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The vas deferens extends over (12) glans penis order super cialis 80 mg online, contains the (13) urethral ori- the top and down the posterior surface of the fice (meatus) discount super cialis 80 mg visa. A movable hood of skin super cialis 80mg lowest price, called the bladder buy super cialis 80mg fast delivery, where it joins the (6) seminal vesicle buy generic super cialis 80mg line. Midsagittal section of male reproductive structures shown through the pelvic cavity. Connecting Body Systems–Genitourinary System The main function of the genitourinary system is to enable sexual reproduction and to regulate extracellular fluids of the body. Specific functional relationships between the genitourinary system and other body systems are summarized below. Blood, lymph, and immune Endocrine • Male reproductive system transports • Kidneys regulate sodium and water bal- testosterone throughout the body in ance, which is essential for hormone trans- blood and lymph. Cardiovascular Female reproductive • Kidneys help regulate essential electrolytes • Male organs of reproduction work in con- needed for contraction of the heart. Digestive • Kidneys aid in removing waste products • Kidneys aid in removing glucose from the produced by the fetus in the pregnant blood when excessive amounts are con- woman. Anatomy and Physiology 315 Connecting Body Systems–Genitourinary System Integumentary Nervous • Kidneys compensate for extracellular fluid • Kidneys regulate sodium, potassium, and loss due to hyperhidrosis. Respiratory Musculoskeletal • Kidneys and lungs assist in regulating acid- • Kidneys work in conjunction with bone base balance of the body. It is time to review male reproductive anatomy by completing Learning Activity 11–2. Medical Word Elements This section introduces combining forms, suffixes, and prefixes related to the genitourinary system. The onset of the disease is usually acute, with Pathology of the urinary system includes a range of symptoms including pain around the kidney, disorders from those that are asymptomatic to dysuria, fatigue, urinary urgency and frequency, those that manifest an array of signs and symp- chills, fever, nausea, and vomiting. However, in some anomalies, infectious diseases, trauma, or condi- cases, organisms may have developed a resistance tions that secondarily involve the urinary struc- and alternative antibiotics may be required. Many times, asymptomatic urinary diseases are first diagnosed when a routine urinalysis shows Glomerulonephritis abnormalities. Forms of glomerulonephritis and chronic urinary tract infection are two such dis- Any condition that causes the glomerular walls orders. Symptoms specific to urinary disorders to become inflamed is referred to as glomeru- include changes in urination pattern, output, or lonephritis. Endoscopic tests, radiological evaluations, glomerular inflammation is a reaction to the toxins and laboratory tests that evaluate renal function are given off by pathogenic bacteria, especially strepto- typically employed to diagnose disorders of the uri- cocci that have recently infected another part of nary system. Glomerulonephritis Signs and symptoms of male reproductive dis- is also associated with diabetes and autoimmune orders include pain, swelling, erectile dysfunction, diseases such as systemic lupus erythematosus, and loss of normal sexual drive (libido). Red blood cells and include pain, discharge, or lesions as well as a vague protein pass through the glomerulus and enter the feeling of fullness or discomfort in the perineal or tubule.. A complete evaluation of the genitalia, nephron tubules and forms solid masses that take reproductive history, and past and present geni- the shape of the tubules in which they develop. They commonly pass identify disorders associated with male reproduc- out of the kidney by way of the urine and may be tive structures. For diagnosis, treatment, and management of The clinical picture for glomerulonephritis genitourinary disorders, the medical services of a includes blood and protein in the urine (hema- specialist may be warranted. The physician who specializes in diagnoses and with acute glomerulonephritis associated with a treatment of genitourinary disorders is known as a streptococcal infection recover with no lasting kid- urologist. Stones (calculi) may form in any part of the uri- nary tract (urolithiasis), but most arise in the kid- Pyelonephritis ney, a condition called nephrolithiasis. These stones may is pyelonephritis, (also called kidney infection or increase in size and obstruct urinary structures. In this disor- they lodge in the ureters, they cause intense throb- der, bacteria invade the renal pelvis and kidney tis- bing pain called colic. Because urine is hindered sue, commonly as a result of a bladder infection that from passing into the bladder, it flows backward has ascended to the kidney via the ureters. When (refluxes) into the renal pelvis and the tubules, the infection is severe, lesions form in the renal causing them to dilate. If the stone is large, an ultrason- ic or electrohydraulic probe is used to break the stone into smaller fragments, which are then more easily removed.

First best super cialis 80mg, together they devise a staircase of fear order super cialis 80mg visa, which breaks down the feared situation into small steps buy super cialis 80mg online. Attending a movie alone and sitting in the middle (95) Attending a movie alone and sitting in the back row by the door (92) Going to the movies with Doug and having him sit in a row behind me (88) Going to the movies with Doug and sitting in the middle (75) Going to the movies and sitting with Doug in the last row by the door (71) Imagining going to the movie and getting stuck in a crowd (70) Going into the theater lobby for a while (69) Buying a ticket by myself (68) Walking up to the ticket window and asking for times of shows (65) Figure 18-1: Walking by the theater while imagining buying a ticket (60) Rosie’s staircase Driving past the theater (48) of fear generic 80mg super cialis with amex. Imagining going to the movie (28) 276 Part V: Helping Others with Anxiety Doug plays a role in most of Rosie’s tasks discount 80 mg super cialis with visa. He reads the script out loud to Rosie while she closes her eyes and tries to picture the experiences. She rates her level of anxiety, and during the first few steps, he stays with her until her anxiety goes down. Not only does he accompany her to the movies, but he also celebrates her successes and encourages her when she starts to falter. It takes attending a number of movies with Doug before she agrees to the final tasks of going by herself. In fact, they begin enjoying their nights at the movies and find that they both love talking about their experiences afterwards over coffee and dessert. Although Rosie balks at going to the theater by herself, her comfort level has increased over the last few months. Rosie and Doug drive to the theater together on her last two items, but he chooses a movie playing on a different screen. Rosie’s fear of the movies had not yet reached the level of severely interfer- ing with her life. Had Rosie not dealt with her fear in this early stage, it would likely have spread from fear of movies to fear of other crowded places. Most people with fears, obsessions, or compulsions need to develop a plan with the help of a therapist. However, the example of Rosie and Doug can serve as an illustration of how a simple plan can be carried out without a therapist. Teaming Up against Anxiety One way you can help your partner overcome anxiety is to collaborate on ways to decrease stress in both your lives. With a little ingenuity, you can explore a variety of solutions that are likely to feel good to you even if you per- sonally don’t suffer from anxiety at all. For example: ✓ Take a stress management class at a local center for adult continuing education. Many of the ideas make life more fun and interesting in addition to reducing stress. It’s a great way to reduce stress, but even if you don’t have much stress, strolling under the sky together is a wonderful time to talk and is great for your health. Chapter 18: When a Family Member or Friend Suffers from Anxiety 277 ✓ Take a yoga, Pilates, or tai chi class together. Again, even if you don’t have anxiety, these classes are terrific for balance, muscle strength, flex- ibility, and overall health. You may choose to attend a church, a synagogue, or a mosque, or scope out a less traditional method of com- muning with a higher power, such as immersing yourselves in nature. Thinking about things bigger than yourselves or the mundane events of the world provides a peaceful perspective. Many people feel that such work enhances the mean- ing and purpose of their lives. And if you don’t have the time for a long vacation, go away for an occasional evening at a local hotel. Getting away from texting, telephones, e-mails, doorbells, and other endless tasks and demands, even for a night, can help rejuvenate both of you. Accepting Anxiety with Love It may seem rather counterintuitive, but accepting your loved one’s battle with anxiety is one of the most useful attitudes that you can take. In other words, whenever you discuss your loved one’s anxiety or engage in any effort to help, you need to appreciate and love all your partner’s strengths and weaknesses. If perfect people even existed, we can only imagine that they would be quite boring. Besides, studies show that people who try to be perfect more often become depressed, anxious, and distressed. You need to accept and embrace both the possibility of productive change as well as the chance that your partner may remain stuck. Accepting your partner is especially important when your efforts to help ✓ Result in an argument ✓ Seem ineffective 278 Part V: Helping Others with Anxiety ✓ Aren’t well-received by your partner ✓ Seem merely to increase your partner’s anxiety even after multiple expo- sure trials What does acceptance do? Acceptance allows you and your loved one to join together and grow closer, because acceptance avoids putting pressure on the one you care about.

As temperature increases discount 80mg super cialis with amex, respi- • Subcutaneous receptors provide pleasura- ratory rate may also increase cheap 80mg super cialis amex. Nails This epithelial layer is continuous with the Nails protect the tips of the fingers and toes from epithelium of the skin super cialis 80 mg otc. The half-moon–shaped area at the base of keratinized stratified squamous epithelial cells the nail discount 80mg super cialis amex, the(4) lunula 80 mg super cialis fast delivery, is the region where new producing a very tough covering. The lunula has a whitish appear- grows, it stays attached and slides forward over ance because the vascular tissue underneath does the layer of epithelium called the (2) nail bed. A mild form of ichthyosis, called winter itch, is commonly seen on the legs of older patients, especially during the winter months. Xenografts are used as a temporary graft to protect the patient against infection and fluid loss. Cutaneous warts and actinic keratosis are common skin disorders that respond well to cryotherapy treatment. General appearance and condition of the skin are clinically important because they may provide clues Skin Lesions to body conditions or dysfunctions. Pale skin may indicate shock; red, flushed, very warm skin may Lesions are areas of tissue that have been patho- indicate fever and infection. Even chewed fingernails Lesions may affect tissue over an area of a definite may be a clue to emotional problems. For diagnosis, size (localized) or may be widely spread through- treatment, and management of skin disorders, the out the body (systemic). Lesions are with diseases that directly affect the skin and systemic described as primary or secondary. The lesions are the initial reaction to pathologically Pathology 79 altered tissue and may be flat or elevated. Burns Secondary skin lesions are changes that take place in the primary lesion due to infection, scratching, Burns are tissue injuries caused by contact with trauma, or various stages of a disease. Some of the can also affect the respiratory and digestive tract major primary and secondary skin lesions are linings. Burns that have a local effect are not as described and illustrated in Figure 5–3. Examples:nevus, wart, pimple, Examples: poison ivy, shingles, ringworm, psoriasis, eczema. Nodule Pustule Palpable, circumscribed lesion; Small, raised, circumscribed larger and deeper than a papule lesion that contains pus; usually (0. Examples: acne, furuncle, Examples:intradermal nevus, pustular psoriasis, scabies. Tumor Bulla Solid, elevated lesion larger than A vesicle or blister larger than 1 2 cm in diameter that extends into cm in diameter. Examples:second degree Examples: lipoma, steatoma, burns, severe poison oak, poison dermatofibroma, hemangioma. Wheal Elevated, firm, rounded lesion with localized skin edema (swelling) that varies in size, shape, and color; paler in the center than its surrounding edges; accompanied by itching. Skin grafting Burns are usually classified as first-, second-, or (dermatoplasty) is commonly required to protect third-degree burns. A formula for estimating the percentage of First-degree (superficial) burns are the least seri- adult body surface area affected by burns is to ous type of burn because they injure only the top apply the Rule of Nines. These burns are ues of 9% or 18% of surface areas to specific most often caused by brief contact with either dry regions. The formula is modified in infants and or moist heat (thermal burn), spending too much children because of the proportionately larger head time in the sun (sunburn), or exposure to chemi- size. Second- Oncology degree (partial-thickness) burns are deep burns that damage both the epidermis and part of the Neoplasms are abnormal growths of new tissue dermis. Symptoms neoplasms are noncancerous growths composed mimic those of first-degree burns, but fluid-filled of the same type of cells as the tissue in which they blisters (vesicles or bullae) form and the burn may are growing. If In third-degree (full-thickness) burns, the the benign neoplasm remains small and places no epidermis and dermis are destroyed and some of pressure on adjacent structures, it commonly is not the underlying connective tissue is damaged, leav- removed. When it becomes excessively large, causes ing the skin waxy and charred with insensitivity to pain, or places pressure on other organs or struc- touch. These burns may be caused are composed of cells that are invasive and spread to by corrosive chemicals, flames, electricity, or remote regions of the body. These cells show altered extremely hot objects; immersion of the body in function, altered appearance, and uncontrolled extremely hot water, or clothing that catches fire. They invade surrounding tissue and, ulti- Because of the extensiveness of tissue destruction, mately, some of the malignant cells from the Figure 5-4.

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