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By L. Moff. Ursuline College. 2018.

It is not certain when skeletal muscle is sufficiently devel- oped to sustain contractions proven 2mg amaryl, but by week 17 the fetal movements known as quickening are strong enough to be recognized by the mother purchase 4 mg amaryl visa. The individual muscle fibers have now thickened amaryl 2 mg, the nuclei have moved peripherally buy amaryl 1mg with visa, and the filaments (myofila- ments) can be recognized as alternating dark and light bands buy amaryl 2 mg. Shortly before a baby is born, the formation of myoblast cells ceases, and all of the muscle cells have been determined. Differ- ences in strength, endurance, and coordination are somewhat ge- netically determined but are primarily the result of individual body conditioning. Muscle coordination is an ongoing process of achieving a fine neural control of muscle fibers. Although inner- vation and muscle contraction occur early during fetal development, EXHIBIT I The development of skeletal muscle fibers. Myotubes grow in length by incorporating addi- tional myoblasts; each adds an additional nucleus. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 EXHIBIT II The development of skeletal muscles. Segmental myotomes give rise to the muscles of the trunk area and girdles. Loosely organized masses of mesoderm form the muscles of the head and extremities. The development of muscles is influenced by the preceding cartilaginous models of bones. The innervation of muscles corresponds to the development of spinal nerves and dermatome arrangement. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 250 Unit 4 Support and Movement Corrugator supercilli Levator anguli oris (cut) FIGURE 9. SKELETON The muscles of facial expression are of clinical concern for Muscles of the axial skeleton include those responsible for facial several reasons,all of which involve the facial nerve. Located right under the skin,the many branches of the facial nerve are vulner- expression, mastication, eye movement, tongue movement, neck able to trauma. Facial lacerations and fractures of the skull frequently movement, and respiration, and those of the abdominal wall, the damage branches of this nerve. The extensive pattern of motor inner- pelvic outlet, and the vertebral column. The facial muscles on one side of the face are af- Objective 10 Locate the major muscles of the axial fected in these people,and that side of the face appears to sag. Identify synergistic and antagonistic muscles and describe the action of each one. The muscles of facial expression are located in a superficial Tetanus is a bacterial disease caused by the introduction of position on the scalp, face, and neck. Although highly variable anaerobic Clostridium tetani into the body, usually from a in size and strength, these muscles all originate on the bones of puncture wound. The bacteria produce a neurotoxin that is carried to the spinal cord by sensory nerves. The motor impulses relayed back the skull or in the fascia and insert into the skin (table 9. The that move the mandible are affected first, which is why the disease is locations and points of attachments of most of the facial muscles commonly known as lockjaw. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 9 Muscular System 251 Corrugator supercilli FIGURE 9. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 252 Unit 4 Support and Movement (a) (b) (c) (d) (e) (f) (g) (h) FIGURE 9. In each of these photographs, identify the muscles that are being contracted. Ocular Muscles Muscles That Move the Tongue The movements of the eyeball are controlled by six extrinsic ocu- The tongue is a highly specialized muscular organ that func- lar (eye) muscles (fig. Five of these muscles tions in speaking, manipulating food, cleansing the teeth, and arise from the margin of the optic foramen at the back of the or- swallowing. The intrinsic tongue muscles are located within the bital cavity and insert on the outer layer (sclera) of the eyeball. The extrinsic tongue muscles are those that originate on cated by their names (superior, inferior, lateral, and medial), and structures other than the tongue and insert onto it to cause two oblique muscles (superior and inferior) rotate the eyeball on gross tongue movement (fig. When the ante- looking to the side, the lateral rectus of one eyeball works with the rior portion of the genioglossus muscle is contracted, the medial rectus of the opposite eyeball to keep both eyes functioning tongue is depressed and thrust forward. The superior oblique muscle passes through a pulleylike muscles are contracted together along their entire lengths, the cartilaginous loop, the trochlea, before attaching to the eyeball.

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The need to continue learning from national care guidelines and specialty-specific publications is emphasized cheap amaryl 1mg line. Key Words: Labor; delivery; informed consent; maternal health care; Cesarean section; American College of Obstetrics and Gyne- cology Guidelines discount 1 mg amaryl overnight delivery. INTRODUCTION Most cases of medical malpractice in obstetrics or gynecology follow from negligent performance of physician obligations that are not unique to this specialty generic 1 mg amaryl free shipping. The physician must have the degree of learning and skill ordinarily possessed by reputable specialists practicing in the same field in the same or similar locality cheap amaryl 2 mg on line. Failure to meet these duties consti- tutes negligence order 4 mg amaryl overnight delivery, that is, the failure to meet the standard of care. Meeting the standard of care requires knowl- edge and application of national professional (e. With the exception of the emergency situation, informed consent must be obtained from the patient or legal guardian prior to providing treatment or performing a procedure. Appropriate alternatives must be disclosed and the risks of the proposed intervention discussed in detail. Although possible death or serious bodily harm must be addressed, it is wise to discuss more common complications of the specific treat- ment and to present them in terms of expected frequency of occurrence. One is failure to document the specific complications covered in the discussion (e. For example, the patient with pelvic pain often has the implied expectation of relief from the pain, but the physician knows this is possible but not certain. Refusal by the patient to consent to a plan of treatment must be made on an informed basis. The physician should thoroughly docu- ment the advice provided, the patient’s refusal to embrace the plan of care, and the potential consequences. It is extremely important that the practitioner not reflect his or her frustration or anger regarding the patient’s expression of her right to refuse care. It is also important to have the patient sign in the medical record what specific aspect, or aspects, of the treatment is being refused. When death or bodily harm results from a physician’s failure to meet the standard of care, causation is established. If no harm inures from a standard-of-care issue, then there is typically no basis for suit. On the other hand, death or serious injury often leads to a malpractice suit even when negligence is not evident. The failure to communicate and to thoroughly document those conversations is the most frequent cause of litigation in obstetrics and gynecology. Communication is a two-way process, and the physician must be a good listener as well as presenter. I ascribe over 35 years of an active clinical practice of maternal and fetal medicine without litigation to open communication with my patients, their families, staff, and colleagues. In the cacophony of back- ground noise, it is important to listen with clarity for the piccolo—in other words, what is really being said or not said by the patient and other Chapter 11 / Obstetrics and Gynecology 141 interested parties. Better still, ask her to explain her understanding of the point at issue. Documentation of what you said to whom and their responses should be legible, accurate, concise, and without rancor. Additionally, it is the wise physician who timely reads the notes written by nurses and others with clarifying notations placed in the progress notes when there are differences of opinion. When problems or complications occur and other specialists are involved, the original physician responsible for the woman’s care must remain involved to provide continuity and coordination of care. The patient and her family expect that her doctor cares enough to see them and to explain what is happening. Under the doctrine of standard of care, the responsible physician also has a duty to the patient to assure that consultants possess the degree of learning and skill possessed by reputable specialists provid- ing consulting services in their area of expertise. The Ob/Gyn special- ist should remain “captain of the ship” for his or her own patients. Consultants must be chosen with due care, and their care appropriately coordinated. The ACOG codified some of the medical conditions to consider for maternal and fetal medicine consultation (2).

It also affords a site of attach- abdominal region is shown in photographs of cadavers in ment for the muscles of the thorax cheap 4mg amaryl mastercard, upper extremities discount 4 mg amaryl free shipping, back generic 1mg amaryl, and figures 10 1mg amaryl with mastercard. The principal organs of the respiratory and circula- tory systems are located within the thorax generic amaryl 2mg fast delivery, and the esophagus of the digestive system passes through the thorax. Because the vis- Knowledge Check cera of the thoracic cavity are vital organs, the thorax is of im- 12. Why are the linea alba, costal margins, linea semilunaris, testines,the liver and gallbladder,the kidneys and adrenal and McBurney’s point important landmarks? Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 316 Unit 4 Support and Movement Trapezius m. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 317 1 2 6 3 4 7 8 5 9 1 Rectus abdominis m. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 318 Unit 4 Support and Movement Diaphragm Liver Transverse colon Superior mesenteric a. Although the inguinal ligament can- not be seen, an oblique groove overlying the ligament is an ap- The surface features of the pelvic region are important primarily to parent surface feature. The Objective 12 Describe the location of the perineum and list surface features of this region are further discussed in chapters 20 the organs of the pelvic and perineal regions. The surface anatomy of the perineum of a female be- comes particularly important during parturition. The important bony structures of the pelvis include the crest of the ilium and the symphysis pubis, located anteriorly, and the is- Knowledge Check chium and coccyx, which are palpable posteriorly. What structures are located spine to the symphysis pubis and is clinically important because within the perineum? Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 319 SHOULDER AND UPPER EXTREMITY Supraclavicular The anatomy of the shoulder and upper extremity is of clinical im- fossa portance because of frequent trauma to these body regions. Objective 13 Identify various surface features of the Clavipectoral shoulder and upper extremity by observation or palpation. Objective 14 Discuss the clinical importance of the axilla, cubital fossa, and wrist. The scapula, clavicle, and proximal portion of the humerus are the bones of shoulder, and portions of each of them are impor- tant surface landmarks in this region. Posteriorly, the spine of the scapula and acromion are subcutaneous and easily located. The acromion and clavicle,as well as several large shoulder muscles,can be seen anteriorly (fig. The rounded curve of the shoulder is formed by the thick deltoid muscle that covers the greater tubercle of the humerus. The deltoid muscle frequently serves as a site for intramuscular injections. The large pectoralis major muscle is prominent as it crosses the shoulder joint and at- FIGURE 10. This depressed re- Several muscles are clearly visible in the brachium (figs. The axilla is clinically important because of the prominent when the elbow is flexed. While the arm is in this posi- subcutaneous position of vessels, nerves, and lymph nodes in tion,the deltoid muscle can be traced as it inserts on the humerus. Two muscles form the anterior and posterior bor- The triceps brachii muscle forms the bulk of the posterior surface ders (fig. A groove forms on the medial side of the pectoralis major muscle, and the posterior axillary fold consists brachium between the biceps brachii and triceps brachii muscles, primarily of the latissimus dorsi muscle as it extends from the where pulsations of the brachial artery may be felt as it carries lumbar vertebrae to the humerus. It is also the place to apply pressure in case mary gland, which is positioned on the pectoralis major mus- of severe arterial hemorrhage in the forearm or hand. The medial and lateral epicondyles are phatic drainage pathway is toward the axilla (see fig. When the elbow is extended, these promi- nences lie on the same transverse plane; when the elbow is flexed, they form a triangle. The ulnar nerve can be palpated in the ulnar sulcus (groove) posterior to the medial epicondyle (see fig.

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