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The mucosa is also protected by cellular and humeral (antibody-mediated) immunity prehypertension and chronic kidney disease best buy sotalol. Here, secretory IgA (sIgA) crosslinks pathogens, masks pathogen adhesion molecules, and neutralizes toxins. Plasma cells release dimeric IgA (dIgA) into the interstitial fluid of the lamina propria. The antibodies are then bound by "polymeric immunoglobulin receptors" that are displayed along the basal membrane domain of enterocytes that line the mucosa of the small intestine. Here, transmembrane immunoglobulin receptors undergo proteolytic cleavage to release secretory IgA (sIgA). Microfold (M) cells (choice C) internalize pathogens and present antigenic peptides to lymphocytes. None of the other cells transport dIgA from the lamina propria to the lumen of the gut. Keywords: Enterocytes, immunoglobulins, secretory IgA 46 the answer is E: Teniae coli. The large intestine includes the cecum, appendix, colon (ascending, transverse, descending, and sigmoid), rectum, and anal canal. The organ exhibits straight, tubular intestinal glands, as well as distinctive thickenings of the outer longitudinal layer of the muscularis externa. These bands of smooth muscle (three equally spaced bands) are referred to as teniae coli (arrow, shown in the image). These bands run longitudinally along the outer wall of the colon and are visible on gross inspection. Contractions of the teniae coli mediate segmentation and peristalsis, which serve to move the contents of the colon. Adventitia (choice A) is loose connective tissue associated with retroperitoneal visceral organs. Haustra coli (choice B) are sacculations on the external surface of the large intestine. Omental appendices (choice C) are fatty projections on the serosal surface of the colon. Keywords: Large intestine, teniae coli 47 the answer is A: Failure of neural crest migration. Congenital megacolon (Hirschsprung disease) results from a congenital defect in the innervation of the large intestine, usually the rectum. Marked dilation of the colon occurs proximal to the stenotic rectum, with clinical signs of intestinal obstruction. Congenital megacolon is caused by defective colorectal innervation that prevents relaxation of sphincter muscles. Biopsy of the rectum shows deficiency or absence of ganglion cells in the myenteric plexus. Ganglion cells of the autonomic nervous system are derived from neural crest cells. None of the other developmental anomalies are linked to the pathogenesis of Hirschsprung disease. Keywords: Hirschsprung disease, congenital megacolon 48 the answer is D: Muscularis externa. In the colon, the muscularis externa is composed of two layers: inner circular and outer longitudinal. As mentioned above, the outer longitudinal layer in the colon is condensed into three equally spaced bands referred to as teniae coli. A myenteric (Auerbach) plexus is present between the inner and outer layers of smooth muscle (arrowheads, shown in the image). Keywords: Gastrointestinal tract, muscularis externa 49 the answer is A: Appendix.

During embryonic development hyperextension knee order sotalol 40mg on line, the urorectal septum grows and divides the primitive hindgut (cloaca) into a urogenital sinus and a rectum. The urogenital sinus is further divided into three parts: the cranial (vesicle) portion forms the urinary bladder; the middle (pelvic) portion forms the urethra and prostate in males and the entire urethra in females; and the caudal (phallic) part grows toward the genital tubercle to form the penis or clitoris. The other male reproductive organs are derived from mesoderm (mesenchyme) of the urogenital ridge. The spermatic cord carries nerves and blood/lymph vessels from the posterior abdominal wall to the scrotum, and it carries the vas deferens from the scrotum to the prostate gland. They represent a portion of the internal oblique muscle that extends through the inguinal canal. The cremasteric reflex serves to raise the testicles, toward the abdominal wall, in response to low temperature to safeguard spermatogenesis. The aponeurosis of the external oblique muscle (choice C) forms the anterior wall of the inguinal canal. The pampiniform venous plexus (choice D, shown in the image) consists of anastomosing branches of the spermatic vein. This plexus serves as a heat exchanger to lower the temperature of arterial blood entering the testes. Examination of this image reveals a highly folded secretory epithelium, surrounded by a thin layer of smooth muscle. The paired seminal vesicles are tortuous tubes, measuring approximately 15 cm in length. Urothelial (transitional) cell carcinoma of the bladder typically manifests as sudden hematuria and, less frequently, manifests as dysuria. Keywords: Seminal vesicles, bladder cancer 41 the answer is B: Pseudostratified epithelium surrounded by layer of smooth muscle. The seminal vesicles consist of a secretory epithelium (nonciliated columnar cells), a thin layer of smooth muscle, and a fibrous coat. Secretory epithelial cells lining follicles (choice C) are seen in the thyroid gland. Simple squamous cells lining open vascular spaces (choice D) are seen in sinusoid capillaries throughout the body. Solid clusters of epithelial cells (choice E) describe nests of endocrine cells that are found in many locations, including the pituitary and parathyroid glands. The accessory glands of the male reproductive tract include paired seminal vesicles, the prostate gland, and several bulbourethral glands. Most (70%) of the fluid in Male Reproductive System semen is contributed by the seminal vesicles. This foamy liquid contains an abundance of amino acids, simple sugars, prostaglandins (arachidonic acid derivatives), enzymes, and other proteins. Fructose is a six-carbon monosaccharide that serves as the principal metabolic substrate for sperm motility. Pyruvic acid (choice E) is a product of glycolysis and an energy source for the Krebs cycle; however, this three-carbon ketone is not secreted by the seminal vesicles. None of the other choices provide a significant source of energy for oxidative phosphorylation in sperm. The prostate gland is divided into three zones: central, transitional, and peripheral. The transitional zone surrounds the prostatic urethra, and the central zone surrounds the paired ejaculatory ducts. Nodular hyperplasia of the prostate is a common disorder characterized clinically by enlargement of the gland and obstruction to the flow of urine through the bladder outlet, and pathologically by the proliferation of glands and stroma. Nodular prostatic hyperplasia results in the retention of urine in the bladder and predisposes to recurrent urinary tract infections. Keywords: Prostate gland, benign prostatic hyperplasia 44 the answer is B: Corpora amylacea. The arrow on this image identifies secretory material of the prostate gland that has precipitated within the lumen of an alveolus. These calcified proteinaceous concretions are termed corpora amylacea (amyloid bodies). The structure revealed in this image lacks evidence of cell nuclei and is, therefore, unlikely to represent a cluster of malignant cells (choice A) or a multinucleated giant cell (choice D). Glassy membranes (choice C) represent the basement membranes of atretic ovarian follicles.

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Dysfunction of the salivary glands may result in tooth decay and inflammation of the oral mucosa heart attack telugu movie review discount generic sotalol canada. Ameloblasts (choice A) produce enamel, the highly calcified superficial layer of the teeth. Cementoblasts (choice B) secrete cementum, a bone-like tissue covering the outer surface of the roots of the teeth. Each tooth consists of a crown (exposed portion of the tooth above the gingiva), a neck (constricted segment at the gum), and one or more roots (embedded in bony alveoli). A bone-like tissue layer called cementum (choice A) covers the outer surface of the root. Beneath the enamel and cementum, dentin (choice C) forms the calcified bulk of the tooth. In the center of the tooth, the pulp cavity is filled with loose connective tissue that also contains blood vessels and nerves. It consists almost exclusively of calcium hydroxyapatite crystals (98%), with very little organic material added. Despite their strength and hardness, enamel, cementum, and dentin can be decalcified and destroyed by bacteria. Bacterial colonies thriving on remnants of food on the enamel surface produce an acid environment that can demineralize the enamel and cause carious lesions (dental caries). At this point, the patient will experience pain that worsens when the affected tooth is exposed to heat, cold, sweet foods, or sweet drinks. Which of the following types of epithelium lines the proximal portion of this autopsy specimen Further studies demonstrate a complete absence of peristalsis and failure of the lower esophageal sphincter to relax upon swallowing. These clinicopathologic findings are explained as a deficiency (or absence) of which of the following structures in the distal esophagus The specimen shown in the image was obtained from which of the following anatomic locations These histopathologic findings are associated with which of following adaptations to chronic persistent cell injury As part of your research, you generate monoclonal antibodies that identify specific populations of gastric epithelial cells. Which of the following cells is characterized by the presence of zymogen secretory granules Which of the following locations in the mucosa provides a niche for multipotent gastric stem cells Which of the following small molecules plays an important role in maintaining bicarbonate secretion by surface mucous cells and increasing the thickness of the surface mucus layer in the stomach These argentaffin cells are classified as "open" or "closed" depending on whether or not their apical membranes reach the lumen of the gut. What is the most likely mechanism for the development of acute erosive gastritis in this patient The cell bodies for visceral motor fibers that innervate the muscularis mucosae are present in which of the following anatomic locations Which of the following is the most likely underlying cause of peptic ulcer disease in this patient What bacterial enzyme allows these pathogens to survive in the acidic environment of the gastric lumen Identify the glandular structures located between the double arrows (shown in the image). Which of the following best explains the pathogenesis of congenital pyloric stenosis in this infant The pathology resident asks you to comment on the glandular tissue located within the lines (shown in the image). A portion of the proximal duodenum at the tumor margin is examined for evidence of malignant cells. Identify the delicate apical membrane feature indicated by the arrows (shown in the image). Foods, antacids, and over-the-counter medications provide no relief, and prescribed inhibitors of acid secretion are only moderately effective. What polypeptide hormone is most likely secreted by this pancreatic islet cell neoplasm

The effects of sublingual and transdermal nitroglycerin are mainly the result of the unchanged drug because these routes avoid the first-pass effect (see Chapters 1 and 3) heart attack 40 year old female discount sotalol uk. Other nitrates are similar to nitroglycerin in their pharmacokinetics and pharmacodynamics. Isosorbide dinitrate is another commonly used nitrate; it is available in sublingual and oral forms. Isosorbide dinitrate is rapidly denitrated in the liver and smooth muscle to isosorbide mononitrate, which is also active. Amyl nitrite is a volatile and rapid-acting vasodilator that was used for angina by the inhalational route but is now rarely prescribed. Cardiovascular-Smooth muscle relaxation by nitrates leads to an important degree of venodilation, which results in reduced cardiac size and cardiac output through reduced preload. Relaxation of arterial smooth muscle may increase flow through partially occluded epicardial coronary vessels. Other organs-Nitrates relax the smooth muscle of the bronchi, gastrointestinal tract, and genitourinary tract, but these effects are too small to be clinically significant. Intravenous nitroglycerin (sometimes used in unstable angina) reduces platelet aggregation. Clinical Uses As previously noted, nitroglycerin is available in several formulations (see Drug Summary Table). Transdermal formulations (ointment or patch) can maintain blood levels for up to 24 h. Toxicity of Nitrates and Nitrites the most common toxic effects of nitrates are the responses evoked by vasodilation. These include tachycardia (from the baroreceptor reflex), orthostatic hypotension (a direct extension of the venodilator effect), and throbbing headache from meningeal artery vasodilation. Nitrates interact with sildenafil and similar drugs promoted for erectile dysfunction. Nitrites are of significant toxicologic importance because they cause methemoglobinemia at high blood concentrations. This same effect has a potential antidotal action in cyanide poisoning (see later discussion). In the past, the nitrates were responsible for several occupational diseases in explosives factories in which workplace contamination by these volatile chemicals was severe. The most common of these diseases was "Monday disease," that is, the alternating development of tolerance (during the work week) and loss of tolerance (over the weekend) for the vasodilating action and its associated tachycardia and resulting in headache (from cranial vasodilation), tachycardia, and dizziness (from orthostatic hypotension) every Monday. Nitrites in the Treatment of Cyanide Poisoning Cyanide ion rapidly complexes with the iron in cytochrome oxidase, resulting in a block of oxidative metabolism and cell death. Fortunately, the iron in methemoglobin has a higher affinity for cyanide than does the iron in cytochrome oxidase. Nitrites convert the ferrous iron in hemoglobin to the ferric form, yielding methemoglobin. Therefore, cyanide poisoning can be treated by a 3-step procedure: (1) immediate inhalation of amyl nitrite, followed by (2) intravenous administration of sodium nitrite, which rapidly increases the methemoglobin level to the degree necessary to remove a significant amount of cyanide from cytochrome oxidase. This is followed by (3) intravenous sodium thiosulfate, which converts cyanomethemoglobin resulting from step 2 to thiocyanate and methemoglobin. Some studies suggest that of the vascular beds, the veins are the most sensitive, arteries less so, and arterioles least sensitive. These changes contribute to an overall reduction in myocardial fiber tension, oxygen consumption, and the double product. Thus, the primary mechanism of therapeutic benefit in atherosclerotic angina is reduction of the oxygen requirement.