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Increased acid production: Increased production of organic acids like acetoacetic acid impotence young males discount super cialis 80mg without a prescription, -hydroxybutyric acid as occurs in diabetic ketoacidosis; increased production of lactic acid as occurs in lactic acidosis; and other conditions such as methanol toxicity erectile dysfunction drugs in kenya buy super cialis in india, salicylate toxicity erectile dysfunction rates purchase super cialis cheap, etc. Reduced acid elimination: Reduction in the elimination of acids such as in renal failure, renal tubular acidosis etc. Excessive loss of bicarbonate: Decreased reclamation of bicarbonate from the renal tubules due to its decreased reabsorption, excessive loss of bicarbonate from duodenal fluid as occurs in acute diarrhea, pancreatitis, intestinal fistula etc. Excretion of Titrable Acids the H ion secreted into tubular fluid is excreted after being titrated by the urinary buffers, which is called as titrable acid. Thus, for each mmol of H+ excreted as a titrable acid, one mmol of bicarbonate ion is added to the plasma. Ammonia being lipid soluble diffuses into tubular lumen and binds to acid to form ammonium ion, which is excreted in the urine. When H+ secretion in collecting duct is decreased, net acid excretion by the kidney is decreased. The resulting fall in pH stimulates respiratory compensatory mechanism and hyperventilation occurs. Renal Compensation Renal compensation to metabolic acidosis causes increased acid excretion, ammonia formation and reclamation of bicarbonate ions. It leads to increase in respiratory rate and depth, which is not possible if the respiratory defect itself is the reason for respiratory acidosis. Etiopathogenesis Respiratory acidosis occurs in conditions that depress respiratory centers, affects respiratory apparatus, and in some other causes. Conditions that affect respiratory apparatus: the common examples are chronic obstructive pulmonary disease, severe asthma, adult respiratory syndrome, chest wall deformity. Other causes: Respiratory acidosis also occurs in extreme obesity, sleep apnea syndrome, abdominal distention as in severe ascites (as in severe ascites), etc. Respiratory acidosis is an imperative situation and body immediately employs the buffer systems to bring down increased level of carbon dioxide. The acid released in the form of H+ is buffered largely by the hemoglobin and the protein buffers. In the early phase this could cause a transient metabolic alkalosis due to overproduction of bicarbonate ion within a short span of time. Metabolic Alkalosis Metabolic alkalosis is a condition of primary bicarbonate excess. Rise in pH is associated with binding of free calcium ions to body proteins and other anions. Etiopathogenesis Metabolic alkalosis can be categorized into three types: saline responsive alkalosis, saline resistant alkalosis and exogenous base-load alkalosis. Saline Responsive Alkalosis In saline responsive alkalosis the urinary chlorine level is less than 10 mM/L. Normotensive Saline Responsive Alkalosis Examples are excess vomiting (loss of acid), pyloric or duodenal obstructions, prolonged administration of diuretics (diuretic abuse), post-hypercapnia, cystic fibrosis, postbicarbonate therapy of organic acidosis etc. The hypovolemia stimulates kidneys to activate renin-angiotensin-aldosterone system. However it gets activated in 6 to 12 hours and reaches its peak action in 2 to 3 days. During vomiting, the bicarbonate enters plasma in exchange of the chloride ions lost and causes alkalosis. Correction with simple sodium chloride in the form of saline is sufficient to reverse these situations. This leads to persistent sodium absorption, hypertension, hypokalemia and alkalosis.

Animal fails to ignore peripheral stimuli (hypermetamorphosis) erectile dysfunction treatment new drugs super cialis 80mg with mastercard, and therefore erectile dysfunction main causes cheap super cialis 80 mg overnight delivery, respond to every stimulus and explore everything over the counter erectile dysfunction pills uk purchase super cialis in united states online. Applied Physiology Psychosurgery In 1935, John Fulton observed that frontal lobotomy in mon keys cures experimentally induced neurosis. Since then, selected lesions of the brain, especially of the limbic areas have been performed for the treatment of psychiatric disor ders, which are popularly known as psychosurgery. Psycho surgery is usually used for the treatment of psychiatric illness in which extremes of aggression is the main symptom. Emotional responses, autonomic reaction and visceral of the body are influenced by limbic system. Nucleus accumbens is the major reward center and dopamine is the key neurotransmitter for motivation. Limbic functions, Papez circuit, Motivation, Emotion, Addiction, Reward system, Avoidance system, Autonomic responses may come as Short Questions. Name the structures of limbic system, What are the limbic functions, What are the components of Papez circuit, Physiology of Motivation, Physiology of Emotion, Physiology of Addiction, Physiology of Reward system, Physiology of Avoidance system, Types of autonomic responses, Neurotransmitter systems and their functions, Causes and features of KluverBucy syndrome. This is because the process of learning involves the storage of new information in memory and its retrieval at appropriate time, and the pro cess of memory involves repeated acquirement of new knowledge (learning). It is known that frequent learning of newer facts increases the horizon of memory. Memory is the simple repetition of what has already been performed or stored, whereas learning involves more than the simple use of memory. It uses all less-understood processes like reasoning, cognitive processes and common sense: 1. The common sites of learning and memory in the human brain are the association areas of the cerebral cortex and sub-cortical structures in the temporal lobe, including the hippocampus and amygdala. The association cortical areas imbibe sensory information from the somatosensory cortex, and visual, auditory, and olfactory cortices. These information are integrated with previous experiences of learned skills and are then stored in the memory. Definitions Learning Learning is defined as acquirement of information or knowledge by experience that results in the alteration of behavior. It depends mostly on motivation that creates adequate interest and attention to promote learning. The stored information should be retrieved and utilized at any time in life whenever needed. Registration of memory that includes proper percep tion and attention: Failure of learning and memory occurs due to impaired perception and attention because the material to be learned is never registered and assimilated (Application Box 138. Recognition and recall: At the appropriate time and place, memory is recalled for proper use. Reutilization: Memory (the learned experience) is utilized for improvement of further learning. Long-term memory is the one that stores information for years together, and sometimes for life. Sensitization Explicit memory and many forms of implicit memory involve short-term and long-term memory.

Relaxin secreted from placenta causes uterine relaxation in the early part of pregnancy like progesterone to facilitate implantation and prevent expulsion of fetus erectile dysfunction in diabetes management discount 80 mg super cialis fast delivery. Toward term disease that causes erectile dysfunction generic super cialis 80 mg mastercard, it causes relaxation of pubic symphysis and pelvic ligaments to facilitate delivery of fetus impotence tcm trusted 80mg super cialis. Chapter 72: Pregnancy and Parturition 643 in the early phase of pregnancy and is significantly high by the end of first trimester. The increase in cardiac output is due to the increase in both stroke volume and heart rate. Stroke Volume Stoke volume increases by about 30%, which peaks at about 24 weeks of pregnancy. Erythropoiesis is stimulated in pregnancy due to increased erythropoietin production. As increase in red cell mass is slower and lesser than the increase in plasma volume, there is a relative decrease in the red cell count due to hemodilution, though actually the red cell production is more. Pulse pressure is wide due to increase in systolic and decrease in diastolic pressures. Hematological Changes Hematological changes are primarily designed to increase oxygen supply to the fetus and protect the fetus against infections. The increase in procoagulant activity is among the striking hematological changes in third trimester of pregnancy. Regional Blood Flow In consequence to increased cardiac output and improved hemodynamics, blood flow increases in uterine, renal, mammary and cutaneous vascular bed. Changes in Respiratory System Respiratory changes aim to improve supply of oxygen to the fetus and removal of carbon dioxide from the fetus. The increase is about 30% at the end of 8th week, which continues to increase to reach the peak of more than 50% of the nonpregnant value. The increase in ventilation is due to the stimulation of respiratory centers by estrogen. Changes in Cardiovascular System Cardiac Output the major hemodynamic change in pregnancy is the increase in cardiac output. In third trimester, inspite of elevation of diaphragm due to increase in size of uterus, ventilation is not impaired significantly. Plasma lipid and cholesterol increase sharply in pregnancy to almost double the nonpregnant value. The level of chenodeoxycholic acid in the bile, which increases the solubility of cholesterol, decreases due to the effect of estrogen. Renal blood flow increases by 35% that parallels the increase in blood volume and cardiac output. Renal vasodilation occurs due to increased local production of prostaglandins that facilitates increased renal plasma flow. The load of filtered glucose increases without increase in tubular capacity to reabsorb glucose. Changes in Endocrine System Pituitary Secretions the size of anterior lobe increases two to three times during gestation, which is mainly due to increase in size and number of prolactin secreting cells. Prolactin secretion starts increasing from end of first trimester and at term it is almost 10 times more than the pre-pregnant level. However, due to negative feedback effects of estrogen, gonadotrophs decrease in size.

Lesion of geniculocalcarine tract damages ipsilateral temporal fibers and contralateral nasal fibers resulting in homonymous hemianopia with macular sparing as macular fibers travel dorsal to the optic radiation and escape the damage erectile dysfunction doctor nyc buy discount super cialis line. Lesion of occipital cortex damages ipsilateral tempo ral fibers and contralateral nasal fibers with macular sparing erectile dysfunction causes std cheap super cialis 80 mg amex. It produces scotoma (blind patches) in the homonymous visual fields diabetic erectile dysfunction pump purchase super cialis 80 mg, which are usually quadrantic Light Adaptation When a person suddenly moves from a dimly lighted area to broad daylight, initially the light seems very bright and uncomfortable and the image appears blurred. The visual system activates several mechanisms to adjust to the bright light so that vision improves after some time. As an immediate reaction to sudden bright light, the pupil con stricts and the amount of light entering the retina is reduced. Mechanisms of Light Adaptation There are two mechanisms of light adaptation: neural and chemical. Following a light stimulus, the sensitivity of retinal photoreceptors decreases that manifests in the form of decreased burst of activity to a constant stimulus. The horizontal cells may have a feedback inhibitory effect upon the photoreceptors. Besides, with the increase in light intensity, the amplitude of receptor response does not rise proportionately. This mecha nism plays a greater role in quickly bringing down the sensitivity of the photoreceptors, so that light adapta tion is mainly a neural phenomenon. Due to this bleaching, rod responsiveness decreases considerably as rhodopsin becomes less available. Thus, with increased light intensity, rods become deactivated and cones get stimulated. Chapter 146: Visual Acuity, Visual Field, Light and Dark Adaptations, and Visual Reflexes 1191 2. Moreover, in the hyperpolarized rods, there is reduced Ca2+ influx that removes the inhibitory effect on gua nylyl cyclase. If a person stays for some time in bright sunlight and then moves into a dimly lighted room, he experiences a temporary blindness that improves after a few minutes. During this time his eye adjusts to the low levels of illu mination, a phenomenon known as dark adaptation. In dim light, the pupil dilates to allow the maximum possible light through the eye to have optimal vision. Maximum fall in cone sensitivity occurs in 5 minutes; Maximum fall in rod sensitivity occurs in 20 minutes. Mechanisms of Dark Adaptation There are two mechanisms of light adaptation: neural and chemical. In the second phase of adaptation, the rod threshold falls reaching its maximum in about 20 minutes. As the rods are more sensitive than the cones, in the low levels of illumination of the darkened room, visual capacity depends mainly on the rods. The time taken to accomplish full dark adaptation depends on the intensity, duration and wavelength of light to which the eyes were exposed when the person was in bright light. If the light was very bright or if the eyes were exposed for longer period, the dark adaptation requires longer time. Longer wavelength of light like red color stim ulates the cones to a fair extent, but rods are relatively insensitive to it. The aircraft pilots and radiologists who work in dim light are advised to wear red goggles when they are in bright light, so that the rods are less bleached and their sensitivity is maintained. When they enter the dimly lit room, they do not have to wait for 20 minutes as rods are soon darkadapted.

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