Harrison's Manual of Medicine, 17th Edition by Anthony Fauci, Visit Amazon's Eugene Braunwald Page, search
By Anthony Fauci, Visit Amazon's Eugene Braunwald Page, search results, Learn about Author Central, Eugene Braunwald, , Dennis Kasper, Stephen Hauser, Dan Longo, J. Jameson, Joseph Loscalzo
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Extra info for Harrison's Manual of Medicine, 17th Edition
Example text
These parallel pathways project to the limbic system and underlie the emotional aspect of pain. Pain transmission is A F B C SS Thalamus Hypothalamus Midbrain Spinothalamic tract Medulla Injury Spinal cord FIGURE 6-1 Pain transmission and modulatory pathways. A. Transmission system for nociceptive messages. Noxious stimuli activate the sensitive peripheral ending of the primary afferent nociceptor by the process of transduction. The message is then transmitted over the peripheral nerve to the spinal cord, where it synapses with cells of origin of the major ascending pain pathway, the spinothalamic tract.
For example, hyperactive amiloride-sensitive ENaC channels cause Liddle’s syndrome, which can respond to therapy with amiloride and related drugs; pts with hyperaldosteronism may in turn respond Electrolytes/Acid-Base Balance CHAPTER 2 21 to blockade of the mineralocorticoid receptor with spironolactone or eplerenone. Finally, severe alkalosis in the critical care setting may require treatment with acidifying agents such as acetazolamide or HCl. Respiratory Acidosis Respiratory acidosis is characterized by CO2 retention due to ventilatory failure.
Pain may be of somatic (skin, joints, muscles), visceral, or neuropathic (injury to nerves, spinal cord pathways, or thalamus) origin. Characteristics of each are summarized in Table 6-1. Neuropathic Pain Definitions: neuralgia: pain in the distribution of a single nerve, as in trigeminal neuralgia; dysesthesia: spontaneous, unpleasant, abnormal sensations; hyperalgesia and hyperesthesia: exaggerated responses to nociceptive or touch stimulus, respectively; allodynia: perception of light mechanical stimuli as painful, as when vibration evokes painful sensation.