated blood (Chapter 108). Direction of blood flow through capillaries is not fixed as in the case of other blood vessels. In other blood vessels, the blood flows in either axial stream containing mainly blood cells or peripheral stream containing plasma. Amount of blood flowing through the capillary system throughout the body is very low. Oxygen, nutrients and other essential substances enter the tissues from capillary blood; carbon dioxide, metabolites and other unwanted substances are removed from the tissues by capillary blood. Exchange of materials across the capillary endothelium occurs by the following processes: 1. These substances diffuse through the intercellular clefts present in the endothelial wall of the capillaries. In skeletal muscles, cardiac muscles, kidneys and intestine, filtration occurs through the slit pores present in capillary endothelium.
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