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Despite popular opinion to the contrary buy 200 mg celecoxib with mastercard, studies support the conclusion that dietary fiber and calcium do not reduce the risk of colorectal cancer celecoxib 200 mg low price. Colorectal cancer may be signaled by constipation or diarrhea celecoxib 200 mg with amex, cramping discount celecoxib 100 mg without a prescription, abdominal pain, and rectal bleeding. Since most colon cancers arise from benign mucosal growths called polyps, cancer prevention is focused on identifying these polyps. Colonoscopy not only allows identification of precancerous polyps, the procedure also enables them to be removed before they become malignant. Even though rectum is Latin for “straight,” this structure follows the curved contour of the sacrum and has three lateral bends that create a trio of internal transverse folds called the rectal valves. Anal Canal Finally, food residue reaches the last part of the large intestine, the anal canal, which is located in the perineum, completely outside of the abdominopelvic cavity. Histology There are several notable differences between the walls of the large and small intestines (Figure 23. For example, few enzyme-secreting cells are found in the wall of the large intestine, and there are no circular folds or villi. Other than in the anal canal, the mucosa of the colon is simple columnar epithelium made mostly of enterocytes (absorptive cells) and goblet cells. In addition, the wall of the large intestine has far more intestinal glands, which contain a vast population of enterocytes and goblet cells. These goblet cells secrete mucus that eases the movement of feces and protects the intestine from the effects of the acids and gases produced by enteric bacteria. Tonic contractions of the teniae coli bunch up the colon into a succession of pouches called haustra (singular = haustrum), which are responsible for the wrinkled appearance of the colon. Attached to the teniae coli are small, fat-filled sacs of visceral peritoneum called epiploic appendages. Although the rectum and anal canal have neither teniae coli nor haustra, they do have well-developed layers of muscularis that create the strong contractions needed for defecation. This mucosa varies considerably from that of the rest of the colon to accommodate the high level of abrasion as feces pass through. The anal canal’s mucous membrane is organized into longitudinal folds, each called an anal column, which house a grid of arteries and veins. Two superficial venous plexuses are found in the anal canal: one within the anal columns and one at the anus. Depressions between the anal columns, each called an anal sinus, secrete mucus that facilitates defecation. The pectinate line (or dentate line) is a horizontal, jagged band that runs circumferentially just below the level of the anal sinuses, and represents the junction between the hindgut and external skin. The resulting difference in pain threshold is due to the fact that the upper region is innervated by visceral sensory fibers, and the lower region is innervated by somatic sensory fibers. However, trillions of bacteria live within the large intestine and are referred to as the bacterial flora. Most of the more than 700 species of these bacteria are nonpathogenic commensal organisms that cause no harm as long as they stay in the gut lumen. In fact, many facilitate chemical digestion and absorption, and some synthesize certain vitamins, mainly biotin, pantothenic acid, and vitamin K. First, peptidoglycan, a component of bacterial cell walls, activates the release of chemicals by the mucosa’s epithelial cells, which draft immune cells, especially dendritic cells, into the mucosa. Dendritic cells open the tight junctions between epithelial cells and extend probes into the lumen to evaluate the microbial antigens. The dendritic cells with antigens then travel to neighboring lymphoid follicles in the mucosa where T cells inspect for antigens. This process triggers an IgA-mediated response, if warranted, in the lumen that blocks the commensal organisms from infiltrating the mucosa and setting off a far greater, widespread systematic reaction.
When the newborn takes the first breath generic 100 mg celecoxib amex, pressure within the lungs drops dramatically buy discount celecoxib 100mg on line, and both the lungs and the pulmonary vessels expand generic celecoxib 200mg mastercard. As the amount of oxygen increases celecoxib 100mg for sale, the smooth muscles in the wall of the ductus arteriosus constrict, sealing off the passage. Eventually, the muscular and endothelial components of the ductus arteriosus degenerate, leaving only the connective tissue component of the ligamentum arteriosum. The ductus venosus closes slowly during the first weeks of infancy and degenerates to become the ligamentum venosum. Capillaries lead back to small vessels known as venules that flow into the larger veins and eventually back to the heart. The arterial system is a relatively high-pressure system, so arteries have thick walls that appear round in cross section. The venous system is a lower-pressure system, containing veins that have larger lumens and thinner walls. Arteries, arterioles, venules, and veins are composed of three tunics known as the tunica intima, tunica media, and tunica externa. The tunica intima is a thin layer composed of a simple squamous epithelium known as endothelium and a small amount of connective tissue. The tunica media is a thicker area composed of variable amounts of smooth muscle and connective tissue. The tunica externa is primarily a layer of connective tissue, although in veins, it also contains some smooth muscle. Blood flow through vessels can be dramatically influenced by vasoconstriction and vasodilation in their walls. Blood pressure is the force that blood exerts upon the walls of the blood vessels or chambers of the heart. The components of blood pressure include systolic pressure, which results from ventricular contraction, and diastolic pressure, which results from ventricular relaxation. Pulse pressure is the difference between systolic and diastolic measures, and mean arterial pressure is the “average” pressure of blood in the arterial system, driving blood into the tissues. The variables affecting blood flow and blood pressure in the systemic circulation are cardiac output, compliance, blood volume, blood viscosity, and the length and diameter of the blood vessels. In the arterial system, vasodilation and vasoconstriction of the arterioles is a significant factor in systemic blood pressure: Slight vasodilation greatly decreases resistance and increases flow, whereas slight vasoconstriction greatly increases resistance and decreases flow. In the venous system, constriction increases blood pressure as it does in arteries; the increasing pressure helps to return blood to the heart. In addition, constriction causes the vessel lumen to become more rounded, decreasing resistance and increasing blood flow. Venoconstriction, while less important than arterial vasoconstriction, works with the skeletal muscle pump, the respiratory pump, and their valves to promote venous return to the heart. Some large molecules can cross in vesicles or through clefts, fenestrations, or gaps between cells in capillary walls. Filtration predominates in the arterial end of the capillary; in the middle section, the opposing pressures are virtually identical so there is no net exchange, This OpenStax book is available for free at http://cnx. The hydrostatic and colloid osmotic pressures in the interstitial fluid are negligible in healthy circumstances. Neural mechanisms include the cardiovascular centers in the medulla oblongata, baroreceptors in the aorta and carotid arteries and right atrium, and associated chemoreceptors that monitor blood levels of oxygen, carbon dioxide, and hydrogen ions. Autoregulation is the local control of vasodilation and constriction by chemical signals and the myogenic response. Exercise greatly improves cardiovascular function and reduces the risk of cardiovascular diseases, including hypertension, a leading cause of heart attacks and strokes. The main regions of the aorta are the ascending aorta, aortic arch, and descending aorta, which is further divided into the thoracic and abdominal aorta. After oxygenating tissues in the capillaries, systemic blood is returned to the right atrium from the venous system via the superior vena cava, which drains most of the veins superior to the diaphragm, the inferior vena cava, which drains most of the veins inferior to the diaphragm, and the coronary veins via the coronary sinus. The precursor hemangioblasts differentiate into angioblasts, which give rise to the blood vessels and pluripotent stem cells that differentiate into the formed elements of the blood. As the embryo grows within the mother’s womb, the placenta develops to supply blood rich in oxygen and nutrients via the umbilical vein and to remove wastes in oxygen-depleted blood via the umbilical arteries. Three major shunts found in the fetus are the foramen ovale and ductus arteriosus, which divert blood from the pulmonary to the systemic circuit, and the ductus venosus, which carries freshly oxygenated blood high in nutrients to the fetal heart.
Ignition (an electric spark or naked flame) a source of fuel/petrol buy celecoxib 100 mg with amex, wood or fabric) and oxygen (air) Clothing on Fire: Always follow this procedure: (1) Stop 100mg celecoxib sale, drop and Roll (2) Stop the casuality panick ing cheap 100 mg celecoxib fast delivery, running around or going outside buy discount celecoxib 100mg on line. The outer layer (epidermis) and the inner layer (dermis) and fatty tis sue (Subcutaneous fat) the epidermis is protected by an oily substance called sebum secreted from sebaceous glands which keeps the skin supple and water proof. The dermis contains the blood vessels, nerves, muscles sebaceous glands, sweat glands, hair follicles Ends of the sensory nerves (sensations like heat, cold, touch, pain) Blood vessels supply nutri ents and regulates the body temperature. Superficial : Only epidermis (eg) Sunburn Partial thickness : Destroys epidermis, Pain, Blister formation Full thickness : No pain sensation, skin scared. Assessing a Burn Types of Burn Causes of the burn Dry burn Flames, contact with hot objects Scald Steam, Hot liquids Electrical Burn High Voltage currents over head cables lighting strikes Frost bite Cold injury Frost bite Chemical burn Industrial chemicals, inhaled fumes and corrosive gases, chemical agents Radiation burns Sun burn, over exposure to ultra – violet rays, Expose to radio active sources. Assess for: Pain, difficulty in breathing, signs of shock Aims: (1) To stop the burning and relieve pain (2) To maintain an open airway(3)To minimize the risk of infection (4) To arrange urgent removal to hospital (5) Principles to be followed stop, drop and roll (6) Help the causality to lie down (7) Continue cooling the affected area (8) Cover the injured area with sterile/clean cloth to protect from infection. If the causalty is unconscious, make sure that the casualty is in safe area, open the causalty’s airway and check for breathing and do C. Do not approach the causalty of high voltage electricity until the current has been switched off and isolated. Chemical burn to the eye, first aider is to wash out the eye so that the chemical is diluted and dispersed. Complaints of headache, dizziness, confusion loss of appetite and nausea, sweating with pale and clammy skin, cramps in the arm, legs and abdomen, Rapid pulse and breathing. Head ache, dizziness, discomfort, restless ness, Hot & 0 0 flushed, dry skin, bounding pulse, high temperature above 104 F (40 C). Causes of Fractures: Direct Force: A bone can be fractured at the point where the force of a blow is applied. In an open fracture, one of the broken bone ends may pierce the skin surface or there may be a wound at the fracture site. Complicated fractures: They occur when the jagged ends of the bone fragments damage blood ves sels, nerves or a joint, broken bones in the chest may penetrate the lung, heart or liver. Depressed fractures: These occur in the skull when the broken ends of the bones are pressed in wards. Pathological Fractures: These occur when the bone is weakened by loss of calcium, infection or cancer. In old age the bones are more brittle, and may break spontaneously due to calcium loss which is part of the ageing process. People who are drowned may not be able to call for help because they expend all their energy to breathe or to keep the head over water. The drowning sequence: Begins with panic or struggle followed by submersion with breath holding, then water swallowing before passing out, within 3 minutes of being under water, loss of consciousness, within 5 minutes, brain suffers damage, then the heart goes into irregular rhythm before it stops breath ing. Additional Care Measures : (1) When you can place him on a firm surface, check breathing and pulse and continue resuscitation if necessary (2) As soon as the casualty begins breathing, place in recovery position. Effects of hemorrhage: The loss of red blood cells causes a lack of oxygen to the tissues of the body. Direct pressure: Place your hand directly over the wound and apply pressure, firm and steady until the bleeding stops. Elevation: Elevate the bleeding part of the body above the level of the heart so that the flow of blood will slow down in that part and blood clothing take place. Pressure Points: Applying pressure over the pressure points pressing over the underlying bone pres sure points on the arms (brachial pressure point) on the groin (femoral pressure point). Applying a tourniquet: A standard tourniquet is a piece of web belting about 36" long with a buckle device to hold it tightly in place when applied. Management: Apply direct pressure over the wound with your fingers and palms, with clean pad/cloth you can ask the casuality to apply direct pressure herself. If you suspect the casuality is going into shock, raise and support her legs so that they are above the level of her heart. Dial for an ambulance and transport the casuality to hospital till then the first aider should not leave the casuality until taken over by doctor or nurse. Advise her not to speak, swallow, cough spit because she may disturb the blood clots that have formed in the nose.