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The viscosity of liquids is commonly determined by considering the viscosity of distilled water as 1 and then comparing the viscosity of other liquids with that blood pressure chart high diastolic 20 mg benicar purchase. The viscosity of blood is influenced largely by hematocrit (hm-t-krit blood pressure chart for age and weight benicar 10 mg purchase with mastercard, hem-t-krit), which is the percentage of the total blood volume composed of red blood cells (see chapter 19). Blood with a hematocrit of 45% has a viscosity about three times that of water, whereas blood with a very high hematocrit of 65% has a viscosity about seven to eight times that of water. The plasma proteins have only a minor effect on the viscosity of blood, but dehydration or uncontrolled production of red blood cells can increase the hematocrit and the viscosity of blood substantially. When a person is in shock, blood pressure can decrease below the critical closing pressure in vessels (see Clinical Impact, "Circulatory Shock," later in this chapter). The tissues supplied by those vessels can become necrotic because of the lack of blood supply. Vessels with a small compliance do not show a large increase in volume when the pressure increases. Consequently, veins act as storage areas, or reservoirs, for blood because their large compliance allows them to hold much more blood than other areas of the circulatory system (table 21. As the pressure in a vessel decreases, the force that stretches the vessel wall also decreases. If the pressure decreases, so that the force is below that minimum requirement, the vessel closes. As the pressure in a vessel increases, the force that stretches the vessel wall also increases. Sometimes a part of an arterial wall becomes weakened and a bulge, called an aneurysm, forms in it. Because the diameter of the vessel at the sight of the aneurysm is greater than other areas of the vessel, the force applied to the weakened part is also greater than at other points along the blood vessel. The greater force causes the weakened vessel wall to bulge even more, further increasing the pressure on it. Ruptured aneurysms in the blood vessels of the brain or in the aorta are often fatal. Richard does not realize that this causes rapid vasoconstriction of his cutaneous blood vessels. Explain the relationship between cross-sectional area of blood vessels and the rate of blood flow. Explain how blood pressure and resistance to flow change as blood flows through the blood vessels. Define pulse pressure and list locations on the body surface where the pulse can be detected. Total crosssectional area (b) Velocity of blood flow (mL/s) Ao r Ar the illa Ve i rio Ar the ap Ve n F. C the anatomy of the circulatory system, the dynamics of blood flow, and the regulatory mechanisms that control the heart and blood vessels determine the physiological characteristics of the circulatory system. Approximately 84% of the total blood volume is contained in the systemic blood vessels. Recall that because of their larger compliance compared to other vessels, veins can hold a larger volume of blood. Smaller volumes of blood are in the arteries (15%) and the capillaries (5%; table 21. The total cross-sectional area of all the capillaries is much greater (2500 cm2) than that of the aorta (5 cm2), although the cross-sectional area of each capillary is much smaller than that of the aorta. As the total cross-sectional area increases, the velocity of blood flow decreases. Pressure and Resistance the left ventricle forcefully ejects blood from the heart into the aorta. As blood flows through the circulation, from arteries through the capillaries and the veins, the pressure falls progressively to a minimum of approximately 0 mm Hg or even slightly lower by the time it returns to the right atrium. The decrease in blood pressure in each part of the systemic circulation is directly proportional to the resistance to blood flow. In other words, the greater the resistance in a blood vessel, the more rapidly the pressure decreases as blood flows through it. Resistance is small in the aorta, so the average pressure at the end of the aorta is nearly the same as at the beginning of the aorta, about 100 mm Hg. The resistance in medium arteries, which are as small as 3 mm in diameter, is also small, so their average pressure is only decreased to 95 mm Hg. In the smaller arteries, however, the resistance to blood flow is greater; by the time blood reaches the arterioles, the average pressure is approximately 85 mm Hg. The resistance to flow is greater in the arterioles than in any other part of the systemic circulation; at their ends, the average pressure is only approximately 30 mm Hg. The Cross-Sectional Area of Blood Vessels If the cross-sectional area of each blood vessel type is determined and multiplied by the number of each type of blood vessel, the result is the total cross-sectional area for each blood vessel type. For example, only one aorta exists, and it has a cross-sectional area of 5 square centimeters (cm2). However, the total cross-sectional area considers the combined area of all capillaries, which number approximately 10 billion in the body. So the total cross-sectional area of all capillaries is 2500 cm2, which is much greater than the cross-sectional area of the aorta (figure 21. As blood flows through the circulation, the velocity of flow changes relative to the total cross-sectional area. The velocity of blood flow is greatest in the aorta, but the total crosssectional area is small.

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The vagus nerves Enteric Nervous System the enteric nervous system consists of nerve plexuses within the wall of the digestive tract (see chapter 24) hypertension questions nclex benicar 40 mg buy with visa. Enteric sensory neurons detect changes in the chemical composition of the contents of the digestive tract or detect stretch of the digestive tract wall blood pressure goals generic 40 mg benicar. Enteric motor neurons stimulate or inhibit smooth muscle contraction and gland secretion. For example, stretch of the digestive tract is detected by enteric sensory neurons, which stimulate enteric interneurons. The enteric interneurons stimulate enteric motor neurons, which stimulate glands to secrete. For example, sweat glands and blood vessels are innervated by sympathetic neurons almost exclusively. In addition, where dual innervation exists, one division may be more predominant than the other division. For example, parasympathetic innervation of the gastrointestinal tract is more extensive and exerts a greater influence than does sympathetic innervation. In cases of dual innervation of a single organ, the sympathetic division has a major influence under conditions of physical activity or stress, whereas the parasympathetic division has a greater influence under resting conditions. However, the sympathetic division is not inactive during resting conditions; rather, it plays a major role during rest by maintaining blood pressure and body temperature. In general, during physical exercise the sympathetic division shunts blood and nutrients to structures that are active and decreases the activity of the nonessential organs. Typical responses produced by the sympathetic division during exercise include the following: 1. Increased heart rate and force of contraction increase blood pressure and the movement of blood. As skeletal or cardiac muscle contracts, oxygen and nutrients are used and waste products are produced. The decrease in oxygen and nutrients and the accumulation of waste products stimulate vasodilation (see chapter 21). Vasodilation is beneficial because it increases blood flow, bringing needed oxygen and nutrients and removing waste products. Too much vasodilation, however, can lower blood pressure, thereby decreasing blood flow. Conversely, increased stimulation of blood vessels of skeletal muscle by sympathetic nerves during exercise causes vasoconstriction, which prevents a drop in blood pressure (see chapter 21). For example, vasoconstriction in the abdominopelvic organs reduces blood flow through them, making more blood available for the exercising tissues. Skeletal muscle cells and liver cells (hepatocytes) are stimulated to break down glycogen to glucose. Skeletal muscle cells use the glucose, and liver cells release it into the blood for use by other tissues. Adipocytes break down stored lipids, releasing fatty acids into the blood, which are used as an energy source by skeletal muscle and cardiac muscle. Vasodilation of blood vessels in the skin brings warm blood close to the surface, where heat is lost to the environment. Sweat gland activity increases, resulting in increased sweat production, and evaporation of the sweat removes additional heat. For example, the process of digesting food slows as digestive glands decrease their secretions and the contractions of smooth muscle that mix and move food through the gastrointestinal tract decrease. Describe the role of the sympathetic division during activity or stress and the general effects on the body. Describe the role of the parasympathetic division during rest and the general effects on the body. Differentiate between cholinergic and adrenergic neurons as to the neurotransmitter secreted and the type of neuron that secretes the neurotransmitter. If the neuron secretes acetylcholine, it is called a cholinergic (kol-in-erjik) neuron; if it secretes norepinephrine (epinephrine), it is called an adrenergic (ad-r-nerjik) neuron. Adrenergic neurons are so named because at one time they were believed to secrete adrenaline, or epinephrine. All preganglionic neurons of the sympathetic and parasympathetic divisions are cholinergic. Almost all postganglionic neurons of the sympathetic division are adrenergic, but a few postganglionic neurons that innervate thermoregulatory sweat glands are cholinergic (figure 16. These substances include nitric oxide; fatty acids, such as eicosanoids; peptides, such as gastrin, somatostatin, cholecystokinin, vasoactive intestinal peptide, enkephalins, and substance P; and monoamines, such as dopamine, serotonin, and histamine. For example, skin temperature, heart rate, and brain waves can be monitored electronically. Then, by watching the monitor and using biofeedback techniques, a person can learn to consciously reduce his or her heart rate and blood pressure and regulate blood flow in the limbs. For example, some people claim they can prevent the onset of migraine headaches or reduce their intensity by learning to dilate the blood vessels in the skin of their forearms and hands. Increased blood vessel dilation increases skin temperature, which is correlated with a decrease in the severity of the migraine. Some people use biofeedback methods to relax by learning to reduce their heart rate or change the pattern of their brain waves. Biofeedback techniques can also be used to reduce the severity of some stomach ulcers, high blood pressure, anxiety, and depression. Some people use meditation techniques to reduce heart rate, blood pressure, the severity of ulcers, and other symptoms associated with stress. The fight-or-flight response occurs when an individual is subjected to stress, as in a threatening, frightening, embarrassing, or exciting situation.

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The sympathetic division has a more general effect than the parasympathetic division because activation of the sympathetic division often causes secretion of both epinephrine and norepinephrine from the adrenal medulla heart attack nursing diagnosis benicar 40 mg purchase with amex. These hormones circulate in the blood and stimulate effectors throughout the body heart attack video cheap benicar 20 mg otc. Because circulating epinephrine and norepinephrine can persist for a few minutes before being broken down, they can also produce an effect for a longer time than the direct stimulation of effectors by postganglionic sympathetic axons. Each sympathetic preganglionic neuron synapses with many postganglionic neurons, whereas each parasympathetic preganglionic neuron synapses with about two postganglionic neurons. Consequently, stimulation of sympathetic preganglionic neurons can result in greater stimulation of an effector. For example, vasoconstriction of cutaneous blood vessels in a cold hand is not always associated with an increased heart rate or other responses controlled by the sympathetic division. What kinds of effects, excitatory or inhibitory, do the sympathetic and parasympathetic divisions produce In the autonomic nervous system, action potentials were conducted to the sympathetic chain ganglia. Sympathetic neurons that regulate digestive function passed through the sympathetic chain ganglia to activate the splanchnic nerves and synapsed in the collateral ganglia. These neurons then conducted the action potentials to the digestive tract, where they decreased the activity of enteric neurons and decreased digestive secretion and motility. The changes in her muscle movements occurred when action potentials were then conducted to the frontal lobe of the cerebrum, where voluntary motor activity is controlled. Action potentials initiated in the motor area of the frontal lobe traveled through descending pathways of the spinal cord. Somatic motor neurons carried action potentials from the spinal cord to the involved skeletal muscles, allowing the movements necessary for Officer Smith to drive her car. The sympathetic division has more influence on effectors under conditions of increased physical activity or stress, whereas the parasympathetic division has more influence under conditions of rest. The postganglionic axons extend to smooth muscle, cardiac muscle, or glands and have an excitatory or inhibitory effect, which is usually unconsciously controlled. Preganglionic axons synapse (at the same or a different level) with postganglionic neurons, which exit the ganglia through the gray rami communicantes and enter spinal nerves. Preganglionic axons synapse (at the same or a different level) with postganglionic neurons, which exit the ganglia through sympathetic nerves. Preganglionic axons pass through the chain ganglia without synapsing to form splanchnic nerves. Preganglionic axons then synapse with postganglionic neurons in collateral ganglia. Preganglionic cell bodies are in nuclei in the brainstem or the lateral parts of the spinal cord gray matter from S2 to S4. Preganglionic axons from the sacral region pass through the pelvic splanchnic nerves to the ganglia. Preganglionic axons pass to terminal ganglia within the wall of or near the organ that is innervated. Preganglionic cell bodies are in the lateral horns of the spinal cord gray matter from T1 to L2. Preganglionic axons pass through the ventral roots to the white rami communicantes to the sympathetic chain ganglia. From there, four courses are possible: Autonomic Nerve Plexuses and Distribution of Autonomic Nerve Fibers 1. Sympathetic axons reach organs through spinal nerves, head and neck nerve plexuses, thoracic nerve plexuses, and abdominopelvic nerve plexuses. Parasympathetic axons reach organs through cranial nerves, thoracic nerve plexuses, abdominopelvic nerve plexuses, and pelvic splanchnic nerves. Sensory neurons run alongside sympathetic and parasympathetic neurons within nerves and nerve plexuses. Norepinephrine and epinephrine bind to alpha and beta receptors (found in most sympathetic effectors). Activation of nicotinic receptors is excitatory, whereas activation of muscarinic, alpha, or beta receptors is either excitatory or inhibitory. Sympathetic activity generally prepares the body for physical activity, whereas parasympathetic activity is more important for resting functions. Autonomic reflexes control most of the activity of visceral organs, glands, and blood vessels. Autonomic reflex activity can be influenced by the hypothalamus and higher brain centers. The sympathetic and parasympathetic divisions can influence the activities of the enteric nervous system through autonomic reflexes. Acetylcholine is released by cholinergic neurons (all preganglionic neurons, all parasympathetic postganglionic neurons, and some sympathetic postganglionic neurons). Norepinephrine is released by adrenergic neurons (most sympathetic postganglionic neurons). Either division alone or both working together can coordinate the activities of different structures. The sympathetic division produces more generalized effects than the parasympathetic division.

Syndromes

  • Loss of central vision (in advanced cases)
  • Green leafy vegetables (such as spinach and broccoli)
  • Undergoing mental health treatment, such as taking antidepressants or mood stabilizers, if mood swings or other mental health problems occur
  • Pallor
  • Fluids through a vein (by IV)
  • Nerve problems

In response to these changes blood pressure normal values benicar 10 mg purchase without a prescription, the vasomotor center decreases sympathetic stimulation of blood vessels blood pressure yoga ramdev cheap benicar 20 mg on-line, and the cardioregulatory center increases parasympathetic stimulation of the heart. As a result, peripheral blood vessels dilate, heart rate decreases, and blood pressure decreases (figure 21. Similarly, a sudden decrease in blood pressure causes the action potential frequency produced by the baroreceptors to also decrease. In response, the vasomotor center increases sympathetic stimulation of the blood vessels, and the cardioregulatory center increases sympathetic stimulation and decreases parasympathetic stimulation of the heart. As a result, peripheral blood vessels constrict, heart rate and stroke volume increase, and blood pressure increases (see figures 21. The carotid sinus and aortic arch baroreceptor reflexes are important in regulating blood pressure moment to moment. When a person rises rapidly from sitting or lying to a standing position, blood pressure in the neck and thoracic regions drops dramatically because of the pull of gravity on the blood. This reduction can cause blood flow to the brain to become so sluggish that dizziness or loss of consciousness results. The falling blood pressure activates the baroreceptor reflexes, which reestablish normal blood pressure within a few seconds. As indicated by the equations, blood pressure is influenced by three factors: (1) heart rate, (2) stroke volume, and (3) peripheral resistance. Because stroke volume depends on the amount of blood entering the heart, regulatory mechanisms that control blood volume also affect blood pressure. For example, an increase in blood volume increases venous return, which increases preload, and the increased preload increases stroke volume. When blood pressure suddenly drops because of hemorrhage or some other cause, the control systems respond by increasing blood pressure to a value consistent with life and by increasing blood volume to its normal value. Two major types of control systems operate to achieve these responses: (1) those that respond in the short term and (2) those that respond in the long term. The short-term regulatory mechanisms respond quickly but begin to lose their capacity to regulate blood pressure a few hours to a few days after blood pressure is maintained at homeostatic values. Longterm regulation of blood pressure is controlled primarily by mechanisms that influence kidney function. Short-Term Regulation of Blood Pressure the short-term, rapidly acting mechanisms controlling blood pressure involve neural and hormonal control mechanisms. Some of these reflex mechanisms operate on a minute-to-minute basis and help regulate blood pressure within a narrow range of values. Predict 8 Explain how the baroreceptor reflexes respond when a person does a headstand. Cardioregulatory 4 Increased sympathetic stimulation of the heart increases and vasomotor the heart rate and stroke volume. A decrease in blood pressure decreases parasympathetic stimulation of the heart and increases sympathetic stimulation of the heart and blood vessels, resulting in an increase in blood pressure. During exercise, blood flow through skeletal muscles can be 15­20 times greater than through resting muscles. The increase in blood flow ensures that the skeletal muscles receive adequate oxygen and nutrients to sustain activity and remove metabolic waste. Local, nervous, and hormonal regulatory mechanisms are responsible for the increased blood flow. When skeletal muscle is resting, only 20­25% of the capillaries in the skeletal muscle are open, whereas during exercise 100% of the capillaries are open. Increased sympathetic stimulation and epinephrine released from the adrenal medulla cause vasoconstriction in the blood vessels of the skin and viscera, but only some vasoconstriction in the blood vessels of skeletal muscles. Even though some vasoconstriction in skeletal muscle blood vessels occurs, the total resistance to blood flow in skeletal muscle decreases because all the capillaries are open. Blood flow through the skeletal muscles is also enhanced because the increased resistance to blood flow in the skin and viscera causes blood to be shunted from these areas to the skeletal muscles. The movement of skeletal muscles compresses veins in a cyclic fashion and greatly increases venous return to the heart. In addition, veins undergo some constriction, which reduces the total volume of blood in the veins without dramatically increasing resistance to blood flow. The resulting increase in the preload and increased sympathetic stimulation of the heart lead to elevated heart rate and stroke volume, which increases cardiac output. As a consequence, blood pressure usually increases by 20­60 mm Hg, which also helps sustain the increased blood flow through skeletal muscle blood vessels. As previously mentioned, blood flow through the skin decreases at the beginning of exercise in response to sympathetic stimulation. However, as body temperature increases in response to increased muscular activity, temperature receptors in the hypothalamus are stimulated. As a result, action potentials in sympathetic nerve fibers causing vasoconstriction decrease, allowing vasodilation of blood vessels in the skin. As a consequence, the skin turns a red or pinkish color, and a great deal of excess heat is lost as blood flows through the dilated blood vessels. The cardioregulatory center increases parasympathetic stimulation and decreases sympathetic stimulation of the heart. The vasomotor center decreases sympathetic stimulation of the blood vessels (baroreceptor reflex). Stimulus Receptors and control centers: Baroreceptors in the carotid arteries and aorta detect a decrease in blood pressure. The cardioregulatory center decreases parasympathetic stimulation and increases sympathetic stimulation of the heart. The vasomotor center increases sympathetic stimulation of the blood vessels (baroreceptor reflex). The adrenal medulla increases secretion of epinephrine and norepinephrine (adrenal medullary mechanism).

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To maintain weight ulterior motive meaning cheap 40 mg benicar with amex, the daily input of energy should equal the metabolic expenditure of energy; otherwise arrhythmia death purchase generic benicar pills, a person will gain or lose weight. For a typical 23-year-old, 70 kg (154-pound) male to maintain his weight, the daily input should be 2700 kcal/day; for a typical 58 kg (128-pound) female of the same age, 2000 kcal/day is sufficient. Reducing kilocaloric intake by 500 kcal/day can result in the loss of 1 pound of body fat per week. When considering the types of nutrients to eat to maintain a healthy weight, we need to consider the number of kilocalories but also the types of nutrients. To convert dietary fat into body fat, 3% of the energy in the dietary fat is used, leaving 97% for Thermic Effect of Food the second component of metabolic energy is used for activities involved in digestion and absorption of food. When food is ingested, the accessory digestive organs and the intestinal lining produce secretions, the motility of the digestive tract increases, active transport increases, and the liver is involved in synthesizing new molecules. Therefore, physical activity resulting from skeletal muscle movement requires the expenditure of energy. In addition, energy is needed for the increased contraction of the heart and muscles of respiration. The number of kilocalories expended in an activity depends almost entirely on the amount and duration of muscular work performed. Energy loss through muscular activity is the only component of energy expenditure that a person can reasonably control. Too little synthesis of certain substances or a buildup of toxic compounds can cause significant health problems. Although the frequency of any given individual disorder is rare, the overall incidence of metabolic disorders is estimated to be up to 1 in 1000 births. Depending on the disorder, specific treatment can prevent or limit harm if it is started early. However, there is no national standard for newborn screening, so the specific disorders for which tests are performed vary from state to state. Although over several hundred genetic disorders are known, most are so rare that it is not cost-effective to test for them. Biotinidase deficiency Maple syrup urine disease Restrict dietary intake of the affected amino acids. Homocystinuria Dislocated lenses of the eyes, intellectual disability, skeletal abnormalities, abnormal blood clotting Mild intellectual disability, language skill difficulties, liver and kidney failure Take high doses of vitamin B6; eat methionine-restricted diet supplemented with cysteine. Tyrosinemia kilocalories lost in exercise reveals why losing weight can be difficult. For example, if brisk walking uses 225 kcal/h, it takes 20 minutes of brisk walking to burn off the 75 kcal in one slice of bread (75/225 = 0. Research suggests that a combination of appropriate physical activity and appropriate kilocaloric intake is the best way to maintain a healthy body composition and weight. If jogging at a pace of 6 mph uses 580 kcal/h, how long does it take to use the kilocalories in one cola or beer Humans can maintain a relatively constant internal body temperature despite changes in the temperature of the surrounding environment. For example, environmental temperatures are too low for normal enzyme function, so the heat produced by metabolism helps maintain body temperature at a steady level that is high enough for normal enzyme function. Free energy is the total amount of energy liberated by the complete catabolism of food. It is usually expressed in terms of kilocalories (kcal) per mole of food consumed. For example, the complete catabolism of 1 mole of glucose (168 g; see chapter 2) releases 686 kcal of free energy. The body generates heat through normal metabolism as well as through the muscle contractions of shivering. The body also exchanges heat with the environment by radiation, conduction, or convection, depending on skin temperature and the environmental temperature. In addition, the body can lose heat to the environment through evaporation of perspiration from the skin. The difference in temperature between the body and the environment determines the amount of heat exchanged between the two. For example, if the environmental temperature is very cold, as on a cold winter day, a large temperature difference exists between the body and the environment, and therefore a large loss of heat occurs. Behaviorally, we can reduce the heat loss by seeking a warmer environment-for example, by going inside a heated house or putting on extra clothes. Physiologically, the body controls temperature difference through the dilation and constriction of blood vessels in the skin and the activity of sweat glands. When the environmental temperature is greater than body temperature, vasodilation brings warm blood to the skin, causing an increase in skin temperature. Radiation from sun and water the average normal body temperature is considered to be 37°C (98. Rectal temperature comes closer to the true core body temperature, but an oral temperature is more easily obtained in older children and adults and therefore is the preferred measure. Radiation is the gain or loss of heat between two objects that are not in physical contact. For example, the body can gain heat by radiation from the sun, a hot coal, or the hot sand of a beach. On the other hand, the body can lose heat by radiation to cool vegetation or snow on the ground. Conduction is the exchange of heat between objects in direct contact with each other, such as the bottoms of the feet and the floor. Convection is a transfer of heat between the body and the air or water, as the air or water moves across the surface of the skin.

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