Created by: CK-12/Adapted by Christine Miller

Rebecca’s family tree, as illustrated in the pedigree above (Figure 5.18.1), shows a high incidence of cancer among close relatives. But are genes the cause of cancer in this family? Only genetic testing, which is the sequencing of specific genes in an individual, can reveal whether a cancer-causing gene is being inherited in this family.

Fortunately for Rebecca, the results of her genetic testing show that she does not have the mutations in the BRCA1 and BRCA2 genes that most commonly increase a person’s risk of getting cancer. This doesn't mean, however, that she doesn’t have other mutations in these genes that could increase her risk of getting cancer. There are many other mutations in BRCA genes whose effect on cancer risk is still not known — and there may be many more yet to be discovered. Figure 5.18.2 from the National Cancer Institute illustrates many of the different types of known mutations in the BRCA1 gene. It is important to continue to study the variations in genes such as BRCA in different people to better assess their possible contribution to the development of disease. As you now know from this chapter, many mutations are harmless, while others can cause significant health effects, depending on the specific mutation and the gene involved.

Mutations in BRCA genes are particularly likely to cause cancer because these genes encode for tumor-suppressor proteins that normally repair damaged DNA and control cell division. If these genes are mutated in a way that causes the proteins to not function properly, other mutations can accumulate and cell division can run out of control, which can cause cancer.

BRCA1 and BRCA2 are on chromosomes 17 and 13, respectively, which are autosomes. As Rebecca’s genetic counselor mentioned, mutations in these genes have a dominant inheritance pattern. Now that you know the pattern of inheritance of autosomal dominant genes, if Rebecca’s grandmother did have one copy of a mutated BRCA gene, what are the chances that Rebecca’s mother also has this mutation? Because it is dominant, only one copy of the gene is needed to increase the risk of cancer, and because it is on autosomes instead of sex chromosomes, the sex of the parent or offspring does not matter in the inheritance pattern. In this situation, Rebecca’s grandmother’s eggs would have had a 50 per cent chance of having a BRCA gene mutation (Mendel’s law of segregation). Therefore, Rebecca’s mother would have had a 50 per cent chance of inheriting this gene. Even though Rebecca does not have the most common BRCA mutations that increase the risk of cancer, it does not mean that her mother does not, because there would also only be a 50 per cent chance that she would pass it on to Rebecca. Rebecca’s mother, therefore, should consider getting tested for mutations in the BRCA genes, as well. Ideally, the individuals with cancer in a family should be tested first when a genetic cause is suspected, so that if there is a specific mutation being inherited, it can be identified, and the other family members can be tested for that same mutation.

Mutations in both BRCA1 and BRCA2 are often found in Ashkenazi Jewish families. However, these genes are not linked in the chromosomal sense, because they are on different chromosomes and are therefore inherited independently, in accordance with Mendel’s law of independent assortment. Why would certain gene mutations be prevalent in particular ethnic groups? If people within an ethnic group tend to produce offspring with each other, their genes will remain prevalent within the group. These may be genes for harmless variations such as skin, hair, or eye colour, or harmful variations such as the mutations in the BRCA genes. Other genetically based diseases and disorders are sometimes more commonly found in particular ethnic groups, such as cystic fibrosis in people of European descent, and sickle cell anemia in people of African descent. You will learn more about the prevalence of certain genes and traits in particular ethnic groups and populations in the chapter on Human Variation.

As you learned in this chapter, genetics is not the sole determinant of phenotype. The environment can also influence many traits, including adult height and skin colour. The environment plays a major role in the development of cancer, too. Ninety to 95 per cent of all cancers do not have an identified genetic cause, and are often caused by mutagens in the environment, such as UV radiation from the sun or toxic chemicals in cigarette smoke. But for families like Rebecca’s, knowing their family health history and genetic makeup may help them better prevent or treat diseases that are caused by their genetic inheritance. If a person knows they have a gene that can increase their risk of cancer, they can make lifestyle changes and have early and more frequent cancer screenings. They may even choose to have preventative surgeries that can help reduce their risk of getting cancer and increase their odds of long-term survival if cancer does occur. The next time you go to the doctor and they ask whether any members of your family have had cancer, you will have a deeper understanding why this information is so important to your health.

Chapter 5 Attributions and References

Unit 5.18 Image Attributions

• Figure 5.18.1 Rebeccas Pedigree Cancer by CK-12 Foundation is used under a  CC BY 3.0 (https://creativecommons.org/licenses/by/3.0/) license. ©CK-12 Foundation Licensed under  • Terms of Use • Attribution

• Figure 5.18.2 Mutations_on_BRCA1 by National Cancer Institute (NCI) on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Reference

Brainard, J/ CK-12 Foundation. (2016). Figure 1 Pedigree for Rebecca's family, as described in the beginning of this chapter, [digital image]. In CK-12 College Human Biology (Section 5.17) [online Flexbook]. CK12.org. https://www.ck12.org/book/ck-12-college-human-biology/section/5.17/

Created by CK-12 Foundation/Adapted by Christine Miller

Painting nails with coloured polish for aesthetic reasons is nothing new. In fact, there is evidence of this practice dating back to at least 3000 BCE. Today, painting and otherwise decorating the nails is big business, with annual revenues in the billions of dollars in North America alone! With all the attention (and money) given to nails as decorative objects, it’s easy to forget that they also have important biological functions.

Nails are accessory organs of the skin. They are made of sheets of dead keratinocytes and are found on the far (or distal) ends of the fingers and toes. The keratin in nails makes them hard, but flexible. Nails serve a number of purposes, including protecting the digits, enhancing sensations, and acting as tools.

A nail has three main parts: the root, plate, and free margin. Other structures around or under the nail include the nail bed, cuticle, and nail fold. These structures are shown in Figure 10.6.2.

• The nail root is the portion of the nail found under the surface of the skin at the near (or proximal) end of the nail. It is where the nail begins.
• The nail plate (or body) is the portion of the nail that is external to the skin. It is the visible part of the nail.
• The free margin is the portion of the nail that protrudes beyond the distal end of the finger or toe. This is the part that is cut or filed to keep the nail trimmed.
• The nail bed is the area of skin under the nail plate. It is pink in colour, due to the presence of capillaries in the dermis.
• The cuticle is a layer of dead epithelial cells that overlaps and covers the edge of the nail plate. It helps to seal the edges of the nail to prevent infection of the underlying tissues.
• The nail fold is a groove in the skin in which the side edges of the nail plate are embedded.

Nails grow from a deep layer of living epidermal tissue, known as the nail matrix, at the proximal end of the nail (see the bottom of the diagram in Figure 10.6.2). The nail matrix surrounds the nail root. It contains stem cells that divide to form keratinocytes, which are cells that produce keratin and make up the nail.

Formation of the Nail Root and Nail Plate

The keratinocytes produced by the nail matrix accumulate to form tough, hard, translucent sheets of dead cells filled with keratin. The sheets make up the nail root, which slowly grows out of the skin and becomes the nail plate when it reaches the skin surface. As the nail grows longer, the cells of the nail root and nail plate are pushed toward the distal end of the finger or toe by new cells being formed in the nail matrix. The upper epidermal cells of the nail bed also move along with the nail plate as it grows toward the tip of the digit.

The proximal end of the nail plate near the root has a whitish crescent shape called the lunula. This is where a small amount of the nail matrix is visible through the nail plate. The lunula is most pronounced in the nails of the thumbs, and may not be visible in the nails of the little fingers.

Rate of Nail Growth

Nails grow at an average rate of 3 mm a month. Fingernails, however, grow up to four times as fast as toenails. If a fingernail is lost, it takes between three and six months to regrow completely, whereas a toenail takes between 12 and 18 months to regrow. The actual rate of growth of an individual’s nails depends on many factors, including age, sex, season, diet, exercise level, and genes. If protected from breaking, nails can sometimes grow to be very long. The Chinese doctor in the photo below (Figure 10.6.3) has very long nails on two fingers of his left hand. This picture was taken in 1920 in China, where having long nails was a sign of aristocracy since it implied that one was wealthy enough to not have to do physical labour.

Both fingernails and toenails protect the soft tissues of the fingers and toes from injury. Fingernails also serve to enhance sensation and precise movements of the fingertips through the counter-pressure exerted on the pulp of the fingers by the nails. In addition, fingernails can function as several different types of tools. For example, they enable a fine precision grip like tweezers, and can also be used for cutting and scraping.

Healthcare providers, particularly EMTs, often examine the fingernail beds as a quick and easy indicator of oxygen saturation of the blood, or the amount of blood reaching the extremities. If the nail beds are bluish or purple, it is generally a sign of low oxygen saturation. To see if blood flow to the extremities is adequate, a blanch test may be done. In this test, a fingernail is briefly depressed to turn the nail bed white by forcing the blood out of its capillaries. When the pressure is released, the pink colour of the nail bed should return within a second or two if there is normal blood flow. If the return to a pink colour is delayed, then it can be an indicator of low blood volume, due to dehydration or shock.

How the visible portion of the nails appears can be used as an indicator of recent health status. In fact, nails have been used as diagnostic tools for hundreds — if not thousands — of years. Nail abnormalities, such as deep grooves, brittleness, discolouration, or unusually thin or thick nails, may indicate various illnesses, nutrient deficiencies, drug reactions, or other health problems.

Nails — especially toenails — are common sites of fungal infections (shown in Figure 10.6.4), causing nails to become thickened and yellowish in colour. Toenails are more often infected than fingernails because they are often confined in shoes, which creates a dark, warm, moist environment where fungi can thrive. Toes also tend to have less blood flow than fingers, making it harder for the immune system to detect and stop infections in toenails.

Although nails are harder and tougher than skin, they are also more permeable. Harmful substances may be absorbed through the nails and cause health problems. Some of the substances that can pass through the nails include the herbicide Paraquat, fungicidal agents such as miconazole (e.g., Monistat), and sodium hypochlorite, which is an ingredient in common household bleach. Care should be taken to protect the nails from such substances when handling or immersing the hands in them by wearing latex or rubber gloves.

Do you get regular manicures or pedicures from a nail technician? If so, there is a chance that you are putting your health at risk. Nail tools that are not properly disinfected between clients may transmit infections from one person to another. Cutting the cuticles with scissors may create breaks in the skin that let infective agents enter the body. Products such as acrylics, adhesives, and UV gels that are applied to the nails may be harmful, especially if they penetrate the nails and enter the skin.

Use the Internet to find several reliable sources that address the health risks of professional manicures or pedicures. Try to find answers to the following questions:

1. What training and certification are required for professional nail technicians?
2. What licenses and inspections are required for nail salons?
3. What hygienic practices should be followed in nail salons to reduce the risk of infections being transmitted to clients?
4. Which professional nail products are potentially harmful to the human body and which are safer?
5. How likely is it to have an adverse health consequence when you get a professional manicure or pedicure?
6. What steps can you take to ensure that a professional manicure or pedicure is safe?

Attributions

Figure 10.6.1

Nails by allison-christine-vPrqHSLdF28 [photo] by allison christine on Unsplash is used under the Unsplash License (https://unsplash.com/license).

Figure 10.6.2

Blausen_0406_FingerNailAnatomy by BruceBlaus  on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 10.6.3

Chinese_doctor_with_long_finger_nails_(an_aristocrat),_ca.1920_(CHS-249) by Pierce, C.C. (Charles C.), 1861-1946 from the USC Digital Library on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/public_domain).

Figure 10.6.4

Toenail fungus Nagelpilz-3 by Pepsyrock on Wikimedia Commons is released into the public domain (https://en.wikipedia.org/wiki/public_domain).

Figure 10.6.5

OLYMPUS DIGITAL CAMERA by Stoive at the English language Wikipedia, on Wikimedia Commons is used under a CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/) license.

References

Blausen.com staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

Guiness World Records. (2014, December 8). Longest fingernails - Guinness World Records 60th Anniversary. YouTube. https://www.youtube.com/watch?v=G35kPhbUZdg

SciShow. (2015, September 14). 5 things your nails can say about your health. YouTube. https://www.youtube.com/watch?v=aTSVHwzkYI4

TED-Ed. (2019, October 29). Claws vs. nails - Matthew Borths. YouTube. https://www.youtube.com/watch?v=7w2gCBL1MCg

Created by CK-12 Foundation/Adapted by Christine Miller

Did you ever hear of a person looking at something or someone with a “jaundiced eye”? It means to take a negative view, such as envy, maliciousness, or ill will. The expression may be based on the antiquated idea that liver bile is associated with such negative emotions as these, as well as the fact that excessive liver bile causes jaundice, or yellowing of the eyes and skin. Jaundice is likely a sign of a liver disorder or blockage of the duct that carries bile away from the liver. Bile contains waste products, making the liver an organ of excretion. Bile has an important role in digestion, which makes the liver an accessory organ of digestion, too.

Accessory organs of digestion are organs that secrete substances needed for the chemical digestion of food, but through which food does not actually pass as it is digested. Besides the liver, the major accessory organs of digestion are the gallbladder and pancreas. These organs secrete or store substances that are needed for digestion in the first part of the small intestine — the duodenum — where most chemical digestion takes place. You can see the three organs and their locations in Figure 15.6.2.

Liver

The liver is a vital organ located in the upper right part of the abdomen. It lies just below the diaphragm, to the right of the stomach. The liver plays an important role in digestion by secreting bile, but the liver has a wide range of additional functions unrelated to digestion. In fact, some estimates put the number of functions of the liver at about 500! A few of them are described below.

Structure of the Liver

The liver is a reddish brown, wedge-shaped structure. In adults, the liver normally weighs about 1.5 kg (about 3.3 lb). It is both the heaviest internal organ and the largest gland in the human body. The liver is divided into four lobes of unequal size and shape. Each lobe, in turn, is made up of lobules, which are the functional units of the liver. Each lobule consists of millions of liver cells, called hepatic cells (or hepatocytes). They are the basic metabolic cells that carry out the various functions of the liver.

As shown in Figure 15.6.3, the liver is connected to two large blood vessels: the hepatic artery and the portal vein. The hepatic artery carries oxygen-rich blood from the aorta, whereas the portal vein carries blood that is rich in digested nutrients from the GI tract and wastes filtered from the blood by the spleen. The blood vessels subdivide into smaller arteries and capillaries, which lead into the liver lobules. The nutrients from the GI tract are used to build many vital biochemical compounds, and the wastes from the spleen are degraded and excreted.

Functions of the Liver

The main digestive function of the liver is the production of bile. Bile is a yellowish alkaline liquid that consists of water, electrolytes, bile salts, and cholesterol, among other substances, many of which are waste products. Some of the components of bile are synthesized by hepatocytes. The rest are extracted from the blood.

As shown in Figure 15.6.4, bile is secreted into small ducts that join together to form larger ducts, with just one large duct carrying bile out of the liver. If bile is needed to digest a meal, it goes directly to the duodenum through the common bile duct. In the duodenum, the bile neutralizes acidic chyme from the stomach and emulsifies fat globules into smaller particles (called micelles) that are easier to digest chemically by the enzyme lipase. Bile also aids with the absorption of vitamin K. Bile that is secreted when digestion is not taking place goes to the gallbladder for storage until the next meal. In either case, the bile enters the duodenum through the common bile duct.

Besides its roles in digestion, the liver has many other vital functions:

• The liver synthesizes glycogen from glucose and stores the glycogen as required to help regulate blood sugar levels. It also breaks down the stored glycogen to glucose and releases it back into the blood as needed.
• The liver stores many substances in addition to glycogen, including vitamins A, D, B12, and K. It also stores the minerals iron and copper.
• The liver synthesizes numerous proteins and many of the amino acids needed to make them. These proteins have a wide range of functions. They include fibrinogen, which is needed for blood clotting; insulin-like growth factor (IGF-1), which is important for childhood growth; and albumen, which is the most abundant protein in blood serum and functions to transport fatty acids and steroid hormones in the blood.
• The liver synthesizes many important lipids, including cholesterol, triglycerides, and lipoproteins.
• The liver is responsible for the breakdown of many waste products and toxic substances. The wastes are excreted in bile or travel to the kidneys, which excrete them in urine.

The liver is clearly a vital organ that supports almost every other organ in the body. Because of its strategic location and diversity of functions, the liver is also prone to many diseases, some of which cause loss of liver function. There is currently no way to compensate for the absence of liver function in the long term, although liver dialysis techniques can be used in the short term. An artificial liver has not yet been developed, so liver transplantation may be the only option for people with liver failure.

The gallbladder is a small, hollow, pouch-like organ that lies just under the right side of the liver (see Figure 15.6.5). It is about 8 cm (about 3 in) long and shaped like a tapered sac, with the open end continuous with the cystic duct. The gallbladder stores and concentrates bile from the liver until it is needed in the duodenum to help digest lipids. After the bile leaves the liver, it reaches the gallbladder through the cystic duct. At any given time, the gallbladder may store between 30 to 60 mL (1 to 2 oz) of bile. A hormone stimulated by the presence of fat in the duodenum signals the gallbladder to contract and force its contents back through the cystic duct and into the common bile duct to drain into the duodenum.

Pancreas

The pancreas is a glandular organ that is part of both the digestive system and the endocrine system. As shown in Figure 15.6.6, it is located in the abdomen behind the stomach, with the head of the pancreas surrounded by the duodenum of the small intestine. The pancreas is about 15 cm (almost 6 in) long, and it has two major ducts: the main pancreatic duct and the accessory pancreatic duct. Both of these ducts drain into the duodenum.

As an endocrine gland, the pancreas secretes several hormones, including insulin and glucagon, which circulate in the blood. The endocrine hormones are secreted by clusters of cells called pancreatic islets (or islets of Langerhans). As a digestive organ, the pancreas secretes many digestive enzymes and also bicarbonate, which helps neutralize acidic chyme after it enters the duodenum. The pancreas is stimulated to secrete its digestive substances when food in the stomach and duodenum triggers the release of endocrine hormones into the blood that reach the pancreas via the bloodstream. The pancreatic digestive enzymes are secreted by clusters of cells called acini, and they travel through the pancreatic ducts to the duodenum. In the duodenum, they help to chemically break down carbohydrates, proteins, lipids, and nucleic acids in chyme. The pancreatic digestive enzymes include:

• Amylase, which helps digest starch and other carbohydrates.
• Trypsin and chymotrypsin, which help digest proteins.
• Lipase, which helps digest lipids.
• Deoxyribonucleases and ribonucleases, which help digest nucleic acids.

 

Attributions

Figure 15.6.1

Scleral_Icterus by Sheila J. Toro on Wikimedia Commons is used under a  CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 15.6.2

Blausen_0428_Gallbladder-Liver-Pancreas_Location by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 15.6.3

Diagram_showing_the_two_lobes_of_the_liver_and_its_blood_supply_CRUK_376.svg by Cancer Research UK on Wikimedia Commons is used under a CC BY-SA 4.0  (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 15.6.4

Gallbladder by NIH Image Gallery on Flickr is used CC BY-NC 2.0 (https://creativecommons.org/licenses/by-nc/2.0/) license.

Figure 15.6.5

Gallbladder_(organ) (1) by BruceBlaus on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license. (See a full animation of this medical topic at blausen.com.)

Figure 15.6.6

Blausen_0698_PancreasAnatomy by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

References

Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

nature video. (2018, December 19). Scar wars: Repairing the liver. YouTube. https://www.youtube.com/watch?v=a0d1yvGcfzQ&feature=youtu.be

TED-Ed. (2014, November 25). What does the liver do? - Emma Bryce. YouTube. https://www.youtube.com/watch?v=wbh3SjzydnQ&feature=youtu.be

TED-Ed. (2015, February 19). What does the pancreas do? - Emma Bryce. YouTube. https://www.youtube.com/watch?v=8dgoeYPoE-0&feature=youtu.be

Created by CK-12 Foundation/Adapted by Christine Miller

If you had a skin rash like the one shown in Figure 15.7.1, you probably wouldn’t assume that it was caused by a digestive system disease. However, that’s exactly why the individual in the picture has a rash. He has a gastrointestinal (GI) tract disorder called Crohn’s disease. This disease is one of a group of GI tract disorders that are known collectively as inflammatory bowel disease. Unlike other inflammatory bowel diseases, signs and symptoms of Crohn’s disease may not be confined to the GI tract.

Inflammatory bowel disease (IBD) is a collection of inflammatory conditions primarily affecting the intestines. The two principal inflammatory bowel diseases are Crohn’s disease and ulcerative colitis. Unlike Crohn’s disease — which may affect any part of the GI tract and the joints, as well as the skin — ulcerative colitis mainly affects just the colon and rectum. Both diseases occur when the body’s own immune systemno post attacks the digestive system. Both diseases typically first appear in the late teens or early twenties, and occur equally in males and females.  Approximately 270,000 Canadians are currently living with IBD, 7,000 of which are children.  The annual cost of caring for these Canadians is estimated at $1.28 billion.  The number of cases of IBD has been steadily increasing and it is expected that by 2030 the number of Canadians suffering from IBD will grow to 400,000.

Crohn’s Disease

Crohn’s disease is a type of inflammatory bowel disease that may affect any part of the GI tract from the mouth to the anus, among other body tissues. The most commonly affected region is the ileum, which is the final part of the small intestine. Signs and symptoms of Crohn’s disease typically include abdominal pain, diarrhea (with or without blood), fever, and weight loss. Malnutrition because of faulty absorption of nutrients may also occur. Potential complications of Crohn’s disease include obstructions and abscesses of the bowel. People with Crohn’s disease are also at slightly greater risk than the general population of developing bowel cancer. Although there is a slight reduction in life expectancy in people with Crohn’s disease, if the disease is well-managed, affected people can live full and productive lives.  Approximately 135,000 Canadians are living with Crohn's disease.

Crohn’s disease is caused by a combination of genetic and environmental factors that lead to impairment of the generalized immune response (called innate immunity). The chronic inflammation of Crohn’s disease is thought to be the result of the immune system “trying” to compensate for the impairment. Dozens of genes are likely to be involved, only a few of which have been identified. Because of the genetic component, close relatives such as siblings of people with Crohn’s disease are many times more likely to develop the disease than people in the general population. Environmental factors that appear to increase the risk of the disease include smoking tobacco and eating a diet high in animal proteins. Crohn’s disease is typically diagnosed on the basis of a colonoscopy, which provides a direct visual examination of the inside of the colon and the ileum of the small intestine.

People with Crohn’s disease typically experience recurring periods of flare-ups followed by remission. There are no medications or surgical procedures that can cure Crohn’s disease, although medications such as anti-inflammatory or immune-suppressing drugs may alleviate symptoms during flare-ups and help maintain remission. Lifestyle changes, such as dietary modifications and smoking cessation, may also help control symptoms and reduce the likelihood of flare-ups. Surgery may be needed to resolve bowel obstructions, abscesses, or other complications of the disease.

Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease that causes inflammation and ulcers (sores) in the colon and rectum. Unlike Crohn’s disease, other parts of the GI tract are rarely affected in ulcerative colitis. The primary symptoms of the disease are lower abdominal pain and bloody diarrhea. Weight loss, fever, and anemia may also be present. Symptoms typically occur intermittently with periods of no symptoms between flare-ups. People with ulcerative colitis have a considerably increased risk of colon cancer and should be screened for colon cancer more frequently than the general population. Ulcerative colitis, however, seems to primarily reduce the quality of life, and not the lifespan.

The exact cause of ulcerative colitis is not known. Theories about its cause involve immune system dysfunction, genetics, changes in normal gut bacteria, and lifestyle factors, such as a diet high in animal protein and the consumption of alcoholic beverages. Genetic involvement is suspected in part because ulcerative colitis tens to “run” in families. It is likely that multiple genes are involved. Diagnosis is typically made on the basis of colonoscopy and tissue biopsies.

Lifestyle changes, such as reducing the consumption of animal protein and alcohol, may improve symptoms of ulcerative colitis. A number of medications are also available to treat symptoms and help prolong remission. These include anti-inflammatory drugs and drugs that suppress the immune system. In cases of severe disease, removal of the colon and rectum may be required and can cure the disease.

Diverticulitis is a digestive disease in which tiny pouches in the wall of the large intestine become infected and inflamed. Symptoms typically include lower abdominal pain of sudden onset. There may also be fever, nausea, diarrhea or constipation, and blood in the stool. Having large intestine pouches called diverticula (see Figure 15.7.2) that are not inflamed is called diverticulosis. Diverticulosis is thought to be caused by a combination of genetic and environmental factors, and is more common in people who are obese. Infection and inflammation of the pouches (diverticulitis) occurs in about 10–25% of people with diverticulosis, and is more common at older ages. The infection is generally caused by bacteria.

Diverticulitis can usually be diagnosed with a CT scan and can be monitored with a colonoscopy (as seen in Figure 15.7.3). Mild diverticulitis may be treated with oral antibiotics and a short-term liquid diet. For severe cases, intravenous antibiotics, hospitalization, and complete bowel rest (no nourishment via the mouth) may be recommended. Complications such as abscess formation or perforation of the colon require surgery.

A peptic ulcer is a sore in the lining of the stomach or the duodenum (first part of the small intestine). If the ulcer occurs in the stomach, it is called a gastric ulcer. If it occurs in the duodenum, it is called a duodenal ulcer. The most common symptoms of peptic ulcers are upper abdominal pain that often occurs in the night and improves with eating. Other symptoms may include belching, vomiting, weight loss, and poor appetite. Many people with peptic ulcers, particularly older people, have no symptoms. Peptic ulcers are relatively common, with about ten per cent of people developing a peptic ulcer at some point in their life.

The most common cause of peptic ulcers is infection with the bacterium Helicobacter pylori, which may be transmitted by food, contaminated water, or human saliva (for example, by kissing or sharing eating utensils). Surprisingly, the bacterial cause of peptic ulcers was not discovered until the 1980s. The scientists who made the discovery are Australians Robin Warren and Barry J. Marshall. Although the two scientists eventually won a Nobel Prize for their discovery, their hypothesis was poorly received at first. To demonstrate the validity of their discovery, Marshall used himself in an experiment. He drank a culture of bacteria from a peptic ulcer patient and developed symptoms of peptic ulcer in a matter of days. His symptoms resolved on their own within a couple of weeks, but, at his wife's urging, he took antibiotics to kill any remaining bacteria. Marshall’s self-experiment was published in the Australian Medical Journal, and is among the most cited articles ever published in the journal.  Figure 15.7.4 shows how H. pylori cause peptic ulcers.

Another relatively common cause of peptic ulcers is chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen. Additional contributing factors may include tobacco smoking and stress, although these factors have not been demonstrated conclusively to cause peptic ulcers independent of H. pylori infection. Contrary to popular belief, diet does not appear to play a role in either causing or preventing peptic ulcers. Eating spicy foods and drinking coffee and alcohol were once thought to cause peptic ulcers. These lifestyle choices are no longer thought to have much (if any) of an effect on the development of peptic ulcers.

Peptic ulcers are typically diagnosed on the basis of symptoms or the presence of H. pylori in the GI tract. However, endoscopy (shown in Figure 15.7.5), which allows direct visualization of the stomach and duodenum with a camera, may be required for a definitive diagnosis. Peptic ulcers are usually treated with antibiotics to kill H. pylori, along with medications to temporarily decrease stomach acid and aid in healing. Unfortunately, H. pylori has developed resistance to commonly used antibiotics, so treatment is not always effective. If a peptic ulcer has penetrated so deep into the tissues that it causes a perforation of the wall of the stomach or duodenum, then emergency surgery is needed to repair the damage.

 

Gastroenteritis, also known as infectious diarrhea or stomach flu, is an acute and usually self-limiting infection of the GI tract by pathogens. Symptoms typically include some combination of diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydration may also occur. The illness generally lasts less than two weeks, even without treatment, but in young children it is potentially deadly. Gastroenteritis is very common, especially in poorer nations. Worldwide, up to five billion cases occur each year, resulting in about 1.4 million deaths.

Commonly called “stomach flu,” gastroenteritis is unrelated to the influenza virus, although viruses are the most common cause of the disease (see Figure 15.7.6). In children, rotavirus is most often the cause which is why the British Columbia immunization schedule now includes a rotovirus vaccine. Norovirus is more likely to be the cause of gastroenteritis in adults. Besides viruses, other potential causes of gastroenteritis include fungi, bacteria (most often E. coli or Campylobacter jejuni), and protozoa(including Giardia lamblia, more commonly called Beaver Fever, described below). Transmission of pathogens may occur due to eating improperly prepared foods or foods left to stand at room temperature, drinking contaminated water, or having close contact with an infected individual.

Gastroenteritis is less common in adults than children, partly because adults have acquired immunity after repeated exposure to the most common infectious agents. Adults also tend to have better hygiene than children. If children have frequent repeated incidents of gastroenteritis, they may suffer from malnutrition, stunted growth, and developmental delays. Many cases of gastroenteritis in children can be avoided by giving them a rotavirus vaccine. Frequent and thorough handwashing can cut down on infections caused by other pathogens.

Treatment of gastroenteritis generally involves increasing fluid intake to replace fluids lost in vomiting or diarrhea. Oral rehydration solution, which is a combination of water, salts, and sugar, is often recommended. In severe cases, intravenous fluids may be needed. Antibiotics are not usually prescribed, because they are ineffective against viruses that cause most cases of gastroenteritis.

Giardiasis, popularly known as beaver fever, is a type of gastroenteritis caused by a GI tract parasite, the single-celled protozoan Giardia lamblia (pictured in Figure 15.7.7). In addition to human beings, the parasite inhabits the digestive tract of a wide variety of domestic and wild animals, including cows, rodents, and sheep, as well as beavers (hence its popular name). Giardiasis is one of the most common parasitic infections in people the world over, with hundreds of millions of people infected worldwide each year.

Transmission of G. lamblia is via a fecal-oral route (as in, you got feces in your food). Those at greatest risk include travelers to countries where giardiasis is common, people who work in child-care settings, backpackers and campers who drink untreated water from lakes or rivers, and people who have close contact with infected people or animals in other settings. In Canada, Giardia is the most commonly identified intestinal parasite and approximately 3,000 Canadians will contract the parasite annually.

Symptoms of giardiasis can vary widely. About one-third third of people with the infection have no symptoms, whereas others have severe diarrhea with poor absorption of nutrients. Problems with absorption occur because the parasites inhibit intestinal digestive enzyme production, cause detrimental changes in microvilli lining the small intestine, and kill off small intestinal epithelial cells. The illness can result in weakness, loss of appetite, stomach cramps, vomiting, and excessive gas. Without treatment, symptoms may continue for several weeks. Treatment with anti-parasitic medications may be needed if symptoms persist longer or are particularly severe.

Attributions

Figure 15.7.1

BADAS_Crohn by Dayavathi Ashok and Patrick Kiely/ Journal of medical case reports on Wikimedia Commons is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0) license.

Figure 15.7.2

512px-Ds00070_an01934_im00887_divert_s_gif.webp by Lfreeman04  on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 15.7.3

Colon_diverticulum by melvil on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 15.7.4

H_pylori_ulcer_diagram by Y_tambe on Wikimedia Commons is used under a CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/) license.

Figure 15.7.5

1024px-Endoscopy_training by Yuya Tamai on Wikimedia Commons is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0) license.

Figure 15.7.6

Gastroenteritis_viruses by Dr. Graham Beards [en:User:Graham Beards] at en.wikipedia on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 15.7.7

Giardia_lamblia_SEM_8698_lores by Janice Haney Carr from CDC/ Public Health Image Library (PHIL) ID# 8698 on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/public_domain).

References

Ashok, D., & Kiely, P. (2007). Bowel associated dermatosis - arthritis syndrome: a case report. Journal of medical case reports, 1, 81. https://doi.org/10.1186/1752-1947-1-81

Marshall, B. J., Armstrong, J. A., McGechie, D. B., & Glancy, R. J. (1985). Attempt to fulfil Koch's postulates for pyloric Campylobacter. The Medical Journal of Australia, 142(8), 436–439.

Marshall, B. J., McGechie, D. B., Rogers, P. A., & Glancy, R. J. (1985). Pyloric campylobacter infection and gastroduodenal disease. The Medical Journal of Australia, 142(8), 439–444.

TED-Ed. (2017, September 28). The surprising cause of stomach ulcers - Rusha Modi. YouTube. https://www.youtube.com/watch?v=V_U6czbDHLE&feature=youtu.be

TED-Ed. (2018, January 4). Who's at risk for colon cancer? - Amit H. Sachdev and Frank G. Gress. YouTube. https://www.youtube.com/watch?v=H5zin8jKeT0&feature=youtu.be

Created by CK-12 Foundation/Adapted by Christine Miller

Does the word muscle make you think of the well-developed muscles of a weightlifter, like the woman in Figure 12.2.1? Her name is Natalia Zabolotnaya, and she’s a Russian Olympian. The muscles that are used to lift weights are easy to feel and see, but they aren’t the only muscles in the human body. Many muscles are deep within the body, where they form the walls of internal organs and other structures. You can flex your biceps at will, but you can’t control internal muscles like these. It’s a good thing that these internal muscles work without any conscious effort on your part, because movement of these muscles is essential for survival. Muscles are the organs of the muscular system.

The muscular system consists of all the muscles of the body. The largest percentage of muscles in the muscular system consists of skeletal muscles, which are attached to bones and enable voluntary body movements (shown in Figure 12.2.2). There are almost 650 skeletal muscles in the human body, many of them shown in Figure 12.2.2. Besides skeletal muscles, the muscular system also includes cardiac muscle, which makes up the walls of the heart, and smooth muscles, which control movement in other internal organs and structures.

Muscles are organs composed mainly of muscle cells, which are also called muscle fibres (mainly in skeletal and cardiac muscle) or myocytes (mainly in smooth muscle). Muscle cells are long, thin cells that are specialized for the function of contracting. They contain protein filaments that slide over one another using energy in ATP. The sliding filaments increase the tension in — or shorten the length of — muscle cells, causing a contraction. Muscle contractions are responsible for virtually all the movements of the body, both inside and out.

Skeletal muscles are attached to bones of the skeleton. When these muscles contract, they move the body. They allow us to use our limbs in a variety of ways, from walking to turning cartwheels. Skeletal muscles also maintain posture and help us to keep balance.

Smooth muscles in the walls of blood vessels contract to cause vasoconstriction, which may help conserve body heat. Relaxation of these muscles causes vasodilation, which may help the body lose heat. In the organs of the digestive system, smooth muscles squeeze food through the gastrointestinal tract by contracting in sequence to form a wave of muscle contractions called peristalsis. Think of squirting toothpaste through a tube by applying pressure in sequence from the bottom of the tube to the top, and you have a good idea of how food is moved by muscles through the digestive system. Peristalsis of smooth muscles also moves urine through the urinary tract.

Cardiac muscle tissue is found only in the walls of the heart. When cardiac muscle contracts, it makes the heart beat. The pumping action of the beating heart keeps blood flowing through the cardiovascular system.

Muscles can grow larger, or hypertrophy. This generally occurs through increased use, although hormonal or other influences can also play a role. The increase in testosterone that occurs in males during puberty, for example, causes a significant increase in muscle size. Physical exercise that involves weight bearing or resistance training can increase the size of skeletal muscles in virtually everyone. Exercises (such as running) that increase the heart rate may also increase the size and strength of cardiac muscle. The size of muscle, in turn, is the main determinant of muscle strength, which may be measured by the amount of force a muscle can exert.

Muscles can also grow smaller, or atrophy, which can occur through lack of physical activity or from starvation. People who are immobilized for any length of time — for example, because of a broken bone or surgery — lose muscle mass relatively quickly. People in concentration or famine camps may be so malnourished that they lose much of their muscle mass, becoming almost literally just “skin and bones.” Astronauts on the International Space Station may also lose significant muscle mass because of weightlessness in space (see Figure 12.2.3).

Many diseases, including cancer and AIDS, are often associated with muscle atrophy. Atrophy of muscles also happens with age. As people grow older, there is a gradual decrease in the ability to maintain skeletal muscle mass, known as sarcopenia. The exact cause of sarcopenia is not known, but one possible cause is a decrease in sensitivity to growth factors that are needed to maintain muscle mass. Because muscle size determines strength, muscle atrophy causes a corresponding decline in muscle strength.

In both hypertrophy and atrophy, the number of muscle fibres does not change. What changes is the size of the muscle fibres. When muscles hypertrophy, the individual fibres become wider. When muscles atrophy, the fibres become narrower.

Muscles cannot contract on their own. Skeletal muscles need stimulation from motor neurons in order to contract. The point where a motor neuron attaches to a muscle is called a neuromuscular junction. Let’s say you decide to raise your hand in class. Your brain sends electrical messages through motor neurons to your arm and shoulder. The motor neurons, in turn, stimulate muscle fibres in your arm and shoulder to contract, causing your arm to rise.

Involuntary contractions of smooth and cardiac muscles are also controlled by electrical impulses, but in the case of these muscles, the impulses come from the autonomic nervous system (smooth muscle) or specialized cells in the heart (cardiac muscle). Hormones and some other factors also influence involuntary contractions of cardiac and smooth muscles. For example, the fight-or-flight hormone adrenaline increases the rate at which cardiac muscle contracts, thereby speeding up the heartbeat.

Muscles cannot move the body on their own. They need the skeletal system to act upon. The two systems together are often referred to as the musculoskeletal system. Skeletal muscles are attached to the skeleton by tough connective tissues called tendons. Many skeletal muscles are attached to the ends of bones that meet at a joint. The muscles span the joint and connect the bones. When the muscles contract, they pull on the bones, causing them to move. The skeletal system provides a system of levers that allow body movement. The muscular system provides the force that moves the levers.

Involuntary, striated muscle found only in the walls of the heart; also called myocardium.

Created by CK-12 Foundation/Adapted by Christine Miller

Imagine the man in Figure 12.3.1 turns his eyes in your direction. This is a very small movement, considering the conspicuously large and strong external eye muscles that control eyeball movements. These muscles have been called the strongest muscles in the human body relative to the work they do. However, the external eye muscles actually do a surprising amount of work. Eye movements occur almost constantly during waking hours, especially when we are scanning faces or reading. Eye muscles are also exercised nightly during the phase of sleep called rapid eye movement sleep. External eye muscles can move the eyes because they are made mainly of muscle tissue.

Muscle tissue is a soft tissue that makes up most of the tissues in the muscles of the human muscular system. Other tissues in muscles are connective tissues, such as tendons that attach skeletal muscles to bones and sheaths of connective tissues that cover or line muscle tissues. Only muscle tissue per se, has cells with the ability to contract.

There are three major types of muscle tissues in the human body: skeletal, smooth, and cardiac muscle tissues. Figure 12.3.2 shows how the three types of muscle tissues appear under magnification. When you read about each type below, you will learn why the three types appear as they do.

Skeletal muscle is muscle tissue that is attached to bones by tendons, which are bundles of collagen fibres. Whether you are moving your eyes or running a marathon, you are using skeletal muscles. Contractions of skeletal muscles are voluntary, or under conscious control of the central nervous system via the somatic nervous system. Skeletal muscle tissue is the most common type of muscle tissue in the human body. By weight, an average adult male is about 42% skeletal muscles, and the average adult female is about 36% skeletal muscles. Some of the major skeletal muscles in the human body are labeled in Figure 12.3.3 below.

Skeletal Muscle Pairs

To move bones in opposite directions, skeletal muscles often consist of muscle pairs that work in opposition to one another, also called antagonistic muscle pairs.  For example, when the biceps muscle (on the front of the upper arm) contracts, it can cause the elbow joint to flex or bend the arm, as shown in Figure 12.3.4. When the triceps muscle (on the back of the upper arm) contracts, it can cause the elbow to extend or straighten the arm. The biceps and triceps muscles, also shown in Figure 12.3.4, are an example of a muscle pair where the muscles work in opposition to each other.

Skeletal Muscle Structure

Each skeletal muscle consists of hundreds — or even thousands — of skeletal muscle fibres, which are long, string-like cells. As shown in Figure 12.3.5 below, skeletal muscle fibres are individually wrapped in connective tissue called endomysium. The skeletal muscle fibres are bundled together in units called muscle fascicles, which are surrounded by sheaths of connective tissue called perimysium. Each fascicle contains between ten and 100 (or even more!) skeletal muscle fibres. Fascicles, in turn, are bundled together to form individual skeletal muscles, which are wrapped in connective tissue called epimysium. The connective tissues in skeletal muscles have a variety of functions. They support and protect muscle fibres, allowing them to withstand the forces of contraction by distributing the forces applied to the muscle. They also provide pathways for nerves and blood vessels to reach the muscles. In addition, the epimysium anchors the muscles to tendons.

The same bundles-within-bundles structure is replicated within each muscle fibre. As shown in Figure 12.3.6, a muscle fibre consists of a bundle of myofibrils, which are themselves bundles of protein filaments. These protein filaments consist of thin filaments of the protein actin, which are anchored to structures called Z discs, and thick filaments of the protein myosin. The filaments are arranged together within a myofibril in repeating units called sarcomeres, which run from one Z disc to the next. The sarcomere is the basic functional unit of skeletal and cardiac muscles. It contracts as actin and myosin filaments slide over one another. Skeletal muscle tissue is said to be striated, because it appears striped. It has this appearance because of the regular, alternating A (dark) and I (light) bands of filaments arranged in sarcomeres inside the muscle fibres. Other components of a skeletal muscle fibre include multiple nuclei and mitochondria.

Slow- and Fast-Twitch Skeletal Muscle Fibres

Skeletal muscle fibres can be divided into two types, called slow-twitch (or type I) muscle fibres and fast-twitch (or type II) muscle fibres.

• Slow-twitch muscle fibres are dense with capillaries and rich in mitochondria and myoglobin, which is a protein that stores oxygen until needed for muscle activity. Relative to fast-twitch fibres, slow-twitch fibres can carry more oxygen and sustain aerobic (oxygen-using) activity. Slow-twitch fibres can contract for long periods of time, but not with very much force. They are relied upon primarily in endurance events, such as distance running or cycling.
• Fast-twitch muscle fibres contain fewer capillaries and mitochondria and less myoglobin. This type of muscle fibre can contract rapidly and powerfully, but it fatigues very quickly. Fast-twitch fibres can sustain only short, anaerobic (non-oxygen-using) bursts of activity. Relative to slow-twitch fibres, fast-twitch fibres contribute more to muscle strength and have a greater potential for increasing in mass. They are relied upon primarily in short, strenuous events, such as sprinting or weightlifting.

Proportions of fibre types vary considerably from muscle to muscle and from person to person. Individuals may be genetically predisposed to have a larger percentage of one type of muscle fibre than the other. Generally, an individual who has more slow-twitch fibres is better suited for activities requiring endurance, whereas an individual who has more fast-twitch fibres is better suited for activities requiring short bursts of power.

Smooth muscle is muscle tissue in the walls of internal organs and other internal structures such as blood vessels. When smooth muscles contract, they help the organs and vessels carry out their functions. When smooth muscles in the stomach wall contract, for example, they squeeze the food inside the stomach, helping to mix and churn the food and break it into smaller pieces. This is an important part of digestion. Contractions of smooth muscles are involuntary, so they are not under conscious control. Instead, they are controlled by the autonomic nervous system, hormones, neurotransmitters, and other physiological factors.

Structure of Smooth Muscle

The cells that make up smooth muscle are generally called myocytes. Unlike the muscle fibres of striated muscle tissue, the myocytes of smooth muscle tissue do not have their filaments arranged in sarcomeres. Therefore, smooth tissue is not striated. However, the myocytes of smooth muscle do contain myofibrils, which in turn contain bundles of myosin and actin filaments. The filaments cause contractions when they slide over each other, as shown in Figure 12.3.7.

Unlike striated muscle, smooth muscle can sustain very long-term contractions. Smooth muscle can also stretch and still maintain its contractile function, which striated muscle cannot. The elasticity of smooth muscle is enhanced by an extracellular matrix secreted by myocytes. The matrix consists of elastin, collagen, and other stretchy fibres. The ability to stretch and still contract is an important attribute of smooth muscle in organs such as the stomach and uterus (see Figures 12.3.8 and 12.3.9), both of which must stretch considerably as they perform their normal functions.

The following list indicates where many smooth muscles are found, along with some of their specific functions.

• Walls of organs of the gastrointestinal tract (such as the esophagus, stomach, and intestines), moving food through the tract by peristalsis
• Walls of air passages of the respiratory tract (such as the bronchi), controlling the diameter of the passages and the volume of air that can pass through them
• Walls of organs of the male and female reproductive tracts; in the uterus, for example, pushing a baby out of the uterus and into the birth canal
• Walls of structures of the urinary system, including the urinary bladder, allowing the bladder to expand so it can hold more urine, and then contract as urine is released
• Walls of blood vessels, controlling the diameter of the vessels and thereby affecting blood flow and blood pressure
• Walls of lymphatic vessels, squeezing the fluid called lymph through the vessels
• Iris of the eyes, controlling the size of the pupils and thereby the amount of light entering the eyes
• Arrector pili in the skin, raising hairs in hair follicles in the dermis

Cardiac muscle is found only in the wall of the heart. It is also called myocardium. As shown in Figure 12.3.10, myocardium is enclosed within connective tissues, including the endocardium on the inside of the heart and pericardium on the outside of the heart. When cardiac muscle contracts, the heart beats and pumps blood. Contractions of cardiac muscle are involuntary, like those of smooth muscles. They are controlled by electrical impulses from specialized cardiac muscle cells in an area of the heart muscle called the sinoatrial node.

Like skeletal muscle, cardiac muscle is striated because its filaments are arranged in sarcomeres inside the muscle fibres. However, in cardiac muscle, the myofibrils are branched at irregular angles rather than arranged in parallel rows (as they are in skeletal muscle). This explains why cardiac and skeletal muscle tissues look different from one another.

The cells of cardiac muscle tissue are arranged in interconnected networks. This arrangement allows rapid transmission of electrical impulses, which stimulate virtually simultaneous contractions of the cells. This enables the cells to coordinate contractions of the heart muscle.

The heart is the muscle that performs the greatest amount of physical work in the course of a lifetime. Although the power output of the heart is much less than the maximum power output of some other muscles in the human body, the heart does its work continuously over an entire lifetime without rest. Cardiac muscle contains a great many mitochondria, which produce ATP for energy and help the heart resist fatigue.

Cardiomyopathy is a disease in which the muscles of the heart are no longer able to effectively pump blood to the body — extreme forms of this disease can lead to heart failure.  There are four main types of cardiomyopathy (also illustrated in Figure 12.3.11):

• Dilated (congestive) cardiomyopathy: the left ventricle (the chamber itself) of the heart becomes enlarged and can't pump blood our to the body.  This is normally related to coronary artery disease and/or heart attack
• Hypertrophic cardiomyopathy: abnormal thickening of the muscular walls of the left ventricle make the chamber less able to work properly.  This condition is more common in patients with a family history of the disease.
• Restrictive cardiomyopathy: the myocardium becomes abnormally rigid and inelastic and is unable to expand in between heartbeats to refill with blood.  Restrictive cardiomyopathy typically affects older people.
• Arrhythmogenic right ventricular cardiomyopathy: the right ventricular muscle is replaced by adipose or scar tissue, reducing elasticity and interfering with normal heartbeat and rhythm.  This disease is often caused by genetic mutations.

Cardiomyopathy is typically diagnosed with a physical exam supplemented by medical and family history, an angiogram, blood tests, chest x-rays and electrocardiograms.  In some cases your doctor would also requisition a CT scan and/or genetic testing.

When treating cardiomyopathy, the goal is to reduce symptoms that affect everyday life.  Certain medications can help regularize and slow heart rate, decrease chances of blood clots and cause vasodilation in the coronary arteries.  If medication is not sufficient to manage symptoms, a pacemaker or even a heart transplant may be the best option.  Lifestyle can also help manage the symptoms of cardiomyopathy — people living with this disease are encouraged to avoid drug and alcohol use, control high blood pressure, eat a healthy diet, get ample rest and exercise, as well as reduce stress levels.

 

Attributions

Figure 12.3.1

Look by ali-yahya-155huuQwGvA [photo] by Ali Yahya on Unsplash is used under the Unsplash License (https://unsplash.com/license).

Figure 12.3.2

Skeletal_Smooth_Cardiac by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 12.3.3

Anterior_and_Posterior_Views_of_Muscles by OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 12.3.4

Antagonistic Muscle Pair by Laura Guerin at CK-12 Foundation on Wikimedia Commons is used under a CC BY-NC 3.0 (https://creativecommons.org/licenses/by-nc/3.0/) license. 

Figure 12.3.5

Muscle_Fibes_(large) by OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 12.3.6

Muscle_Fibers_(small) by OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 12.3.7

Smooth_Muscle_Contraction by OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 12.3.8

Blausen_0747_Pregnancy by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 12.3.9

Size_of_Uterus_Throughout_Pregnancy-02 by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 12.3.10

1024px-Blausen_0470_HeartWall by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 12.3.11

Tipet_e_kardiomiopative by Npatchett at English Wikipedia on Wikimedia Commons is used under a CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) license. (Work derived from Blausen 0165 Cardiomyopathy Dilated by BruceBlaus)

References

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 4.18 Muscle tissue [digital image].  In Anatomy and Physiology (Section 4.4). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/4-4-muscle-tissue-and-motion

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 28.18 Size of uterus throughout pregnancy [digital image].  In Anatomy and Physiology (Section 28.4). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/28-4-maternal-changes-during-pregnancy-labor-and-birth

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure 10.3 The three connective tissue layers [digital image].  In Anatomy and Physiology (Section 10.2). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/10-2-skeletal-muscle

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure 10.4 Muscle fiber [digital image].  In Anatomy and Physiology (Section 10.2). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/10-2-skeletal-muscle

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure 10.24 Muscle contraction [digital image].  In Anatomy and Physiology (Section 10.8). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/10-8-smooth-muscle

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure 11.5 Overview of the muscular system [digital image].  In Anatomy and Physiology (Section 11.2). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/11-2-naming-skeletal-muscles

Blausen.com staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

Brainard, J/ CK-12 Foundation. (2012). Figure 5 Triceps and biceps muscles in the upper arm are opposing muscles. [digital image]. In CK-12 Biology (Section 21.3) [online Flexbook]. CK12.org. https://www.ck12.org/book/ck-12-biology/section/21.3/ (Last modified August 11, 2017.)

khanacademymedicine. (2012, October 19). Three types of muscle | Circulatory system physiology | NCLEX-RN | Khan Academy. YouTube.

TED-Ed. (2017, February 14).  What happens during a heart attack? - Krishna Sudhir. YouTube. https://www.youtube.com/watch?v=3_PYnWVoUzM&feature=youtu.be