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Medical Word Elements • Demonstrate your knowledge of this chapter Pathology by completing the learning and medical record Eye Disorders activities generic avalide 162.5 mg with mastercard. Specific sensations include smell Eye (olfaction) cheap avalide 162.5mg fast delivery, taste (gustation) generic avalide 162.5mg without a prescription, vision avalide 162.5 mg cheap, hearing (audi- tion) buy discount avalide 162.5 mg, and equilibrium. Each specific sensation is The eye is a globe-shaped organ composed of connected to a specific organ or structure in the three distinct tunics, or layers: the fibrous tunic, body. Pronunciation Help Long Sound a—rate ¯ e—rebirth¯ ¯ı—isle o—over ¯ u—unite¯ Short Sound a—alone˘ e—ever ˘ ˘ı—it o—not˘ u—cut˘ Anatomy and Physiology 467 (4) Choroid (10) Retina (1) Sclera (5) Iris (2) Cornea (11) Fovea (in macula) Retinal artery and vein (7) Pupil (12) Optic nerve (8) Lens (13) Optic disc (15) Anterior chamber (17) Vitreous chamber (14) Posterior chamber Inferior rectus muscle (16) Canal of Schlemm (9) Suspensory ligament (3) Conjunctiva (6) Ciliary body Figure 15-1. Fibrous Tunic choroid allows the optic nerve to enter the inside of The outermost layer of the eyeball, the fibrous the eyeball. The anterior portion of the choroid tunic, serves as a protective coat for the more sen- contains two modified structures, the (5) iris and sitive structures beneath. The sclera, or “white of the tile membrane whose perforated center is called the eye,” provides strength, shape, and structure to the (7) pupil. As the sclera passes in front of the eye, it passing through the pupil to the interior of the eye. Rather than As environmental light increases, the pupil con- being opaque, the cornea is transparent, allowing stricts; as light decreases, the pupil dilates. The cornea is iary body is a circular muscle that produces aqueous one of the few body structures that does not con- humor. The ciliary body is attached to a capsular tain capillaries and must rely on eye fluids for bag that holds the (8) lens between the (9) suspen- nourishment. As the ciliary muscle contracts and tiva, covers the outer surface of the eye and lines relaxes, it alters the shape of the lens making it the eyelids. These changes in shape allow the eye to focus on an image, a process called Vascular Tunic accommodation. The (4) choroid pro- The innermost sensory tunic is the delicate, vides the blood supply for the entire eye. It consists of a thin, pigmented cells that prevent extraneous light from outer pigmented layer lying over the choroid and a entering the inside of the eye. It has two types the refractive structures of the eye, focusing light of visual receptors: rods and cones. Cones function in bright light and produce color The adnexa of the eye include all supporting vision. In the cen- control the movement of the eye: the superior, ter of the macula is the (11) fovea. When the eye inferior, lateral, and medial rectus muscles and the focuses on an object, light rays from that object are superior and inferior oblique muscles. Because the fovea is com- cles coordinate the eyes so that they move in a syn- posed of only cones that lie very close to each other, chronized manner. Two movable folds of skin constitute the eyelids, each with eyelashes that protect the front of the Other Structures eye. As light strikes the Lying superior and to the outer edge of each eye are photopigment, a chemical change occurs that stimu- the (2) lacrimal glands, which produce tears that lates rods and cones. The tears collect at the impulses that are transmitted through the (12) optic inner edges of the eyes, the canthi (singular, can- nerve to the brain, where they are interpreted as thus), and pass through pinpoint openings, the vision. The optic nerve and blood vessels of the eye (3) lacrimal canals, to the mucous membranes that enter at the (13) optic disc. It is found in the (14) posterior The ear is the sense receptor organ for hearing and chamber and (15) anterior chamber of the anterior equilibrium. Hearing is a function of the cochlea; segment and provides nourishment for the lens and the semicircular canals and vestibule control equi- the cornea. If aqueous humor fails to drain from the The ear consists of three major sections: the outer eye at the rate at which it is produced, a condition ear, or external ear; the middle ear, or tympanic called glaucoma results. Anatomy and Physiology 469 Temporal bone (6) Stapes (10) Semicircular canals (1) Auricle (5) Incus (4) Malleus Vestibular branch Vestibulocochlear nerve Cochlear branch (7) Cochlea (11) Vestibule (8) Oval window (9) Eustachian tube (2) External auditory (3) Tympanic canal membrane External ear Middle ear Inner ear Figure 15-3. Its inner surfaces are lined with a sions ultimately generates impulses that are sent to highly sensitive hearing structure called the organ of the brain and interpreted as sound. Corti, which contains tiny nerve endings called the An (1) auricle (or pinna) collects waves traveling hair cells. A membrane-covered opening on the through air and channels them to the (2) external external surface of the cochlea called the (8) oval auditory canal, also called the ear canal. The ear window provides a place for attachment of the canal is a slender tube lined with glands that pro- stapes.

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The major challenge that remains is to find enhancers that will reversibly increase membrane permeability without causing toxicity during long-term use discount avalide 162.5mg visa. Various surfactants and protease inhibitors have been reported to increase the pulmonary absorption of peptides and proteins on an experimental basis but their clinical use is not established and the current general consensus seems to be against their inclusion in pulmonary formulations buy 162.5mg avalide otc. The future will undoubtedly see products for inhalation on the market which contain systemically-acting drugs buy avalide 162.5mg amex. Based on the published literature generic avalide 162.5 mg visa, it is likely that we will witness new designs in devices and formulations to achieve greater bioavailability and control in the pulmonary delivery of both conventional drugs (small organic molecules) and the increasing number of proteins 162.5 mg avalide with amex, nucleotides and biotechnology compounds which require a mucosal transport route to the systemic circulation. Describe the factors affecting the absorption and metabolism of drugs in the airways. Describe the three principal categories of aerosol generator employed in inhalation therapy. Outline the rationale for the development of “new technologies” for pulmonary drug delivery. Preparations for local delivery include: Anti-infectives These include antibacterial, antifungal, antiprotozoal, antichlamydial and antiviral agents. Symptoms include vaginal discharge, offensive odor, itching, and vaginal irritation. Three etiologies account for over 90% of the cases: trichomonas (25%), Candida (Candida albicans, yeast) (25%), and bacterial vaginosis (40%). Metronidazole and other 5-nitroimidazoles (tinidazole, ornidazole) are used in the treatment of trichomonas. Vaginal yeast infections (candida) are treated primarily with antifungal imidazole drugs (clotrimazole, econazole, isoconazole and miconazole). The preparations, which are available over the counter, generally comprise pessaries or creams inserted high into the vagina. Oral or intravaginal metronidazole is effective in the treatment of bacterial vaginosis. Intravaginal administration of metronidazole results in much lower systemic levels than oral administration, thus side-effects such as nausea, alcohol intolerance and peripheral neuropathy, as well as the risk of possible teratogenic effects, are reduced with vaginal treatment. Estrogens At the onset of menopause, at approximately 50 years of age, there is a decline in circulating estrogen, which worsens over the next 7–8 years. A related physiological event associated with a decline in estrogen levels is a substantial reduction in vaginal blood flow, with concomitant drying of vaginal tissue. Symptoms of dry vagina include discomfort with tight fitting clothing, burning sensation, purulent discharge, postcoital bleeding, lack of lubrication with sexual arousal, and dyspareunia. There is also a substantial rise in vaginal pH to as high as 7, which increases the incidence of vaginal infections. Vaginal estrogen creams are highly effective in the treatment of atrophic vaginitis. A very low dose is recommended in order to minimize absorption of the estrogen and therefore combat endometrial stimulation. Modified vaginal release estrogen tablets and an estrogen impregnated vaginal ring are also available to treat vaginal dryness. Spermicidal agents 275 These include nonoxynol-9, octoxinol and p-di-isobutylphenoxypoly(ethoxyethanol). Spermicidal contraceptives are useful additional safeguards but do not give adequate contraceptive protection if used alone; they are suitable for use with barrier methods. They have two components: a spermicide and a vehicle which itself may have some inhibiting effects on sperm activity. The systemic absorption of these drugs had previously been considered only from the standpoint of toxicity. However, in addition to local delivery, there has recently been considerable interest in the possibility of vaginal delivery for the systemic delivery of drugs, via the mucous membranes of the vagina. Current technologies in vaginal drug delivery are concerned with the systemic delivery of drugs such as estrogens, progesterones and prostaglandins. New technologies are exploring the systemic delivery of, for example, therapeutic peptides and proteins, via the vaginal route. This chapter reviews the structure and physiology of the vagina and the present and future utilization of the vagina for drug delivery. It is normally collapsed on itself and can hold between 2–3 g of fluid or gel without leakage to the outside. Microscopically, the vaginal wall consists of: • the epithelial layer, with underlying basement membrane; • the lamina propria (connective tissue); • the muscular layer; • the tunica adventitia (the vaginal fascia, which consists of loose connective tissue).

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Connecting Body Systems–Endocrine System The main function of the endocrine system is to secrete hormones that have a diverse effect on cells 162.5 mg avalide, tissues cheap avalide 162.5 mg online, organs purchase 162.5 mg avalide, and organ systems purchase 162.5 mg avalide otc. Specific functional relationships between the endocrine system and other body systems are summarized below buy avalide 162.5mg with visa. Blood, lymph, and immune Genitourinary • Hormones from the thymus stimulate • Hormones play a major role in the devel- lymphocyte production. Cardiovascular • Hormones influence heart rate, contrac- Integumentary tion strength, blood volume, and blood • Hormones regulate activity of the seba- pressure. Musculoskeletal • Hormones influence motility and glandu- • Hormone secretions influence blood flow lar activity of the digestive tract, gallblad- to muscles during exercise. Anatomy and Physiology 403 Medical Word Elements This section introduces combining forms, suffixes, and prefixes related to the endocrine system. The characteristics of this disease are Pathology edema, low blood levels of T3 and T4, weight gain, Disorders of the endocrine system are caused by cold intolerance, fatigue, depression, muscle or underproduction (hyposecretion) or overproduc- joint pain, and sluggishness. In general, Hyperthyroidism results from excessive secre- hyposecretion is treated with drug therapy in the tions of T3,T, or both. Hypersecretion is disorders of hyperthyroidism are Graves disease generally treated by surgery. Graves disease is considerably ciencies result from genetic defects in the glands, more prevalent and is characterized by an elevated surgical removal of the glands, or production of metabolic rate, abnormal weight loss, excessive poor-quality hormones. Also, the eyes are likely to protrude (exophthalmos) because of edematous swelling in Pituitary Disorders the tissues behind them. Thyroid Disorders Thyroid gland disorders are common and may develop at any time during life. They may be the result of a developmental problem, injury, disease, or dietary deficiency. If not treated, this disorder leads to mental retardation, impaired growth, low body temperatures, and abnormal bone formation. Usually these symptoms do not appear at birth because the infant has received thyroid hormones from the mother’s blood during fetal development. Treatment for hyperthyroidism Addison disease, a relatively uncommon chronic may involve drug therapy to block the production disorder caused by a deficiency of cortical hor- of thyroid hormones or surgical removal of all or mones, results when the adrenal cortex is damaged part of the thyroid gland. Atrophy of the adrenal glands is treating this disorder is to administer a sufficient probably the result of an autoimmune process amount of radioactive iodine to destroy the thy- in which circulating adrenal antibodies slowly roid secretory cells. The gland usually suffers 90% destruction before clinical signs of adrenal insuffi- Parathyroid Disorders ciency appear. Hypofunction of the adrenal cortex interferes with the body’s ability to handle inter- As with the thyroid gland, dysfunction of the nal and external stress. In severe cases, the distur- parathyroids is usually characterized by inadequate bance of sodium and potassium metabolism may or excessive hormone secretion. Other clinical manifestations include by primary parathyroid dysfunction or elevated muscle weakness, anorexia, gastrointestinal symp- blood calcium levels. This condition can result toms, fatigue, hypoglycemia, hypotension, low from an injury or from surgical removal of the blood sodium (hyponatremia), and high serum glands, sometimes in conjunction with thyroid sur- potassium (hyperkalemia). The primary effect of hypoparathyroidism is condition begins early, usually with adrenocortical a decreased blood calcium level (hypocalcemia). If Decreased calcium lowers the electrical threshold, untreated, the disease will continue a chronic course causing neurons to depolarize more easily, and with progressive but relatively slow deterioration. In increases the number of nerve impulses, resulting some patients, the deterioration may be rapid. Treatment may also include (glucocorticoids) in treating such diseases as orthopedic surgery to correct severe bone defor- rheumatoid arthritis, lupus erythematosus, mities. When the disease is • adrenal tumor resulting in excessive produc- generalized and all bones are affected, this disor- tion of cortisol der is known as von Recklinghausen disease. Overproduction of mineralocorticoids and Glands glucocorticoids causes blood glucose concentration As discussed, the adrenal glands consist of the to remain high, depleting tissue protein. Each has its sodium retention causes increased fluid in tissue that own structure and function as well as its own set of leads to edema. Other symp- Diabetes mellitus occurs in two primary forms: toms include fatigue, high blood pressure, and exces- • Type 1 diabetes is usually diagnosed in chil- sive hair growth in unusual places (hirsutism), espe- dren and young adults and was previously cially in women.

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It also acts as a passageway for the (1) adipose tissue discount 162.5 mg avalide with mastercard, which enlarges the size of the delivery of the fetus order avalide 162.5mg with amex. Breast size to the vaginal orifice discount avalide 162.5mg without a prescription, is composed of erectile tissue is primarily determined by the amount of fat that is richly innervated with sensory endings 162.5mg avalide visa. The around the glandular tissue but is not indicative clitoris is similar in structure to the penis in the of functional ability buy avalide 162.5mg fast delivery. Each breast is composed of Anatomy and Physiology 353 Rib Pectoral muscle Mammary lobule (2) Lactiferous duct (3) Nipple Supraclavicular lymph node (1) Adipose tissue Internal mammary lymph node Axillary lymph node (3) Nipple (4) Areola (1) Adipose tissue Breast tissue Lymph vessel Figure 12-3. Menstrual Cycle 15 to 20 lobules of milk-producing glands that are drained by a (2) lactiferous duct, which Menarche, the initial menstrual period, occurs at opens on the tip of the raised (3) nipple. Circling puberty (about age 12) and continues approxi- the nipple is a border of slightly darker skin called mately 40 years, except during pregnancy. During pregnancy, the breasts duration of the menstrual cycle is approximately enlarge and remain so until lactation ceases. Phase Description Menstrual Days 1 to 5 Uterine endometrium sloughs off because of hormonal stimulation; a process that is accompa- nied by bleeding. The detached tissue and blood are discharged through the vagina as menstrual flow. Ovulatory Days 6 to 14 When menstruation ceases, the endometrium begins to thicken as new tissue is rebuilt. As estrogen level rises, several ova begin to mature in the graafian follicles with only one ovum reaching full maturity. At about the 14th day of the cycle, the graafian follicle ruptures, releasing the egg, a process called ovulation. The egg then leaves the ovary and travels down the fallopian tube toward the uterus. Postovulatory Days 15 to 28 The empty graafian follicle fills with a yellow material and is now called the corpus luteum. Secretions of estrogen and progesterone by the corpus luteum stimulate the building of the endometrium in preparation for implantation of an embryo. If fertilization does not occur, the corpus luteum begins to degenerate as estrogen and progesterone levels decline. These symptoms usually occur about 5 days after the decline in hormones and include nervous tension, irritability, headaches, breast tenderness, and a feeling of depression. At this time, the full-term fetus is usually posi- Pregnancy tioned head down within the uterus. It increases greatly in size Labor and Childbirth and muscle mass; houses the growing placenta, which nourishes the embryo-fetus; and expels the Labor is the physiological process by which the fetus after gestation. The first is the stage of dilation, canal elongates as the uterus rises in the pelvis. The which begins with uterine contractions and termi- mucosa thickens, secretions increase, and vascular- nates when there is complete dilation of the cervix ity and elasticity of the cervix and vagina become (10 cm). The last stage is the placental stage, or imately 9 months and is followed by childbirth afterbirth. Up to the third month of pregnancy, birth when the uterine contractions discharge the the product of conception is referred to as the placenta from the uterus. From the third month to the time of birth, the unborn offspring is referred to as the fetus. Menopause Pregnancy also causes enlargement of the breasts, sometimes to the point of pain. Many Menopause is cessation of ovarian activity and other changes occur throughout the body to diminished hormone production that occurs at accommodate the development and birth of the about age 50. Toward the end of gestation, the myometri- absence of menses (amenorrhea) has persisted for um begins to contract weakly at irregular intervals. Restraint in Many women experience hot flashes and vagi- prescribing estrogens for long periods in all nal drying and thinning (vaginal atrophy) as menopausal women arises from concern that estrogen levels fall. This diagnostic procedure helps identify many Pathology pelvic abnormalities and diseases. Cytological and Many female reproductive disorders are caused by bacteriological specimens are usually obtained at infection, injury, or hormonal dysfunction. Obstetrics is the branch of and discharge are signs and symptoms commonly medicine that manages the health of a woman and associated with sexually transmitted diseases and her fetus during pregnancy, childbirth, and the must not be ignored.

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