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sympathetic system in its distribution. The parasympathetic sys- information about the condition of the bodys internal envi-
tem distributes only to the head, visceral cavities of the trunk, ronment. This information is integrated in the CNS, often
and erectile tissues of the external genitalia. With the exception triggering visceral or somatic reflexes or both. Visceral reflexes
of the latter, it does not reach the body wall or limbs, and except regulate blood pressure and chemistry by altering such func-
for initial parts of the anterior rami of spinal nerves S2S4, its tions as heart and respiratory rates and vascular resistance.
fibers are not components of spinal nerves or their branches. Visceral sensation that reaches a conscious level is generally
Four discrete pairs of parasympathetic ganglia occur in the categorized as pain that is usually poorly localized and may
head (see Chapters 7 and 9). Elsewhere, presynaptic parasym- be perceived as hunger or nausea. However, adequate stim-
pathetic fibers synapse with postsynaptic cell bodies, which ulation, such as the following, may elicit true pain: sudden
occur singly in or on the wall of the target organ (intrinsic or distention, spasms or strong contractions, chemical irritants,
enteric ganglia). Most presynaptic parasympathetic fibers are mechanical stimulation (especially when the organ is active),
long, extending from the CNS to the effector organ, whereas and pathological conditions (especially ischemiainadequate
the postsynaptic fibers are short, running from a ganglion lo- blood supply) that lower the normal thresholds of stimulation.
cated near or embedded in the effector organ. Normal activity usually produces no sensation but may do so
when there is ischemia. Most visceral reflex (unconscious)
sensation and some pain travel in visceral afferent fibers that
Visceral Afferent Sensation accompany the parasympathetic fibers retrograde. Most vis-
Visceral afferent fibers have important relationships to the ceral pain impulses (from the heart and most organs of the
ANS, both anatomically and functionally. We are usually un- peritoneal cavity) travel centrally along visceral afferent fibers
aware of the sensory input of these fibers, which provides accompanying sympathetic fibers.
Medical Imaging
Body Systems Arch of aorta
Clavicle Rib Trachea Pulmonary
Familiarity with imaging techniques commonly used in clinical artery
settings enables one to recognize abnormalities such as congeni-
tal anomalies, tumors, and fractures. The introduction of contrast
media allows the study of various luminal or vascular organs and
potential or actual spaces, such as the digestive or alimentary sys-
tem, blood vessels, kidneys, synovial cavities, and subarachnoid
space. This section consists of short descriptions of the principles
of some of the commonly used diagnostic imaging techniques:
Conventional radiography (ordinary X-ray images)
Computerized tomography (CT) Heart
Ultrasonography (US)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
CONVENTIONAL RADIOGRAPHY
The essence of a radiological examination is that a highly penetrat- Right dome
of diaphragm Apex of heart
ing beam of X-rays transilluminates the patient, showing tissues of
differing densities of mass within the body as images of differing Postero-anterior (PA) projection
densities of light and dark on the X-ray film (Fig. I.32). A tissue
FIGURE I.32. Radiograph of thorax (chest).
or organ that is relatively dense in mass, such as compact bone in
a rib, absorbs more X-rays than does a less dense tissue, such as
spongy (cancellous) bone (Table I.5). Consequently, a dense tissue area when the film is processed. A very dense substance is radi-
or organ produces a relatively transparent area on the X-ray film opaque, whereas a substance of less density is radiolucent.
because relatively fewer X-rays reach the emulsion in the film. Many of the same principles that apply to making a shadow
Therefore, relatively fewer grains of silver are developed at this apply to conventional radiography. Radiographs are made with the
Fat
Spongy bone
Detectors
part of the patients body being studied close to the X-ray film or
detector to maximize the clarity of the image and minimize mag-
nification artifacts. In basic radiological nomenclature, postero- (A)
anterior (PA) projection refers to a radiograph in which the X-rays
traversed the patient from posterior (P) to anterior (A); the X-ray
tube was posterior to the patient and the X-ray film or detector Right Left
was anterior. A radiograph using anteroposterior (AP) projection
radiography is the opposite. Both PA and AP projection radio- Rib
graphs are viewed as if you and the patient were facing each other
(the patients right side is opposite your left); this is referred to as Pancreas
an anteroposterior view. Thus, the standard chest X-ray, taken to
examine the heart and lungs, is an AP view of a PA projection. For Liver Aorta
lateral radiographs, radiopaque letters (R or L) are used to indicate
Vertebra
the side placed closest to the film or detector, and the image is
viewed from the same direction that the beam was projected. Left
The introduction of contrast media (radiopaque fluids such as kidney
iodine compounds or barium) allows the study of various luminal
or vascular organs and potential or actual spacessuch as the (B) Transverse CT image of upper abdomen
digestive tract, blood vessels, kidneys, synovial cavities, and the
subarachnoid spacethat are not visible in plain films. Most
radiological examinations are performed in at least two projections
at right angles to each other. Because each radiograph presents
a two-dimensional (2-D) representation of a three-dimensional
(3-D) structure, structures sequentially penetrated by the X-ray
beam overlap each other. Thus, more than one view is usually
necessary to detect and localize an abnormality accurately.
COMPUTERIZED TOMOGRAPHY
CT shows images of the body that resemble transverse anatomi-
cal sections (Fig. I.33). A beam of X-rays is passed through the
body as the X-ray tube and detector rotate around the axis of the
body. The amount of radiation absorbed by each different type
of tissue of the chosen body plane varies with the amount of fat,
bone, and water in each element. A computer compiles and gen- (C) Three-dimensional CT reconstruction
erates images as 2-D slices and total 3-D reconstructions. of bones of wrist and hand (palmar view)
RK
RK
(B)
LK
LRV
LRA
FIGURE I.35. Magnetic resonance imaging. A. Sagittal MRI study of the head and upper neck. B. Magnetic resonance angiogram of heart and great
vessels.
(B)
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