Condet

Todd M. Johnson, MD

• Chief, Abdominal Imaging
• David Grant USAF Medical Center
• Travis AFB, California

The uterus in the female and the accessory sexual glands in the male should also be palpated to check that they are not also involved in any disease process treatment for shingles pain management order 2mg artane with visa. The scan should be carried out per rectum and a transabdominal scan can provide further useful additional information pain treatment center bethesda md purchase artane 2mg visa. The enlarged urachus can often be palpated running caudally from the umbilicus towards the bladder pain treatment center seattle wa order artane 2 mg with mastercard. Ultrasonographic confirmation of diagnosis and the extent of tissue involvement is very helpful phantom pain treatment buy 2mg artane with visa. They can also be detected and evaluated by an ultrasonographic scan through the right dorsal flank. Cystitis is more common in females than in males and often occurs shortly after parturition, especially when dystocia has occurred. Notes on specific clinical signs associated with some common bovine urinary system diseases Diseases of the kidney Pyelonephritis Usually sporadic, often in fat, middle aged cows; can also affect calves. Blood clots are sometimes seen in the urine or protruding from the external urethral orifice. The bladder wall may feel thickened, hard to the touch and painful on rectal examination. It can be difficult to diagnose and treat, and may be accompanied by heavy losses. The case history may include a number of factors which predispose to precipitation of solutes in the urinary tract. Glomerulonephritis, interstitial nephritis and nephrosis Specific physical clinical findings may not be present. Affected animals have a perineal swelling; aspiration may reveal urine, blood and debris. The scan may show free fluid in the ventral abdomen and no evidence of a distended bladder. Diseases causing haemoglobinuria in cattle Bacillary haemoglobinuria An uncommon condition seen in animals over 1 year of age. Babesiosis Seen in tick infested areas and chiefly in the spring, summer and autumn months in non-immune animals. Diseases causing haematuria in cattle Enzootic haematuria A chronic non-infectious disease of cattle aged over 1 year characterised by the formation of haemangiomata in the bladder which may lead to severe bleeding and possibly death. Postparturient haemoglobinuria An uncommon condition seen chiefly in Scotland in harsh weather conditions. Animals are on a low phosphorus diet and often feeding on rape, cabbage, turnips and kale. A more detailed and comprehensive examination may be requested and is necessary when a particularly valuable cow fails to conceive. In every case it must be remembered that the genital system is just one part of the patient. Unless the patient is in good health and her genital system is functioning normally, conception may not occur. Whenever the genital system is examined the veterinarian should also assess the general health of the patient and be alert to the possibility that disease involving other body systems may also be present. The target on many dairy farms is for cows to achieve a calving to calving interval of 365 days. Some consider this calving interval to be an unattainable and possibly undesirable goal in high yielding cows. Information required should include the overall disease profile of the farm, milk yields and both past and present fertility records. None the less, a calving interval of 365 days is very important to enable the herd to calve at approximately the same time and over a short period each year. Other congenital defects resulting in infertility are rare but none the less must be considered in such a group of animals. History of the case Details of both herd and individual patient history are of great importance in the recognition and diagnosis of problems in the female genital system.

Although a single neuron may innervate Percent of slow-twitch fibers 70 60 50 40 30 20 10 0 Percent of slow-twitch fibers Males Females 80 70 60 50 40 30 20 10 0 Vastus lateralis Deltoid High Cyclists Untrained Sprinters Middledistance jumpers runners Figure 2-18 Fiber distribution among athletes back pain treatment tamil cheap artane 2mg otc. The space between the membrane of the neuron and the muscle cell membrane at the motor end plate is called the neuromuscular cleft pain tongue treatment buy artane 2 mg amex. The neuromuscular junction is important because it is here that the electrical signal from the motor neuron is transmitted to the surface of the muscle cell that is to contract pain spine treatment center darby pa generic 2mg artane visa. Muscle cells are also supplied with afferent (sensory) nerve endings pain treatment center of illinois discount artane 2mg visa, which are sensitive to mechanical and chemical changes in the muscle tissue and which relay this information back to the central nervous system. The information carried by afferent neurons is used by the central nervous system to make adjustments in muscular contractions. The Neuromuscular Junction Spinal cord many muscle fibers, each muscle fiber is only innervated by a single neuron. Figure 2-21 illustrates the relationship between the motor unit (originating in the central nervous system) and the muscle fibers. The cell body of the motor neuron is located within the gray matter of the spinal cord, and the axon extends through the ventral root of the spinal nerve to carry the electrical signal to the muscle fiber. Each branch of the motor neuron termi- Spinal cord Cell body motor neurons Alpha motor neurons 2 1 Muscle fibers Figure 2-20 Motor units. This change in permeability and subsequent depolarization leads to the Figure 2-21 Functional relationship between motor (efferent) neurons and muscle cells. Although the neuromuscular junction functions much like other synapses, three important differences exist: 1. The second (and most often discussed) role of calcium is to control the position of the regulatory proteins troponin and tropomyosin on actin. Reflexes can be classified into two types: autonomic reflexes, which activate cardiac and smooth muscle and glands, and somatic reflexes, which result in skeletal muscle contraction. These receptors are stimulated by stretch, and they provide information to the central nervous system regarding the length and rate of length change in skeletal muscles. Stimulation of the muscle spindles results in reflex contraction of the stretched muscle via a myotatic reflex, also known as the stretch reflex. The muscle spindle consists of a fluid-filled capsule composed of connective tissue; it is long and cylindrical with tapered ends. The typical spindle is 4 to 7 mm long and approximately 1/5 the diameter of the muscle fiber. In contrast to intrafusal fibers, the muscle fibers that Reflex Control of Movement Reflexes play an important role in maintaining an upright posture and in responding to movement in a coordinated fashion. Two types of intrafusal fibers are located within the muscle spindle: nuclear bag fibers and nuclear chain fibers. Nuclear bag fibers are thicker and contain many nuclei that are centrally located. These fibers extend beyond the spindle capsule and attach to the connective tissue of the extrafusal fibers. Nuclear chain fibers are shorter and thinner and have fewer nuclei in the central area of the fiber. Both types of intrafusal fibers contain contractile elements at their distal poles. The central region of the fibers does not contain contractile elements; this represents the sensory receptor area of the spindle. A typical muscle spindle contains two nuclear bag fibers and approximately five nuclear chain fibers. The intrafusal fibers of the spindle are innervated by sensory nerves called annulospiral and flower-spray neurons. The branches of the large, myelinated annulospiral neurons wrap around the center of both types of intrafusal fibers. The flower-spray fibers are smaller than and conduct impulses more slowly than the annulospiral fibers. Both types of afferent fibers are stimulated when the central portion of the spindle is stretched. Because the intrafusal fibers are arranged in parallel with the extrafusal fibers, they are stretched or shortened with the whole muscle. The flower-spray nerve endings have a higher threshold of excitation than the annulospiral nerve endings. The flower-spray nerve endings provide information about the relative muscle length; the annulospiral nerve endings are concerned primarily with the rate of length change.

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Exercise and weight loss for the overweight are the first approaches to treating type 2 diabetes pain treatment center of baton rouge cheap artane 2 mg mastercard, and these measures often lead to management of the disorder pain management with shingles purchase artane 2mg on line. Drugs for increasing insulin production or improving cellular responses to insulin may also be prescribed advanced pain treatment center chicago artane 2mg amex, with insulin treatment given if necessary pain medication for senior dogs order artane 2 mg with amex. Women must be monitored during pregnancy for signs of diabetes mellitus, especially those with predisposing factors, because this condition can cause complications for both the mother and the fetus. Again, ensuring a proper diet is a first step to management, with insulin treatment recommended if needed. Excess insulin may result from a pancreatic tumor, but more often it occurs after administration of too much hormone to a diabetic patient. The resultant hypoglycemia leads to insulin shock, which is treated by administration of glucose. It is marked by darkening of the skin, weakness, and alterations in salt and water balance. It is associated with obesity, weakness, hyperglycemia, hypertension, and hirsutism (excess hair growth). It results in excessive thirst and production of large amounts of very dilute urine. The word mellitus comes from the Latin root for honey, referring to the sugar content of the urine. Protrusion of the eyeballs as seen in Graves disease Overgrowth caused by an excess of growth hormone from the pituitary during childhood; also called giantism Excess sugar in the urine Enlargement of the thyroid gland. Excess glucose in the blood Abnormally low level of glucose in the blood A condition resulting from an overdose of insulin, causing hypoglycemia Acidosis (increased acidity of body fluids) caused by an excess of ketone bodies, as in diabetes mellitus; diabetic acidosis A state of hyperglycemia caused by cellular resistance to insulin, as seen in type 2 diabetes, in association with other metabolic disorders; syndrome X or insulin resistance syndrome A condition caused by hypothyroidism in an adult. Its function in humans is not clear, but it seems to regulate behavior and sexual development in response to environmental light. Usually results from deficiency or faulty metabolism of carbohydrates, as in cases of diabetes mellitus and starvation. A hereditary disorder that causes tumors in several endocrine glands; classified according to the combination of glands involved A usually benign tumor of the adrenal medulla or other structures containing chromaffin cells (cells that stain with chromium salts). Sudden massive hemorrhage and degeneration of the pituitary gland associated with a pituitary tumor. Common symptoms include severe headache, visual problems, and loss of consciousness. Hypofunction of the anterior pituitary (panhypopituitarism), usually because of an infarction; pituitary cachexia A sudden onset of the symptoms of thyrotoxicosis occurring in patients with hyperthyroidism who are untreated or poorly treated. Degeneration of bone caused by excess production of hormone from the parathyroid glands. Calculation based on the amount of T4 present and T3 uptake that is used to diagnose thyroid dysfunction A test that measures the binding of glucose to hemoglobin during the lifespan of a red blood cell. It reflects the average blood glucose level over 2 to 3 months and is useful in evaluating long-term therapy for diabetes mellitus. Measurement of glucose levels in blood plasma after administration of a challenge dose of glucose to a fasting patient. A value equal to or greater than 200 mg/dL in the 2-hour sample indicates diabetes. A test that measures thyroid uptake of radioactive iodine as an evaluation of thyroid function A method of measuring very small amounts of a substance, especially hormones, in blood plasma using radioactively labeled hormones and specific antibodies Visualization of the thyroid gland after administration of radioactive iodine Test that measures the main protein that binds T4 in the blood Removal of a pituitary tumor through the sphenoid sinus (space in the sphenoid bone). The gland under the brain that controls other glands is the. The gland in the neck that affects metabolic rate is the. The endocrine glands located above the kidneys are the. The hormone insulin is so named because it is produced by the. He was terrified, having survived heart surgery, to now have to worry about multisystem organ failure. He also manifested a low-grade fever, hypotension, tachycardia, and decreased breath sounds over all lung fields. His cardiac enzymes were normal, but he showed an increase in serum leukocytes, amylase, and lipase. He was monitored for all physiologic parameters, with close attention paid to his fluid and electrolyte balance and intravascular volume, and recovered and was discharged after 6 days.

Pediatrics as a discipline recognizes that sexual experimentation lower back pain quick treatment buy cheap artane 2mg online, with oneself and others pain treatment for dogs with cancer 2 mg artane with visa, is a normal part of adolescent development knee pain treatment physiotherapy order artane 2mg overnight delivery. More controversial are the issues of age of initiation of sexual activity and the nature of those activities chest pain treatment guidelines order artane 2 mg line. There is a wide spectrum of viewpoints within pediatrics, reflecting broader societal views, on these latter issues. Masturbation, homosexual orientation, and sexual fantasies and experimentation are considered a part of the spectrum of normal adolescent sexual development. She believes her menses have been "more or less" regular but she has never kept track. She states that when she has her menses, she has pain that is occasionally bad enough that she misses school. She states that she feels perfectly fine and refuses to have a pelvic exam performed. You explain carefully the need for a thorough gynecological exam and how the exam will be done. Clinical Course: After discussing contraceptive options with the patient, she decides on the combined oral contraceptive pill. One month later, you get a call from her mother who is upset when she sees her medical insurance statement which shows an itemized expense list which contains a pregnancy test, a gonorrhea culture, and a prescription claim for birth control pills. When dealing with the adolescent patient, it is important to remember that the adolescent is the patient, even if she is accompanied by a parent, usually the mother. She may be afraid that it will be painful, and will likely be embarrassed about undressing (1). In allaying such fears, it would be helpful to direct the majority of the initial discussion toward the adolescent and to explain the exam completely. Speaking to the mother alone is useful for obtaining family history that may be pertinent and for uncovering any concerns that she may have. Patients in this age range are often modest about the changes taking place in their bodies, and it is often best to leave it up to the girl whether she wants her mother present during the exam. It is important to speak to the patient alone at some point because she may have information that she is reluctant to reveal in the presence of her mother. When attempting to solicit information about her menstrual cycles, it is best to ask specific questions regarding the frequency of menstrual flow, length of menses, and the amount of blood lost. When assessing the amount of blood lost, the patient should be asked how long it takes to soak through a tampon or pad, if she ever has to awaken in the night to change a pad, or if she has to use both methods at once. It is not enough to simply note how many pads or tampons the patient uses in a day because she may change pads as soon as one is soiled, wait until it is soaked, or change it according to her class schedule which dictates when she can make it to the restroom. Estradiol promotes the formation of uterine endometrial glandular cells and stroma. Menarche occurs when estrogen levels are sufficient to stimulate proliferation of the uterine endometrium. Estradiol also stimulates the development of the follicle and its levels increase in puberty until ovulatory cycles are established. Following menarche, plasma estradiol levels range from 50-200 pg/ml during the follicular phase, while progesterone levels range from 200-2500 ng/dl (average 750) during the luteal phase (2). The majority of cycles within the first 2 years after menarche are anovulatory, and there tends to be great variance in cycle interval, duration of flow, and amount of blood loss. Cycle intervals may be as long as 6 months and continue to be irregular for the first 15 cycles (2,4,5,6). Dysfunctional Uterine Bleeding In a normal cycle, an average of approximately 35 mL blood is lost (range 20-60 mL) (7). A good guideline may be to consider 8 pads or 12 tampons, well soaked, as the upper limit of normal; however even these estimates are user-dependent and may not correlate well with actual blood loss. A normal cycle interval ranges from 21-35 days, with less than 21 or more than 35 days considered abnormal (8). Until ovulatory cycles are established in the adolescent, endometrial proliferation occurs without progesterone regulation. The endometrium grows until the level of estrogen cannot sustain it, resulting in endometrial sloughing. In the adolescent, this results in cycles that are irregularly regular until regular ovulation is established. The time to develop ovulatory cycles is dependent on the age at which menarche occurs.

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