Showing posts with label Anatomy and Physiology. Show all posts
Showing posts with label Anatomy and Physiology. Show all posts
Pathophysiology of Myocardial Infarction
5:48 AM
Anatomy and Physiology
Increased Intracranial Pressure
5:45 AM
Anatomy and Physiology
Increased Intracranial Pressure
Intracranial pressure (ICP) is the pressure in the skull that results from the volume of three essential components: cerebrospinal fluid(CSF), intracranial blood volume and central nervous system tissue. The normal intracranial pressure is between 5-15 mmHg. This is slightly lower than the mean systemic arterial pressure but considerably higher than venous pressure.
The intact cranium is essentially inexpandable containing about 1400 grams ofcentral nervous system (CNS) or brain tissue, 75 ml of blood and about 75 ml of cerebrospinal fluid (CSF). These three components of the cranial vault maintain a state of equilibrium. Their pressure and volume determine the condition of balance. According to Monro-Kellie hypothesis, any increase in one of these elements must be balanced or compensated by a proportional constriction either or both of the other two components such as decreasing the volume of cerebral blood flow, shifting CSF flow (into the spinal canal) or increasing CSF absorption. Absence of these compensatory changes results toincreased intracranial pressure. Once ICP reaches around 25 mmHg marked elevation in intracranial pressure will be noted.
CSF is formed from the blood by the choroid plexuses, which are hanging at the roof of the brain’s ventricles. From the point where it is produced, it flows through the aqueduct of Sylvius to the fourth ventricles. Three apertures (opening) are found in the fourth ventricle which serves as passageway going to the subarachnoid spaces in the brain and spinal cord. These openings are Foramina of Magendie (median aperture) and two Foramina of Luschka (lateral apertures). A presence of tumor in choroid plexus may cause an overproduction of CSF. If the passageway of CSF is obstructed or brain tissue damage during surgery occurs, elevated ICP is inevitable.
Normally, a change in CSF and blood volume occurs. For instance, during exhalation a temporary rise in intrathoracic pressure occurs. This impairs cerebral venous drainage and thereby reabsorption of CSF. An increase in ICP might likely occur, unless the blood will be expelled or the brain tissue will shrink (compensatory mechanism). If no compensation will occur, based on Monro-Kellie hypothesis, a slight increase in intracranial pressure will take place. The same process occurs during Valsalva maneuver (forcible exhalation against a closed glottis), sneezing, coughing and straining at stool. This is the main reason why people with increase ICP and at risk for cerebral hemorrhage are instructed to avoid these instances.
Presence of carbon dioxide can also increase ICP. Carbon dioxide is a potent vasodilator that dilates aretrioles (including those in the chorionic plexus in the brain) which elevates cerebral blood volume and ICP.
Etiology
CSF – hydrocephalus
- Overproduction of CSF
- Meningitis
- Subarachnoid hemorrhage
- Brain tumor
- Impediment of CSF flow
- Narrowed foramina of Magendie and Luschka
- Obstruction in the Aqueduct of Sylvius
- Arnold-Chiari disorder
- Interference with CSF absorption
- Surgery
CNS tissue
- Head injury
- Cerebral edema
Blood
- Cerebral venous sinus thrombosis
- Hematoma
- Increased carbon dioxide partial pressure
Sources:
- Medical Surgical Nursing by Smeltzer and Bare
- Pathophysiology by Nowak and Handford
Thalassemias
5:44 AM
Anatomy and Physiology
Thalassemias
Definition
Thalassemia is a group of inherited disorders which is associated with hemoglobin defects. The disorder results in excessive destruction of red blood cells leading to anemia.
Types of Thalassemia
There are two main types of Thalassemia based on the chain of hemoglobin it affects. These are the following:
- Beta Thalassemia or Cooley’s anemia – defect in the beta-chain of hemoglobin is present.
- Alpha Thalassemia – defect in the alpha-chain of hemoglobin is present.
Forms of Thalassemia
Both the alpha and beta thalassemia include the following forms:
- Major - threatening disease characterized by severe anemia, hemolysis and ineffective erythropoiesis
- Minor - a mild form of anemia. The affected individual has only one defective gene and is asymptomatic.
Incidence
Aplha thalassemias occur frequently among Southeast Asians,Middle East Asians, Chinese and Africans.
Beta Thalassemias occur frequently to those of Mediterranean origin and lesser to Chinese, other Asians and African Americans.
Review of Related Anatomy and Physiology
Red blood cells or erythrocytes carry oxygen to the different parts of the body. Different from other cells, RBC’s do not contain a nucleus (anucleated). These small cells are circular and flattened with depressed centers on both sides resembling to that of a doughnut when viewed under a microscope. Their size and shape provides a large surface area for carrying oxygen in relation to their volume. The normal RBC count is 4-6 million/mm3. RBC’s has the life span of 120 days.
Hemoglobin is a form of protein that contains iron which is responsible for transporting oxygen that is carried in blood. Adult hemoglobin contains a beta chain (HBB) while a fetus’ hemoglobin has a gamma chain. Hemoglobin is comprised of four protein (amino acid) components. It has two beta-globin and two alpha-globin. The subunit beta-globin is located inside the RBCs. These amino acids carry an iron-bearing molecule called heme. Heme molecules, which are only found in mature RBC’s, enables the erythrocytes to pick oxygen from the lungs and transport it throughout the body. Once oxygen attaches to hemoglobin it gives the blood its bright red pigment.
The more hemoglobin molecules the RBC contain, a higher amount of oxygen will they be able to carry. If the hemoglobin is defective, the erythrocyte will also malfunction. A red blood cell is just a vessel; the one that performs the oxygen transportation is the hemoglobin. Normal hemoglobin is 13-18 grams/100 ml of blood in males and 12-16 grams in females.
Pathophysiology
Risk Factors
- Family history
- Asian, Chinese, Mediterranean or African American ethnicity
Causes
- Thalassemia is an inherited disorder that follows an autosomal recessive pattern.
Thalassemias are inherited disorders of hemoglobin synthesis that result from a change in globin chain production. Beta-globin normally joins to alpha-globin component of hemoglobin. When beta-protein is lacking, alpha-globin accumulates and causes destructive membrane effects and vice versa. This leads to destruction of red blood cells. Not only that it causes membrane damage and cell destruction but it also suppresses the mitosis in stem cells, thus RBC production falls. The result of impaired hemoglobin synthesis is a microcytic, hypochromic anemia.
Hypocalcemia in Newborns
5:43 AM
Anatomy and Physiology
Hypocalcemia in Newborns
Definition
Hypocalcemia is a disorder where there is a lowered blood calcium levels in newborns. It is defined as a total serum calcium concentration of less than 7 mg/dl. It is divided into early onset which occurs in the first 72 hours of life and late onset at about 5 to 10 days of age.
Incidence
Occurrence of this disorder is about 30% in infants with very low birth weight (<1500 g) and approximately 89% in premature infants. A very high prevalence rate is also noted in infants born with a diabetic mother.
Review of Anatomy and Physiology
Parathyroid glands are masses of glandular tissues found on the posterior surface of the thyroid gland. The parathyroids secrete parathyroid hormone (PTH) or parathormone which regulates the calcium levels in the blood. PTH is called a hypercalcemic hormone as it acts to increase the serum calcium blood levels.
Normal calcium levels in the blood vary with age: (from Saunder’s Foundations of Maternal-Newborn Nursing by Murray and McKinney, 4th Ed)
Cord = 9-11.5 mg/dl
Newborn, 3-24 hours = 9-10.6 mg/dl
Newborn, 24-28 hours = 7-12 mg/dl
Newborn, 4-7 days = 9-10.9 mg/dl
When the calcium levels in the blood drop, the parathyroids release PTH, which stimulates osteoclasts (bone cell destruction) to break down bone matrix and release calcium in the blood. The PTH also stimulates the kidneys and intestine to absorb more calcium. In contrary, the hormone that functions to decrease calcium in the blood (hypocalcemic hormone) is the calcitonin. Calcitonin is produced by the thyroid glands which cause calcium to be deposited in the bones.
Pathophysiology
Causes
Early Onset Hypocalcemia
- Maternal diabetes (gestational or insulin dependent) related to increased calcium demands of a macrosomic infant. Hypocalcemia tends to accompany the hypoglycemia that occurs in infants of a diabetic mother.
- Perinatal Asphyxia or stress
Perinatal asphyxia (suffocation) or stress could lead to anoxia. Phosphorous is released with anoxia, thus elevating its level. As phosphorous levels rise, calcium levels drop. This may also be related to renal insufficiency, metabolic acidosis and diminished parathyroid hormone secretion.
- Prematurity
Preterm babies are at an increased risk of early onset hypocalcemia in the extrauterine life. This may be related to immature parathyroid glands, premature separation of trans-placental supply, diminished responsiveness of target organs to parathyroid hormone, increased calcitonin, poor intake and decreased responsiveness to Vitamin D.
- Intrauterine growth retardation
Late Onset Hypocalcemia
- Vitamin D deficiency
This is possible related to malabsorption, renal insufficiency, maternal Vitamin D deficiency or hepatobiliary disease. Vitamin D is needed for the absorption of calcium, without it the body cannot utilize calcium.
- High phosphate formula
Phosphorous and calcium levels are maintained in an inverse proportion to each other in the bloodstream. If phosphorous levels rise, calcium levels decrease. If calcium levels elevate, phosphorous levels drop.
If an infant is fed with a phosphate-rich formula or cow’s milk tendencies of having a low calcium level in the blood may result. Whole cow’s milk has 7 times more phosphate load than breastmilk.
- Low magnesium levels or hypomagnesemia
- Congenital hypoparathyroidism
- Real disease or insufficiency
Special Senses – TASTE and SMELL
5:40 AM
Anatomy and Physiology
Overview
The nose has two primary functions. The first is olfaction – the sense of smell. However, the second function is of primary interest to this discussion – filtration, heating and humidification of the inhaled air. To accomplish the second task, the nasal cavity contains a convoluted set of passageways called the turbinates on the lateral wall of each nasal cavity.
The nose performs other various functions such as:
- Respiration.
- Air conditioning of the inspired air.
- Filtration of the inspired air.
- Olfaction or sense of smell.
- Resonating the spoken voice.
- Draining the para nasal sinuses and the nasolacrimal duct.
ANATOMY OF THE NOSE
The nose consists of the following:
- External nose – triangular-shaped projection in the center of the face.
- Nostrils – The two openings into the nasal passages.
- Nasal passages – passages that are lined with mucous membranes and tiny hairs (cilia) that help to filter the air and move nasal and sinus mucous to the back of the throat. Nasal passages are separated by the nasal septum.
- Septum – made up of cartilage and bone and covered by mucous membranes. The cartilage also gives support to the lower part of the nose and divides the nasal passages into right and left sides.
- Sinuses – four-paired, air-filled cavities.
OLFACTORY RECEPTORS AND THE SENSE OF SMELL
Chemoreceptors are those that respond to chemicals in solution for taste and olfaction. The olfactory receptors are believed to be sensitive to a much wider range of chemicals. Thousands of olfactory receptors occupy a postage stamp-sized area in the roof of each nasal cavity. These are the receptors for the sense of smell.
Air entering the nasal cavities must make a hairpin turn to enter the respiratory passageway below which causes more air to flow superiorly across the olfactory receptors, thus, intensifying the sense of smell. Olfactory receptor cells are special neurons that are equipped with olfactory hairs. Olfactory hairs are long cilia that protrude from the nasal epithelium and are continually bathed by a layer of mucus secreted by underlying glands.
When the receptors are stimulated by chemicals that are dissolved in the mucus, they transmit impulses along the olfactory filaments, which collectively make up the olfactory nerve (cranial nerve I) to the olfactory complex of the brain. It is in the brain that the interpretation of the odor occurs. The olfactory pathways are closely tied into the limbic system, the emotional-visceral part of the brain. Hence, olfactory impressions are long lasting and are very much part of our memories and emotions.
The olfactory receptors are extremely sensitive. Only a few molecules are required to activate them. Olfactory neurons tend to adapt rather quickly when they are exposed to unchanging stimulus of odor. This is the main reason why a woman stops smelling her own perfume but quickly picks up the scent of another person’s perfume.
The tongue is a versatile organ with specialized functions like taste and speech. Beneath a cover of taste buds, the tongue is almost entirely made up of muscle. The muscles of the tongue are essential for its bodily movement and intrinsic manipulations, required for actions like speech, articulation, deglutition or swallowing, whistling, licking, kissing and even cleaning teeth.
Taste is the brain’s interpretation of chemicals that trigger receptors on the tongue, which are housed in the taste buds. The basic chemical components, are found in foods, toxins, and other ingested matter. Unappealing tastes are usually associated with toxins, as this is a defense mechanism preventing consumption. The chemicals bind their particular receptors and initiate signaling that travels through the nerves to the brain, where they are interpreted.
Taste Buds
The taste buds are specific receptors for the sense of taste which are widely distributed in the oral cavity. Of the 10,000 taste buds that humans have, most are located in the tongue. Few are found on the soft palate and inner surface of the cheeks.
Papillae – small peg-like projections that covers the dorsal surface of the tongue. These peg-like projections are of three types namely:
- Sharp filiform papillae
- Rounded fungiform papillae
- Circumvallate papillae
Taste buds are found on the sides of the circumvallate papillae but are more numerous on the fungiform papillae. When a person eats something, the specific cells that respond to the chemical dissolved in the saliva are epithelial cells called gustatory cells. Gustatory cells are surrounded by supporting cells in the taste bud. Their long microvilli, the gustatory hairs, protrude through the tastepore and when they are stimulated, they depolarize and impulses are transmitted to the brain. To carry the taste impulses three cranial nerves transports it to the gustatory cortex namely:
- Cranial nerve VII
- Cranial nerve IX
- Cranial nerve X
image courtesy of medicalook.com, health.howstuffworks.com
Special Senses – The EYES
5:24 AM
Anatomy and Physiology
Overview
A person’s sense of sight is very important to humans. Vision is arguably the most used of the 5 senses and is one of the primary means that we use to gather information from our surroundings. The human eye is the organ which gives us the sense of sight, allowing us to observed and learn more about the surrounding world than we do with any of the other four senses.
People use their eyes in almost every activity they perform, whether reading, working, watching television, writing a letter, driving a car, and in countless other ways. Most people probably would agree that sight is the sense they value more than all the rest. The eyes are at work from the moment a person is wake up to the moment he or she closes them to go to sleep.
This special organ takes in tons of information about the world around you — shapes, colors, movements, and more. Then they send the information to your brain for processing so the brain knows what’s going on outside of your body.
Anatomy of the Eye
External and Accessory Structures
The adult eye is a sphere-shaped organ that measures about 1 inch or 2.5 cm in diameter. However, only one sixth (1/6) of the eye’s surface can normally be seen and the rest is enclosed and protected by a cushion of fat and the walls of the bony orbit.
The accessory structures of the eye are the following:
- Extrinsic eye muscles. The extrinsic muscles of the eye come from the bones of the orbit and are movable due to broad tendons in the eye’s tough outer surface. There are six extrinsic eye muscles that function to MOVE the eye in various directions:
- Superior rectus muscle – rotates the eye upward and toward the midline
- Inferior rectus muscle – rotates the eye downward and toward the midline
- Medial rectus – rotates the eye toward the midline
- Lateral rectus – rotates the eye away from the midline
- Superior oblique – rotates the eye downward and away from the midline
- Inferior oblique – rotates the eye upward and away from the midline
- Eyelids. The eyelids protect the eyes anteriorly which meet at the medial and the lateral corners of the eye. From the border of each eyelid are the EYELASHES. The eyelashes help filter out foreign matter, including dust and debris, and prevent it from getting into the eye. Eyelid edges associate with modified sebaceous glands make up the TARSAL GLANDs. These glands produce an oily secretion that lubricates the eye. Between the eyelashes, modified sweat glands called ciliary glands are found.
- Conjunctiva. The conjunctiva is a mucous membrane that begins at the edge of the cornea and lines the inside surface of the eyelids and sclera, which serves to lubricate the eye. It is the thin, transparent tissue that covers the outer surface of the eye. This structure is nourished by tiny blood vessels that are nearly invisible to the naked eye. The conjunctiva is composed of 3 sections:
- Palpebral Conjuctiva – covers the posterior surface of the eyelids
- Bulbar Conjuctiva – coats the anterior portion of the eyeball
- Fornix – the transition portion, forming the junction between the posterior eyelid and the eyeball
NOTE: Although the palpebral conjunctiva is moderately thick, the bulbar conjunctiva is very thin. The latter also is very movable, easily sliding back and forth over the front of the eyeball it covers. Since it is clear, blood vessels are easily visible underneath it.
Within the bulbar conjunctiva are “goblet cells,” which secrete “mucin.” This is an important component of the pre-corneal tear layer that protects and nourishes the cornea.
- Lacrimal Apparatus. The lacrimal apparatus consists of the lacrimal gland and a number of ducts that drain the lacrimal secretions into the nasal cavity. Located above the lateral end of each eye are the lacrimal glabds that continually release a dilute salt solution, known as tears, onto the anterior surface of the eyeball through several small ducts. The flow of tears flush across the following structures orderly:
- Eyeball
- Lacrimal canals medially
- Lacrimal sac
- Nasolacrimal duct that empties into the nasal cavity.
Lacrimal secretion contains antibodies and an enzyme that destroys bacteria known as lysozyme. Hence, tears cleanse and protect the eye surface as it moistens and lubricates it. in cases when lacrimal secretion substantially increases, tears spill over the eyelids and fill the nasal cavities. This causes congestion and the “sniffles.” When eyes are irritated by foreign objects or chemicals and when a person is emotionally upset lacrimal secretion is stimulated and increased.
Internal Eye structures
The Eyeball
The eye, commonly called the eyeball, is a hollow sphere and is composed of:
- 3 tunics or coats
- Humors – the interior filled with fluids that help maintain the shape of the eye
- Lens – the main focusing apparatus of the eye. This structure is supported within the eye cavity dividing it into two chambers.
TUNICS of the EYEBALL
- Fibrous Tunic – this is the outermost tunic and is also known as the sclera, the thick and white connective tissue. The fibrous tunic (sclera) is seen anteriorly as the “white part of the eye.” The central portion of this tunic is modified so that it is crystal clear. The cornea is the transparent “window” through which light enters the eye and is well supplied with nerve endings. This is the main reason why blinking and increased tearing occur when the cornea is touched because most nerve endings found here are pain fibers.
- Vascular tunic – this is the middle coat of the eyeball and has three distinguishable regions namely:
- Choroid – this is located posteriorly and lies between the sclera and the retina. It contains the blood vessels that provide nourishment to the outer layers of the retina. It is composed of layers of blood vessels that nourish the back of the eye. The choroid is opaque and deeply pigmented with melanin to absorb excessive light; else internal reflection would form multiple images on the retina. It is less vascular where the retina is thin. The choroid connects with the ciliary body toward the front ofthe eye and is attached to edges of the optic nerve at the back of the eye.
2. Ciliary Body – the ciliary body is made up of ciliary muscles and ciliary processes. It lies just behind the iris. This is the structure to which lens are attached by a suspensory ligament called the ciliary zonule and then the iris. The pigmented iris has a rounded opening, the pupil, through which light passes. Nourishment for the ciliary body comes from blood vessels which also supply the iris. Ciliary processes are short, black tissues arranged radially. They secrete aqueous humour.
One function of the ciliary body is the production of aqueous, the clear fluid that fills the front of the eye. It also controls accomodation by changing the shape of the crystalline lens. When the ciliary body contracts, the zonules relax. This allows the lens to thicken, increasing the eye’s ability to focus up close. When looking at a distant object, the ciliary body relaxes, causing the zonules to contract.
3. Sensory Tunic – this is the innermost tunic of the eye and is called the retina. This structure extends anteriorly only to the ciliary body. It converts images into electrical impulses that are sent along the optic nerve to the brain where the images are interpreted. The retina can be compared to the film of a camera. It contains millions of receptor cells, the rods and cones. Rods andcones are called photoreceptors because they respond to light.
The rods and cones are not distributed evenly in the retina. The rods are most dense at the periphery or edge of the retina and decrease in number as the center of the retina is approached. It is more numerous, some 120 million, and are more sensitive than the cones. However, they are not sensitive to color. The 6 to 7 million cones provide the eye’s color sensitivity and they are much more concentrated in the central yellow spot known as the macula. In the center of that region is the fovea centralis a 0.3 mm diameter rod-free area with very thin, densely packed cones. Consequently, this is the area of greatest visual acuity or the point of sharpest vision and anything we wish to view critically is focused on the fovea centralis.
The photoreceptor cells are distributed over the entire retina, except where the optic nerve leaves the eyeball. This is the site called the optic disc or blind spot. When light from an object is focused on the optic disc, it disappears from our point of view and we cannot see it.
LENS
The crystalline lens is located just behind the iris. Light enteringthe eye is focused on the retina by the lens. The nucleus, the innermost part of the lens, is surrounded by softer material called the cortex. The lens is encased in a capsular-like bag. It is held upright in the eye by a suspensory ligament, the ciliary zonule, attached to the ciliary body. Together, the lens and the ciliary body help control fine focusing of light as it passes through the eye. The lens is divided into two segments namely:
- Anterior (aqueous) segment – located anterior to the lens and contains a clear wayetry fluid called aqueous humor. The aqueous humor helps to nourish the cornea and the lens. It is continually produced by the ciliary body.
- Posterior (vitreous) segment – located posterior to the lens and is filled with a gel-like substance called the vitreous humor or the vitreous body. The vitreous is a thick, transparent substance that fills the center of the eye. It is composed mainly of water and comprises about 2/3 of the eye’s volume, giving it form and shape. The viscous properties of the vitreous allowthe eye to return to its normal shape if compressed. The vitreous humor helps maintain the shape of the eye.
image courtesy of health.allrefer.com, medical-dictionary.thefreedictionary.com, walgreens.com, genericlook.com
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