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The medial wall is formed by portion of the maxilla prostate cancer 100 psi discount speman 60pills visa, lacrimal prostate cancer urine test buy 60 pills speman free shipping, ethimoid & sphenoid bone prostate cancer yoga purchase speman once a day. Some of the principal openings and And the structures passing through are: Optic foramen (canal) passes optic nerve Superior orbital fissure passes supra orbit nerve and artery. Inferior orbital fissure passes maxillary branch of trigeminal and zygomatic nerve and infra orbital vessel. Supra orbital foramen (notch) passes occulomotor, trochlear, ophthalmic branch of trigeminal and abducent nerves. It composes 2/5th of the height of the body and has average length in male of 71 c. Encloses & protect spinal cord, supports the head and serves as a point of attachment for the ribs & muscles of the back. Each disc is composed of the outer fibrous ring consisting fibro-cartilage called annulus fibrosis and the inner soft, pulpy highly elastic structure called the nucleus pulpous. The disc permits various movement of the vertebral column, absorb shock and form a strong joint. There are 4 normal curves formed by vertebras, two are concave and the other two are convex. The presences of the curve have several functions; these are absorption of shock, maintenance of balance, protection of 81 Human Anatomy and Physiology column from fracture and increasing the strength of the column. In the age of the fetus there is only a single anterior concave curve, but approximately the third post natal month, when the child begin to hold head erect, the cervical curve develops. The cervical & lumbar curves are an anteriorly convex and because they are modification of the fetal position they are called secondary curves. The thoracic and sacral curves are anteriorly concave, since they retain the anterior concavity of the fetal curve they are referred primary curves. It has superior and inferior roughened area for attachment with intervertebral discs. The laminae are flat parts that join to form the posterior portion of the vertebral arch. The space that lies between the vertebral arch and body contains the spinal cord called vertebral foramina. The vertebral foramina of all vertebras together form the vertebral (spinal) canal. The pedicles are notched superiorly & inferiorly to form an opening between vertebrae on each side of the column called Intervertibral foramen. Intervertibral foramen is an opening between the vertebras that serves as passage of nerves that come out of spinal cord to supply the various body parts. There are seven processes that arise from the vertebral arch at the point where the lamina and pedicle joins. The Spinous processes extends posteriorly & inferiorly from the junction of the laminae. Atlas supports head, permits "yes" motion of head at joint between skull and atlas; axis Permits "no" motion at joint between axis and atlas. Thoracic vertebrae (12) Bodies and transverse processes have facets that articulate T1-T12 with ribs; laminae are short, thick, and broad. Lumbar vertebrae(5) Largest, strongest vertebrae; adapted for attachment of bending of spine. Sacrum Wedge-shaped, made up of five fused bodies united by four (5 fused bones) intervertebral disks. Coccyx Triangular tailbone, united with sacrum by intervertebral (3 to 5 fused bones) disk. Support back mus cles; allow forward and backward In a child there are 33 separate vertebrae, the 9 in the sacrum and coccyx not yet being fused. Thorax is a bony cage formed by sternum (breast bone), costal cartilage, ribs and bodies of the thoracic vertebra. It consists 3 basic portions: the manubrium (superior portion), the body (middle & largest portion) and the xiphoid process (inferior & smallest portion). The manubrium on its superior portion has a depression called jugular (supra sternal) notch.

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With the exception of trauma and stroke; the common causes of coma can be remembered by the mnemonic variety of medical conditions increase the instability or irritability of the brain and can lead to man health and environment order discount speman seizures; these include stroke; head trauma (recent or pragt); withdrawal from druga or alcohol prostate spet-085 hair loss buy 60pills speman free shipping, inadequate oxygen (hypoxia) mens health workout programs cheap speman 60 pills on-line, low blciiid sugar (hypoglycemia), and meningitis. There are four main types of seizures: Generalized motor seizures (grand mal seizures), which are characterized by loss of consciousness, tonic clonic movements (characterized by phases of continuous muscle contraction as well as Because the patient cannot tell you what hurts and because little or no history may be obtainable; the phases of alternating muscle contraction and it; laxation); and soniatiineS tongue bitinz, incontinence; and mental confusion. The seizure is usually followed by a period of coma or drowsiness, the postictal state (from the Latin "ictus," meaning "seizure"). The following points are important when obtaining the history from the seizure patient, the family, or -bystanders: Does the patient have a history of seizures? How long=clicLthe Focal motor seizures, Which usually cause one part of the body (0. If-the-seiture-is-witnessed; note where the twitching started and in which direction the eyes deviated; this information may help the physician to localize the irritable focus in the brain. Psybhomotor seizures (temporal lobe seizures); which are characterized by an altered personality seizure last? It may be necessary to obtain this information from bystanders if you do not witness the seizure. In some patients; temporal lobe seizures may cause sudden, unexplained attacks of rage; in others, thi-Se zures are manifested by automatic (involuntary) types of behaviOr. Petit mal seizures, which usually occur in chil= Does the patient abuse alcohol or drugs? They are characterized by a brief loss of consciousness without loss of motor tone. The child suddenly stares off into space for a few seconds and then returns immediately to consciousness without showing any motor symptoms: these four types of seizures, which are caused by temporary cerebral dysfunction, must be distinguished frOin-from Is there,any historY of diabetes (hypoglycemia can cause seizures), heart disease (arrhythmias can cause cerebral hypoxia, which can lead to seizures), or stroke (damage from old strokes can cause irritable foci in-the brain)? The movements are bizarre and often can be interrupted by a sharp command; the patients rarely injure themselves; bite their tongues; or are incontinent. With experience; you will usually be able to distinguish the hysterical from the genuine seizure. The physical examination is essentially the same as that outlined in earlier parts of this chapter. You should also conduct a thorough neurological evaluation as described above, paying particular attention to: Signs of head trauma and injury to the tongue or to other parts of the body which. Because of the nature of the electrical discharge in the brain; seizures usually follow a typical sequence. Many patients experience an aura, a peculiar sensation lasting a few seconds, which precedes and warns of an impending epileptic attack. The aura may consist of auditory or visual hallucinations, a peculiar taste -in the mouth, or a painful sensation in the abdomen. During the clonic phase; rigidity alternates with relaxation; and the patient may Evidence of alcohol or drug abuse such as alcohol on the breath or needle tracks on the arms. Treatment of an isolated seizure is aimed at maintaining an airway and preventing injury to the patient. Use the following guidelines in managing seizures: Never restrain the patient during the tonic-clonic phase of the seizure. Protect the patient from falling or banging into surrounding objects; clear be incontinent. There is a massive autonomic discharge, accompanied by hyperventilation; salivation, and rapid heart beat (tachycardia). If poSsible, keep the patient on his or her side td reduce the possibility of aspiration. Knowledge Of this sequence can help you distinguish the grand mal from the hysterical seizure. If the teeth are not already clenched, however, place a soft, gauze-wrapped tongue depressor between the molars to prevent 253 tongue biting. Never jam any object into the mouth ii the teeth are already clenched, as thiS can seriously injure the teeth and mouth. Maintain an airway, and administer oxygen; a After the tonic- clonic phase is over; make sure he-patient-is-on-his-or-her-side-an-d-continue administering oxygen; Suction the mouth if suction equipment is available. Speech disorders; confusion; and; in severe cases, Status epilepticus is defined as two or more seizures without an intervening period of consciousness. Repeated uncornrolled seizures may lead to aspiration, brain dam ge, fracture of the long bones and spine, death of part of the heart muscle (cardiac Predisposing factors for strokes include high blood pressure (hypertension), diabetes; and abnormal blood lipid levels; Most stroke victims are elderly, but yaung women taking oral contraceptives and young blacks with sickle-cell di-seas-6 sometimes have strokes muscle necrosis), and severe dehydration. In adult% the most common cause of status epilepticus is failure to take prescribed medicines.

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Gas in the small bowel is always abnormal prostate cancer wristband speman 60 pills on-line, except: (1) in the duodenal cap prostate oncology 91356 order 60 pills speman with visa, (2) in the terminal ileum (rare) mens health vegan buy speman cheap online, (3) in children <2yrs. They can usually give you the diagnosis, its site and chronicity, and sometimes its cause, for example, intussusception (12. If he is not well enough to sit up by himself, support him in the sitting position while you take an erect film. This will be more useful than the alternative, which is a lateral decubitus film, taken from the side while he is lying down. When you examine the films, first see if there is a distended large bowel shadow, and especially a caecal shadow. The caecum and ascending colon are distended, but there are no signs of the transverse colon or rectum. This is typical of distal large bowel obstruction; there was a carcinoma of the sigmoid colon. These are supine films, so there are no fluid levels, but the valvulae and haustra show up well. Elsewhere, fluid levels in the small bowel indicate: (1) mechanical obstruction, (2) paralytic ileus, or (3) gastroenteritis. The larger and more numerous they are, the lower and the more advanced the obstruction. Gas in the large bowel is normal, but not if the bowel shadow is hugely distended. If there are fluid levels in the large bowel, they may be: (1) normal (if there are only a few), or (2) caused by gastroenteritis. If the large bowel is also distended there is: (1) a mechanical obstruction, (2) paralytic ileus, or (3);some other cause for the dilatation, such as amoebic colitis. If there are distended loops of large and small bowel irregularly distributed with gas in the rectum, suspect paralytic ileus. If there is no gas in the caecum (which normally contains some gas), suspect that the small bowel is completely obstructed. If there are distended loops in the small bowel and minimal air in the colon, suspect partial small bowel obstruction. If there is gaseous distension of the large bowel with minimal small bowel distension, suspect large bowel obstruction or the Ogilvie syndrome. If there is much gas in the caecum (which may be huge), the large bowel is obstructed. As the pressure builds up, the small bowel often starts to distend, because the ileocaecal valve is incompetent (in of patients). If there is a gas in the rectum and rectal examination is normal clinically, obstruction is unlikely; but if the large bowel is hugely distended this suggests pseudoobstruction. If the large bowel is relatively empty, and the fluid levels in the erect film pass obliquely upwards from the right iliac fossa to the left hypochondrium, like a stepladder, they suggest volvulus of the small bowel. Ultrasound is usually unhelpful, but if there is a mass, it can show if this is solid, or contains worms, or gives the classic double ring appearance of intussusceptions. Rapid resuscitation and urgent surgery is necessary, but try to exclude pancreatitis first. If there are obvious abdominal signs, but the patient looks comparatively well, (and he has not been vomiting), suspect large bowel or incomplete small bowel obstruction. If there are the other signs of obstruction, but loose stools are passed with or without flatus, there may be: (1) An incomplete large bowel obstruction. If there is a history of several days of fever, anorexia and localized abdominal pain, followed by colicky pain and the other symptoms of obstruction, suspect that obstruction has followed intraperitoneal sepsis. Distension may mask the abdominal findings, but you may be able to elicit deep tenderness and induration in the right lower quadrant, suprapubically, rectally, or, in a woman, vaginally. If the abdomen is distended and associated with vomiting but no typical colicky pain of obstruction, suspect ileus rather than obstruction, especially if there is toxaemia and dehydration.

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