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One such entity buy viagra jelly 100 mg otc, fibromuscular dys- plasia, is a condition in which the blood vessel wall develops structural irregularities. Fibromus- cular dysplasia can affect people of any age or gender, but most commonly involves young women. B shows a series of narrowings in the renal artery caused by this dysplastic disease. B An arteriogram of the left renal artery, demonstrating changes of fibromuscular dysplasia. Our assumption that in the Cardiac output Qart Pa/SVR (9) steady state, the outputs of the right and left hearts are ex- Cardiac output and systemic vascular resistance are actly equal is true. Their regulation allows control the outputs of the left and right heart occur and are physi- of mean arterial pressure. An assumption in the above discussion is that the right SYSTOLIC AND DIASTOLIC PRESSURES heart and pulmonary circulation faithfully transfer blood flow from the systemic veins to the left heart. In fact, cou- Thus far, we have discussed only mean arterial pressure, pling of the output of the right heart and the pulmonary cir- despite the fact that the pumping of blood by the heart CHAPTER 12 An Overview of the Circulation and Hemodynamics 217 is a cyclic event. In a resting individual, the heart ejects Bulk Flow and Diffusion Are Influenced by blood into the aorta about once every second (i. The phase during The aorta has the largest diameter of any artery, and the which cardiac muscle contracts is called systole, from subsequent branches become progressively smaller the Greek for “a drawing together. Although the capillaries are the the pressures in the atria increase and push blood into smallest blood vessels, there are several billion of them. During ventricular systole, pressures in For this reason, the total cross-sectional area of the lu- the ventricles rise and the blood is pushed into the pul- mens of all systemic capillaries (approximately 2,000 monary artery or aorta. During diastole (“a drawing 2 cm ) greatly exceeds that of the lumen of the aorta (7 apart”), the cardiac muscle relaxes and the chambers fill 2 cm ). In a steady state, the blood flow is equal at any two from the venous side. Because of the pulsatile nature of cross sections in series along the circulation.

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The corti- apparatus and the resulting heavy neural input buy 100mg viagra jelly with mastercard, which is cospinal tract deficit also produces an increased sensitiv- likely to be greater than that produced by his underlying ity of the spinal reflex pathways, resulting in overly vigor- condition. The use of salt restriction and diuretics would reduce the slight resistance to passive movement that is detectable in overall hydration state of his body and tend to reduce ab- a relaxed muscle, becomes greatly increased and demon- normal pressure within the labyrinthine system. Spastic tone is antimotion sickness drugs would interfere with the natural most evident in the flexor muscles of the arm and the ex- neural compensation that would, it is hoped, reduce the tensor muscles of the leg. The extensor movement of the first toe in response to Reference stroking the plantar aspect of the foot, termed Babinski Drachman DA. JAMA sign, is thought to occur because of modification of flexor 1998;280:2111–2118. The Cushing response (described by famous neurosurgeon flex when the plantar surface is stimulated. Harvey Cushing) consists of the development of hyperten- The neurophysiological details of how the deficit in sion, bradycardia, and apnea in patients with increased in- corticospinal input actually produces these commonly tracranial pressure most often a result of tumors or other le- encountered abnormalities in muscle tone and reflex sions, such as hemorrhage, that compress the brain. A current theory is pressure is transmitted downward to the brainstem and dis- that the disturbance of central control reduces the torts the medulla, where the centers for blood pressure, threshold of the stretch reflex but does not alter its gain. Correct interpre- References tation of these abnormalities in vital signs permits begin- Lance JW. The control of muscle tone, reflexes, and move- ning treatments that reduce intracranial pressure. Quantitative relations an artificial respirator, and then instituting hyperventilation between hypertonia and stretch reflex threshold in spastic to lower the blood PCO2 to produce cerebral vasoconstric- hemiparesis. Another autonomic reaction from the CNS that is uti- CASE STUDY FOR CHAPTER 6 lized daily in hospitals is the response of fetal heart rate Autonomic Dysfunction as a Result of CNS Disease to compression of the head during labor.

The tendon of this muscle is especially formed by the sternocleidomastoid muscle anteriorly and the prominent to the side of the jugular notch 100 mg viagra jelly mastercard. The trapezius mus- trapezius muscle posteriorly; the clavicle forms its base inferiorly. An inflamma- Three structures traversing the neck are extremely important tion of the trapezius causes a “stiff neck. These structures are the common if a shirt collar is too tight, the external jugular vein can be carotid artery, which carries blood to the head; the internal jugular seen as it courses obliquely across the sternocleidomastoid vein, which drains blood from the head; and the vagus nerve, which conducts nerve impulses to visceral organs. Cervical lymph nodes of the lateral neck region may protected in the neck by their deep position behind the sternocleido- become swollen and painful from infectious diseases of the oral mastoid muscle and by their enclosure in a tough connective tissue or pharyngeal regions. Most of the structures of the nucha are too deep to be of importance in surface anatomy. The spines of the lower cervical Internal Anatomy vertebrae (especially C7), however, can be observed and pal- pated when the neck is flexed. The organs of the neck are ridge that extends superiorly from vertebra C7 to the external highly integrated and packed into a relatively small area. Clinically, the ligamentum has to support the head,at the same time permitting flexibility. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 308 Unit 4 Support and Movement Submandibular triangle Submental triangle Anterior cervical triangle Supraclavicular Carotid triangle triangle Posterior cervical Omotracheal triangle triangle Omoclavicular (a) (b) triangle Stylohyoid m. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 309 1 8 2 3 7 4 8 5 9 6 9 10 1 11 2 12 3 13 4 14 15 7 5 16 6 1 Accessory n. Surface Anatomy Knowledge Check The trunk, or torso, is divided into the back, thorax (chest), ab- 9. Identify the pelvis and perineum are discussed in the following section. With reference to the triangles of the neck, where would in determining the location and condition of the visceral organs. Back TRUNK No matter how obese a person may be, a median furrow can be seen on the back, along with some of the spinous process of the The locations of vital visceral organs in the cavities of the trunk vertebrae (fig.

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There is an opening in the choroid at the back regulates the diameter of the pupil (table 15 purchase viagra jelly 100mg visa. Contraction of the pupillary The ciliary body is the thickened anterior portion of the constrictor muscle of the iris, stimulated by bright light, con- vascular tunic that forms an internal muscular ring toward the stricts the pupil and diminishes the amount of light entering the front of the eyeball (fig. Contraction of the pupillary dilator mus- collectively called the ciliary muscles are found within the cil- cle, in response to dim light, enlarges the pupil and permits more iary body. The transparent lens consists of tight lay- folds of the iris, so that all newborn babies have blue eyes. A thin, few months, the melanin moves to the surface of the iris and gives clear lens capsule encloses the lens and provides attachment for the baby his or her permanent eye color, ranging from steel blue to dark brown. The arrangement of smooth muscle fibers of the iris presents a The shape of the lens determines the degree to which the unique pattern for each person that is a thousand times more distinc- light rays that pass through will be refracted. Contraction of the ciliary muscles relaxes the suspensory ligament and makes the lens more Internal Tunic (Retina) spherical. A flattened lens permits viewing of a distant contact with the choroid, and an inner nervous layer, or visual object,whereas a rounded lens permits viewing of a close object. The thick nervous layer of the retina ter- The iris is the anterior portion of the vascular tunic and is minates in a jagged margin near the ciliary body called the ora continuous with the choroid. The thin pigmented layer extends anteri- as the colored portion of the eyeball (figs. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 506 Unit 5 Integration and Coordination Lens within lens capsule Conjunctiva Iris Zonular fibers of suspensory ligament Cornea Sclera Creek Meridional fibers Ciliary muscle of ciliary body Circular fibers (a) Ciliary muscle of ciliary body Zonular fibers of suspensory ligament Lens (b) FIGURE 15. The pigmented layer and nervous layer of the retina are not at- ripheral parts of the retina, where they respond to dim light for tached to each other, except where they surround the optic black-and-white vision. Because of this loose connection, the two layers may become separated as a detached retina. Cone cells, which number aration can be corrected by fusing the layers with a laser. The photoreceptors synapse with bipolar neurons, The nervous layer of the retina is composed of three princi- which in turn synapse with the ganglion neurons.

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