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Body As A Whole Clinical Abx Rx Emphysema Cholecystitis Ards Vs Vap Bnenefit Preop Antibiot Rx Gsw Colon Charact Nsqip Charact Parastomal Hernias Charact Patient Safety Cond Assoc Fam Hist Ca Cecum Cond Assoc Norm Anion Gap Acidosis Dx Antihtromb Iii Defic Pulm Embol Dx Hand Infection Dx Lymphocele Cadav Renaltplt Dx Test Anuria Po Renal Tplt Dx Test Soft Tissue Sarcoma Thigh Dx Thrombosis Hepatic A Liver Txp Electrol Abnorm Succinycfholine Etiol Acidosis Post Pancreas Tplt Etiol Hyponatremia Pancreatitis Etiol Of Recurrence Lap Hernia Repair Etiol Pulm Parench Change Inhal Inj Etiol Shock Post Thoracoabd Aneurysm Findings Hypomagnesemia Indic Placement Pulm Art Catheter Init Iv Fluid Dehydration Init Rx Coagulopathy Chr Renal Fail Init Rx Hydrofluor Acid Burn Extrem Jcaho Requir For Sedation Maintenance Temp In Or Most Common Metast Extrem Sarcoma Most Likely Complic Tpn Periop Tx Hemophilia Pharm Preop Prep Adrenalect Pheo Predict Postop Infect Malnutrition Preop Rx Incr Inr From Coumadin Reductoperative Fire Risks Assoc Soft Tissue Sarcoma Rx 0.6Mm Melanoma Forearrm Rx Burn Wound Rx Carbon Monixide Inhalation Rx Co2 Embolus Lap Chole Rx Coagulopathy Massive Txn Rx Hemodynam Instability Urosepsis Rx Hyponatremia Cirrhosis/Ascites Rx Incarc Inguinal Hernia Rx Scrot Heatom Po Ing Hern Rep Rx Sudden Oliguria Po Renal Txp Rx Thigh Mass Rx Umbilical Hernia Ascites Rx Urokinase Overdose Rx Ventil Complicat R Upper Lobectomy Rx VWD Sign Lidocaine Toxiciry Tetanus Ppx Urinary Retention Post Hemmorrhoid

Basic Abundant Fecal Flora Acute Rejection Renal Transplant Adoptive Immunorx Tumor Calc Free Water Deficit Charact Dendritic Cells Charact Enterocytes Charact Local Anesthetics Charact Mrsa Charact Radiation Inrury Charact Vitamin K Common Rxn Iodinw Contrast Decr Risk Surg Site Infections Design I.Jnpaired T Test Dna Mutation Familial Ca Druge Dose Adjust Hemodialysis Elev Cytokine Assoc Poor Prognos Etiol Febrile React Blood Tmns Etiol Oliguria Lap Hernia Rep Etiol Postop Myocard Ischemia Fuel Source Neoplastic Cells Incr Bact Infect Newbown Vs Adult Incr Risks Infliximab Rx Indic Cea Test Inhibitor Platelet Aggregation Lab Abnl Vwd Maint Cricoid Press Rapid-Seq Intub Mech Altered Immun Post-Splenectomy Mech Skin Necrosis Coumadin Mech Systemic Opioids Mechanism Antibiotic Resistance Metabolic Signif Resp Quotient Poor Prognos Cutaneous Melanoma Predict Fetal Lling Maturity Rest Energy Espend Post Chole Site Submucosal Tumor Spread Sx Wawter Toxicity Viral Etiol Post-Transplant Malig Virulence Factors Staph

Gastrointestinal Clinical Best Success Rx H Pylori Best Test Rx H Pylori Charact Amoebic Liver Abscess Charact Pancreaticoduodenectomy Charact Zenker'S Diverticulum Characte Hepatic Adenoma Dx Acute Gastric Dilatation Dx Afferent Limb Obstruct Dx Afferent Limb Obstruct Dx Blown-Out Duodenal Stump Dx Caustic Ingestion Dx Caustic Ingestion Dx Cbd Stricture Chron Pancreatitis Dx Cbd Stricture Chron Pancreatitis Dx Cricopharyngeal Diverticulum Dx Gastric Sympt Po Redo Fundoplic Etiol Sb Inussuscept Adult Fx Focal Nodular Hyperplas Liver Liver Lesion Amenable Operative Exc Most Common Etiol Cbd Inj Lap Chole Org Assoc Mult Liver Abscess Organism Assoc Mult Liver Abscess Palliative Rx Ca Pancreas Rx Adenoca Rectum Rx Adenoca Rectum Rx Appendix Acute Ileitis Rx Cbd Inj Lap Chole Rx C-Diff Pregnancy Rx Cholangitis Rx Colon Ca Mets Seg I & Ii Liver Rx Colonic Pseudo-Obstruction Rx Dark Stoma Post Ap Resect Rx Duodenal Obstruction Crohn'S Disease Rx Duodenojejunal Adenoca Rx Esophageal Perph Rx Gallstone Illeus Rx Iatrogen Esoph Perforation Rx Ileal Lymphoma Rx Ileal Lymphoma Rx Incompl Reduc Ileocolic Intussus Rx Liver Hemobilia Rx Pancreatic Fistula Rx Recent 4Cm Pseudocyst Rx Rectal Bleed Ost Hemorrhoid Band Rx Retained Cbd Stone Post T-Tube

Basic Science Activation Trypsinogen Advant Parietal Cell Vagotomy Anat Gastroduodenal Artery Anat Replaced R Hepatic Art Charact Lipid Digestion/Absorption Charact Tri.Incal Vagotomy Etiol Jejunal/Ileal Atresias Etiol Peptic Ulcer Recurrence Etiol Stroke-Related Pneumonia Findings Assoc Hepatorrenal Synd Genetic Mutat Chr Pancreatitis Inhib Gastric Mucus / Bicarb Secretion Mech Action Gastrin Most Effect Sitmulant Pancr Acinar Polyp Histol Peutz.Jeghers Prognostic Test Liver Funct Reserve Site Effect Of Motilin Source Ghrelin Secretion

Cardiovascular / Respiratory Clinical Abnormal Hemodynamic Values Advant Lytic Rx Lower Extrem Ischem Anticoag Bleeding In Dvt Charact Thoracic Outlet Syndrome Common Complic Poplit Aneurysm Dx S. Epidermidis Graft Infect Etiol Arm Swelling Pitcher Etiol Fever Po Cabg Etiol Late Death Heart Txp Etiol Late Hemorrhage Graft Findings Nascet Incision Forearm Fasciotomy Incision Site Cricothyroidotomy Indic Po Intra-Aortic Balloon Pump Init Rx R Vent Fail 2Nd Pulm Embol Init Rx Thoracic Aortic Dissection Likely Etiol Acute Pulseless Leg Most Common Site Traum Aortic Rupt Post-Infact Heart Defects Preop Test Pulm Resection Preop Test Pulmonary Resect Rx Anticoag Bleeding In Dvt Rx Hemothorax Rx High Outflow Press Dialysis Accessadjnct Impr Vasc Graft Patency Rx Postop Cerebral Embolus Rx Post-Thrombect Leg Pain

Basic Science Anat Innominate Artery Anat Subclavian Art Ards Risk Factors Charact Acute Hypoxia Charact Nor Low Extrem Venous Press Charact O2 Extractionr Atio Charact Ptx Pos Press Ventil Charact Pulm Dysf Assoc Morbid Obes Compar Ards/Ali Deter Myocard O2 Consump/Energy Excp Deter Myocard O2 Consump/Energy Exp Development Atherosclerosis Earliest Sign Gas Embol Lap Splenex Early Abnorm Carotid Ulcer Plaque Early Abnorm Carotid Ulcer Plaque Effect Inspirat Phase Emch Vent Hemodynamic Effects Tension Pneumo Init Rx R Vent Fail/Pe Interpret Respiratory Quotient 0.7 Most Common Site Lung Abscess Renal Effects Peep Rx Tachyarrhythmias System Vasc Resist Hypovlem Shock Vasoconstrict Arterioles Skel Musc Ventilator Goals In Ards Gu Head Neck Skin Musc Nerv Syst Clinical Rx Hyponatrem Closed Head Inj Nerve Inj Calf Fasciotomy Charact Merkel-Cell Ca Rx Renal Trauma/Fx Ribs Dx Test Solitary Enck Mass Rx Incidental 4Cm Ovarian Cyst Rx Metastatic Ovarian Ca Rx Squam Cell Ca Lower Lip Rx Inadvertent Intra-Op Ureteral Inj Rx Incidental 4Cm Ovarian Cyst Rx Parotid Mass Rx Buccal Squam Cell Ca Optimal Cerebral Perfusion Pressure Rx Rectal Bleeding Laminectomy Rx Gsw L Flank / Mid Thig Charact Lymph Malformation Skin Charact Blood Urethral Meatus W/ Inj Rx Inappropriate Adh Nerve Inj Anterior Disloc Humerus Rcx Gsw Ureter Charact Stsg

Basic Anat Extern Br Superior Larynceal N Anat Intrinsic Muscles Hand Anat L Gonadal Vein Calcium Composit R,Enal Calculi Cond Assoc Mid-Shaft Humerus Fx Cond Assoc Normal Wound Healing Etiol Marfan'S Synd Fibroblast Source Surgical Woltnd Relation Creatinine To Gfr Remodeling Phase Wound Healing Renal Reg Body Fluid Ph

Endocrine Hematic Lymphatic Breast Clinical Charact Adult Intestinal Lmphoma Charact Adult Intestinal Lymphoma Charact Adult Intstinal Lymphoma Charact Gastrinoma Cond Assoc Test Hyperparathyroidism Dx Finding Inflammatory Ca Breast Dx Lymphangiosarcoma Dx Test Possible Abdom Lymphoma Dx/Rx Insulinoma Effect Sup Laryngeal Nerve Inj Etiology Post-Femtib Bypass Swelling Eval Galactorrhea Init Rx Sarcoma Thigh Localization Of Gastrinoma Myeloprolif Disord Benefit Splenect Myeloproliferative Disorder Benefit Splenect Rx Cal Ulcer In Esrd Rx Dcis > 1 Cm Rx Dcis >1 Cm Rx Gynecomast Assoc Anabolic Steroids Rx Hurthle Cell Neoplasm Rx Intraop Incr Bp Pheochrom Rx Lcis Breast Rx Metastatic Vipoma Rx Missing Hyperplastic Parathyroid Rx Pancreaatic Lymphoma Rx Pancreatic Lymphoma Rx Pediatric Splenic Inrury Rx Post-Menopausal Breast Ca Rx Post-Menopausal Breast Cancer Rx Splenic Abscess Rx Splenic Abscess Solid/Cystic Ca Thyroid Timing Platelet Rx Splenectomy For Itp

Basic Anat Level Iii Axillary Nodes Charact Brca -2 Gene Dx Test Cushing'S Synd Pt W/ Highest Rate Breast Ca

breast

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TBW has traditionally been measured using indicator dilution techniques in which radioactive tracers such as deuterium oxide (D2O) were given to subjects and a steady state allowed to develop before measurements of the D2O in the plasma were made. More recently, other techniques have added greatly to our ability to measure TBW content as well as the content of all of the elements within the body. Perhaps the most sophisticated method of measurement of body composition, involves neutron activation analysis, techniques in which the body is exposed to a source of thermal neutrons. These neutrons enter the atomic nuclei, resulting in the transformation of that nucleus to a more activated energy state. This activated state is transient and later returns to the baseline, resulting in energy release from the nucleus in the form of gamma radiation, which can then be measured using whole-body shielded gamma detectors.1 Using these techniques, total body oxygen, carbon, hydrogen, nitrogen, calcium, phosphorus, sulfur, potassium, sodium, and chlorine can be measured.

easurements of total body potassium (TBK) can be used to estimate intracellular water. This is accomplished using a technique similar to neutron activation analysis. Normally, potassium within the body exists in two states, nonradioactive 39K and radioactive 40 K. Because 40 K represents a stable proportion of total K within the body (0.0118%), measurement of the gamma radiation of the 40K radioisotope using the sensing equipment similar to that used in neutron activation analysis can be accomplished.

The transcellular space, a third and smaller component of ECF, consists of water that is separated from other compartments by endothelial and epithelial barriers, including cerebrospinal, ocular, and synovial fluids, as well as fluid in the gastrointestinal (GI) tract.

TBK is normally approximately 42 mEq/kg, and most of this potassium is intracellular and freely exchangeable

The Donnan equilibrium describes the relationship between solutions of permeable and impermeable complex anions when these anions are unevenly distributed across a semipermeable membrane.

An osmotic gradient of just 1 mOsm generates a pressure gradient of 19.3 mm Hg.

For every 100 mg/dL elevation in blood glucose, measured serum sodium falls 1.5 mEq/L,

The van't Hoff equation is used to convert osmolality to osmotic pressure: p=CRT where p = osmotic pressure, C = osmolal solute concentration, R = gas constant, and T = absolute temperature. At body temperature, each milliosmole develops a 19.3 mm Hg pressure gradient; thus, normal plasma protein concentrations generate a colloid oncotic pressure of 15.4 mm Hg (19.3 mm Hg ×0.8 mOsm/L). When measured directly, plasma oncotic pressure equals approximately 24 mm Hg.

In the absence of ADH, the permeability of renal collecting tubules to water is decreased causing free water reabsorption to decrease and excretion to increase. Urine osmolality (Uosm) can decline to 100 mOsm/kg H2O (Fig. 10-2). As excess free water is eliminated, Posm begins to rise. Conversely, free water depletion causes an increase in Posm. As Posm approaches 295 mOsm/kg H2O, thirst is stimulated as is ADH secretion. As ADH levels rise to approximately 5 pg/mL, the renal collecting tubules become maximally permeable to water. Water is reabsorbed from the collecting ducts in response to the concentration gradient developed in the renal medullary interstitium. Thus, the final concentration of urine depends on both the permeability of the collecting ducts (controlled by ADH secretion) and the concentration of the medullary interstitium. Maximal Uosm may approach 1200 mOsm/kg H2O.

The low-pressure baroreceptors of the intrathoracic vena cava and atria are located in vessels that are distensible and not affected by sympathetic stimulation

Arterial baroreceptors are located in the aortic arch and carotid arteries. They respond to changes in heart rate, arterial pressure, and the rate of rise in the arterial pressure.

In addition to large-vessel baroreceptors, there are arterial baroreceptors in the afferent arterioles of the kidneys. These baroreceptors modulate renin secretion.

Renin is a 40-kd proteolytic enzyme that is released from the juxtaglomerular cells of afferent arterioles in the kidney in response to several stimuli. These include changes in arterial pressure, changes in sodium delivery to the macula densa of the distal convoluted tubule, increases in β-adrenergic activity, and increases in cellular cyclic adenosine monophosphate.

Renin cleaves the decapeptide angiotensin I from circulating angiotensinogen, an α2-globulin produced by the liver. Angiotensin I is cleaved to the octapeptide angiotensin II by angiotensin-converting enzyme (ACE), which is produced by vascular endothelial cells. One pass through the pulmonary microvasculature converts most angiotensin I to angiotensin II. Angiotensin II acts both locally and systemically to increase vascular tone. It also stimulates catecholamine release from the adrenal medulla, increases sympathetic tone through central effects, and stimulates catecholamine release from sympathetic nerve terminals.

Aldosterone acts directly on the distal tubule cells by modifying gene expression and stabilizing the epithelial Na+ channel in the open state and by increasing the number of channels in the apical membrane of these cells.5 By increasing protein production in these tubular cells, aldosterone induces an influx of sodium, which causes an increase in cellular Na+-K+-adenosine triphosphatase activity. The net result is increased sodium reabsorption and increased potassium excretion.

NP is synthesized and released by atrial myocytes in response to atrial wall distention. As mentioned previously, small changes in right atrial pressure produce large increases in plasma levels of ANP.6 There is evidence that ANP has a direct inhibitory effect on renal sodium reabsorption, which is probably maximal at the level of the medullary collecting tubules.

PGE2 is produced primarily by the interstitial cells of the renal medulla. The release of PGE2 has been shown to depend on increases in interstitial pressure, which can be induced by changes in renal perfusion, ureteral obstruction, or alterations in oncotic pressure. Under these conditions, PGE2 increases sodium excretion in the absence of changes in glomerular filtration rate. PGE2 antagonizes the action of vasopressin (ADH) and inhibits ADH-induced sodium reabsorption along the medullary collecting duct and thick ascending limb.

PGI2 is produced by the glomeruli and endothelial cells of the kidney and is present in the greatest concentrations in the renal cortex. PGI2 is a vasodilator, and its effects on renal vascular resistance increase both renal blood flow and glomerular filtration rate. PGI2 production is augmented by increases in angiotensin, catecholamines, and sympathetic tone and may act to counterbalance their vasoconstricting effects.