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The microsomal enzyme inducers increase the activity of glucuronyl transferase in liver gastritis sore throat discount ranitidine 300 mg buy on line. Exposure of the skin to white light causes photoisomerization of bilirubin to water-soluble lumirubin which can be rapidly excreted in bile without requiring any conjugation. Thus, phototherapy is of value in treating infants with jaundice, irrespective of its cause. A pplied A spects Kernicterus Unconjugated bilirubin because of its hydrophobic property can cross the bloodbrain barrier. When concentration of unconjugated bilirubin in plasma exceeds that which can be tightly bound to albumin (2025 mg/dL), it enters into the central nervous system and thus results in kernicterus or encephalopathy. The disease is characterized by raised serum bilirubin levels (usually exceed 20 mg/dL). In this, some activity of the enzyme is retained, therefore in these patients, serum bilirubin level does not exceed 20 mg/dL and responds to phototherapy and phenobarbitol. Anaemias Definition and classification Definition Anaemia is not a single disease but a group of disorders in which haemoglobin concentration of blood is below the normal range for the age and sex of the subject. Therefore, anaemia is labelled when haemoglobin concentration is less than: · 13 g/dL in adult males, · 11. Grading of anaemia, depending upon the level of haemoglobin, has somewhat arbitrarily been made as: · Mild anaemia-Hb 810 g/dL · Moderate anaemia-Hb 68 g/dL and · Severe anaemia-Hb below 6 g/dL. Deficiency anaemias · Iron deficiency anaemia, · Megaloblastic anaemia (pernicious anaemia) due to deficiency of vitamin B12, · Megaloblastic anaemia due to deficiency of folic acid and · Protein and vitamin C deficiency can also cause anaemia. These are relatively uncommon and occur in conditions associated with increased destruction of red blood cells. It is of two main types: · Primary aplastic anaemia, and · Secondary aplastic anaemia. It is seen in tuberculosis, chronic infections, malignancies, chronic lung diseases. Such a morphological picture is seen in: · Acute posthaemorrhagic anaemia, · Haemolytic anaemias and · Aplastic anaemias. Examples of such anaemias are: · Iron deficiency anaemia, · Chronic posthaemorrhagic anaemia, · Sideroblastic anaemia and · Thalassaemia. Examples are: · Megaloblastic anaemia (pernicious anaemia) is due to deficiency of vitamin. General clinical features of anaemia Anaemic hypoxia results due to decreased O2-carrying capacity of blood in anaemia owing to reduced haemoglobin concentration. So, general clinical features (symptoms and signs) in patients with anaemia are due to those caused by: · Resulting tissue hypoxia, and · Resulting compensatory mechanisms.
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To neutralize them gastritis diet 3 day cheap 300 mg ranitidine with visa, either the positive charged cations should move in or ve charge anions should flow out of the cell. This whole reaction catalysed by carbonic anhydrase inhibitor is called reversal of chloride shift. Neural control mechanisms include: · A system for automatic control of respiration as an involuntary function. The involuntary control system of respiration is located in the medullary and pontine centres of the brain stem. Thus, respiration enjoys the distinction of being an involuntary function which can be influenced voluntarily. Respiratory reflexes which modify the effects of neural mechanisms are those initiated by stimulation of stretch receptors, irritant receptors, Jreceptors and chest wall receptors. The chemical control mechanisms are initiated by stimulation of the chemoreceptors (central and peripheral). Functions of respiratory regulatory mechanisms include: · Genesis of normal respiratory spontaneous rhythm. Neural regulation of respiration the neural mechanisms regulating respiration can be described under two headings: · Automatic control system, and · Afferent impulses to respiratory centres. The respiratory control pattern generator, which is responsible for automatic respiration, is located in the medulla. A group of neurons called pacemaker cells from the pre-Botzinger complex, which are situated between nucleus ambiguus and lateral reticular nucleus. These neurons discharge rhythmically and generate rhythmic motor activity in phrenic nerve, hypoglossal nerve and intercostal nerves. Opioids are used as analgesic, but at the same time it causes respiratory depression as a side effect. The axons of I-neurons cross the mid-line and descend on the contralateral side of spinal cord to make contact with the spinal motor neurons of inspiratory muscles, namely, the diaphragm (supplied by the phrenic nerve arising from C3 to C5 spinal segments) and the external intercostal muscles (supplied by the intercostal nerves). This leads to a steady increase in the lung volume during inspiration rather than the respiratory gasps (abrupt distension). These muscles, therefore relax allowing elastic recoil of the chest wall and the lungs to cause expiration. In this way, the cycle of inspiration/expiration goes on continuously to cause tidal respiration. Their axons cross the midline and descend on the contralateral side to make contact with the motor neuron pool for the muscles of expiration, i. This part mainly contains I-neurons called the bulbospinal inspiratory premotor neurons. It contains several types of E-neurons which form a complex called Botzinger complex. Some of these neurons control the pharyngeal and laryngeal musculature which must relax during expiration.
It therefore promotes osmosis of water from the interstitial fluid to intravascular spaces gastritis from ibuprofen 150 mg ranitidine buy otc, thereby increasing the plasma volume. Sympathomimetic drugs are useful as: · Sympathomimetic drugs are usually not useful in haemorrhagic shock where the sympathetic system is already very active. In general, it does not have marked effect since the hypoxia of shock is of the anaemic or stagnant type and not of hypoxic type. They are particularly useful in anaphylactic shock: · They increase the strength of heart in the last stages of shock, · By stabilizing lysosomal membranes, they prevent release of enzymes of cells and · They help in metabolism of glucose by the severely damaged cells. Heart failure Heart failure is a pathophysiological state of the heart when cardiac performance is too low to maintain the cardiac output to meet the demands of the metabolizing tissues. According to Starling law of heart, an increase in preload (end-diastolic volume) augments cardiac function, but when there is too much increase in preload then (it operates through descending limb of Starling curve, see page 246) it leads to ventricular dilatation and heart failure. Types and causes of heart failure Heart failures can be classified by various ways. Chronic heart failure develops due to gradual deterioration of heart functions, as in patients suffering from valvular diseases. It means impairment of cardiac performance is being compensated by certain adaptive changes that prevent development of overt heart failure. Local changes, which are in the form of: · Enlargement of chambers of heart, · Myocardial hypertrophy and · Increase in heart rate. Systemic changes are: - Activation of reninangiotensinaldosterone system and sympathetic system and - Release of antidiuretic hormone and atrial natriuretic peptide. Initially, compensatory changes improve cardiac performance, but as the disease advances they fail and become counterproductive. In the presence of certain precipitating factors such as infections, anaemia, pregnancy, thyrotoxicosis, arrhythmia and myocardial infarction or due to failure of compensatory mechanisms, compensated heart failure leads to decompensated heart failure. Anatomically, left heart comprises left atrium, left ventricle, aortic valve and mitral valve. Left ventricular outflow obstruction due to: · Systemic hypertension · Aortic valve stenosis · Coarctation of aorta ii. Reduced ventricular contractility due to: · Cardiomyopathy particularly involving left ventricle and · Anterior wall myocardial infarction. Like left heart anatomically right heart includes right atrium, right ventricle and tricuspid and pulmonary valves. In this condition, there is simultaneous involvement of right and left heart due to disease of myocardium, or left ventricular failure and after sometime involves the right heart also. Backward heart failure is the one in which decreased cardiac output results in the elevation of the end-diastolic volume and thus increases the ventricular pressure. The elevation of left and right ventricular pressure results in pulmonary and systemic congestion, respectively. Systolic heart failure occurs due to poor myocardial contractility (systolic dysfunction) and 2.
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Taklar, 22 years: Cardiac muscle Functional anatomy · Structural organization of cardiac muscle · Structure of a cardiac muscle fibre · Sarcotubular system. These fibres are myelinated, have a diameter of less than 3 µm and their conduction velocity varies from 4 to 30 m/s.
Irhabar, 41 years: Role in speech Salivary mucus lubricates the oral mucosa and thus aids speech by facilitating movements of lips and tongue. Dorsal (tegmental) part of pons contains: · Decussations of trepezoid body, · Nuclei of 5th, 6th, 7th and 8th cranial nerves, · Pontine reticular formation and · A number of descending and ascending tracts.
Shawn, 42 years: Sodium reabsorption the process of sodium reabsorption in proximal tubule is isosmotic, i. It is also related to the fibres of 7th nerve (as they wind round the abducent nucleus), and to some fibres arising from the cochlear nuclei.