By A. Kalesch. James Madison University.

Family reactions to The expression of sexual urges is one chronic illness and disability may be sim- form of sexuality buy zerit 40mg free shipping. Chronic illness or dis- ilar to those experienced by the individ- ability can affect sexual expression be- ual and may include shock 30mg zerit for sale, denial, anger, cause of physical limitations, depression, guilt, anxiety, and depression. Families lack of energy, pain, alterations in self- must make adaptations, adjustments, and image, or the reactions of others. In some role changes both as a unit and as individ- conditions, the main barrier to sexual ual family members. The way in which expression may be problems with self-con- families react and adapt to chronic illness cept and body-image; in other condi- and disability affects an individual’s sub- tions, physical changes may present phys- sequent adjustment. Whether families ical barriers that affect sexual function foster independence or dependence, show directly. In When a family member is no longer some instances, it may be necessary to able to perform certain functions, families help individuals overcome their own mis- may react in various ways. There may be perceptions and fears in order to establish a strong desire to be a “normal” family a means for sexual expression. Family members with prior ex- instances, individuals may need assistance pectations for the individual’s future or to overcome barriers or to learn methods “what he or she might have been” may of sexual expression different from those experience anger, resentment, or disap- used previously. In any case, sexual adjust- pointment if they see chronic illness or ment is a significant element in the disability interfering with the achieve- restoration of an individual’s maximal ment of their expectations. They may need to FAMILY ADAPTATION TO CHRONIC become more involved with health profes- ILLNESS AND DISABILITY sionals and service agencies or may need to be increasingly assertive to obtain nec- The family is the social network from essary services. If individuals with chron- which individuals derive identity and with ic illness or disability require significant 16 CHAPTER 1 PSYCHOSOCIAL AND FUNCTIONAL ASPECTS OF CHRONIC ILLNESS AND DISABILITY care or therapies to be administered at attitudes and reactions of those within the home, family members may become environment all influence the interpreta- fatigued because of the extra responsibil- tion of quality of life. People with similar conditions, members may be called upon to provide symptoms, and limitations may perceive not only emotional support but also their condition in totally different man- physical care, supervision, transporta- ners. Determining factors are the charac- tion, or a variety of other services neces- teristics of the condition and its treat- sitated by the individual’s condition. In ment, the age and developmental stage of addition, changes in roles or financial cir- the individual, the degree of limitation cumstances due to chronic illness or dis- and the extent of disability experienced, ability may alter the goals and plans of and how characteristics of the condition other family members, such as a sibling’s affect the individual’s definition of qual- plans for college or a parent’s retirement ity of life. The amount of care and attention one individual accepts and adapts to may required by individuals with chronic ill- be overwhelming and intolerable to ness or disability may create emotional another.

Stimulation of separate parasympathetic nerves can result in slowing of the heart order zerit 30 mg without a prescription, dilation of visceral blood vessels discount zerit 40mg without a prescription, and in- creased activity of the GI tract (table 13. Autonomic Nervous © The McGraw−Hill Anatomy, Sixth Edition Coordination System Companies, 2001 Chapter 13 Autonomic Nervous System 445 TABLE 13. This drug, however, does not affect the cholinergic receptors of skele- Somatic motor neurons, postganglionic parasympathetic neu- tal muscle or those of autonomic ganglia. The acetylcholine re- rons, and all preganglionic autonomic neurons are cholinergic— ceptors of visceral organs are therefore said to be muscarinic. The cholinergic effects of somatic motor neurons and preganglionic autonomic The muscarinic effects of ACh are specifically inhibited by the drug atropine, derived from the deadly nightshade plant neurons are always excitatory. Indeed, extracts of this plant were used glionic parasympathetic neurons are usually excitatory, with by women during the Middle Ages to dilate their pupils (at- some notable exceptions; the parasympathetic neurons innervat- ropine inhibits parasympathetic stimulation of the iris). Autonomic Nervous © The McGraw−Hill Anatomy, Sixth Edition Coordination System Companies, 2001 446 Unit 5 Integration and Coordination Central Nervous System Cranial Terminal parasympathetic ganglion nerves Visceral ⊃• ACh ACh effectors Paravertebral ganglion ⊃• NE Visceral ACh effectors Adrenal medulla Sympathetic ACh E, NE (hormones) (thoracolumbar) nerves ⊃ • NE Visceral ACh effectors Collateral ganglion Sacral parasympathetic Visceral nerves ⊃ • effector ACh ACh organs FIGURE 13. Those nerves that release ACh are called cholinergic; those that release NE are called adrenergic. The adrenal medulla secretes both epinephrine (85%) and norepinephrine (15%) as hormones into the blood. Organs with Dual Innervation which is stimulated by impulses through sympathetic nerve end- ings, causes dilation; contraction of the pupillary constrictor Many organs receive dual innervation—they are innervated by muscle, which is innervated by parasympathetic nerve endings, both sympathetic and parasympathetic neurons. Complementary Effects The effects of sympathetic and parasympathetic stimulation on Antagonistic Effects salivary gland secretion are complementary. The secretion of wa- The effects of sympathetic and parasympathetic innervation on tery saliva is stimulated by impulses through parasympathetic the sinoatrial (SA) node (“pacemaker”) of the heart (see fig. In this case, sympathetic and parasympathetic neurons in- stimulate the constriction of blood vessels throughout the GI nervate the SA node.

The importance of histamine as an effector of gastric acid The gastric phase is mainly a result of gastric distension secretion has been indirectly demonstrated by the effec- and chemical agents such as digested proteins cheap 30 mg zerit free shipping. Distension tiveness of cimetidine cheap 40 mg zerit overnight delivery, an H2 blocker, in reducing acid se- of the stomach stimulates mechanoreceptors, which stimu- cretion. H2 blockers are commonly used for the treatment late the parietal cells directly through short local (enteric) of peptic ulcer disease or gastroesophageal reflux disease. Vago-vagal re- The effects of each of these three stimulants (ACh, gas- flexes are mediated by afferent and efferent impulses trav- trin, and histamine) augment those of the others, a phe- eling in the vagus nerves. Potentiation is said to are also potent stimulators of gastric acid secretion, an ef- 488 PART VII GASTROINTESTINAL PHYSIOLOGY TABLE 27. Second, excess acid icals, such as alcohol and caffeine, stimulate gastric acid se- can damage the gastric and the duodenal mucosal surfaces, cretion through mechanisms that are not well understood. The gastric phase accounts for about 50% of total gastric The body has an elaborate system for regulating the amount acid secretion. Gastric luminal pH is a sen- During the intestinal phase, protein digestion products sitive regulator of acid secretion. Proteins in food provide in the duodenum stimulate gastric acid secretion through buffering in the lumen; consequently, the gastric luminal pH the action of the circulating amino acids on the parietal is usually above 3 after a meal. Distension of the small intestine, probably via the re- pacity of protein is exceeded or if the stomach is empty, the lease of the hormone enterooxyntin from intestinal en- pH of the gastric lumen will fall below 3. The intestinal phase the endocrine cells (D cells) in the antrum secrete somato- accounts for only about 10% of total gastric acid secretion. Gastric Acid Secretion Is Inhibited by Another mechanism for inhibiting gastric acid secretion is acidification of the duodenal lumen. Acidification stimu- Several Mechanisms lates the release of secretin, which inhibits the release of The inhibition of gastric acid secretion is physiologically im- gastrin, and several peptides, collectively known as entero- portant for two reasons. First, the secretion of acid is impor- gastrones, which are released by intestinal endocrine cells. The saying, “no in the genesis of peptic ulcers is unclear, but in a significant acid, no ulcer,” has withstood the test of time and is still number of patients, eradication of the bacteria reduces the accepted by most physicians and researchers as generally rate of ulcer recurrence. One possible cause of gastric and duodenal ulcers is of the enzyme urease, which hydrolyzes urea to produce reduced mucosal defense mechanisms.