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Depolarization at one node of Ranvier is sufficient to trigger regeneration of the voltage at the next node order lansoprazole australia gastritis diet . Therefore cheap 15 mg lansoprazole fast delivery chronic gastritis raw vegetables, in myelinated nerve fibers the action potential does not move as a wave but recurs at successive nodes buy lansoprazole overnight delivery gastritis gluten, traveling faster than in nonmyelinated fibers order generic lansoprazole gastritis diet underactive thyroid. This is referred to as saltatory conduction (from the Latin word saltare, which means “to hop or leap”). Chapter 15: Feeling Jumpy: The Nervous System 241 Synapses Neurons don’t touch, which means that when a nerve impulse reaches the end of a neuron, it needs to cross a gap to the next neuron or to the gland or muscle cell for which the message is intended. An electric synapse — generally found in organs and glial cells — uses channels known as gap junc- tions to permit direct transmission of signals between neurons. But in other parts of the body, chemical changes occur to let the impulse make the leap. The end branches of an axon each form a terminal knob or bulb called a bouton terminal (that first word’s pro- nounced boo-taw), beyond which there is a space between it and the next nerve path- way. Synaptic vesicles in the knob release a transmitter called acetylcholine that flows across the gap and increases the permeability of the next cell mem- brane in the chain. An enzyme called cholinesterase breaks the transmitter down into acetyl and choline, which then diffuse back across the gap. An enzyme called choline acetylase in the synaptic vesicles reunites the acetyl and choline, prepping the bouton terminal to do its job again when the next impulse rolls through. Capacity to record, store, and relate information to be used to determine future action 6. The terminal structure of the cytoplasmic projection of the neuron cannot be a(n) a. Contains storage vesicles for excitatory chemical Minding the Central Nervous System and the Brain Together, the brain and spinal cord make up the central nervous system. The spinal cord, which forms very early in the embryonic spinal canal, extends down into the tail portion of the vertebral column. But because bone grows much faster than nerve tissue, the end of the cord soon is too short to extend into the lowest reaches of the spinal canal. In an adult, the 18-inch spinal cord ends between the first and second lumbar vertebrae, roughly where the last ribs attach. The cord continues as separate strands below that point and is referred to as the cauda equina (horse tail). A thread of fibrous tissue called the filum terminale extends to the base of the coccyx (tailbone) and is attached by the coccygeal ligament. Part V: Mission Control: All Systems Go 244 Spinal cord An oval-shaped cylinder with two deep grooves running its length at the back and the front, the spinal cord doesn’t fill the spinal cavity by itself. Also packed inside are the meninges, cerebrospinal fluid, a cushion of fat, and various blood vessels. Three membranes called meninges envelop the central nervous system, separating it from the bony cavities. The dura mater, the outer layer, is the hardest, toughest, and most fibrous layer and is composed of white collagenous and yellow elastic fibers. The arachnoid, or middle membrane, forms a web-like layer just inside the dura mater. The pia mater, a thin inner membrane, lies close along the surface of the central nerv- ous system.

Clinical triads: Anaesthetic skin patches 266 Peripheral neuritis Presence of acid-fast bacilli from skin lesion Two major types of leprosy 1 buy cheapest lansoprazole and lansoprazole gastritis diet gastritis symptoms. Comparison of the two types of leprosy Characteristics Lepromatous leprosy Tuberculoid leprosy 1 cheap 15 mg lansoprazole visa gastritis diet . Usually positive Laboratory diagnosis: Specimen: Skin scrapings from the ear lobe purchase generic lansoprazole pills gastritis symptoms empty stomach. Non-viable bacilli stain poorly and unevenly as fragmented buy 15 mg lansoprazole amex gastritis diet xenadrine, beaded and granular red bacilli. When dry, hold fold of skin tightly between the thumb and forefinger until it becomes pale. Using the sterile blade, make a small cut through the skin surface, 5mm long and 2-3mm deep, where the bacteria is be found. Make a small circular smear of the tissue juice (Cover the cut with a small dressing). Wipe the back of the slide clean, and place in a draining rack for the smears to air-dry (protect from direct sun light). Most are soil saprophytes, but some are human pathogens responsible to cause actinomycosis nocardiosis and actinomycetoma. Large group of gram positive bacilli with a tendency to form chains and filaments. Endogenous members of the bacterial flora in the mouth and lower gastrointestinal tract Actinomycosis Chronic suppurative and granulomatous infection with interconnecting sinus tracts that contain sulfur granules Etiology: Actinomyces israeli Actinomyces naeslundii Characteristics:. Gram positive, facultative anaerobe substrate filaments that grow in co2 enriched condition Pathogenesis and clinical features:. Infection is initiated by trauma that introduces these endogenous bacteria into the mucosa 1. Cervico facial actinomycosis 270 Fluctuant mass with draining fistula in jaw area, and may extend to involve bone and lymphnodes in the head and neck 2. Thoracic actinomycosis Resemle subacute pulmonary infection with extension to chest wall and ribs 3. Abdominal actinomycosis May be secondary to ruptured appendix or ulcer with extensive involvement of abdominal organs Lab. Diagnosis: Specimen: Tissue, pus, sputum Smear: Gram-positive filaments with lobulated sulfur granules Culture: Thioglycolate broth or blood agar incubated anaerobically or co2 enriched condition Biochemical reacrion: Catalase positive/negative Treatment: Penicillin Clindamycin + Surgery Erythromycin Nocardiosis Etiology: Nocardia asteroides complex N. Aerobic gram positive, partially aci fast bacilli Pathogenesis and cloinical features: Route of transmission: Inhalation Usual presentation is subacute or chronic pulmonary infection with dissemination to the brain and skin Lab. Spirochete consist of protoplasmic cylinder bounded by a cell wall and outer membrane. There is an axial filament or endoflagella between the cell wall and outer membrane. Not cultured in artificial media, in fertilized eggs and tissue culture, but the saprophytic Reiter strain grows in anaerobic culture. Remain viable in the blood or plasma store at 4 c at least for 24 hrs (transmitted via blood transfusion) Antigenic structure:. Primary stage: Hard chancre: Clean-based, non-tender, indurated genital ulcer with inguinal lymphadenopathy.

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Compensatory tachycardia may restore blood pressure generic lansoprazole 30 mg fast delivery gastritis diet coffee, but increased myocardial oxygen consumption can cause ischaemia buy cheap lansoprazole 15mg online gastritis oatmeal, dysrhythmias and infarction buy lansoprazole 15 mg low price chronic gastritis dogs. Compensatory tachycardia may increase myocardial oxygen supply purchase lansoprazole overnight delivery gastritis diet , but it also increases consumption. Damage to over 70 per cent of the left ventricle is rapidly fatal (Hinds & Watson 1996). Treatment attempts to increase systemic perfusion pressure while limiting myocardial hypoxia. Artificial ventilation and removing the work of breathing with paralysing agents (Nimmo & Nimmo 1993) optimises tissue oxygen availability. Inotropes may be necessary to increase cardiac output, but will aggravate myocardial ischaemia (Nimmo & Nimmo 1993). Mortality from cardiogenic shock varies between 30 and 90 per cent, survival being lower with aggressive treatment (Califf & Bengston 1994). Survivors often develop congestive cardiac failure, necessitating cardiac surgery. Since this large increase in blood vessel capacity is not being matched by increased volume, central pres-sure (and perfusion) falls. Bradycardia from excessive and uncountered vagal tone further reduces blood pressure. Failure of autonomic response makes inotropes ineffective, but volume replacement may compensate for increased blood vessel capacity. Unresponsive sudden hypotension usually indicates a stroke; with a critically ill patient this often proves terminal so that medical assistance should be summoned urgently. Histamine is released following an antigen-antibody reaction and is a potent systemic vasodilator, greatly increasing total blood vessel capacity. Being part of specific immunity, it is released on a second or subsequent exposure to antigens. Anaphylactic shock can be an emergency, and is treated with adrenaline to restore circulating blood pressure and antihistamines (steroids). Slow bleeding (usually spontaneous) may be tolerated until 2 litres accumulate (Cockroft 1997); rapid tamponade (usually from cardiac surgery or trauma) is an emergency, usually causing imminent cardiac arrest once compensatory tachycardia and vasoconstriction fail. Blood is then aspirated, needles usually remaining (capped off) in case further blood accumulates. Blood clots cannot be aspirated through spinal needles, but once coagulation begins, bleeding has probably ceased. This gross extension of normal homeostasis causes, rather than results from, the problem. Sepsis Sepsis rates increased by 137 per cent between 1984–94 (Bone 1994), largely due to escalating risks from: ■ increasingly invasive techniques ■ improved survival from simpler pathologies increasing immunocompromise ■ ageing populations (immunity is impaired with age) ■ greater use of immunosuppressive therapy (including steroids) ■ more resistant organisms. Mortality The 1909 mortality rate from sepsis of 41 per cent remains essentially unchanged today (Ellis 1995), a stark (if alarmist) reminder of the problems and limits facing medicine. Shock 259 Pathology Bacteria initiate sepsis, but shock is a problem of inflammatory response rather than bacterial invasion so that treatment should limit excessive inflammatory responses (Deitch 1995). Cell membrane damage (from microorganisms and inflammation) release vasoactive mediators (e.

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Fat mobilization by catecholamines is potentiated by • posterior cataracts; glucocorticosteroids order lansoprazole 15 mg with visa gastritis diagnosis code. The major therapeutic uses of the gluco- • proximal myopathy; corticosteroids exploit their powerful anti-inflammatory and • growth retardation in children; immunosuppressive properties generic lansoprazole 15mg without a prescription gastritis location. Applied topically to skin or mucous membranes buy cheapest lansoprazole gastritis diet , after prolonged glucocorticosteroid administration purchase lansoprazole discount chronic gastritis years. Gradual potent steroids can cause local vasoconstriction and massive tapered withdrawal is less hazardous. However, even in doses administered systemically can cause hypertension due to patients who have been successfully weaned from chronic treat- generalized vasoconstriction. The receptor–glucocorticosteroid unusual if the daily glucocorticosteroid dose is lower than the complex translocates to the nucleus, where it binds to gluco- amount usually secreted physiologically. This increases the transcription of various their underlying condition and also on the dose and duration of signal transduction proteins. Sodium and water retention, potassium loss Haematological Lowers lymphocyte and eosinophil counts; Florid complexion and increases neutrophils, platelets and polycythaemia clotting tendency Alimentary Increases production of gastric acid and pepsin Anorexia and nausea Dyspepsia; aggravation of peptic ulcer Cardiovascular system Sensitizes arterioles to catecholamines; Hypotension, fainting Hypertension, enhances production of angiotensinogen. High-dose intravenous hydrocortisone is used short term At physiological concentrations, it plays little if any part in to treat acute severe asthma (usually followed by oral pred- controlling blood glucose, but it does cause hyperglycaemia nisolone) or autoimmune inflammatory diseases (e. Hydrocortisone cream is relatively low in potency and Glucocorticosteroids – major side effects is of particular use on the face where more potent steroids are contraindicated. Hydrocortisone is rapidly absorbed from the gastro-intestinal • Metabolic effects including hyperglycaemia and tract, but there is considerable inter-individual variation in hypokalaemia occur rapidly, as does insomnia and mood disturbances. Treatment must therefore inflammatory potency of synthetic glucocorticoids be re-evaluated regularly and if long-term use is deemed essen- increases. Prednisolone is considered in musculoskeletal systems, and for immunosuppression in progressive rheumatoid arthritis when other forms of treatment transplant patients. Low doses of prednisolone may drome) is due to either a tumour or hyperplasia of the zona be symptomatically useful in the short-term management of glomerulosa of the adrenal cortex. Clinical features include noc- patients with severe articular symptoms from systemic lupus turia, hypokalaemia, hypomagnesaemia, weakness, tetany, erythematosus and larger doses may be appropriate for limited hypertension and sodium retention. Spironolactone and periods in such patients with steroid-responsive forms of eplerenone are mineralocorticoid antagonists (see Chapters 31 glomerulonephritis or with progressive central nervous system and 36) that compete with aldosterone and other mineralocorti- involvement. They Other diseases where prednisolone may be indicated are used as potassium-sparing diuretics and to treat primary or include severe asthma and some interstitial lung diseases, e. The immunosuppressant effect of prednisolone is Fludrocortisone (9-α-fluorohydrocortisone) is a potent syn- further utilized in transplantation, usually in combination with thetic mineralocorticoid, being approximately 500 times more ciclosporin or azathioprine, in order to prevent rejection powerful than hydrocortisone. Benign haematological disorders for which pred- steroid receptor and mimics the action of aldosterone. It under- nisolone is indicated include autoimmune haemolytic anaemia goes significant presystemic metabolism, but unlike aldos- and idiopathic thrombocytopenic purpura and is an essential terone is active by mouth. It is used as replacement therapy in component of chemotherapeutic regimens for lymphoma and patients with adrenocortical insufficiency. It is generally reserved for a few distinct indications, including: • Mineralocorticoids mimic aldosterone’s effects on the distal nephron, causing sodium retention and potassium excretion. It is used to prolong the action of local anaesthetics (via sone as a mineralocorticoid. Tumours of the adrenal medulla that of cortisol secretion, allows aldosterone production to secrete adrenaline and other pharmacologically active cate- continue. Current concepts – corticosteroid insuffi- • The adrenal cortex secretes three major hormones.