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By R. Kliff. Northwest College of Art. 2017.

In proximal tubule cells generic 60caps neem with visa, this movement is favored process leads to a rise in plasma [HCO3 ] cheap neem 60 caps with mastercard. Conversely, a loss by the inside negative membrane potential of the cell and by of HCO3 from the body is equivalent to adding H to the blood. To Peritubular Tubular Tubular excrete large amounts of acid, the kidneys must rely on in- blood epithelium urine creased ammonia excretion. Most ammonia is synthesized in HCO - - proximal tubule cells by deamidation and deamination of 3 HCO3 H+ + HCO - the amino acid glutamine: (reclaimed) H 3 (filtered) NH NH CO CO2 + H2O H CO 4 4 2 2 3 CA H CO 2 3 2 Glutamine → Glutamate → -Ketoglutarate (24) CA Glutaminase Glutamate dehydrogenase CO2 H2O As discussed earlier, ammonia is secreted into the urine by two mechanisms. As NH3, it diffuses into the tubular urine; as NH4 , it substitutes for H on the Na /H ex- changer. In the lumen, NH3 combines with secreted H to 2 form NH4 , which is excreted. Fil- For each mEq of H excreted as NH4 , one mEq of new tered HCO3 combines with secreted H and HCO3 is added to the blood. Carbonic anhydrase (CA) is present in tubule cell produces H and HCO3 , as described earlier. In this figure, H2PO4 If excess acid is added to the body, urinary ammonia ex- is the titratable acid formed. The secreted H combines with urine traps more ammonia (as NH ) in the urine. Second, 2– 4 the basic form of the phosphate (HPO4 ) to form the acid renal ammonia synthesis from glutamine increases over sev- phosphate (H2PO4 ). The secreted H replaces one of the Na ions accompanying the basic phosphate. The new HCO3 generated in the cell moves into the blood, to- gether with Na. For each mEq of H excreted in the urine as titratable acid, a mEq of new HCO3 is added to the Peritubular Tubular Tubular blood. This process eliminates H in the urine, replaces blood epithelium urine ECF HCO3 , and restores a normal blood pH.

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The Perthes lesion is similar to the Tendinosis or tenosynovitis of the LBT may occur in as- Bankart lesion generic 60 caps neem with visa, but without the tear of the capsule cheap 60 caps neem with amex. The torn and the coracoacromial ligament during abduction and labrum is rotated medially, and a small cleft or separa- rotation of the arm. Attritional tendinosis is associated tion can be seen between the glenoid margin and the with a narrow bicipital groove and hence it affects the ex- labrum. In contrast to the Bankart lesion, the ALPSA le- tracapsular portion of the tendon. Magnetic resonance sion can heal, leaving a deformed and patulous labrum. After the acute episode of dislocation, Complete rupture of the LBT more often occurs prox- the arm frequently remains locked in adduction and in- imally, at the level of the proximal portion of the extra- ternal rotation. Posterior instability caused by repeated capsular segment, within the groove. MRI demonstrates micro-trauma, without frank dislocation, may cause per- the absence of the LBT in the groove and its distal dis- sistent shoulder pain in young athletes. Intracapsular tears of the LBT are seen more ion and internal rotation are the mechanism involved in often in patients with rotator cuff tears. This nosis affecting the intertubercular portion of the LBT can may be also associated with posterior capsular laxity. A bifid LBT (normal tear, posterior capsular stripping or laxity, fracture, ero- variant) should not be confused with a partial longitudi- sion, or sclerosis and ectopic bone formation of the pos- nal tear. In the first type, the insertional sions involve the superior part of the labrum with vary- fibers of the subscapularis tendon are intact. Pain, click- ond type, the subscapularis tendon is detached and the ing, and occasional instability in a young patient are the LBT is medially displaced, becoming entrapped intra-ar- typical clinical manifestations. Shoulder 5 Compressive Neuropathies rial mixed with hyperintense cartilage may mimic pig- mented villonodular synovitis, especially if bone erosions The suprascapular nerve and its branches can become are present.

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Northwest College of Art.

The wall of the heart consists of the conduction is called an electrocardiogram Principal Veins of the Body epicardium buy 60caps neem amex, myocardium generic 60 caps neem overnight delivery, and (ECG or EKG). Blood from the head and neck is drained (a) The right atrium receives blood from Blood Vessels (pp. Arteries and veins have a tunica externa, blood from the brain is drained by the and the right ventricle pumps blood tunica media, and tunica interna. Arteries ventricle pumps blood into the transport blood away from the heart. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 600 Unit 6 Maintenance of the Body 3. In the thorax, the superior vena cava is oxygen and nutrients are obtained from 2. Lymphatic capillaries drain interstitial formed by the union of the two the placenta rather than from the fetal fluid, which is formed from blood plasma; brachiocephalic veins and also collects lungs and GI tract. Fully oxygenated blood is carried only in capillaries, it is called lymph. The lower extremity is drained by both the umbilical vein, which drains the 3. This blood is carried via the via two large lymph ducts—the thoracic the fifth lumbar vertebra, the right and ductus venosus to the inferior vena cava duct and the right lymphatic duct. Partially oxygenated blood is shunted contain phagocytic cells and lymphatic 5. Blood from capillaries in the GI tract is from the right to the left atrium via the nodules that produce lymphocytes.