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The disorder is caused by a that PRL may inhibit GnRH release discount cymbalta 30mg free shipping, reduce LH secretion in failure of olfactory lobe development and GnRH defi- response to GnRH stimulation, and act directly at the level ciency. Primary amenorrhea can also be caused by a con- of the ovary by inhibiting the action of LH and FSH on fol- genital malformation of reproductive tract structures origi- licle development. Secondary amenorrhea is the cessation of menstrua- Anorexia nervosa, a severe behavioral disorder associated tion for longer than 6 months. Pregnancy, lactation, and with the lack of food intake, is characterized by extreme menopause are common physiological causes of second- malnutrition and endocrine changes secondary to psycho- ary amenorrhea. Other causes are premature ovarian fail- logical and nutritional disturbances. About 30% of patients ure, polycystic ovarian syndrome, hyperprolactinemia, develop amenorrhea that is not alleviated by weight gain. Strenuous exercise, especially by competitive athletes and Premature ovarian failure is characterized by amenor- dancers, frequently causes menstrual irregularities. Two rhea, low estrogen levels, and high gonadotropin (LH and main factors are thought to be responsible: a low level of FSH) levels before age 40. The symptoms are similar to body fat, and the effect of stress itself through endorphins those of menopause, including hot flashes and an in- that are known to inhibit the secretion of LH. The etiology is variable, in- of stress, such as relocation, college examinations, general cluding chromosomal abnormalities; lesions resulting illness, and job-related pressures, have been known to in- from irradiation, chemotherapy, or viral infections; and duce some forms of oligomenorrhea. Polycystic ovarian syndrome, also called Stein-Leven- Female Infertility Is Caused by thal syndrome, is a heterogeneous group of disorders char- Endocrine Malfunction and Abnormalities acterized by amenorrhea or anovulatory bleeding, an ele- vated LH/FSH ratio, high androgen levels, hirsutism, and in the Reproductive Tract obesity. Although the etiology is unknown, the syndrome The diagnosis and treatment of amenorrhea present a chal- may be initiated by excessive adrenal androgen production, lenging problem. The amenorrhea must first be classified as during puberty or following stress, that deranges the hypo- primary or secondary, and menopause, pregnancy, and lac- thalamic-pituitary axis secretion of LH. The next step is to determine verted peripherally to estrogens and stimulate LH release.

It is a infection that involves the renal pelvis is called pyelitis; if it continues complex function that requires a stimulus from the urinary blad- into the nephrons purchase 40 mg cymbalta mastercard, it is known as pyelonephritis. To reduce the risk of der and a combination of involuntary and voluntary nerve im- these infections, a young girl should be taught to wipe her anal re- gion in a posterior direction, away from the urethral orifice, after a pulses to the appropriate muscular structures of the urinary bowel movement. In young children, micturition is a simple reflex action that occurs when the urinary bladder becomes sufficiently distended. Urethra Voluntary control of micturition is normally developed by the time a child is 2 or 3 years old. Specialized urethral glands, embedded in average capacity of the urinary bladder is 700 to 800 ml. A vol- the urethral wall, secrete protective mucus into the urethral canal. The invol- stimulate stretch receptors and trigger the micturition reflex, cre- untary smooth muscle sphincter, the superior of the two, is the ating a desire to urinate. The lower sphincter, composed of third, and fourth sacral segments of the spinal cord. Following voluntary skeletal muscle fibers, is called the external urethral stimulation of this center by impulses arising from stretch recep- sphincter (fig. Stimulation of these muscles causes a rhythmic contrac- fice into the vestibule between the labia minora. The urethral tion of the urinary bladder wall and a relaxation of the internal orifice is positioned between the clitoris and vaginal orifice (see urethral sphincter. The female urethra has a single function: to transport ceived in the brain, but there is still voluntary control over urine to the exterior. Urinary System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 688 Unit 6 Maintenance of the Body FIGURE 19.

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Body of sternum Axilla Nipple Xiphoid process Groove over Rib linea alba FIGURE 10 cheap 30mg cymbalta visa. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 312 Unit 4 Support and Movement In addition to helping one know where to listen with a stetho- scope to heart sounds, surface features of the thorax are im- portant for auscultations of the lungs, radiographs, tissue biopsies, sternal taps for bone marrow studies, and thoracic surgery. Although the anatomical features of the rib cage are quite consistent, some Pectoralis major m. Most of the abnormalities are Axilla congenital and include such conditions as a projecting sternum (pi- Lateral process geon breast) or a receding sternum (funnel chest). Because it does not have a bony framework like that of the thorax the surface anatomy is not as well defined. Bony land- marks of both the thorax and pelvis are used when referring to ab- dominal structures (fig. The right costal margin of the rib cage is located over the liver and gallbladder on the right side, and the left costal margin is positioned over the stomach and spleen on the left. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 313 8 1 1 9 2 2 10 3 11 4a 6 4b 12 5 6 3 7 7 4 5 8 9 1 Deltoid m. The linea alba separates the paired, straplike gions or four quadrants in order to describe the location of inter- rectus abdominis muscles, which can be seen when a person flexes nal organs and to clinically identify the sites of various pains or the abdomen (as when doing sit-ups). Clinically, the linea alba is a favored site for abdominal surgery because an incision made along this line severs no muscles Although the position of the umbilicus is relatively consistent in all and few vessels or nerves. For example, there may be an has been said that only a zipper would provide a more convenient opening to the outside, called a fistula, or herniation of some of the ab- entry to the abdominal cavity. Acquired umbilical hernias may develop in children who have a weak abdominal wall in this area, or they may develop in The lateral margin of the rectus abdominis muscle can be pregnant women because of the extra pressure exerted at this time. The external abdominal oblique nal cavity in a procedure called laparotomy. Laparotomy is frequently done to examine or perform surgery on the internal female reproduc- muscle is the superficial layer of the muscular abdominal wall.

During pregnancy cymbalta 60mg overnight delivery, maternal calcium prior to the establishment of the portal system, indicating intake increases, and 1,25 dihydroxyvitamin D3 and PTH that the hypothalamic-releasing hormones may diffuse down increase to meet the increased calcium demands of the fe- to the pituitary from the hypothalamic sites. In the mother, total plasma calcium and phosphate de- Experiments with long-term catheterization of monkey cline without affecting free calcium. The placenta has a fetuses indicate that by the last trimester, both LH and specialized calcium pump that transfers calcium to the fe- testosterone increase in response to GnRH administration. Although PTH and calci- sulin-like growth factors (IGF-I and IGF-II) from the liver. In addition, low GH have normal birth size; therefore, other mecha- the placenta has 1 -hydroxylase and can convert 25-hy- nisms may control the secretion of IGFs in the fetus. At the end levels increase in the fetus until midgestation and decline of gestation, calcium and phosphate levels in the fetus are thereafter when fetal weight is increasing significantly, rep- higher than in the mother. However, after delivery, neona- resenting another dichotomy in GH and IGF in the fetus tal calcium levels decrease and PTH levels rise to raise the versus postnatal life. Although the role of PRL in fetal growth The Sex Chromosomes Dictate the is unclear, it has been implicated in adrenal and lung func- tion, as well as in the regulation of amniotic fluid volume. Development of the Fetal Gonads The fetal adrenal glands are unique in both structure and Sexual differentiation begins at the time of fertilization by function. At month 4 of gestation, they are larger than the a random unification of an X-bearing egg with either an X- kidneys, as a result of the development of a fetal zone that or Y-bearing spermatozoon and continues during early em- constitutes 75 to 80% of the whole gland. The outer defini- tive zone will form the adult adrenal cortex, whereas the deeper fetal zone involutes after birth; the reason for the in- Placenta volution is unknown, but it is not caused by the withdrawal Mother Fetus of ACTH support. The fetal zone produces large amounts of DHEAS and provides androgenic precursors for estrogen synthesis by the placenta (see Fig. The definitive zone Pancreas Pancreas produces cortisol, which has multiple functions during fetal life, including the promotion of pancreas and lung matura- tion, the induction of liver enzymes, the promotion of intes- tinal tract cytodifferentiation and, possibly, the initiation of labor. ACTH is the main regulator of fetal adrenal steroido- Defect in Plasma genesis, partly evidenced by the observation that anen- insulin action insulin cephalic fetuses have low ACTH and the fetal zone is small. The adrenal medulla develops by about week 10 and is capa- ble of producing epinephrine and norepinephrine.