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The type of treatment received varies greatly Investigation of subtle psychological or from facility to facility and depends on the behavioral symptoms is also important in particular type of crisis experienced order 100mg clomid free shipping menstrual goddess. In addi- Treatment usually begins with detoxifi- tion buy clomid 25 mg on-line womens health institute of macon, the incidence of accidents and cation, which may or may not involve injury is often increased. Detoxification is only an initial step in the treatment of substance The first step in the treatment of sub- use disorders, however. Ongoing therapy stance-related disorders is identifying and that includes a variety of rehabilitation acknowledging the problem. Screening may strategies, such as psychotherapy, family be hampered by several barriers, including: therapy, and self-help programs (e. In almost all instances, typically accompany it as well as for their abstinence is a treatment goal. In some instances, drugs are prescribed Successful treatment of substance use dis- in the ongoing treatment of substance orders generally requires more than one dependence. Antabuse and methadone (or level of care during the long recovery pro- other opiate substitute), which were dis- cess. Treatment may involve outpatient or cussed earlier, are drugs commonly used inpatient care and continued aftercare. They deny that a substance use Because nutritional deficiencies frequent- problem exists or may rationalize their ly accompany substance use disorders, behavior by redefining their substance most detoxification centers and residential use so that it appears to be acceptable. Educational pro- perform violent acts when they are under grams that stress the importance of nutri- the influence of certain substances. Those tion, as well as other aspects of a healthy who are predisposed to this type of reac- lifestyle, are often incorporated into the tion may become involved in criminal general treatment program. PSYCHOSOCIAL AND VOCATIONAL As individuals become increasingly ISSUES IN SUBSTANCE ABUSE dependent on the substance, the concept of living without it produces fear and Psychological Issues dread. Individuals interpret removal of the substance as removal of all joy and excite- The extent to which psychological dis- ment from life. As with all types of per- ability is the direct result of a substance- ceived loss, individuals may experience related disorder or the cause of the dis- grief and bereavement. Individuals Recovery from a substance use disorder with substance use disorders frequently involves restoration of self-esteem and have low self-esteem and experience confidence, as well as willingness to depression. They may have feelings of in- accept responsibility for personal behav- adequacy, loneliness, and isolation that ior. Influenced the losses they have experienced and to and controlled by the substance, they may develop skills for coping in the future. Doubt that they will be able to includes long-term vigilance and a contin- cope without the substance may erode uing commitment to remain drug-free. Lifestyle Issues Individuals who are psychologically dependent on a substance feel a need and A substance-related disorder affects longing for the substance and become irri- every aspect of individuals’ daily life. As table, depressed, anxious, and resentful dependence on the substance becomes when the substance is not available. Indi- more pronounced, individuals may lose viduals with a psychological craving for a interest in self-care, may show a decreased substance may attribute their need to a desire for food, and may have a variety of personal flaw in their character or may sleep disturbances, resulting in sleep dep- consider their need as a negative reflection rivation. Either interpretation fur- focused on obtaining more of the sub- ther contributes to lowered self-esteem stance. Psychosocial and Vocational Issues in Substance Abuse 225 Substance use can affect individuals’ Individuals with a substance use disor- ability to drive. Poor driving performance der may be unable to function within can result in accidents or arrests, which their social network. Social and family rela- problem, so that individuals must depend tionships are strained and often destroyed on others for their transportation needs. Decreas- experience not only decreased libido but ing reliability in performing social roles also adverse effects on sexual perform- and continued inability to maintain com- ance, including impotence, a common mitments cause those affected by the indi- side effect of chronic alcohol abuse. Indi- vidual’s deterioration to feel disappointed viduals recovering from a substance use and angry. Others in the social environ- disorder may need to learn or relearn the ment may have to alter their own roles to components of a healthy lifestyle, such as incorporate duties the individual once good hygiene and grooming, proper diet, had.

Outer Many different models for the countercurrent mechanism medulla have been proposed; each must take into account the princi- ple of conservation of matter (mass balance) discount 100 mg clomid with mastercard pregnancy foods to eat. In the steady state order 100mg clomid overnight delivery menstruation calculator menstrual cycle, the inputs of water and every nonmetabolized solute must equal their respective outputs. It provides some additional insight Inner into the countercurrent mechanism. Notice that fluids enter- medulla ing the medulla (from the proximal tubule, descending vasa recta, and cortical collecting ducts) are isosmotic; they all have an osmolality of about 285 mOsm/kg H2O. It follows from mass balance considerations that somewhere a hypoosmotic 50 fluid has to leave the medulla; this occurs in the ascending limb of the loop of Henle. Because water is added to the medulla along the de- 30 scending limbs of the loops of Henle and the collecting ducts, this water must be removed at an equal rate. The cending limbs of the loops of Henle cannot remove the numbers indicate relative amounts (100 fil- added water, since they are water-impermeable. The heavy outline from the thick is removed by the vasa recta; this is why ascending exceeds ascending limb to the outer medullary collecting duct indicates descending vasa recta blood flow (see Fig. Urea is added to the inner blood leaving the medulla is hyperosmotic because it drains medulla by its collecting ducts; most of this urea reenters the loop a region of high osmolality and does not instantaneously of Henle, and some is removed by the vasa recta. Concentrating Mechanism Urea is also added to the inner medulla by diffusion from the It has long been known that animals or humans on low-pro- urine surrounding the papillae (calyceal urine). Urea ac- tein diets have an impaired ability to maximally concen- counts for about half of the osmolality in the inner medulla. A low-protein diet is associated with a de- The urea in the interstitial fluid of the inner medulla coun- creased [urea] in the kidney medulla. The proximal convoluted tubule is fairly perme- balance osmotically the other solutes (e. Fluid collected from the distal convoluted tubule, however, has as much urea as the amount filtered. Therefore, urea is A Dilute Urine Is Excreted When secreted in the loop of Henle. Plasma AVP Levels Are Low The thick ascending limb, distal convoluted tubule, con- necting tubule, cortical collecting duct, and outer Figure 23. As water is reabsorbed along cortical and outer medullary Tubular fluid is diluted along the ascending limb and be- collecting ducts, the [urea] rises. The result is the delivery comes more dilute as solute is reabsorbed across the rela- to the inner medulla of a concentrated urea solution. A con- tively water-impermeable distal portions of the nephron and centrated solution has chemical potential energy and can collecting ducts. In these cir- The inner medullary collecting duct has a facilitated urea cumstances, the osmotic gradient in the medulla is reduced transporter, which is activated by AVP and favors urea dif- but not abolished. The decreased gradient results from sev- fusion into the interstitial fluid of the inner medulla. Urea eral factors, including an increased medullary blood flow, 400 PART VI RENAL PHYSIOLOGY AND BODY FLUIDS H2O Inherited Defects in Kidney Tubule Ep- 100 TABLE 23. The collecting ATPase ducts are relatively water-impermeable (heavy outlining) because Nephrogenic Vasopressin-2 (V ) Polyuria, polydipsia 2 AVP is absent. Note that the medulla is still hyperosmotic, but less diabetes insipidus receptor or so than in a kidney producing osmotically concentrated urine. Specific molecular defects have been identified in the proximal tubule (renal glucosuria, cystinuria), thick as- cending limb (Bartter’s syndrome), distal convoluted INHERITED DEFECTS IN KIDNEY TUBULE tubule (Gitelman’s syndrome), and collecting duct (Lid- dle’s syndrome, pseudohypoaldosteronism type 1, distal EPITHELIAL CELLS renal tubular acidosis, nephrogenic diabetes insipidus). Recent studies have elucidated the molecular basis of several Although these disorders are rare, they shed light on inherited kidney disorders. In many cases, the normal and mu- the pathophysiology of disease in general. It appears the finding that increased epithelial Na channel activ- that inherited defects in kidney tubule receptors (e. REVIEW QUESTIONS DIRECTIONS: Each of the numbered (C) mL plasma/min (E) Collecting duct intercalated cells items of incomplete statements in this (D) mL urine/min 3. A man needs to excrete 570 mOsm of section is followed by answers or by (E) mL urine/mL plasma solute per day in his urine and his completions of the statement.

In many cells 50mg clomid for sale articles on women's health issues, a de- pump will increase its activity and reduce intracellular Na CHAPTER 2 The Plasma Membrane clomid 100mg line women's health uc, Membrane Transport, and the Resting Membrane Potential 33 to its normal value. Cells that regularly encounter hyper- Passive exit + K tonic extracellular fluids have developed additional mecha- via nongated nisms for maintaining normal volume. These cells can syn- channel Active transport by thesize specific organic solutes, enabling them to increase + + Na /K -ATPase intracellular osmolality for a long time and avoiding alter- + ATP + ing the concentrations of ions they must maintain within a K 2K narrow range of values. The organic solutes are usually + small molecules that do not interfere with normal cell func- Na tion when they accumulate inside the cell. For example, cells of the medulla of the mammalian kidney can increase ++ 3 Na3 Na the level of the enzyme aldose reductase when subjected to elevated extracellular osmolality. This enzyme converts ADP glucose to an osmotically active solute, sorbitol. Synthesis of sorbitol and inositol represents different answers to the problem of in- creasing the total intracellular osmolality, allowing normal Passive entry + cell volume to be maintained in the presence of hypertonic via nongated Na extracellular fluid. The rate of Na en- try is matched by the rate of active transport of Na out of the Oral administration of rehydration solutions has dramati- cell via the Na /K -ATPase. The intracellular concentration of cally reduced the mortality resulting from cholera and Na remains low and constant. Similarly, the rate of passive K other diseases that involve excessive losses of water and exit through nongated K channels is matched by the rate of ac- solutes from the gastrointestinal tract. The intracellular ents of rehydration solutions are glucose, NaCl, and water. During each cycle The glucose and Na ions are reabsorbed by SGLT and of the ATPase, two K are exchanged for three Na and one other transporters in the epithelial cells lining the lumen of molecule of ATP is hydrolyzed to ADP. Deposition of these type indicate high and low ion concentrations, respectively. Ion Movement Is Driven by the Absorption of glucose increases the absorption of NaCl Electrochemical Potential and water and helps to compensate for excessive diarrheal losses of salt and water. If there are no differences in temperature or hydrostatic pressure between the two sides of a plasma membrane, two forces drive the movement of ions and other solutes across the membrane. One force results from the difference in the THE RESTING MEMBRANE POTENTIAL concentration of a substance between the inside and the The different passive and active transport systems are coor- outside of the cell and the tendency of every substance to dinated in a living cell to maintain intracellular ions and move from areas of high concentration to areas of low con- other solutes at concentrations compatible with life. The other force results from the difference in sequently, the cell does not equilibrate with the extracellu- electrical potential between the two sides of the membrane, lar fluid, but rather exists in a steady state with the extra- and it applies only to ions and other electrically charged cellular solution. When a difference in electrical potential exists, concentration (10 mmol/L in a muscle cell) is much lower positive ions tend to move toward the negative side, while than extracellular Na concentration (140 mmol/L), so negative ions tend to move toward the positive side. Na enters the cell by passive transport through nongated The sum of these two driving forces is called the gradi- Na channels. The rate of Na entry is matched, however, ent (or difference) of electrochemical potential across the by the rate of active transport of Na out of the cell via the membrane for a specific solute. The expression of this intracellular Na is maintained constant and at a low level, force is given by: C even though Na continually enters and leaves the cell. The where represents the electrochemical potential ( is passive exit of K through nongated K channels is the difference in electrochemical potential between two matched by active entry via the pump (see Fig. Main- sides of the membrane); Ci and Co are the concentrations tenance of this steady state with ion concentrations inside of the solute inside and outside the cell, respectively; Ei is the cell different from those outside the cell is the basis for the electrical potential inside the cell measured with re- the difference in electrical potential across the plasma spect to the electrical potential outside the cell (Eo); R is the membrane or the resting membrane potential. By inserting these units in and each of these ions contributes to the resting membrane equation 5 and simplifying, the electrochemical potential potential. By contrast, the permeability of the membrane of will be expressed in cal/mol, which are units of energy. If most cells to divalent ions is so low that it can be ignored the solute is not an ion and has no electrical charge, then z in this context. In this The Goldman equation gives the value of the mem- case, the electrochemical potential is defined only by the brane potential (in mV) when all the permeable ions are ac- different concentrations of the uncharged solute, called the counted for: chemical potential. The driving force for solute transport RT PK[K ]o PNa[Na ]o PCl[Cl ]i becomes solely the difference in chemical potential. E E ln (8) i o PK[K ]i PNa[Na ]i PCl[Cl ]o F Net Ion Movement Is Zero where PK, PNa, and PCl represent the permeability of the at the Equilibrium Potential membrane to potassium, sodium, and chloride ions, re- spectively; and brackets indicate the concentration of the Net movement of an ion into or out of a cell continues as long ion inside (i) and outside (o) the cell. Net movement stops and equilib- not permeable to one of these ions, the contribution of rium is reached only when the driving force of electrochemi- the impermeable ion to the membrane potential will be cal potential across the membrane becomes zero.

You can dissect the body layer by layer clomid 50 mg mastercard women's health boot camp workout, or use a scroll bar to navigate up to a depth of 330 layers clomid 50mg free shipping menstruation age 8. You can also highlight a specific structure for an in-depth study or search by anatomical term to locate all instances of a structure. Other features include an alphabetized glossary and labeled structures for easy identification. Keep abreast of breaking news by clicking the latest scientific headlines from The New York Times or links to prominent journals in the Briefing Room. Visit the Student Center to ask a question on the discussion boards, brush up on test-taking tips, or perform job and internship searches. Conduct a virtual laboratory experiment at BioLabs, or head to The Quad to browse the vast array of rich, multimedia content specific to your course. History of Anatomy © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 History of Anatomy 1 Definition of the Science 2 Prescientific Period 2 Scientific Period 4 Clinical Case Study Answer 20 Chapter Summary 20 Review Activities 21 Clinical Case Study A 55-year-old women visits the village apothecary for her increasing shortness of breath. The physician, learning of the woman’s symptoms and finding swelling in her legs, makes the diagno- sis of dropsy and prescribes a course of therapy meant to rid the body of evil humors. He applies a dozen of his healthiest leeches to the woman’s legs and drains a pint of her blood by opening a vein in her arm. The ex- perience reinforces to the doctor the concept of evil humors and the effectiveness of bloodletting as a therapy. Current therapy for this condition is oral fluid restriction and medications that in- duce diuresis (increased urination) with the ultimate goal of decreasing fluid volume. It is no wonder that losing a pint of blood made this woman feel better in the short term. Unfortu- nately, repeated courses of this crude therapy left patients profoundly anemic (low red blood cell count) and actually worsened their heart failure. Throughout medical history, how has an accurate understanding of human anatomy and physiology led to better disease therapy? FIGURE: Blood letting was a technique of medical practice widely used for over two thousand years. History of Anatomy © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 2 Unit 1 Historical Perspective the structure of the body often has been stimulated by the desire DEFINITION OF THE SCIENCE of the medical profession to explain a body dysfunction. Various The science of human anatomy is concerned with the structural religions, on the other hand, have at one time or another stifled organization of the human body. The descriptive anatomical termi- the study of human anatomy through their restrictions on human nology is principally of Greek and Latin derivation. Over the centuries, peoples’ innate interest in their own bodies and physical capabilities has found various forms of ex- Objective 2 Distinguish between anatomy, physiology, and pression. Many of the Objective 3 Explain why most anatomical terms are derived great masters of the Renaissance portrayed human figures in their from Greek and Latin words. Indeed, several of these artists were excellent anatomists be- cause their preoccupation with detail demanded it. Such an artis- tic genius was Michelangelo, who captured the splendor of the Human anatomy is the science concerned with the structure of human form in sculpture with the David (fig. The term anatomy is derived from a Greek ings like those in the Sistine Chapel. The body found expression in his writings: “What a piece of work is a science of physiology is concerned with the function of the man! It is inseparable from anatomy in that structure tends to re- moving, how express and admirable! Anatomy and physiology are both In the past, human anatomy was an academic, purely de- subdivisions of the science of biology, the study of living organ- scriptive science, concerned primarily with identifying and nam- isms. The anatomy of every structure of the body is adapted for ing body structures. Although dissection and description form performing a function, or perhaps several functions. Human as the basis for understanding the structure and function of the anatomy is a practical, applied science that provides the founda- human body for many centuries. Every beginning anatomy stu- tion for understanding physical performance and body health.