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A larger (3) afferent arteriole carries through the long discount 10 mg bentyl with mastercard gastritis loose stools, twisted pathway of the blood to the glomerulus order bentyl 10 mg overnight delivery chronic gastritis medscape, and a smaller (4) efferent tubule. The dif- electrolytes and amino acids are returned to ference in the size of these vessels provides the need- the peritubular capillaries and reenter the ed pressure to force blood plasma into Bowman circulating blood. Once this happens, the fluid is no longer • Secretion is the final stage of urine forma- plasma but is called filtrate. Substances are actively secreted from the passes behind the renal corpuscle, it forms the blood in the peritubular capillaries into the (5) peritubular capillaries. Waste products, of four sections: the (6) proximal convoluted tubule, such as ammonia, uric acid, and metabolic followed by the narrow (7) loop of Henle, then the products of medications are secreted into the larger (8) distal tubule and, finally, the (9) collecting filtrate to be eliminated in the urine. The collecting tubule transports newly formed urine to the renal pelvis for excretion by the kidneys. Urine leaves the collecting tubule and enters the The nephron performs three physiological renal pelvis. From here it passes to the bladder functions as it produces urine: until urination takes place. The union of the vas deferens with the duct from Male Reproductive System the seminal vesicle forms the (7) ejaculatory The purpose of the male reproductive system is to duct. The seminal vesicle contains nutrients that produce, maintain, and transport sperm, the male support sperm viability and produces approxi- sex cell required for fertilization of the female egg. The prostate gland The primary male reproductive organ consists secretes a thin, alkaline substance that accounts of two (1) testes (singular, testis) located in an for about 30% of seminal fluid. Within the protect sperm from the acidic environments of testes are numerous small tubes that twist and the male urethra and the female vagina. Two pea- coil to form (3) seminiferous tubules, which shaped structures, the (9) bulbourethral (Cowper) produce sperm. The testes also secrete testos- glands, are located below the prostate and are terone, a hormone that develops and maintains connected by a small duct to the urethra. Lying over the bulbourethral glands provide the alkaline fluid superior surface of each testis is a single, tightly necessary for sperm viability. It is cylindrical stores sperm after it leaves the seminiferous and composed of erectile tissue that encloses the tubules. The urethra expels semen and urine which sperm passes after its production in the from the body. Tracing the duct upward, the epididymis at the base of the bladder closes, which not only forms the (5) vas deferens (also called the semi- stops the urine from being expelled with the nal duct or ductus deferens), a narrow tube that semen, but also prevents semen from entering passes through the inguinal canal into the the bladder. The vas deferens extends over (12) glans penis, contains the (13) urethral ori- the top and down the posterior surface of the fice (meatus). A movable hood of skin, called the bladder, where it joins the (6) seminal vesicle. Midsagittal section of male reproductive structures shown through the pelvic cavity. Connecting Body Systems–Genitourinary System The main function of the genitourinary system is to enable sexual reproduction and to regulate extracellular fluids of the body. Specific functional relationships between the genitourinary system and other body systems are summarized below. Blood, lymph, and immune Endocrine • Male reproductive system transports • Kidneys regulate sodium and water bal- testosterone throughout the body in ance, which is essential for hormone trans- blood and lymph. Cardiovascular Female reproductive • Kidneys help regulate essential electrolytes • Male organs of reproduction work in con- needed for contraction of the heart. Digestive • Kidneys aid in removing waste products • Kidneys aid in removing glucose from the produced by the fetus in the pregnant blood when excessive amounts are con- woman. Anatomy and Physiology 315 Connecting Body Systems–Genitourinary System Integumentary Nervous • Kidneys compensate for extracellular fluid • Kidneys regulate sodium, potassium, and loss due to hyperhidrosis. Respiratory Musculoskeletal • Kidneys and lungs assist in regulating acid- • Kidneys work in conjunction with bone base balance of the body. It is time to review male reproductive anatomy by completing Learning Activity 11–2. Medical Word Elements This section introduces combining forms, suffixes, and prefixes related to the genitourinary system. The onset of the disease is usually acute, with Pathology of the urinary system includes a range of symptoms including pain around the kidney, disorders from those that are asymptomatic to dysuria, fatigue, urinary urgency and frequency, those that manifest an array of signs and symp- chills, fever, nausea, and vomiting.
The patient presented in our case is considerably younger than average for a hypertensive patient generic 10 mg bentyl 7 day gastritis diet. Hypertension can occur in patients of any age; however generic 10mg bentyl overnight delivery diet chart for gastritis patient, its prevalence increases with age. An algorithm is useful only when there is a suspicion of a sur- gically correctable etiology to hypertension. Cushing’s Disease Rapid weight gain, early menopause, and oligomenorrhea are sug- gestive of Cushing’s disease, which may be associated with striking physical findings. It is associated with the classically described “buffalo” hump, moon facies, easy bruising, and striae. It typi- cally occurs in middle-aged people and may be associated with proximal muscle weakness. Pheochromocytoma Pheochromocytoma classically is associated with refractory hyperten- sion along with complaints of headaches, sweating, and palpitations. This history usually is related to essential hypertension; however, a precise family history regarding hypertension should be sought. It includes medullary carcinoma of the thyroid, pheochro- mocytoma, and hyperparathyroidism. Vascular Etiology Renal Artery Stenosis Renal artery stenosis has been associated with a history of peripheral vascular disease and episodes of pulmonary edema. Coarctation of the Aorta Complex congenital heart disease may be associated with coarctation of the aorta. Generally, more complex cardiac disease leads to early, concomitant discovery of coarctation (75% of cases). Coarctation of the aorta in young patients may reveal a wide variety of findings depending on associated anomalies. In particular, auscultation of the precordium may reveal murmurs consistent with atrial or ventricular septal defects, aor- topulmonary shunts, or valvular stenoses. Case Discussion On physical examination, the patient appears anxious and well nour- ished. You obtain a 24-hour urine collection for metanephrines, vanillylman- delic acid, and plasma catecholamines. Diagnostic Testing Specific tests are used to rule out a diagnosis suggested by the history and physical findings. Endocrine Etiology Conn’s Disease Conn’s disease is evaluated by assessing plasma renin activity. Surgical Hypertension 329 diuretic administration in the presense of Conn’s disease. In a normal individual, rapid volume expansion should cause aldosterone levels to decrease to below 10ng/dL. In cases in which the diagnosis is established biochemically but the imaging does not reveal the lesion, adrenal vein sampling can help localize the lesion or diagnose bilateral hyperplasia. Cushing’s Syndrome Cushing’s syndrome is best evaluated by urinary free cortisol levels. If urinary cortisol is elevated or suppression does not occur, Cushing’s syndrome is far more likely. If a pheochromocytoma is suspected, the first screening tests are urinary catecholamines, metanephrines, vanillylmandelic acid, and plasma catecholamines. The clonidine suppression test is used to confirm the suspicion of pheochromocytoma when the urinary or plasma analyses are positive. If a patient has a pheochromocytoma, the circulating levels fail to suppress after 3 hours. Vascular Etiology Renal Artery Stenosis Duplex scanning usually is the first test used to screen for renal artery stenosis. Obtaining renal vein samples for renin levels quantitates the physio- logic significance of the stenosis to the specific kidney. The sensitivity of renal vein renin sampling is increased by the administration of captopril prior to venous blood sampling. Coarctation of the Aorta Coarctation of the aorta usually is diagnosed in early childhood and is associated with more complex cardiac anomalies.
Te erythrocytosis seen in relative polycythemia plasma rather than an increase in red blood cell occurs because of: volume or mass order 10 mg bentyl free shipping gastritis diet . Decreased plasma volume of circulating blood levels are high only in secondary polycythemia discount bentyl 10mg online chronic gastritis frequently leads to. Hematology/Apply knowledge of fundamental biological characteristics/Polycythemia/1 10. All of these options Hematology/Evaluate laboratory data to recognize health and disease states/Myeloproliferative neoplasms/3 28 Chapter 1 | Hematology 12. What influence does the Philadelphia (Ph1) Answers to Questions 12–17 chromosome have on the prognosis of patients with chronic myelocytic leukemia? Te prognosis is better if Ph1 is present arm deletion of chromosome 22, but is actually C. Te prognosis is worse if Ph1 is present a translocation between the long arms of D. This results in production Hematology/Evaluate laboratory data to recognize of a chimeric protein with tyrosine kinase activity health and disease states/Genetic theory and that activates the cell cycle. An increase in basophils An increase in basophils and eosinophils is a Hematology/Evaluate laboratory data to recognize common finding. Multiple myeloma and Waldenström’s macroglobulinemia have all the following in common except: A. Osteolytic lesions Hematology/Evaluate laboratory data to recognize health and disease states/Myeloma/Characteristics/2 1. What is the characteristic finding seen in the Answers to Questions 18–22 peripheral smear of a patient with multiple myeloma? All of the following are associated with the the triad of diagnostic markers for multiple myeloma. Serum and/or urine M component (monoclonal a lower concentration of monoclonal protein is protein) usually seen. Philadelphia chromosome plasma cells comprise less than 10% of nucleated Hematology/Correlate clinical and laboratory data/ cells in the bone marrow. Multiple myeloma is most difficult to distinguish the designation used to describe this condition. Most malignant plasma cells actively produce Hematology/Apply knowledge of fundamental immunoglobulins. In multiple myeloma, the normally biological characteristics/Myeloma/2 controlled and purposeful production of antibodies 21. Te pathology of multiple myeloma includes is replaced by the inappropriate production of even which of the following? The immunoglobulins produced by a and other cytokines clone of myeloma cells are identical. All of these options production of identical antibodies is referred to by Hematology/Apply knowledge of fundamental the general name of monoclonal gammopathy. Multiple myeloma malignancy of the: interrupts this balance by the secretion of at least A. Erythroid cell precursors resorption and release of calcium, which leads to Hematology/Apply knowledge of fundamental lytic lesions of the bone. A Waldenström’s macroglobulinemia is a malignancy of disease/2 of the lymphoplasmacytoid cells, which manufacture IgM. Although the cells secrete immunoglobulin, they are not fully differentiated into plasma cells and lack the characteristic perinuclear halo, deep basophilia, and eccentric nucleus characteristic of classic plasma cells. Cells that exhibit a positive stain with acid Answers to Questions 23–25 phosphatase and are not inhibited with tartaric acid are characteristically seen in: 23. T-cell acute lymphoblastic leukemia activity has occasionally been reported in B-cell and rarely T-cell leukemia. Sustained platelet count >600 × 109/L Hematology/Apply knowledge of special procedures/ Myeloproliferative diseases/Classifications/3 1. A 19-year-old man came to the emergency Answers to Questions 1–3 department with severe joint pain, fatigue, cough, and fever. Answers to Questions 4–5 Which section of the scatterplot denotes the number of monocytes?
