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Intermediate layer: Internal intercostal muscles span the intercostal space from the sternum and costal cartilages posteriorly to the angle of the ribs medications hyperkalemia cheap disulfiram 500 mg mastercard, running in an inferolateral direction from superior to inferior ribs. Deep layer: Innermost intercostal and transversus thoracis muscles represent this incomplete layer. Innermost intercostal muscles are most developed posterolaterally and may span one or two intercostal spaces. Transversus thoracis muscles consist of four to five paired slips of muscle that attach between the posterior surface of the inferior sternum to superior costal cartilages. Anterior views Deep A general rule for main intercostal muscle function is that it is opposite of muscle name! Diaphragm: Although not an intrinsic muscle of the thoracic wall, the diaphragm is the most important respiratory muscle. This dome-shaped muscle arises from the costal margins of the inferior thoracic aperture and upper lumbar vertebrae. The strong central tendon of the diaphragm serves as a common insertion point for the peripheral fibers. With inspiration, the diaphragm flattens and then assumes its relaxed dome shape during expiration. Accessory respiratory muscles: Muscles that contribute to the thoracic wall and aid respiratory function include serratus posterior superior, serratus posterior inferior, and levator costarum. These muscles may also play an important role in proprioception of the thoracic cage. Axioappendicular, neck, and abdominal muscles: Muscles that have attachments to the ribs, sternum, and costal cartilages also contribute to the structure and stability of the thoracic cage. These muscles include pectoralis major, pectoralis minor, subclavius, scalenes, serratus anterior, external abdominal oblique, internal abdominal oblique, transversus abdominis, and rectus abdominis. Innervation Thoracic spinal nerves 1-11 give rise to 11 paired thoracic anterior rami known as intercostal nerves. The T 12 anterior rami pair travel inferior to the 12th rib and are known as subcostal nerves. At the angle of the rib, a typical intercostal nerve travels between the innermost and internal intercostal muscles along the costal groove with intercostal veins and arteries. Along their course, intercostal nerves give off lateral and anterior cutaneous branches to the areas of skin that correspond to thoracic dermatomes T 1-T11. As a result of upper limb development, T 1 and T 2 spinal nerve dermatome distribution is also found along the medial arm and forearm. Muscular and sensory branches: Muscular branches arise along the course of the intercostal nerves to innervate the muscles of the thoracic wall. Sensory branches also arise to mediate sensation from peripheral portions of the diaphragm and diaphragmatic and costal pleura.

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The epithelium consists of surface mucous cells that line both the stomach lumen and the gastric pits symptoms for pneumonia disulfiram 250 mg with mastercard. Liver · the liver is located in the upper right quadrant and has four anatomical lobes-right, left, quadrate, and caudate. Imaging 171 Chapter Summary (continued) · the cell membranes of adjacent hepatocytes form a bile canaliculus that is sealed by a zonula occludens (tight junction). Gallbladder · the gallbladder is a small bile reservoir located in the gallbladder fossa of the liver, in the upper right quadrant. Pancreas · the pancreas has four main parts-head, neck, body, and tail-and extends from the second part of the duodenum to the hilum of the spleen. The mature B lymphocytes are organized into lymphatic follicles that are closely associated with the central arteriole. Small Intestine · the small intestine comprises a short duodenum, jejunum, and ileum. The latter two sections sit centrally in the abdominal cavity, often framed by the large intestine. Abdomen Chapter Summary (continued · the duodenum receives blood supply from branches of the celiac trunk and superior mesenteric arteries to allow for important collateral flow. These sections have specific arterial arrangements of multiple arterial arcades and vasa recta. The jejunum has 1-2 arcades with long vasa recta, while the ileum has 3-5 arcades and short vasa recta. The epithelium consists of enterocytes and goblet cells that cover the intestinal villi. Appendix · the appendix is a wormlike diverticulum that is attached to the cecum and suspended in a mesoappendix. Large Intestine · the large intestine frames the more centrally located small intestine and consists of the cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anal canal. The epithelium consists of enterocytes and goblet cells that line the lumen of the large intestine. Posterior Abdominal Wall · the posterior abdominal wall is supported by lumbar vertebrae; intervertebral discs; and a collection of muscles, including psoas major, quadratus lumborum, transversus abdominis, diaphragm, and iliacus. However, a large fecal mass is found in the colon, and a large release of flatus and feces follows the rectal examination. This baby suffers from colonic aganglionosis, or Hirschsprung disease, which results in the retention of fecal material, causing the normal colon to enlarge.

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The microorganism may then: · spread to adjacent hepatic cells in the liver (hepatitis viruses) medications vs medicine order disulfiram 500 mg line, or splenic lymphoid tissues (measles virus) · re-invadetheblood(S. Few, if any, host defences are in a position to control this type of viral spread once nerves are invaded. Each circulating microorganism invades characteristic target organs and tissues If uptake by reticuloendothelial macrophages is not complete within a short time, or if large numbers of microorganisms are present in the blood, there is an opportunity for localization elsewhere in the vascular system. Why each circulating microorganism invades characteristic target organs and tissues (Table 16. After localization and organ invasion, the replicating pathogen is shed from the body if the organ has a surface with access to the outside world. It may also be shed back into the bloodstream, either directly or via the lymphatic system. Spread via cerebrospinal fluid Once microorganisms have crossed the blood­ cerebrospinal barrier, they spread rapidly in the cerebrospinal fluid spaces Such microorganisms can then invade neural tissues. Injury or disease in an abdominal organ provides a source of infection for peritonitis, as do chest wounds or lung infections for pleurisy. A distinction is sometimes made between pathogenicity and virulence: virulence implies a quantitative measure of pathogenicity. It has long been known that there are host genetic influences on susceptibility to infectious disease, and that mutations in microorganisms affect their pathogenicity. A number of these genetic factors have been revealed by the application of molecular genetics techniques, and as a result it is increasingly possible to identify the specific gene products involved. The present-day European population shows considerable resistance to this disease. During the great epidemics of pulmonary tuberculosis in Europe in the seventeenth, eighteenth and nineteenth centuries, genetically susceptible individuals were weeded out. In 1850, mortality rates in Boston, New York, London, Paris and Berlin were over 500 / 100 000, but with improvements in living conditions these fell to 180 / 100 000 by 1900, and they have fallen even more since then. However, previously unexposed populations, especially in Africa and the Pacific Islands, show much greater susceptibility to respiratory tuberculosis. Genetic determinants in the host the ability of a microorganism to infect and cause disease in a given host is influenced by the genetic constitution of the host At a relatively gross level, some human pathogens either do not infect other species or infect only closely related primates. Also, within a given host species, there are genetic determinants of susceptibility. The best examples are found in animals, but there are examples for human disease (see below). One example at the molecular level is the sickle cell gene and susceptibility to malaria. The sickle cell gene causes a substitution of the amino acid valine for glutamic acid at one point in the b-polypeptide chain of the haemoglobin molecule. The new haemoglobin (haemoglobin S) becomes insoluble when reduced, and precipitates inside the red cell envelope, distorting the cell into the shape of a sickle. In homozygous individuals, there are two of these genes and the individual has the disease sickle cell anaemia, because the red cells are so fragile they sickle under normal circumstances.

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Uruk, 48 years: The largest outbreaks occurred in mainland China, with 5327 cases and 348 deaths, and Hong Kong, where 1755 cases and 298 deaths were reported. The incus body is used with a cup for the stapes head and a strut or hook to the malleus handle just below the tensor tympani insertion.

Steve, 30 years: Treatment with intravenous immunoglobulin and aspirin reduces the incidence of coronary artery damage and prevents the aneurysms if given early enough. Vasculature: the scalp receives blood supply primarily from branches of the external carotid artery, including posterior auricular, occipital, and superficial temporal arteries.

Bernado, 55 years: Gram-negative species can also take up and use larger molecules after preliminary digestion in the periplasmic space. Characteristics Laboratory identification Diseases Transmission Pathogenesis Flagellates living in blood and tissues.

Candela, 54 years: Streptomycin is the drug of choice, although other antimicrobials have been used (doxycycline and gentamicin). The ovary is covered by a simple cuboidal epithelium called the serosal epithelium with a subjacent connective tissue layer called the tunica albuginea.

Charles, 39 years: Vestigial remnants of mesonephric tubules (called the epoophoron and paroophoron) may be found in the female. In ischaemic wounds, production of numerous toxins and tissue-destroying enzymes allows organism to establish itself and multiply in wound.

Dennis, 34 years: In evolutionary terms, all infection has its costs to the host because it diverts valuable resources from the activities of survival and reproduction; there has therefore been pressure to develop means of overcoming infection whether or not it causes disease. In addition, each zygapophyseal (facet) joint is innervated by articular medial branches of posterior rami from adjacent spinal nerves, giving the synovial joint a dual innervation.

Leon, 49 years: Sigmoid mesocolon: this ligament spans between the inferior, left posterior abdominal wall and the sigmoid colon. The palm of the hand faces anteriorly when the forearm is supinated and posteriorly when the forearm is pronated.

Hatlod, 45 years: People who come into contact with infected animals, especially their placentas. Dermatomes from L1 are counted distally down the superior border of the lower limb (top red arrow) to L5 and then back proximally up the inferior border of the lower limb (bottom red arrow) to S2.