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Adipose tissue accumulates in the greater omentum treatment for esbl uti buy naxocina 100 mg cheap, giving it the appearance of a fat-filled apron that covers the anterior surface of the abdominal viscera. The mesentery that attaches the small intestine to the posterior abdominal wall is called the mesentery proper. Because the digestive tract is open at the mouth and anus, the inside of the tract is continuous with the outside environment, and food entering the digestive tract may contain not only useful nutrients but also indigestible components such as fiber, or harmful materials such as bacteria. Therefore, the inner lining of the digestive tract serves as a protective barrier to those indigestible and harmful materials and nutrients must be specifically transported across the wall of the digestive tract. Once across the wall of the digestive tract, the nutrients enter the circulation to access tissues of the body. The digestive tract consists of the oral cavity, pharynx, esophagus, stomach, small intestine, large intestine, and anus. The salivary glands empty into the oral cavity, and the liver and pancreas are connected to the small intestine. These are the mucosa, the submucosa, the muscularis, and a serosa or an adventitia (figure 16. The innermost tunic, the mucosa (mu-ko sa), consists of mucous epithelium, a loose connective tissue called the lamina propria, and a thin smooth muscle layer, the muscularis mucosae. The epithelium in the mouth, esophagus, and anus resists abrasion, and the epithelium in the stomach and intestine absorbs and secretes. Digestive If you placed a pin completely through both folds of the greater omentum, through how many layers of simple squamous epithelium would the pin pass Other abdominal organs lie against the abdominal wall, have no mesenteries, and are described as retroperitoneal (re troper i-to-ne al; behind the peritoneum). The retroperitoneal organs include the duodenum, pancreas, ascending colon, descending colon, rectum, kidneys, adrenal glands, and urinary bladder. The lips are muscular structures, formed mostly by the orbicularis oris (or-biku-laris oris) muscle (see figure 7. The keratinized stratified epithelium of the skin becomes thin at the margin of the lips. The color from the underlying blood vessels can be seen through the thin, transparent epithelium, giving the lips a reddish-pink appearance. At the internal margin of the lips, the epithelium is continuous with the moist stratified squamous epithelium of the mucosa in the oral cavity. They help manipulate the food within the oral cavity and hold the food in place while the teeth crush or tear it. Mastication begins the process of mechanical digestion, which breaks down large food particles into smaller ones. The anterior part of the tongue is relatively free, except for an anterior attachment to the floor of the mouth by a thin fold of tissue called the frenulum (frenu-lum) (figure 16. The anterior two-thirds of the tongue is covered by papillae, some of which contain taste buds (see chapter 9). The posterior one-third of the tongue is devoid of papillae and has only a few scattered taste buds. In addition, the posterior portion does contain a large amount of lymphatic tissue, which helps form the lingual tonsil (see chapter 14). The tongue moves food in the mouth and, in cooperation with the lips and cheeks, holds the food in place during mastication. In addition, the tongue is a major sensory organ for taste, as well as one of the major organs of speech. Teeth There are 32 teeth in the normal adult mouth, located in the mandible and maxillae. The teeth can be divided into quadrants: right upper, left upper, right lower, and left lower. In adults, each quadrant contains one central and one lateral incisor (in-si zor; to cut); one canine (ka nin; dog); first and second premolars (premo larz; molaris, a millstone); and first, second, and third molars (mo larz). The third molars are called wisdom teeth because they usually appear in the late teens or early twenties, when the person is old enough to have acquired some degree of wisdom. Most of them are replacements for the 20 primary teeth, or deciduous (de-sid u-us) teeth, also called milk or baby teeth, which are lost during childhood (figure 16.

It is important to recognize whether a feeding vessel or an entire vascular bed requires embolization bacteria facts purchase cheap naxocina on-line. The presence of anastomoses and collaterals between arterial territories must be appreciated as this will require embolization of both inflow and outflow arteries. Finally the effect on the end organ or vascular territory must also be considered. Embolization agents used in trauma can be divided into those that result in permanent vessel occlusion or those where occlusion is temporary. Gelfoam results in temporary occlusion, which can last up to a few weeks-a useful property in trauma that allows time for the vessel to heal. The powder form is made up of small particles and hence facilitates occlusion down to the capillary level. The sheet form is more useful for larger vessels and is cut into small pledgets of 1-mm to 2-mm diameter that are soaked in contrast media before syringing and injecting. Gelfoam is suitable for multiple bleeding points and is frequently the choice in pelvic trauma. Coil embolization results in permanent occlusion through both a mechanical obstruction and a thrombogenic effect. The coils are made from stainless steel or platinum and are available in a range of sizes, usually coated with thrombogenic fibers. To be effective, they must be tightly packed in a stable position within the artery. If contrast extravasation is confirmed, the degree of extravasation must be matched to the hemodynamic status of the patient. If the amount of extravasation does not correlate with the shock, other sources of bleeding should be sought before embarking on embolization. For instance, embolization of a renal artery should never be performed without confirming the presence of two functioning kidneys. If using particulate agents, a test injection with contrast is usually sufficient to confirm that the catheter tip is not displaced during the injection. If using coils, passage of a guide wire will allow the operator to see whether the delivery catheter tip is not in a stable position. During delivery of the agent, continuous fluoroscopy is essential, and completion angiography should be performed to confirm the effect on flow. After coil embolization, provided the flow is not too brisk, patience and a delay of a couple of minutes may be all that are required to facilitate vessel thrombosis. If the flow does appear brisk, further coils will need to be packed into the region. Equally a patient may become hemodynamically compromised during the procedure necessitating open surgery. If a decision is made to convert to open surgery, a temporary occlusion balloon can be placed in the artery proximal to the injury. Care needs to be applied when transferring the patient but this technique is the endovascular equivalent of arterial clamping-restoring blood pressure and providing time for the surgeon to proceed with damage control techniques. The first-line treatment is to stabilize the fracture through application of a pelvic binder, and this frequently results in cessation of venous bleeding. Continued instability suggests arterial bleeding, and gelfoam angioembolization of the internal iliac arteries is usually indicated. Stabilization of the bony pelvis may require urgent external fixation either before or during concomitant laparotomy. Control of pelvic bleeding during the trauma laparotomy can be challenging, and intraoperative hemostasis can be facilitated via the technique of preperitoneal packing in order to facilitate tamponade. Preperitoneal packing can be combined with follow-on embolization to ensure cessation of hemorrhage. The spleen remains one of the most commonly injured organs following blunt abdominal trauma. There is controversy regarding the use of proximal embolization over more distal selective embolization. Blunt trauma to the liver results more frequently in parenchymal venous than arterial injury.

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Today infection news buy cheap naxocina online, Sadie begged her mom to pack a snack of chocolate chip cookies and grape soda. This snack was packed with calories that would give the children lots of energy, but otherwise, it had very little nutritional value. For carbohydrates, lipids, and proteins, describe their dietary sources, their uses in the body, and the daily recommended amounts of each in the diet. However, knowing about nutrition is important because the food we eat provides us with the energy and the building blocks necessary to synthesize new molecules. A basic understanding of nutrition can help us answer these and other questions so that we can develop a healthful diet. Nutrition (noo-trish un; to nourish) is the process by which food is taken into and used by the body; it includes digestion, absorption, transport, and metabolism. Nutrition is also the study of food and drink requirements for normal body function. Nutrients can be divided into six major classes: carbohydrates, lipids, proteins, vitamins, minerals, and water. Carbohydrates, lipids, and proteins are the major organic nutrients and are broken down by enzymes into their individual subunits during digestion. Subsequently, many of these subunits are broken down further to supply energy, whereas other subunits are used as building blocks for making new carbohydrates, lipids, and proteins. They are essential participants in the chemical reactions necessary to maintain life. The body requires some nutrients in fairly substantial quantities and others, called trace elements, in only minute amounts. Nutrition, Metabolism, and Body Temperature Regulation 477 Essential nutrients are nutrients that must be ingested because the body cannot manufacture them-or it cannot manufacture them in adequate amounts. The essential nutrients include certain amino acids, certain fatty acids, most vitamins, minerals, water, and some carbohydrates. The term essential does not mean that the body requires only the essential nutrients. Other nutrients are necessary, but if they are not ingested, they can be synthesized from the essential nutrients. Most of this synthesis takes place in the liver, which has a remarkable ability to transform and manufacture molecules. A balanced diet consists of enough nutrients in the correct proportions to support normal body functions. The latest recommendations, the Dietary Guidelines for Americans, 2010, were published in January 2011. In light of the increasing problem of obesity in the United States, the latest recommendations focus on two concepts: (1) balancing calorie intake to obtain and maintain a healthy weight, and (2) increasing consumption of healthy, nutrient-rich foods. The MyPlate icon shows a plate and glass with portions representing foods from the fruits, vegetables, grains, proteins, and dairy food groups. To emphasize the importance of making healthy food choices, half the plate is fruits and vegetables. Results from these studies demonstrate that eating a healthy diet does provide certain health benefits. People who ate the best, according to the index, were compared to those who ate the worst. Men who ate best had a 28% reduction in heart disease and an 11% decrease in chronic diseases compared to men who ate worst. Women who ate best had a 14% reduction in heart disease but no significant decrease in chronic diseases compared to women who ate worst. There was no significant difference in cancer rates between the men and women who ate best compared to those who ate worst. Kilocalories the energy the body uses is stored within the chemical bonds of certain nutrients. A kilocalorie (kil o-kal-o-re) (kcal) is 1000 cal and is used to express the larger amounts of energy supplied by foods and released through metabolism.

Small veins are venules covered with a layer of smooth muscle and a layer of connective tissue virus removal mac generic 500mg naxocina with amex. Medium-sized and large veins contain less smooth muscle and fewer elastic fibers than arteries of the same size. Veins of the Upper Limbs the deep veins are the brachial, axillary, and subclavian; the superficial veins are the cephalic, basilic, and median cubital. Veins of the Thorax the left and right brachiocephalic veins and the azygos veins return blood to the superior vena cava. The pulmonary trunk carries oxygen-poor blood from the heart to the lungs, and pulmonary veins carry oxygen-rich blood from the lungs to the left atrium of the heart. Veins from the kidneys, adrenal glands, and gonads directly enter the inferior vena cava. Veins from the stomach, intestines, spleen, and pancreas connect with the hepatic portal vein, which transports blood to the liver for processing. The brachiocephalic, left common carotid, and left subclavian arteries branch from the aortic arch to supply the head and the upper limbs. The common carotid arteries divide to form the external carotids (which supply the face and mouth) and the internal carotids (which supply the brain). Blood pressure is a measure of the force exerted by blood against the blood vessel walls. Blood pressure can be measured by listening for Korotkoff sounds produced as blood flows through arteries partially constricted by a blood pressure cuff. Arteries of the Upper Limbs the subclavian artery continues as the axillary artery and then as the brachial artery, which branches to form the radial and ulnar arteries. Pressure and Resistance In a normal adult, blood pressure fluctuates between 120 mm Hg (systolic) and 80 mm Hg (diastolic) in the aorta. If blood vessels constrict, resistance to blood flow increases, and blood flow decreases. Thoracic Aorta and Its Branches the thoracic aorta has visceral branches, which supply the thoracic organs, and parietal branches, which supply the thoracic wall. Abdominal Aorta and Its Branches the abdominal aorta has visceral branches, which supply the abdominal organs, and parietal branches, which supply the abdominal wall. Blood pressure, capillary permeability, and osmosis affect movement of fluid across the wall of the capillaries. Arteries of the Lower Limbs the common iliac arteries give rise to the external iliac arteries, and the external iliac artery continues as the femoral artery and then as the popliteal artery in the leg. Blood flow through a tissue is usually proportional to the metabolic needs of the tissue and is controlled by the precapillary sphincters. The nervous system is responsible for routing the flow of blood, except in the capillaries, and for maintaining blood pressure. Epinephrine and norepinephrine released by the adrenal medulla alter blood vessel diameter. The baroreceptor reflex changes peripheral resistance, heart rate, and stroke volume in response to changes in blood pressure. The heart releases atrial natriuretic hormone when atrial blood pressure increases. Atrial natriuretic hormone stimulates an increase in urine production, causing a decrease in blood volume and blood pressure. The baroreceptor, chemoreceptor, and adrenal medullary reflex mechanisms are most important in short-term regulation of blood pressure. Hormonal mechanisms, such as the renin-angiotensin-aldosterone system, antidiuretic hormone, and atrial natriuretic hormone, are more important in long-term regulation of blood pressure. Epinephrine released from the adrenal medulla as a result of sympathetic stimulation increases heart rate, stroke volume, and vasoconstriction. Reduced elasticity and thickening of arterial walls result in hypertension and decreased ability to respond to changes in blood pressure.