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The lining epithelium invaginates to form glands erectile dysfunction lab tests cheap tadacip 20 mg on line, extending into the lamina propria (mucosal glands) or submucosa (submucosal glands), and ducts, transporting secretions from the liver and pancreas through the wall of the digestive tube (duodenum) into its lumen. In the stomach and small intestine, both the mucosa and submucosa extend into the lumen as folds, called rugae and plicae, respectively. In other instances, the mucosa alone extends into the lumen as finger-like projections, or villi. Mucosal glands increase the secretory capacity, whereas villi increase the absorptive capacity of the digestive tube. The mucosa shows significant variations from segment to segment of the digestive tract. The submucosa consists of a dense irregular connective tissue with large blood vessels, lymphatics, and nerves branching into the mucosa and muscularis. The muscularis contains two layers of smooth muscle: the smooth muscle fibers of the inner layer are arranged around the tube lumen (circular layer); fibers of the outer layer are disposed along the tube (longitudinal layer). Contraction of the smooth fibers of the circular layer reduces the lumen; contraction of the fibers of the longitudinal layer shortens the tube. When the digestive tube is suspended by the mesentery or peritoneal fold, the adventitia is covered by a mesothelium (simple squamous epithelium) forming a serosa, or serous membrane. An exception is the esophagus, surrounded by the adipose tissue of the mediastinum. Microvasculature of the digestive tube We start our discussion with the microvasculature of the stomach. Gastric microvasculature Dense irregular connective tissue of the submucosa Pit, or foveola 4 Arteriole Nerve fiber Gastric gland Collecting venule Fenestrated capillary bed Anastomosis of adjacent capillary beds Submucosal arteriole 3 1 Gastric arteries form a subserosal plexus that links to the intramuscular plexus. Blood and lymphatic vessels and nerves reach the walls of the digestive tube through the supporting mesentery or the surrounding tissues. Some branches from the plexuses run longitudinally in the muscularis and submucosa; other branches extend perpendicularly into the mucosa and muscularis. In the mucosa, arterioles derived from the submucosal plexus supply a bed of fenestrated capillaries around the gastric glands and anastomose laterally with each other. Collecting venules descend from the mucosa into the submucosa as veins, leave the digestive tube 480 15. Mesenteric veins drain into the portal vein, leading to the liver (see Chapter 17, Digestive Glands). Pathology: Gastric microcirculation and gastric ulcers Gastric microcirculation plays a significant role in the protection of the integrity of the gastric mucosa. The rich blood supply to the gastric mucosa is of considerable significance in understanding bleeding associated with stress ulcers. Stress ulcers are superficial gastric mucosal erosions observed after severe trauma or severe illness and after the long-term use of aspirin and corticosteroids. In most cases, stress ulcers are clinically asymptomatic and are detected only when they cause severe bleeding. Innervation of the digestive tube Nucleus Neuron Axons Smooth muscle cells Myenteric plexus of Auerbach Inner muscle layer (circular).

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Four major zones can be distinguished erectile dysfunction icd 10 tadacip 20 mg sale, starting at the end of the cartilage and approaching the zone of erosion: 1. The reserve zone is a site composed of primitive hyaline cartilage and is responsible for the growth in length of the bone as the erosion and bone deposition process advances. The hypertrophic zone is defined by chondrocyte apoptosis and calcification of the territorial matrix surrounding the columns of previously proliferated chondrocytes. Endochondral ossification: Four major zones Epiphyseal cartilage Epiphyseal cartilage Reserve zone Primitive hyaline cartilage responsible for the growth in length of the bone as erosion and bone deposition advance into this zone. Reserve zone Proliferative zone Proliferating chondrocytes align as vertical and parallel columns. Proliferative zone Hypertrophic zone Apoptosis of chondrocytes and calcification of the territorial matrix. Vascular invasion zone Perichondrium changing into periosteum · To direct the mineralization of the surrounding cartilage matrix. As a result of chondrocyte hypertrophy, the longitudinal and transverse septa separating adjacent proliferating chondrocytes appear thinner due to a compression effect. A calcification process is visualized along the longitudinal and transverse septa. Endochondral ossification: Zones of proliferation, hypertrophy, and vascular invasion 1 Proliferative zone the proliferative zone contains flattened chondrocytes in columns or clusters parallel to the growth axis. The longitudinal septa, corresponding to the interterritorial matrix, are not degraded by the vascular invasion. Osteoblasts beneath the sites of vascular invasion begin to deposit osteoid along the longitudinal septa forming trabecular bone. Endochondral ossification: Zones of proliferation and hypertrophy Chondrocytes in the proliferative zone are arranged in vertical rows. Note that the dilated cisternae of the rough endoplasmic reticulum contain newly synthesized matrix proteins. Chondrocytes separate from each other and enlarge in size, a characteristic feature of cells entering the hypertrophic zone. Territorial matrix Nucleus Cisternae of the rough endoplasmic reticulum Proliferative zone Degenerating (hypertrophic) chondrocyte Lacuna Longitudinal septum Transverse septum Hypertrophic zone In the hypertrophic zone, the matrix between rows of cells forms longitudinal and transverse septa that eventually calcify. Calcification prevents the supply of nutrients to the chondrocytes, and cell death occurs. As vascular invasion takes place below the hypertrophic zone, invading osteoblasts deposit osteoid on the calcified matrix with the help of osteoclasts that remove residual chondrocytes and matrix. Endochondral ossification: Zones of hypertrophy and vascular invasion Unmineralized Calcified cartilage osteoid contains matrix (longitudinal type I collagen fibers septum) and proteoglycans A capillary sprout, in contact with hypertrophic chondrocytes, has penetrated a transverse septum.

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By some estimates 498a impotence tadacip 20 mg order with mastercard, they spend only eight hours there in transit from the bone marrow to their permanent positions in the tissues. Once in the tissues, monocytes enlarge and differentiate into phagocytic macrophages. They are larger and more effective than neutrophils, ingesting up to 100 bacteria during their life span. Macrophages also remove larger particles, such as old red blood cells and dead neutrophils. Macrophages play a very important role in the development of acquired immunity because they are antigen-presenting cells. Lymphocytes Lymphocytes and their derivatives are the key cells that mediate the acquired immune response of the body. Only 5% of these are found in the circulation, where they constitute 20­35% of all white blood cells. Most lymphocytes are found in lymphoid tissues, where they are especially likely to encounter invaders. Although lymphocytes all look alike under the microscope, there are three major sub-types with significant differences in function and specificity, as you will learn later in the chapter. B lymphocytes and their derivatives are responsible for antibody production and antigen presentation. Dendritic cells are found in the skin (where they are called Langerhans cells) and in various organs. When dendritic cells recognize and capture antigens, they migrate to secondary lymphoid tissues, such as lymph nodes, where they present the antigens to lymphocytes. Membrane receptor Lysosome Nucleus Pathogen Polysaccharide capsule Membrane proteins Phagocyte Phagocyte Pathogen Antibody molecules 1 Phagocytosis brings pathogens into immune cells. Phagosome Ingested pathogen 5 Antibodies bind to phagocyte receptors, triggering phagocytosis. Digested antigen 3 Lysosomal enzymes digest pathogen, producing antigenic fragments. If invaders get past those barriers, the innate immune system provides the second line of defense. The innate immune response consists of patrolling and stationary immunocytes that attack and destroy invaders. These immune cells are genetically programmed to respond to a broad range of material that they recognize as foreign, which is why innate immunity is considered nonspecific. Innate immunity either clears the infection or contains it until the acquired immune response is activated. The digestive and respiratory systems are most vulnerable to microbial invasion because these regions have extensive areas of thin epithelium in direct contact with the external environment. The opening to the uterus is normally sealed by a plug of mucus that keeps bacteria in the vagina from ascending into the uterine cavity.

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The physical and biochemical characteristics of the central zone of a granuloma depends on the pathogen erectile dysfunction at age of 30 tadacip 20 mg order with mastercard. Lymph nodes the function of lymph nodes is to filter the lymph, maintain and differentiate B cells, and house T cells. The capsule consists of dense irregular connective tissue surrounded by adipose tissue. The capsule at the convex surface of the lymph node is pierced by numerous afferent lymphatic vessels. Afferent lymphatic vessels have valves to prevent the reflux of lymph entering a lymph node. They are located under the capsule (subcapsular sinus) and along trabeculae of connective tissue derived from the capsule and entering the cortex (paratrabecular sinus). Highly phagocytic macrophages are distributed along the subcapsular and paratrabecular sinuses to remove particulate matter present in the percolating lymph. Lymph entering the paratrabecular sinus through the subcapsular sinus percolates to the medullary sinuses and exits through a single efferent lymphatic vessel. Lymph in the subcapsular sinus can bypass the paratrabecular and medullary sinuses and exit through the efferent lymphatic vessel. The hilum is a concave surface of the lymph node where efferent lymphatic vessels and a single vein leave and an artery enters the lymph node. Medullary sinusoids, spaces lined by endothelial cells surrounded by reticular cells and macrophages. Lymph node Cortex Outer cortex Inner cortex Medulla Capsule Paratrabecular sinus Mantle Lymphatic follicle Germinal center Blood vessel Subcapsular sinus Medullary sinus Medullary cord Capsule (dense connective tissue) High endothelial venule Subcapsular sinus 2 Vein Artery Hilum 3 Paratrabecular sinus Afferent lymphatic vessel with valves Lymphatic follicle with a germinal center in the outer cortex. Lymphatic follicle 2 Mantle zone (B cell zone) B cells with high-affinity surface Ig migrate to the medullary cords and differentiate into plasma cells secreting IgM or IgG into the lymph of the efferent lymphatic vessels. B cell Mature B cells that are not specific for the specific antigen accumulate in the mantle zone, forming a cap on top of the lymphoid follicle. Proliferation occurs after B cells have been activated by helper T cells by presentation of a specific antigen. Efferent lymphatic vessel Capsule Mantle zone Trabecula Subcapsular sinus Paratrabecular sinus Germinal center An efferent lymphatic vessel collects immunoglobulins and lymphocytes that are then transported to the blood circulation Stroma of a lymph node Medullary cord Reticular fibers Blood vessels in the hilum of a lymph node Lymphatic follicle Silver staining 334 10. They are distributed as sentinels in the periphery to monitor the presence of foreign antigens. They relocate to secondary lymphoid organs, lymph nodes in particular, to interact with memory T cells present in the deep cortex. This is a strategic location, because plasma cells can secrete immunoglobulins directly into the lumen of the medullary sinuses without leaving the lymph node. Pathology: Lymphadenitis and lymphomas Lymph nodes constitute a defense site against lymphborne microorganisms (bacteria, viruses, parasites) entering the node through afferent lymphatic vessels.

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Customer Reviews

Julio, 23 years: The mucosa displays multiple folds lined by a simple columnar epithelium and is supported by a lamina propria that contains a vascular lymphatic plexus.

Luca, 32 years: Excessive secretion of prolactin (hyperprolactinemia) by a benign tumor of the hypophysis in both genders causes gonadotropin deficiency.

Gorok, 21 years: The most common characteristics of Pelizaeus-Merzbacher disease are flickering eyes, and physical and mental retardation.

Rakus, 54 years: They include hamartomas (epidermal nevi), reactive hyperplasias (pseudoepitheliomatous hyperplasia), benign tumors (acanthomas), and premalignant dysplasias, in situ, and invasive carcinomas.

Josh, 43 years: The intrinsic pathway consists in the leakage of mitochondrial cytochrome c into the cytosol.

Pavel, 58 years: Clinical significance: Propylthiouracil can block the conversion of T4 to T3 in peripheral tissues (liver).