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It occurs in two phases: an initial slow process of initiation of mineralization followed by rapid mineralization process allergy symptoms and headaches purchase zyrtec 5mg with mastercard. The bone matrix is surrounded by a metastatic solution of calcium and phosphate ions (solution in which concentration of Ca2+ and Po43- exceeds the solubility product of the salt but precipitation is inhibited by certain inhibitors like pyrophosphate) allergy symptoms eyes pictures order generic zyrtec from india. For enucleation to take place, pyrophosphate has to be cleaved into inorganic phosphate by alkaline phosphatase which also has activity of pyrophosphatase. Thereafter, hydroxide and bicarbonate ions are gradually added to the mineral mixture, and mature hydroxyapatite crystals are slowly formed. In this way, a number of lamellae are laid down one over another and these lamellae together form a trabecula of bone, but many such trabeculae constitute the trabecular or cancellous bone. Within each lamella, mineral fluid containing channels, called canaliculi, traverse the mineralized bone. Through these channels, the interior osteocytes remain connected with surface lining cells and with other osteocytes via syncytial cell processes. This system of interconnected cells formed by osteocytes and osteoblasts spreads over all the bone surfaces except small surface area adjacent to osteoclasts. A small amount of fluid called the bone fluid is present between the bone and osteocytic membrane. This arrangement permits transfer of calcium from the enormous surface area of the interior to the exterior of the bone units, and then into the extracellular fluid. This transfer process, which is carried out by the osteocytes, is known as osteocytic osteolysis. It probably does not actually decrease bone mass, but it simply removes calcium from the most recently formed crystals. Conversion of trabecular bone to compact bone All newly formed bone is cancellous. In bone resorption, destruction of entire matrix of bone occurs resulting in diminished bone mass. As mentioned earlier, these are giant multinucleated cells formed probably by fusion of circulating monocytes (or bone marrow monocyte precursor cells). The lining cells also secrete a molecule that attracts osteoclasts to the site of new denuded bone. Attachment of osteoclast on denuded bone surface (periosteum or endosteum) is the second step of bone resorption. At the site of attachment, the osteoclasts release proteolytic enzymes and lysosomal enzyme and acid from the villi-like projections. The enzymes digest and dissolve organic matrix of the bone, and acids cause dissolution of the bone salts. All the dissolved materials are now released into extracellular fluid, some elements enter the blood. The remaining elements are cleaned up by the macrophages and a shallow cavity is formed in the bone-resorbing compartment. Urinary excretion of organic products released during resorption provides quantitative indices of bone resorption. It is an observation that there is neuroendocrinal regulation of bone mass via leptin. This is a consistent observation that obesity protects against bone loss because obese persons are resistant to the effect of leptin. Bone remodelling refers to a process of bone resorption followed by bone formation which keeps on occurring throughout life in a cyclic manner. The bone remodelling appears to be the result of co-ordinated activity of groups of interacting osteoclast and osteoblast cells which make up the bone remodelling unit.

Therefore quercetin allergy symptoms generic 10mg zyrtec with amex, low pO2 induced vasodilation increases the blood flow and corrects the deficiency allergy symptoms new virus order zyrtec 10 mg otc. Since it will not get adequately oxygenated, thus, the local low pO2 induced vasoconstriction in the lungs is a phenomenon that diverts pulmonary blood flow from the alveoli that are poorly ventilated to better ventilated regions so that blood can be properly oxygenated. The smooth muscles of pulmonary arteries contain O2 sensitive K+ channels, which mediate the vasoconstriction caused by hypoxia. The functional significance of this response is same as in the case of local hypoxia. Chronic hypoxia, as occurs in high altitude dwellers, is associated with a marked increase in pulmonary arterial pressure (pulmonary hypertension), which imposes a heavy afterload on the right ventricle that results in right ventricular hypertrophy, right heart failure and pulmonary oedema. Humoral control the pulmonary vessels respond to circulating agents through their receptors located on smooth muscles of the vasculature Table 5. Special problems related to pulmonary haemodynamics have important implications for gas exchange in the lungs. The rate at which the respiratory gases diffuse across the respiratory membrane is a much more complicated problem, requiring a deeper understanding of the physics of diffusion and gas exchange. This is highly quantitative concept which was developed to help in understanding respiratory exchange when there is imbalance between alveolar ventilation and alveolar blood flow. Various important aspects of this process have also been discussed in this chapter. Physics of gas diffusion and gas partial pressures It is worthwhile to recapitulate some of the basic principles and laws governing the behaviour of gases, for a better understanding of the process of diffusion between alveolar air and pulmonary capillary blood. Consequently, the present discussion is on some of the important aspects concerning physics of gas diffusion and gas partial pressures. Gas pressure the gas molecules have a kinetic energy so they are in a continuous random motion. These molecules bounce against each other and/or against the walls of container and exert a pressure. The gas pressure (P) exerted depends upon following factors: Concentration of molecules (n). It is obvious that greater the concentration of the molecules of gas, the greater would be the force exerted by the molecules against the container walls at any given time. Therefore, the pressure of a gas is directly proportional to its concentration, i. Therefore, it is obvious that the pressure exerted by a constant number of gas molecules will be more if the volume is less and vice versa. Therefore, at a constant temperature, the pressure (P) of a given mass of gas is inversely proportional to its volume (V), i. Thus, the partial pressure (p) refers to the pressure exerted by any one gas present in a mixture of gases. It is equal to the total pressure exerted by the mixture of gases times the fraction of the total amount of mixture of gases it represents. Hence, the partial pressure (p) of a gas can be calculated by multiplying its fractional concentration by the total pressure. For example, environmental air (which has atmospheric pressure (at sea level) of about 760 mmHg) is a mixture of 21% oxygen (O2) and 79% nitrogen (N2). Therefore, the partial pressure (p) of O2 and N2 respectively will be: Partial pressure of gases in water and tissues It is important to have knowledge about the partial pressure of gases in water and tissues, because the respiratory gases to cross the respiratory membrane must first dissolve in the tissues and then diffuse into the plasma of pulmonary capillaries. The pressure (p) of a gas in a solution is determined not only by its concentration but also by its solubility coefficient. When a gas under pressure comes in contact with a liquid, some of the gas molecules get dissolved in it. As more and more molecules become dissolved, they diffuse all over the liquid medium and some of them start bouncing out of the liquid phase into the gas phase. Ultimately, an equilibrium is reached when the number of gas molecules entering the liquid phase equals the number of molecules leaving it. Partial pressure of a gas in a liquid represents the pressure it would exert in the gas phase.

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Mechanism of tidal respiration Inspiration Inspiration is an active process allergy symptoms after drinking beer cheap zyrtec 10 mg, normally produced by contraction of the inspiratory muscles (negative-pressure breathing) allergy forecast jupiter fl buy zyrtec us. Use of a respirator to inflate the respiratory system produces positive pressure (positive-pressure breathing). During tidal inspiration (quiet breathing), the diaphragm and external intercostal muscles contract and cause an increase in all the three dimensions of the thoracic cavity. The diaphragm is a domeshaped, musculotendinous partition between the thorax and abdomen. The abdominal organs support the diaphragmatic dome and act as a fulcrum, while the diaphragmatic contraction raises the lower ribs. From pivot-like joint with the vertebrae, the ribs slope obliquely downwards and forwards. The abductor muscles of the larynx contract during inspiration pulling the vocal cords apart. Usually, hiccup is of short duration, but when it becomes debilitating, then use of dopamine antagonist and centrally acting analgesics may help. Mechanism of forced respiration Forced inspiration Forced inspiration is characterized by: 1. Forceful contraction of external intercostal muscles causing more elevation of ribs leading to more increase in transverse and anteroposterior diameter of the thoracic cavity. Forced expiration Forced expiration is required when respiration is increased during exercise or in the presence of severe respiratory disease. Contraction of the internal intercostal: It causes the effect which is just opposite to that of external intercostal muscles. Hence, their contraction tends to pull all the ribs downwards, thereby reducing the anteroposterior diameter (because of the falling of the pump-handle effect) as well as the transverse diameter (because of the action of ribs like the falling of the bucket-handle effect) of the thoracic cavity. Besides their role in deep breathing, the expiratory muscles are also involved in other forced expiratory efforts. Pressure and volume changes during the respiratory cycle Pressure changes Intrapulmonary pressure changes during the respiratory cycle (fig. The movement of air in and out of the lungs depends primarily on the pressure gradient between the alveoli and the atmosphere. The intrapulmonary or alveolar pressure is the air pressure inside the lung alveoli. At the end-expiration, once again the alveolar pressure regains the atmospheric pressure (zero mm of Hg). At the end of inspiration, the inspiratory muscles relax and the recoiling force of lungs begins to pull the chest wall back to expiratory position. Valsalva manoeuvre or when expiratory muscles work against closed glottis, there occurs a marked decrease in the thoracic volume causing deflation of lungs.

The reaction is catalyzed by the enzyme glucuronyl transferase present in the hepatic microsomes (smooth endoplasmic reticulum of liver cells) allergy forecast columbus oh discount 10mg zyrtec with mastercard. The conjugated bilirubin from the hepatic cells is excreted into the bile canaliculi through active transport allergy symptoms video buy 10 mg zyrtec with visa, i. This active transport is the rate-limiting step in the entire process of bilirubin excretion and needs energy. Most of the conjugated bilirubin is excreted into the bile and enters the intestine. Some of it escapes into general circulation and is excreted by the kidneys in urine as urine bilirubin. The conjugated bilirubin which enters the intestine with the bile is degraded by the intestinal bacteria in the terminal ileum and the large intestine. The bacterial enzyme -glucuronidase splits off the glucuronide and converts bilirubin into the urobilinogen (stercobilinogen), which is a colourless compound. From the liver some urobilinogen escapes into general circulation and some gets re-excreted into the bile (enterohepatic circulation). The total serum bilirubin includes conjugated, as well as, unconjugated bilirubin. The Van den Bergh test described below is helpful in determining the type of bilirubin present in the serum. For quantitative estimation of bilirubin contents in the serum Van den Bergh test is performed using the diazo reagent (mixture of sulphanilic acid, hydrochloric acid and sodium nitrite). When diazo reagent is added to the serum containing conjugated bilirubin (water soluble), a reddish-brown colouration is obtained within 30 s. When diazo reagent is added to the serum mainly containing unconjugated bilirubin (water insoluble), no colour is obtained. However, if some solvent like methanol (which dissolves the unconjugated bilirubin) is added, the reddish-brown colouration is obtained. Hyperbilirubinaemia (jaundice) Jaundice (icterus) refers to the yellow appearance of the skin, sclera and mucous membranes resulting from an increased bilirubin concentration (hyperbilirubinaemia) in the body fluids. Hyperbilirubinaemia producing jaundice can result from the following mechanisms: 1. Excessive breakdown (haemolysis) of red blood cells produces the so-called haemolytic jaundice or prehepatic jaundice or retention hyperbilirubinaemia due to over production. Damage to the liver cells (infective or toxic) produces the so-called hepatic or hepatocellular jaundice. Obstruction to bile ducts produces the obstructive or posthepatic or cholestatic jaundice or regurgitation hyperbilirubinaemia (due to reflux into bloodstream). Characteristic features of these three varieties of jaundice are described in Table 3. Hepatocellular jaundice (hepatic jaundice) Cholestatic or obstructive jaundice (posthepatic jaundice) Obstruction to the bile flow due to any c ause from hepatoc ytes to duodenum. Ina bility of the liver to effic iently c onjugate as well as transport bilirubin into the bile due to liver c ell damage c aused by some infec tive or toxic agent. Types of serum bilirubin accumulated Unconjuga ted hyperbilirubinaemia oc c urs sinc e it is being produc ed in exc ess of what c an be c onjugated by the liver. Van den Bergh test Indirect positive rea ction (bec ause unc onjugated bilirubin is present Bipha sic rea ction (bec ause c onjugated and in blood). S inc e albumin is not filtered into urine, unc onjugated bilirubin too is not filtered in urine. Bec ause of this haemolytic jaundic e is also c alled a choluric ja undice (no bile pigment in urine).