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The thoracic and pelvic curves are freedom of movement; called primary curves because they retain the shape of the fetus purchase 15 mcg mircette otc. Vertebrae are similar in their general structure from one region The vertebral column is typically composed of 33 individ- to another discount 15mcg mircette fast delivery. A typical vertebra consists of an anterior drum- ual vertebrae, some of which are fused. There are 7 cervical, shaped body, which is in contact with intervertebral discs 12 thoracic, 5 lumbar, 3 to 5 fused sacral, and 4 or 5 fused coc- above and below (fig. Between structural arrangement permits only limited movement between the pedicles of adjacent vertebrae are the intervertebral foram- adjacent vertebrae but extensive movement for the vertebral col- ina, through which spinal nerves emerge as they branch off the umn as a whole. When viewed from the side, four curvatures of the verte- bral column can be identified (fig. Skeletal System: © The McGraw−Hill Anatomy, Sixth Edition Introduction and the Axial Companies, 2001 Skeleton 160 Unit 4 Support and Movement Body Transverse Superior foramen Occipital articular condyle process of skull Atlas Vertebral Pedicle foramen Vertebral arch Lamina Axis Spinous process Body of C3 (note that it is bifid) (b) Intervertebral disc between C5 and C6 Anterior arch Dens of axis Spinous of atlas process of C7 Superior articular Body of facet (articulates axis (a) with occipital condyle) Atlas Axis Transverse foramina Transverse processes Posterior arch of atlas Spinous process of axis (c) FIGURE 6. Seven processes arise from the vertebral arch of a typical Regional Characteristics of Vertebrae vertebrae: the spinous process, two transverse processes, two superior articular processes, and two inferior articular Cervical Vertebrae processes (fig. The spinous process and transverse processes serve for muscle attachment and the superior and infe- The seven cervical vertebrae form a flexible framework for the rior articular processes limit twisting of the vertebral column. The bone tissue of cervical vertebrae The spinous process protrudes posteriorly and inferiorly from the is more dense than that found in the other vertebral regions, vertebral arch. The transverse processes extend laterally from and, except for those in the coccygeal region, the cervical verte- each side of a vertebra at the point where the lamina and pedicle brae are smallest. The superior articular processes of a vertebra interlock with presence of a transverse foramen in each transverse process the inferior articular processes of the bone above. The vertebral arteries and veins pass through this opening as they contribute to the blood flow associated with the A laminectomy is the surgical removal of the spinous brain. Cervical vertebrae C2–C6 generally have a bifid, or processes and their supporting vertebral laminae in a particu- lar region of the vertebral column. The bifid spinous processes increase to relieve pressure on the spinal cord or nerve root caused by a the surface area for attachment of the strong nuchal ligament that blood clot, a tumor, or a herniated (ruptured) disc. The first cervical vertebra has formed on a cadaver to expose the spinal cord and its surrounding no spinous process, and the process of C7 is not bifid and is larger meninges. Skeletal System: © The McGraw−Hill Anatomy, Sixth Edition Introduction and the Axial Companies, 2001 Skeleton Chapter 6 Skeletal System: Introduction and the Axial Skeleton 161 Facet for Creek head of rib Transverse process Body Body T1 Demifacet for head of rib Demifacet for Pedicle head of rib Vertebral foramen Transverse Pedicle process Superior articular Facet for Facet for process head of rib tubercle of rib Facet for Superior tubercle of rib Lamina articular T2–T8 process Spinous process Spinous Demifacet for (b) process head of rib Inferior articular process T9 Intervertebral foramen Intervertebral disc T10 Facet for head of rib (a) FIGURE 6. The atlas is the first cervical vertebra (sometimes called cer- of the first three cervical vertebrae are common and follow abrupt vical 1 or C1). The atlas lacks a body, but it does have a short, forced flexion of the neck.

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Motor impulses through fibers from the anterior branches of spinal nerves C5 through the paired phrenic nerves cause the diaphragm to contract buy mircette 15 mcg on line, mov- T1 and a few fibers from C4 and T2 purchase 15mcg mircette mastercard. The roots converge to form trunks, and The nerves of the cervical plexus are summarized in the trunks branch into divisions. Brachial Plexus The brachial plexus may suffer trauma, especially if the clavi- cle, upper ribs, or lower cervical vertebrae are seriously frac- The brachial plexus is positioned to the side of the last four cer- tured. Occasionally, the brachial plexus of a newborn is severely vical vertebrae and the first thoracic vertebra. It is formed by the strained during a difficult delivery when the baby is pulled through anterior rami of C5 through T1, with occasional contributions the birth canal. In such cases, the arm of the injured side is para- lyzed and eventually withers as the muscles atrophy in relation to the from C4 and T2. Each brachial plexus innervates called a brachial block or brachial anesthesia. The site for injection of the entire upper extremity of one side, as well as a number of the anesthetic is located midway between the base of the neck and the shoulder, posterior to the clavicle. Structurally, the brachial plexus is divided into roots, trunks, divisions, and cords (figs. The roots of Five major nerves—the axillary, radial, musculocutaneous, the brachial plexus are simply continuations of the anterior rami ulnar, and median—arise from the three cords of the brachial of the cervical nerves. The anterior rami of C5 and C6 converge plexus to supply cutaneous and muscular innervation to the to become the superior trunk, the C7 ramus becomes the mid- upper extremity (table 12. The axillary nerve arises from the dle trunk, and the ventral rami of C8 and T1 converge to be- posterior cord. It provides sensory innervation to the skin of the come the inferior trunk. Each of the three trunks immediately shoulder and shoulder joint, and motor innervation to the del- divides into an anterior division and a posterior division. The posterior cord from the posterior cord and extends along the posterior aspect of is formed by the convergence of the posterior divisions of the the brachial region to the radial side of the forearm. It provides upper, middle, and lower trunks; hence, it contains fibers from sensory innervation to the skin of the posterior lateral surface of C5 through C8. The medial cord is a continuation of the ante- the upper extremity, including the posterior surface of the hand rior division of the lower trunk and primarily contains fibers from (fig. The lateral cord is formed by the convergence of the of the elbow joint, the brachioradialis muscle that flexes the anterior division of the upper and middle trunk and consists of elbow joint, and the supinator muscle that supinates the forearm fibers from C5 through C7. Peripheral Nervous © The McGraw−Hill Anatomy, Sixth Edition Coordination System Companies, 2001 Chapter 12 Peripheral Nervous System 417 FIGURE 12. Cervical plexus region Deltoid muscle Brachial plexus region Musculocutaneous nerve Brachiocephalic artery Median nerve Subclavian artery Ulnar nerve Medial pectoral nerve Medial antebrachial cutaneous nerve Pectoralis major muscle Thoracodorsal nerve Serratus anterior muscle Latissimus dorsi muscle FIGURE 12.

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When disease or disability results in altered bowel control 15mcg mircette for sale, incontinence may become as devastating a problem as the disease itself purchase mircette 15 mcg. Control of incontinence and prevention of constipation and diarrhea are possible through an effective bowel program, which requires a knowledge of normal and altered bowel physiology as well as an in-depth assessment of bowel function. The lower bowel acts under voluntary control to store and eliminate feces. Inability to store fecal matter causes problems with involuntary bowel or incontinence. The bowel consists of three separate parts: the ileum, the cecum, and the colon. It is approximately 12 feet long and extends from the jejunum to the ileocecal opening. Almost all absorption and digestion is accomplished in the small intestine. The small intestine absorbs water and sodium and secretes mucus, potassium, and bicarbonate for stool formation. The cecum is 6 cm in length and lies below the terminal ileum, forming the first part of the large intestine. The colon is the division of the large intestine that extends from the cecum to the rectum. In the colon, fluids and electrolytes are reabsorbed and feces are stored so that defecation can occur at an acceptable time. Defecation is affected by peristalsis, anorectal sensory aware- ness, anal sphincter function, and abdominal muscle func- tion and strength. The rectum is the 12 cm segment of the large bowel between the sigmoid colon and the anal canal. Striated muscle in the anal canal and pelvic floor provides sup- port to the rectal wall and anus, thus maintaining continence. Neurogenic bowel results from the interruption of neural pathways that supply the rectum, external sphincter, and accessory muscles involved in defecation. Nerve impulses that are disrupted may impede cerebral recognition of anal contents and the need to empty stool at a desired or planned time. Decreased activity related to altered mobility, fatigue, or a sedentary lifestyle may contribute to slow bowel function. Constipation has been defined as less than or equal to two bowel movements per week; or the need for stimulation, the use of laxatives, enemas, or suppositories more than once a week. Constipation has also been characterized by hard, dry stool, causing straining or painful defecation and resulting in a delay of passage of food residue. Medications contributing to constipation may include analgesics anticholinergics anticonvulsants antidepressants diuretics psychotherapeutics iron opiates muscle relaxants 9.

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