Ventral portions of the tube will become the basal plate and give rise to motor neurons 1950s medications generic 10 mg domperidone fast delivery, whereas the dorsal portions become the alar plates medicine you can take while pregnant buy domperidone 10 mg visa, derivatives of which subserve sensory functions symptoms of ebola purchase domperidone 10mg with visa. Meninges are formed by mesoderm surrounding the neural tube with contributions to the arachnoid and pia from neural crest symptoms pink eye purchase 10mg domperidone amex. Folic acid symptoms yeast infection generic domperidone 10mg overnight delivery, also known as folate medications list template 10 mg domperidone sale, is a B-vitamin that can be found in some enriched foods and vitamin supplements. Folic acid is found in some foods, such as enriched breads, pastas, rice, and cereals (some with 100% of the daily requirement). Damage is dependent on gestational age, alcohol dosage, and pattern of maternal alochol abuse. Focal deficiencies in neural crest cell migration may result in lack of innervation to specific organs or parts of organs. In Hirschsprung disease (aganglionic megacolon), failure of neural crest cells to migrate to a portion of the colon results in a localized deficiency in parasympathetic intramural ganglia that may cause a loss of peristalsis and bowel obstruction. Each arch receives its blood supply from a specific aortic arch and its innervation from a specific cranial nerve (special or branchial visceral efferent fibers). The third aortic arch provides most of the adult blood supply to the head and neck. The skeletal muscles of the head and neck primarily arise from the pharyngeal arches and have a unique innervation (special visceral efferent). The face develops from a midline frontonasal prominence and bilateral maxillary and mandibular prominences. Teeth originate from both ectodermal (enamel) and neurectodermal (neural crest: dentin, pulp, cementum, and periodontal ligament) derivatives. Eye the eye is derived from three different germ layers: Neuroectoderm: Vesicular outgrowths of the forebrain differentiate into retina and optic nerve. Surface ectoderm: Contributes to the lens, cornea, and epithelial coverings of the lacrimal glands, eyelids, and conjunctiva. Structures of the outer and middle ear are derived from the first and second pharyngeal arches and the first pharyngeal cleft. Structures of the inner ear are derived from the ectodermal otic placode, not neuroectoderm. Maternal rubella can cause defects in both eye (fourth to sixth weeks of gestation) and ear (seventh to eight weeks). The heart tubes forming on either side of the endodermal tube are brought together by lateral body folding. Looping of the heart tube occurs while the tube is being divided into left and right portions by the interatrial and interventricular septa. In the interatrial septum, the septum primum and septum secundum do not close off the foramen ovale until birth. Failure of the atrioventricular endocardial cushions to fuse can result in septal and valve defects. Neural crest cells contribute to septation of the truncus arteriosus and the formation of the aortic and pulmonary outflows, as well as the aortic arches. Vasculature Vasculogenesis versus Angiogenesis the endothelial lining of most blood vessels forms by coalescence of vascular endothelial progenitors (angioblasts) of mesodermal origin. The endothelial cells proliferate, migrate, differentiate, and organize into tubular structures with subsequent vacuolization to form a lumen. Subsequently, periendothelial cells form from local mesoderm and differentiate into muscle and connective tissue elements. That process is known as vasculogenesis and occurs in both embryonic and adult tissues. Vasculogenesis is the de novo formation of blood vessels and differs from angiogenesis, initiated in a pre-existing vessel. Angiogenesis also is a prominent characteristic of inflammation, pathology such as diabetic retinopathy, wound repair, placental development during embryogenesis, and tumor formation. Molecular triggers for angiogenesis include the cytokines, small, extracellular signal proteins or peptides that function as local mediators in cell-cell communication. Pharmaceutical agents modeled after these anti-angiogenic peptides are being developed to inhibit tumor growth. Development of the Vasculature the paired doral aortae and the five aortic arches form an early symmetric arterial system. Regression of portions of these vessels later results in the asymmetrical adult arterial system. High-Yield Facts 9 the vitelline arteries connect the yolk sac to the abdominal dorsal aorta. Blood islands are the first sites of hematopoiesis and seed other hematopoietic tissues. The paired umbilical arteries develop from the caudal end of the dorsal aorta and invade the mesoderm of the placenta. The caval venous system is derived mostly from the right anterior and posterior cardinal veins. The vitelline veins form the veins of the digestive system, including the portal vein, and the terminal part of the inferior vena cava. No components of the umbilical veins remain patent after closure of the ductus venosus. These are, in succession, the liver (week 5), spleen (week 5), and bone marrow (month 6). All components of hematopoietic organs are derived from mesoderm except for the epithelium of the thymus, which is derived from endoderm of the third pharyngeal pouch. The midgut endoderm is the last to fold into a tube and remains connected to the yolk sac via the yolk stalk. Formation of the mesodermal urorectal septum divides the cloaca into the urogenital sinus and primitive rectum. Failure to recanalize can result in stenosis, preventing the passage of amniotic fluid swallowed by the fetus causing polyhydramnios. Failure of neural crest cell migration to the distal hindgut results in aganglionic megacolon (Hirschsprung disease), which may cause fatal intestinal obstruction. Failure of the midgut loop to return to the abdominal cavity may result in an omphalocele or umbilical hernia. Associated digestive organs (liver, gallbladder, and pancreas) originate as outgrowths of the endodermal tube. Connective tissue components of the liver are derived from both splanchnic and somatic (septum transversum) lateral plate mesoderm. Lateral plate mesoderm also forms the peritoneum and mesenteries of the abdominal cavity. In the fourth week, a respiratory diverticulum arises as an outgrowth of the ventral endodermal tube. Endoderm will form the respiratory epithelium, whereas splanchnic lateral plate mesoderm will form connective tissue elements including cartilage, smooth muscle, and blood vessels. The diaphragm forms from the septum transversum, the two pleuroperitoneal membranes, the dorsal mesentery of the esophagus (where the crura develop), and the muscular parts of the dorsal and lateral body wall. Although most alveoli do not form until after birth, the lungs are capable of sufficient gas exchange after 6. Surfactant is essential for expansion of the pulmonary alveoli; it lowers the air-interface surface tension and prevents the alveoli from collapsing at the end of expiration. Three pairs of kidneys develop in cranio-caudal sequence in the urogenital ridge of intermediate mesoderm: pronephros, mesonephros, and metanephros. The ureteric bud induces surrounding intermediate mesoderm to form the metanephric cap, which forms the excretory units of the kidney. During kidney development, epithelial-mesenchymal interactions occur reciprocally between the epithelium of the ureteric bud and the mesenchyme of the metanephric cap (blastema) to convert the mesenchyme of the metanephric cap into an epithelium. Those complex inductions are regulated by a cascade of growth factors that allow a dialogue between the epithelium and mesenchyme and the eventual formation of urineproducing (nephron) and collecting portions. The epithelial lining (transitional epithelium) of the ureters, as well as their muscular and connective tissue components, are derived from intermediate mesoderm. The transitional epithelium of the bladder and most of the urethra are derived from hindgut endoderm of the urogenital sinus. The endoderm of the urogenital sinus gives rise to the epithelia of distal organs of the reproductive system and the external genitalia. As in the urinary system, connective tissue and smooth muscle of these terminal elements are provided by splanchnic lateral plate mesoderm. Germ cells migrate from their origins in yolk sac endoderm into the indifferent sex cords of the urogenital ridge by week 6. The Sry gene on the Y chromosome directs the differentiation of the medullary sex cords into testes. Leydig cells produce testosterone and other sex hormones that regulate further male differentiation. The mesonephric system will persist in the male and the paramesonephric system in the female. In males, the mesonephric system gives rise to the efferent ductules, epididymis, ductus deferens, seminal vesicles and ejaculatory ducts. In females the paramesonephric system gives rise to the oviduct, uterus and upper part of the vagina. In males, the urogenital sinus endoderm gives rise to the epithelia of the urethra and associated prostate and bulbourethral glands. In the female, the endoderm of the urogenital sinus is the origin of the epithelium of the lower vagina, the upper portion being formed by the paramesonephric ducts. Female differentiation is the intrinsic pathway and occurs in the absence of androgens and/or functioning androgen receptors. Syncytiotrophoblast cells are in direct contact with maternal tissue, whereas the embryo proper is separated from the cytotrophoblast by extraembryonic mesoderm (together, the chorion). The presumptive umbilical blood vessels form in the wall of the allantois, an endodermal outpocket of the urogenital sinus. The amnionic membrane develops from epiblast and is continuous with embryonic ectoderm. The lining of the yolk sac develops from hypoblast and is continuous with embryonic endoderm. High-Yield Facts 13 the yolk sac gives rise to the first blood islands that will form the vitelline vessels. Passive immunity is transfered to the fetus by transport of immunoglobulin G (IgG) from the maternal to the fetal circulation. In the bilayer, the hydrophilic portions of the lipids are arranged on the external and cytosolic surfaces, and the hydrophobic tails are located in the interior. Transmembrane proteins are anchored to the core of the bilayer by their hydrophobic regions and can be removed only by detergents that disrupt the bilayer. Peripheral membrane proteins are attached to the surface of the membrane by weak electrostatic forces and are easy to remove by altering the pH or ionic strength of their environment. It contains various membrane-bound organelles, nonmembranous structures (such as lipid droplets, glycogen, and pigment granules), and structural or cytoskeletal proteins in either a soluble or insoluble form. Lysosomes degrade intracellular and imported debris, and peroxisomes oxidize a variety of substrates, through beta-oxidation and are the sole source of plasmalogens. In the absence of mannose 6phosphate on lysosomal enzymes (I-cell disease) they follow the default pathway and are secreted from the cell. Receptor-mediated endocytosis is the process that permits selective uptake of molecules into the cell using clathrin-coated pits and vesicles. The late endosome is more acidic than the early endosome and generally leads to degradation of the molecules in lysosomes. Also included in the cytoplasm are three classes of proteins that form the cytoskeletal infrastructure: actin bundles that determine the shape of the cell; intermediate filaments that stabilize the cell membrane and cytoplasmic contents; and microtubules (tubulin), which use molecular motors. The nuclear envelope contains pores for bidirectional transport and is supported by intermediate filament proteins, the lamins. This is the "beads on a string" structure with the histones forming the octamer arrangment of paired H2A, H2B, H3, and H4. The next orders of packing are the 30 nm chromatin fibril, the chromatin fiber with loops of chromatin fibrils, and chromatin fibers loosely or tightly packed in euchromatin and heterochromatin respectively. Equal distribution of chromosomes is accomplished by the microtubules of the mitotic spindle. The separation of cytoplasm (cytokinesis) occurs through the action of an actin contractile ring. The cell cycle consists of interphase (G1, S, and G2), and the stages of mitosis (M): prophase, prometaphase, metaphase, anaphase, and telophase. The cell cycle is regulated at the G1/S and G2/M boundaries (checkpoints) by phosphorylation of complexes of a protein kinase [cyclin-dependent kinase (Cdk) protein] and a cyclin (cytoplasmic oscillator). Phosphorylation of lamins results in their breakdown as well as the dissolution of the nuclear envelope. Overarching the Cdks are the Cdk inhibitors that form an additional regulatory layer at each of the cell cycle checkpoints. Study of the cell cycle is critical to an understanding of the regulation of abnormal proliferation as occurs in cancer cells. Two tumor suppressor genes that have been well studied are retinoblastoma gene (Rb) and p53. Rb is active (suppressing growth) in the hypophosphorylated state and inactive in the hyperphosphorylated form. In its nonphosphorylated form Rb serves as a brake on the cell cycle at the G1/S interface by binding to the transcription factor, E2F.
Which of the following drugs has not been associated with photosensitive reactions? Which of the following is the most important action that nursing student should take? A: Atherosclerosis B: Diabetic nephropathy C: Autonomic neuropathy D: Somatic neuropathy 8 symptoms pancreatitis quality domperidone 10mg. This patient has a history of a myeloma diagnosis medicine quizlet order domperidone 10mg line, constipation medicine 6 year buy 10mg domperidone visa, intense abdominal pain symptoms 5 dpo order domperidone 10mg, and polyuria medications reactions purchase 10mg domperidone fast delivery. Which of the following microorganisms has noted been linked to meningitis in humans? A: Following surgery B: Upon admit C: Within 48 hours of discharge D: Preoperative discussion 22 treatment quotes images generic domperidone 10mg fast delivery. Which of the following would you not expect to see with this patient if this condition were acute? A 84 year-old male has been loosing mobility and gaining weight over the last 2 months. The patient also has the heater running in his house 24 hours a day, even on warm days. A parent calls the pediatric clinic and is frantic about the bottle of cleaning fluid her child drank 20 minutes. A nurse is caring for an adult that has recently been diagnosed with respiratory alkalosis. A: Anxiety attacks B: Dizziness C: Hyperventilation cyanosis D: Blurred vision 49. A patient has recently been diagnosed with polio and has questions about the diagnosis. The overall mental and physical abilities of the child is the most important factor. Rajendra Prasad Centre for ophthalmic Sciences, All India institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029 Ph. When one thinks in depth about various implants, we realize that this topic touches almost every structure of eye and every subspeciality in Ophthalmology. However it is uncommon to find a book which covers various sub-specialities and implants used by them. With this idea at the back of our mind, we have selected commonly used implants in various parts of the eye. The authors of each chapter have vast experience in their own field & each one of them could write a book on the topic itself. Wherever possible we have tried give references so that this booklet may become a starting point for Ophthalmologists to gather desired information and knowledge in detail. Panophthalmic coverage of various implants along with references by various authors, I am sure will prove to be useful educative material for all. An insight into the other implants used in various sub-specialities has also been provided. Shah Cornea, Anterior Segment & Refractive Surgery Services Netra Mandir, Borivli, Mumbai Dr. However, when implanted in a 45 year old lady, it led to high myopia & astigmatism. Parry and later Epstein further modified the posterior chamber intraocular lenses but they did not gain much popularity. Various workers like Strampelli, Choyce, Danheim, Barraquer provided their own designs. Noteworthy amongst these was Binkhorst Iris clip lens with four closed loops, 2 in front and 2 behind which was subsequently modified by Fyodorov. Worst designed the Iris Claw lens which was a single piece lens with superior and inferior haptics with narrow slits that insert into the stroma of midperipheral iris for fixation. They happened with the realization that posterior capsular membrane provided the ideal support for an intraocular lens. Sonawale Community & General Ophthalmology Services Netra Mandir, Borivli, Mumbai From the time when they were first introduced, Intraocular lenses have seen continuous change in the designs and materials used in their manufacture in a quest to find the perfect replacement for the natural crystalline lens removed during the cataract surgery. In mid to late 1970s it was realized that capsular membrane was ideal support for intraocular lens. These are supported in the capsular bag or by haptics placed in the ciliary sulcus. Larger optics (7 mm) were introduced to reduce the chances of papillary capture as well as to reduce optical aberrations. Meniscus lens They have convex anterior surface and concave posterior surface Aspheric lens They improve optical quality by reducing higher order aberrations like Spherical aberrations and thus improving contrast sensitivity and quality of vision especially in low lights. Multifocal Intraocular lens They have more than one focal point for distance as well as near. Lot of new designs are coming up in this segment, currently available ones are Diffractive & Refractive lenses. Surface coating with hydrogels, chondroitin surface coating and surface passivation by fluorocarbons are other ways of surface modification. Sutured Lenses these are the lenses which are supported by sutures passed through haptics and supported to the sclera. Flexible Acrylic - Acrylic lenses are available in two varieties, hydrophilic and hydrophobic - Copolymer of phenyl ethylacrylate and phenylethylmethacrylate. Shah Cataract & Refractive Surgery Services Netra Mandir, Borivli Mumbai Cataract surgery is a refractive procedure in true sense. The goal of modern cataract surgery is not removal of opaque lens from the visual axis and replacing it with an artificial lens to provide 6/6 vision, but it aims at quality of vision along with unaided near, distant and intermediate range of vision that the natural young accommodating lens provides at the age of 20 years. Multifocality can be achieved by implanting 1) Unifocal lens which can accommodate 2) Bifocal lens which provides 2 focal points; one for distance and second for near, or 3) Multifocal lens which provides multiple focal points for distance, intermediate and near vision. Types of lenses Diffractive Lenses: these are usually bifocal lenses wherein bifocality is grinded on the posterior surface of lens. Refractive Lenses: these are usually multifocal lenses wherein multifocality is grinded on the anterior surface of lens. Accommodative Lenses: these are unifocal lenses which give some amount of accommodation due to anterior shift of its optical portion during the act of accommodation. One casts a sharp mage on the retina while other casts blurred image Fig I, 3-A,B,C. Hence after implantation of these lenses patient takes some time to get adjusted to the lens. Hence with these lenses there are more than one unwanted images on retina which brain has to learn to ignore. Though alternate zones show dominance for distance and near, each zone has progressive power for distance, intermediate and near vision. Fig I, 3-D Multiple focal points of Refractive lens Patient selection As a beginner, it is advisable to select Hyperopic patient rather than Myopic since their unaided distance as well as near vision is less than normal. A housewife or someone whose needs are relatively less is 8 a good patient in the beginning. Patients actively involved in night driving are once again not ideal candidates due to problems of glare and halos with these lenses. Best results are achieved when bilateral implants are done at short interval and hence patient ready for other eye operation within a month or two is ideal. Accurate measurement of corneal power and antero posterior length of eye should be emphasized in every case. Various Multifocal lenses Array (Fig I,3-E) was the first multifocal lens to be introduced. It has 5 zones, 1st 3rd and 5th being distant dominant and 2nd and 4th being near dominant zones. Light allocation is 50% for distance, 37% for near and 13% for intermediate vision. It is a lens of the diffractive variety and gives excellent distant as well as near vision. Multifocal rings grinded on the posterior surface come closer to each other as we go to the periphery of lens. Design based on normative topographic asphericity in general population it can neutralize positive asphericity of cornea in large number of patients. This lens maintains good centration and quickly gets stabilized in the capsular bag. The lens can be introduced in the eye with specially designed injector system through a 2. Having achieved 6/6 for distance during subjective refraction, patient may continue to have 6/6 vision inspite of adding more minus power in trial frame. It is also wise not to be in a hurry to give addition for near vision in spectacle correction since most patient take some time to get habituated with this different focusing system implanted in their eyes. Such vigilant skill will help to avoid unnecessary mistakes in glass prescription. Halos and glare are quite common but patient gets adjusted to it within a short time. Though it is best to implant both eyes with multifocal lens, people with monocular lens in one eye and multifocal in other eye can get adjusted to it. This knowledge is important when one faces a situation wherein, having implanted multifocal lens in one eye, second eye has an intraoperative complication preventing the surgeon from implanting multifocal lens in second eye. The anterior shift normally can yield about 2 D addition, which is not the full addition required by the patient. This disadvantage is to some extent compensated by little improved quality of vision in dull illumination since this lens has monofocal optic. When ciliary muscle contracts the haptics are compressed pushing the optic forward due to the hinge. During accommodation the posterior optical plate moves forward towards the opening in the center of anterior ring increasing plus power of focusing system. Visual performance with multifocal intraocular lenses: mesopic contrast sensitivity under distance and near conditions. From the data collected with help of aberrometry from a large population, an average asphericity was calculated. Thus once again this will not help to remove spherical aberration in this given eye and hence good quality vision can not be achieved. It was in 1948 when Sir Harold Ridley (Moorfields Eye Hospital) reconceived the idea and with the help of Rayner Optical Company designed the first modern Intra Ocular Lens. In Eyes with insufficient capsular support due to intraoperative traumatic posterior capsular rupture 3. The lens is best placed in the capsular bag, which affords stable fixation at a position closest to the nodal point of the eye. In absence of any capsular remnants, the options available are anterior chamber lenses, iris fixated lenses and scleral fixated posterior chamber lenses. Original techniques involved the ab interno approach that is passing the needle from inside to outside the eye (Figure 1,6-A) which gave way to the ab- externo approach, in which the sulcus positioning of 3 the suture is more predictable. Besides the accurate suture placement, it avoids the risk of catching the vitreous with the needle and incarcerating it at the fixation point4. Fig I,6-A Abinterno approach To avoid suture erosion of the knots, scleral flaps have become popular to cover the knots or are rotated into the scleral tissue. Recently, the adequacy of 10-0 prolene has been questioned in maintaining the long term stability of scleral fixated lenses and use of 9-0 prolene is being advocated instead. Airaqueous exchange of anterior chamber is performed using two 26 G needles introduced at the limbus. The straight needle and the 26 G needle are entered perpendicular to the scleral surface, advanced towards each other in the posterior chamber and the former is docked into the lumen of 26 G needle (Figure I, 6-B). The 26 G needle is retrieved from the temporal scleral bed along with the prolene suture which is seen stretched across the posterior chamber. The two are tied together and another bite is taken from the proximal end of the undersurface of the scleral flap (Figure I, 6-E). A controlled and balanced tension on the 10,0 nylon suture causes the scleral flap to fall back and cover the mesh of suture knots (Figure I, 6-F). The sutures underneath the scleral flap are trimmed and a similar procedure is repeated on the opposite scleral bed. The conjunctiva is repositioned with the bipolar cautery or conjunctivo-limbal suture. Endophthalmitis: Pathogens can gain access at the time of surgery or at a later date via the exposed sutures. Lens tilt/decentration: When using two point fixation, the points should be exactly 180 degrees apart. Retinal detachment: It is more common when the anterior hyaloid face has been disturbed with/without vitreous prolapse. Posterior chamber intraocular lens implanpation in absence of posterior capsular support. Tilt and decentration after primary and secondary transsclerally sutured posterior chamber intraocular lens implantation. Laser refractive surgery in such cases is limited by the amount of corneal tissues available and predictability of the results. The implantation of phakic intraocular lens neither affects the shape nor the thickness of cornea and provides predictable refractive results. Inclusion Criteria Endothelial cell count should be atleast 2500cells/mm, the anterior chamber depth more than 3mm, the pupil round and the angle 22 of the anterior chamber open.
In humans symptoms jaundice generic 10mg domperidone with mastercard, the L com mon carotid branches directly off the aortic arch; only the R common carotid branches off the brachiocephalic artery medicine lock box buy 10 mg domperidone amex. In the cat 911 treatment center generic domperidone 10mg without prescription, the aorta gives off the two external iliac arteries symptoms 5th week of pregnancy cheap 10mg domperidone with amex, then persists briefly before dividing into the two internal iliac arteries and the median sacral artery; there are no common iliac arteries medications like abilify buy 10mg domperidone fast delivery. In humans treatment interstitial cystitis discount 10 mg domperidone overnight delivery, the external and internal iliac arteries arise by branching off the common iliac arteries. How do the relative sizes of the external and internal jugular veins differ in the human and the cat? In the cat the inferior vena cava is called the, and the superior vena cava is precava referred to as the. Define the following terms: Ascending aorta: the aorta as it emerges from the heart and travels toward the head. If the student cats are double injected, it might be of value to order one triple-injected cat for demonstration of the lymphatic system. Before ordering, make sure that triple injected means that the lymphatic system has been injected. Often, triple injection means that the hepatic portal venous system has been injected separately from the vascular system injections. It returns lymph from the lower body and upper left quadrant of the body to the left subclavian vein. Answers to Activity Questions Activity 1: Identifying Organs of the Respiratory System (pp. The primary bronchi are large; subsequent branches are smaller and smaller in diameter. Multimedia Resources: See Appendix B for Guide to Multimedia Resource Distributors. Answers to Activity Questions Activity 1: Identifying Alimentary Canal Organs (pp. The mesenteries provide a route for blood and lymphatic vessels and nerves to travel to and from the small intestine. There are no major differences in external anatomy along the length of the small intestine. Activity 2: Exposing and Viewing the Salivary Glands and Oral Cavity Structures (pp. The numerous filiform papillae are used by the cat for grooming and for removing flesh from bones. Human filiform papillae are less numerous, blunted, and softer. They have a reduced need for grinding and thus have fewer molars. The villi in the duodenum are more elongated and more numerous than those in the ileum. Villi contribute to the increase in surface area that is necessary for absorption of nutrients, especially in the duodenum. Most absorption occurs in the proximal portion of the small intenstine. Once the kidneys have been isolated there should be no difficulty identifying the ureters. Answers to Activity Questions Activity: Identifying Organs of the Urinary System (pp. The ureters enter the bladder on the right and left lateral surfaces toward the posterior (caudal) end. How does the position of the kidneys in the cat differ from their position in humans? In the cat, the kidneys are located at the same level or the right kidney is more anterior. The urethra carries urine from the urinary bladder to the exterior. How does the site of urethral emptying in the female cat differ from its termination point in the human female? Cat: with the vagina, it empties into the urogenital sinus, then to the body exterior. In the cat they are superior, separate, and medial to the kidneys, close to the inferior vena cava. Caution students with male dissection animals to be careful when dissecting out the spermatic cord to avoid breaking it. Remind students that they are responsible for doing both male and female dissections. Students must use bone cutters to cut through the pubic region of the pelvis to complete the dissection. Answers to Activity Questions Activity 2: Identifying Organs of the Female Reproductive System (pp. The female cat has a uterus; that of the human female is simplex. Cat: Y-shaped central inferior chamber (body) from which two horns (cornua) extend. Designate a disposal container for organic debris, set up a dishwashing area with hot soapy water and sponges, and provide lab disinfectant such as Wavicide-01 (Carolina) or 10% bleach solution for washing down the lab benches. Set out disposable gloves, dissecting kits, dissection trays, plastic storage bags, twine, metric rulers, paper towels, and name tags. Emphasize the use of the blunt probe as a dissecting instrument, rather than the scalpel. Muscle development may be poor in some fetal pig specimens if they are very young. Answers to Activity Questions Activity 3: Dissecting Trunk and Neck Muscles Superficial Muscles of the Posterior Trunk and Neck (pp. The acromiotrapezius and spinotrapezius muscles appear to have the same functions in the pig as in humans. Activity 5: Dissecting Hindlimb Muscles Muscles of the Posterolateral Hindlimb (pp. In humans the semimembranosus is also medial to and partially obscured by the semitendinosus. The origin of the rectus femoris in humans is the anterior inferior iliac spine and just above the acetabulum. Dissection Review Many human muscles are modified from those of the pig (or any quadruped) as a result of the requirements of an upright posture. How do the size and orientation of the human sartorius muscle differ from that in the pig? In humans, the sartorius is a thin straplike muscle running obliquely across the anterior thigh. In the pig it is broad and flat and covers most of the anterolateral thigh. In addition to these functions, it also extends the knee in the pig. The human rectus abdominis is definitely divided by four transverse tendons (tendinous intersections). These tendons support the muscular abdominal wall so that the viscera are not allowed to become pendulous in the upright posture of humans. In what region (cervical, thoracic, lumbar, or sacral) of the spinal cord would you find the following special features? As you trace a spinal nerve laterally, it divides into dorsal and ventral (rami/roots). Describe the appearance of the sympathetic trunk as seen in your dissection animal. From anterior to posterior, put the nerves issuing from the brachial plexus of the pig in proper order. How do the location of the endocrine organs in the fetal pig compare with those in the human? They are similar but in the pig the pancreas is more diffuse, the adrenal glands are medial rather than superior to the kidneys, and the thymus is much larger. Given the assumption (not necessarily true) that human beings have more stress than adult pigs, which endocrine organs would you expect to be relatively larger in humans? During fetal development, T cells are rapidly dividing and maturing in the thymus gland. Remind them that the individual systems will be studied in detail at a later date. The thoracic duct drains lymph from the left side of the head, neck, trunk, and left upper the thoracic duct: extremity, as well as all of the abdomen and both lower extremities into the left subclavian vein. The right lymphatic duct drains lymph from the right side of the head, neck, the right lymphatic duct: trunk, and right upper extremity into the right subclavian vein. What differences did you observe between the origin of the common carotid arteries in the pig and in the human? In the pig, the common carotid arteries may arise from the bicarotid trunk (a branch off the brachiocephalic trunk) or directly from the brachiocephalic artery. In humans, the right common carotid artery arises from the brachio cephalic artery; the left common carotid artery arises directly from the aortic arch. How do the relative sizes of the external and internal jugular veins differ in the human and the pig? In the pig, often there are two brachial veins in each forelimb, which anastomose frequently along their course. What differences did you note between the origin of the hepatic portal vein in the pig and in humans? The internal iliac arteries are branches of the umbilical arteries at the aorta terminus. Humans: the external and internal iliac arteries arise from the division of the common iliac arteries, which are the final aorta branches. Answers to Activity Questions Activity 1: Identifying Respiratory Organs of the Fetal Pig (pp. The lungs have never been inflated; therefore the tissue contains essentially no air and is dense. Lungs that have been inflated contain trapped air and will float. In the pig the large intestine will have a very different arrangement from that of the human. Answers to Activity Questions Activity 2: Identifying Digestive Organs in the Abdominal Cavity (pp. The mesenteries provide a route for vessels and nerves to travel to and from the small intestine. The ileocecal valve prevents regurgitation of material from the cecum into the ileum. Dissection Review Several differences between pig and human digestive anatomy should have become apparent during the dissection. Note the pertinent differences between the human and the pig relative to the following structures. Structure Number of liver lobes Appendix Appearance and distribution of colon Presence of round ligament Pig Five Absent, cecum present Ascends and then forms a tight coil before descending Absent. How do the structure and connectivity of the urinary bladder of the fetal pig differ from those of the urinary bladder of the human (or the adult pig, for that matter)? The fetal urinary bladder is very elongated and continues into the umbilical cord as the allantoic stalk. After birth, it is transformed into the adult urinary bladder, which empties into the urethra. What differences in fetal elimination of nitrogenous wastes account for the structural differences described above? How does the site of urethral emptying in the female pig differ from its termination point in the human female? The female pig has a uterus; that of the human female is. Cite the differences between the pig and the human relative to the following structures: They are very tiny and relatively much shorter in the pig. Set out disposable gloves, safety glasses, dissecting instruments, dissection tray, plastic storage bags, paper towels, and name tags. Sometimes the dissection animal is in very poor condition, in which case the student should exchange it for a different specimen. To prevent damage to muscles during skinning, separate skin from underlying tissues by inserting a blunt probe into the skin incision in the neck. Answers to Activity Questions Activity 3: Dissecting Head, Neck, and Trunk Muscles Head and Neck Muscles (pp.
The horn of the hoof and wall treatment of tuberculosis generic domperidone 10mg without a prescription, the interdigital space and the coronet should be visually inspected symptoms 1 week after conception purchase 10 mg domperidone mastercard, palpated 236 and manipulated to identify abnormalities medicine zofran buy 10mg domperidone. Overgrown horn should be removed and the remaining horn carefully examined for erosion and penetration by underrunning infection which occurs in foot-rot 909 treatment buy discount domperidone 10 mg on line. Earth packed in this space and stones lodged between the digits can cause lameness which is relieved by their removal symptoms 7dpo discount domperidone 10 mg fast delivery. If these vesicles have burst symptoms prostate cancer generic 10mg domperidone mastercard, a ragged-edged erosion is Clinical Examination of the Sheep Scald Soil balling Interdigital fibroma Foot rot White line abscess Puncture wounds Shelly hoof Figure 15. Gross swelling of a digit in association with acute pain on manipulation may indicate a septic arthritis of the proximal or distal interphalangeal joints; radiography is useful in locating the site and providing further diagnostic detail. Joints with septic arthritis have distended capsules, are hot and painful, and have reduced movement. Erysipelas infection can occur in lambs and adult sheep, and causes some joint swelling and thickening of the epiphyses of affected limbs. There may also be some joint effusion, but this is often less than in cases of septic arthritis caused by Streptococcus dysgalactiae. Checks are made on muscles for evidence of atrophy or abnormal swellings and pain. If white muscle disease is suspected, a blood sample can be checked for creatinine phosphokinase, and a urine sample for myoglobinuria. In many of these conditions treatment of the individual is of limited value, but a rapid and accurate diagnosis is essential to implement appropriate flock treatment control and prevention. Metabolic conditions in adult ewes include pregnancy toxaemia (dullness, recumbency, head pressing), hypocalcaemia (weakness, recumbency, flaccid paralysis), 238 hypomagnesaemia (hyperaesthesia, staggers) and kangeroo gait (ataxia). Head tilt, which is a rotation about the long axis, may indicate inner- or middle-ear infection or a lesion in the upper medulla ipsilateral to the lower ear. Compulsive circling movements may indicate a brainstem or cerebellar lesion on the side to which the animal turns or a cerebral lesion which is usually on the contralateral side. Facial paralysis may cause unilateral bulging of the cheeks by retention of the cud, lingual paralysis, drooping of the ear and/or eyelid. The hemiwalking test is performed by holding up the thoracic and hind limb on one side and forcing the animal to Straw wrapped around hind leg Figure 15. A wide-based stance indicates proprioceptive abnormality and/or a cerebellar lesion. The Taenia multiceps (Coenurus cerebralis) cyst is usually found in the right or left cerebrum or the cerebellum. In sheep the vein may be tortuous, having a constant position only at the angle of the jaw. In clipped and unclipped sheep it is readily raised by a ligature placed carefully around the base of the neck. Many sheep farmers do not like wool clipped off their sheep if they are show specimens, and the ligature method allows ready location of the jugular vein without clipping by palpation and parting the fleece. Conditions such as swayback caused by copper deficiency, entropion or coccidiosis may be recurrent problems. The current vaccination programmes, including diseases causing abortion, clostridial diseases and orf, should be considered. Prophylactic treatments, such as antibiotic treatments for watery mouth and the use of anticoccidials, may be relevant to the current problem. Lack of protocols for navel dressing may be related to an increase in the incidence of neonatal joint ill. The clinical signs observed, the group affected, and the morbidity and mortality rates of the current problem should be noted together with possible risk factors. Meningeal haemorrhages and fractured limbs can result from excessive traction being applied during manipulation. Ewes with a poor condition score may also have reduced quantities of milk and colostrum. Cryptosporidiosis, rotavirus infection and salmonellosis may be seen between 48 hours and 7 days of age. Star gazing with the head held in dorsiflexion may indicate congenital cerebellar atrophy of daft lamb disease. A depressed neonatal lamb which is weak and unable to stand may be hypothermic and/or hypoglycaemic. Sudden death, trembling, blindness and fitting in growing lambs are signs seen in cerebrocortical necrosis. Growing lambs affected by louping ill may show a wide range of neurological signs including an abnormal bound- Signalment Some conditions affecting lambs are age related. The onset of hypothermia and/or hypoglycaemia usually occurs during the first 24 hours of life. Sudden collapse, stiff hind legs, weakness or breathing difficulties in lambs may be caused by white muscle disease, and an elevated serum creatinine phophokinase in addition to vitamin E and selenium levels may confirm the diagnosis. Stiffness and an unwillingness to move with muscle tremors may be seen in tetanus which is usually associated with a recent wound. The use of incubators and intraperitoneal glucose injections can be lifesaving, but poorly supervised use of incubators can result in hyperthermia with fatal consequences. Physical examination Lambs can be lifted onto a table or held under the arm by an assistant for examination. Heart rate and respiration the heart rate of a normal lamb is 80 to 100 beats per minute and the respiratory rate 36 to 48 breaths per minute. Septicaemia this may be caused by a variety of bacterial organisms, and affected lambs are dull, weak, unable to stand, pyrexic and anorexic, sometimes with nervous signs. In septicaemic animals hypopyon may be present, with the anterior chamber containing inflammatory material. Entropion or inturning of the eyelids is a common condition which may be unilateral or bilateral; keratitis, corneal ulceration and tear staining may be present as a consequence. In the absence of entropion the conjunctival recesses beneath both eyelids and the third eye lids should be examined for a foreign body such as a grass seed. Pustular or scabby lesions around the mouth in several lambs with reluctance to suckle may suggest orf infection. Chest Fractured ribs may be a cause of abnormal breathing rhythm due to pain; palpation and radiography (if justifiable) can be used to confirm the diagnosis. Auscultation of the heart should be performed; the presence of a murmur may indicate a congenital heart defect such as a ventricular septal defect or a vegetative endocarditis from another septic focus such as joint ill. The infection may extend internally, affecting the congenital umbilical structures and liver. This septic focus may also give rise to bacteraemia and/or septicaemia causing joint ill, meningitis and internal organ abscessation. Umbilical hernias may be visually identified, and palpation will reveal whether the contents are reducible or not. An enlarged abdomen in a lamb 7 days old and above which is otherwise alert may indicate atresia ani. This is likely to be rattle belly or watery mouth caused by Escherichia coli endotoxaemia. Abdominal pain is recognised by extreme tensing of the abdomen and groaning on palpation. Abdominal pain is present in other Feet the condition and integrity of the horn of the hooves should be checked and any swellings investigated. Each bone should be palpated, and if a fracture suspected the site should be gently manipulated to check for crepitus. Applying a stethoscope to the area on manipulation may increase the chances of auscultating crepitus. Radiology, if economically justified, will confirm the diagnosis and detail the type of fracture. Extreme protein deficiency and a dietary imbalance of phosphorous and calcium may result in osteodystrophy, causing deformities such as an inward or an outward bowing of the forelimbs. Joint ill this is a relatively common condition in lambs and previous observations may increase the 246 suspicion of this condition. The skin over the enlarged joint capsule is aseptically prepared and a sample of joint fluid obtained using a sterile needle and syringe. Streptococcus dysgalactiae, Escherichia coli, Erysipelothrix rhusiopathiae and, in tick areas, Staphylococcus aureus, are common causes. There may be staining of the perineum by diarrhoea, and scouring may be observed during defaecation following or during placement of the thermometer in the rectum. The association between diarrhoea, endoparasitism and fly-strike should be considered with lambs at grass, and the skin around the tail examined for the presence of maggots. Check that the rubber ring has not been incorrectly placed around the neck of the scrotum ensnaring part of the urethra. Blood testing the lambs may confirm cobalt deficiency or a low vitamin E and/or selenium status. Further clinical tests, clinical pathology and possibly a post-mortem examination may be employed to confirm or refute the provisional diagnosis. The importance of a comprehensive clinical examination and an accurate diagnosis in these circumstances cannot be overemphasised. The difficulties of examining pigs can be largely overcome by using a quiet and gentle approach. In general, the greater the restraint of the pig the less effective the clinical examination. For some procedures such as blood sampling and X-ray examination, restraint and possibly sedation are essential. Its tendency to squeal when restrained makes some aspects of the examination such as auscultation of the chest difficult, but seldom impossible. Attempting to examine one or two sick pigs in a group of twenty others can be difficult. Records available may also contain details of the carcase quality and the food conversion rate of recent batches of finished pigs. The following points are noted: (1) Are the affected pigs home-bred or were they purchased? A mild transitory enteritis is seen in many herds when new grain is introduced into the diet after harvest. This is easily identified if set feeding times are used, and is less easily detected in ad libitum systems. It is not uncommon to be called to a farm on which a number of pigs in a group have been found dead, others are showing varying degrees of illness and other batches in nearby accommodation are possibly also at risk. The breed and type of pigs kept will be known as will the type of unit, for example weaner production or bacon pig production. Details of this, including the drugs used and the frequency and success of usage will be known. If the long-term history is not known, much information can be quickly obtained by observation and questioning the owner or stockperson. For example, common causes of enteritis in piglets include Escherichia coli and rotavirus organisms which rarely cause disease in adults. Is it full of dust, causing people entering to cough or experience breathing difficulties? It may also be seen in cases of gastritis caused by Hyostrongylus rubidus and in cases of severe illness, for example peracute and acute erysipelas. Pigs on a twice daily feeding regime should empty their trough within 10 minutes of being fed. Is the field free from old bricks and other debris which might predispose to foot or other orthopaedic injuries? Observation of the pigs Initial observation of the undisturbed pigs At this stage, the clinician is looking for any obvious signs of abnormal behaviour and general signs of ill health which may later require further detailed investigation. If sleeping pigs are suddenly alerted, healthy animals often make a short sharp barking noise which sounds as if they are clearing their throats. They also often make this same noise if new straw has been added to the pen and they are galloping around in an excited fashion. Recently weaned and mixed groups of pigs will spend much time fighting or sham fighting until their hierarchy is established. Any pigs that are not with the main group and are standing or lying away from them may be unwell. Inspection of all the pigs on the farm is also an essential part of the routine visit and one for which the veterinary surgeon is particularly well qualified. The clinician must look in every corner of each pen to ensure no ill pigs are there. Response of the pigs to people Pigs are often initially startled by the arrival of the Lesions of chronic mastitis Figure 16. Excessive interest in boots may be seen in pigs suffering from iron deficiency anaemia. Specific signs of disease noted at this stage may include poor bodily condition, respiratory abnormalities including coughing, sneezing or laboured breathing, neurological signs, lameness, diarrhoea, pruritus and abnormal body shape. If hungry, the piglets will stay close to the sow making a high pitched rather disgruntled sound. When not feeding her piglets, the sow usually lies in sternal or less commonly in lateral recumbency.
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References
Mittal R, Saxena S, Guleria S, et al. Visceral leishmaniasis: a rare cause of unexplained pyrexia in a renal allograft recipient. Nephron. 1995;70:123-124.
Kovacs JA, Hiemenz JW, Macher AM, et al. Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 1984;100(5):663-671.
Brott TG, Halperin JL, Abbara S, et al: ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery Developed in Collaboration With the American Academy of Neurology and Society of Cardiovascular Computed Tomography, J Am Coll Cardiol 57:1002-1044, 2011.
Dawson BV, Johnson PD, Goldberg SJ, et al. Cardiac teratogenesis of halogenated hydrocarbon-contaminated drinking water. J Am Coll Cardiol. 1993; 21:1466-72.
Wallace MB, Fritscher-Ravens A, Savides TJ. Endoscopic ultrasound for the staging of non-small-cell lung cancer. Endoscopy. 2003;35(7):606-610.
Dawson BH. The blood vessels of the human optic chiasma and their relation to those of the hypophysis and thalamus. Brain 1958;81:207.
Erkizan H, Kong Y, Merchant M, et al. A small molecule blocking oncogenic protein EWS-FLI1 interaction with RNA helicase A inhibits growth of Ewing's sarcoma. Nat Med 2009;15(7):750-756.
Gurion R, Belnik-Plitman Y, Gafter-Gvili A, et al. Colony-stimulating factors for prevention and treatment of infectious complications in patients with acute myelogenous leukemia. Cochrane Database Syst Rev 2011; (9):CD008238.
