Solution Key The Language of Medicine 12th Edition (2023)

Table of Contents Instructions for Online Access Cover Photo Cover Copyright Dedication Foreword WELCOME TO THE 12TH EDITION OF THE LANGUAGE OF MEDICINE NEW TO THE 12TH EDITION HOW TO USE THE BOOK ALSO AVAILABLE Acknowledgments Reviewers Chapter 1 Basic Word Structure Goals in the Study of Medical Language

Word analysis exercises Solutions to the exercises Chapter 2 Terms relating to the body as a whole Structural organization of the body Abdominal-pelvic regions and quadrants Structure of the back (spine) Positional and directional concepts Body levels Exercises Solutions to the exercises Chapter 3 Suffixes Introduction A Closer Look Exercises Answers to the Exercises Chapter 4 Prefixes Introduction Closer Look Exercises

Exercise Answers Chapter 5 Digestive System Introduction Anatomy and Physiology Digestive System Pathology Pathological Conditions Exercises Exercise Answers Chapter 6 Additional Digestive System Suffixes and Terminology Introduction Laboratory Tests and Clinical Procedures Exercises Exercise Answers Chapter 7 Urinary System Introduction Anatomy of Major Organs Physiology: How the kidneys produce urine urinalysis Pathological terminology: kidney, bladder and comorbidities Laboratory tests and clinical procedures

Exercises Answers to Exercises Chapter 8 Introduction to the Female Reproductive System Organs of the Female Reproductive System Menstrual and Pregnancy Pathology: Gynecological, Breast, Pregnancy, and Neonatal Clinical Tests and Procedures Exercises Exercises Answers to Exercises Chapter 9 Introduction to the Male Reproductive System Anatomy Pathological Conditions; Sexually Transmitted Infections Laboratory Tests and Clinical Procedures Exercises Answers to Exercises Chapter 10 Nervous System Introduction General structure of the nervous system

Neurons, nerves, and glial cells The brain Spinal cord and meninges Pathology Laboratory tests and clinical procedures Exercises Exercises Solutions Chapter 11 Cardiovascular system Introduction Blood vessels and circulatory system Anatomy of the heart Physiology of the heart Blood pressure Pathology: the heart and blood vessels Laboratory tests and clinical procedures Exercises Solutions to the exercises Chapter 12 Respiratory System Introduction Anatomy and Physiology of Respiration Pathology

Clinical Procedures Exercises Exercise Answers Chapter 13 Blood System Introduction Blood Composition and Formation Blood Types Blood Clotting Pathology Laboratory Tests and Clinical Procedures Exercises Exercise Answers Chapter 14 Lymphatic and Immune System Introduction Lymphatic System Immune System Pathological Conditions Laboratory Tests and Clinical Procedures Exercises Exercise Answers

Chapter 15 Musculoskeletal System Introduction Bones Pathology - Bones Joints Pathology - Joints Muscles Pathology - Muscles Laboratory Tests and Clinical Procedures Exercises Exercise Solutions Chapter 16 Skin Introduction Anatomy of the Skin Accessory Structures of the Skin Pathology Laboratory Tests and Clinical Procedures Exercises Exercise Solutions Chapter 17 Senses Introduction

The Eye Refractive Errors Pathology - the Eye Clinical Procedures - the Eye The Ear Pathology - the Ear Clinical Procedures - the Ear Exercises Exercise Solutions Chapter 18 Endocrine System Introduction Thyroid Parathyroid Adrenal Pancreas Pituitary Ovaries Testis Pathology Laboratory Tests Clinical Procedures

Exercises Answers to Exercises Chapter 19 Cancer Medicine (Oncology) Introduction Characteristics of Tumors Carcinogenesis Classification of Cancer Tumors Pathological Descriptions Grading and Staging Systems Cancer Treatment Laboratory Tests Clinical Procedures Exercises Answers to Exercises Chapter 20 Radiology and Nuclear Medicine Introduction Radiology Nuclear Medicine Exercises Answers to Exercises

Chapter 21 Pharmacology Introduction Drug Names, Standards and References Administration of Drugs Drug Effects and Interactions Drug Toxicity Classes of Drugs Exercises Answers to Exercises Chapter 22 Psychiatry Introduction Psychiatric Clinical Symptoms Psychiatric Disorders Therapeutic Modalities Exercises Answers to Exercises Mini-Dictionary A B C D

E F G H I J K L M N O P Q R S T U V W X Y Z

Glossary Appendix I Plural Forms Appendix II Abbreviations, Acronyms, Eponyms, and Symbols Abbreviations Acronyms Eponyms Symbols Appendix III Normal Hematological Reference Values and Implications of Abnormal Results Appendix IV Medications Images Credits Index Chabner Makes Medical Terminology MEMORABLE... Students... Educators... Order Now!

fifteen

Copyright THE LANGUAGE OF MEDICINE, TWELFTH EDITION ISBN: 978-0-323-55147-2 Copyright © 2021, Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or information storage and retrieval systems, without the written permission of the publisher. For details on how to obtain permission, more information about the publisher's permissions policies, and our agreements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, visit our website: www.elsevier.com/permissions. This book and the individual contributions contained herein are copyrighted by the publisher (unless otherwise noted herein).

Note Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, method, compound, or experiment described herein. Due to the rapid advances in medical science in particular, independent verification of diagnoses and drug dosages should be carried out. To the fullest extent of the law, Elsevier, authors, publishers or contributors shall have no responsibility for any injury and/or damage to any person or property, whether due to product liability, negligence or otherwise, or arising out of the use or operation of any method, product, instruction or idea provided by contained in the material contained herein. Previous editions copyrighted 2017, 2014, 2011, 2007, 2004, 2001, 1996, 1991, 1985, 1981 and 1976.

Kontrollnummer der Library of Congress: 2020932476 Senior Content Strategist: Linda Woodard Senior Content Development Manager: Luke Held Publishing Services Manager: Julie Eddy Senior Project Manager: Abigail Bradberry Design Direction: Amy Buxton Printed in Canada Letzte Ziffer ist die Drucknummer: 9 8 7 6 5 4 3 2 1

Dedication to Gus, Amari, Solomon, Bebe, Ben and Louisa They make everything worthwhile.

foreword

WELCOME TO THE 12TH EDITION OF THE LANGUAGE OF MEDICINE This new issue continues to focus on its groundbreaking relevance to medical practice. Drawing on the latest technology, medical procedures and treatments, The Language of Medicine brings medical terminology to life. Dynamically redrawn images and up-to-date photographs, as well as compelling patient stories, illustrate medical terminology in action. I am honored that this text continues to be the book that educators return to year after year because their students tell them it works! As a student, you will find The Language of Medicine speaks to you, regardless of your background or level of education. It is written in simple, non-technical language that creates an exceptionally accessible path to learning. Because it's a workbook-text combo, engage and interact on virtually every page by writing and reviewing terms, labeling charts, and answering questions. Terminology is explained so you can understand medical terms in their proper context, which is the structure and function of the human body in health and disease. During the writing of this text, through its 12 editions, I have listened to hundreds of students and teachers and incorporated their insightful suggestions. Medical reviewers have once again helped me to ensure that the terminology included reflects the latest clinical practice. New information and illustrations are the result of recommendations from those who have provided so generous feedback. My ongoing goal in writing The Language of Medicine is to help you not only learn medical terminology, but have fun while learning! You will find that medical terminology comes alive and stays with you as you use my interactive, logical and easy to understand method. Undoubtedly, learning this language requires dedication and hard work, but the benefits are great. Knowledge of medical terminology will give you a strong start to your career.

NEW IN EDITION 12 The biggest bonus for students and teachers is the brand new MINI DICTIONARY at the end of the book. This is a complete list of all medical terms in the text with easy to understand explanations. My thought was to provide an instant and convenient way to find definitions, see pronunciations, and review answers to all terminology sections. It will also be a useful reference, not only during your coursework, but as you begin your new medical career!

While the essential elements of The Language of Medicine remain, the new 12th edition is even more relevant to real-life medical situations. The 12th edition contains helpful hints to point out important facts and create clarity. There are also new, first-hand stories about medical conditions and procedures. These personal accounts make medical terminology more understandable and relevant.

HOW TO USE THE BOOK The language of medicine makes learning easy. The book guides and coaches you step-by-step through the learning experience. Don't be overwhelmed! Learn systematically, step by step. I've helped you study each chapter by organizing the information into small chunks. Icons are provided to help you navigate sections of the text.

ALSO AVAILABLE Evolve Resources for Students (free access included with purchase of this text) The student website that accompanies this new edition is packed with activities, games, additional information and video clips to increase your understanding and test your knowledge. In addition, on the site, you can hear the terms corresponding to the Pronunciation of Terms section of each chapter (over 3,000 terms in total). Access your resources at: http://evolve.elsevier.com/Chabner/language.

INSTANT MEDICAL LANGUAGE TRANSLATOR (sold separately) Instant Medical Language Translator is a uniquely useful resource for all healthcare professionals and students of medical terminology. It's a pocket-sized reference for medical terminology with convenient information at your fingertips!

TEACHERS' RESOURCE GUIDE The Language of Medicine Teachers' Resource Guide (includes Teacher's Guide, ExamView Test Database, PowerPoints and Picture Collection) is available with even more new quizzes, lesson suggestions, crosswords, medical reports and reference material. The picture collection contains all illustrations and photos of the 12th edition. Teacher materials and a test bank can be accessed online at http://evolve.elsevier.com/Chabner/language. The essential features you rely on when learning and teaching medical terminology remain in this new edition. These are:

• Simple, non-technical explanations of medical terms. • Workbook format with plenty of room to write answers. • Explanations of clinical procedures, laboratory tests, and abbreviations related to each body system. • Terms pronunciation sections with phonetic spellings and spaces to write meanings of terms. • Sections on practical applications with case reports, surgical and diagnostic tests as well as laboratory and X-ray reports. • Exercises that test your understanding of the terminology as you work through the text step-by-step

step (answers are included). • Summary sheets that summarize terminology to help you learn. • Comprehensive glossaries and appendices for reference in the classroom and in the workplace. Every student and teacher who chooses The Language of Medicine becomes my partner in the exciting adventure of learning medical terms. Continuity is key. Keep communicating with me via email ([emailprotected]) with your suggestions and comments so that future prints and editions may benefit. A website affiliated with The Language of Medicine dedicated to supporting students and teachers is located at h p://evolve.elsevier.com/Chabner/language. I hope you share with me any other resources you'd like to see on this site so we can make them an even more useful part of the learning process. You should know that I still experience the thrill and joy of teaching new students. I love being in a classroom and feel privileged to continue writing this text. I hope that my enthusiasm and passion for medical language will transfer to you through these pages. Work hard but have fun with The Language of Medicine!

DAVI ELLEN CHABNER

Acknowledgments Maureen Pfeifer has been my exceptional and indispensable editorial partner for the past 22 years. Her phenomenal expertise in all facets of communication, coordination, production, editing, updating and management is amazing. She has the unique ability to "make things happen" and "make things right". Both personally and professionally, I am grateful for her unique insights and skills. She is intelligent, calm and optimistic in the face of all issues affecting The Language of Medicine and its ancillary products. Above all, I count on their loyalty and trust in our creation of an extremely useful and valuable textbook and resource for students and teachers. Thank you Maureen for everything you do for me, especially when you take things "off my plate". Bruce A. Chabner, MD, and Elizabeth Chabner Thompson, MD, MPH, continue to be amazing sources for expert and up-to-date medical advice. Their contributions were essential to the review and editing of all chapters and glossaries. My faithful friend Dan Longo, MD, has never turned me down for valuable medical advice and chapter editing. He was also a wonderful resource for finding experts. Jim Perkins, Assistant Professor of Medical Illustration at the Rochester Institute of Technology, has been involved since The Language of Medicine 6th edition. He has worked with me to create drawings that are not only helpful but essential in making the terminology easier to understand. I rely on his unique talent for clarity, accuracy and detail. I am indebted to the many medical reviewers listed on pages xv-xvi who provided important advice and commentary on specific chapters. Their insight and expertise enable this 12th edition to reflect what is current, accurate and cutting edge in medicine today.

The class teachers listed on pages xvi-xvii have studied the text extensively and carefully, and I have listened to their comments, which are incorporated into this new edition. Many other instructors contacted me personally via email with helpful suggestions. I'm always happy to hear from students who comment on the book and ask important questions. I try to answer each one as quickly and accurately as possible. Thanks to Shulamit Izen, Vashine Kamesan, Stephanie Kitchingham, Alfred Kyrollos, Rachel Recolcolin, Megan Peterson, Christina Sastre, Julia Sjoquist, Victoria Swanson and Lan Wang. The personal stories throughout the text are personal, first-hand accounts of people involved with disease and medical interventions. The authors of these stories are extraordinarily generous in sharing their insights and reactions for the benefit of all. Special thanks to: Stan Ber, Nancy J. Brandwein, Mary Braun, Bruce A. Chabner, Lenore Estrada, Sidra DeKoven Ezrahi, Elizabeth F. Fideler, Tanzie Johnson, Kevin Mahoney, Frank McGinnis, Brenda Melson, John Melson, John Murphy, Laura Claridge Oppenheimer, Carolyn Peter, Bob Rowe, Ruthellen Sheldon, Elizabeth Chabner Thompson, Cathy Ward, and Kemisha White. Elsevier Health Sciences' outstanding staff continues to be critical to the success of The Language of Medicine. Luke Held, Content Development Manager, is always responsive, available, and effective in managing the many details of the project. I appreciate Linda Woodard, Senior Content Strategist, for her expert management and unwavering support of my books. Thanks to Annie Martin, Director, Book Production, Jeff Paerson, Book Production Manager, and Julie Eddy, Publishing Services Manager, for their excellent production efforts. Abbie Bradberry, Book Production Specialist, oversaw the day-to-day aspects of the production process tirelessly and effectively. Thank you, Abbie! Kim Denando and Amy Buxton created and directed the design for this issue. I appreciate their competence and responsiveness. I continue to be impressed with the talents of the entire marketing team, particularly Julie Burche, Senior Director of Product

Portfolio Marketing and Samantha Page, Marketing Manager, Product Portfolio Marketing. They do a phenomenal job of keeping The Language of Medicine in tune with the needs of faculty and students. Many thanks to Manju Thirumalaivasan, Senior Multimedia Producer, and Prakash Kannan, Multimedia Team Lead, for their work on the electronic products associated with this new edition. A very special thank you to Elsevier Health Sciences' exceptional and dedicated sales team which is second to none! Led by Bryan Gripka, Vice President of Sales, this dedicated team works tirelessly to bring my books and learning system to market. You are the best!!! My family and friends continue to be my greatest comfort and support. The kids, Noonie, Brandon and Marla are always "in my corner". Grandchildren Bebe, Solomon, Ben, Gus, Louisa and Amari make me feel "on top of the world". Juliana DoCarmo allows me the luxury of being able to work and concentrate by taking on so many everyday tasks. I am grateful to Bob Williams, the photo specialist, who continues to provide expert advice on images throughout the book. My husband, Bruce, has always encouraged my passion for teaching and writing, giving me the space and time to enjoy both. I rely on his calm reassurance and willingness to answer any questions, medical or otherwise. After all, our puppies, Ginger and Fred, remain the love of our lives, providing countless hours of excitement and joy.

Reviewers The following have reviewed the text and/or accessories: MEDICAL REVIEWER Dr Medicine Harvard Medical School Boston, Massachuse Lisa Cauley MD, MPH ENT/Head and Neck Surgery The O awa Hospital O awa, Canada Michael J. Curtin MD Medical Director, St. Luke's Sports Medicine Orthopedic Surgery and Sports Medicine St. Luke's Clinic Boise, Idaho Morris A. Fisher MD Neurologist Edward Hines Jr. Veterans Hospital Hines, Illinois Professor of Neurology Loyola University Chicago Stritch School of Medicine Maywood, Illinois Carlos A. Jamis-Dow M.D.

Radiologe Su er Medical Group Sacramento, Kalifornien Jay Loeﬄer MD Leiter der Radiation Oncology Massachuse’s General Hospital Cancer Center Herman and Joan Suit Professor Harvard Medical School Boston, Massachuse Dan L. Longo MD Stellvertretender Herausgeber New England Journal of Medicine Professor für Medizin Harvard Medical School Boston, Massachuse s Neera R. Nathan MD, MSHS Massachuse s General Hospital Boston, Massachuse s Tomas G. Neilan MD, MPH Division of Cardiology Department of Medicine Massachuse s General Hospital Boston, Massachuse s Aparna Parikh MD Massachuse s General Hospital Boston, Massachuse s Mihir Parikh MD Beth Israel Deaconess Medical Center Boston, Massachuse s Cliﬀ Rosen MD Rosen Laboratory Scarborough, Maine James L. Rosenzweig MD

Endocrinology, Diabetes and Metabolism Hebrew Rehabilitation Center Roslindale, MA Henry E. Schniewind MD,

Boston, Massachuse s

Sydney Schoensee PT, DPT, FAAOMPT St. Luke's Rehabilitation McCall, Idaho Noëlle S. Sherber MD, FAAD Dermatologin Mitbegründerin, Sherber+Rad Washington, DC Leigh H. Simmons MD Assistenzprofessor für Medizin Harvard Medical School Division of General Internal Medicine Massachuse s General Hospital Boston, Massachuse s Daniel I. Simon MD President, University Hospitals Case Medical Center President, Harrington Heart & Vascular Institute Chief, Division of Cardiovascular Medicine University Hospitals Health System Herman K. Hellerstein Chair of Cardiovascular Research und Professor of Medicine Case Western Reserve University School of Medicine Cleveland, Ohio Jill Smith MD Chefarzt der Ophthalmologie Newton-Wellesley Hospital Newton, Massachuse Daniel Talmasov MD Harvard Longwood Psychiatry Boston, Massachuse s

Beatrix Thompson,

New Haven, Connecticut

Cornelia L. Trimble MD Professor Departments of Obstetrics and Gynecology, Oncology and Pathology The Johns Hopkins Medical Institutions Baltimore, Maryland TEACHER REVIEWER Teresa S. Boyer MSN, APN-BC, PMHNP Associate Professor of Nursing Motlow College Lynchburg, Tennessee Cheryl Christopher RHIA Adjunct Borough of Manha at Community College New York, New York Mary Jane Durksen Medical Office Administrator Diploma Lead Virtual Instructor/Courseware Developer AOLC Ontario, Canada Shelba Durston MSN, RN, CCRN, SAFE Professor of Nursing San Joaquin Delta College Stockton, California Erin J. Fi Gerald RN, BSN, MBA Norwalk Community College Norwalk, Connecticut Rosalie Griﬃth RN, MSN, MA.Ed Nursing Success Coordinator Chesapeake College Wye Mills, Maryland Shawn McGowan

Manager, Healthcare Division AOLC Ontario, Canada Angela J. Moore RN, MSN Ed. Assistant Director, Nurses Career Care Institute Lancaster, California José L. Mosqueda Senior Healthcare Instructor Erie Neighborhood House Chicago, Illinois Mary Prorok RN, MSN Instructor South Hills School of Business & Technology Altoona, Pennsylvania Danielle Robel MBA Professor, Health Sciences AAMA, Milwaukee Area Technical College Milwaukee Wisconsin Deb Stockberger MSN, RN Health Division Instructor North Iowa Area Community College Mason City, Iowa Donna J. Wilde MPA, RHIA Professor, Health Informatics and Information Management Shoreline Community College Sea le, Washington Charles K. Williston BA, MS, CPC Instructor Traviss Career Center Lakeland, Fla. Lynda Wilson Masters in the Art of Teaching, EMT Paramedic

Professor of Medical Terminology Valencia College Orlando, Florida Mindy Wray MA, CMA (AAMA), RMA Program Director, Medical Assisting ECPI University Greensboro, North Carolina Carole Zeglin MSEd, BSMT, RMA Associate Professor/Director Medical Laboratory Technology, Medical Assisting, and Phlebotomy /Sample Processing Programs Westmoreland County Community College Youngwood, Pennsylvania

CHAPTER 1

Basic word structure CHAPTER SECTIONS: Goals in learning medical language 2 Word analysis 3 Terminology 6 Practical applications 16 Exercises 17 Solutions to exercises 24 Pronunciation of terms 27 Review sheet 29

CHAPTER OBJECTIVES • Identify basic objectives to guide your study of medical terminology. • Break down medical words into their component parts. • Learn the meaning of the basic combination forms, suffixes and prefixes of medical terminology. • Use these combination forms, suffixes and prefixes to form medical words.

Goals in learning medical terminology There are three goals to keep in mind when learning medical terminology:

• Analyze words by breaking them down into parts. Your goal is to learn the tools of word analysis that facilitate the understanding of complex terminology. Don't just memorize terms; Consider breaking down terms into their component parts — the building blocks of terminology. This book shows how to break down both complicated and simple concepts into understandable word elements. Medical terms are similar to jigsaw puzzles in that they are made up of small pieces that make each word unique, with one big difference: the pieces can be mixed and used in many combinations to form other words as well. As you become familiar with word parts and learn what they mean, you will be able to recognize these word parts in completely new combinations with other terms. • Relate medical terms to the structure and function of the human body. Memorizing terms, while essential to language retention, should not become the primary goal of your degree. A major focus of this book is the explanation of terms related to the functioning of the body in health and disease. Medical terms that are explained in their proper context are also easier to remember. Therefore, the term hepatitis, which means inflammation (itis) of the liver (hepat), is easier to understand once you know where the liver is and how it works. No prior knowledge of biology, anatomy or physiology is required for this study. The explanations in this book are simple and basic. • Watch out for spelling and pronunciation problems. Some medical terms are pronounced the same but spelled differently, which explains their different meanings. For example, have ilium and ileum

identical pronunciations, but the first term, ilium, means part of the hip bone, while the second term, ileum, refers to part of the small intestine (Figure 1-1). Even when terms are spelled correctly, they can be misunderstood due to mispronunciation. For example, the urethra (u-re-thrah) is the tube that leads from the urinary bladder to the outside of the body, while a ureter (u-reh-ter) is one of two tubes, each leading from a single kidney and inserting into the urinary bladder. Figure 1.2 illustrates the different anatomy of the urethra and ureters.

FIGURE 1-1 The terms ileum and ilium can be confusing because they are pronounced the same and refer to body parts that are in the same general body region. TIP: The ileum, with an "e," is a part of the digestive tract related to food.

FIGURE 1-2 Male urinary tract. The terms urethra and ureter can be confusing as they are both tubes of the urinary system, but spellings and pronunciations are different. Note their location: two ureters between the kidneys and the urinary bladder, and a urethra between the urinary bladder and the outside of the body. TIP: The ureter has two "e" and the urethra has only one "e".

Word Analysis Learning medical terminology is very similar to learning a new language. At first glance, the words seem strange and complicated, although they can represent well-known disorders and concepts. For example, cephalgia means "headache," and an ophthalmologist is an "ophthalmologist." Your first task in learning medical language is to understand how to break words down into their component parts. Logically, most concepts, whether complex or simple, can be broken down into basic parts and then understood. For example, consider the following term broken into three parts:

The root is the basis of the word. All medical terms have one or more roots. For example, the root hemate means blood. The suffix is the end of the word. All medical terms have a suffix. The suffix -logy means study process. The connecting vowel - usually o, as in that term - connects the root to the suffix or the root to another root. A combination vowel has no meaning of its own; it connects one part of a word to another. It is helpful to read the meaning of medical terms, starting with the suffix and then going back to the beginning of the term. Thus, the term hematology means the process of examining the blood. Here is another well-known medical term:

Electrocardiogram, read from the suffix to the beginning of the term, means recording of the electricity in the heart. Note that there are two connecting vowels in this term - both o. The first o connects the two roots electr and cardi; the second o joins the root cardi and the suffix gram. Try another term:

Gastritis, read from the end of the term (suffix) to the beginning, means inflammation of the stomach. Note that the combining vowel o is absent from this term. This is because the ending -itis begins with a vowel. The combining vowel is omitted before a suffix beginning with a vowel. However, it is preserved between two roots, even if the second root begins with a vowel. Consider the following term:

The whole term means process of examining the stomach and intestines. Note that although the second root, Enter, begins with a vowel, the connecting vowel between Gastr and Enter is retained. When a term contains two or more roots that refer to body parts, the anatomical position often determines which root comes before the other. For example, the stomach receives food first, before the small intestine - hence the word is formed as gastroenterology, not "enterogastrology".

In summary, remember three general rules: 1. READ the meaning of medical terms from the suffix to the beginning of the term and across. 2. REMOVE the combining vowel (usually o) before a suffix that begins with a vowel: gastritis, not "gastroitis". 3. KEEP the combining vowel between two roots: gastroenterology, not "gastrenterology". In addition to the root, suffix and combination vowel, two other word parts often occur in medicine. These are the combination form and the prefix. The combination form is simply the root plus the combination vowel. You are already familiar with the following combination forms and their meaning:

Combining forms are used with many different suffixes. Remembering the meaning of a combination form can help you better understand unfamiliar medical terms. The prefix is a small part that comes at the beginning of a term. Not all medical terms contain prefixes, but the prefix can have an important bearing on the meaning. Consider the following examples:

In summary, the most important elements of medical terms are as follows: 1. ROOT: foundation of the term 2. SUFFIX: end of word 3. PREFIX: beginning of word 4. COMBINED VOWEL: vowel (usually o) connecting the root to the suffix or the root to one other root 5. COMBINATION FORM: Combination of the root and the combination vowel

Terminology

In the previous examples, the combination forms gastr/o (stomach), hemat/o (blood) and cardi/o (heart) were presented to you. This section of the chapter contains a list of additional combination forms, suffixes and prefixes with examples of

medical words that use these parts of the word. Similar lists are included for each chapter in the book. Write the meaning of the medical term in the space provided. Then check the correct pronunciation for each term using the List of term pronunciations on pages 27 and 28. The mini-dictionary starting on page 897 contains definitions for all the terms in this book. The Evolve website for The Language of Medicine also includes audio pronunciations for each term. Use it! Most medical terms are derived from Greek and Latin roots. Greek, Roman, and Arabic physicians had developed medically useful concepts and associated vocabulary well before the 21st century. Greek and Latin origins for medical terms are presented on the Evolve website for your interest.

Study Guide for Chapter 1. Use slashes to separate each term into its component parts (Aden/Oma) and write its meaning (Gland tumor) in the space provided. Although most medical terms can be easily broken down into components and understood, others defy easy explanation. Information in italics below a medical term helps you define and understand the term. You can check the meanings with the MiniDictionary at the end of this book. 2. Complete the exercises, pages 17-23, and check your answers on pages 24-26. 3. Practice your pronunciation of each term using the list of term pronunciations, pages 27-28. Find definitions of each term See Mini-Dictionary starting on page 897. 4. Complete the Review Sheet, pages 29 and 30. Check your answers against the Glossary of Parts, page 967. Then test yourself by matching terms and meanings on the Review Sheet write a separate sheet of paper. 5. Create your own flashcards. Use the assessment sheet as a guide and create flashcards to take with you wherever you study! 6. Create your own book tabs to have easy access to key concepts and commonly used sections such as: B. The Glossary of Word Parts starting on page 967. 7. Repeat terms using audio pronunciation on the Evolve website. Make sure you take an active part in the learning process by writing down terms and their meanings and testing yourself repeatedly. Here is your study mantra: READ, WRITE, RECITAL and REVIEW. I guarantee success if you follow these simple steps. This is a proven method - it really works!

Combining Shapes Write the meaning of each medical term in the space provided. Remember, you can find each term pronounced phonetically starting on page 27, and you can listen to the pronunciations on the Evolve website.

COMBINING MEANING SHAPE aden/o gland

arthr/o bi/o

carcinoma

cardi/the cephal/the cerebr/the cis/the

horse hair

used

cyt/o derm/o dermat/o electr/o encephal/o enter/o

erythr/o gastr/o

Glyc/o

TERMINOLOGY

IMPORTANCE

Adenoma Gland tumor________________________________________ The suffix -oma means tumor or mass. Adenitis ________________________________________ The suffix -itis means inflammation. Joint Arthritis ________________________________________ Life Biology ________________________________________ The suffix -logy is composed of the root protocol (study) and the final suffix -y (process or state). Biopsy ________________________________________ The suffix -opsy means viewing process. Living tissue is removed from the body and viewed under a microscope. malignant, carcinoma ________________________________________ Cancer A carcinoma is a malignant tumor. Cancers grow from the epithelial cells (surface or skin cells) that cover the outside of the body and line organs, cavities, and tubes in the body (Figure 1-3A and B). Heart Cardiology ________________________________________ Head Head ________________________________________ (seh-FAL-ik) The suffix -ic means associated. A head lay describes a "head first" position for the birth of an infant. Cerebrum Cerebral ________________________________________ (largest part The suffix -al means associated. Figure 1-4 shows the cerebrum and its many functional areas of the brain). cut cut ________________________________________ The prefix in- means in and the suffix -ion means process. Excision ________________________________________ The prefix ex- means out. secrete (to endocrine glands __________________________ form and The prefix endo- means within; endocrine glands (e.g. thyroid, pituitary and adrenal glands) secrete hormones directly within (in) the bloodstream. Other glands, called exocrine glands, release their secretions (e.g e.g., saliva, sweat, tears, milk) through tubes (ducts) to the outside of the body or includes a cyst (sac scop, meaning visual examination, and the last ending -y, meaning process. containing fluid) Cell cytology _______________________________________ See Figure 1-5 for examples of blood cells Skin dermatitis _________________________ subcutaneous _____________________________________________ The prefix hypo- means under or below.Electricity Electrocardiogram _______________________________________ The Su ffix -gram means recording. Abbreviated EKG (or sometimes EKG). Electroencephalogram of the brain ____________________________________________________ Abbreviated EEG. Intestinal enteritis _______________________________________ (usually the small intestine is narrower but much smaller in length than the large intestine (colon). See Figure 1-1 on page 2, which shows the small and large intestine. Intestine) Red erythrocytes _______________________________________ The suffix -cyte means cell. Erythrocytes transport oxygen in the blood. Gastric Gastrectomy _______________________________________ The suffix -ectomy means excision or removal. All or, more commonly, part of the stomach is removed. Gastrotomy _______________________________________ The suffix -tomy is another complex suffix containing the root tom, meaning to cut, and the final suffix -y, meaning process of. Sugar Hyperglycemia _______________________________________ The prefix hyper- means excessive, over, or more than normal. The suffix emia means blood condition.

COMBINING MEANING FORM gnos/o knowledge

Gynäk/o Hämat/o Saum/o

woman, female blood

hepat/o iatr/o

Liver treatment, doctor

net/o

White

log/o nephr/o

study of the kidney

neuro/onc/o

nerve tumor (cancer)

eyes/o

Eye

cheese/o

Bone

Way/o

illness

ped/o

Kind

Psycho

Mind

Radio

X-rays

ren/o

Kidneys

rhino

Nose

TERMINOLOGY

IMPORTANCE

Diagnosis ______________________________________ The prefix dia means complete. The suffix -sis means state or state of. A diagnosis is made after obtaining sufficient information about the patient's condition. It is literally a "state of complete knowledge." Prognosis ______________________________________ The prefix pro- means before. Literally "knowledge beforehand", a prognosis is a prediction about the outcome of an illness, which, however, is only made after the diagnosis has been established. Gynecology ______________________________________ Hematology ______________________________________ Hematoma ______________________________________ In this term -oma means a mass or collection of blood rather than a growth of cells (tumor). A hematoma occurs when blood leaks from blood vessels and collects as a clot in a cavity or organ, or under the skin. See Figure 1-6. Hemoglobin ______________________________________ The suffix -globin means protein. Hemoglobin carries oxygen in red blood cells. Hepatitis ______________________________________ iatrogenic ______________________________________ The suffix -gene means related to produce, produced by, or produced in. Iatrogenic conditions are adverse reactions resulting from a treatment or intervention by a physician. Leukocytes ______________________________________ These blood cells help the body fight disease. Dermatology ______________________________________ Nephritis ______________________________________ Nephrology ______________________________________ Neurology ______________________________________ Oncology _______________________________________ Oncologist _______________________________________ The suffix -is means someone who specializes in a field of medicine (or other profession). Ophthalmoscope ______________________________________ (of-THAL-mo-skope) The suffix -scope means an instrument for visual examination. TIP: Pronunciation helps! The first syllable is "off" and this is where the "f" sound "ph" is written. Osteitis ________________________ Osteoarthritis ______________________________________ This condition of aging is actually a degeneration of bones and joints, often accompanied by inflammation. Pathology ______________________________________ Pathologist ______________________________________ A pathologist examines biopsy samples under a microscope and examines cadavers to determine cause of death. Pediatrics ______________________________________ Please note that ped/o is also included in the term orthopaedist. Orthopedists were once doctors who straightened children's bones (orth/o means straight) and corrected deformities. Orthopedists today specialize in diseases of the bones and muscles in people of all ages. Psychology ______________________________________ Psychiatrist ______________________________________ Radiology ______________________________________ Low-energy X-rays are used for diagnostic imaging. renal ______________________________________ Ren/o (Latin) and nephr/o (Greek) both mean kidney. Ren/o is used with -al (Latin) to describe the kidney, while nephr/o is used with other suffixes such as -osis, -itis and -ectomy (Greek) to describe abnormal conditions and surgical procedures. Sniffles ______________________________________

COMBINING MEANING FORM sarc/o ﬂesh

sequel/it

Thrombose/o

ur/o

TERMINOLOGY

IMPORTANCE

Sarcoma ______________________________________ This is a malignant (cancerous) tumor. A sarcoma (Figure 1-7) grows from cells of “fleshy” connective tissue such as muscle, bone, and fat, while a carcinoma (another type of cancerous tumor) grows from epithelial cells that line the outside or inside of organs in the body. cut resection ______________________________________ The prefix means back. A resection is cutting back in the sense of cutting out or removing (excision). A gastric resection is a gastrectomy, or removal of the stomach. Clot, occluding platelets ______________________________________ Also known as platelets, these cells help blood to clot. A thrombus is the actual clot that forms, and thrombosis (-osis meaning condition) is the condition of clot formation. Urinary tract, urologist ______________________________________ urine

Figure 1-3 A. Carcinoma of the skin. This is basal cell carcinoma, the most common form of skin cancer. It usually occurs on sun damaged skin. B. Esophageal carcinoma is a malignant tumor of the esophagus (tube that leads from the throat to the stomach).

Figure 1-4 The cerebrum and the functions it controls. A cerebrovascular accident (CVA) or stroke occurs when blood vessels (vascul/o means blood vessel) in the cerebrum become damaged, preventing blood from reaching functional areas of the brain. Cells that are deprived of oxygen and nutrients become damaged, leading to loss of movement or speech and other signs and symptoms of CVA.

FIGURE 1-5 Blood cells. Note red blood cells (erythrocytes), white blood cells (leukocytes), and clotting cells (thrombocytes or platelets).

Figure 1-6 A: Note the hematoma under the nail. B, Hematoma from broken ribs.

Figure 1.7 Muscle sarcoma in thigh. (Courtesy of Dr. Sam Yoon, Sloan Kettering Hospital, New York City.)

Suffix

SUFFIX -ac -al -algen

MEANING in relation to pain

-cyte cell -ectomy excision, removal -emia blood condition

-gen

in relation to Produce, Produced by or Produced in

-globin protein -gram record -ic, -ical in relation to -ion -ist -itis -logy -oma

process specialist inflammation process of the study tumor, mass, swelling

-aside

process of viewing

-or

Condition, usually abnormal (slight increase in count when used with blood cells)

-pathie

disease state

-Scope

Visual inspection tool

-skopie

Process of visual inspection

-sis -tomy

state of; Condition Cu process, cutting process, condition

-y

TERMINOLOGY MEANING cardiac ____________________________________ neural _________________________________________ arthralgia __________________________ neuralgia ___________________________ erythrocytes _________________________ nephrectomy _________________________ leukemia _____________________________________ Literally, this term means “a blood condition of white (blood cells)”. In fact, it is a blood condition in which cancerous white blood cells multiply (increase in number). carcinogenic __________________________________________ Cigarette smoke is carcinogenic. pathogenic ________________________________________ Many viruses and bacteria are pathogenic organisms. Osteogenic sarcoma ________________________________________ This is a malignant tumor that arises in the bone. Hemoglobin ________________________________________ Electroencephalogram ________________________________________ Stomach ________________________________________ Neurological ________________________________________ Log/o means examination of. Excision ________________________________________ Ophthalmologist ________________________________________ Cystitis ________________________________________ Endocrinology ________________________________________ Hepatoma ________________________________________ A hepatoma (hepatocellular carcinoma) is a malignant tumor of the liver. Biopsy ________________________________________ Biopsy samples will be taken and viewed under a microscope. Nephrosis ________________________________________ Leukocytosis ________________________________________ This condition, a slight increase in normal white blood cells, occurs when white blood cells multiply to fight an infection. Don't confuse leukocytosis with leukemia, a cancerous (malignant) condition characterized by high levels of abnormal, immature white blood cells. Encephalopathy ________________________________________ (en-sef-ah-LOP-ah-the) Adenopathy ________________________________________ (ah-deh-NOP-ah-the) This condition, also known as lymphadenopathy, is related to lymph nodes (collections of stationary cells along the way of lymphatic vessels) . ) that are enlarged by infection or the spread of malignant (cancer) tumors. Endoscope _______________________________________ Endo- means inside. A cystoscope is a type of endoscope. A periscope is a non-medical term denoting an instrument for visually examining an area around (peri) an obstacle. Endoscopy ________________________________________ (en-DOS-ko-pe) The endoscopy is performed with an endoscope. A common endoscopic procedure is the colonoscopy (colon/o = colon or large intestine). Prognosis ________________________________________ Osteotomy ________________________________________ (os-te-OT-o-me) Gastroenterology ________________________________________

prefixes

PREFIX MEANING a-, an- no, not, without

aut-, autodiaendoepiex-, exohyperhypo-

imperiproretrosubtrans

TERMINOLOGY MEANING Anemia ________________________________________ Anemia is a reduced number of red blood cells or an abnormality in the hemoglobin (a chemical) in red blood cells. This leads to a reduced supply of oxygen to the body cells. Anemic patients look so pale that early doctors thought they were literally "bloodless." self, own autopsy ________________________________________ This term literally means "process of self-examination". Therefore, an autopsy is the examination of a corpse with your own eyes to determine the cause of death and the nature of the disease. complete, diagnosis ____________________________________ bis The plural form of diagnosis is diagnoses. inside the endocrinologist ___________________________________ above, on the epigastric __________________________________ epidermis ___________________________________ This outermost layer of skin overlies the middle layer of skin, called the dermis. out, external excision ___________________________________ of, external exocrine glands ___________________________________ excessive, hyperthyroidism ___________________________________ above, more The suffix -ism means process or condition. as normally deficient, hypogastric _____________________________________ below, When hypo- is used with a body part it means below. below, less hypoglycemia _____________________________________ than normal Hypoglycemia in this term means deficient. in, in incision _____________________________________ surrounding, pericardium _____________________________________ around The suffix -um means a structure. The pericardium is the membrane that surrounds the heart. before, prostate _____________________________________ forward This exocrine gland "stands" (state) in front of or in front of the male urinary bladder (see Figure 1-2). It produces semen that contains fluid and sperm. back, resection _____________________________________ backward, This is an operation in which tissue is “cut back” or removed. The Latin resectio means trimming or pruning. behind retrocardial _____________________________________ below, below subhepatic _____________________________________ across, transhepatic _____________________________________ through

Complex suffixes

Many suffixes, such as B. -scopy, contain an embedded root word. Other examples are opsy (ops is a root) and -logy (log is a root).

hyperglycemia and diabetes

Hyperglycemia (high blood sugar) is most commonly associated with diabetes. People with diabetes have high blood sugar levels because they lack insulin (in type 1 diabetes) or because they don't have effective insulin (in type 2 diabetes). Insulin is the hormone normally released by the pancreas (an endocrine gland near the stomach) to "accompany" sugar from the bloodstream into the cells. Sugar (glucose) is then broken down in the cells to release energy. In the absence of insulin, sugar cannot enter cells and accumulates in the bloodstream (hyperglycemia).

urologist and nephrologist

A urologist is a surgeon who operates on the urinary tract and the organs of the male reproductive system. A nephrologist is an internal medicine (nonsurgical) doctor who diagnoses and treats diseases of the kidneys. Both urologists and nephrologists are doctors.

Ophthalmologist, optometrist, optometrist

An ophthalmologist is a doctor who specializes in the diagnosis and treatment (surgical and medical) of diseases of the eye. An optometrist is a medical professional who examines the eyes (metr/o = measure) and prescribes corrective lenses and can treat eye diseases. An optometrist grinds lenses and adjusts eyeglasses, but does not examine the eyes, prescribe corrective lenses, or treat eye diseases.

What is chronic traumatic encephalopathy?

Chronic (long-term) traumatic encephalopathy (CTE) is a severe brain injury associated with severe head trauma (as found in soccer and boxing). The autopsy images below show a normal brain and a brain affected by CTE.

Plural

Terms ending in -is (diagnosis, prognosis) form their plural by dropping the -is and adding -es. See Appendix I, page 989, for additional pluralization rules.

Understand Hyperthyroidism

In hyperthyroidism, an overactive thyroid (an endocrine gland in the neck) secretes more thyroxine (thyroid hormone, or T4) than normal. Because thyroxine causes cells to burn fuel and release energy, signs and symptoms of hyperthyroidism include increased energy levels and nervousness, tachycardia (increased heart rate), weight loss, and exophthalmos (bulging eyeballs).

Practical Applications

This section offers you the opportunity to use your skills in understanding medical terms in this chapter and to expand your knowledge of new terms. Be sure to check your answers against the answers to practical applications on page 27. You should find helpful explanations there.

Specialists Match the abnormal condition in column I to the treating doctor (specialist) in column II. Write the letter from the right specialist in the space provided. COLUMN I: Abnormal Conditions 1. Heart attack 2. Ovarian cysts 3. Bipolar (manic-depressive) disorder 4. Breast adenocarcinoma 5. Iron deficiency anemia 6. Retinopathy 7. Stroke 8. Kidney failure 9. Inflammatory bowel disease 10. Prostate adenocarcinoma

_______ _______ _______ _______ _______ _______ _______ _______ _______ _______

COLUMN II: Physicians (specialists) A. Gastroenterologist B. Hematologist C. Nephrologist D. Cardiologist E. Oncologist F. Gynecologist G. Urologist H. Ophthalmologist I. Neurologist J. Psychiatrist

Exercises The following exercises are designed to help you learn the concepts presented in this chapter. Writing terms repeatedly is a great way to learn this new language. The solutions to these exercises can be found starting on page 24. This is an easy way to check your work. Reviewing each answer not only deepens your understanding of a term, but often gleans additional information from the answer. Each exercise is not designed as a test, but as an opportunity to learn the material.

A Complete the following sentences. 1. Word beginnings are _________________________________. 2. Word endings are ___________________________________. 3. The base of a word is known as _____________________. 4. A letter that combines a suffix and a root or two roots in one term is the _______________________. 5. The combination of a root and a combination vowel is known as _____________. B Give the meaning of the following combination forms. 1. Cardi/o ___________________________________________________ 2. Aden/o ___________________________________________________ 3. Bi/o _____________________________________________________ 4. Cerebr/o _________________________________________________ 5. Ceph/o _________________________________________________ 6. Arthr/o _________________________________________________ 7. Carcin/o _________________________________________________

8. Cyst/o ___________________________________________________ 9. Cyt/o ___________________________________________________ 10. Derm/o or Dermat/o _____________________________________________ 11. Encephal/o _________________________________________________ 12. Electr/o _________________________________________________ C Give the meaning of the following suffixes. 1. -oma _____________________________________________________ 2. -al _____________________________________________________ _ 3. -itis ____________________________________________________ 4. -logy ___________________________________________________ 5. -scopy ___________________________________________________ 6. -ic ___________________________________________________________ _ 7. -gram ____________________________________________________ 8. -opsy ___________________________________________________ D Separate the following terms with slashes split into parts and give the meaning of the whole term. 1. Cerebral _____________________________________ 2. Biopsy ___________________________________________________

3. Adenitis _________________________________________________ 4. Scalp ___________________________________________________ 5. Carcinoma _________________________________________________ 6. Cystoscopy ________________________________________________ 7. Electrocardiogram __________________________________________ 8. Cardiology _________________________________________________ 9. Electroencephalogram __________________________________________ 10. Dermatitis _________________________________________________ 11. Arthroscopy ________________________________________________ 12. Cytology ___________________________________________________ E. 1. Erythr/o 2.___________________________________ Enter/o ___________________________________________________ 3. Gastr/o ___________________________________________________ 4. Gnos/o ___________________________________________________ 5. Hemat/o ___________________________________________________ 6. Cis/o ___________________________________ ________________________________ 7. Nephr/o ___________________________________________________

8. leuk/o ____________________________________________________ 9. iatr/o ____________________________________________________ 10. hepat/o ___________________________________________________ 11. neur/o ___________________________________________________ 12. gynäk/o ___________________________________________________ F Complete the medical term according to its meaning as given. 1. White blood cells: ____________________cyte 2. Inflammation of the stomach: Gastr_________________________ 3. Related to treatment: ___________genetic 4. Examination of the kidneys: ________________________________________________________________________ 5. Red blood cells: ___________cyte 6. Blood mass: ____________________om 7. Process of viewing living tissue (using a microscope): bi_________________________ 8. Nerve pain: neur_________________________ 9. Procedure of visual examination of the eye: ___________scopy 10. Inflammation of the small intestine: ___________itis G Choose from the combination forms below to match the numbered English terms. Write the correct combination form in the space provided. onc/o ophthalm/o oste/o path/o

psych/o radi/o ren/o rhin/o sarc/o sect/o thromb/o ur/o English terms 1. Kidney ________________________________ 2. Disease ________________________________ 3. Eye ________________________________________________ 4. Cut _________________________________ 5. Nose _________________________________ 6. Flesh ___________________________________ 7. Mind ___________________________________ 8. Urinary tract ________________________________ 9. Bone _________________________________ 10. X-rays ________________________________ 11. Wound closure ________________________________ 12. Tumor ________________________________ H Underline the ending of each term, and then give the meaning of the term. 1. Ophthalmoscopy _____________________________________________________ _________ 2. Ophthalmoscope _____________________________________________________ __________ 3. Oncology ___________________________________________________________ ________________

4. osteitis _____________________________________________________ _____________ 5. psychosis _____________________________________________________ ________________ 6. thrombocyte _____________________________________________________ _____________ 7. renal _____________________________________________________ ___________________ 8. nephrectomy _____________________________________________________ _____________ 9. osteotomy _____________________________________________________ __________ 10. resection _____________________________________________________ _______________ 11. carcinogenic ____________________________________________________ _____________________ 12. ___________________________ in the Matchx Column I with its meaning in Column II. Write the correct meaning in the space provided.

SPALTE I Suffix 1. -Algie ________________________________ 2. -Ion ________________________________ 3. -Emie ________________________________ 4. -Gramm ________________________________ 5. -Umfang ________________________________ 6. -Ose ________________________________ 7. -Ektomie ______________________________________________ 8. -Gen ________________________________ 9. -Pathie ________________________________ 10. -Tomie ________________________________ 11. -itis ________________________________ 12. -Zyt ________________________________ 13. -Globin ________________________________

COLUMN II Meaning Condition, usually abnormal blood condition Cell disease Condition Process of cuing, incision Inflammation Instrument for visual examination of pain associated with production, production or protein recording Excision, removal (resection)

J Choose from the listed terms to complete the following sentences. Arthralgia Carcinogenic cystitis Encephalopathy Endocrine exocrine hematoma Hepatoma (hepatocellular carcinoma) Iatrogenic leukemia Leukocytosis Neuralgia 1. When Paul smoked cigars, he inhaled a ____________ substance with each puff. 2. Sally's sore throat, fever and chills prompted her doctor to order a white blood cell count. The results, which indicate infection, showed a slight increase in normal cells, a condition called ______________________. 3. Mr. Smith's liver enlarged and caused him abdominal pain. His radiological examinations and biopsy revealed a malignant tumor or ______________________. 4. Mrs. Rose complained of pain in her hip joints, knees and shoulders every morning. She was told she was in pain

joints or ______________________. 5. Dr. Black was trained to treat diseases of the pancreas, thyroid, adrenal, and pituitary glands. Thus he was an expert on the ______________________ glands. 6. Ms Walsh told her doctor she had pain when urinating. After the tests, the doctor's diagnosis was inflammation of the urinary bladder or ______________________. 7. Elizabeth's overhead tennis shot hit David in the thigh, generating a big _________________. His skin looked bruised and the affected area was tender. 8. Mr. Bell's white blood cell count is 10 times higher than normal. Examination of his blood shows cancerous white blood cells. His diagnosis is __________________________. 9. Mr. Kay was resuscitated (revived after a possible or apparent death) in the emergency room after suffering a heart attack. Unfortunately, he suffered a broken rib from the doctor's chest compressions. This is an example of a __________________________ fracture. 10. After playing a season for a professional football team, Bill Smith decided to retire because he was concerned about the dangers of concussions and head injuries - a condition called CTE or Chronic Traumatic _________________________. K Give the meaning of the following prefixes. 1. dia_____________________________________________________ _ 2. pro_____________________________________________________ _ 3. aut-, auto_________________________________________________ 4. a-, an_____________________________________________

5. hyper____________________________________________________ 6. hypo_________________________________________________________________ 7. epi_____________________________________________________ 8. endo_____________________________________________ 9. retro_____________________________________________ 10. trans_________________________________________________ 11. peri___________________________________________________________ 12. ex-, exo_________________________________________________ 13. sub___________________________________________________________ 14. re___________________________________________________________________ _ L Underline the prefix in the following terms, and then give the meaning of to the entire term. 1. Diagnosis _______________________________________ _____________ 2. Prognosis _______________________________________ _____________ 3. Subhepatic _____________________________________________________ ___________ 4. Pericardium _____________________________________________________

___________ 5. Hyperglycemia _______________________________________________________ _________ 6. Subcutaneous _______________________________________ ___________ 7. Epigastric _______________________________________ _____________ 8. Resection _______________________________________ _____________ 9. Hypoglycemia _______________________________________ ___________ 10. Anemia _______________________________________ _________ 10. Anemia _______________________________________ _________ 1. Study of the urinary system: ________________________ study of women and Diseases of women: __________ logy 3. Study of blood: ________________________ logy 4. Study of tumors: ________________________ logy 5. Study of kidneys: __________ logy 6. Study of nerves: ________________________ logy 7. Treatment of children: __________ iatrics 8. Examination of X-rays in of diagnostic imaging: __________ logy 9. Examination of the eyes: __________ logy 10. Examination of the Stomach and intestines: __________ logy

11. Study of the glands that secrete hormones: ________________________ logy 12. Treatment of the mind: __________ iatric 13. Study of the disease: ________________________ logy 14. Study of the heart: _____________ logy N Give the meaning of the underlined part of the word, then define the Expression. 1. cerebrovascular accident ________________________________________________ 2. encephalitis _____________________________________________________ _____ 3. cystoscope _____________________________________________________ ______ 4. transhepatic _____________________________________________________ _____ 5. osteogenic sarcoma _____________________________________________________ _______ 6. hypogastric _____________________________________________________ ______ 7. endocrine glands _____________________________________________________ __ 8. nephrectomy _____________________________________________________ _____ 9. exocrine glands _____________________________________________________ ___ 10. Neuralgia _____________________________________________________

_______ O Choose from the terms below to complete the following sentences. Anemia Biopsy Diagnosis Leukemia Nephrologist Neuropathy Oncogenic Oncologist Osteoarthritis Pathogenesis Prognosis Psychiatrist Psychologist Platelet Thrombosis Urologist 1. Pamela Crick is 72 years old and suffers from a degenerative joint disease caused by the wear and tear of the tissue around her joints. This disease, which literally means "inflammation of the bones and joints," is _____________________________. 2. The __________________________ sample was taken during surgery and sent to a pathologist who will examine it under a microscope to get a correct diagnosis. 3. A/An ___________________________ performed an operation to remove Mr. Simon's cancerous kidney. 4. Mrs. Rose has suffered from diabetes with hyperglycemia for many years. This condition can lead to long-term complications such as: B. the nerve disease called diabetic ______________________.

5. A virus or bacterium causes disease and is therefore a __________________________ organism. 6. Jordan has a disease caused by abnormal hemoglobin in his RBCs. The erythrocytes change shape and collapse into sickle-shaped cells, which become clots and can stop blood flow. His condition is called sickle cell _____________________. 7. dr Max Shelby is a doctor who treats cancer and sarcoma. He is a _______. 8. Bill was having trouble stopping the bleeding from a cut on his face while shaving. He knew his medication was causing a drop in platelets, or a low _______________ count, and that was probably why his blood wasn't closing very well. 9. dr Susan Parker told Paul that his condition would improve in a few weeks with treatment. She said his __________________________ was excellent and he could expect a full recovery. 10. After Ms. Jones fled the World Trade Center on September 11, 2001, she faced many problems with her job, her husband, and her family relationships. She went to a _________________ who prescribed medication to treat her depression. P Circle the correct term to complete each sentence. 1. Mrs. Brody had a cough and fever. Her doctor directed her to go to the department (pathology, radiology, hematology) for a chest x-ray. 2. After the birth of her fourth child, Ms. Thompson had trouble holding her urine (a condition known as urinary incontinence). She made an appointment with one (gastroenterologist, pathologist, urologist) to assess her condition. 3. dr Monroe told a new mom she lost a lot of blood during the birth of her child. She had (anemia, leukocytosis, adenitis) and required a blood transfusion immediately.

4. Mr. Preston had chest pains on his morning walks. He made an appointment to discuss his new symptom with a (nephrologist, neurologist, cardiologist). 5. After my skiing accident, Dr. Curtin proposed (cystoscopy, biopsy, arthroscopy) to visually examine my swollen, painful knee.

Solutions to tasks A 1. Prefixes 2. Suffixes 3. Root 4. Combination vowel 5. Combination form B 1. Heart 2. Gland 3. Life 4. Cerebrum, largest part of the brain 5. Head 6. Joint 7. Cancer, cancer 8 Bladder 9 Cell 10 Skin 11 Brain 12 Electricity C 1 Tumor, mass, swelling 2 Concerning 3 Inflammation 4 Examination process 5 Visual examination process

6. pertaining to 7. recording (image) 8. contemplation process D 1. cerebr/al - involving the cerebrum or most part of the brain 2. bi/opsia - process of contemplation of life (removal of living tissue and contemplation 3. aden /itis - inflammation of a gland 4. cephal/ic - belonging to the head 5. carcin/oma - cancerous tumor (cancerous tumor) 6. cyst/o/scopy - visual process examination of the urinary bladder 7. electr/o/cardi/o/gram - Recording of the electricity in the heart 8. Cardi/o/Logic - Examination process of the heart 9. Electr/o/Encephal/o/Gram - Recording of the electricity in the brain 10. Dermat/itis - Inflammation of the skin 11. Arthr/O/Scopy - Process of visually examining a joint 12. Cyt/O/ology - Process of examining cells E 1. Red 2. Intestine (usually small intestine) 3. Stomach 4. Knowledge 5. Blood 6. Cut 7. Kidney

8. White 9. Treatment, doctor 10. Liver 11. Nerve 12. Woman, female F 1. Leukocyte 2. Gastritis 3. Iatrogenic 4. Nephrology 5. Erythrocyte 6. Hematoma 7. Biopsy 8. Neuralgia 9. Ophthalmoscopy 10. Enteritis G 1. ren/o 2. path/o 3. ophthalm/o 4. sect/o 5. rhin/o 6. sarc/o 7. psych/o 8. ur/o 9. oste/o 10. radi/ O

11. Thromb/o 12. Onc/o H 1. Ophthalmoscopy - process of visual examination of the eye 2. Ophthalmoscope - instrument for visual examination of the eye 3. Oncology - examination of tumors 4. Ostitis - bone inflammation 5. Psychosis - abnormal condition of the Mental 6. Platelet - occlusion cell (platelet) 7. Kidney - belonging to the kidney 8. Nephrectomy - removal (excision or resection) of kidney bone 10. Resection - act of pushing back (meaning "cutting out" or removal) 11. Carcinogen - related to the development of cancer 12. Sarcoma - tumor of flesh tissue (cancer tumor in connective tissue such as bone, fat and muscle) I 1. Pain 2. Process 3. Blood condition 4. Photograph (image) 5. Instrument for visual inspection 6. Condition , mostly abnormal 7. excision, removal (resection) 8. concerning manufacture, produced by, or produced in 9. disease state

10. Cu process, incision 11. Inflammation 12. Cell 13. Protein J 1. Carcinogen 2. Leukocytosis 3. Hepatoma (hepatocellular carcinoma) 4. Arthralgia 5. Endocrine 6. Cystitis 7. Hematoma 8. Leukemia 9. Iatrogenic 10 Encephalopathy K 1. complete, to 2. before 3. self, own 4. no, not, without 5. excessive, over, more than normal 6. deficient, under, less than normal 7. over, after 8. within 9 .behind 10. across, through 11. circumferential

12. from 13. below, under 14. back L 1. diagnosis - complete knowledge; a decision on the nature of the patient's condition after the appropriate tests have been performed. 2. Prognosis - before knowledge; a prognosis of treatment success after diagnosis 3. subhepatic – below the liver. No connecting vowel is required between the prefix and the root. 4. Pericardium - the membrane that surrounds the heart 5. Hyperglycemia - condition of excess sugar in the blood 6. Subcutaneous - under the skin 7. Epigastric - over the stomach 8. Resection - process of retraction (in the sense of exposure) 9 Hypoglycemia – condition of a deficiency (low) level of sugar in the blood 10. Anemia – condition of a low number of erythrocytes (red blood cells) or a lack of hemoglobin in these cells. Note that the root in this term is em, which is abbreviated from hem, meaning blood. M 1. Urology 2. Gynecology 3. Hematology 4. Oncology 5. Nephrology 6. Neurology 7. Pediatrics (the combining vowel o was deleted between ped and iatr)

8. Radiology 9. Ophthalmology 10. Gastroenterology 11. Endocrinology 12. Psychiatry 13. Pathology 14. Cardiology N 1. Cerebrum (largest part of the brain). A cerebrovascular accident, or stroke, is damage to the blood vessels of the cerebrum that leads to the death of brain cells. 2. Brain. Encephalitis is inflammation of the brain. 3. urinary bladder. A cystoscope is an instrument used to visually examine the urinary bladder. The cystoscope is inserted into the urethra and bladder. 4. over, through. Transhepatic means across or through the liver. 5. Meat. Osteogenic sarcoma is a malignant (cancerous) tumor that originates in bone, which is considered the fleshy (connective) tissue of the body. 6. under, under, deficient. Hypogastric means below the stomach. 7. inside. Endocrine glands secrete hormones in the body. Examples include the pituitary, thyroid, and adrenal glands. 8. Excision or resection. Nephrectomy is the removal of a kidney. 9. outside. Exocrine glands excrete chemicals to the outside. Examples are the sweat, lacrimal or lacrimal glands, the prostate and the salivary glands. 10. Pain. Neuralgia is nerve pain.

O 1. Osteoarthritis 2. Biopsy 3. Urologist (a nephrologist is a doctor who treats kidney disease but does not operate on patients) 4. Neuropathy 5. Pathogenic 6. Anemia 7. Oncologist 8. Platelets 9. Prognosis 10. Psychiatrist (a psychologist can treat mentally ill patients but is not a doctor and cannot prescribe medication) P 1. Radiologist 2. Urologist 3. Anemia 4. Cardiologist 5. Arthroscopy Practical Application Answers 1. D A cardiologist is a specialist in internal medicine who additional benefits are provided by (scholarship) training in the diagnosis and treatment of heart disease. 2. F A gynecologist specializes in surgery and internal medicine to diagnose and treat disorders of the female reproductive system. Ovarian cysts are fluid sacs that form on and inside the ovaries (female organs that produce eggs and hormones). 3. J A psychiatrist is a specialist in the diagnosis and treatment of mental illness. If you have bipolar disorder (manic-depressive illness),

mood periodically shifts from excessive mania (excitability) to deep depression (sadness, despair, and discouragement). 4. E An oncologist is a specialist in internal medicine who undertakes fellowship training in the diagnosis and medical (drug) treatment of cancer. 5. B A hematologist is an internal medicine physician who undertakes fellowship training in the diagnosis and treatment of blood disorders such as anemia and blood clotting disorders. 6. H An ophthalmologist trains in both surgery and internal medicine to diagnose and treat diseases of the eye. The retina is a sensitive layer of light receptor cells at the back of the eye. Retinopathy can occur as a secondary complication of chronic diabetes (due to hyperglycemia). 7. I A neurologist is a specialist in internal medicine who undertakes specialist training in the diagnosis and treatment of diseases of the nervous tissue (brain, spinal cord and nerves). A CVA causes damage to areas of the brain, resulting in a loss of function. 8. C A nephrologist is an internal medicine physician who undertakes fellowship training in the diagnosis and medical treatment of kidney disease. A nephrologist does not perform surgery on the urinary tract, but treats kidney disease with medication. 9. A gastroenterologist is an internal medicine physician who is completing fellowship training in the diagnosis and treatment of disorders of the gastrointestinal tract. Examples of inflammatory bowel disease include ulcerative colitis (inflammation of the large intestine) and Crohn's disease (inflammation of the last part of the small intestine). 10. G A Urologist is a surgeon who operates on organs of the urinary tract and the male reproductive system (such as the prostate). Urologists also prescribe medication for some medical conditions. pronunciation of terms

The terms you learned in this chapter are presented here with their pronunciations. The CAPITAL LETTERS indicate the accented syllable. You can find the meaning of all terms in the mini-dictionary starting on page 897. You can also listen to each term on the Evolve website (h p://evolve.elsevier.com/Chabner/language/).

TERM Adenitis Adenom Adenopathie Anämie Arthralgie Arthritis Autopsie Biologie Biopsie karzinogenes Karzinom Herzkardiologie zephalische zerebrale Zystitis Zystoskopie Zytologie Dermatitis Dermatologie Diagnose Elektrokardiogramm Elektroenzephalogramm Enzephalopathie endokrine Drüsen Endokrinologe Endokrinologie Endoskop Endoskopie Enteritis Epidermis epigastrische Erythrozytenexzision exokrine Drüsen Gastrektomie Gastromatoenterologie Gastrotomie Häpatologie Gynäkämie Häpatologie Häpatologie Häpatologie Hyperthyreose subkutan hypogastrisch Hypoglykämie iatrogene Inzision leukemia leukocyte leukocytosis nephrectomy nephritis nephrology nephrosis

AUSKUNFT ah-deh-NI-tis ah-deh-NO-mah ah-deh-NOP-ah-the ah-NE-me-ah ar-THRAL-jah ar-THRI-tis AW-top-se bi-OL- o-je BI-op-se kar-sih-no-JEN-ik kar-sih-NO-mah KAR-de-ak kar-de-OL-o-je see-FAL-ik see-RE-bral sis- TI-tis sis-TOS-co-pe si-TOL-o-je dort-mah-TI-tis dort-mah-TOL-o-je di-ag-NO-sis eh-lek-tru-KAR-de- o-gram eh-lik-tro-en-SEF-ah-lo-gram en-sef-ah-LOP-ah-the EN-do-krin glanz en-do-krin-OL-o-gist en-do- krin-OL-o-je EN-do-scope en-DOS-co-pe en-teh-RI-tis ep-ih-DER-mis ep-ih-GAS-trick eh-RITH-ro-site ek-SIZH -un EK-so-creen blick gas-TREK-zu-mir GAS-trick gas-thin-en-teh-ROL-o-je gas-TROT-o-me gi-neh-COLD-o-jist gi-neh -KOL-o-je he-mah-TOL-o-je he-mah-TO-mah HE-mo-glo-bin hep-ah-TI-tis hep-ah-TO-mah hi-per-gli-SE -me-ah hi-per-THI-royd-izm hi-po-DER eyes hi-po-GAS-Trick hi-po-gli-SE-me-ah i-ah-tro-JEN-ik in-SIZH - un lu-KE-me-ah LU-ko-site lu-ko-si-TO-sis neh-FREK-zu-mir neh-FRI-tis neh-FROL-o-je neh-FRO-sis

TERM Neural Neuralgia Neurology Neurology Oncologist Oncology Ophthalmologist Ophthalmoscope Osteitis Osteoarthritis Osteosarcoma Osteotomy Pathogenic Pathologist Pathology Pediatric Pericardium Prognosis Prostate Psychiatrist Psychology Radiology Renal Resection Retrocardial Rhinitis Sarcoma Subhepatic Platelets Transhepatic Urologist

PRONOUNS NU-ral nu-RAL-jah nu-ro-LOJ-ik nu-ROL-o-je ong-COLD-o-jist ong-COLD-o-ge of-thal-MOL-o-jist of-THAL- mo-scope os-te-ich-tis os-te-o-ar-THRI-tis os-te-o-JEN-ic sar-KO-mah os-te-OT-o-me Pfad-o-JEN- ik Pfad-OL-o-jist Pfad-OL-o-je pe-de-AH-Trick peh-rih-KAR-de-um prog-NO-sis PROS-enge Drüse see-KI-ah-traurig see-COL -o-je ra-de-OL-o-je RE-nal re-SEK-meiden reh-tro-KAR-de-ac ri-NI-tis sar-KO-mah sub-heh-PAT-ik THROM-bo -site tranz-heh-PAT u-ROLE-o-gist

evaluation sheet

This overview sheet and the others that follow each chapter are complete lists of the word elements contained in the chapter. They serve to bring the terminology together and reinforce your learning by giving you the opportunity to write the meaning of each part of the word in the spaces provided and test yourself. Check your answers against the information in the chapter or glossary (Medical Word Parts – English) at the end of the book. It's a good idea to open the glossary with the tab so you can find it easily.

combine shapes

KOMBINATIONSFORM aden/o arthr/o bi/o carcin/o cardi/o cephal/o cerebr/o cis/o crin/o cyst/o cyt/o derm/o, dermat/o electr/o encephal/o enter/ o erythr/o gastr/o glyc/o gnos/o gynec/o hem/o, hemat/o hepat/o iatr/o leuk/o log/o nephr/o neur/o onc/o ophthalm/o oste/o path /o ped/o psych/o radi/o ren/o rhin/o sarc/o sect/o thromb/o ur/o

IMPORTANCE _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________

Suffix

SUFFIX -ac -al -algia -cyte -ectomy -emia -genic -globin -gram -ic, -ical -ion -ist -itis -logy -oma -opsy -osis -pathy -scope -scopy -sis -tomy -y

Prefixes PREFIX a-, anaut-, autodiaendoepiex-, exohyperhypoinperiproretrosubtrans-

Suffixes meaning in relation to

There are many suffixes that mean "belonging". In this chapter, you learned -ac, -al, -ic, and -ical. For a more comprehensive list, see Glossary (English to medical parts of words), page 967.

CHAPTER 2

Terms related to the body as a whole CHAPTER SECTIONS: Structural organization of the body 32 Abdominal-pelvic regions and quadrants 46 Division of the back (spine) 48 Positional and directional concepts 50 Body planes 52 Terminology 53 Practical applications 57 Exercises 58 Answers to exercises 63 Pronunciation of terms 65 review sheet 67

CHAPTER OBJECTIVES • Define terms related to the structural organization of the body. • Identify body cavities and recognize the organs they contain. • Locate and identify the anatomical and clinical divisions of the abdomen. • Locate and name the anatomical divisions of the back. • Become familiar with terms that describe positions, directions and planes of the body. • Identify the meanings of new word elements and use them to understand medical terms.

Structural Organization of the Body This chapter provides an orientation to the body as a whole—cells, tissues, organs, and systems—along with terminology that describes positions and directions within the body. We start with the smallest living unit, the cell, and build on an understanding of complex body systems. In order to know how organs function in both health and disease, it is important to understand how their individual cellular units work.

Cells The cell is the basic unit of all living things (animal or plant). Cells are everywhere in the human body - every tissue, every organ consists of these individual units.

Similarity in Cells All cells are similar in that they contain a gelatinous substance made up of water, protein, sugars, acids, fats and various minerals. Figure 2-1 shows several parts of a cell, which are described below as they might appear if photographed with an electron microscope. Label the structures in Figure 2-1. Throughout the book, numbers or letters in parentheses indicate that the bold prefix should be used in labeling.

FIGURE 2-1 Main components of a cell. Ribosomes (RI-bo-sohmz) are small granules that help the cell make proteins.

The cell membrane [1] not only surrounds and protects the cell, but also regulates what goes in and out of the cell. The cell nucleus [2] controls the operation of the cell. It controls cell division and determines the structure and function of the cell. Chromosomes [3] are rod-shaped structures within the cell nucleus. All human body cells - with the exception of the sex cells, the egg cell and the sperm (short for spermatozoon) - contain 23 pairs of chromosomes. Each sperm and egg has only 23 unpaired chromosomes. After an egg cell and a sperm cell unite to form an embryo, each cell of the embryo has 46 chromosomes (23 pairs) (Figure 2-2).

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Figure 2-2 Egg and sperm cells, each containing 23 chromosomes.

Chromosomes contain regions called genes. There are several thousand genes in an ordered sequence on each chromosome. Every gene contains a chemical called DNA (deoxyribonucleic acid). DNA regulates the cell's activities according to its sequence (arrangement into genes) on each chromosome. The DNA sequence resembles a set of recipes in code. When this code is passed from the nucleus to the rest of the cell, it controls the cell's activities, such as B. cell division and the synthesis of proteins. A karyotype is a photograph of a person's chromosomes arranged by size, shape, and number (Figure 2-3). Karyotyping can determine whether chromosomes are normal. For example, an obstetrician may recommend that a pregnant woman have an amniocentesis (puncture of the bladder around the fetus to remove fluid and cells) so that the baby's karyotype can be evaluated.

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Figure 2-3 Karyotype of a normal male. 23 pairs of chromosomes are shown. The 23rd pair is the XY pair present in normal males. In normal women, the 23rd pair is XX. In this karyotype, the chromosomes have been treated with chemicals, resulting in bands of light and dark areas.

When a baby is born with a chromosomal abnormality, serious problems can result. In Down syndrome, the karyotype shows 47 chromosomes instead of the normal number of 46 (Figure 2-4). The extra chromosome 21 leads to the development of a child with Down syndrome (also called trisomy 21 syndrome). The incidence is about 1 in 750 live births, but as the mother ages, the presence of the chromosomal abnormality increases.

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Figure 2-4 A, Karyotype of a Down syndrome patient with trisomy 21. There is one extra copy of chromosome 21 in addition to the usual pair, for a total of three (tri-). B, Photograph of child with typical Down syndrome facial expression. Features include a small, somewhat flat nose and upturned eyes. Other characteristics of patients with Down syndrome are mental weakness and heart defects.

Continue captioning Figure 2-1. The cytoplasm [4] (cyt/o = cell, -plasm = formation) includes all material outside the cell nucleus that is enclosed by the cell membrane. It carries out the work of the cell (e.g. contraction in a muscle cell, transmission of impulses in a nerve cell). The cytoplasm contains specialized apparatus to meet the cell's chemical needs. Mitochondria [a] are small sausage-shaped bodies that are the main source of energy for the cell. They use nutrients and oxygen to release energy stored in food. During the chemical process called catabolism, complex foods like sugar and fat are broken down into simpler substances (catamean breakdown) and energy is released from the mitochondria. Thus, catabolism provides the energy for the cells to do the body's work. The endoplasmic reticulum [b] is a network (reticulum) of channels within the cell. These channels are cellular tunnel systems that make proteins for the cell. Attached to the endoplasmic reticulum are ribosomes that build long protein chains. Anabolism, which occurs in the endoplasmic reticulum, is the process of building (ana- means building) large proteins from small pieces of protein called amino acids. Examples of important proteins for cell growth are hormones and enzymes. Together these two processes - anabolism and catabolism - make up the metabolism of the cell. Metabolism is the entirety of the chemical processes taking place in a cell. With a “fast metabolism”, foods such as sugar and fat are used up very quickly and energy is released.

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When a person has a “slow metabolism”, food is burned slowly and fat accumulates in cells.

Study section 1

Practice spelling each term and become familiar with its meaning. anabolism

Process of building large proteins from small pieces of protein called amino acids. Ana- means high, bol means throw, and -ism is a process. Catabolism Process by which complex nutrients are broken down into simpler substances and energy is released. Cata- means down, bol means throw, and -ism is a process. Cell Structure that surrounds and protects the cell. It determines what enters the cell and what leaves the membrane. Chromosomes Rod-shaped structures in the cell nucleus that contain regions of DNA called genes. There are 46 chromosomes (23 pairs) in every cell, with the exception of egg and sperm cells, which contain only 23 single, unpaired chromosomes. Cytoplasm All of the material that is outside of the cell nucleus yet contained within the cell membrane. DNA chemical found in each chromosome. Arranged like a sequence of recipes in code, it directs the cell's activities. Endoplasmic network of channels in the cytoplasm of the cell. Here, large proteins reticulum are made from smaller pieces of protein. Genes Regions of DNA within each chromosome. Karyotype mapping (classification) of chromosomes in the cell nucleus. The chromosomes are arranged in numerical order to determine their number and structure. Metabolism All of the chemical processes in a cell. It includes catabolism and anabolism. Meta- means change, bol means to form and -ism means process. Mitochondria Rod-shaped structures in the cytoplasm that are the main source of energy (small "power plants") for the cell. Catabolism is the process that occurs in mitochondria. (From the Greek, mitos means thread and chondrion means granule.) TIP: Think “mighty” mitochondria! nucleus control center of the cell. It contains chromosomes and controls cell activities.

anabolic steroids

These drugs are similar to androgens (male hormones) in their effects on the body. They build protein inside the cells.

metabolism and thyroid

The thyroid secretes thyroid hormone (thyroxine or T4), which stimulates metabolism in cells. Elevated hormone levels accelerate

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Metabolism (increased energy and weight loss) and decreased hormone levels slow metabolism (sluggishness and weight gain).

Differences in Cells While we have just seen that cells contain similar structures, cells change during their development in the embryo to form many different types. Cells vary or specialize throughout the body to perform their individual functions. For example, a muscle cell is long and slender and contains fibers that help contract and relax; an epithelial cell (a lining and skin cell) may be square and flat to provide protection; A nerve cell can be long and have various fibrous processes that help in its task of transmitting impulses; A fat cell contains large, empty spaces for fat storage. These are just a few of the many types of cells in the body. Figure 2-5 shows the different sizes and shapes of muscle, epithelial, nerve, and fat cells. The term that describes this change in cells during their maturation and specialization is differentiation.

FIGURE 2-5 Cell Types. A, muscle cell; B, epithelial cell; C, nerve cell; and D, fat cell.

differentiation

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It is still a scientific mystery why cells with the same DNA change or specialize into different cell types in the developing embryo. Factors are believed to affect genes (DNA), which leads to the differentiation of cells. If we can figure out what causes differentiation as they mature, we may be able to better understand what happens to cells when they revert to a more primitive, unspecialized form, as in cancer cells.

Tissues A tissue is a group of similar cells that work together to accomplish a specific task. A histologist (hist/o = tissue) is a scientist who specializes in the study of tissues. Different tissue types are recognized. Tissues of the same type can be found in different regions of the body. Figure 2-6 shows four types of fabrics.

FIGURE 2-6 Tissue Types. A, epithelial. B, muscle. C, connective tissue (fat). D, nerve.

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Epithelial tissue Distributed throughout the body, epithelial tissue forms the lining of the internal organs and the outer surface of the skin that covers the body. It also lines exocrine and endocrine glands and is responsible for the secretions that the glands produce. The term epithelial originally referred to the tissue at (epi-) the nipple (thel/o). Now it describes all the tissues that cover the outside of the body and line the inner surface of the internal organs.

Muscle tissue Voluntary muscles are found in the arms and legs and in parts of the body where movement is under conscious control. Involuntary muscles, found in the heart and digestive system and other organs, allow for movements that are not under conscious control. The heart muscle is a specialized type of muscle found only in the heart. Contractions of this muscle type can be seen as a beating heart on an ultrasound scan of a 6-week-old fetus.

Connective Tissue Examples include fatty tissue, cartilage (elastic, fibrous tissue that attaches to bone), bone, and blood.

Nerve tissue Nerve tissue conducts impulses throughout the body.

Organs Different types of tissue combine to form an organ. For example, an organ like the stomach is made up of muscle tissue, nerve tissue, and glandular epithelial tissue. The medical term for internal organs is intestines (singular: intestines). Examples of abdominal viscera (organs located in the abdomen) are the liver, stomach, intestines, pancreas, spleen and gallbladder.

Systems Systems are groups of organs that work together to perform complex functions. For example, the mouth, esophagus, stomach, and small and large intestines are organs that do the work of the digestive system to digest food and absorb it into the bloodstream. Figure 2-7 gives an overview of the differences between cells, tissues, organs and systems.

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FIGURE 2-7 Cells, Tissues, Organs and Systems.

Next, the body systems are listed with their individual organs. Learn to spell and identify the organs in bold. SYSTEM Digestion

ORGANS Mouth, throat (pharynx), esophagus (tube from the throat to the stomach), stomach, intestines (small and large), liver, gallbladder, pancreas Urinary tract or kidneys, ureters (tubes from the kidneys to the bladder), urinary tract excretory bladder, urethra ( tube from the bladder to the outside of the body) Respiration Nose, pharynx, larynx (speech system), trachea (windpipe), bronchi, lungs (where gas exchange occurs) Reproductive organs Female: ovaries, fallopian tubes, uterus (womb), vagina, mammary glands Male: Testicles and related tubes, urethra, penis, prostate Endocrine Thyroid gland (in the neck), pituitary gland (at the base of the brain), sex glands (ovaries and testicles), adrenal glands, pancreas (islets of Langerhans), parathyroid glands Nerves Brain, spinal cord, nerves and nerve aggregations Circulation Heart, blood vessels (arteries, veins and capillaries), lymph vessels and nodes, spleen, thymus gland musculoskeletal muscles, bones and connect ts skin and Si nne skin, hair, nails, sweat glands and sebaceous glands; eye, ear, nose, organs and tongue

Study section 2

Practice spelling each term and become familiar with its meaning.

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adipose tissue cartilage

Collection of fat cells.

Flexible connective tissue often hurts bones at joints. Cartilage forms part of the pinna and nose. Rings of cartilage surround the trachea. epithelial skin cells that cover the outside of the body and line the inner surfaces of cells and organs. Histologist Specialist in tissue studies. larynx voice box; located above the trachea. (LAHHINT: Remember the word laryngitis, which means RINKS inflammation) voice box that can lead to loss of your voice! throat neck. The pharynx serves as a common passageway for food (from (FAH mouth goes to the esophagus) and air (from the nose to the trachea). Pituitary gland Endocrine gland at the base of the brain. Gland NOTE: Be careful when spelling pituitary; it includes 2 i's Thyroid Endocrine gland surrounding the trachea in the neck Gland Trachea Trachea (Tube that leads from the pharynx and larynx to the bronchi.) Ureter One of two tubes, each leading from a single kidney to the urinary bladder TIP: Note Spelling: Ureter has two e, and there are two ureters Urethra Tube from the urinary bladder to the outside of the body TIP: Spelling note: Urethra has an e, and there is only one urethra Uterus Uterus; holds the embryo/fetus during its development Guts Internal organs in the main cavities of the body, particularly the abdomen.

Body Cavities A body cavity is a space within the body that contains internal organs (intestines). Label Figure 2.8 as you learn the names of the body cavities. Some of the important organs contained within these cavities are also listed.

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Figure 2-8 Body cavities. Ventral (front) cavities are located at the front of the body (blue). Dorsal (back) cavities are located in the back (red).

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CAVE ORGANS Skull [1] Brain, pituitary gland. Chest Lung, heart, esophagus, trachea, bronchi, thymus, aorta (large [2] artery). The thoracic cavity is divided into two smaller cavities (Figure 2-9): a. Pleural cavity - space surrounding each lung. The pleura is a double membrane that surrounds and protects the lungs. When the pleura is inflamed (as in pleurisy or pleurisy), the pleural cavity can fill with fluid. This is called a pleural effusion. b. Mediastinum - Centrally located space outside and between the lungs. It contains the heart, aorta, trachea, esophagus, thymus, bronchi and many lymph nodes. Continue captioning Figure 2-8. Abdominal The peritoneum is the double-folded membrane that surrounds the abdominal cavity [3] (Figure 2-10). It hurts the abdominal organs up to the abdominal muscles and surrounds each organ to hold it in place. The kidneys are two bean-shaped organs located behind the abdominal cavity (retroperitoneal area) on either side of the spine (see Figures 2-10 and 2-12). The abdominal cavity also contains the stomach, small and large intestines, spleen, pancreas, liver and gallbladder. The diaphragm (a muscular wall) separates the abdominal and chest cavities (see Figure 2-8). Pelvis [4] Parts of the small and large intestine, rectum, urinary bladder, urethra and ureter; Female uterus and vagina. Spine [5] Nerves of the spinal cord.

FIGURE 2-9 Thoracic cavity.

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Figure 2-10 Abdominal (peritoneal) cavity (side view and in light blue). Note the peritoneum, a membrane that surrounds the organs in the abdominal cavity. With diseases of the abdominal organs, fluid can accumulate in the abdominal cavity. This fluid is called ascites. The retroperitoneal area lies behind the peritoneum. The kidneys are in the retroperitoneal region.

The cranial and spinal cavities are the dorsal (dors/o = back) body cavities due to their location on the back or back of the body. The thoracic, abdominal, and pelvic cavities are ventral (ventr/o = abdomen) body cavities because they are located in the front (anterior) part of the body (see Figure 2-8). While the thoracic and abdominal cavities are separated by a muscular wall called the diaphragm, the abdominal and pelvic cavities are not separated and are collectively referred to as the abdominal and pelvic cavities. Figures 2-11 and 2-12 show the abdominal and thoracic viscera from anterior (ventral) and posterior (dorsal).

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Figure 2.11 Organs of the abdominal, pelvic, and thoracic cavities, anterior view.

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Figure 2-12 Organs of the abdominal, pelvic and thoracic cavities, posterior view.

Section 3

Practice spelling each term and become familiar with its meaning.

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abdomen below the chest, which contains organs such as the liver, stomach, gallbladder, and intestines; also called abdominal cavity or peritoneal cavity. Skull Cavity Space in the head that contains the brain and is surrounded by the skull. Cranial means pertaining to the skull. Diaphragm Muscle that separates the abdominal and thoracic cavities. The diaphragm moves up and down, helping you breathe. dorsal Belonging to the back. (posterior) mediastinum Central space outside and between the lungs. Pelvic cavity Space below the abdomen that contains parts of the intestines, rectum, urinary bladder, and reproductive organs. Pelvis means the pelvis consisting of the hip bones surrounding the pelvic cavity. Peritoneum Double-folded membrane surrounding the abdominal cavity. The peritoneum ache the abdominal viscera of the muscles and acts as a protective membrane (which contains blood vessels and nerves) around the organs. Pleura Double-folded membrane that surrounds each lung. Pleural means pertaining to the pleura. TIP: Don't confuse pleural with plural, which means more than one! pleural space between the pleural layers. Cavity Spinal Cavity Space within the spine (backbone) that contains the spinal cord. See Figure 2-13. Thoracic space in the chest that contains the heart, lungs, bronchi, trachea, esophagus, and other organs. ventral Refers to the front. (in front)

FIGURE 2-13 Spinal cavity. A disc is a cartilage pad that serves as a cushion between each backbone of the spine.

Peritoneum and other membranes

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Many vital organs are covered and protected by membranes. The peritoneum surrounds the abdominal viscera (liver, small and large intestine, stomach) and the pleura covers the lungs. You can visualize organs being surrounded by a double membrane by imagining your fist pushing deep into a soft balloon. The balloon is then folded in two layers over the fist, just as the pleura surrounds the lungs and the peritoneum surrounds the abdominal organs. The double wrap around the organs provides protection and padding as well as a site for muscle attachment. In the case of inflammation or disease of organs or membranes, fluid can accumulate in the membrane spaces surrounding the organs. This accumulation of fluid in the pleural cavity is called a pleural effusion. A build-up of fluid in the abdominal cavity is called ascites.

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Abdominal-pelvic regions and quadrant regions Doctors divide the abdominal-pelvic region into nine regions. Label these regions in Figure 2-14.

FIGURE 2-14 Abdominal-pelvic regions. These regions can be used clinically to locate internal organs.

Right hypochondrial region [1]: right upper region below (hypo-) the cartilage (chondr/o) of the ribs that extend across the abdomen Left hypochondrial region [2]: left upper region below the costal cartilage Epigastric region [3]: Region above the stomach Right lumbar region [4]: right middle region near the waist Left lumbar region [5]: left middle region near the waist Navel region [6]: region of the navel or umbilicus Right groin region [7]: right lower region in near the groin (inguin/o = groin), this is the area where the legs meet the torso

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from the body. This region is also known as the right iliac region because it is near the ilium (the upper part of the hip bone). Left groin region [8]: Lower left region near the groin. Also known as the left iliac region. Hypogastric region [9]: mid-lower region below the umbilical region.

Quadrants The abdominal-pelvic region can be divided into four quadrants by two imaginary lines - one horizontal and one vertical - crossing in the middle of the body. Figure 2-15 shows the four abdominal-pelvic quadrants; Put the correct abbreviation in the row under each label in the chart.

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Figure 2-15 abdominal-pelvic quadrants. Write the abbreviation for each quadrant on the line provided.

Right upper quadrant (RUQ) - contains liver (right lobe), gallbladder, parts of pancreas, parts of small and large intestine. Left upper quadrant (LUQ) - contains liver (left lobe), stomach, spleen, parts of pancreas, parts of small and large intestine Right lower quadrant (RLQ) - contains parts of small and large intestine, right ovary, right fallopian tube, cecum , right ureter Left Lower Quadrant (LLQ) - contains parts of the small and large intestines Large intestine, left ovary, left fallopian tube, left ureter

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Areas of the Back (Spine) The spine is made up of a series of bones that extend from the neck to the tailbone. Each bone is a vertebra (plural: vertebrae). Label the subdivisions of the back in Figure 2.16A while studying the following:

Figure 2-16 A, Anatomical layout of the back (spine). A disc is a small pad of cartilage between each spine. B, MRI (magnetic resonance image) of a herniated disc at the L4-L5 level of the spine.

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BREAKDOWN BREAKDOWN LOCATION OF THE BACKS Cervical [1] C cervical region. There are seven cervical vertebrae (C1 to C7). Thorax [2] T chest area. There are 12 thoracic vertebrae (T1 to T12). Each bone is connected to a rib. Lumbar Spine [3] L Lumbar (waist) or flank region (between the ribs and the hip bone). There are five lumbar vertebrae (L1 to L5). Sacrum [4] S Five bones (S1 to S5) are fused into one bone, the sacrum. Coccyx [5] The coccyx (coccyx) is a small bone made up of four fused parts.

Do not confuse the vertebral column (backbone or vertebrae) with the spinal cord (nerves surrounded by the column). The spine is bone tissue while the spinal cord is nerve tissue. The spaces between the vertebrae (intervertebral spaces) are identified by the two vertebrae between which they occur - for example, the L5–S1 space is between the fifth lumbar vertebra and the first sacral vertebra; T2–3 is between the second and third thoracic vertebrae. Within the space and between the vertebrae is a small cushion called the intervertebral disc. The intervertebral disc, consisting of water and cartilage, is a shock absorber. Occasionally, a disc can displace (herniate) and put pressure on a nerve (see Figure 2-16B). This "herniated disc" can cause pain in an area of the body affected by the nerve.

Section 4

Practice spelling each term and become familiar with its meaning.

Abdominal-pelvic regions hypochondriacal epigastric lumbar umbilical cord inguinal hypogastric area

Right and left upper regions under the ribs. Middle upper region over the stomach. Right and left middle region near the waist. Central region near the navel. Right and left lower region near groin. Also called iliac regions. Middle inferior region below the umbilical region.

Bauch-Becken-Quadrant ROAD ROAD ROAD ROAD

Right upper quadrant. Left upper quadrant. Right lower quadrant. Left lower quadrant.

departments of the back

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zervikal thoracic lumbar sacral Steißbein

Neck area (C1 to C7). Chest area (T1 to T12). Lumbar area (waist) (L1 to L5). Region of the sacrum (S1 to S5). Region of the coccyx (coccyx).

Related terms vertebrae vertebrae vertebral column spinal cord intervertebral disc

Single backbone. TIP: There are two e's in Vortex Backbones. (VER-teh-bray) Bone tissue surrounding the spinal cavity. nerve tissue in the spinal cavity. Cartilage pads between the vertebrae.

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Position and Direction Terms Label Figure 2-17 to identify the following position and direction terms.

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Figure 2-17 Position and direction information. Note that the standing figure is in the anatomical position, with the palms facing out and the fifth (pinky) finger in a medial position (closer to mid-body). The thumb is sideways.

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LOCATION Anterior (ventral) [1] Posterior (dorsal) [2] Deep [3]

RELATIONSHIP Front of the body. Example: The forehead is on the front (ventral) side of the body. back of the body. Example: The back of the head is posterior (dorsal) to the face. away from the surface. Example: The stab wound penetrated deep into the stomach. On the surface. Example: Superficial veins can be viewed through the skin.

Superficial [4] Proximal [5] Near the point of attachment to the trunk or near the beginning of a structure. Example: The proximal end of the thigh bone (femur) connects to the hip socket. Distal [6] Far from the point of attachment to the trunk or far from the beginning of a structure. Example: The femur joins the knee at its distal end. Inferior [7] Below another structure. Example: The feet are on the lower part of the body. They are inferior to the knees. Superior [8] Above another structure. Example: The head is above the neck. Cephalic (belonging to the head) also means over another structure. Medial [9] Refers to the middle or closer to the medial plane of the body. Example: In the anatomical position (palms outward), the fifth (pinky) finger is medial. Lateral [10] Refers to the side. Example: In the anatomical position (palms facing out), the thumb is on the side. Supine [11] Lie on your back. Example: The patient lies supine during an abdominal examination and, in women, during a pelvic (gynecologic) examination. See Figure 2-21 on page 62. Prone [12] Lie on your stomach. Example: The spine is examined in the prone position. A patient lies prone on his stomach.

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Planes of the Body A plane is an imaginary flat surface. Label Figure 2-18 to identify the following levels of the body:

Figure 2.18 Planes of the body. The figure is in the anatomical position. Notice the views of the body represented by each layer.

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PLANE Frontal (coronal) plane [1] Sagi ale (lateral) plane [2] Transverse (axial) plane [3]

POSITION Vertical plane dividing the body or structure into anterior and posterior parts. A common chest X-ray is a PA (posteroanterior) view, which is in the frontal (coronal) plane. See Figure 2-18. Vertical longitudinal plane dividing the body or structure into right and left sides. The Midsagi al plane divides the body into right and left halves. A lateral (side) chest X-ray film is taken in the sagial plane. Horizontal (cross-sectional) plane that runs parallel to the ground across the body. This cross-sectional plane divides the body or structure into upper and lower sections. A CT (computed tomography) scan is one of a series of X-ray images taken in the transverse (axial or cross-sectional) plane.

Section 5

Practice spelling each term and become familiar with its meaning. anterior (ventral) deep distal frontal (coronal) plane inferior lateral medial posterior (dorsal) prone proximal sagi ale (lateral) plane

front of the body. away from the surface. Far from the point of attachment to the trunk or far from the start of a structure. Vertical plane dividing the body or structure into anterior and posterior parts. Below another structure; affect the lower part of the body. Concerns the page. Refers to the middle or near the medial plane of the body. back of the body.

Lie on your stomach (face down, palms down). Near the point of attachment to the trunk or near the start of a structure. Longitudinal vertical plane dividing the body or structure into right and left sides. From the Latin sagi a, meaning arrow. When an arrow is shot from a bow, it enters the body in the sagial plane, separating right from left. The Midsagi al plane divides the body into right and left halves. superficial On the surface. consider Over another structure; concerning head. (Upside down) Lie on your back (face up, palms up). TIP: The supine position lies on the transverse horizontal (cross-sectional) plane of your spine, which divides the body into upper and lower (axial) parts. airplane

Terminology

Break each term into its component parts and write its meaning in the space provided.

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combine shapes

Figure 2-19 The cervix is the lower part or neck of the uterus.

FIGURE 2-20

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COMBINING MEANING TERMINOLOGY MEANING SHAPE Abdomin/o Abdomen Abdomen The abdomen is the region below the chest that contains internal organs (such as the liver, intestines, stomach, and gallbladder). adip/o bold bold The suffix -ose means belonging to or full of. Another combination form meaning fat is lip/o. Lipids are fats. anter/o front anterior The suffix -ior means belonging. Neck/Cervical (body of the cervix or The cervix is the neck of the uterus. See Figure 2-19. of the uterus) Chondr/o-cartilage Chondrome (Type of connective tissue This is a benign tumor. Chondrosarcoma) This is a malignant tumor. The root sark indicates that the malignant tumor arises from some kind of flesh or connective tissue. chrom/o color Chromosomes These core structures absorb the color of dyes used to stain the cell. The suffix -somes means body. Literally, this term means "color bodies," because that's how they appeared to researchers who first saw them under the microscope. coccyg/o coccyx coccygeal (coccyx) crani/o skull craniotomy cyt/o cell cytoplasm The suffix -plasm means formation. dist/o far, distant distal dors/o back dorsal part of the body hist/o tissue histology ili/o ilium iliaca (upper part See Figure 2-20 for an image of the ilium of the hip bone) groin/o groin inguinal kary/o -nucleus karyotype The suffix -type means classification or image. later/o lateral lateral lumbar spine/o lower back lumbosacral medi/o mid medial nucleus/o nucleus nucleus pelvis/i pelvis pelvis The pelvis includes all of the bones surrounding the pelvic cavity (Figure 2-20). pharyng/o pharynx pharyngeal (pharynx) The pharynx (FAH-Rinks) is the common passageway for food from the mouth and air from the nose. poster/o back, posterior behind proxim/o next proximal sacr/o sacrum sacral

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COMBINING MEANING TERMINOLOGY MEANING SHAPE sarc/o flesh sarcoma spin/o spine, backbone of the spine thel/o, theli/o mammary epithelial cell This cell, originally identified in the skin of the nipples, lies on body surfaces, external (outside the body) and internal (lining of cavities and organs). Thorac/o thoracic thoracotomy trache/o trachea, tracheal tube navel/o navel, navel navel ventral side ventral side ventral to the body vertebrae/o vertebrae(s), spinal column(s) viscera/o internal viscera

Prefixes PREFIX MEANING TERMINOLOGY MEANING Anaup-Anabolism This is a cellular process in which proteins are built from simpler substances (amino acids). catadown Catabolism Complex nutrients are broken down into simpler substances and energy is released. epiabove epinephrine The suffix -ine means a substance. Epinephrine is a hormone secreted by the adrenal glands, which are located above (epi-) the kidneys (nephr/o). It is used to treat (like an EpiPen®) severe allergic reactions. It opens the airways and increases heart rate in medical emergencies. hypobelow hypochondriac region The Greeks thought that organs (liver and spleen) in the hypochondriacal region of the abdomen were the origin of imaginary diseases - hence the term hypochondriac, a person with unusual anxiety for their health and with symptoms not attributable to any disease process. Intervertebral discs A disc is an intervertebral structure. intravenous The abbreviation for intravenous is IV. Metachange Metabolism Literally, to cause a change (meta-) (bol/o), meaning the chemical changes (processes) that take place in a cell.

Suffix

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The following are some new suffixes introduced in this chapter. See the Glossary (Medical Parts of Words - English) at the end of the book for additional suffixes meaning "concerning". SUFFIX -eal -iac -ior -ism -ose -plasm -somes -typ

MEANING refers to refers to process, state refers to, full of formation body image, classification

Cervical

The term cervical can have two different meanings depending on where it is used. In a gynecological report, cervical means the lower part or neck of the womb (cervix). In a spine radiological report of cervical vertebrae, cervical refers to the neck of the body.

Pelvis comparison of woman and man The female pelvis is wider and more massive than the male pelvis. The female pelvic opening has a larger, rounded, oval shape, while the male pelvic opening is deep, narrow, and funnel- or heart-shaped. Thus, the female pelvis can accommodate the fetus during pregnancy and its downward passage through the pelvic cavity at birth.

epinephrine and adrenaline

These are the SAME hormones! Two different names for the same substance secreted by the adrenal glands (above the kidneys).

Practical Applications

Be sure to check your answers with the answers to practical applications on page 64.

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X-ray Views Circle the correct answers in the following sentences that relate to each chest X-ray view.

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FIGURE A

1. This is an (coronal, sagi ale, axial) view. The heart lies (anterior, posterior, dorsal) on the vertebrae.

FIGURE B

2. This is a (coronal, sagi ale, axial) view. It is a (CT, traditional X-ray) image.

FIGURE C

3. This is an (coronal, sagittal, axial) view. It is a (lateral, transverse, anterior/posterior) image.

surgical measures

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Assign the surgical procedure in column I an indication for its implementation in column II. Note: You are not looking for the exact meaning of each surgical procedure, but rather the reason why it is performed. COLUMN I Procedure 1. Craniotomy 2. Thoracotomy 3. Discectomy 4. Mediastinoscopy 5. Tracheotomy 6. Laryngectomy 7. Arthroscopy 8. Laparoscopy (Peritoneoscopy) *Lymph †A

_______ _______ _______ _______ _______ _______ _______ _______

COLUMN II Indications A. Emergency procedures to remove foreign bodies from the trachea B. Inspection and repair of torn cartilage in the knee C. Removal of a diseased or injured part of the brain D. Inspection of lymph nodes* in the area between the lungs E. Removal of squamous cell carcinoma in the Larynx F. Open-heart surgery or removal of lung tissue G. Examination of abdominal organs (lapar/o means abdomen) and removal of diseased tissue H. Relieving symptoms of a bulging disc

Nodules are collections of tissue that contain white blood cells called lymphocytes.

Squamous epithelium is a type of epithelial cell.

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Exercises Remember to check your answers carefully against the Answers to the Exercises, page 63.

A The terms listed are part of a cell. Match each term to the correct meaning. Cell membrane Chromosomes Cytoplasm DNA Endoplasmic reticulum Genes Mitochondria Cell nucleus 1. Material of the cell that is outside the cell nucleus yet enclosed by the cell membrane ___________________________________________ 2. Regions of DNA within each chromosome _____________________________________________ __ 3. Small sausage-shaped structures representing the principle energy source for the cell _____________________________________________ _____________________________________ 4. Network of channels within the cytoplasm; the site of protein synthesis __________________________ 5. Structure that surrounds and protects the cell ___________________________________________ 6. Control center of the cell, which contains chromosomes _______________________________________

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7. Chemical in each chromosome _____________________________________________ __ 8. Rod-shaped structures in the cell nucleus that contain regions called genes _______________________ B Use medical terms or numbers to complete the sentences below. 1. A picture of chromosomes in the cell nucleus is a/a _________________________________. 2. The number of chromosomes in a normal male muscle cell is _____________________________. 3. The number of chromosomes in the female egg cell is ____________________________________. 4. The process of building proteins in a cell is __________________________________________. 5. Complex nutrients are broken down into similar substances and energy is released _____________________________________________ ____________________________________. 6. The sum of the chemical processes in a cell is __________________________________________. 7. A scientist who studies tissues is a _____________________________________________ ____. 8. The medical term for internal organs is _____________________________________________ ___. C Match the body parts or tissues listed to their correct descriptions. adipose tissue

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Cartilage Epithelial tissue Larynx Pharynx Pituitary gland Pleura Thyroid Trachea Ureter Urethra Uterus 1. Larynx __________________________________________ _____________ 2. Membrane around the lungs ________________________________________ ________ 3. Pharynx ________________________________________________ ________________________________ 4. Tube from the kidney to the urinary bladder __________________________________________ 5. Accumulation of fat cells ________________________________________________ ___________________ 6. Endocrine organs the base of the brain ___________________________ 7. Trachea _____________________________________________ ___________________________

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8. flexible connective tissue that hurts the bones at the joints _______________________ 9. skin cells that cover the outside of the body and line the internal organs __________ 10. endocrine gland that surrounds the windpipe in the neck _____________________ 11. uterus _____________________________________________ ________________________________ 12. tube running from the urinary bladder to the outside of the body ___________________________ D Name the five body cavities. 1. cavity surrounded by the skull ___________ 2. thoracic cavity surrounded by the ribs _____________ 3. cavity below the rib cage containing the stomach, liver and gallbladder ___________ 4. cavity surrounded by the hip bones _____________ 5. cavity surrounded by the bones of the back _____________________________________________ E Select the following terms to define the listed terms. space surrounding each lung space between the lungs muscle separating the abdominal and thoracic cavities

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membrane around the abdominal organs area below the navel (as well as below the stomach) area above the stomach area of the navel areas near the groin neural tissue within the spinal cavity bony tissue surrounding the spine cartilage pads between two adjacent vertebrae 1. Lower abdominal region _____________________________________________ ____________________ 2. Mediastinum _____________________________________________ _________________________ 3. Spinal cord __________________________________________ _____________ 4. Diaphragm __________________________________________ _____________ 5. Intervertebral disc __________________________________________ ___________ 6. Pleural cavity ___________________________ ____________________ 7. Vertebral column _________________________________ ___________

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8. Groin area _____________________________________________ ______________________ 9. Peritoneum _____________________________________________ ____________ 10. Umbilical area _____________________________________________ _________ 11. Epigastric area _____________________________________________ ______________________ F Name the five divisions of the back. 1. Neck region _____________________________________________ _____________________ 2. Thoracic region _____________________________________________ ____________________ 3. Waist region __________________________________________ _______ 4. Sacral region _____________________________________________ ___________________ 5. Coccyx region _____________________________________________ __________________ G Indicate the meaning of the following abbreviations.

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1. LLQ _____________________________________________ _________________________________ 2. L5–S1 _____________________________________________ ________________________________ 3. RUQ _____________________________________________ ________________________________ 4. C3–C4 _____________________________________________ ________________________________ 5. RLQ _____________________________________________ ________________________________ H Give the opposites of the following terms. 1. Deep ________________________________ 2. Proximal ___________________________ 3. Supine ________________________________ 4. Medial ______________________________ 5. Dorsal ______________________________ 6. Dorsal ___________________________ I Choose from the following medical terms to complete the sentences below. distal frontal (coronal) inferior lateral midsagi al

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Proximal superior (cephalic) transverse (axial) vertebra Vertebra 1. The kidney lies laterally or ______________________ the spinal cord. 2. The ___________ end of the thigh bone (femur) connects to the kneecap (patella). 3. The ___________ plane divides the body into a front and a back part. 4. Each backbone is a _____________________________________________ ______________. 5. Multiple backbones are _____________________________________________ ______________. 6. The diaphragm lies __________________________ to the organs in the chest cavity. 7. The ____________ plane divides the body into right and left halves. 8. The ______________________ end of the upper arm bone (humerus) is at the shoulder. 9. The ________________________ plane divides the body into an upper and a lower part. 10. The pharynx is located ___________________________________________ the esophagus. J Provide meanings for each of the following.

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1. craniotomy _____________________________________________ ___________________________ 2. cervical _____________________________________________ ______________________________ 3. chondroma _____________________________________________ ___________________________ 4. chondrosarcoma ________________________________________ _______________________ 5. nucleic _____________________________________________ ______________________________ 6. epinephrine ________________________________________ __________________________ 7. intravenous _____________________________________________ __________________________ 8. pharyngeal _____________________________________________ __________________________ 9. laryngitis _____________________________________________ 9. laryngitis _____________________________________________ for the following definitions. Pay attention to the spelling! 1. Space under the chest with liver, stomach, gallbladder and intestines _____________________

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2. Extensible connective tissue a to bones at joints _______________________ 3. Rod-shaped structures in the cell nucleus containing regions of DNA _______________________ 4. Muscle separating abdominal and chest cavities _____________________ 5. Larynx _____________________________________________ ___________________________ 6. Vertical plane dividing the bodies into right and left side ____________________ 7. pertaining to the neck _____________________________________________ _________________ 8. tumor (benign) of the cartilage _____________________________________________ ___________ 9. control center of the cell; directs the activities of the cell _________________________________ 10. relating to the trachea _____________________________________________ _____________ L Complete each term based on the meaning given. 1. Concerning internal organs: __________________________ al 2. Tumor of the flesh tissue (malignant): ____________ oma

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3. belonging to the breast: __________________________ ic 4. picture of the chromosomes in the cell nucleus: __________________________ type 5. sausage-shaped cell structures where degradation takes place: mito ___________ 6. space between the lungs: media ____________________ 7. endocrine gland at the base of the brain: __________________________ ary gland 8. to skin cells (surface cells): epi __________________________ 9. too far from the beginning of a structure: ____________ al 10. on the surface of the body: super ____________ M Circle the correct term to complete each sentence. 1. dr Curnen said the wound (inguinal, upper, superficial) barely scratched the surface. 2. Since the liver and spleen are on opposite sides of the body, the liver is in (RUQ, LUQ, LLQ) the abdominal cavity and the spleen is in (RUQ, LUQ, RLQ). 3. When a gynecologist performs a pelvic exam, the patient lies supine in the lithotomy position (anterior, posterior, medial) (Figure 2-21).

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Figure 2-21 Dorsal lithotomy position. Steinschnitt means stone carving (lith/o = stone). This supine position is used for pelvic pelvic exams and removing stones from the urinary tract.

4. Sally complained of pain around her navel. The doctor described the pain as (periumbilical, epigastric, hypogastric). 5. After removing the fluid from around her 16 week old fetus and checking the chromosome picture, the doctor told Ms Jones that the fetus had trisomy 21. The diagnosis was made by analysis of an abnormality (urine sample, X-ray film, karyotype). 6. The (spinal, sagittal, abdominal) cavity contains digestive organs. 7. The ER doctor suspected appendicitis when Brandon was admitted with stabbing (LLQ, RLQ, RUQ) pain. 8. Susan had the hiccups after quickly eating spicy Indian food. Her doctor explained that the hiccups are involuntary contractions or spasms of the (navel, diaphragm, mediastinum) that lead to uncontrolled breathing in air. 9. Maria's coughs and sneezes were the result of an allergy to animal dander affecting her system (respiratory, cardiovascular, urinary).

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10. While ice skating, Natalie fell and landed on her butt. She had pain (cervical, thoracic, coccyx) for a few weeks but no broken bones on x-ray.

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Solutions to exercises A 1. Cytoplasm 2. Genes 3. Mitochondria 4. Endoplasmic reticulum 5. Cell membrane 6. Cell nucleus 7. DNA 8. Chromosomes B 1. Karyotype 2. 46 (23 pairs) 3. 23 4. Anabolism 5. Catabolism 6. Metabolism 7. Histologist 8. Intestines C 1. Larynx 2. Pleura

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3. Pharynx 4. Ureter 5. Adipose tissue 6. Pituitary gland 7. Trachea 8. Cartilage 9. Epithelial tissue 10. Thyroid gland 11. Uterus 12. Urethra D 1. Skull 2. Chest 3. Abdomen 4. Pelvis 5. Spine E 1. Area below the navel 2. Space between the lungs 3. Nerve tissue within the spinal cavity 4. Muscle separating abdominal and thoracic cavities 5. Cartilage pads between two adjacent vertebrae

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6. space surrounding each lung 7. bone tissue surrounding the spinal cavity 8. areas near the groin 9. membrane surrounding the abdominal organs 10. area of the umbilicus 11. area above the stomach F 1. cervical 2. thoracic 3. lumbar 4 sacrum 5. coccyx G 1. left lower quadrant (the abdominal-pelvic cavity) 2. between the fifth lumbar vertebra and the first sacral vertebra (a common site for a herniated disc) 3. right upper quadrant (the abdominal-pelvic cavity). -cavity) 4 .between the third and fourth cervical vertebrae 5. right lower quadrant (of the abdominal-pelvic cavity) H 1. superficial 2. distal 3. prone

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4. lateral 5. ventral (anterior) 6. inferior I 1. lateral 2. distal 3. frontal (coronal) 4. vertebra 5. vertebra 6. inferior 7. midsagi al 8. proximal 9. transverse (axial) 10. superior (head) J 1. craniotomy - incision of the skull 2. cervical - referring to the body neck or cervix 3. chondroma - cartilage tumor (benign or benign tumor) 4. chondrosarcoma - cartilage flesh tumor (cancerous, malignant tumor) 5. nucleus – pertaining to the core

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6. epinephrine - substance (hormone) secreted by the adrenal glands (epi- = top; nephr- = kidney) 7. intravenous - within a vein 8. pharyngeal - affecting the pharynx (throat) 9. laryngitis - inflammation of the Larynx (larynx) K 1. Abdomen or peritoneal cavity 2. Cartilage 3. Chromosomes 4. Diaphragm 5. Larynx 6. sagi al – note spelling with two t 7. Cervical 8. Chondrome 9. Nucleus 10. Trachea L 1. Visceral 2. Sarcoma 3. Thorax 4. Karyotype 5. Mitochondria – memory tip: catabolism and mitochondria, cat and mouse!

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6. mediastinum 7. pituitary 8. epithelial 9. distal 10. superficial M 1. superficial 2. RUQ; LUQ 3. dorsal; often referred to as dorsolithotomy position 4. periumbilical 5. karyotype 6. abdominal 7. RLQ 8. diaphragm 9. respiratory 10. coccyx Answers to practical applications X-ray views

1. sagi al, anterior 2. axial, CT 3. coronal, anterior/posterior Surgical interventions

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1. C A trephine is a type of circular saw used for craniotomy. 2. F 3. H Endoscopic discectomy is performed through a small incision in the back, lateral to the spine. All or part of the disc will be removed. 4. D A small incision is made above the breastbone and an endoscope is inserted to inspect the lymph nodes around the trachea. 5. A 6. E 7. B 8. G A small incision is made near the navel and a laparoscope is inserted. Laparoscopy, or minimally invasive surgery, is used to examine organs and perform many surgical procedures, such as: B. removal of the gallbladder or appendix or tying off the fallopian tubes. Laparoscopy is also called peritoneoscopy. pronunciation of terms

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BEGRIFF Abdomen Bauchhöhle Fettanabolismus Vorderknorpelkatabolismus Zellmembran kephalisch zervikales Chondrom Chondrosarkom Chromosom Steißbein Steißbein Schädelhöhle Kraniotomie Zytoplasma Tiefes Zwerchfell Scheibe distales dorsales endoplasmatisches Retikulum Epigastrische Region Epinephrin Epithelzellen Frontalebene Gene Histologie Hypochondrische Regionen Hypogastrische Region Iliakale untere Leistenregion Intervertebralitis Kehlkopf laterale Lendenwirbelsäule Lendenwirbelsäule lumbosakral mediales Mediastinum Stoffwechsel Mitochondrien Nucleus Beckenhöhle Peritoneum

AUSKUNFT AB-do-men ab-DOM-ih-nal KAV-ih-te AH-dih-pohs ah-NAB-o-liz-im an-TE-re-oder KAR-tih-lij kah-TAB-o- Liz-im-Zelle MEM-Gehirn seh-FAL-ik SER-vih-cool con-DRO-mah con-dro-sar-KO-mah KRO-mo-sohm kok-sih-JE-al KOK-sechs KRA-ne - all KAV-ih-te cra-ne-OT-o-me SI-zu-plaz-im thiefen DI-ah-von der Platte DIS-tal DOR-sal en-do-PLAZ with reh-TIK-u-lum ep - ih-GAS-Trick RE-jen ep-ih-NEF-rin ep-ih-THE-le-al sels FRUN-Number playn jeenz his-TOL-o-je hi-po-KON-dre-ak RE- jens hi -po-GAS-Trick RE-jen IL-e-ak in-FE-re-or IN-gwih-nal RE-jens in-ter-ver-TE-bral in-trah-VE-nus KAIR-e-o -Type lah-rin-JI-tis LAH-rinks LAT-er-al LUM-Balken RE-jens LUM-Balken Whirlpool lum-bo-SA-kral ME-de-al me-de-ah-STI-num meh- TAB - o-lism mi-zu-KON-dre-ah nu-CLA-ik NU-cle-us PEL-vik KAV-ih-te per-eh-zu-NE-um

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DEFINITION pharynx pharynx pituitary pleura pleural cavity posterior prone proximal sacrum sacrum sagial plane sarcoma spinal cavity spinal cord spinal cord superficial upper supine position thoracic cavity thoracotomy thyroid trachea transverse plane tracheal umbilical region ureter urethra uterus abdominal vertebrae vertebrae vertebrae viscera viscera

AUSKUNFT fah-ren-JE-al FAH-rinks pih-TU-ih-ter-e Drüse PLUR-ah PLUR-al KAV-ih-te pos-TE-re-oder prohn PROKS-ih-mal SA-kral SA- krum SAJ-ih-tal playn sar-KO-mah SPI-nal KAV-ih-te SPI-nal KOL-um SPI-nal Cord su-per-FIH-shul su-PE-re-or su-PINE thor-AH -sik KAV-ih-te thor-ah-KOT-o-me THI-royd Drüse TRA-ke-ah TRA-ke-al tranz-VERS playn um-BIL-ih-kal RE-jen U-reh-ter u -RE-thrah U-ter-us VEN-tral VER-sie-brah VER-sie-schreien ver-TE-bral VIS-er-ah VIS-er-al

evaluation sheet

Write the meaning of each combination form, prefix or suffix in the space provided and test yourself. Check your answers against the information in the chapter or Glossary (Medical Parts of Words - English) at the end of the book.

combine shapes

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KOMBINATIONSFORM abdomin/o adip/o anter/o cervic/o chondr/o chrom/o coccyg/o crani/o cyt/o dist/o dors/o hist/o ili/o inguin/o kary/o laryng/o later /o lumb/o medi/o nucle/o pelv/i pharyng/o poster/o proxim/o sacr/o sarc/o spin/o thel/o, theli/o thorakal/o trache/o umbilic/o ventr / o Wirbel/o Eingeweide/o

Prefixes PREFIX anacataepihypointermeta-

IMPORTANCE ___________________ ___________________ ___________________ ___________________ ___________________ ___________________

Suffix

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SUFFIX -al -eal -ektomie -iac -ior -ism -oma -ose -plasm -somes -tomy -typ

Label the regions and quadrants (use abbreviations) of the abdominal-pelvic cavity. Check your answers in the chapter, pages 46 and 47.

Name the divisions of the spine. Review your answers on page 48. Neck area (C1 to C7) __________________________________________________________ ____________ Chest area (T1 to T12) __________________________________________________________ _________ Lower back (lumbar area) (L1 to L5) ___________________________________________ _ Sacrum area (S1 to S5) __________________________________________________________ ___ Coccyx region __________________________________________________________ __________________

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Name the layers of the head as shown below. Check your answers on page 52.

vertical plane dividing the body into front and back parts _____________________________ ______________ horizontal plane dividing the body into upper and lower parts _____________ vertical plane dividing the body into right and left parts ___________________________ Name the positional and directional terms. Check your answers on pages 50-51. Front of the body __________________________________________________________ _________________

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Back of the body __________________________________________________________ __________________ away from the body surface __________________________________________________________ _ on the body surface __________________________________________________________ _______ far from a point of attachment to the trunk or far from the beginning of a structure __________________________________________________________ ______________________________ near a point of attachment to the trunk or near the beginning of a structure __________________________________________________________ ______________________________ below another structure __________________________________________________________ _______________ above another structure __________________________________________________________ ___________ belonging to the side ____________________________________________________ _____________ belonging to the middle _______________________________________________________ ___ _____________ lying on his stomach __________________________________________________________ ________________ lying on his back __________________________________________________________ ________________ Give the meaning of the following cell-related terms. Check your answers with Lesson 1, page 35. Chromosomes __________________________________________________________ ______________

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Mitochondria __________________________________________________________ _________________ Cell nucleus __________________________________________________________ ________ DNA __________________________________________________________ _______ Endoplasmic reticulum _____________________________________________ ______ Cell membrane __________________________________________________________ _______ Catabolism __________________________________________________________ _____ Anabolism __________________________________________________________ _______________________ Metabolism _________________________ Check your answers with Lesson 3, page 45 , which separates the thoracic and abdominal cavities _______________________ Space between the lungs, which contains the heart, trachea, and aorta ________________________ _________ Spine __________________________________________________________ __Cartilage pads between each spine and the next ________________________________________________ FYI: Here are common spine abnormalities.

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CHAPTER 3

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Suffixes CHAPTER SECTIONS: Introduction 72 Combining Forms 72 Suffixes and Terminology 74 Taking a Closer Look 82 Practical Applications 88 Exercises 88 Solutions to Exercises 96 Pronunciation of Terms 98 Review Sheet 100

CHAPTER OBJECTIVES • Define new suffixes and review those introduced in previous chapters. • Gain practice in word analysis by using these suffixes with combinations of forms to form and understand concepts. • Identify the functions of the different types of blood cells in the body.

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Introduction In this chapter you will come across many of the most common suffixes in medical language. As you work through the entire book, these suffixes will come up often. An additional group of suffixes is presented in Chapter 6. This chapter introduces additional combination forms that can be used to form words with suffixes. Your mastery of this material and your analysis of the words in the Suffixes and Terminology section will expand your medical vocabulary.

combine shapes

Use the following list of combination forms when writing the meanings of the terms starting on page 74.

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KOMBINATIONSFORM abdomin/o acr/o acu/o aden/o adip/o amni/o angi/o arteri/o arthr/o axill/o bi/o blephar/o bronch/o carcin/o cardi/o chem/o chondr /o chron/o col/o zyste/o enzephal/o erythr/o hem/o hepat/o hydr/o inguin/o isch/o lapar/o laryng/o leuk/o lymph/o mamm/o mast/ o morph/o muc/o my/o myel/o necr/o nephr/o neur/o neutr/o nucle/o ophthalm/o opi/o oste/o ot/o path/o

MEANING Abdomen Extremities, above, extreme tip sharp, strong, sudden Glandular fat Amnion (sac surrounding the embryo in the uterus) Vessel Artery Joint Armpit Life Eyelid Bronchi (two tubes, one right and one left, branching off the trachea to lungs) cancer heart drug, chemical cartilage time colon (colon) urinary bladder brain red blood liver water, fluid groin abdomen, abdominal wall larynx white lymph Clear fluid that washes between tissues and is contained in lymphatic vessels and nodes throughout the body. breast breast shape, phlegm muscle spinal cord shape; Bone marrow Context of use indicates the meaning intended. Death (of cells or whole body) Kidney Nerves Neutrophils (a white blood cell) Cell nucleus Eye Opium Bone Ear Disease

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KOMBINATIONSFORM peritone/o phag/o phleb/o plas/o pleur/o pneumon/o pulmon/o radi/o rect/o ren/o rhin/o sarc/o spleen/o staphyl/o strept/o thorac/o Thromb /o Mandel/o Luftröhre/o Ven/o

MEANING peritoneum to eat, to swallow venous formation, development pleura (membrane that surrounds the lungs and abuts the chest wall) lungs lungs x-rays rectum kidney nose meat spleen cluster twisted chains chest clot tonsils trachea (trachea) vein

Encephal/o, Cerebr/o, Cephal/o, Crani/o and Psych/o Don't confuse the meanings of these combination forms! Encephal/o = brain Cerebr/o = cerebrum (largest part of the brain) Cephal/o = head Crani/o = skull Psych/o = spirit

Larynx and other body parts ending in x coccyx = coccyx larynx = larynx pharynx = larynx = finger or toe

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To create combination shapes for body parts ending in x, replace x with g: coccyg/o laryng/o pharyng/o phalang/o

Suffixes and Terminology Noun Suffixes After the meaning of each suffix, the terminology illustrates the use of that suffix. Remember the basic rule for forming a medical term: use a connecting vowel, such as B. o to connect the root with the suffix. However, omit the combining vowel if the suffix begins with a vowel—e.g., gastr/itis, not “gastr/o/itis”. From page 82 further details on certain terms are given. This section, titled A Closer Look, will give you a fuller understanding of the terminology.

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SUFFIX -Algae

MEANING Pain

-the

Hernia (see Look Closer: Hernia, page 82) Puncture to remove fluid

-Percent

-kokken (singular) -kokken (plural)

berry-shaped bacterium (plural: bacteria)

-cyte

cell

-Pumpkin

Pains

-ectomy

Excision, removal, resection Blood condition

-ämie

-Genesis

state of production, design

(Video) The Language of Medicine Ch1: Basic Word Parts/Intro to Medical Terminology

TERMINOLOGY MEANING Arthralgia ________________________ Otalgia ______________________________________ Neuralgia ______________________________________ Myalgia ______________________________________ Fibromyalgia is a common chronic condition associated with widespread pain in the muscles and fibrous tissues around the joints. Rectocele ______________________________________ Cystocele ______________________________________

Thoracentesis ______________________________________ Note that this term is abbreviated from thoracentesis. Amniocentesis ______________________________________ The amnion is the sac (membrane) that surrounds the embryo (fetus after 8 weeks) in the uterus. Fluid collects in the amnion and can be drawn for analysis between 12 and 18 weeks of pregnancy. See Figure 3-1. Abdominocentesis ______________________________________ This procedure is commonly known as abdominal paracentesis (para means next to or near). A tube is placed through an abdominal incision and fluid is removed from the abdominal cavity (next to the abdominal organs). Streptococci ______________________________________ Staphylococci ______________________________________ (stah-ﬁh-lo-KOK-si) Microbiologists often refer to bacteria in clusters as “staphylococci”. See Taking a Closer Look: Streptococci, Staph, and Other Bacteria, page 83. Red Cells ______________________________________ See Taking a Closer Look: Blood Cells, page 84. White Cells ______________________________________ Platelets ________________________ Pleurodynia ______________________________________ Pain in the muscles of the chest wall, aggravated by breathing. Laryngectomy ______________________________________ Mastectomy ______________________________________ Anemia ______________________________________ Ischemia ______________________________________ Literally: withholding (isch/o) blood (-emia) from a body part or tissue. Hypoperfusion (blood clots in a vessel or narrowing and occlusion of a vessel) causes tissue to become ischemic and even die if deprived of oxygen for long enough. TIP: You may be familiar with a TIA (Transient Ischemic Ack), which is a "mini-stroke" that occurs when blood is trapped from tissues in the brain. Carcinogenesis ______________________________________ Pathogenesis ______________________________________ Angiogenesis ______________________________________

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SUFFIX -Gram -Graphic -Graphic -itis

-logie -lyse

-malazie -megaly

- own

-aside

-or

-pathie

MEANING Record

TERMINOLOGY MEANING Electroencephalogram ________________________ Mammogram ______________________________________ Instrument Electroencephalograph for recording ______________________________________ Process of Electroencephalography Recording _______________________ Angiography _______________________ Inflammation Bronchitis ________________________ Myelitis ______________________________________ Myel/o in this term means spinal cord. Tonsillitis ______________________________________ Tonsils (note the single letter spelling, while the combination form has a double letter) is lymphoid tissue at the back of the throat. See Figure 3-2. Thrombophlebitis ______________________________________ Also called phlebitis. Study of ophthalmology ______________________________________ Morphology ______________________________________ Breakdown, hemolysis ______________________________________ Destruction, normal breakdown of red blood cells. Excessive destruction of the detached red blood cells can lead to a type of anemia called hemolytic anemia. softening osteomalacia ______________________________________ chondromalacia ______________________________________ enlargement acromegaly ______________________________________ See more specifically: acromegaly, page 86. splenomegaly _______________________________________ tumor, mass, fibroid ____________________ Accumulation of a benign tumor. Liquid myosarcoma _______________________________________ A malignant tumor. Muscle is a type of flesh tissue (sarc/o). Multiple Myeloma _______________________________________ Myel/o in this term means bone marrow. This malignant tumor occurs in bone marrow tissues throughout the body. Hematoma _______________________________________ for viewing Biopsy _______________________________________ Necropsy _______________________________________ This term is used in veterinary medicine. An autopsy is an autopsy performed on people. Condition, Necrosis _______________________________________ Normal Hydronephrosis Abnormal _______________________________________ Leukocytosis _______________________________________ Disease Cardiomyopathy Condition _______________________________________ Primary disease of the heart muscle with no known underlying etiology (cause).

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SUFFIX -Penny

-Phobia

-place

- plastics

-Ptosis -Rrhoe -Sklerose -Scope -Skopie

-Stasis

-Magen

MEANING deficiency

TERMINOLOGY MEANING Erythropenia _______________________________________ Neutropenia _______________________________________ In this term, neutr/o means neutrophilic (a type of white blood cell). Thrombocytopenia _______________________________________ Anxiety Fear of heights _______________________________________ Fear of heights. Acr/o means extremities in the sense of extreme or far points. TIP: Think of acrobats performing high-wire acts. Agoraphobia _______________________________________ Agora means marketplace. This is an anxiety disorder characterized by fear of being outside alone, in open or closed places, or using public transportation. Development, formation of achondroplasia, _________________________ growth This is a hereditary disease or can be the result of a mutation (change) in a specific gene. The bones of the arms and legs do not grow to their normal size due to a defect in cartilage and bone formation. Dwarfism occurs, characterized by short limbs but normal sized head and torso and normal intelligence. See Figure 3-3. Surgical Angioplasty __________________________ Reconstruction An interventional cardiologist opens a narrowed blood vessel (artery) with a balloon, which is inflated after it is inserted into the vessel. Stents, or sloed tubes, are then inserted to keep the artery open. Drooping, Blepharoptosis _________________________________ Traps, Doctors use ptosis (TO-sis) alone to indicate drooping or drooping of the upper eyelids or breasts. See Figure 3-4. Drainage, rhinorrhea ________________________________ Drainage hardening atherosclerosis _________________________________ In atherosclerosis (a form of atherosclerosis), fatty deposits (ather/o means fatty material) accumulate in an artery. Instrument Laparoscope _________________________________ for visual examination Process of laparoscopy _________________________________ visual See Figure 3-5B below and Look More Closely: Laparoscopy, examination page 86. (with an endoscope) control, metastasis _________________________________ stopping meta- means beyond. A metastasis is the spread of a malignant tumor beyond its original site to a secondary organ or site. Hemostasis _________________________________ Blood flow is stopped naturally by occluding or artificially by compressing or suturing a wound. A hemostat is a surgical clamp used in operating rooms to stop blood flow. Opening to colostomy _________________________________ Making tracheostomy _________________________________ Mouth (stoma)

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SUFFIX -Therapy

-to my

-Trophy

MEANING treatment

TERMINOLOGY MEANING Hydrotherapy _________________________________ Chemotherapy _________________________________ Radiation therapy _________________________________ High-energy radiation is used to treat, not diagnose, disease. Incision, Laparotomy _________________________________ Lancing This procedure, also known as a “lap,” involves making a large incision in the peritoneal cavity, often on a probing basis. Do not confuse laparotomy with laparoscopy. See Figure 3-5. Phlebotomy _________________________________ Tracheostomy _________________________________ See A Closer Look: Tracheostomy, page 87. Development, Hypertrophy _________________________________ Nutrition (hy-PER-tro-fe) Cells increase in size, not number. Muscles in weightlifters often hypertrophy. Atrophy _________________________________ Cells decrease in size. Muscles atrophy when immobilized in a cast and not used.

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Figure 3-1 Amniocentesis. Under ultrasound guidance (imaging based on high-frequency sound waves), the doctor inserts a needle through the wall of the uterus and the amniotic fluid into the amniotic cavity. Amniotic fluid, which contains fetal cells, is collected and grown (cultured) for microscopic analysis. A karyotype is made to examine chromosomes. The fluid is examined for chemicals that indicate fetal defects.

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Figure 3-2 Tonsillitis. This shows a streptococcal tonsillitis with severe erythema (redness) of the tonsils (see arrows) and a cream-yellow exudate (pus with leukocytes and bacteria). Normally, tonsils contain lymphocytes that fight bacteria. If they become infected and inflamed, a tonsillectomy may be necessary.

Figure 3.3 Achondroplasia. A boy with achondroplasia. Its anomalies include short stature with a normal trunk length, short limbs and fingers, crooked legs, a prominent forehead, and a depressed bridge of the nose. (Courtesy of A.E. Chudley, MD, Department of Genetics and Metabolism, Department of Pediatrics and Child Health, Children's Hospital, Winnipeg, Manitoba, Canada.)

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Figure 3.4 Upper eyelid ptosis (blepharoptosis). This condition can be congenital (present at birth), occur with age, or be associated with a stroke (cerebrovascular accident), damage to the cranial nerves, and other neurological disorders. The eyelid droops due to muscle weakness.

FIGURE 3-5 A. Laparotomy. This large incision was closed with surgical staples. B. Laparoscopy. The abdomen is examined through small incisions and with a laparoscope. This procedure is often used to examine and remove organs such as the appendix and gallbladder.

The following are shorter noun suffixes usually associated in rooted words.

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SUFFIX MEANING -er someone who -ia

-ist -oid -ole -ule -um, ium -us -y

TERMINOLOGY MEANING X-ray technician _________________________________ A technician who assists in the production of diagnostic X-ray images. Disease Leukemia _________________________________ This is a group of cancers that starts in the bone marrow and leads to a high number of abnormal, immature white blood cells. Pneumonia _________________________________ Specialist Nephrologist _________________________________ Similar, Opioid _________________________________ Derived from Adenoids _________________________________ See A Closer Look: Adenoids, page 87. Small, small arterioles _________________________________ See Figure 3-6. small, small venule _________________________________ See Figure 3-6. Structure, Pericardium _________________________________ Tissues This membrane surrounds the heart. Structure, mucus _________________________________ Substance Esophagus _________________________________ Eso- means within or within. condition, nephropathy _________________________________ process (neh-FROP-ah-the)

FIGURE 3-6 Relationship of blood vessels. An artery carries oxygen-rich blood from the heart to the body's organs. In the organs, the arteries narrow into arterioles (small arteries), which branch into capillaries (the smallest blood vessels). Oxygen leaves the blood through the thin walls of the capillaries and enters the cells. Therefore, the capillaries, which branch into venules (small veins), carry deoxygenated blood. Venules lead to a vein that returns deoxygenated blood to the heart.

Adjective Suffixes There is no simple rule to explain which suffix meaning "belonging to" is used with a particular combination form. Concentrate on identifying the suffix in each term; Then write down the meaning of the term. For a list of suffixes meaning "belonging to", see the Glossary of Word Parts starting on page 967.

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SUFFIX MEANING -ac, -iac in relation to -al in relation to

-ar -and

in relation to in relation to

-eal -genic

relating to relating to manufacture, produced by or in -ic, -ical relating to

-ose -ous -tic

TERMINOLOGY MEANING Heart _________________________________ Peritoneal _________________________________ Groin _________________________________ Myocardium _________________________________ A myocardial infarction (MI) is a heart attack. An infarction is an area of dead tissue (necrosis) that results from ischemia (lack of blood supply to that tissue). Larynx _________________________________ carcinogenic _________________________________ osteogenic _________________________________ An osteogenic sarcoma is a malignant tumor that develops in the bone.

chronic _________________________________ Acute is the opposite of chronic. It describes a disease that begins quickly and has severe symptoms and a short duration. pathological _________________________________ pertaining to, obese _________________________________ fully pertaining to mucous membrane _________________________________ Mucous membranes (an adjective) produce the sticky secretion called mucus (a noun). in relation to necrotic _________________________________

formation of plural forms

Words ending in -us usually form their plural by dropping -us and adding -i. More examples of plural formation after -us follow: nucleus → nuclei bronchus → bronchis thrombus → thrombi For more information on plural formation, see Appendix I at the end of the book.

Anämie

While anemia literally means "no blood," it is actually a condition characterized by a reduction in the number of red blood cells, or the amount of hemoglobin in the blood. Examples of types of anemia are:

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• Iron deficiency anemia (iron is needed to make hemoglobin) • Sickle cell anemia (erythrocytes assume an abnormal sickle shape and block blood vessels) • Aplastic anemia (erythrocytes, leukocytes, and platelets are not produced in the bone marrow)

Splenomegaly

The spleen is an organ in the left upper quadrant (LUQ) of the abdomen (below the diaphragm and to the side of the stomach). It is made up of lymphoid tissue and blood vessels, disposes of dying red blood cells and contains white blood cells to fight disease. Splenomegaly occurs with the development of hypertension in hepatic veins and hemolytic blood diseases (anemias with excessive destruction or lysis of red blood cells). If the spleen is removed (splenectomy), other organs take over its function.

Common surgical repair procedures

Popular methods are:

Abdominoplasty - Abdomen Mammoplasty - Breast Blepharoplasty - Eyelid Rhinoplasty - Nose

Opioid

An opioid is a drug derived from the opium poppy plant. Opioids, also known as narcotics (narc/o means stupor or sleep), include heroin, fentanyl, oxycodone (OxyContin), hydrocodone (Vicodin), codeine, and morphine. These drugs act on brain receptors to reduce pain. Opioid abuse increases the risk of addiction, overdose, and death. A drug called buprenorphine treats opioid addiction. While relieving acute and chronic pain, it minimizes withdrawal symptoms. Narcan (naloxone) is a drug used to counteract the effects of a life-threatening opioid overdose.

Axillary lymph nodes and breast cancer

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Breast cancer cells often spread to axillary lymph nodes. When this occurs, the tumor found in the axillary lymph nodes is a breast cancer metastasis. The first lymph node to which the cancer is most likely to spread is called the axillary sentinel node. It is removed and biopsied during the mastectomy or lumpectomy to determine if the cancer has spread (metastasized) beyond the breast.

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A Closer Look Hernia A hernia is a protrusion of an organ or the muscular wall of an organ through the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes up through the esophageal opening in the diaphragm into the mediastinum (Figure 3-7). A hernia occurs when part of the bowel protrudes down into the groin area, and usually into the scrotum in men. A cystocele occurs when part of the urinary bladder ruptures through the vaginal wall as a result of weakness in the pelvic muscles (Figure 3-8). A rectocele is the bulging of part of the rectum toward the vagina (Figure 3-8). An omphalocele (omphal/o = navel, navel) is an intestinal prolapse caused by a weakness in the abdominal wall around the navel that occurs in infants at birth. See Figure 3-9.

Figure 3-7 Hiatal hernia. Consequences of a hiatal hernia include reflux of stomach contents and acid into the esophagus, resulting in esophagitis. This inflammation causes chest pain, commonly mistaken for a heart attack, and known as "heartburn."

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Figure 3-8 Hernias: cystocele and rectocele. Arrows point to areas of herniation. In a cystocele, part of the bladder protrudes backwards toward the vagina. In a rectocele, part of the rectum protrudes anteriorly toward the vagina.

Figure 3.9 Omphalocele. This baby was born with a large omphalocele containing intra-abdominal viscera. His parents were advised to wait and have surgery when his abdominal muscles grew large enough to close over the hernia. Surgery was performed after 7.5 months to permanently repair the hernia.

Streptococci, Staphylococci, and Other Bacteria Streptococci, a berry-shaped bacterium, grow in twisted chains. One group of streptococci causes conditions such as "strep throat," tonsillitis, rheumatic fever, and certain kidney diseases, while another group causes infections in the teeth, the sinuses (cavities) of the nose and face, and the heart valves. Staphylococci, other berry-shaped bacteria, grow in small clusters like grapes. Staph lesions can be external (skin abscesses, boils, styes) or internal (bone and kidney abscesses). An abscess is a collection of pus, white blood cells, and protein present at the site of infection. MRSA (methicillin-resistant Staphylococcus aureus) is a

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severe staph disease that is difficult to treat with antibiotics. It can become an antibiotic-resistant infection if the MRSA bacteria develop the ability to resist or defeat the drugs designed to kill them. Examples of diplococci (berry-shaped bacteria organized in pairs; dipl/o = two) are pneumococci (pneum/o = lungs) and gonococci (gon/o = seeds). Pneumococci cause bacterial pneumonia, and gonococci invade the reproductive system and cause gonorrhea (a sexually transmitted infection). Figure 3-10 illustrates the different growth patterns of streptococci, staphylococci, and diplococci.

Figure 3-10 types of cocci bacteria. Note the berry or round shape of each bacterium. Streptococci and staphylococci are gram-positive bacteria, which means that they retain the light purple color of the stain used in the Gram method (named after Hans C.J. Gram, Danish physician, 1853-1938). Gram-negative bacteria (such as diplococci) have the pink color of the counterstain (safranin) used in the Gram method.

Another group of bacteria is not round but rod-shaped. An example is the bacterium Clostridium diﬃcile. C. diﬃcile infection, which causes inflammation of the colon and severe diarrhea, is common in patients who take antibiotics for a long time. This is because C. diﬃcile bacteria can become resistant to these antibiotics. Stool transplantation (bacteriotherapy) may be needed to restore normal bacteria to the digestive tract. This is the transfer of stool containing normal bacteria from a healthy donor into the colon of a patient with chronic C. diﬃcile infection.

Blood Cells As you read the following, refer to Figure 3-11 to see the differences between the three different cell types in blood.

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FIGURE 3-11 Types of blood cells. TIP: Here's an easy way to remember the names of the five leukocytes: Never (Neutrophils) Let (Lymphocytes) Monkeys (Monocytes) Eat (Eosinophils) Bananas (Basophils)

Erythrocytes or red blood cells are the first type. These cells are made in the bone marrow (soft tissue in the middle of certain bones). They transport oxygen from the lungs via the blood to all body cells. Body cells use oxygen to burn food and release energy (catabolism). Hemoglobin (globin = protein), an important protein in erythrocytes, transports oxygen through the bloodstream.

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LEUKOCYTES, or white blood cells, are the second type. There are five different types of leukocytes: three granulocytes, or polymorphonuclear cells, and two mononuclear cells.

• Granulocytes contain dark colored granules in their cytoplasm and have a multilobed nucleus. They are made in the bone marrow. There are three types: 1. Eosinophils (granules turn red [eosin/o = rosy] with an acidic colour) are more common in allergic diseases such as asthma. About 3% of leukocytes are eosinophils. 2. Basophils (granules stain blue with basic [bas/o = basic] staining). The function of basophils is not clear, but the number of these cells increases during the healing phase of inflammation. Less than 1% of leukocytes are basophils. 3. Neutrophils (granules staining pale purple with neutral staining) are the most important disease-fighting cells and the most numerous. About 50% to 60% of all leukocytes are neutrophils. They are phagocytes (phag/o = eat, swallow) - they gobble up and digest bacteria like circulating "Pac-Men". Neutrophils are called "polys" or polymorphonuclear leukocytes (poly = many, morph/o = shape) because of their multilobed nucleus. • Mononuclear cells have a large nucleus (mononuclear) and only a few granules in their cytoplasm. They are produced in the bone marrow, as well as in the lymph nodes and spleen. There are two types of mononuclear leukocytes (see Figure 311):

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4. Lymphocytes (lymph cells) fight disease by producing antibodies, thereby destroying foreign cells. They can also directly bump into foreign cells and destroy them. Two types of lymphocytes are T cells and B cells. About 32% of white blood cells are lymphocytes. In AIDS (acquired immune deficiency syndrome), patients suffer from severe depletion of T lymphocytes (T cells). 5. Monocytes (which contain a [mon/o = a] very large nucleus) engulf and destroy cellular debris after neutrophils have suffered an attack on foreign cells. Monocytes leave the bloodstream and invade tissues (such as the lungs and liver) to become macrophages, which are large phagocytes. Monocytes make up about 4% of all leukocytes. See Table 3-1 to review the five types of leukocytes. Each type fights infection in a specific way. This is similar to the five branches of the armed forces (Navy, Army, Air Force, Navy, and Coast Guard), each with specific capabilities and procedures. TABLE 3-1 FIVE TYPES OF LEUKOCYTES (WHITE BLOOD CELLS)

Thrombocytes or platelets (guard cells) are the third type of blood cell. These are actually tiny fragments of cells that are made in the bone marrow and are necessary for blood closure.

Acromegaly Acromegaly is an endocrine disorder. It occurs when the pituitary gland, which hurts at the base of the brain, produces an excessive amount of growth hormone after puberty is complete. The excess growth hormone usually results from a benign tumor of the pituitary gland. A person with acromegaly is usually of normal height because the

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p g y yp y g Long bones stopped growing after puberty, but bone and soft tissues in the hands, feet, and face grow abnormally (Figure 3-12). It was believed that Abraham Lincoln had traits of acromegaly. See Chapter 18, Endocrine System, page 699. Gigantism is the result of an overproduction of pituitary growth hormone that begins in childhood.

Figure 3.12 Acromegaly. Note the changes in facial features (broadening of the nose and jaw) and enlargement of my grandmother Bessie Brandwein's hands.

Laparoscopy Laparoscopy (a form of minimally invasive surgery) is a visual examination of the abdominal cavity using a laparoscope. A surgeon inserts the laparoscope, a lighted telescopic instrument, through an incision in the abdomen near the navel. Then gas (carbon dioxide) is infused into the peritoneal cavity to separate and prevent injury to abdominal structures during surgery. Surgeons use laparoscopy to examine abdominal viscera for signs of disease (taking biopsies) or for procedures such as removal of the appendix, gallbladder, adrenal gland, spleen, or ovaries; resection of the colon; and hernia repair. In tubal ligation, the laparoscope contains an instrument to clamp and collapse the fallopian tubes, preventing sperm from reaching the eggs exiting the ovary (Figure 3-13).

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Figure 3.13 Laparoscopy for tubal ligation (rupture of tubal continuity) as a means of preventing future pregnancy. The vaginal speculum keeps the vaginal cavity open. The uterine cannula is a tube that is inserted into the uterus to manipulate the uterus during the procedure. Forceps passed through the laparoscope grasp or move tissue.

Tracheostomy A tracheostomy is an incision in the windpipe, typically done to open it below a blockage. A tracheotomy may be performed to remove a foreign body or to obtain a biopsy sample (Figure 3-14A).

FIGURE 3-14 A, tracheostomy. B, tracheostomy.

A tracheostomy is an opening in the windpipe through which an indwelling tube is inserted. The hose must allow air to flow in

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the lungs or to clear secretions (mucus) from the bronchi. If a temporary tracheostomy is performed, extreme care is taken when inserting the tracheostomy tube under the larynx to avoid damaging the vocal cords (Figure 3-14B).

Adenoids The adenoids are small collections of lymphoid tissue in the part of the pharynx (throat) near the nose and nasal passages. The literal meaning "glandular-like" is appropriate since they are neither endocrine nor exocrine glands. Enlargement of the adenoids can result in airway obstruction from the nose to the pharynx, and adenoidectomy may be advised. The tonsils are also lymphoid tissue and their location, along with that of the adenoids, is shown in Figure 3-15.

Figure 3.15 Polyps and tonsils. The adenoids and tonsils are lymphoid tissues in the pharynx (throat).

Practical application procedures and their definitions Choose the correct diagnostic or treatment procedure for each of the numbered definitions. See page 97 for answers. Amniocentesis

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Angiography Angioplasty Colostomy Laparoscopy Laparotomy Mastectomy Paracentesis (abdominocentesis) Thoracentesis Tonsillectomy 1. Removal of abdominal fluid (ascites) from the peritoneal space _________________________________ 2. Large abdominal incision to remove ovarian adenocarcinoma _________________________________ 3. Removal of the breast _________________________________ 4. A method of determining the karyotype of a fetus _________________________________ 5. Surgical procedure to remove pharyngeal lymphoid tissue _________________________________ 6. Surgical procedure to open blocked coronary arteries _________________________________ 7. Method to remove fluid from the chest (pleural effusion) _________________________________ 8. Procedure to drain waste from the body after bowel resection _________________________________ 9. X-ray procedure to examine blood vessels before surgery ____ _____________________________ 10. Minimally invasive procedure ry inside the abdomen _________________________________

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Exercises Remember to check your answers carefully against the answers to the exercises on pages 96 and 97.

A Give the meaning of the following suffixes. 1st -cele ________________ ____ 2nd -emia _____________________________________________ ____ 3rd -coccus ________________ 4th -gram _____________________________ ____ 5th -cyte ______________ 6th -algae ________________ 7th -ectomy _____________________________________________ ____ 8th -centesis _____________________________________________ ____ -genesis _____________________________________________ ____

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10. -Graph _____________________________________________ ____ 11. -itis _____________________________________________ ____ 12. -Graphy _____________________________________________ ____ B Using the combination forms listed and your knowledge of the suffixes, form medical terms for the following definitions. amni/o angi/o arthr/o bronch/o karzin/o cyst/o isch/o larynx/o mast/o my/o myel/o rhin/o staphyl/o strept/o thorac/o 1. hernia of the Bladder _____________________________________________

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2. Muscle pain ___________________________________________ 3. Process of carcinogenesis ___________________________________________ 4. Inflammation of the spinal cord ___________________________________________ 5. Berry-shaped bacteria in tangled chains ___________________________________________ 6. Surgical puncture to remove fluid from the breast ___________________________________ 7. Removal of the breast __________________________________________ 8 Inflammation of the tubes leading from the Leading the trachea to the lungs __________________________________________ 9. Retaining blood from cells __________________________________________ 10. Procedure of recording (X-ray) blood vessels ___________________________________ 11. Visual inspection of joints __________________________________________ 12. Berry-shaped bacteria in clusters __________________________________________ 13. Laryngeal resection __________________________________________ 14. Surgical intervention caustic procedure for removing fluid from the sac around a fetus

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C Match the given terms that describe blood cells with the following meanings. basophil eosinophil erythrocyte lymphocyte monocyte neutrophil platelet 1. granulocytic white blood cells (granules turn purple) that destroy foreign cells by engulfing and digesting them; also called polymorphonuclear leukocytes __________________________________________ 2. mononuclear white blood cells that destroy foreign cells by producing antibodies ________________________________________________ ________________ 3. closing cell; also called platelets _________________________________________________ 4. Leukocytes with reddish colored granules and increased number in allergic reactions ________________________________________________ __________ 5. Red blood cells ___________________________________________ 6. Mononuclear white blood cells that absorb and digest cell debris; contains a large cell nucleus ________________________________________________ ____________________

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7. granulocytic white blood cells increasing during the healing phase of inflammation ________________________________________________ _____________________ D Give the meaning of the following suffixes. 1. -logy ___________________________ 2. -lysis _____________________________ 3. -pathy ___________________________ 4. -penia ___________________________ 5. -malacia ___________________________ 6. -osis ______________ 7. -phobia ___________________________ 8. -megaly ______________________________ 9. -oma ________________ 10 11. -plasia _____________________________ 12. -Plastic ____________________________ 13. -Sclerosis _______________________ 14. -Stasis _______________________ E Using the combination forms below and your knowledge of the suffixes, construct medical terms for the following definitions. acr/o arteri/o bi/o blephar/o cardi/o chondr/o

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hem/o hydr/o morph/o my/o myel/o Phleb/o rhin/o sarc/o splen/o 1. Enlargement of the spleen __________________________________________ 2. Examination of the shape (of cells) __________________________________________ 3. Cartilage softening __________________________________________ 4. Abnormal State of the water (fluid) in the kidney __________________________________________ 5. Disease state of the heart muscle __________________________________________ 6. Hardening of the arteries __________________________________________ 7. Tumor (benign) of the muscle __________________________________________ 8. Skin tumor (malignant) of the muscle __________________________________________ 9. Rhinoplasty surgery __________________________________________ 10. Bone marrow tumor __________________________________________

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11. Fear of heights __________________________________________ 12. View of living tissue under the microscope __________________________________________ 13. Hemostasis (by mechanical or natural means) __________________________________________ 14. Inflammation of the eyelid __________________________________________ 15. Incision in a vein __________________________________________ F Indicate the plural formations of the following terms: 1 Bacterium _______________________ 2. Metastases _________ 3. Vertebrae _______________________ 4. Streptococci _______________________ 5. Cell nucleus _______________________ 6. Prognosis _______________________ G Match the following terms to their meanings. Achondroplasia Acromegaly Atrophy Chemotherapy Colostomy Hydrotherapy Hypertrophy Laparoscope Laparoscopy

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metastatic necrosis osteomalacia 1. drug treatment _____________________________________________ _ 2. state of death (of cells) ___________________________ _ 3. bone softening ___________________________ _ 4. opening of the colon to the outside of the body _____________ _ 5. no development; shrinkage of cells __________________________________________ _ 6. out of control; Spread of a malignant tumor to another organ _____________________________________________ _ 7. Instrument for visual examination of the abdomen _____________ _ 8. Enlargement of extremities; an endocrine disorder that causes the pituitary gland to produce excess growth hormone after puberty _____________________________________________ _

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9. State of malformation of cartilage in the embryo, leading to short bones and dwarfism _____________ _ 10. Procedure of viewing the abdominal cavity ___________________________ _ 11. Treatment with water _______________ _ 12. Overdevelopment of cells (enlargement of individual cells) _____________________________________________ _ H Give Check out the meaning of the following suffixes. 1st -ia _______________________ 2nd -trophy _________ 3rd -stasis _________ 4th -stomy _________ 5th -stomy _________ 6th -ole _________ 7th -um _________ 8th -ule _________ 9th -y _________ 10th -oid _________ 11. -genic ________________________ 12. -ptosis ________________________

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I Use the following lists of combined forms and suffixes to form medical terms for the following definitions. COMBINING FORMS arteri/o pleur/o lapar/o pneumon/o mamm/o radi/o nephr/o ven/o

SUFFIXE -dynia -ectomy -gram -ia

-ole -pathy -plasty -scopy

-Therapie -Tom -ule

1. Abdominal incision _____________________________________________ _ 2. Visual examination of the abdomen _____________________________________________ _ 3. A small artery ___________________________ _ 4. Condition of the lungs _________________________ _ 5. Treatment with X-rays _________________________ _ 6. Photograph (X-ray film) of the chest _____________________________________________ _ 7. Pain in the chest wall and the membranes surrounding the lungs _____________ _ 8. a small vein _____________________________________________

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_ 9. Kidney disease ________________ _ 10. Surgical correction of the breast ___________________________ _ J Underline the ending in the following terms and give the meaning of the entire term. 1. Larynx _____________________________________________ _ 2. Inguinal _____________________________________________ _ 3. Chronic _____________________________________________ _ 4. Pulmonary _____________________________________________ _ 5. Fat _____________________________________________ _ 6. Peritoneal _____________________________________________ _ 7. Axillary _____________________________________________ _

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8. Necrosis _____________________________________________ _ 9. Opioid _____________________________________________ _ 10. Phlegm _____________ _ 11. Agoraphobia ___________________________ _ 12. Esophagus __________________________ _ K Choose from the blood and blood vessel terms listed to complete the following sentences. anemia angioplasty arterioles hematoma hemolysis hemostasis ischemia leukemia leukocytosis multiple myeloma myocardial neutropenia

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Thrombocytopenia Venules 1. Billy has been diagnosed with an excessively high cancerous white blood cell count or _________________. His doctor prescribed chemotherapy and expected an excellent prognosis. 2. Mr Clark's angiogram showed that he had severe atherosclerosis of one of the arteries that supplied blood to his heart. His doctor recommended that ________________ open his blocked artery by inserting a catheter (tube) through his artery and popping a balloon at the end of the catheter to widen the artery. 3. Due to the shock of multiple foot strikes, long-distance runners may experience a breakdown of red blood cells called _____________________. This condition, which leads to excessive loss of blood cells, is called runner's ________. 4. The doctors refused to operate on Joe because of his low platelet count, a condition called ______________________. 5. The blockage of an artery leading to Mr. Stein's brain resulted in blood flow to the nerve tissue in his brain being blocked. This condition, called _____________________, can lead to tissue necrosis and stroke. 6. Small arteries, or ______________________, were fractured under Ms. Bein's head when she was hit on the head with a rock. She soon developed a lot of blood, a/an

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________________________, under the skin in that region of her head. 7. Sarah Jones had a staph infection that caused her white blood cell count to rise, known as _____________________________. She was treated with antibiotics and her blood count returned to normal. 8. Inside the body, the bone marrow (soft tissue inside the bones) is the "factory" for making blood cells. Mr. Sco developed _____________________________, a malignancy of the bone marrow cells in his hip, upper arm and femur. 9. During surgery, surgeons use clamps to occlude blood vessels and prevent blood loss. In this way they receive ___________________ and avoid blood transfusions. 10. Small vessels that carry blood from capillaries and tissues to the heart are _____________________. 11. Chemotherapy causes the destruction of rapidly dividing cancer cells as well as rapidly dividing normal white blood cells. This lack of white blood cells is a side effect of chemotherapy known as _____________________. 12. An acute _____________________________ myocardial infarction is the medical term for a heart attack. L Complete the medical term for the following definitions.

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DEFINITION 1. Membrane surrounding the heart 2. Hardening of the arteries 3. Enlargement of the liver 4. New opening of the trachea to the outside of the body 5. Inflammation of the tonsils 6. Surgical puncture to remove fluid from the abdomen 7. Muscle pain 8. Affects the membranes surrounding the lungs 9. Examination of the eye 10. Clusters of berry-shaped (spherical) bacteria 11. Uncontrollable (spreading of a cancerous tumor) 12. Affects the larynx

MEDICAL TERMS peri ______________________ artery ________ liver ________ trachea ______________________ ____________________ abdominal inflammation ________ my ________ _______ al ______ logie ____ cocci meta ________ ______ eal

M Select from the meanings in column II to match the suffixes in column I. Write each meaning in the space provided. COLUMN I Suffixes: Conditions 1. -Algia or -Dynia ___________________________________ 2. -Cele ___________________________________ 3. -Megaly ___________________________________ 4. -Grandma ___________________________________ 5. -Penie ___________________________________ 6. -Phobia ___________________________________ 7. -Plasia ___________________________________ 8. -Emie ___________________________________ 9. -itis ___________________________________ 10. -Trophy ___________________________________ 11. -Stasis ___________________________________ 12. -Sclerosis ___________________________________ 13. -Lysis ___________________________________ 14. -Ptosis ___________________________________ 15. -Malacia ___________________________________

COLUMN II Meaning Control of blood condition; stop deficiency destruction; breakdown development; food falls; drooping; prolapse enlargement anxiety induration induration hernia inflammation pain softening tumor; Dimensions

N Choose from the meanings in column II to match the suffixes in column I. Write each meaning in the space provided.

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COLUMN I Suffixes: Procedure 1. -Puncture ___________________________________ 2. -Opsia ___________________________________ 3. -Ectomy ___________________________________ 4. -Tomy ___________________________________ 5. -Stoma ___________________________________ 6. -Therapy ___________________________________ 7. -Plastic ___________________________________ 8. -Scopy ___________________________________ 9. -Scope ___________________________________ 10th -graph ___________________________________ 11th -gram ___________________________________ 12th -graph ___________________________________

COLUMN II Meanings Excision Incision Instrument for recording Visual examination instrument New opening process for recording Visual examination process Recording Puncture to remove fluid Surgical repair to view treatment

O Circle the correct word to complete the following sentences. 1. Ms Daley, who has nine children, went to see her GP because she was having trouble urinating. After the exam, the doctor noticed that her bladder was protruding into her vagina and told her that she had one (rectocele, cystocele, hiatal hernia). 2. Susan coughed constantly for a week. Her doctor told her that her chest X-ray showed evidence of pneumonia. Her sputum (material coughed up from the bronchi) contained (ischemic, pleuritic, pneumococcal) bacteria. 3. Mr. Manion went to his GP because he could not keep his upper left eyelid from drooping. His doctor told him that he had a neurological problem called Horner's syndrome characterized by (necrosis, hydronephrosis, ptosis) of his eyelid. 4. Jill broke her left arm in a fall while mountain biking. After 6 weeks in cast to treat the fracture, her left arm was noticeably smaller and weaker than her right arm - the muscles were (atrophied,

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g p hypertrophied, metastatic). Her doctor recommended physical therapy to strengthen the affected arm. 5. Ms. Brody was diagnosed with breast cancer. The first phase of her treatment included one (nephrectomy, mastectomy, lung resection) to remove her breast and tumor. After the surgery, her doctors (chemotherapy, radiotherapy, hydrotherapy) recommended the use of medications such as doxorubicin (Adriamycin) and paclitaxel (Taxol). 6. At the age of 29, Kevin's facial features became coarser and his hands and tongue enlarged. After a CT (computed tomography) scan of the head, doctors diagnosed the cause of these changes (hyperglycemia, hyperthyroidism, acromegaly) as a slowly progressing endocrine disease involving the pituitary gland. 7. Every winter during "cold and flu season" Daisy developed (chondromalacia, bronchitis, cardiomyopathy). Her doctor prescribed antibiotics and respiratory therapy to help her recover. 8. After having arthroscopy, laparotomy, radiation therapy on his knee, Alan noticed swelling and inflammation near the small incisions. dr Nicholas assured him that this is a common side effect of the procedure, which resolves spontaneously. 9. Under the microscope, Dr. Vance see clusters of bacteria called (eosinophils, streptococci, staph). She made them

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Diagnosis of (staphylococcemia, eosinophilia, streptococcemia) and the patient was started on antibiotic therapy. 10. David loved weightlifting, but he recently noticed a bulge in his right groin. He visited his doctor, who made the diagnosis (hiatus hernia, rectocele, hernia) and recommended surgical repair.

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Solutions to Task A 1. Hernia 2. Blood condition 3. Berry-shaped bacterium 4. Vinyl record 5. Cell 6. Pain 7. Removal, excision, resection 8. Puncture to remove fluid 9. Process of manufacture, shaping 10. Instrument for recording 11. Inflammation 12. Process of recording B 1. Cystocele 2. Myalgia (“myodynia” is not used) 3. Carcinogenesis 4. Myelitis 5. Streptococci (bacteria is a plural term) 6. Thoracentesis or thoracocentesis 7. Mastectomy

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8. Bronchitis 9. Ischemia 10. Angiography 11. Arthroscopy 12. Staphylococcus 13. Laryngectomy 14. Amniocentesis 15. Rhinorrhea C 1. Neutrophil 2. Lymphocyte 3. Platelet 4. Eosinophil 5. Erythrocyte 6. Monocyte 7. Basophil D 1. Process of study 2. breakdown, separation, destruction 3. disease process 4. deficiency, less than normal 5. softening 6. condition, abnormal condition

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7. Fear of 8. Enlargement 9. Tumor, mass 10. Viewing process 11. Formation, growth 12. Surgical repair 13. Induration, induration 14. Stop, control E 1. Splenomegaly 2. Morphology 3. Chondromalacia 4. Hydronephrosis 5. Cardiomyopathy 6. Atherosclerosis 7. Myoma 8. Myosarcoma 9. Rhinoplasty 10. Myeloma (referred to as multiple myeloma) 11. Acrophobia 12. Biopsy 13. Hemostasis 14. Blepharitis

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15. Phlebotomy F 1. Bacteria 2. Metastases 3. Vertebrae 4. Streptococci 5. Nuclei 6. Prognosis G 1. Chemotherapy 2. Necrosis 3. Osteomalacia 4. Colostomy 5. Atrophy 6. Metastasis 7. Laparoscope 8. Acromegaly 9. Achondroplasia 10. Laparoscopy 11. Hydrotherapy 12. Hypertrophy H

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1. state 2. development, nourishment 3. stop, control 4. new opening 5. incision, incise 6. small, small 7. structure 8. small, small 9. state, process 10. similar 11. associated 12. falling, Drooping, Prolapse I 1. Laparotomy 2. Laparoscopy 3. Arterioles 4. Pneumonia (this condition is actually pneumonitis) 5. Radiation therapy 6. Mammography 7. Pleurodynia 8. Venules 9. Nephropathy 10 Mammoplasty

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J 1. laryngeal - pertaining to the larynx 2. inguinal - pertaining to the groin 3. chronic - temporal (over a long period of time); the opposite of chronic is acute 4. pulmonary - referring to the lungs 5. adipose - referring to (or full of) fat 6. peritoneal - referring to the peritoneum (membrane around the abdominal organs) 7. axillary - referring to the Armpit, under arm 8. Necrotic - relating to death 9. Opioid - substance derived from opium 10. Phlegm - relating to phlegm 11. Agoraphobia - Fear of open spaces and being alone away from home (Agora means marketplace ) 12. Esophagus – tube leading from the pharynx to the stomach K 1. Leukemia 2. Angioplasty 3. Hemolysis; anemia 4. thrombocytopenia 5. ischemia 6. arterioles; hematoma

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7. leukocytosis 8. multiple myeloma 9. hemostasis 10. venules 11. neutropenia 12. myocardium L 1. pericardium 2. atherosclerosis 3. hepatomegaly 4. tracheostomy 5. tonsillitis 6. abdominal centesis (this procedure is also known as paracentesis) 7. myalgia 8. Pleura 9. Ophthalmology 10. Staphylococci 11. Metastases 12. Larynx M 1. Pain 2. Hernia

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3. Enlargement 4. Tumor; Mass 5. Deficiency 6. Anxiety 7. Formation 8. Blood Condition 9. Inflammation 10. Development; nutrition 11. control; stopping 12. hardening 13. destruction; collapse 14. falling; drooping; Prolapse 15. Softening N 1. Puncture to remove fluid 2. for viewing 3. excision 4. incision 5. new opening 6. treatment 7. surgical repair 8. process of visual examination 9. instrument for visual examination

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10. Recording process 11. Recording 12. Instrument for recording O 1. Cystocele 2. Pneumococcus 3. Ptosis 4. Atrophy 5. Mastectomy; chemotherapy 6. acromegaly 7. bronchitis 8. arthroscopy 9. staphylococci; Staphylococcemia 10. Hernia Answers to Practical Applications 1. Paracentesis (Abdominocentesis) 2. Laparotomy 3. Mastectomy 4. Amniocentesis 5. Tonsillectomy 6. Angioplasty 7. Thoracentesis 8. Colostomy

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9. Angiography 10. Laparoscopy pronunciation of terms

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TERM abdominocentesis achondroplasia acromegaly acrophobia acute adenoids adipose agoraphobia amniocentesis anemia angiogenesis angiography angioplasty arteriole arteriosclerosis arthralgia atrophy axillary basophil biopsy blepharoptosis bronchitis carcinogenesis carcinogenic cardiac cardiomyopathy chemotherapy chondromalacia chronic colostomy cystocele electrocephalograph electroencephalogram electroencephalography eosinophil erythrocyte erythropenia esophagus hematoma hemolysis hemostasis hydronephrosis hydrotherapy hypertrophy inguinal ischemia laparoscope laparoscopy laparotomy Larynx-Laryngektomie-Leukämie

AUSSPRACHE ab-dom-in-o-sen-TE-sis a-kon-dro-PLAY-ze-ah ak-ro-MEG-ah-le ak-ro-FO-be-ah uh-KYOOT AH-deh- noydz AH-dih-pohz ah-gor-ah-FO-be-ah am-ne-o-sen-TE-sis ah-NE-me-ah an-je-o-JEN-ih-sis an-je- OG-rah-fe AN-je-o-plas-te ar-TE-re-ole ar-te-re-o-skleh-RO-sis ar-THRAL-jah AT-ro-fe AK-sil-ar- e BA-so-fil BI-up-see bleh-fah-rop-TO-sis brong-KI-tis kar-sih-no-JEN-eh-sis kar-sih-no-JEN-ik KAR-de-ak kar-de-o-mi-OP-ah-the ke-mo-THER-ah-pe kon-dro-mah-LA-shah KRON-ik ko-LOS-to-me SIS-to-seel eh-lek- glauben-an-SEF-ah-lo-graph eh-wie-glauben-an-SEF-ah-lo-gram eh-wie-glauben-an-sef-ah-LOG-rah-fe e-o-SIH-no-fil eh-RITH-ro-site eh-rith-ro-PE-ne-a eh-SOF-ah-gus he-mah-TO-mah he-MOL-ih-sis he-mo-STA-sis hi-dro- neh-FRO-sis hi-dro-THER-ah-the hi-PER-tro-fe IN-gwih-nal is-KE-me-ah LAP-ah-ro-scope lap-ah-ROS-ko-the lap -ah-ROT-o-me lah-rin-JE-al lah-rin-JEK-zu-mir lu-KE-me-ah

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TERM leukocyte leukocytosis lymphocyte mammogram mastectomy metastasis monocyte morphology mucous membrane mucus myalgia myelitis myeloma myoma myocardial myosarcoma necropsy necrosis necrotic nephrologist nephropathy neuralgia neutropenia neutrophil ophthalmology opioid osteogenic osteomalacia otalgia paracentesis pathogenesis pathologic pericardium peritoneal phlebotomy platelet pleural pleurodynia pneumonia polymorphonuclear leukocyte ptosis pulmonary radiographer radiotherapy rectocele rhinorrhea splenomegaly Staphylokokken Streptokokken Thorakozentese Thrombozyten Thrombozytopenie

AUSKUNFT LU-co-site lu-co-si-TO-sis LIM-fo-site MAM-o-gram mas-TEK-zu-mir meh-TAS-tah-sis MON-o-site mor-FOL-o- je MU-cus MEM-brayn MU-cus mi-AL-jah mi-eh-LI-tis mi-eh-LO-mah mi-O-mah mi-o-KAR-de-al mi-o-sar-KO -mah NEH-Körper-see and-KRO-sis and-KROT-ik and-FROL-o-jist and-FROP-ah-there nu-RAL-jah nu-tro-PE-ne-ah NOW-tro-file of-thal-MOL-o-je O-pe-oyd os-te-o-JEN-ik os-te-o-mah-LA-shah o-TAL-jah par-ah-sen-TE-sis path- o-JEN-eh-sis path-o-LOJ-ik peh-rih-KAR-de-um peh-rih-to-NE-al fieh-BOT-o-me PLAY-let PLUR-al plur-o-DIN -e-ah nu-MO-ne-ah pol-e-morph-o-NU-kle-ar LU-co-site TO-sis PUL-mo-nar-e ra-de-OG-rah-fer ra- de-o-THER-ah-pe REK-to-seel ri-no-RE-ah spleh-no-MEG-ah-le staf-ih-lo-KOK-si strep-to-KOK-sis thor-ah- cen-TE-sis THROM-Loss-Site throm-Loss-Site-o-PE-ne-at

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TERM Thrombophlebitis Tonsillitis Tracheostomy Tracheostomy Venule

AUSKUNFT throm-bo-ﬂeh-BI-tis TON-sih-lar ton-sih-LI-tis tra-ke-OS-to-me tra-ke-OT-o-me VEN-ule

evaluation sheet

Write the meaning of each part of the word in the space provided and test yourself. Check your answers against the information in the chapter or Glossary (Medical Word Parts - English) at the end of this book.

noun suffixes

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SUFFIX -algia -cele -centesis -coccus (-cocci) -cyte -dynia -ectomy -emia -er -genesis -gram -graph -graphy -ia -ist -itis -logy -lysis -malacia -megaly -ole -oma - Opsie -ose -Pathie -Penie -Phobia -Plasie -Plasticity -Ptosis -Rrhoea -Sclerosis -Scope -Scope -Stasis -Stoma -Therapy -Tomie -Trophäe -ule -um, -ium -us -y

IMPORTANCE ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

adjective suffixes

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SUFFIX -ac, -iac -al -ar -ary -eal -genic -ic, -ical -oid -ose -ous -tic

combine shapes

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IMPORTANCE ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ___ ____ _______________ ____________________ ____________________ ______ ______

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KOMBINATIONSFORM pneumon/o pulmon/o radi/o rect/o ren/o rhin/o sarc/o splen/o staphyl/o strept/o thorac/o thromb/o mandel/o trache/o ven/o

Give the medical term for the following blood cells. red blood cell ___________________________________________ closing blood cell ______________________________________________ white blood cell __________________________________________ Name five different types of white blood cells (the first level is indicated). e ________________________________________ b ________________________________________ n ________________________________________ l ________________________________________ m _______________________________________

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CHAPTER 4

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Prefixes CHAPTER SECTIONS: Introduction 104 Combining Forms and Suffixes 104 Prefixes and Terminology 105 Taking a Closer Look 114 Practical Applications 119 Exercises 120 Solutions to Exercises 125 Pronouncing Terms 126 Review Sheets 128

CHAPTER OBJECTIVES • Define basic prefixes used in medical language. • Analyze medical terms that combine prefixes and other word elements. • Learn about the Rh state as an example of an antigen-antibody reaction.

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Introduction This chapter on prefixes, like the previous chapter on suffixes, gives you practice in word analysis and provides a basis for studying the body system terminology that follows. The list of combination forms, suffixes, and meanings will help you analyze the terminology in the rest of the chapter. To support a broader understanding, A Closer Look includes more detailed explanations of new terms starting on page 114.

Formen und Suffixe kombinieren Formen kombinieren KOMBINATIONSFORM carp/o cis/o cost/o cutane/o dactyl/o duct/o ﬂex/o furc/o gloss/o glyc/o immun/o morph/o mort/o nat/i norm /o ox/o pub/o seps/o somn/o son/o tens/o the/o thel/o, theli/o thyr/o top/o tox/o trache/o urethr/o

SIGNIFICANCE carpal bones cut rib skin fingers, toes lead, wear bend ramification tongue sugar protection form, form death birth rule, order oxygen pubic bone; front part of the pelvis or hip bone infection sleep put tone force, strain, stretch, nipple thyroid place; shield (the shape of the thyroid resembled [-oid] a shield to those who named it) location, position, location poison trachea, trachea, urethra

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Suffixes These suffixes are used in this chapter in combination with prefixes. Some are complex suffixes that contain roots. For example, the suffix pnea contains a root pne, meaning breathing, and a final suffix -a, meaning condition. SUFFIX -crine -drome -fusion -gene -lapse -lysis -meter -mission -or -oxia -partum -phoria -physis -plasia -plasma -pnoe -ptom -ptosis -rrhea -stasis -trophy

MEANING separate run come together; pour matter that produces slides, falls, sagging, collapse, destruction, measure of separation, send one that gives birth to oxygen, giving birth, carrying; Feeling (state of mind) Growth Development, formation, growth structure or formation Respiration, occurrence Falling, drooping, prolapse Flow, stopping discharge, controlling development, nutrition

Prefixes and Terminology

Write the meaning of the medical term in the space provided. Remember: The Evolve website provides the definition and audio pronunciation for each term.

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PREFIX MEANING TERMINOLOGY MEANING a-, an- no, not, apnea _____________________________________________ without anoxia _____________________________________________ divergent from abnormal ___________________________________________ Abductor __________________________________________ A muscle that pulls a limb away from the body. TIP: Note that the abductor has the b facing away from the a. Adductor _____________________________________________ A muscle that pulls a limb toward the body. TIP: Note that in the adductor, the d points to the a. Adrenal Glands _____________ These glands are actually on top of each kidney. See Figure 4-1. anaup, apart from anabolism __________________________________________ Analysis _____________________________________________ Urinalysis (urine/o + [an]/analysis) is a laboratory test of urine that helps diagnose many medical conditions. Lysis in this term means separation. antebefore, ante cibum __________________________________________ more The word cibum means meals. The notation a.c. seen on prescription orders means before meals. You can imagine that p.c. means after (after) meals. Anteﬂexion __________________________________________ Antepartum _________________________________________ Antibiotic ___________________________________________ Antibiotics destroy or inhibit the growth of microorganisms such as bacteria. Penicillin was the first antibiotic discovered and was widely used in the 1940s. Many penicillin-like antibiotics have since been discovered and have shown valuable activity against penicillin-resistant organisms. Antibody _____________________________________________ Protein produced against an antigen (foreign body). Antigen _____________________________________________ In this term, anti- is the abbreviation for antibody. An antigen (bacterium or virus) is a substance that stimulates the production of an antibody (gene). See A Closer Look: Antigens and Antibodies, page 114. Antisepsis __________________________________________ An antiseptic (-sis becomes -tic to form an adjective) substance fights infection. Septicemia is a serious bacterial infection of the blood. Antitoxin ___________________________________________ This is an antibody, often from an animal (such as a horse), that acts against a toxin. An example is tetanus antitoxin, which is administered against tetanus, an acute bacterial infection of the nervous system. autoself, own autoimmune disease ________________________________ bifurcation __________________________________________ normal splitting into two branches, e.g. B. Bifurcation of the trachea to form the bronchi. The root furc means branching. bilateral _____________________________________________ Brady- slow bradycardia ___________________________ Usually a pulse less than 60; a slow heart rate. Tachycardia (tachycardia means rapid) is a pulse greater than 100 beats per minute. Catabolism ___________________________________________

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PREFIX MEANING TERMINOLOGY MEANING conwith, congenital anomaly together See A Closer Look: Congenital Anomaly, page 116. connective __________________________________________ The root nect means to bind or bind. Connective tissue supports and binds other body tissues and parts. Bone, cartilage and fibrous tissue are connective tissue. Contra- against, contraindication _____________________________________ against Contra- in this term means against. contralateral ________________________________________ Contra- in this term means the opposite. A stroke that affects the right side of the brain can cause contralateral left arm and leg paralysis. dedown, lack of dehydration __________________________________________ of blood flow, diameter ___________________________________________ complete diarrhea _____________________________________________ dialysis _______________________________________ literally means complete (dia) separation (-lysis). In hemodialysis, a machine (artificial kidney) separates waste from the blood when the kidneys stop working. Another form of dialysis is peritoneal dialysis. Dysanomaly, dyspnea _____________________________________________ bad Often caused by respiratory or cardiac disease, strenuous exercise, difficulty, or anxiety. painful dysentery ___________________________________________ dystrophy __________________________________________________________ Muscular dystrophy includes many inherited disorders that cause muscle weakness and wasting. Dysplasia ___________ ecoout, ouside ectopic pregnancy ___________________________________ ectopic pregnancy means out of place and modifies the noun "pregnancy". See Figure 4-2. Endoin, in the endocardium __________________________________________ Endoscope __________________________________________ Endotracheal _________________________________________ An endotracheal tube, inserted through the mouth into the windpipe, is used for oxygen administration and general anesthetic procedures. Epiupon, up, epithelium __________________________________________ above eugut, euphoria ___________________________________________ normal well-being. euthyroid __________________________________________ Normal thyroid function. Exout, external exophthalmos ______________________________________ Protrusion of the eyeball associated with enlargement and overactivity of the thyroid gland. half-half hemiglossectomy _______________________

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PREFIX MEANING TERMINOLOGY MEANING hyperexcessive, hyperglycemia _____________________________________ top This is a sign of diabetes mellitus. Lack of insulin (type 1 diabetes) or ineffective insulin (type 2 diabetes) leads to high blood sugar levels. Hyperplasia ________________________________________ Increase in cell count. This is a feature of tumor growth. Hypertrophy ________________________________________ Enlargement of individual cells. Muscle, heart and kidney cells show hypertrophy when workload is increased. The opposite of hypertrophy is atrophy (cells shrink). See Figure 4-3. High Blood Pressure ________________________________________ High blood pressure occurs when the force of the blood pushing against the walls of the arteries is constantly too high. hypodeﬁcient, subcutaneous injection ________________________________ under hypoglycemia _____________________________________ innot insomniac __________________________________________ ininto, within incision _____________________________________________ infrainfra, infracostal __________________________________________ under intercostal __________________________________________ The intercostal muscles lie between adjacent ribs. intrain, within, intravenous _________ in macro-large macrocephaly _______________________________________ This is a congenital anomaly. Macrocephaly is often associated with excess fluid in the brain (hydrocephalus). malbad malaise _____________________________________________ (mal-AYZ) This is a French word meaning malaise. It is a disease symptom that often marks the beginning of an illness. malicious __________________________________________ From Latin ignis, meaning fire. Benign (ben- = good) is non-cancerous, while malignant means cancerous. Metacarpal, Metacarpal Bones _____________________________________ Change The five bones of the hand lie beyond the wrist bones, but in front of the finger bones (phalanges). Metamorphosis ______________________________________ Meta- in this term means change. The change in development from the larval stage (caterpillar) to the adult stage (bu erfly) is a form of metamorphosis. Embryonic (immature) stem cells spontaneously change (undergo metamorphosis) to form different types of mature cells. Metastases _____________________________ Meta- = Beyond and -Stasis = Controlling, stopping. A metastasis is a malignant tumor that has spread to a secondary site. micro-small microscope _____________________________ Microcephaly __________________________________________ Microcephaly is associated with a smaller, underdeveloped brain. Zika virus infection during pregnancy can cause microcephaly. Newborn Newborn _____________________________________________ The neonatal period is the interval from birth to 28 days. Neoplasm ___________________________________________ A neoplasm can be benign or malignant. Panall Pancytopenia ________________________________________ Deficiency of erythrocytes, leukocytes and platelets.

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PREFIX MEANING TERMINOLOGY MEANING paraabnormal, paralysis _____________________________________________ adjacent, near abnormal disruption of the connection between nerve and muscle. Originally from the Greek paralusis, meaning separation or loosening on one side, describing loss of motion on one side of the body (in stroke patients). Parathyroid glands ___________________________________ Para- means next to. Behind the thyroid are the four parathyroid glands. They secrete a hormone that regulates calcium levels in the blood and tissues. through percutaneous _______________________________________ perium-giving pericardium ________________________________________ polymany, much polymorphonuclear _____________________ polyneuritis ____________________________________ post-after, behind post-mortem ________________________________________ postpartum __________________________________________ pre-before, in precancerous __________________________________________ before pre-natal __________________________________________ probebefore, precursor of the disease (such symptoms, such fever) as chickenpox) and signal its onset. Altered mood, tiredness, flashes of light, or stiff muscles can accompany the prodromal migraine aura, which occurs before the actual headache. Prolapse _____________________________________________ The suffix -lapse means to slide, sag, or fall. See Figure 4-4. A prolapsed eyelid is commonly referred to as ptosis (blepharoptosis). before, prosthesis __________________________________________ next An artificial limb is a prosthesis. Figure 4-5 shows Amy Palmiero Winters running with a prosthetic leg. Relapse, relapse again _____________________________________________ An illness or its signs and symptoms return after an apparent recovery. Remission __________________________________________ Signs and symptoms subside and the patient feels better. Remission can be spontaneous or the result of treatment. In some cases, permanent remission means the disease is cured. recombinant DNA ____________________________________ Genetic engineering uses recombinant DNA techniques. See A Closer Look: Recombinant DNA, page 116. retrobehind, retroperitoneal ____________________________________ Backward retroflexion __________________________________________ An abnormal position of an organ, such as a B. the uterus, bent or tilted backwards. subunder subcutaneous _______________________________________ supra- superior, suprapubic __________________________________________ superior The pubic bone forms the anterior portion of the hip bone, as shown in Figure 4-6A. A suprapubic catheter is useful for emptying the bladder above the pubic bone. See Figure 4-6B.

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PREFIX MEANING TERMINOLOGY MEANING syn-, together, syndactyly __________________________________________ symmit See Figure 4-7. Synthesis ___________________________________________ Protein synthesis involves building complex proteins from simpler amino acids. Syndrome __________________________________________ See A Closer Look: Syndrome, page 117. Symbiosis __________________________________________ TIP: Before the letters b, m, and p, syn- becomes sym-. The term symptom is an important example. Pay attention to the spelling! Don't forget the p in the symptom. Symmetry __________________________________________ Equality of parts on opposite sides of body. What is asymmetry? Symphysis __________________________________________ A symphysis is a joint in which the bony surfaces are firmly connected by a layer of fibrocartilage. See Figure 4-6C. tachy-rapid tachypnea ___________________________________________ (tah-KIP-ne-ah) Transacross, transfusion __________________________________________ by transferring blood or parts of blood from one person to another. transurethral _______________________________________ See more precisely: Transurethral resection of the prostate, page 118. ultrabeyond, ultrasound _______________________ excess See more precisely: ultrasound, page 118. unione unilateral _________________________________________

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Figure 4-1 Adrenals. These are endocrine glands located above each kidney. One of the hormones they secrete is adrenaline (epinephrine). This expands the bronchi, the heart beats faster and blood pressure rises.

FIGURE 4-2 Ectopic Pregnancy. The normal pregnancy implantation is in the upper part of the uterus. Ectopic pregnancy most commonly occurs in one fallopian tube (i.e., ectopic pregnancy). In this condition, the fetus is not viable. Surgery is often necessary to remove the ectopic tissue. Tubal surgery can damage a fallopian tube, and scar tissue can cause future pregnancy problems.

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Figure 4-3 Differences between normal cells, hyperplasia, hypertrophy and atrophy.

Figure 4-4 Uterine Prolapse. In a first-degree prolapse, the uterus descends into the vaginal canal. In a second-degree prolapse, the body of the uterus is still in the vagina, but the cervix protrudes from the vaginal orifice (opening). In a third-degree prolapse (not shown), the entire uterus protrudes from the opening. For treatment, the uterus can be held in place with a plastic pessary (oval support) inserted into the vagina. Some affected women may need a hysterectomy (removal of the uterus).

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FIGURE 4-5 Prosthesis. Amy Palmiero-Winters is the first woman with a prosthetic leg to finish the Badwater 135, a 135-mile race from Badwater, Death Valley to Mount Whitney, California.

Figure 4.6 A. Bones of the pelvic bone (hip bone). B. Suprapubic catheter. C. Pubic symphysis. This is the area where the pubic bones have grown together.

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Figure 4.7 Syndactyly. The foot on the left (pale) shows syndactyly (webbed toes). The right foot (darker) shows normal toes. Syndactyly is an inherited, congenital anomaly of the fingers or toes.

sleep apnea

Sleep apnea occurs when breathing suddenly stops during sleep. A CPAP (Continuous Positive Airway Pressure) machine is used to keep the airways open.

anti and ante

Be careful not to confuse these prefixes. Note their different pronunciation. Anti- is pronounced an-tih and ante- is pronounced an-te.

autoimmune disease

In an autoimmune disease, the body makes antibodies against its own good cells and tissues, leading to inflammation and injury. Examples of autoimmune diseases are rheumatoid arthritis, which affects joints; celiac disease, which affects the intestinal tract; and Graves' disease, which affects the thyroid.

Peritonealdialyse

In peritoneal dialysis, a special fluid is inserted into the abdominal cavity through a tube in the abdomen. waste materials such as urea

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seep out of the blood into the fluid over a period of time. The fluid and waste are then drained from the abdominal cavity. See Figure 7-16 on page 223.

signs and symptoms

A sign is an objective finding perceived by an examiner, such as B. fever, skin rash or hyperglycaemia. A symptom (from the Greek symptoma, what is happening) is a subjective change in status perceived by the patient. Examples of symptoms are loss of appetite, abdominal pain and exhaustion (tiredness). Both signs and symptoms are useful clues in diagnosing a disease such as diabetes mellitus.

Intra-, Inter-, Infra-

Be careful not to confuse these prefixes: intra- means in, within, in; means between; infra- means under, under.

Symbiosis

Symbiosis occurs when two organisms live together in close association, either for mutual benefit or not. Examples include: • Bacteria in the gut and the cells that line the gut favor each other. • Parasites (tapeworms and fleas) feed on another organism and harm the host. In psychiatry, symbiosis is a relationship between two people who are emotionally dependent on one another.

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A Closer Look Antigens and Antibodies; The Rh condition An antigen, usually a foreign substance (such as a toxin, virus, or bacterium), stimulates the production of antibodies. Antibodies are protein substances made by white blood cells in response to the presence of foreign antigens. For example, the flu virus (antigen) enters the body and causes the production of antibodies in the bloodstream. These antibodies then bind to the antigens (viruses) that produced them, marking them for destruction. The reaction between an antigen and an antibody is an immune response (immun/o means protection). See Figure 4-8. When you get a vaccine, you actually get dead or weakened antigens, which stimulate white blood cells (lymphocytes) to make antibodies. These antibodies remain in your blood to protect you from future exposure to these specific antigens.

FIGURE 4-8 Immune Response. When antigens (bacteria) enter the body through a flesh wound, antibodies are produced to destroy the antigens.

Another example of an antigen-antibody reaction is the Rh condition. A person who is Rh positive (Rh+) has a protein coating (antigen) on their red blood cells (RBCs). This specific antigenic factor is something that the person is born with and is normal. People who are Rh negative (Rh-) also have normal RBCs, but their red blood cells lack the Rh factor antigen.

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When a Rh− female and Rh+ male conceive an embryo, the embryo can be Rh− or Rh+. A dangerous condition arises only if the embryo is Rh+ (because this is different from the Rh− mother). During the birth of the first Rh+ baby, some of the baby's blood cells that contain Rh+ antigens may enter the mother's bloodstream. This sensitizes the mother so that she produces a small amount of antibodies against the Rh+ antigen. Because this occurs at birth, the first baby is generally unaffected and is normal at birth. Sensitization can also occur after miscarriage, abortion, or blood transfusions (with Rh+ blood). Difficulties arise in the second Rh+ pregnancy. If this embryo is also Rh+, antibodies acquired during pregnancy from the mother (from the first pregnancy) enter the embryo's bloodstream. These antibodies attack and destroy the embryo's Rh+ erythrocytes (hemolysis). The affected child is born with hemolytic disease of the newborn (HDN). One of the clinical signs of HDN is jaundice (yellow skin pigmentation). Jaundice results from excessive destruction of RBCs. When RBCs break down, the hemoglobin in the cells produces bilirubin (a chemical pigment). High levels of bilirubin in the blood (hyperbilirubinemia) cause jaundice. To prevent bilirubin from affecting the infant's brain cells, newborns are treated with bright lights (phototherapy). The light breaks down the bilirubin, which is then expelled from the infant's body. Doctors give Rh immunoglobulin to a Rh− woman within 72 hours of any Rh+ delivery, abortion, or miscarriage. The globulin binds to Rh+ cells entering the maternal circulation and prevents the formation of Rh+ antibodies. This protects future babies from developing HDN. Figure 4-9 gives an overview of the Rh state as an example of antigen-antibody interaction.

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FIGURE 4-9 Rh state as an example of an antigen-antibody reaction.

Congenital Anomaly An anomaly is an irregularity in a structure or organ. Examples of congenital anomalies (that an infant is born with) include webbed fingers or toes (syndactyly), heart defects, and clubfeet. See Figure 4-10A. Some congenital abnormalities are hereditary (passed on to the infant via chromosomes from father or mother or both), while others are caused by factors present during pregnancy. For example, if a pregnant woman drinks heavily during pregnancy, her child will often present with a pattern of physical and mental defects at birth. See Figure 4-10B.

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Figure 4-10 Congenital anomalies. A, Clubfoot is a hereditary congenital anomaly. The "clubbing" can affect one or both feet. B, Fetal alcohol syndrome (FAS) is a congenital abnormality caused by environmental factors during pregnancy. Note the facial features of FAS: skin folds at the corners of the eyes; long, smooth furrow between nose and upper lip; thin upper lip; and a flat bridge of the nose.

Recombinant DNA In recombinant DNA technology, a gene (a region of DNA) is taken from one organism and inserted into the DNA of another organism. For example, recombinant techniques are used to produce insulin outside the body. The gene that codes for insulin (i.e. contains the recipe for making insulin) is excised from a human chromosome (using special enzymes) and transferred to a bacterium such as Escherichia coli (E. coli). The bacterium then contains the gene for the production of human insulin and, since it multiplies very quickly, can produce insulin in large quantities. Diabetics who cannot make their own insulin can use this synthetic product (see Figure 4-11). CRISPR is an acronym for New DNA Editing Tool, which alters DNA sequences to knock out genes or replace them with new versions. CRISPR means Clustered Regular-Interspaced Short Palindromic Repeats!

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FIGURE 4-11 Production of recombinant DNA and insulin.

Syndromes A syndrome (from Greek dromos, meaning career) is a group of signs or symptoms that come together to produce a typical clinical picture of a disease or inherited abnormality. For example, Reye's syndrome is characterized by vomiting, brain swelling, increased intracranial pressure, hypoglycemia, and liver dysfunction. It can occur in children after a viral infection treated with aspirin. Marfan syndrome is an inherited connective tissue disorder characterized by a tall, thin body type with long, "spiky" fingers and toes (arachnodactyly), an elongated head and heart, blood vessels, and ocular abnormalities (see Figure 4-12).

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Figure 4.12 Marfan syndrome. A and B show people with Marfan. Note the unusually large body type and long, spidery fingers. Olympic swimmer Michael Phelps (not pictured) has Marfan Syndrome. His height is 6′4″ and his arm span is 6′7″.

Transurethral resection of the prostate Transurethral resection of the prostate (TURP) involves removing part of the prostate using an instrument (resectoscope) passed through (trans-)the urethra. The procedure is indicated when prostate tissue increases (hyperplasia) and interferes with urination. This condition is called benign prostatic hyperplasia, or BPH. Figure 4-13 shows a TURP procedure.

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Figure 4-13 Transurethral resection of the prostate (TURP). The resectoscope contains a light, valves to control the fluid flushed, and an electrical loop that cuts tissue and occludes blood vessels.

Ultrasound Ultrasound is a diagnostic procedure that uses ultrasound waves (inaudible sound waves) to create an image of an organ or tissue. A machine records ultrasound echoes as they pass through different types of tissue. X-rays are not used! Echocardiograms are ultrasound images of the heart. Figure 4-14 shows a fetal ultrasound image (sonogram).

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FIGURE 4-14 Ultrasound. A, Note the facial features of this beautiful 30 week old fetus in a (very) early "baby" picture of my granddaughter Beatrix Bess Thompson! B, Bebe, smiling, aged 3 months. (Courtesy of Dr. Elizabeth Chabner Thompson.)

Practical Applications

Check your answers against the answers to practical applications on page 126. You should find helpful explanations there.

A Useful Weapon Against Anemia Anemia is a major problem for many patients with chronic kidney failure. This is because as kidney function declines, the kidneys secrete less erythropoietin, a hormone that stimulates red blood cell production. Under normal conditions, when the body feels a decrease in red blood cells or a lack of oxygen, more erythropoietin is produced, causing the number of erythrocytes to increase. Epoetin alfa (Epogen or Procrit) is a synthetic form of human erythropoietin. It is genetically engineered through recombinant DNA technology and stimulates the bone marrow to form and release red blood cells. As hematocrit increases, patients experience increased energy, appetite, and increased endurance. The FDA has approved Epogen for the treatment of anemia in patients on dialysis and in patients with chronic kidney failure who are not on dialysis. It is also effective to counteract the myelosuppressive effects of chemotherapy. Other hematopoietic drugs made using recombinant DNA technology include Neupogen (filgrastim), for neutropenia, and thrombopoietin (TPO), for thrombocytopenia.

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1. Anemia is a major problem for chronic renal failure patients because a. the kidney overproduces erythropoietin b. Patients may experience heart failure and lose consciousness c. Patients produce less of a hormone that stimulates the production of erythrocytes 2. The type of erythropoietin used for these patients is a. made in a laboratory using pieces of DNA that code for the hormone b. made from the blood of other patients c. given by bone marrow transfusion 3. The hematocrit is a. a measurement of white and red blood cell volume b. the percentage of red blood cells in a blood volume c. lower in people with greater endurance and energy 4. Patients are on dialysis if a. they suffer from chronic renal failure b. they have a low hematocrit c. they are undergoing chemotherapy 5. Side effects of myelosuppressive chemotherapy can be managed by a. cytostatics b. Epogen, Neupogen and Thrombopoietin c. Hemodialysis or peritoneal dialysis

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Exercises Be sure to check your answers carefully against the answers to the exercises, pages 125–126.

A Give the meaning of the following prefixes. 1. ante_____________________________________________ 2. ab_____________________________________________ 3. ana_____________________________________________ 4. anti_____________________________________________ 5. a-, an_____________________________________________ 6. ad_____________________________________________ 7. auto_____________________________________________ 8. cata_____________________________________________ 9. brady_____________________________________________ 10. contra_____________________________________________ 11. bi_____________________________________________ 12. con_____________________________________________ B Assign the following meanings to the terms listed.

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Adductor Adrenal Analysis Anoxia Anteflexion Antepartum Antisepsis Apnea Bilateral Bradycardia Congenital Anomaly Contralateral 1. Bending _____________________________________________ _______________________ 2. Muscle that carries the limb to the body ________________________________________ __________ 3. Prenatal _____________________________________________ ________________________ 4. Slow heartbeat ________________________________________ ________________________ 5. Gland near (top ) each kidney _____________________________________________ ________________________ 6. Respiratory arrest _____________________________________________ ________________________

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7. affecting the opposite side _____________________________________________ ________________________ 8. against infections _____________________________________________ ________________________ 9. separating _____________________________________________ _______________________ 10. affecting two (both) sides ________________________________________ ________________________ 11. lack of oxygen in the tissues ________________________________________ __________ 12. irregularity present at birth _____________________________________________ ________________________ C Select from the listed terms the appropriate ones for the following descriptions. Anabolism Antibiotic Antibody Antigen Antitoxin Autoimmune disease Catabolism Congenital abnormality Contraindication

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1. Chemical substance, such as erythromycin (-mycin = mould), made from mold and used against bacterial life __________________________ 2. Process of burning food (breaking it down) and releasing the energy stored in the food __________________________________________ ___________________________ 3. Reason why a doctor would advise against taking a certain drug _____________________________________________ ________________________ 4. a disorder in which the body's leukocytes produce antibodies that damage its own good tissues _______________________ 5. a foreign substance (virus or bacterium) that causes the production of antibodies _____________________________________________ __________ 6. on Antibody that acts against toxins entering the body _____________________________________________ ______ 7. Process of building proteins in cells by assembling small pieces of protein so-called nnte Amino acids _____________________________________________ ________________________ 8. Protein produced by lymphocytes in response to the presence of a specific antigen in the blood

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_____________________________________________ ________________________ D Give the meaning of the following prefixes. 1st ec_____________________________________________ 2nd dys_____________________________________________ 3rd de_____________________________________________ 4th dia_____________________________________________ 5th hemi_____________________________________________ 6th hypo_____________________________________________ 7th epi_____________________________________________ 8th hyper_____________________________________________ 9th endo_____________________________________________ 10th eu_____________________________________________ 11th in_____________________________________________ 12th inter_____________________________________________ 13th intra_____________________________________________

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14. infra_____________________________________________ 15. macro_____________________________________________ 16. micro_____________________________________________ E Complete the following terms according to their meaning. 1. Normal thyroid function: __________ Thyroid 2. Painful breathing: ________________________ Pneumonia 3. Pregnancy out of place (outside the uterus): __________ Subject 4. Instrument for visual examination inside the body: Endo _____________________________________________ 5. Removal of half of the tongue : ________________________ glossectomy 6. feeling good (exaggerated) (of well-being): __________ phoria 7. inside the trachea: endo _____________________________________________ 8. blood condition of less than normal sugar: __________ glycemia 9. condition (congenital anomaly) of large head: _________ head 10 .between the ribs: __________ ribs 11. within a vein: intra _____________________________________________

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12. State of abnormal formation (of cells): dys ____________________________________ 13. State of over formation (number of cells): _____________ plasia 14. Structure (membrane) forming the inner lining of the heart: endo _______________________ 15. below the ribs: infra _____________________________________________ 16. Blood condition with excessive amount of sugar: hyper _____________________________________________ 17. A group of congenital disorders with abnormal development of muscle mass and strength is: Infant head and brain: ____________________________________ Scalp F Match the listed terms with the following meanings. dehydration dialysis diarrhea exophthalmos (proptosis) cut insomnia malaise malignant metamorphosis

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p Metastatic microscopic pancytopenia 1. Indeterminate physical malaise _____________________________________________ ________________________ 2. Insomnia __________________________________________ __________ 3. Dehydration ________________________________________ __________ 4. Spread of a cancerous tumor to a secondary organ or tissue ________________________________________ __________ 5. Instrument for viewing small objects ________________________________________ ________________________ 6. A cut in an organ or Tissues _____________________________________________ __________ 7. Protrusion of the eyeballs _________________________ 8. State of shape or change in shape _____________________________________________ ________________________ 9. Aqueous secretions from the colon _____________________________________________ ________________ ________

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10. Lack of all (blood) cells _____________________________________________ ________________________ 11. Separation of waste products from the blood by using a machine that takes over the work of the kidneys ___________________________ 12. Harmful, carcinogenic _____________________________________________ __________ G Give the meaning of the following prefixes. 1st mal_____________________________________________ 2nd pan_____________________________________________ 3rd per_____________________________________________ 4th meta_____________________________________________ 5th para_____________________________________________ 6th peri_____________________________________________ 7th poly_____________________________________________ 8th post_____________________________________________ 9th pro_____________________________________________

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10th pre_____________________________________________ 11th sub_____________________________________________ 12th supra_____________________________________________ 13th re_____________________________________________ 14th retro_____________________________________________ 15th tachy_____________________________________________ 16th syn_____________________________________________ 17th uni_____________________________________________ 18th trans_____________________________________________ 19th neo_____________________________________________ 20th epi_____________________________________________ H Underline the prefix in the following terms and give the meaning of the whole term on . 1. Pericardium _____________________________________________ ________________________ 2. Percutaneous _____________________________________________ __________

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3. retroperitoneal _____________________________________________ ________________________ 4. suprapubic _____________________________________________ ________________________ 5. polyneuritis _____________________________________________ ________________________ 6. retroﬂexion _____________________________________________ ________________________ 7. transurethral _____________________________________________ ________________________ 8. subcutaneous _____________________________________________ ________________________ 9. tachypnea _____________________________________________ ________________________ 10. unilateral _____________________________________________ ________________________ 11. prosthesis _____________________________________________ ________________________ 12. bilateral _____________________________________________ ________________________

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13. Symptom _____________________________________________ ________________________ 14. Syndrome _____________________________________________ ________________________ I Match the listed terms to the following meanings. Adrenal Neoplasm Paralysis Parathyroid Prodrome Prolapse Recombinant DNA Relapse Remission Syndactyly Syndrome Ultrasound 1. Recurrence of a disease or its symptoms _______________________ 2. Loss of motion in the muscles _______________________________________ ________________________ 3. Congenital anomaly in which fingers or toes are webbed (formed together)

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_____________________________________________ ________________________ 4. Four endocrine glands located near (behind) another endocrine gland in the neck ________________________________________ _______________________ 5. Glands located above the kidneys _____________________________________________ ________________________ 6. Symptoms that precede the actual disease _____________________________________________ __________ 7. Technique of genetic transfer Material from one organism to another _____________________________________________ ________________________ 8. Sliding, sagging downwards or forwards _____________________________________________ ________________________ 9. Neoplasm or tumor _______________________________________ _______________________ 10. Process of using sound waves to create an image of organs and structures in the body _____________________________________________ ________ ________________ 11. Group of signs and symptoms that occur together and indicate a specific disorder _____________________________________________ ________________________

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12. Symptoms subside and patient feels better _____________________________________________ _______________________ J Complete the following words according to their meaning. 1. pertaining to new birth: neo _____________________________________________ ________________________ 2. after death: post _____________________________________________ ________________________ 3. spread of cancerous growth: meta _____________________________________________ _______________________ 4. branching into two: bi _____________________________________________ __________ 5. increase in development (cell size): hyper _____________________________________________ ________________________ 6. Concerns a chemical that acts against bacterial life: __________ Biotic 7. Bone of the hand (beyond the wrist): __________ Carpal 8. Protein produced by leukocytes to fight foreign organisms: Anti ______________________________________ 9. Group of symptoms together occur: ________________________ drome 10. Surface or skin tissues of the body: __________ Thelium

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K Circle the correct bold word to complete the following sentences. 1. dr Tate felt that Ms. Snow's thrombocytopenia was a clear indication (analysis, contraindication, synthesis) for performing elective surgery. 2. Medical science was revolutionized by the introduction of (antigens, antibiotics, antibodies) in the 1940s. Now some infections can be treated with just one dose. 3. Robert's 82-year-old grandfather complained of (malaise, dialysis, insomnia) despite taking the sleeping pills prescribed by his doctor. 4. Ms. Payne described pressures on her (pituitary, parathyroid, pubic symphysis) during her pregnancy that made it difficult for her to find a comfortable position, even when seated. 5. People with diabetes often accidentally take too much insulin. This results in their blood sugar being lowered enough for them to be admitted to the ER with (hyperplasia, hypoglycemia, hyperglycemia). 6. Before his migraines started, John noticed changes in his vision, such as: B. bright spots, zigzag lines and double vision. His doctor told him these were (symbiotic, exophthalmic, prodromal) symptoms. 7. Julie experienced (hyperglycemia, dehydration, hypothyroidism) after a hike in the Grand Canyon without adequate water supply.

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8. At the age of 65, Paul Smith often felt full in his bladder but had difficulty urinating. He visited his (cardiologist, nephrologist, urologist), who examined and diagnosed his prostate (hyperplasia, atrophy, ischemia). The doctor recommended resection (intracostal, transurethral, peritoneal) of Paul's prostate. 9. After running the Boston Marathon, Elizabeth felt nauseated and dizzy. She noticed that she was suffering from (malaise, euphoria, hypoglycemia) and drank a sugary sports drink which made her feel better. 10. While taking an antibiotic that reacted with sunlight, Ruth's doctor advised her that sunbathing was (unilateral, contraindicated, contralateral) and could cause severe sunburn. 11. Puerperal fever (related to childbirth) was an iatrogenic infection; it was carried from woman to woman from doctor days ago (antigens, antibodies, antisepsis). 12. Dysplastic nevi (abnormally pigmented lesions or moles) on a patient's skin may be a (precancerous, metastatic, unilateral) sign of a malignant skin cancer called melanoma. 13. Brain neurons may appear (relapse, hypertrophy, atrophy) in old age due to ischemia from restricted blood flow. 14. Changes in cell growth that result in cells that vary in size, shape, and appearance are the result of chronic inflammation and irritation. When the condition occurs in the cervix, it is called cervical (prolapse, paralysis, dysplasia).

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Solutions to exercises A 1. in front, forward 2. away from 3. up, apart 4. against 5. no, not, without 6. to 7. yourself, own 8. down 9. slowly 10. against, opposite 11. two 12. along with B 1. anteflexion 2. adductors 3. antepartum 4. bradycardia 5. adrenal 6. apnea 7. contralateral

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8. antisepsis 9. analysis 10. bilateral 11. anoxia 12. congenital anomaly C 1. antibiotic 2. catabolism 3. contraindication 4. autoimmune disease 5. antigen 6. antitoxin 7. anabolism 8. antibody D 1. external, external 2. abnormal , bad, difficult, painful. TIP: Remember the word dysfunctional. 3. below, lack of 4. through, completely 5. half 6. deficient, under 7. up, up, up

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8. excessive, above, beyond 9. inch, within 10. good, well 11. inch, not 12. between 13. within 14. below, inferior 15. large 16. small E 1. euthyroid 2. dyspnea 3. ectopic 4 Endoscope 5. Hemiglossectomy 6. Euphoria 7. Endotracheal 8. Hypoglycemia 9. Macrocephaly 10. Intercostal 11. Intravenous 12. Dysplasia 13. Hyperplasia

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14. Endocardium 15. Infracostal 16. Hyperglycemia 17. Dystrophy 18. Microcephaly F 1. Malaise 2. Insomnia 3. Dehydration 4. Metastases 5. Microscope 6. Incision 7. Exophthalmos (Proptosis) 8. Metamorphosis 9. Diarrhea 10. Pancytopenia 11 Dialysis 12. malignant G 1. bad 2. every 3rd to 4th change, beyond

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5. near, beside, abnormal 6. surrounding 7. many, much 8. after, behind 9. before, before 10. before, before 11. under 12. over 13. back, again 14. behind, back 15. quickly 16 .along, with 17. one 18. across, through 19. new 20. top, on, on H 1. pericardium – membrane surrounding the heart 2. percutaneous – in relation to through the skin 3. retroperitoneal – in relation to behind the peritoneum 4. suprapubic - above the pubic bone 5. polyneuritis - inflammation of many nerves 6. retroflexion - bending backwards

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7. transurethral - referring to through the urethra 8. subcutaneous - referring to below the skin 9. tachypnea - rapid, rapid breathing 10. unilateral - affecting one side 11. prosthetic - artificial limbs or body parts (literally: 12. bilateral - both sides 13. Symptom - subjective change in condition as observed by a patient 14. Syndrome - group of objective findings characterizing an abnormal condition I 1. Relapse 2. Paralysis 3. Syndactyly 4. Parathyroid 5 Adrenal 6. Prodrome 7 .recombinant DNA 8. Prolapse 9. Neoplasm 10. Ultrasound 11. Syndrome 12. Remission

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J 1. Newborn 2. Post mortem 3. Metastasis 4. Bifurcation 5. Hypertrophy 6. Antibiotic 7. Metacarpal 8. Antibody 9. Syndrome 10. Epithelium K 1. Contraindication 2. Antibiotics 3. Insomnia 4. Pubic symphysis 5. Hypoglycemia 6. Prodromal 7. Dehydration 8. Urologist; hyperplasia; transurethral 9. hypoglycemia 10. contraindicated 11. antisepsis

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12. Precancer 13. Atrophy 14. Dysplasia Answers to practical applications 1. C 2. A 3. B 4. B 5. B Pronunciation of terms

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BEGRIFF Abduktoren abnorme Adduktoren Nebennieren Anabolismusanalyse Anoxia ante cibum (a.c.) Anteflexion antepartum Antibiotikum Antigen Antisepsis Antitoxin Apnoe Autoimmunerkrankung gutartige Verzweigung bilaterale Bradykardie Katabolismus kongenitale Anomalie Bindegewebe Kontraindikation kontralaterale Dehydration Dialyse Durchmesser Durchfall Dysenterie Dysplasie Dyspnoe Dystrophie Eileiterschwangerschaft Endokard Endotrachealoskop End Euthyreose Exophthalmus Hemiglossektomie Hyperglykämie Hyperplasie Hypertonie Hypertrophie Subkutane Injection Hypoglycemia Incision Infracostal Insomniac

AUSKUNFT ab-DUK-tor ab-NOR-mal ah-DUK-tor ah-DRE-nal glanz ah-NAB-o-liz-im ah-NAL-ih-sis ah-NOK-se-ah AN-te SE- bum an-te-FLEK-meiden an-te-PAR-tum an-tih-bi-OT-ik AN-tih-bod-e AN-tih-jen an-tih-SEP-sus an-tih-TOX-in AP-ne-ah aw-to-ih-MUNE dih-ZEEZ beh-NINE bi-fur-KA-shun bi-LAT-er-al bra-de-KAR-de-ah kah-TAB-o-liz-im con-JEN-ih-al ah-NOM-ah-le con-NEK-tiv TIH-shu con-trah-in-dih-KA-shun con-trah-LAT-er-al de-hi-DRA-shun di -AL-ih-sis di-AM-eh-ter di-ah-RE-ah DIS-en-ter-e dis-PLA-ze-ah DISP-ne-ah DIS-tro-fe ek-TOP-ik PREG -nan-se en-do-KAR-de-um EN-do-scope en-do-TRA-ke-al ep-ih-THE-le-um u-FOR-e-ah u-THI-royd ek- sof-THAL-mos hem-e-glos-SEK-zu-mir hi-per-gli-SE-me-ah hi-per-PLA-ze-ah hi-per-TEN-shun hi-PER-tro-fe hi-po-THER in-JEK-shun hi-po-gli-SE-me-ah in-SIZH-un in-frah-KOS-tal in-SOM-ne-ak

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TERM intercostal intravenous macrocephaly malaise malignant metacarpal metamorphosis metastases microcephaly microscopic neonatal neoplasia pancytopenia paralysis parathyroid percutaneous pericardium polymorphonuclear polyneuritis postmortem postpartum precancerous prenatal prodrome prolapse prosthesis recombinant DNA recurrence remission retroflexion retroperitoneal subcutaneous transsonoptachubic syntachdactynodial symbiosis syntachdactyactynoe symptoms syntachdactyactynoe symmetry syndrome

AUSKUNFT inter-KOS-tal in-trah-VE-nus mak-ro-SEH-fah-le mal-AYZ mah-LIG-nant met-ah-KAR-pal Knochen met-ah-MOR-fuh-sis meh -TAS -tah-sis mi-cro-SEH-fah-le MI-cro-scope ne-o-NA-tal NE-o-plazm pan-si-to-PE-ne-ah pah-RAL-ih-sis par- ah-THI-royd glanz per-ku-TA-ne-us peh-rih-KAR-de-um pol-e-mor-fo-NU-kle-ar pol-e-nu-RI-tis post- MOR- Term post-PAR-tum pre-CAN-serve-us pre-NA-Number PRO-drohm PRO-Lapse pros-THE-sis re-KOM-bih-nant DNA RE-Lapse re-MIH-meiden reh-tro -FLEK -shun reh-tro-peh-rih-to-NE-al sub-ku-TA-ne-us su-prah-PU-bik sim-be-O-sis SIM-met-re SIM-fih-sis SIMP- tum sin-DAK-tih-le SIN-drohm SIN-theh-sis tah-KIP-ne-ah tranz-FU-zhun tranz-u-RE-thral ul-trah-so-NOG-rah-fe u- ist- LAT-äh-al

evaluation sheet

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Write the meaning of each word part in the space provided and test yourself. Check your answers against the information in the chapter or glossary (Medical Word Parts - English) at the end of the book.

prefixes

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PRÄFIX a-, anabadanaanteantiautobibradycataconcontradediadysecen-, endoepieexhemihyperhypoininfrainterintramacromalmetamicroneopanparaperperipolypostpreproprosreretrosubsuprasyn-, symtachytransultrauni-

IMPORTANCE ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ___ ____ _______________ ____________________ ____________________

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Prefixes with a similar meaning PREFIX a-, an-, inante-, pre-, proanti-, contracon-, syn-, symde-, catadia-, per-, transdys-, malec-, ecto-, exendo-, in-, intraepi, hyper, suprahypo, infra, subre, retro, postultra, meta

Kombinationsformen KOMBINATIONSFORM carp/o cost/o cutane/o dactyl/o duct/o ﬂex/o gloss/o glyc/o immun/o later/o morph/o mort/o nat/i necr/o norm/o ophthalm /o ox/o pub/o ren/o seps/o somn/o son/o tens/o the/o thyr/o top/o tox/o trache/o urethr/o ven/o

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Suffix SUFFIX -crine -drome -fusion -gene -lapse -lysis -meter -mission -or -partum -phoria -physis -plasia -plasma -pnoe -ptom -ptosis -rrhea -stasis -trophy

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CHAPTER 5

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Digestive System CHAPTER SECTIONS: Introduction 132 Anatomy and Physiology 132 Vocabulary 142 Terminology 145 Pathology of the Digestive System 151 Personal: Living with Crohn's Disease 162 Exercises 163 Answers to Exercises 171 Pronunciation of Terms 173

CHAPTER OBJECTIVES • Name the organs of the digestive system and describe their location and function. • Define combinations of organs and know the meaning of the associated terminology. • Describe signs, symptoms, and conditions affecting the digestive system.

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Introduction The digestive system is divided into Chapters 5 and 6. Chapter 5 covers the anatomy, physiology, pathology, and basic terminology of the system. Chapter 6 introduces additional terminology and an overview of digestive system terms, as well as laboratory tests, clinical procedures, and acronyms. I didn't combine the chapters because I didn't want to overwhelm you with an exceptionally long chapter so early in your studies. In my own teaching, I find that my students are grateful for this separation, and particularly for the breather and review of terminology in Chapter 6. My decision to start with the digestive system was based on the perception that this body system (similar to a long conveyor belt with the mouth at the entrance and the anus at the exit) is one of the simpler and easiest to understand. However, keep in mind that the book is organized so that you can begin studying the systems of the body with each chapter in the order that best reflects your interests. The digestive or gastrointestinal tract begins with the mouth, where food enters, and ends with the anus, where solid waste leaves the body. The four functions of the system are assimilation, digestion, absorption and elimination. First, complex food material taken in the mouth is ingested. Second, it is mechanically and chemically digested or broken down on its way through the gastrointestinal tract. Digestive enzymes speed up chemical reactions and aid in the breakdown (digestion) of complex nutrients. Complex proteins are digested into simpler amino acids; complicated sugars are reduced to simple sugars like glucose; and large fat molecules (triglycerides) are broken down into simpler substances such as fairy acids. Digestion occurs in the mouth, stomach and small intestine. Third, nutrients from the digested food pass through absorption through the lining cells, or epithelium, of the small intestine and into the bloodstream. Nutrients then migrate to all cells of the body. Cells then break down nutrients in the presence of oxygen to release energy. Cells also use amino acid nutrients to build large protein molecules needed for growth and development. In addition, fat molecules from the intestine are absorbed into the lymphatic vessels. The fourth function of the digestive system is to remove solid waste that cannot be absorbed into the bloodstream. The large intestine concentrates these solid wastes, called feces, and the wastes eventually leave the body through the anus.

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Anatomy and Physiology Oral cavity The gastrointestinal tract begins with the oral cavity. Oral means pertaining to the mouth (or/o). Label Figure 5-1 as you learn the major parts of the oral cavity.

Figure 5-1 Oral cavity.

The cheeks [1] form the walls of the oval oral cavity, and the lips [2] surround the opening to the oral cavity. The hard palate [3] forms the front part of the palate and the muscular soft palate [4] lies behind it. Rugae are irregular ridges in the mucous membrane covering the front part of the hard palate. The uvula [5], a small soft-tissue prominence, attaches to the soft palate. It supports the production of sounds and language. The tongue [6] extends across the floor of the oral cavity and its muscles extend to the lower jawbone. It moves food during chewing (chewing) and swallowing (gulping). Papillae, small raised areas on the tongue, contain taste buds that are sensitive to the chemical nature of food and allow different tastes to be distinguished as food moves across the tongue.

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The tonsils [7], collections of lymphoid tissue located in depressions in the mucous membranes, lie on either side of the oropharynx (part of the throat near the mouth). They are filters that protect the body from invading microorganisms and produce lymphocytes, disease-fighting white blood cells. The gums [8] are the fleshy tissues that surround the tooth sockets [9]. Figure 5-2 shows a dental arch with 16 permanent teeth (there are 32 permanent teeth in the entire oral cavity). The names of the teeth are labeled in Figure 5-2.

Figure 5-2 Upper permanent teeth in the dental arch. The buccal surface faces the cheek while the lingual surface faces the tongue. The labial surface faces the lips. Dentists refer to the labial and buccal surfaces as the facial (faci/o = face) surface.

Figure 5-3 shows the internal anatomy of a tooth. Label it as you read the following description:

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Figure 5-3 Anatomy of a tooth.

A tooth consists of a crown [1] that protrudes beyond the gumline and a root [2] that lies in the bony tooth socket. The outermost layer of the crown, the enamel [3], protects the tooth. It is the hardest tissue in the human body. Dentin [4], the main substance of the tooth, lies beneath the enamel and extends across the entire crown. The color of dentin ranges from creamy white to yellow and affects the color of the teeth because the enamel is translucent. The cement covers, protects and supports the dentin in the root. A periodontal membrane surrounds the cementum and holds the tooth in the tooth socket. The pulp [5] lies beneath the dentine. This soft and delicate tissue fills the center of the tooth. The pulp canal (also called root canal) contains blood vessels, nerve endings, connective tissue and lymph vessels. Root canal treatment is often necessary when there is disease or an abscess (collection of pus) in the pulp canal. A dentist opens the tooth from above and cleans the canal of infected tissue, nerves, and blood vessels. The canal is then disinfected and filled with material to prevent the entry of microorganisms that could cause tooth decay. Three pairs of salivary glands (Figure 5-4) surround and open into the oral cavity. These exocrine glands produce saliva that lubricates the mouth. Saliva contains important digestive enzymes as well as healing growth factors such as cytokines. Saliva is released from a parotid gland [1], a submandibular gland [2], and a sublingual gland [3] on either side of the mouth. Narrow passages lead saliva into the oral cavity. The glands produce about 1.5 liters of saliva daily.

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Figure 5.4 Salivary glands.

Pharynx See Figure 5-5. The pharynx, or throat, is a muscular tube about 5 inches long that is lined with a mucous membrane. It serves as a passage for both air passing from the nose (nasal cavity) to the windpipe (trachea) and food passing from the oral cavity to the esophagus. During swallowing (swallowing), a flap of cartilaginous tissue, the epiglo, covers the trachea to keep food from entering and becoming lodged. See Figure 5-5A and B.

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Figure 5.5 Swallow (Swallow). A, Epiglottis closes over the trachea as the food bolus travels down the pharynx toward the esophagus. B, Epiglottis opens as bolus flows down esophagus.

Your mother was right! Don't talk while you eat! Speaking while eating causes the epiglo to open, allowing food to accidentally enter the windpipe, causing you to choke.

Figure 5-6 shows the passage of food as it travels from the esophagus through the gastrointestinal tract. Write it down as you read the following paragraphs.

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Figure 5.6 The gastrointestinal tract.

Esophagus The esophagus [1] is a 9- to 10-inch fibromuscular tube that extends from the pharynx to the stomach. Peristalsis is the involuntary, progressive, rhythmic contraction of muscles in the wall of the esophagus (and other gastrointestinal organs) that propels a bolus (mass of food) down toward the stomach. The process is like pushing a marble through a rubber hose.

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Stomach Food passes from the esophagus to the stomach [2]. The stomach (Figure 5.7) consists of three main parts: fundus (upper part), body (middle part), and antrum (lower part). Rings of muscle called sphincters control the openings in and out of the stomach. They prevent regurgitation (backflow from the normal direction) of food. The lower esophageal sphincter (LES) relaxes and contracts to move food from the esophagus to the stomach. The pyloric sphincter allows food to leave the stomach and enter the small intestine when it is ready. Folds in the mucous membrane lining the stomach are called rugae. The rugae increase surface area for digestion and contain glands that produce the enzyme pepsin to start the digestion of proteins. Hydrochloric acid is also secreted to help digest protein and kill any bacteria remaining in the food.

Figure 5.7 Parts of the stomach. The fundus and body (often referred to collectively as the fundus) are a reservoir for ingested food and a site of action for acid and pepsin (stomach enzymes). The antrum is a muscular grinding chamber that breaks down food and gradually feeds it into the duodenum.

The stomach prepares food for the small intestine, where further digestion and absorption into the bloodstream takes place. food sheets

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the stomach in 1 to 4 hours or longer depending on the amount and type of food eaten.

Small Intestine (Small Intestine) (Continue labeling from Figure 5.6 on page 136.) The Small Intestine (Small Intestine) extends for 20 feet from the pyloric sphincter to the first part of the large intestine. It has three parts. The first section, the duodenum [3], is only 1 foot long. It receives food from the stomach, as well as bile from the liver [4] and gallbladder [5] and pancreatic juices from the pancreas [6]. Enzymes and bile help digest food before it makes its way to the second part of the small intestine, the jejunum [7], about 8 feet long. The jejunum joins the third section, the ileum [8], about 11 feet long. The ileum a hurts to the first part of the colon. Millions of tiny, microscopic projections called villi line the walls of the small intestine. The tiny capillaries (microscopic blood vessels) in the villi absorb the digested nutrients into the bloodstream and lymphatics. Figure 5-8 shows different views of villi in the lining of the small intestine.

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Figure 5.8 Villi in the lining of the small intestine. Villi increase the surface area for absorbing nutrients.

Colon (colon) (Continue labeling Figure 5-6 on page 136.) The large intestine extends from the end of the ileum to the anus. It consists of three main components: the cecum, the large intestine, and the rectum. The cecum [9] is a pouch on the right side that connects to the ileum at the ileocecal valve (sphincter). The appendix [10] is attached to the cecum. The appendix has no clear function and can become inflamed and infected if it becomes clogged or blocked. The large intestine, about 5 feet long, has four named segments: ascending, descending, transverse, and sigmoid. The ascending colon [11] extends from the cecum to the underside of the liver, where it curves to the left (liver flexure) and becomes the transverse colon [12]. The transverse colon runs horizontally to the left to the spleen and then bends down (splenic flexure) into the descending colon [13]. The sigmoid colon [14], shaped like an S (sigmoid means similar to the Greek empty sigma, which curves like the empty S), begins at the distal end of and leads to the descending colon

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into the rectum [15]. The rectum ends in the lower opening of the gastrointestinal tract, the anus [16]. The large intestine takes the liquid waste products of digestion (the material that cannot enter the bloodstream) and stores these wastes until they can be eliminated from the body. Because the colon absorbs most of the water from the waste material, the body can pass solid feces (stool). Defecation is the expulsion or passage of feces from the body through the anus. Diarrhea, or watery stools, results from decreased absorption of water into the bloodstream through the walls of the colon.

Liver, Gallbladder, and Pancreas Three major accessory organs of the digestive system—liver, gallbladder, and pancreas—play critical roles in proper digestion and absorption of nutrients. Label Figure 5-9 as you study the following:

Figure 5.9 Liver, gallbladder and pancreas. The ampulla of Vater is located at the junction of the pancreatic duct and common bile duct, which enters the duodenum.

The liver [1], located in the right upper quadrant (RUQ) of the abdomen, produces a thick, orange-black, sometimes greenish fluid called bile. Bile contains cholesterol (a fa y substance), bile acids and several bile pigments. One of these pigments, bilirubin, is produced by the breakdown of hemoglobin in normal red blood

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cell destruction. Bilirubin travels through the bloodstream to the liver, where it is conjugated, or converted to a water-soluble form. Conjugated bilirubin is then added to the bile and enters the intestines (duodenum). Bacteria in the colon break down bilirubin into a variety of pigments that give feces a brownish color. Bilirubin and bile leave the body with the feces. When the bile duct is blocked or the liver is damaged and bilirubin cannot be excreted in the bile, the bilirubin stays in the bloodstream and causes jaundice (hyperbilirubinemia) — yellowing of the skin, whites of the eyes, and mucous membranes. In addition, stools may become lighter in color due to less bilirubin and bile being excreted into the gastrointestinal tract. Figure 5.10 shows the bilirubin pathway from the destruction of red blood cells (hemolysis) to excretion in the bile in the faeces.

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FIGURE 5-10 Bilirubin pathway from bloodstream to excretion in feces. Elevated blood levels of unconjugated bilirubin indicate ongoing hemolysis (destruction of red blood cells). Elevated levels of conjugated bilirubin in the blood indicate obstruction of the bile ducts. Both types of bilirubin are elevated in the blood of patients with liver disease.

(Continue labeling Figure 5-9.) The liver continually releases bile, which then travels through the hepatic duct and meets the cystic duct. The cystic duct leads to the gallbladder [2], a pear-shaped sac under the liver that stores and concentrates bile for later use. After meals, the gallbladder contracts in response to the presence of food in the stomach and duodenum, forcing bile from the bile duct into the common bile duct [3]. Meanwhile, the pancreas [4] secretes pancreatic juices (enzymes) that are released into the pancreatic duct, which joins the common bile duct once it enters the duodenum [5]. The duodenum thus receives a mixture of bile and pancreatic juices. The bile has a washing-active effect on the fats in the duodenum. During emulsification, bile breaks up large globules of fat, creating more surface area for enzymes from the pancreas to digest the fats.

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y p g Without bile, most of the fat that enters the body goes undigested, and the stool can look foul. In addition to producing bile, the liver has several other vital and important functions:

• Maintaining normal blood glucose (sugar) levels. The liver removes excess glucose from the bloodstream and stores it as glycogen (starch) in the liver cells. When blood sugar levels get dangerously low, the liver converts stored glycogen back into glucose through a process called glycogenolysis. Additionally, when the body needs sugar, the liver can convert proteins and fats into glucose through a process called gluconeogenesis. • Manufacture of blood proteins such as albumin and those necessary for blood clotting • Release of bilirubin, a pigment in bile • Elimination of drugs and toxins (toxins) from the blood The portal vein carries blood from the intestines to the liver. Nutrients from digested food enter the portal vein immediately after absorption in the capillaries of the small intestine, giving the liver its first chance to utilize the nutrients. The pancreas (Figure 5-11) is both an exocrine and endocrine organ. As an exocrine gland, it produces enzymes for digesting starch, such as amylase (amyl/o = starch, -ase = enzyme); to digest fat, such as lipase (lip/o = fat); and to digest proteins such as protease (prote/o = protein). These enter the duodenum through the pancreatic duct.

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Figure 5.11 The pancreas and its functions.

As an endocrine gland (secreting into the bloodstream), the pancreas secretes insulin. This hormone, needed to release sugar from the blood, acts as a carrier to get glucose into the body's cells to use for energy. Figure 5-12 is a flow chart that traces the journey of food through the gastrointestinal tract.

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Figure 5.12 Path of food through the gastrointestinal tract.

vocabulary

The following list repeats many of the terms introduced in this chapter. Short deﬁnitions and additional information reinforce your meaningfulness

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understanding of the terms. All terms are included in the Term Pronunciation section later in this chapter.

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Absorption

passage of substances through the walls of the small intestine into the bloodstream. Amino acids Small protein building blocks that are released when proteins are digested. Amylase Enzyme (-ase) secreted by the pancreas and salivary glands to digest starch (amyl/o). Anus Terminal or opening of the digestive tract to the outside of the body. Cecal sac attached to the cecum (in the right lower quadrant [RLQ]). It literally means to append (pend/o) to (ap-, which is a form of ad-). Bile Digestive juice made in the liver and stored in the gallbladder. It breaks up (emulsifies) large fat globules. Bile was originally called bile (lat. bilis, meaning bile or anger), probably because it has a beer flavor. It consists of bile pigments (colors), cholesterol and bile salts. Bilirubin Pigment released by the liver into bile. intestines intestines Canines Pointed, canine-like teeth (canine means dog) next to the incisors. Also called canines or canines. Cecum First part of the large intestine. Colon Portion of the large intestine, consisting of the ascending, transverse, descending, and sigmoidal segments. common bile Carries bile from the liver and gallbladder to the duodenum. Also called choledochal duct. Defecation Removal of feces from the digestive tract through the anus. Swallow Swallow. NOTE: The pronunciation is de-glu-TISH-un. Dentin Primary material in teeth. It is covered by enamel in the crown and a protective layer of cement in the root. Digestion Breaking down complex foods into simpler forms. Duodenum First part of the small intestine. duo=2, cave=10; the duodenum measures 12 inches long. Elimination Elimination of substances from the body; in the digestive system, the removal of indigestible materials as feces. Emulsification Breaking up large globules of fat into smaller globules. This increases the surface area that enzymes can use to digest the fat. Enamel Hard, outermost layer of a tooth. Enzyme Chemical that accelerates a reaction between substances. Digestive enzymes break down complex foods into simpler substances. Enzymes are given names ending in -ase. esophagus tube that connects the throat to the stomach. Eso- means inside; phag/o means to swallow. Fatty acids Substances produced during the digestion of fats. faeces Solid waste; Stool. The term faeces means to refer to faeces. gallbladder Small sac under the liver; stores bile. NOTE: Gallbladder is a word! Glucose Simple sugars. glycogen starch; Glucose is stored in liver cells in the form of glycogen. hydrochloric acid Substance (strong acid) produced in the stomach; supports digestion. acidic ileum Third part of the small intestine from the Greek eilos, meaning twisted. When the abdomen was examined at autopsy, the bowel appeared twisted and the ileum was often an area of obstruction. Incisor One of the four front teeth in the dental arch. Insulin Hormone produced by the endocrine cells of the pancreas. It helps transport sugar into the body cells. Jejunum Second part of the small intestine. The Latin jejunus means empty; this part of the intestine was always empty when examining a body after death. NOTE: The pronunciation is jeh-JU-num.

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Lipase Leber

Chewing molars of the lower esophageal sphincter (LES).

Pancreatic enzyme necessary to digest fats. Large organ in the RUQ of the abdomen. The liver secretes bile; stores sugar, iron and vitamins; produces blood proteins; destroys worn out red blood cells; and filters out toxins. The normal adult liver weighs about 3 pounds. Muscle ring between esophagus and stomach. Also called cardiac sphincter.

Chew. Three large, flat teeth at the back of the mouth, on either side of the dental arch. Premolars are two teeth in front of the molars. palate roof of the mouth. The hard palate lies in front of the soft palate and is supported by the maxillary bone (upper jaw). The soft palate is the back fleshy part between the mouth and throat. pancreas Organ behind the stomach; produces insulin (used to transport sugar into cells) and enzymes (used to digest food). Papillae Small projections on the tongue. Taste buds (taste receptor cells) are located within the papillae (pap-IL-e). Parotid Gland Salivary gland in the cheek, just in front of the ear. Note the literal meaning of parotid (par- = near; ot/o = ear). Peristalsis Rhythmic contractions of the tubular organs. In the gastrointestinal tract, peristalsis moves contents at different speeds through: stomach, 0.5 to 2 hours; small intestine, 2 to 6 hours; and large intestine, 6 to 72 hours. Peri-meaning surroundings; -stalsis is constriction. NOTE: The pronunciation is peh-rihSTAL-sis. Pharynx Throat, the common passageway for food from the mouth and air from the nose. Portal vein Large vein that carries blood from the intestines to the liver. Protease Enzyme that digests protein. pulp Soft tissue inside a tooth that contains nerves and blood vessels. Pylorus muscle ring at the end of the stomach, near the duodenum. From the Greek sphincter pyloros, meaning gatekeeper. It is normally closed but opens when a wave of peristalsis passes over it. Pylorus Distal region of the stomach, opening to the duodenum. Rectum Last section of the large intestine that connects the end of the large intestine to the anus. rugae ridges on the hard palate and stomach wall. NOTE: The pronunciation is RU type. Saliva Digestive juice produced by the salivary glands. Saliva contains the enzyme amylase, which initiates the digestion of starches into sugars. Parotid, sublingual and submandibular salivary glands. glands sigmoid colon Lower, S-shaped section of colon, just before rectum; empties into the rectum. Sphincter Ring-shaped ring of muscle that narrows a passageway or closes a natural opening. Stomach Muscular organ that absorbs food from the esophagus. The parts of the stomach are fundus (proximal section), body (middle section) and antrum (distal section). Triglycerides Fat molecules made up of three parts fatty acid and one part glycerol. Triglycerides (fats) are a subgroup of lipids. Another type of lipid is cholesterol. Uvula Soft tissue hanging down the middle of the soft palate. The Latin uva means bunch of grapes.

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Villi (singular: microscopic projections in the wall of the small intestine that absorb villi) transport nutrients into the bloodstream.

The portal veins

Note the relationship of the portal vein (also called hepatic portal vein) between the intestine and the liver (Figure 5-13). This vein is not a true vein because it does not carry blood directly to the heart like other veins. In liver disease, blood pools in the portal vein, causing portal hypertension (high blood pressure) and esophageal varices. See page 155.

Figure 5.13 Portal vein and its relationship to the liver and small intestine.

Terminology

Write the meaning of the medical term in the space provided. Check the pronunciation of terms on pages 173-176 for unfamiliar words.

Body Parts

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Figure 5-14 Stages of appendicitis. A, Obstruction and bacterial infection cause a red, swollen, and inflamed appendix. B, pus and bacteria invade the wall of the cecum. C, Pus perforates (breaks through) the wall of the cecum into the abdomen, causing peritonitis (inflammation of the peritoneum).

Figure 5.15 A. Location of the stomata in the ileum and colon. B. Colostomy care.

Figure 5.16 Three types of anastomoses. These are examples of an enteroenterostomy. The suffix -stomy, when used with two or more combination forms (enter/o and enter/o), indicates the surgical creation of a new opening between those parts of the body.

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Figure 5.17 Mesentery. The omentum and mesocolon are parts of the mesentery. The omentum (raised in this figure) actually hangs down like an apron over the bowel. The mesentery contains blood and lymph vessels. The lymph nodes in the mesentery are important indicators of the spread of colon cancer (staging of colon cancer).

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COMBINING MEANING TERMINOLOGY MEANING FORM an/o anus perianal _______________________ append/o appendix appendectomy _______________________________________ appendic/o appendicitis _______________________________________ See Figure 5-14. Bucc/o Cheek Cheek mucosa _______________________________________ A mucous membrane is a mucous membrane that lines cavities or ducts that open to the outside. cec/o cecum cecal _______________________________________ celi/o belly, coeliac ____________________ Abdomen Abdomin/o and lapar/o also mean abdomen. Celiac disease is damage to the lining of the small intestine that occurs in response to eating gluten. Cheil/o Lip Cheilosis ________________________________________ Labi/o also means lip. cholecyst/o gallbladder cholecystectomy _______________________________________ chol/e = bile, bile. Choledoch/o common choledochotomy _______________________ bile duct col/o colon colostomy _______________________________________ The suffix -stomy, when used with a compound form for an organ, means an opening to the outside of the body. A stoma is an opening between an organ and the body surface (Figure 5-15A and B). Colon/o Colon Colonic _______________________________________ Colonoscopy _______________________________________ dent/i tooth dentibuccal _______________________________________ Odont/o also means tooth. Duodenum/duodenum Duodenum _______________________________________ Enter/o intestine, enterocolitis _______________________________________ mostly TIP: If two combination forms for small gastrointestinal organs appear in one term, the organ closer to the mouth appears first. Enteroenterostomy _______________________________________ New opening between two previously unconnected sections of small intestine. This is an anastomosis, i.e. any surgical connection between two parts such as vessels, ducts or sections of intestine (ana = upwards, stom = opening, -sis = state) (Figure 516). Mesentery _______________________________________ Part of the double peritoneal fold that stretches around the organs in the abdomen, the mesentery holds the organs in place. It literally lies in the middle (mes-) of the gut, a membrane that pierces the gut against the muscular wall at the back of the abdomen (Figure 5-17). parenteral _______________________________________ Par (from para-) means apart from in this term. An intravenous line brings the parenteral nutrition directly into the bloodstream, bypassing the intestinal tract (enteral nutrition). Parenteral injections can also be given subcutaneously or intramuscularly.

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COMBINING MEANING TERMINOLOGY MEANING FORM esophagus/o esophagus esophagus ________________________________________ TIP: Changing the suffix from -al to -eal softens the final g (eh-sof-ah-JE-al). faci/o face face _______________________________________ gastr/o stomach gastrostomy _______________________________________ gingiv/o gums gingivitis _______________________________________ gloss/o tongue hypoglossal _______________________________________ Lingu/o also means tongue. Hepat/o liver hepatoma ________________________________________ Also called hepatocellular carcinoma. Hepatomegaly _______________________________________ Ile/o ileum Ileocecal sphincter _______________________________________ Also called ileocecal valve. Ileitis _______________________________________ Ileostomy _______________________________________ See Figure 5-15A, page 146. jejun/o jejunum Choledochojejunostomy _______________________________________ An anastomosis. Gastrojejunostomy _______________________________________ This is part of a gastric bypass procedure. See Figure 6-7B, page 187. Labi/o Lip Labial __________________________ Lapar/o Abdomen Laparoscopy _____________________________________________ A form of minimally invasive surgery (MIS). Examples are laparoscopic cholecystectomy (Figure 5-28, page 160) and laparoscopic appendectomy. lingu/o tongue sublingual _______________________________________ mandibul/o lower jaw, submandibular ____________________ mandibula odont/o tooth orthodontist _______________________________________ ortho means straight. Periodontist _______________________________________ Endodontist _______________________________________ Performs a root canal treatment. or/o mouth oral ________________________________________ Stomat/o also means mouth. Palate/O-Palate Palate Plastic ____________________ Procedure to repair cleft palate and cleft lip; Repair of a cleft palate. pancreat/o pancreas pancreatitis __________________________ peritone/o peritoneum peritonitis _______________________________________ The e of the root is omitted in this term. Pharyng/o Throat Pharynx ____________________ Palatopharyngoplasty _______________________________________ Used to treat cases of snoring or sleep apnea caused by obstructions in the throat or nose.

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COMBINING MEANING TERMINOLOGY MEANING FORM proct/o anus and proctologist _______________________________________ rectum pylor/o pyloric pyloroplasty _______________________________________ sphincter rect/o rectum rectocele _______________________________________ sialaden/o salivary sialadenitis _______________________________________ gland sigmoid/o sigmoid sigmoidoscopy _______________________________________ colon stomat/o mouth stomatitis _______________________________________ uvul/o uvula Uvulektomie _______________________________________

Substances COMBINATION MEANING TERMINOLOGY MEANING FORM Amyl/o Starch Amylase _______________________________________ The suffix -ase means enzyme. bil/i gall, galle biliary _______________________________________ The bile ducts include the organs (liver and gallbladder) and ducts (hepatic, cystic, and common bile ducts) that secrete, store, and empty bile into the duodenum. Bilirubin/o Bilirubin Hyperbilirubinemia (bile _______________________________________ pigment) Chole/e bile, bile cholelithiasis _______________________________________ Lith/o means stone or calculus; -iasis means abnormal condition. Chlorohydr/o hydrochloric acid __________________________ Gastric juice deficiency is associated with gastric carcinoma. Gluc/o Sugar Gluconeogenesis _______________________________________ Liver cells produce new sugar from fats and proteins. Glycogen/o Sugar Hyperglycemia ____________________________________________________ Glycogen/o Glycogen, Glycogenolysis Animal _______________________________________ Starch Liver cells convert glycogen back to glucose when blood sugar levels drop. lip/o-fat, lipid-lipoma _______________________________________ lith/o-stone lithogenesis _______________________________________ prote/o-protein protease _______________________________________ py/o-pus pyorrhoea _______________________________________ periodontitis; an advanced stage of periodontitis (gingivitis). Sial/o Saliva, Sialolith _______________________________________ Saliva Steat/o Fat Steatorrhea _______________________________________ Improperly digested (malabsorbed) fats appear in feces.

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Suffixes SUFFIX MEANING TERMINOLOGY MEANING -ase Enzyme Lipase ________________________________________ Enzymes accelerate chemical reactions. Lipase helps digest fats. In all types of liver disease, liver enzyme levels may be elevated, indicating damage to liver cells. Signs and symptoms include malaise, anorexia, hepatomegaly, jaundice, and abdominal pain. -chezia defecation, hematochezia __________________________ excretion (he-mat-o-KE-ze-ah) Bright red blood is found in feces. of excretions -iasis abnormal choledocholithiasis ________________________________________ condition meal postprandial ________________________________________ prandial Post cibum (p.c.), seen on written prescriptions, also means after meals.

cholecyst/o and cyst/o

Do not confuse cholecyst/o (gallbladder) with cyst/o, the urinary bladder.

ileum and ilium

Don't confuse the ileum, the third part of the small intestine, with the ilium, the top and largest part of the pelvis (hip bone).

Chol/e and Col/o

Do not confuse chol/e meaning bile or bile with col/o meaning colon! The context of the term will help you determine the correct spelling.

pyorrhea and pyuria

Pyorrhea is a discharge (rrhoea) of pus from the gums, and pyuria is the presence of pus in the urine (sign of urinary tract infection).

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Digestive System Pathology This section introduces medical terms that describe signs and symptoms (clinical signs) and pathological conditions of the gastrointestinal tract. Sentences after each definition describe the etiology (eti/o = cause) of the disease and treatment. If the etiology (cause) is not understood, the condition is idiopathic (idi/o = unknown). See Chapter 21, Pharmacology, for a list of medications prescribed to treat gastrointestinal signs and symptoms.

signs and symptoms

A sign is an objective finding — such as an increase in body temperature, a rash, or a noise heard when listening to the chest — that suggests the presence of a disease, as perceived by an examiner. In contrast, a symptom is a subjective sensation or change in health—such as itching, pain, fatigue, or nausea—as experienced by the patient. Clearly, the same trait can be noticed by both doctor and patient, making it both a sign and a symptom!

signs and symptoms

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Figure 5-18 A. Ascites, or abnormal intraperitoneal fluid, can be caused by conditions such as liver disease, peritonitis, and ovarian cancer. B. Ascites in a male patient. The photo was taken after paracentesis (puncture to remove fluid from the abdomen). Note the gynecomastia (condition of female breasts) in this patient due to excess estrogen that may accompany cirrhosis, particularly in individuals with alcoholism.

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Figure 5.19 Jaundice due to liver disease.

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Anorexia

ascites

borborygmi (singular: borborygmus) constipation

Diarrhea

Dysphagia

belching flatulence hematochezia jaundice (icterus)

mane

loss of appetite Anorexia (-orexia = appetite) is often a sign of malignancy or liver disease. Anorexia nervosa is a lack of appetite associated with emotional problems such as anger, anxiety, and an irrational fear of gaining weight. It is an eating disorder and is discussed in Chapter 22 along with a similar eating disorder, bulimia nervosa. Unusual accumulation of fluid in the abdomen (Figure 5.18A and B). This condition occurs when fluid leaks from the bloodstream and builds up in the abdominal cavity. It can be a sign of neoplasms or inflammatory diseases in the abdomen, venous hypertension (high blood pressure) due to liver disease (cirrhosis), or heart failure. Treatment for ascites includes administration of diuretics and paracentesis to remove abdominal fluid. Rumbling or gurgling sounds caused by the movement of gas, liquid, or both in the gastrointestinal tract. Signs of hyperactive bowel peristalsis, borborygmi (bowel sounds) are often present with gastroenteritis and diarrhea. Difficulty passing stools (feces). When peristalsis is slow, stools are dry and hard. A diet rich in fruits, vegetables, and water is helpful. Laxatives and purgatives are medications used to promote stool movement. Chronic idiopathic constipation (CIC) is persistent constipation with no apparent cause. Frequent discharge of soft, watery stools. Abrupt onset of diarrhea immediately after eating indicates an acute infection or toxin in the gastrointestinal tract. Untreated severe diarrhea can lead to dehydration. Anti-diarrheal medication is helpful. difficulty swallowing. This sensation feels like a "lump in the throat" when a swallowed bolus does not progress, either due to a physical disability (obstructive dysphagia) or a motor disorder in which esophageal peristalsis is not coordinated (motor dysphagia). Gas expelled from the stomach through the mouth. The burping produces a characteristic sound and is also known as a belch (belch). Gas expulsion through the anus. Bloating is excessive gas in the stomach and intestines. One sign of a bowel obstruction is the inability to pass gas. Passing of fresh, bright red blood from the rectum. The cause of hematochezia is usually hemorrhoids, but it can also be colitis, ulcers, polyps, or cancer. Yellow-orange discoloration of the skin and whites of the eyes caused by high levels of bilirubin in the blood (hyperbilirubinaemia). See Figure 5-19. Jaundice can occur when (1) excessive destruction of erythrocytes, as in hemolysis, causes excess bilirubin in the blood; (2) malfunction of liver cells (hepatocytes) due to liver disease prevents the liver from excreting bilirubin in the bile; or (3) obstruction of bile flow, such as B. by choledocholithiasis or tumor, prevents bilirubin in the bile from being excreted in the duodenum. Black tarry stools ; feces with digested blood. This clinical sign usually reflects a condition in which the blood has had time to be digested (acted on by intestinal juices) and results

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nausea

Steatorrhoe

Bleeding in the upper gastrointestinal tract (duodenal ulcer). A positive result in the stool guaiac test (see page 183) indicates blood in the stool. Unpleasant feeling in the stomach with a tendency to vomit. Common causes include motion sickness, early pregnancy and viral gastroenteritis. Nausea and vomiting can be symptomatic of a perforation (hole in the wall) of an abdominal organ; obstruction of a bile duct, stomach or intestines; or exposure to poisons. fat in the faeces. Steatorrhea is the production of foamy, foul-smelling feces that often float down the toilet. Improper digestion or absorption of fat causes fat to remain in the gut. This can occur with a disease of the pancreas (pancreatitis) when pancreatic enzymes are not secreted. It is also a sign of an intestinal disease that involves malabsorption of fat.

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Pathological conditions of the oral cavity and teeth

Figure 5.20 Normal teeth and gums and pathological conditions. A, Normal teeth and gums. B, aphthous stomatitis. C, dental caries. D, herpetic stomatitis. E, oral leukoplakia. F, gingivitis.

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aphthöse Stomatitis Zahnkaries

herpetische Stomatitis

oral Leukoplakia Periodontitis

Inflammation of the mouth with small, painful sores. The ulcers associated with this condition are commonly referred to as canker sores (KANK-er); the cause is unknown (Figure 5-20B). Caries. Plaque is caused by the accumulation of food, salivary proteins and necrotic deposits on the enamel. Bacteria grow in the plaque and cause the production of acid that dissolves the tooth enamel, resulting in a cavity (cavity area) (Figure 5-20C). If the bacterial infection reaches the pulp of the tooth, root canal treatment may be necessary. Inflammation of the mouth caused by infection with the herpes virus. Painful, fluid-filled blisters on the lips, gums, gums, and tongue, commonly called cold sores or cold sores (Figure 5-20D). It is caused by the herpes simplex virus type 1 (HSV1). Genital herpes (due to HSV2) affects the reproductive organs. Both diseases are highly contagious. White plaques or patches on the lining of the mouth. This precancerous lesion (Figure 5-20E) can result from chronic tobacco use (pipe smoking or chewing tobacco). Malignant potential is assessed by microscopic examination of biopsied tissue. Inflammation and degeneration of gums, teeth and surrounding bone. Gingivitis (Figure 5-20F) occurs as a result of a build-up of plaque and tartar or calculus (a yellow-brown, calcified deposit on the teeth). During a gingivectomy, the periodontist uses a metal instrument to scrape plaque and tartar from the teeth; Any pockets of pus (pyorrhea) are then drained and removed to allow new tissue to form. Localized infections are treated with systemic antibiotics.

Upper gastrointestinal tract

Figure 5-21 A: Esophageal varices. B, Endoscopic view of esophageal varices.

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Figure 5-22 Hernias. A, hiatal hernia. B, hernia. A direct hernia occurs through the abdominal wall in an area of muscle weakness. An indirect hernia occurs through the inguinal canal (passageway in the lower abdomen) where the prolapsed tissue/intestine descends into the scrotum.

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Achalasia

esophageal cancer

esophageal varices

stomach cancer

gastroesophageal reflux disease (GERD)

Hernia

gastric ulcer

Failure of the lower esophageal sphincter (LES) muscle to relax. Achalasia (-chalasia = relaxation) results from the loss of peristalsis so that food cannot easily pass through the esophagus. Both the failure of the LES to relax and the loss of peristalsis result in dilatation (widening) of the esophagus above the narrowing. Doctors recommend a bland, low-bulk diet and mechanical stretching of the LES to relieve symptoms. Malignant tumor of the esophagus. The most common symptom of esophageal cancer is difficulty swallowing (dysphagia). Smoking and chronic alcohol consumption are important risk factors. Long-term irritation of the esophagus caused by gastric reflux is a premalignant condition called barre esophagus. Surgery, radiation therapy, and chemotherapy are treatment options. Swollen varicose veins at the bottom of the esophagus (Figure 5-21). Liver disease (such as cirrhosis and chronic hepatitis) causes increased pressure in the veins near and around the liver (portal hypertension). This leads to dilated, tortuous esophageal veins with a risk of bleeding (bleeding). Treatment may include banding (tying off the swollen veins in the esophagus) or sclerotherapy (injecting a solution into a vein to close it off). Drug therapy to lower portal hypertension can be used to reduce the risk of variceal bleeding. Malignant tumor of the stomach. Smoking, alcohol consumption and chronic gastritis associated with bacterial infection are major risk factors for gastric cancer. Gastric endoscopy and biopsy diagnose the condition. Cure depends on early detection and surgical removal. Solids and liquids return to the mouth from the stomach. Heartburn is a burning sensation caused by regurgitation of hydrochloric acid from the stomach into the esophagus. Chronic exposure of the esophageal lining to gastric acid and pepsin (an enzyme that digests protein) leads to reflux esophagitis. Drug treatment for GERD includes antacids (acid-suppressing) agents and drugs to increase the tone of the LES. Protrusion of an organ or part through the tissues and muscles that normally contain it. A hiatal hernia occurs when the upper portion of the stomach protrudes through the diaphragm (Figure 5-22A). This condition can lead to GERD. A hernia occurs when a small loop of bowel protrudes through weak tissue in the lower abdominal wall (fascia) around the muscles (Figure 5-22B). The surgical repair of inguinal hernias is known as herniorrhaphy (-rrhaphy means suture). Open wound in the lining of the stomach or duodenum. A bacterium, Helicobacter pylori (H. pylori), is responsible for many cases of stomach ulcers. The combination of bacteria, acidosis and gastric juice damages the epithelial lining. Drug treatment includes antibiotics, antacids, and agents to protect the gastric and intestinal mucosa.

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Lower gastrointestinal tract (small and large intestine)

Figure 5.23 Anal fistula and colonic polyps. A, Anal fistula and two types of polyps. B, multiple polyps of the colon.

Figure 5.24 Adenocarcinoma of the colon. This tumor has "clumped" edges and an ulcerated midsection.

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Figure 5.25 A. Diverticula (leading to diverticulosis) form when the lining of the colon bulges due to the weakened muscular wall. B and C, diverticulitis can result from fecal matter becoming lodged in diverticula. Avoiding foods with seeds and nuts reduces the risk of this condition.

Figure 5.26 Intussusception and volvulus.

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Anal fistula colonic polyps

colon cancer

Crohn's disease ("Crohn's disease")

Diverticulosis

Ruhr

hemorrhoids

Ileus inflammatory bowel disease (IBD) intussusception

Abnormal tube-like passage near the anus. The fistula often results from a break, tear, or abscess in the wall of the anus or rectum (infected area) (Figure 5.23A). Polyps (benign growths) protrude from the lining of the colon. Figure 5-23A shows two types of polyps: pedunculated (attached to the membrane with a stalk) and sessile (attached directly to the mucosa) polyps. Figure 5-23B shows multiple polyps of the colon. Many polyps are premalignant (adenomatous polyps); These growths are often removed (polypectomy) as a preventive measure and for further examination (biopsy). Adenocarcinoma of the colon or rectum or both. Colorectal cancer (Figure 5-24) can arise from polyps in the colon or rectum region. The diagnosis is made by detecting blood in the stool and by performing a colonoscopy. Prognosis depends on the stage (degree of spread) of the tumor, including size, depth of invasion, and lymph node involvement. Surgical treatment may require excision of a larger section of the colon with reconnection of the cut ends (anastomosis). Chemotherapy and radiation therapy are given as needed. Chronic inflammation of the intestinal tract. Crohn's disease can occur anywhere from the mouth to the anus, but is most common in the ileum (ileitis) and colon. Signs and symptoms include diarrhea, severe abdominal pain, fever, anorexia, weakness, and weight loss. Both Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease (IBD). Treatment is with drugs that control inflammation and other symptoms, or by surgically removing diseased sections of bowel and anastomizing the remaining parts. Read for yourself: Living With Crohn's Story on page 162. Abnormal protuberances (diverticula) in the lining of the colon. See Figure 5-25A. Diverticulitis is a complication of diverticulosis. When fecal matter becomes trapped in diverticula, diverticulitis can occur. Pain and rectal bleeding are symptoms. Figure 5-25B and C show diverticulitis in a section through the sigmoid colon. Initial treatment for acute diverticulitis includes a liquid diet and oral antibiotics. In severe cases, the patient may need hospitalization, intravenous antibiotics, and surgery to remove the affected area of the colon with anastomosis of the cut ends. Painful inflammation of the gut, often caused by a bacterial infection. Dysentery commonly occurs in the large intestine and results from ingestion of food or water containing bacteria (salmonella or shigella), amoebas (unicellular organisms), or viruses. Symptoms include bloody stools, abdominal pain, and sometimes fever. Swollen, twisted varicose veins in the rectal area. Varicose veins can be internal (inside the rectum) or external (outside the anal sphincter). Pregnancy and chronic constipation that put pressure on the anal veins often cause hemorrhoids. Loss of peristalsis with consequent obstruction of the bowel. Surgery, trauma, or bacterial injury to the peritoneum can result in paralytic ileus (acute, temporary loss of peristalsis). Inflammation of the colon and small intestine. See Crohn's disease and ulcerative colitis. telescoping of the bowel.

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Reizdarmsyndrom (IBS)

Ulcerative colitis

volvulus

In this state, one segment of the intestine collapses into the opening of another segment (Figure 5.26). It often occurs in children and in the ileocecal region. Bowel obstruction with pain and vomiting may occur. A barium enema can diagnose and successfully reduce intussusception. Otherwise, surgery to remove the affected section of bowel (with subsequent anastomosis) may be required. Group of GI symptoms (abdominal pain, bloating, diarrhea, constipation) with no structural abnormalities in the gut. IBS can be related to stress or it can occur after an infection. Treatment includes a diet high in bran and fiber, as well as laxatives and antidiarrheals to help establish regular bowel movements. Other names for IBS are irritable bowel and spastic colon. IBS is a type of functional gastrointestinal disorder (FGID). These are disorders of the gastrointestinal tract, but without structural or biochemical abnormalities. A low-FODMAP (an acronym for carbohydrates that are poorly absorbed by the gut) diet has been helpful in improving symptoms in many IBS patients. Chronic inflammation of the large intestine with the presence of ulcers. This idiopathic, chronic, relapsing disease of diarrhea (an inflammatory bowel disease) is characterized by rectal bleeding and pain. Inflammation often begins in the colon and spreads proximally, affecting the entire colon. Drug treatment and a careful diet are recommended. Resection of the diseased bowel with ileostomy may be necessary. In some cases it is cured by total colectomy. Patients with ulcerative colitis have a higher risk of developing colon cancer. Twisting of the bowel on itself. Volvulus causes bowel obstruction. Clinical features are severe pain, nausea, and vomiting, and the absence of bowel sounds. Surgical correction is necessary to prevent necrosis of the affected portion of the bowel (see Figure 5-26).

Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD)

While IBS is a disease without structural abnormalities of the gut, IBD (Crohn's disease and ulcerative colitis) involves structural abnormalities.

liver, gallbladder and pancreas

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Figure 5.27 Locations of gallstones in the gallbladder and bile ducts. A, stone in the gallbladder that causes mild or no symptoms. B: Stone obstructs the cystic duct and causes pain. C, stone blocking the common bile duct, causing pain and jaundice. D, Stone at lower end of common bile duct and pancreatic duct causing pain, jaundice, and pancreatitis.

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Figure 5-28 A: Trocars for laparoscopic cholecystectomy. Trocars are used to puncture and penetrate the abdomen. These devices are metal tubes consisting of a hollow metal tube (cannula) that accepts an obturator (a rigid, detachable metal instrument with a sharp, triangular point) that is used to pierce the wall. Circled numbers indicate common positions for trocar insertion: 1 is a 10/11 mm umbilical trocar (the largest trocar diameter is 15). 2 is a 10/11mm midline trocar. 3 and 4 are 5mm trocars that are placed in the right upper quadrant of the abdomen. B, gallstones. Mechanical manipulation during laparoscopic cholecystectomy has resulted in fragmentation of several cholesterol gallstones, exposing the interior, which is pigmented due to trapped bile pigments. The gallbladder mucosa is reddened and irregular as a result.

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Figure 5.29 A: Normal liver. B, Liver with alcoholic cirrhosis.

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Cholelithiasis

cirrhosis

hepatocellular carcinoma (HCC)

pancreatic cancer

Pancreatitis

Virushepatitis

Gallstones in the gallbladder. Stones prevent bile from leaving the gallbladder and bile ducts (Figure 5-27). Many patients remain asymptomatic and do not require treatment; Symptoms associated with gallbladder stones are either biliary colic (pain from blocked ducts) or cholecystitis (inflammation and infection of the gallbladder), both of which require treatment. Laparoscopic or minimally invasive surgery (laparoscopic cholecystectomy) can currently be performed to remove the gallbladder and stones (Figure 5-28A and B). Chronic degenerative disease of the liver. Cirrhosis is often the result of chronic alcoholism, viral hepatitis, iron overload, or other causes. Liver lobes scar with fibrous tissue, liver cells degenerate, and the liver becomes infiltrated with fat. Cirrh/o means yellow-orange, which describes the color of the liver caused by fat accumulation. Figure 5-29 shows a normal liver and a liver with alcoholic cirrhosis. liver cancer. Cancer that starts in the liver is primary liver cancer (as opposed to secondary liver cancer, which starts in another organ and metastasizes to the liver). HCC is commonly associated with hepatitis B and C virus infections and cirrhosis due to chronic alcohol use. Nonalcoholic steatohepatitis (NASH) is a fayeous infiltration of the liver that can progress to cirrhosis and HCC. Surgery, radiation, and chemotherapy are therapeutic options. Hepatocellular carcinoma produces alpha-fetoprotein (AFP), a tumor marker that is often elevated in the blood of patients with this type of cancer. AFP is used to screen for HCC in patients with cirrhosis. Liver cancer that starts in the bile ducts is called cholangiocarcinoma. Bile duct cancer can also arise from the gallbladder. Malignant tumor of the pancreas. It often occurs in the head of the pancreas (closer to the duodenum) where it can block the ducts. Although the cause is unknown, pancreatic cancer is more common in smokers and people with diabetes and chronic pancreatitis. Symptoms and signs include abdominal or back pain, fatigue, jaundice, anorexia, diarrhea, and weight loss. The standard surgical treatment when the tumor can be resected is a pancreatoduodenectomy (Whipple operation). Chemotherapy and radiation can also be used. Inflammation of the pancreas. Digestive enzymes attack the pancreatic tissue and damage the gland. Other etiological factors include chronic alcoholism, drug toxicity, gallstone obstruction of the common bile duct, and viral infections. Treatment includes drugs to relieve epigastric pain, intravenous fluids, bowel rest, and subtotal pancreatectomy if necessary. Inflammation of the liver caused by a virus. Hepatitis A is viral hepatitis caused by the hepatitis A virus (HAV). It is a disease transmitted through contaminated food or water and is characterized by a slow onset of symptoms. Hepatitis B is caused by the hepatitis B virus (HBV) and is transmitted through sexual contact, blood transfusions, or the use of contaminated needles, or it can be acquired by transmission from mother to fetus. Severe infection can result in liver cell destruction, cirrhosis, or death. A vaccine that confers immunity is available and is recommended for people at risk of exposure. Hepatitis C is caused by the hepatitis C virus (HCV) and is transmitted through blood transfusions

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or needle vaccination (e.g. for intravenous drug users who share needles). The acute disease can progress to chronic hepatitis and hepatocellular carcinoma. Two drugs recently approved by the FDA for hepatitis C are Mavyret and Vosevi. Liver enzyme levels may be elevated in all types, indicating damage to liver cells. Signs and symptoms include malaise, anorexia, hepatomegaly, jaundice, and abdominal pain.

What's "in" gallstones?

Gallstones are made up of cholesterol, bilirubin (pigment in bile) and calcium salts. They can vary in size and shape - from as small as a grain of sand to as big as a golf ball!

Whipple procedure in pancreatic cancer

This operation consists of:

• Removal of distal half of stomach (antrectomy) • Removal of gallbladder and common bile duct (cholecystectomy and choledocectomy) • Removal of part of pancreas and duodenum (pancreatoduodenectomy) • Reconstruction consists of pancreatojejunostomy, hepaticojejunostomy, and gastrojejunostomy Steve Jobs, co-founder of Apple Inc. , and Luciano Pavaro i, opera singer, had this operation.

Personal life with Crohn's disease

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When a friend told me yesterday that she had the flu, I was jealous. For someone with a chronic illness like me, having something acute always seems luxurious. Lie in bed, read glossy magazines, take over-the-counter medication, sleep in, and in a few days you'll be fine. I have Crohn's disease, a chronic inflammation of the small intestine characterized by flare-ups and remissions. During the flare-ups I had fever, diarrhea, vomiting, pain and intestinal blockage. Even in remission I'm never "okay". I am currently in remission two years after a third operation which removed another part of my small intestine. This time, internal bleeding, a rare symptom of Crohn's disease, necessitated surgery. I had to endure weekly iron infusions that turned into bi-monthly blood transfusions when my hemoglobin dropped to 6 (12 is normal). It wasn't a way of life. After the operation, the bleeding stopped, but I had severe, watery diarrhea for a year. It wasn't a way of life either, and unfortunately, wonderful as my doctor is, I've found that few gastroenterologists want to deal with the aftermath of small bowel surgery. After several doctor visits and through trial and error, I finally got these symptoms under control with codeine, lomotil, and metamucil, but I'll never get vitamin B12, so I'll have to take monthly shots for the rest of my life. Along with taking medication to deal with less and less small intestine, I take medication in hopes of preventing the next flare-up. Every few weeks I inject myself with a biologic drug, Humira, but I will eventually have to be weaned off this drug because of possible long-term side effects, the scariest of which is lymphoma. However, at 52 and with two school-age children, I have learned to place the greatest value on my current quality of life over possible unknown dangers lurking in the future. I often think of the past. What would my life be like if our GP hadn't told my parents that my constant diarrhea, which I've had since childhood, was caused by "nerves"? By the time I was 21, my weight had dropped to under 100 pounds and I was twisted with pain after every meal. My father arranged for me to see his GP who gave me a small bowel series

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revealed that I had Crohn's disease and that part of my small intestine was "as narrow as a pencil". By that time, even for prednisone (then the drug of choice despite side effects ranging from swollen face to psychosis) it was too late to open the inflamed passage and I had my first surgery just months after my diagnosis. Thinking about those times - like all the other flaring times - makes me cringe. Even though you may never experience pain again, you can remember how it felt. In my case, it was as if a large metal bike lock chain was being driven through my delicate gut. Before that first surgery, I was fresh out of college and yearning to make a difference in the world, but I spent most of my evenings curled up in my small bedroom, listening to the soothing tunes of "Make Believe Ballroom Hour" on the radio. Or I would lie down, with nausea and diarrhea accompanying the pain, with my back against the cold bathroom floor tiles. Later, as a mother of two young children, I lay on the couch and watched life whirl around me, feeling guilty for not being able to participate. These flare-ups have had a silver lining and that is the tender affection of those around me: husband, family and friends. When you have Crohn's disease, no one knows you have it until things get unbearable. It's not the kind of illness you're talking about, but if you have pain and fever, you can approximate the times when the flu hit you. However, they know that it takes more than a dose of Nyquil or a night's sleep to become "beer." You know you're facing another series of drugs—often unproven ones—or that you'll likely end up in the hospital for another surgery. Nancy J. Brandwein is a writer, editor, and food columnist.

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Exercises Be sure to check your answers carefully against the answers to the exercises, pages 171–172.

A Match the following digestive system structures to their meanings below. anus cecum large intestine duodenum esophagus gallbladder ileum jejunum liver pancreas pharynx sigma sigma 1. consists of ascending, transverse, descending and sigmoidal sections __________________________ 2. small sac under the liver; stores bile _________________ 3. first part of the large intestine _________________ 4. end of the digestive tract, which opens to the outside _________________ 5. second part of the small intestine _________________ 6. tube connecting the throat to the stomach _________________ 7. third part of the small intestine _________________

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p 8th major organ in RUQ; secretes bile, stores sugar, produces blood proteins _________________ 9. Throat _________________ 10. lowest part of large intestine _________________ 11. first part of small intestine _________________ 12. organ under stomach; produces insulin and digestive enzymes _________________ B Label the following flow chart of the journey of food through the gastrointestinal tract. The terms you will need are listed below: anus ascending colon cecum descending duodenum esophagus gallbladder ileum jejunum liver pancreas pharynx rectum salivary glands sigmoid colon stomach transverse intestine

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C Circle the term in bold that fits the definition given. You should also be able to define the other terms! 1. microscopic projections in the walls of the small intestine:

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papillae villi rugae 2. salivary gland near the ear: submandibular sublingual parotid 3. muscular ring at the end of the stomach: pyloric sphincter uvula lower esophageal sphincter 4. soft, inner portion of a tooth: dentin-enamel-pulp 5. chemical that accelerates stimulating reactions and helps digest food: triglycerides amino acid enzyme 6. dye released with bile: glycogen bilirubin melena 7. hormone produced by endocrine cells of the pancreas: insulin amylase lipase 8. rhythmic contraction of muscles in the walls of the Gastrointestinal tract: swallowing chewing peristalsis 9. breakdown of large fat globules: absorption emulsification anabolism 10. pointed canine tooth medial to premolars: incisor canine D Complete the following. 1. Labi/o and Cheil/o mean _____________________________________________ _________________ 2. Gloss/o and Lingu/o mean _________________

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3. Or/o and stomat/o mean _________________ 4. Dent/i and odont/o mean _________________ 5. Lapar/o and celi/o mean _________________ 6. Gluc/o and glyc/o mean _________________ 7. Lip/o, steat/o and adip/o mean _________________ 8. The suffixes -iasis and -osis mean _________________ 9. Chol/e and bil/i mean _________________ 10. Resection and -ectomy mean _________________ E Make up medical terms based on the definitions given. 1. Removal of a salivary gland _____________________________ _____________ 2. Throat _________________ 3. Rectal hernia _________________ 4. Liver enlargement _________________ 5. Surgical repair of the palate _________________ 6. After eating _________________ 7. Visual examination of the anal and rectal region _________________ 8. Examination of the cause ( disease) _________________ 9. Common bile duct incision _________________ 10. Concerning teeth and cheek _________________ 11. Small bowel disease state _________________ 12. Reopening between the common bile duct and jejunum _________________

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13. Concerns around the anus _________________ 14. New opening from the large intestine to the outside of the body _________________ 15. Under the lower jaw _________________ 16. Concerns the face _________________ F Match the following doctors or dentists to their specialties. Intestinal surgeon Endodontist Gastroenterologist Nephrologist Oral surgeon Orthodontist Periodontist Proctologist Urologist 1. treats diseases of the anus and rectum _____________________________ 2. operates on the organs of the urinary tract _________________ 3. straightens teeth _________________ 4. performs root canal treatment _________________ 5. operates on the mouth and teeth _________________ 6. treats kidney diseases _________________ 7. Diagnoses and treats gastrointestinal diseases _________________

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8. treats gum disease _________________ 9. operates on the intestinal tract _________________ G Make medical terms to describe the following inflammations. 1. Inflammation of the appendix _________________ 2. Inflammation of the large intestine _________________ 3. Inflammation of the passage from the throat to the stomach _________________ 4. Inflammation of the mucous membrane surrounding the abdomen _________________ 5. Inflammation of the gallbladder _________________ 6. Inflammation of the third part of the small intestine _________________ 7. Inflammation of the Pancreas _________________ 8. Inflammation of the gums _________________ 9. Inflammation of the liver _________________ 10. Inflammation of the mouth _________________ 11. Inflammation of the salivary gland _________________ 12. Inflammation of the small and large intestine _________________ H Match the given terms with the following meanings. Anastomosis bile duct defecation cheilitis

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Gluconeogenesis Glycogenolysis Hyperbilirubinemia Hyperglycemia Mesenteric mucosa Parenteral portal vein 1. High blood glucose level _____________ 2. Lip inflammation _________________ 3. Associated with administration of drugs and liquids other than through the mouth _________________ 4. Mucosa _________________ 5. Excretion of feces from the body through the anus _________________ 6. Breakdown (conversion) of starch into sugar _________________ 7. fan-like membrane connecting the small intestine to the abdominal wall _________________ 8. large vessel that carries blood from the intestine to the liver _________________ 9. new surgical procedure connection between structures or organs _________________ 10. the affect bile ducts _________________ 11. Process of forming new sugars from proteins and fats _________________ 12. high levels of a bile pigment in the bloodstream _________________

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I Give the names of the following gastrointestinal signs or symptoms based on their descriptions. 1. Passing of bright red blood from rectum _________________ 2. Loss of appetite _________________ 3. Fat in stool _________________ 4. Black tarry stool; Feces with digested blood _________________ 5. abnormal accumulation of fluid in the abdomen _________________ 6. rumbling noises in the gastrointestinal tract caused by gas _________________ 7. gas leakage through the anus _________________ 8. an uncomfortable feeling in the stomach and a tendency to vomit _________________ 9 loose, watery stools _________________ 10. Difficulty passing stool (feces) _________________ 11. Difficulty swallowing _________________ 12. Gas leaking from the stomach through the mouth _________________ J Write short answers to the following questions. 1. What is jaundice? _____________________________________________ _____________________ 2. List three ways a patient can develop jaundice: a. ___________________________________________ ____

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___________________________________________ ____

(Video) Medical Term Ch 1

___________________________________________ ____ 3. What does it mean when a disease is called idiopathic? ________________________________ K Select from the list of pathological conditions to make a diagnosis. Achalasia Anal fistula Aphthous ulcers Stomatitis Colon polyps Colon cancer Crohn's disease (Crohn's disease) Dental caries Esophageal cancer Herpetic stomatitis Oral leukoplakia Pancreatic cancer Periodontal disease 1. Mr Jones, a smoker and heavy drinker, has complained of dysphagia for the past several months. A longstanding condition of barre esophagus led to his malignant condition. Diagnosis: ________________________________. 2. An abnormal tube-like passage near his anus caused Mr. Rosen's proctalgia. his doctor

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Surgery performed to close the anomaly. Diagnosis: ________________________________. 3. Carol's dentist informed her that the enamel of three teeth had been damaged by acid-producing bacteria. Diagnosis: ________________________________. 4. Paola's symptoms of chronic diarrhea, abdominal cramps and fever led her doctor to suspect that she had inflammatory bowel disease affecting the distal portion of her ileum. The doctor prescribed steroid medication to cure her condition. Diagnosis: ________________________________. 5. Mr. Hart learned that his colonoscopy showed the presence of small benign growths protruding from the lining of his colon. Diagnosis: _____________________________. 6. During a routine dental exam, Dr. Friedman white plaques on Mr. Longo's cheeks. He advised Mr. Longo, who was a chronic smoker and heavy drinker, to have these precancerous lesions removed. Diagnosis: ________________________________. 7. Whenever Carl had a stressful time at work, he would develop a cold sore (cold sore) on his lip resulting from reactivation of a previous viral infection. His doctor told him that there is no treatment that is 100% effective in preventing these lesions from coming back. Diagnosis: ________________________________. 8. Mr. Green had a biopsy of a neoplastic lesion in his descending colon. The pathology report indicated

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a malignancy. A partial colectomy was necessary. Diagnosis: ________________________________. 9. Small sores (cancers) appeared on Diane's gums. They were painful and annoying. Diagnosis: ________________________________. 10. Sharon's failure to floss her teeth and remove plaque regularly led to the development of gingivitis and pyorrhea. Her dentist advised her to see a specialist who could treat her condition. Diagnosis: ________________________________. 11. Imaging tests showed a tumor in a section of Mr. Smith's pancreas. His doctor told him that since it had not spread, he could hope for a cure through surgery. He had a pancreatoduodenectomy (Whipple operation), which was successful. Diagnosis: ________________________________. 12. Mr Clark complained of pain when swallowing. His doctor explained that the pain was caused by a failure of the muscles in his lower esophagus to relax while he swallowed. Diagnosis: ________________________________. L Match the following pathological diagnoses to their definitions. cholecystolithiasis (gallstones) liver cirrhosis diverticulosis dysentery esophageal varices hemorrhoids

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Hiatal Hernia Ileus Intussusception Irritable Bowel Syndrome Pancreatitis Peptic Ulcer Ulcerative Colitis Viral Hepatitis Volvulus 1. Bulging of the upper part of the stomach through the diaphragm ___________________________ 2. Painful, inflamed bowel due to bacterial infection _________________ 3. Swollen, twisted veins in the rectum area _________________ 4. Open sore or lesion of the lining of the Stomach or duodenum _________________ 5. Loss of peristalsis _________________ 6. Twisting of the bowel on itself _________________ 7. Swollen varicose veins on the surface of the distal part of the esophagus _________________ 8 .Abnormal protuberances in the intestinal wall _________________ 9. Chronic inflammation of the large intestine with destruction of its interior Surface _________________ 10. Telescoping of the intestine _________________

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11. Inflammation of the liver caused by type A, type B or type C virus _________________ 12. Inflammation of the pancreas _________________ 13. Stones in the gallbladder _________________ 14. Chronic degenerative liver disease with scarring secondary to alcoholism or infectious hepatitis _________________ 15. Gastrointestinal symptoms (diarrhea or constipation, abdominal pain, bloating) with no evidence of structural abnormalities _________________ M Complete the following terms according to their meanings below. 1. membrane (peritoneal fold) that holds the intestines together: mes _________ 2. removal of the gallbladder: _________ ectomy 3. black or dark brown, tarry, bloody stools: mel _______________________ 4. high levels of pigment in the blood (jaundice) : hyper _________ 5. under of the tongue: sub _________ 6. Twisting of the bowel on itself: vol _______________________ 7. Organ under the stomach that produces insulin and digestive enzymes: pan _________________ 8. Loss of appetite: a _______________________

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9. swollen, twisted veins in the rectum: __________ fallopian tubes 10. new connection between two previously unconnected tubes: ana _______________________ 11. acid deficiency in the stomach: a _______________________ 12. recirculation of solid and liquid substances from the stomach to the mouth: gastrointestinal -Disease _________ 13. Removal of soft tissues hanging from the palate: _______________________ Ectomy 14. Stone formation: _________ Origin.

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Exercise Answers A 1. Large intestine 2. Gallbladder 3. Cecum 4. Anus 5. Jejunum 6. Esophagus 7. Ileum 8. Liver 9. Throat 10. Sigma 11. Duodenum 12. Pancreas B See Figure 5-12 on page 141 .

C 1. Villi. Papillae are nipple-like protrusions in the tongue where the taste buds are located, and rugae are folds in the lining of the stomach and hard palate. 2. Parotid. The submandibular gland is located under the mandible and the sublingual gland is located under the tongue.

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3. Sphincter of the pylorus. The uvula is soft tissue attached to the soft palate, and the lower esophageal sphincter is a muscular ring between the esophagus and the stomach. 4. Pulp. Dentin is the hard part of the tooth just below the enamel and in the root, and the enamel is the hard, outermost part of the tooth that forms the crown. 5. Enzyme. A triglyceride is a large fat molecule and an amino acid is a substance formed when proteins are digested. 6. Bilirubin. Glycogen is animal starch made from sugar in liver cells, and melena is dark, tarry stool. 7. Insulin. Amylase and lipase are digestive enzymes produced by the exocrine cells of the pancreas. 8. Peristalsis. Swallowing is swallowing and chewing is chewing. 9. Emulsification. Absorption is the passage of substances through the walls of the small intestine into the bloodstream, and anabolism is the process by which proteins are built up in a cell (protein synthesis). 10. Canine. An incisor is one of the four front teeth in the dental arch (not pointed or canine-like), and a molar is one of the three large teeth just behind (distal to) the two premolars. D 1. Lip

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2. Tongue 3. Mouth 4. Tooth 5. Abdomen 6. Sugar 7. Fat 8. Anomaly 9. Bile, bile 10. Removal, excision E 1. Sialadenectomy 2. Pharynx 3. Rectocele 4. Hepatomegaly 5. Palatoplasty 6. postprandial (post cibum – cib/o refers to meals or ingestion)

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13. perianal 14. colostomy 15. submandibular 16. facial F 1. proctologist 2. urologist 3. orthodontist 4. endodontist 5. oral surgeon 6. nephrologist 7. gastroenterologist 8. periodontist 9. colorectal surgeon G 1. appendicitis 2. colitis 3 esophagitis 4 peritonitis (note that the e is omitted) 5. cholecystitis 6. ileitis 7. pancreatitis 8. gingivitis

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9. Hepatitis 10. Stomatitis 11. Sialadenitis 12. Enterocolitis (when two combination forms for gastrointestinal organs appear in one term, use the one closest to the mouth first) H 1. Hyperglycemia 2. Cheilitis 3. Parenteral 4 .Mucosa 5 Stool 6. Glycogenolysis 7. Mesentery 8. Portal vein 9. Anastomosis 10. Bile duct 11. Gluconeogenesis 12. Hyperbilirubinemia I 1. Hematochezia 2. Anorexia 3. Steatorrhea

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4. Melena 5. Ascites 6. Borborygmi (bowel sounds) 7. Flatulence 8. Nausea 9. Diarrhea 10. Constipation 11. Dysphagia 12. Eructation J 1. Yellow-orange coloring of the skin and other tissues (hyperbilirubinemia) 2. a . any liver disease (hepatopathy – such as cirrhosis, hepatoma, or hepatitis) such that bilirubin cannot be converted to bile and excreted in the stool b. Impeding the flow of bile so that bile and bilirubin are not excreted and accumulate in the bloodstream c. Excessive hemolysis leading to overproduction of bilirubin and high blood levels 3. Cause unknown K 1. Esophageal cancer 2. Anal fistula 3. Dental caries

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4. Crohn's disease (Crohn's disease) 5. Colonic polyps 6. Oral leukoplakia 7. Herpetic stomatitis 8. Colon cancer 9. Aphthous stomatitis 10. Periodontitis 11. Pancreatic cancer 12. Achalasia L 1. Hiatus hernia 2. Dysentery 3. Hemorrhoids 4 Gastric ulcer 5. Ileus 6. Volvulus 7. Esophageal varices 8. Diverticulosis 9. Ulcerative colitis 10. Intussusception 11. Viral hepatitis 12. Pancreatitis 13. Cholecystolithiasis (gallstones)

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14. cirrhosis 15. irritable bowel syndrome M 1. mesentery 2. cholecystectomy 3. melena 4. hyperbilirubinemia 5. sublingual 6. volvulus 7. pancreas 8. anorexia 9. hemorrhoids 10. anastomosis 11. achlorhydria 12. gastroesophageal reflux 13. uvulectomy lithogenesis Pronunciation of understand

The terms you learned in this chapter are presented here with their pronunciations. For the meaning of all terms, see the MiniDictionary starting on page 897. You can also listen to each term on the Evolve website (h p://evolve.elsevier.com/Chabner/language/).

vocabulary and terminology

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TERM absorption achlorhydria amino acids amylase anastomosis anus appendectomy appendicitis appendixe bile biliary bilirubin bowel buccal mucosa canine teeth cecal cecum celiac cheilosis cholecystectomy choledochojejunostomy choledocholithiasis choledochotomy cholelithiasis colon colonic colonoscopy colostomy common bile duct defecation deglutition dentibuccal dentin digestion duodenal duodenum elimination emulsiﬁcation enamel endodontist enterocolitis enteroenterostomy enzyme esophageal Ösophagus Gesichtssäuren Kot Gallenblase Magen-Darm-Trakt Gastrojejunostomie Gastrostomie

AUSKUNFT ab-SORP-meiden a-chlor-HI-dre-ah ah-ME-nein AS-idz AM-ih-layz ah-nas-zu-MO-sis A-nus ah-pen-DEK-zu-mir ah -pen-dih-SI-tis ah-PEN-diks Galle BIH-le-er-e bih-le-RU-bin BOW-el BUK-al mu-KO-sah KA-neun Yesterday SE-year SE-year SE -le-ak ki-LO-sis ko-le-sis-TEK-zu-mir ko-leh-do-ko-jeh-ju-NOS-zu-mir ko-leh-do-ko-lih-THI-ah -sis ko-leh-do-KOT-o-me ko-le-lih-THI-ah-sis KO-lon ko-LON-ik ko-lon-OS-ko-pe ko-LOS-to-me KOM- am Gallengang there-feh-KA-meiden de-glu-TIH-meiden den-tih-BUK-al DEN-tin di-JEST-meiden du-o-DE-nal do-o-DE-num e-lim- ih -NA-shun e-mul-sih-fih-KA-shun e-NAM-el en-do-DON-tist en-ter-o-ko-LI-tis en-ter-o-en-ter-OS - to-me EN-zime eh-sof-ah-JE-al eh-SOF-ah-gus FA-shul FAH-te AS-idz FE-seez GAWL-blah-der gas-through-in-TES-that- nal tract gas-through-jeh-ju-NOS-to-me gas-through-me

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TERM gingivitis gluconeogenesis glucose glycogen glycogenolysis hepatoma hepatomegaly hydrochloric acid hyperbilirubinemia hyperglycemia hypoglossal ileitis ileocecal sphincter ileostomy ileum incisor insulin jejunum labial laparoscopy lipase lithogenesis liver lower esophageal sphincter mastication melena mesentery molar teeth oral orthodontist palate palatopharyngoplasty palatoplasty pancreas pancreatitis papillae parenteral parotid gland perianal periodontist peristalsis peritonitis pharyngeal Pharynx Pfortader Postprandiale Prämolaren Proktologe Proteasepulpa Pylorussphinkter Pyloroplastik

AUSKUNFT jin-jih-VI-tis glu-ko-ne-o-JEN-eh-sis GLU-kohs GLI-ko-jen gli-ko-je-NOL-ih-sis hep-ah-TO-mah hep-ah -to-MEG-ah-le hi-dro-CHLOR-ik AS-id hi-per-bih-le-ru-bih-NE-me-ah hi-per-gli-SE-me-hi-po- GLOS -al il-e-ich-tis il-e-o-SE-kal SFINK-ter il-e-OS-für-mich IL-e-um in-SI-zor IN-su-lin je-JU-num LA- be - al lap-ah-ROS-ko-pe LI-payz lith-o-JEN-eh-sis LIV-er LO-er eh-sof-ah-JE-al SFINK-ter mas-tih-KA-shun MEL -en -ah MES-en-ter-e MO-lar Zähne OR-al or-tho-DON-tist PAH-lat pah-lat-o-fah-RIN-go-plas-te pah-LAT-o-plaste PAN-kre-as pan-kre-ah-TI-tis pap-IL-e par-EN-ter-al par-OT-id Drüse peh-re-A-nal peh-re-o-DON-tist peh - rih-STAL-sis peh-rih-to-NI-tis fah-ran-JE-al FAH-rinks POR-tal vine post-PRAN-de-al pre-MO-lar teeth proc-TOL-o-jist PRO - tea-Augen Fruchtfleisch pi-LOR-ic SPHIN-ter pi-LOR-o-plastic-tea

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CONCEPT Pylorus Rectocele Rectum Rugae Saliva Salivary glands Sialadenitis Sialolith Sigmoidum Sigmoidoscopy Sphincter Steatorrhea Stomach Stomatitis Sublingual Submandibular Triglycerides Uvula Uvulectomy Villi

PRONOUNS pi-LOR-us REK-to-seel REK-tum RU-guy sah-LI-vah SAH-lih-vah-re glandz si-al-ah-deh-NI-tis si-AL-o-lith SIG- moyd KO-lon sig-moyd-OS-ko-pe SFINK-ter ste-at-o-RE-ah STUM-ak sto-mah-TI-tis sub-LING-wal sub-man-DIH-bu-lar tri -GLIS-eh-ridez U-vu-lah u-vu-LEK-zu-mir VIL-i

pathological terminology

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TERM achalasia anal ﬁstula anorexia aphthous stomatitis ascites borborygmi cholelithiasis cirrhosis colonic polyps colorectal cancer constipation Crohn disease dental caries diarrhea diverticula diverticulosis dysentery dysphagia eructation esophageal cancer esophageal varices etiology ﬂatus gastric cancer gastroesophageal reﬂux disease hematochezia hemorrhoids hepatocellular carcinoma herpetic stomatitis hiatal hernia icterus idiopathic ileus inﬂammatory bowel Krankheit Leistenbruch Invagination Reizdarmsyndrom Gelbsucht Lipom Meläna Übelkeit Orale Leukoplakie Bauchspeicheldrüsenkrebs Pankreatitis Magengeschwür Parodontitis Pyorrhoe Colitis ulcerosa Virushepatitis Volvulus

AUSKUNFT ak-ah-LA-jah A-nal FIS-tu-la an-oder-EK-se-ah AF-also sto-mah-TI-tis ah-SI-teez bor-bor-IG-me ko-le -lih-THI-ah-sis sih-RO-sis co-LON-ik POL-ips co-lo-REK-tal CAN-see con-stih-PA-shun KROHN dih-ZEEZ DEN-tal KAH-reez di- ah-RE-ah di-ver-TIH-ku-lah di-ver-tih-ku-LO-sis DIS-en-ter-e dis-PHA-je-ah e-ruk-TA-shun eh-sof- ah-JE-al CAN-see eh-sof-ah-JE-al VAR-ih-seez e-te-OL-o-je FLA-tus GAS-trick CAN-see gas-through-eh-sof-ah- JE-al RE-flux dih-ZEEZ he-mah-to-KE-se-ah HEH-mah-roydz hep-at-o-SEL-u-lar kar-sih-NO-mah her-PET-ik sto- mah-TI-tis hi-A-tal HER-ne-ah IK-ter-us id-e-o-PATH-ik IL-e-us in-FLAM-ah-tor-e BOW-el dih-ZEEZ IN-gwih -nal HER-ne-ah-in-sow-SEP-meiden IR-it-ah-bel BOW-el SIN-drohm JAWN-dis li-PO-mah MEL-en-ah NAW-ze-ah OR-al lu -ko-PLA-ke-ah pan-kre-AH-tik CAN-ser pan-kre-ah-TI-tis PEP-tic UL-ser peh-re-o-DON-tal dih-ZEEZ pi-oder-RE -ah UL-ser-ah-tiv ko-LI-tis VI-ral hep-ah-TI-tis VOL-vu-lus

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Note: For a combined review sheet for this chapter and the next, see Chapter 6 on page 201.

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CHAPTER 6

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Additional Digestive System Suffixes and Terminology CHAPTER SECTIONS: Introduction 178 Suffixes 178 Terminology 181 Laboratory Tests and Clinical Procedures 183 Abbreviations 190 Personal: Cholecystectomy 191 Practical Applications 192 Exercises 192 Answers to Exercises 198 Pronunciation of Terms 199 Summary Sheet 201

CHAPTER OBJECTIVES • Define new suffixes and use them to form terms related to the digestive system. • List and explain laboratory tests, clinical procedures, and acronyms relevant to the digestive system. • Apply your new knowledge to understand medical terms in their proper context, such as: B. in medical reports and records and in personal vignettes.

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Introduction In this chapter, you practice word formation without introducing a large number of new terms. It uses many familiar terms from Chapter 5, which should give you a breather after your hard work. Study the following suffixes and complete the meaning of the terms. Checking the meaning of terms with a dictionary can prove helpful and add another dimension to your understanding. The information contained in the "Laboratory Tests and Clinical Procedures" and "Abbreviations" section relates to the gastrointestinal system and is useful for those working in clinical or laboratory medicine fields. The Practical Applications section gives you examples of medical language in context. Congratulate yourself as you decipher medical phrases, surgical reports and case studies.

Suffix

Write the meaning of the medical term in the space provided.

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SUFFIX MEANING -ectasia, dilatation -ectasia (dilation), enlargement -vomit Vomiting

TERMINOLOGY MEANING Cholangiectasia _________________________________ Cholangi/o means bile duct (vessel). Biliary obstruction can cause cholangiectasia (ko-lan-je-EK-tah-sis). Hematemesis ___________________________________ Bright red blood is vomited, often associated with esophageal varices or stomach ulcers. -Pepsia Digestive Dyspepsia _____________________ -Phagia Eating, Polyphagia _________________________________ Swallowing Excessive appetite and uncontrolled eating. Dysphagia ___________________________________ Plastic Surgical Repair Abdominoplasty _________________________________ This is commonly referred to as a “tummy tuck”. Other surgical repairs include rhinoplasty and blepharoplasty. -ptysis spitting hemoptysis _________________________________ (he-MOP-tih-sis) Spitting blood from the airways and lungs. -Rrhagia, bursting bleeding ____________________________________ -Rrhagia (of blood) loss of a large amount of blood in a short period of time. Gastrorrhagia ____________________________________ Suture herniorrhaphy ____________________________________ rrhaphy (her-ne-OR-ah-fe) Repair (as with sutures or stitches) of a hernia. Hernioplasty is a synonym. -rrhoe flow, diarrhea ____________________________________ outflow The embedded root rrh means outflow or outflow. -Spasm involuntary pylorospasm ____________________________________ contraction of bronchospasm ____________________________________ muscles A major feature of bronchitis and asthma. - Stop stasis, control cholestasis ____________________________________ The flow of bile from the liver to the duodenum is interrupted. Stenosis, pyloric stenosis ____________________________________ Stenosis This is a congenital defect in newborn babies that blocks the flow of food into the small intestine. -tresia opening atresia ________________________________________ Absence of a normal opening. Esophageal atresia ________________________________________ A congenital abnormality in which the esophagus is not connected to the stomach. This anomaly is often accompanied by a tracheoesophageal fistula (Figure 6-1). Biliary Atresia ________________________________________ Congenital hypoplasia, or failure of bile ducts to form, causes neonatal cholestasis and jaundice.

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Figure 6.1 Esophageal atresia with tracheoesophageal fistula.

-Ektasie, -Ektasie

These suffixes are used frequently in the respiratory terminology in Chapter 12. Examples are bronchiectasis and atelectasis (a- = not, tel = complete), which is a collapsed lung.

Dysphagia/Dysplasia/Dysphasia

Do not confuse dysphagia, which is difficulty swallowing, with dysplasia, which is abnormal formation (plas/o = education), or dysphasia, which is abnormal speech (phas/o = speech).

Hemoptysis and Hematemesis

Hemoptysis spits blood out of the airways, a sign of bleeding and disease in the bronchi and lungs. Hematemesis is vomiting blood, a sign of bleeding from the upper part of the gastrointestinal tract.

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-rrhoe

The suffix -rrhoe is used to indicate the flow or discharge of various substances: • rhinorrhea - mucus from the nose • menorrhea - menstrual blood (men/o) from the lining of the uterus • leukorrhea - white, yellowish fluid from the vagina

Stenosis

Stenosis comes from the Greek and means "narrowing". It is sometimes called a stricture. While this term is used in the gastrointestinal system to describe a narrowing, as in intestinal obstruction, biliary tract obstruction, and pyloric stenosis, there are other types of strictures as well. These include: • arterial stenosis • valvular stenosis • spinal stenosis • tracheal stenosis Examples of suffixes used alone as separate terms are: Vomit A vomit basin is a kidney-shaped container placed by a hospital bed to collect (emetic) vomit . If a child swallows poison, the doctor may prescribe a drug to induce vomiting. An emetic is a strong solution, such as ipecac syrup, that is given to induce vomiting after a patient has swallowed poison. Spasms Eating spicy foods can cause the sphincters of the stomach to spasm. Stasis Overgrowth of bacteria in the small intestine can lead to stasis of the intestinal contents. Stenosis Projectile vomiting in an infant during feeding is a clinical sign of pyloric stenosis.

Terminology

Write the meaning of the terms in the spaces provided.

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COMBINING MEANING TERMINOLOGY MEANING SHAPE bucc/o ______________ buccal ________________________________________ cec/o ______________ cecum volvulus _________________________ celiac disease ______________ celiac disease ________________________________________ Damage to the lining of the small intestine in response to eating gluten (protein found in wheat, barley, and rye). ). The result is malabsorption and malnutrition. Treatment is a lifelong gluten-free diet. It is also called celiac sprue. Cheil/o ______________ Cheilosis ________________________________________ Characterized by scales and cracks on the lips and resulting from a lack of vitamin B2 (thiamine) in the diet. chol/e ______________ cholelithiasis ________________________________________ cholangi/o ______________ cholangitis ________________________________________ An i is omitted from this term. The most common cause of this condition is bacterial infection. Cholangiocarcinoma ____________________________________ Cholecyst/o ______________ Cholecystectomy __________________________ Choledoch/o ______________ Choledochus __________________________ Choledochectasia _______________________ Col/o ______________ Colectomy _________________________ Surgeons perform a LAP (laparoscopic) colectomy as an alternative to removing a non-open colectomy. Colon/o ______________ Colonoscopy ________________________________________ dent/i ______________ Toothache ________________________________________ Duodenum/o ______________ Duodenum _________________________ enter/o ____________ Gastroenteritis ________________________________________ Esophagus/o ______________ Esophageal atresia ________________________________________ This congenital abnormality requires surgical correction. gastr/o ______________ Gastrojejunostomy ________________________________________ Gastrostomy __________________________________________ A gastrostomy is also known as a G-tube or "bu on". One type is a PEG (percutaneous endoscopic gastrostomy) tube that is inserted (laparoscopically) through the abdomen into the stomach to deliver food and fluids when swallowing is not possible. Gingiv/o ______________ Gingivectomy ________________________________________

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COMBINING MEANING TERMINOLOGY MEANING FORM gloss/o ______________ glossectomy ________________________________________ gluc/o ______________ gluconeogenesis _________________________ glyc/o ______________ glycogen _________________________ A form of sugar stored in the liver. hepat/o ______________ hepatomegaly ________________________________________ herni/o ______________ herniorrhaphy ___________________________________ ile/o ______________ ileostomy ________________________________________ jejun/o ______________ cholecystojejunostomy ___________________________________ labi/o ______________ labiodental ___________________________________ lingu/o ______________ sublingual ________________________________________ lip/o ______________ lipase ________________________________________ lithchol/o ______________ odontia o ______________ periodontal membrane ________________________________________ or/o ______________ oropharynx ________________________________________ The tonsils are located in the oropharynx. Palate/o _______ Palatoplasty ________________________________________ Also called palatorrhaphy; This procedure corrects cleft palate, a congenital abnormality. Pancreat/o ______________ Pancreas ________________________________________ Pancreatoduodenectomy ________________________________________ Sometimes referred to as pancreaticoduodenectomy. This is a Whipple procedure, a surgical treatment for pancreatic cancer. See page 192. proct/o ______________ proctosigmoidoscopy ________________________________________ pylor/o ______________ pyloric stenosis ________________________________________ rect/o ______________ rectal carcinoma ________________________________________ sialaden/o ______________ sialadenectomy ___________________________________ splen/o ______________ splenic ﬂexure ________________________________________ The downward bend in the transverse colon near the spleen. The hepatic flexure is the bend in the transverse colon near the liver. Steat/o ______________ Steatorrhea ________________________________________ Stomata/o ______________ Aphthous stomatitis ________________________________________

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Laboratory Tests and Clinical Procedures Focus on learning the meanings in bold versus the laboratory test or procedure. Additional information is provided to improve your understanding of the terms.

Laboratory tests Amylase and lipase tests Liver function tests (LFTs)

Stool culture stool guaiac test or hemoccult test

Tests for levels of amylase and lipase enzymes in the blood. Elevated levels are associated with pancreatitis. Tests for the presence of enzymes and bilirubin in the blood. LFTs are performed with blood serum (clear liquid that remains after blood clots). Examples of LFTs are tests for ALT (alanine transaminase) and AST (aspartate transaminase). ALT and AST are enzymes present in many tissues. Levels are elevated in the serum of patients with liver disease. High levels of ALT and AST indicate damage to liver cells (as in hepatitis). Alkaline phosphatase (alkphos) is another enzyme that may be elevated in patients with liver, bone, and other disorders. Serum bilirubin levels are elevated in patients with liver disease and jaundice. A direct bilirubin test measures conjugated bilirubin. High levels indicate liver disease or bile duct obstruction. An indirect bilirubin test measures unconjugated bilirubin. Elevated levels indicate excessive hemolysis, which can occur in a newborn. Test for microorganisms present in the faeces. The feces are placed in a growth medium and examined microscopically. (Figure 6-2A). Test to detect occult (hidden) blood in feces. This is an important screening test for colon cancer. Guaiac (GWĪ-ăk) is a chemical made from the wood of trees. When added to a stool sample, it reacts with blood present in the stool. See Figure 6-2B.

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Figure 6.2 A: Stool culture. B, stool guaiac test.

Clinical procedures X-ray tests X-ray imaging is used in a variety of ways to detect pathological conditions. X-ray images are often used in the dental practice to localize cavities (caries). Many of the x-ray tests listed here use a contrast agent (a substance that x-rays cannot penetrate) to visualize a specific area of the digestive system. Due to its increased density compared to body tissue, the contrast makes it possible to distinguish organs and body parts on the film or screen.

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lower gastrointestinal series (barium enema) upper gastrointestinal series

Cholangiographie

Computed tomography (CT)

X-rays of the colon and rectum after barium injection into the rectum. Radiologists inject barium (a contrast agent) into the rectum via enema. Figure 6-3A shows a barium enema study of a colon with diverticulosis. Radiographs of the esophagus, stomach, and small intestine after oral administration of barium. A small bowel follow-through study, often performed immediately after an upper gastrointestinal series, shows sequential x-rays of the small bowel as barium passes through (Figure 63B). A barium swallow is an examination of the esophagus. X-ray examination of the biliary system after injection of contrast medium into the biliary tract. In percutaneous transhepatic cholangiography, the contrast agent is injected through the abdominal wall into the bile ducts of the liver using a needle. In endoscopic retrograde cholangiopancreatography (ERCP) (Figure 6-4A), contrast material is administered through an oral catheter (tube) and then passes through the esophagus, stomach, and duodenum into the bile ducts. This procedure helps diagnose problems with the bile ducts, gallbladder, and pancreas. A series of X-ray images are taken in multiple views (particularly cross-sectional). A CT scan uses a circular array of X-rays to create the cross-sectional image based on differences in tissue density. The use of contrast media allows visualization of organs and blood vessels and highlights differences in blood flow between normal and diseased tissue (Figure 6-4B and Figure 6-5A and B). Tomography (tom/o means cuing) produces a series of X-ray images showing multiple views of an organ. An earlier term for a CT scan is a "CAT scan" (Computerized Axial Tomography Scan).

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Figure 6.3 A: Barium enema. This x-ray from a barium enema study shows diverticulosis. The arrowheads point to the diverticula throughout the colon. Most patients with diverticula are asymptomatic, but complications (diverticulitis, perforated diverticulum, obstruction, or hemorrhage) can occur. B, A radiograph of a small bowel follow-through showing the normal appearance of the jejunum (J) in the upper left abdomen and the ileum (I) in the lower right abdomen. Note the contrast medium in the stomach (S) and cecum (C).

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FIGURE 6-4 A: Endoscopic retrograde cholangiopancreatography (ERCP) showing choledocholithiasis in a patient with biliary colic (pain). Multiple stones are visible in the gallbladder and common bile duct. The stones (arrows) are seen as filling defects in the contrast-sedated gallbladder and duct. This patient was treated with an open (performed by laparotomy) cholecystectomy and a choledolithographotomy. B, Contrast computed tomography scan showing a large 'porcelain stone' in the gallbladder. The patient was asymptomatic, but a therapeutic option for this type of stone is removal of the gallbladder (using laparoscopy) to prevent future problems (such as cholecystitis or gallbladder carcinoma). (B, courtesy of the Department of Radiology, Massachusetts General Hospital, Boston.)

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FIGURE 6-5 Computed tomography (CT) images of a normal and diseased liver. A, normal liver. Contrast material was injected intravenously, making the blood vessels appear bright. The liver (L) and spleen (S) have the same density on this CT image. B, fatty liver. The radiopacity of the liver tissue is reduced due to the large volume of fat in the tissue, making it appear darker than normal. Excess fat can lead to liver inflammation and cirrhosis.

Ultrasound examinations Abdominal ultrasound Endoscopic ultrasound (EUS)

Sound waves radiated into the abdomen create an image of the abdominal viscera. Sonography is particularly suitable for examining fluid-filled structures such as the gallbladder. Using an endoscope in combination with ultrasound to examine the organs of the gastrointestinal tract. An endoscope is inserted through the mouth or rectum and ultrasound images are obtained. This test is commonly used to evaluate esophageal, pancreatic, and rectal cancer.

Magnetic resonance imaging Magnetic resonance imaging (MRI)

Magnetic waves create images of organs and tissues in all three planes of the body. This technique does not use X-rays. It detects subtle differences in tissue composition, water content, and blood vessel density, and can reveal sites of trauma, infection, or cancer. See Figure 6-6, which shows an MRI scan of a patient with rectosigmoid carcinoma and polyps in the rectum. CT scans would not have shown these lesions as clearly.

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Figure 6.6 Rectum (MRI). A 68-year-old man presented with rectal bleeding. MRI shows (A) colonic adenocarcinoma in the rectosigmoid region and (B) villous adenoma in the rectum.

Nuclear medicine test HIDA scan

Radioactive imaging test that tracks the production and flow of bile from the liver and gallbladder to the intestines. HIDA stands for hepatobiliary iminodiacetic acid. Cholescintigraphy is another name for this test, which determines if the gallbladder is functioning properly.

Other procedures

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stool transplant

bariatric surgery

Gastrointestinal Endoscopy

Laparoscopy

liver biopsy

Nasogastrische Intubation Parazentese (Abdominozentese)

Transfer of stool from a healthy donor into a recipient's gastrointestinal tract. Overuse of antibiotics can wipe out normal colon bacteria and lead to infection with C. diﬃcile (harmful bacteria that cause diarrhea and colitis). A stool transplant restores normal stool bacteria through colonoscopy. Methods of weight loss in people with severe obesity. One type of bariatric surgery is bariatric gastric resection (bar/o = weight, iatr/o = treatment) in which a large portion of the stomach is removed (Figure 6-7A). Another bariatric procedure is gastric bypass. This surgery reduces the size of the stomach to a volume of 2 tablespoons and bypasses much of the small intestine (Figure 6-7B). Visual examination of the gastrointestinal tract with an endoscope. A doctor inserts a flexible fiberglass tube through the mouth or anus to see parts of the gastrointestinal tract. Examples are esophagogastroduodenoscopy (EGD) (Figure 6-8), colonoscopy (Figures 6-9 and 6-10), sigmoidoscopy, proctoscopy, and anoscopy. Virtual colonoscopy (CT colonography) combines CT scanning and computer technology to allow doctors to examine the entire length of the colon through X-ray imaging in just minutes. Patients with abnormal findings then require a conventional colonoscopy for further evaluation or treatment, e.g. B. with biopsy or polypectomy. Visual (endoscopic) examination of the abdomen using a laparoscope inserted through small incisions in the abdomen. Laparoscopic cholecystectomy (see Figure 5-28, page 160) and laparoscopic appendectomy are performed by gastrointestinal and general surgeons. See the story In Person: Cholecystectomy of a woman who underwent a laparoscopic cholecystectomy (see page 191). Removal of liver tissue for microscopic examination. A doctor inserts a needle through the skin to remove a small piece of tissue for examination under a microscope. The average specimen is less than 1 inch long. The procedure helps doctors diagnose cirrhosis, chronic hepatitis, and liver tumors. Inserting a tube through your nose into your stomach. Doctors use a nasogastric (NG) tube to remove fluid from the stomach and intestines postoperatively (NG decompression). See Figure 6-11. Puncture to remove fluid from the abdomen. This procedure is necessary to drain fluid (that has collected in the ascites) from the peritoneal (abdominal) cavity.

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Figure 6.7 A. Sleeve gastrectomy. B. gastric bypass. First (a) the stomach is clamped so that it is reduced into a small pouch. Next (b) a shortened jejunum is pulled up to connect with the smaller stomach. This redirects food so it has a shorter travel time through the gut and less food is absorbed into the bloodstream.

Figure 6.8 A: Normal endoscopy of the esophagus. B, Esophagogastroduodenoscopy. This endoscopic view shows severe esophagitis in a patient with gastroesophageal reflux disease (GERD).

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Figure 6.9 Colonoscopy with polypectomy. Before the procedure, the patient takes funds to clean the intestines from feces. The patient is sedated and the gastroenterologist advances the instrument retrograde, guided by images from a video camera at the tip of the colonoscope. If a polyp is found, a wire loop is passed through the endoscope and looped around the stalk. After the loop is gently tightened, an electric current is applied to sever the stem. The polyp is removed for tissue examination under a microscope (biopsy).

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FIGURE 6.10 Colonoscopy case report. A 60-year-old man with a history of multiple and prominent colonic adenomas (with some areas of high-grade dysplasia) underwent colonoscopy. The endoscope was passed through the anus and advanced to the cecum. Two pedunculated polyps (arrows) were found at the flexure of the liver. The polypectomy was performed using a hot snare. Resection and salvage were complete.

FIGURE 6.11 Nasogastric intubation. The nasogastric tube aspirates secretions from the patient's stomach and intestines. The patient had a twisted, blocked bowel (ileus), and the suction relieved the pressure, allowing the bowel to develop and decompress without surgery.

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Abbreviations AFP Alkphos ALT, AST BE BM BRBPR CD CIC CT EGD EPI ERCP ESLD EUS FOBT G Tube GAVE

Alpha-fetoprotein - tumor marker for liver cancer alkaline phosphatase

Alanine transaminase, aspartate transaminase - enzymes measured in blood to assess liver function barium enema stool bright red blood per rectum - hematochezia celiac disease chronic idiopathic constipation computed tomography esophagogastroduodenoscopy exocrine pancreatic insufficiency endoscopic retrograde cholangiopancreatography end stage liver disease endoscopic ultrasound test for occult blood in stool gastrostomy tube - feeding tube gastrointestinal ectomy – dilated small blood vessels in the antrum (the last part of the stomach) GB gallbladder GERD gastroesophageal reflux disease GI gastrointestinal HBV hepatitis B virus IBD inflammatory bowel disease (Crohn’s disease and ulcerative colitis) J-tube jejunostomy tube – feeding tube LAC laparoscopically assisted colectomy LAP laparoscopic LFTs Liver function tests – Alk Phos, Bilirubin, AST, ALT MRI Magnetic resonance imaging NASH Non-alcoholic steatohepatitis (Fy liver) NG Gastric tube Tube NPO n ot oral (Latin null per os) PEG percutaneous endoscopic gastrostomy tube - feeding tube PEJ percutaneous endoscopic jejunostomy tube - feeding tube Tube PTHC percutaneous transhepatic cholangiography PUD peptic ulcer disease TPN total parenteral nutrition Intravenous solutions contain sugars, amino acids, electrolytes and vitamins. T-tube Special tubes (shaped like a small T) placed in the bile duct for drainage into a small pouch (bile sac) on the outside of the body

Personally

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Cholecystectomy

This first-person narrative describes the symptoms and treatment of a woman with gallbladder stones. Everyone enjoys a small after-dinner dessert, but when ice cream or a creamy cake causes pain, most would avoid it. I loved candy, and despite the vengeance they took on my waist, I still wouldn't go without an ice cream cone — until my gallbladder decided it had had enough. After several long nights of writhing in pain, I tried to avoid fay foods but couldn't resist the temptation of frozen yogurt. I pushed my shopping cart through the supermarket with one hand; with the other hand, I fed myself delicious low-fat (not fat-free) frozen yogurt. I never dreamed that the endant at the quick serve window would actually give me soft serve. Within 10 minutes of eating the questionable yogurt, I was breaking out in a sweat; a wave of nausea swept through me and a knife-like pain stabbed my upper right quadrant. It hurt even more when I pressed my hand to brace myself against the pain. A few months earlier I had had an ultrasound of my gallbladder after a similar painful episode and the surgeon recommended a cholecystectomy. The U/S showed multiple stones in my gallbladder. Most stones were just the right size to lodge in the common bile duct and block the flow of bile that occurs after a fay meal. When I heard the ultrasound results, I swore off all Fay foods. I just didn't think that ice cream masquerading as "low-fat yogurt" would be the final straw! I soon abandoned my shopping cart and apologized to the store manager for throwing up all through aisle 4. The unrelenting pain didn't stop when I vomited - it only got worse. I have no idea how I made it home and to bed, but my husband found me in a profuse sweat a few hours later. I managed to call my surgeon and arrange for a "semi-emergent" surgery the next morning.

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dr Fernandez and his team performed a laparoscopic cholecystectomy and informed me when I came out of the anesthetic that I no longer had a "bag of marbles" for a gallbladder. I had a bloated feeling in my abdomen for two weeks after the surgery (carbon dioxide gas was injected into the abdomen before the surgery to create space between the abdominal organs). I felt "solid as a drum" for the first few days, and then day by day it went away. My four tiny incisions healed well and in about 2 weeks I was feeling "normal" again. Now I can eat ice cream to my heart's content and only suffer from the padding at my waist, not the stabbing pain just above it. Without missing a beat, my liver now delivers the bile into my small intestine right after I eat a fay meal. The bile emulsifies (breaks down) the fat. I just don't have a storage bag to keep bile in reserve. I had appendectomy, my wisdom teeth were removed and now I've given up my gallbladder! How many "useless" body parts are there? Elizabeth Chabner Thompson is CEO/Founder of Masthead, a company dedicated to providing innovative products for breast cancer patients. She is a doctor, swimmer, cross-country skier and proud mother of four children between the ages of 16 and 21.

Practical Applications

For answers to the case report questions, see page 199.

Case Report: Pancreatic Cancer and Whipple Procedure A 62-year-old man presented to the emergency department with complaints of fatigue, weight loss, jaundice, and anorexia. Diagnostic studies including abdominal CT with contrast agent, ERCP and EUS were performed. CT scan showed a 4 cm resectable mass at the head of the pancreas and ERCP revealed evidence of biliary obstruction; A stent was placed to open the canal. Examination of a tissue biopsy sample taken under US guidelines confirmed adenocarcinoma of the head of the pancreas. Additional studies showed no evidence of liver or other metastases. Surgical treatment using a Whipple procedure was recommended. This procedure was performed and included pancreatoduodenectomy, choledochojejunostomy and gastrojejunostomy. Lymph node removal and cholecystectomy were part of the surgical procedure. During the operation it was found that the tumor was limited to the head of the pancreas. Despite distance from

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of the tumor, the likelihood of recurrence is high, with a cure rate of only about 20%. Case Report Questions 1. What caused the patient's jaundice? a. Excessive hemolysis b. viral hepatitis c. Obstruction of the bile duct d. cholelithiasis 2. Which test identified the mass as adenocarcinoma? a. Whipple method b. Biopsy with endoscopic sonography c. CT scan with contrast medium d. ERCP 3. What is involved in a Whipple procedure? a. Removal of the pancreas (malignant area) and duodenum b. removal of the gallbladder c. removal of lymph nodes d. All of the above 4. What anastomosis was performed? a. gallbladder and duodenum combined. b. Common bile duct, pancreatic duct, and small intestine are all interconnected. c. Stomach and pancreas reconnected. i.e. Liver and pancreas connected to the stomach.

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Exercises Remember to check your answers carefully against the answers to the exercises on pages 198 and 199.

A Give the meaning of the following suffixes. 1. -pepsia _____________________________________________ _____________________________ 2. -ptysis _____________________________________________ _____________________________ 3. -emesis _____________________________________________ _____________________________ 4. -phagia ________________________________________ _____________________________ 5. -rrhea _____________________________________________ _____________________________ 6. -rrhage, -rrhagia _____________________________________________ _____________________________ 7. -rrhaphy _____________________________________________ _____________________________ 8. -plasty _____________________________________________ _____________________________ 9. -ectasis, -ectasia ______________________________________________ _____________________________

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10. -Stenosis _____________________________________________ _____________________________ 11. -Stasis _____________________________________________ _____________________________ 12. -Spasm ___________________________________________ _____________________________ 13. -Tresia _____________________________________________ _____________________________ B Form medical terms for the following definitions. Use the combination forms listed as needed to create terms. chol/e cholangi/o choledoch/o gastr/o hemat/o hem/o herni/o palat/o pylor/o 1. Stasis of bile ______________________________________ 2. Suture of hernia ______________________________________ 3. Enlargement of the bile ducts ______________________________________

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4. Spitting up blood (from the respiratory tract) ______________________________________ 5. Vomiting blood (from the digestive tract) ______________________________________ 6. Surgical repair of the palate ______________________________________ 7. Narrowing of the pyloric sphincter ______________________________________ 8. Eruption of blood from the stomach ______________________________________ 9. Sudden involuntary muscle contraction in the distal region of the stomach ______________________________________ 10. Eruption of blood _______________________________________ 11. Incision in the common bile duct _____________________________________ C Give the meaning of the following terms. 1. Dysphagia _____________________________________________ _____________ 2. Polyphagia _____________________________________________ ___________________________ 3. Dyspepsia _____________________________________________ ___________________________ 4. Biliary atresia __________________________________________ _____________

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5. rhinorrhea _____________________________________________ ___________________________ 6. cholestasis _____________________________________________ ___________________________ 7. esophageal atresia _____________________________________________ ___________________________ 8. pyloroplasty _____________________________________________ ___________________________ 9. splenorrhagia _____________________________________________ ___________________________ 10. proctosigmoidoscopy _____________________________________________ ___________________________ 11. hemorrhage _____________________________________________ ___________________________ 12. cholangitis _____________________________________________ ___________________________ D Match the listed surgical procedures with the meanings die folgen. Abdominoplastik Zökostomie Cholezystektomie Cholezystojejunostomie

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Colectomy Gingivectomy Herniorrhaphy Ileostomy Palatoplasty Pancreatoduodenectomy Paracentesis Sphincterotomy 1. Removal of the gallbladder _______________________ 2. Resection of the large bowel _______________________ 3. Suture of a weakened muscular wall (hernia) _____________ 4. Reopening of the first segment of the intestine to the outside __________________________ 5. Surgical repair of the abdomen ______________ 6. Incision of a muscle ring 7. Removal of the pancreas and duodenum ______________ 8. Opening of the third part of the small intestine to the outside ______________ 9. Removal of the gum tissue _______________________ 10. Anastomosis between the gallbladder and the second part of the small intestine

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p _____________________________ 11. Puncture of abdomen for fluid collection ______________ 12. Surgical repair of palate _______________________ E Use the meanings given to complete the following terms. 1. Fat secretion: Steat ________________________ 2. Difficulty swallowing: Dys __________ 3. Gallstone abnormality: Chole ________________________ 4. Cheek area: __________ al 5. Affecting lips and teeth: __________ tooth 6. Vomiting blood: Hemat __________________________ 7. Liver enlargement: hepato __________ 8. Under the tongue Concerning: sub ________________________ 9. Removal of the gallbladder: __________ ectomy 10. Concerning the choledochus: chole __________ 11. Bleeding from the stomach: gastro __________ F Give the meaning of the following terms.

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1. cecal volvulus _____________________________________________ _______________________ 2. aphthous stomatitis _____________________________________________ _______________________ 3. celiac disease _____________________________________________ _______________________ 4. lipase _____________________________________________ _______________________ 5. cheilosis _____________________________________________ _______________________ 6. oropharynx _____________________________________________ _______________________ 7. glycogen _____________________________________________ _______________________ 8. glossectomy _____________________________________________ _______________________ 9. sialadenectomy _____________________________________________ _______________________ 10. Parodontalmembran _____________________________________________ _______________________

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11. Choledochectasia _____________________________________________ _________ 12. Cholangiocarcinoma _____________________________________________ _______________________ G Match each laboratory test or clinical procedure listed with its description. • Ultrasound of the abdomen • Barium enema • Computed tomography of the abdomen • Endoscopic retrograde cholangiopancreatography • Endoscopic ultrasonography • Bariatric surgery/gastric bypass • Gastrostomy (G-tube) • HIDA scan • Laparoscopy • Liver biopsy • Nasogastric intubation • Percutaneous transhepatic cholangiography • Serum bilirubin • Small bowel control • Stool culture • Stool guaiac (hemoccult) 1. Measuring the bile pigment in the blood _________________________________ 2. Placing feces in a nutrient medium for bacterial analysis _________________________________

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3. X-ray examination of lower gastrointestinal tract _________________________________ 4. Imaging of abdominal viscera with sound waves _________________________________ 5. Test to detect hidden blood in feces _________________________________ 6. Sequential X-rays of small intestine _________________________________ 7. Injection of contrast medium through the skin into the liver to um Obtaining x-rays of the bile ducts _________________________________ 8. Inserting a tube through the nose into the stomach _________________________________ 9. Transverse x-rays of the abdominal organs _________________________________ 10. Injecting contrast medium through an endoscope for x-ray imaging of the pancreas and bile ducts _________________________________ 11. Stomach reduction and gastrojejunostomy _________________________________ 12. Inserting a endoscope and ultrasound imaging to show the organs of the gastrointestinal tract _________ _ _______________________ 13. Percutaneous removal of liver tissue with subsequent microscopic examination _________________________________ 14. Visual examination (endoscopic) of the abdominal viscera through small abdominal incisions _________________________________

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15. Reopening of the stomach to the outside of the body for food intake ________________________________ 16. Radioactive imaging of the liver, gallbladder and intestines _________________________________ H In column I, indicate the meaning of the abbreviations. Then choose the correct description from Column II. COLUMN I 1. TPN ___________________ 2. PUD ___________________ 3. EGD _____ 4. IBD ___________________ 5. BE ___________________ 6. BRBPR ___________________ 7. LFTs ___________________ 8. GERD _____ 9. HBV _________________ 10. CT ___________________

_______ _______ _______ _______ _______ _______ _______ _______

COLUMN II A. Tests such as measuring ALT, AST, Alk-Phos and serum bilirubin. B. Heartburn is a symptom of this condition. C. Includes Crohn's disease and ulcerative colitis. D. H. pylori causes this condition. E. Intravenous injection of food. Q. This is a lower gastrointestinal series. G. X-ray process that produces a series of cross-sectional images. H. This infectious agent causes chronic liver inflammation. I. Hematochezia describes this gastrointestinal symptom. J. Endoscopic visualization of the upper gastrointestinal tract.

_______ _______

I Provide the suffixes for the following terms. 1. Bursting out (of blood) __________________________ 2. Discharge, discharge ____________________ 3. Suture ____________________ 4. Dilatation ____________________ 5. Narrowing (stricture) ____________________ 6. Vomiting ___________ 7. Spikes ___________ 8. Excision ___________

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9. Digestion ____________________ 10. Eating, Swallowing ___________ 11. Induration ___________ 12. Stopping, Controlling ___________ 13. Surgical Repair ___________ 14. Opening ___________ 15. Surgical Puncture ___________ 16. Involuntary Contraction _____________ 17. Reopening ___________ 17. Reopening ___________ what at a Fecal transplant happens and why it is necessary. ________________________ ________________________ __________ __________ __________ __________ ________________________ K Circle the correct bold phrase in parentheses to complete each sentence. 1. When Mrs. Smith developed diarrhea and cramping abdominal pain, she consulted one (urologist, nephrologist, gastroenterologist) and was concerned that the cause of her symptoms might be (inflammatory bowel disease, esophageal varices, achalasia). 2. After a thorough history and physical exam, Dr. Blakemore with Mr. Bean, a longtime drinker

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(Haemorrhoids, pancreatitis, appendicitis). Mr. Bean had complained of severe abdominal pain and a change in bowel habits. 3. Many pregnant women cannot lie flat after eating without experiencing a burning sensation in their chest and throat. The usual cause of this symptom is (volvulus, dysentery, gastroesophageal reflux). 4. Mr. and Mrs. Cho brought their young son to the clinic after he had several bouts of projectile vomiting. The pediatric surgeon suspected a diagnosis (inguinal hernia, pyloric stenosis, ascites). 5. Boris had terrible problems with his teeth. He needed not only a periodontist for his (aphthous stomatitis, oral leukoplakia, gingivitis), but also one (endodontist, oral surgeon, orthodontist) to straighten his teeth. 6. After 6 weeks of radiation therapy of her throat, Be y experienced severe irritation and inflammation of the esophagus. She complained to her doctor about her sequelae (dyspepsia, dysphagia, hematemesis). 7. Steven, 7 years old, is hospitalized with recurrent abdominal pain, occasional constipation and diarrhea, and weight loss. His pediatrician makes the diagnosis (lipase deficiency, dysentery, celiac disease) and recommends a (fat, gluten, sugar) free diet. 8. Chris had been a heavy drinker of alcohol throughout his adult life. His wife noticed an increasing yellow discoloration of the whites of his eyes and skin. After a physical exam and blood tests, its

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Family doctor told him his (intestines, skin, liver) was sick. The yellow discoloration was (jaundice, melena, bloating), and his condition was (cheilosis, cirrhosis, steatorrhea). 9. When Carol was working as a phlebotomist, she accidentally cut her finger while drawing blood from a patient. Unfortunately the patient had (pancreatitis, hemoptysis, hepatitis) and HBV was transmitted to Carol. Blood tests (liver biopsy, gastrointestinal endoscopy, stool culture) confirmed Carol's unfortunate diagnosis. Her doctor told her that her condition was chronic and that she could be a candidate for a (bone marrow, liver, kidney) transplant in the future. 10. Operation Smile is a rescue project that performs surgical repairs including (herniorrhaphy, oral gingivectomy, palate plastic) on children with a congenital cleft palate. 11. After months of treatment with antibiotics, Anne developed abdominal pain and chronic severe diarrhea. Harmful bacteria C. diﬃcile have infested them (stomach, large intestine, esophagus). In order to restore normal bacteria in the gut, she underwent gastric bypass (gastric bypass, laparoscopic gastrectomy, stool transplant).

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Solutions to tasks A 1. Digestion 2. Spitting (from the airways) 3. Vomiting 4. Eating, swallowing 5. Discharge, discharge 6. Hemorrhage 7. Stitching 8. Surgical repair 9. Dilation (dilatation), widening 10. Narrowing , tightening 11. until it stops; Control 12. Sudden involuntary muscle contraction 13. Orifice B 1. Cholestasis 2. Herniorrhaphy 3. Cholangiectasia 4. Hemoptysis 5. Hematemesis 6. Palatoplasty

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7. Pyloric stenosis 8. Gastrorrhagia 9. Pylorospasm 10. Hemorrhage 11. Choledochotomy C 1. Difficulty swallowing 2. Overeating 3. Difficulty digesting 4. Bile ducts are not patent (congenital abnormality) 5. Nasal mucus discharge 6. Biliary arrest 7. Esophagus is not open (closed) at birth (congenital anomaly) 8. Surgical repair of pyloric sphincter 9. Hemorrhage (bleeding) from spleen 10. Visual (endoscopic) examination of rectum and sigmoid colon 11. Hemorrhage 12. Inflammation of bile duct ( vessel) D 1. cholecystectomy 2. colectomy

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3. Herniorrhaphy 4. Zocostomy 5. Abdominoplasty 6. Sphincterotomy 7. Pancreatoduodenectomy 8. Ileostomy 9. Gingivectomy 10. Cholecystojejunostomy 11. Paracentesis (abdominocentesis) 12. Palatoplasty E 1. Steatorrhoea 2. Dysphagia 3. Cholelithiasis 5. Labiodental 4. Buccal lithiasis Hematemesis 7. Hepatomegaly 8. sublingual 9. Cholecystectomy 10. Choledochus 11. Gastrorrhagia F

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1. Torsion of the intestine in the area of the appendix 2. Inflammation of the mouth with small ulcers 3. Autoimmune disease in which villi in the lining of the small intestine are damaged, caused by a reaction to gluten found in foods such as wheat, barley and rye 4. Fat-digesting enzyme 5. Abnormal condition of the lips 6. Part of the pharynx near the mouth 7. Storage form of sugar 8. Removal of part or all of the tongue 9. Removal of a salivary gland 10. Membrane covering a tooth 11. Dilatation of the common bile duct 12. Malignant Tumor of bile vessels G 1. serum bilirubin 2. stool culture 3. barium enema 4. abdominal ultrasonography 5. stool guaiac (hemoccult) 6. small bowel follow-through 7. percutaneous transhepatic cholangiography (PTHC) 8. nasogastric intubation

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9. CT of the abdomen 10. Endoscopic retrograde cholangiopancreatography (ERCP) 11. Bariatric surgery (gastric bypass) 12. Endoscopic ultrasonography (EUS) 13. Liver biopsy 14. Laparoscopy (form of minimally invasive surgery) 15. Gastrostomy (G-tube) 16. HIDA-Scan H 1. total parenteral nutrition: E 2. Stomach ulcers: D 3. Esophagoduodenoscopy: J 4. Inflammatory bowel disease: C 5. Barium enema: F 6. Bright red blood per rectum: I 7. Liver function tests: A 8. Gastroesophageal reflux disease: B 9. Hepatitis B virus: H 10. Computed tomography: G I 1. -rrhagia, -rrhagia 2. -rrhoea

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3. -rhaphy 4. -ectasis, -ectasia 5. -stenosis 6. -vomiting 7. -ptysis 8. -ectomy 9. -pepsia 10. -phagia 11. -sclerosis 12. -stasis 13. -plastic 14. - Tresia 15. -Puncture 16. -Spam 17. -Stoma 18. -Tomy J In a stool transplant, the stool of a healthy donor is transferred into the colon of a patient/recipient. This is necessary when the patient's colon contains harmful bacteria such as C. diﬃcile. After the transplant, normal stool bacteria colonize the patient's colon.

K 1. Gastroenterologist; inflammatory bowel disease 2. Pancreatitis

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3. gastroesophageal reflux 4. pyloric stenosis 5. gingivitis; orthodontist 6. dysphagia 7. celiac disease; gluten 8. liver; jaundice; cirrhosis 9. hepatitis; liver biopsy; Liver 10. Palate plastic 11. Large intestine; Fecal Transplantation Answers to Practical Applications Case Report: Pancreatic Cancer and the Whipple Procedure

1st c 2nd b 3rd d 4th b Pronunciation of terms

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TERM abdominal ultrasonography abdominoplasty amylase and lipase tests aphthous stomatitis atresia bariatric surgery biliary atresia bronchospasm buccal cecal volvulus celiac disease cheilosis cholangiectasis cholangiocarcinoma cholangiography cholangiopancreatography cholangitis cholecystectomy cholecystojejunostomy cholecystolithiasis choledochal choledochectasia cholelithiasis cholestasis colectomy colonoscopy computed tomography dentalgia diarrhea duodenal dyspepsia dysphagia endoscopic ultrasonography esophageal atresia fecal transplant gastroenteritis gastrointestinale Endoskopie Gastrojejunostomie Gastrorrhagie Gastrostomie Gingivektomie Glossektomie Glukoneogenese Glykogen Hämatemesis Hämoptyse Blutung Hepatomegalie Herniorrhaphie HIDA-Scan Ileostomie labiodental

AUSKUNFT ab-DOM-in-al ul-trah-so-NOG-rah-fe ab-DOM-in-o-plas-te AM-ih-legt und LI-bezahlt Tests AF-also sto-mah-TI-tis a-TRE-ze-ah bah-re-AH-trk SUR-jeh-re BIH-le-ah-re a-TRE-ze-ah BRONG-ko-crampf BUK-al SE-kal VOL-vu-lus SE -le-ak dih-ZEEZ ki-LO-sis ko-lan-je-EK-tah-sis ko-lan-je-o-kar-sih-NO-mah ko-lan-je-OG-rah-fe ko -lan-je-o-pan-kre-uh-TOG-rah-fe ko-lan-JI-tis ko-le-sis-TEK-to-me ko-le-sis-to-jeh-jun-NOS- to-me ko-le-sis-to-lih-THI-ah-sis ko-le-DOK-al ko-le-do-kek-TA-se-ah ko-le-lih-THI-ah-sis ko -le-STA-sis this-LEK-to-me this-lon-OS-this com-PU-ted to-MOG-rah-fe den-TAL-jah di-ah-RE-ah du-o- DE-nal dis-PEP-se-ah dis-FA-je-ah en-do-SKOP-ikul-trah-so-NOG-rah-fe eh-sof-ah-JE-al a-TRE-ze-ah fe-call tranz-plant gas-by-teh-RI-tis gas-by-TES-this-at-a-DOS-co-pe gas-by-jeh-ju-NOS-zu-mich gas- tro-RA-jah gas-TROS-zu-mir gin-gih-VEK-zu-mir gloss-EK-zu-mir glu-co-ne-o-JEN-eh-sis GLI-co-jen he-mah- TEM-eh-sis he-MOP-that-sis HEM-or-ij hep-ah-to-MEG-ah-le her-ne-OR-ah-fe HIH-d ah scan il-the-OS-to-me the-be-o-THE-number

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TERM laparoscopy lipase liver biopsy liver function tests lower gastrointestinal series magnetic resonance imaging gastric tube intubation oropharynx palatoplasty pancreas pancreatoduodenectomy paracentesis periodontal membrane polyphagia proctosigmoidoscopy pyloric stenosis pylorospasm rectal carcinoma sialadenectomy splenic flexure steatorrhea stool culture stool guaiac sublingual upper gastrointestinal series

AUSSPRACHE Lap-ah-ROS-ko-pe LI-zahlt LIV-er bi-OP-se LIV-er FUNK-meidet Tests LO-er gas-tru-in-TES-tin-al SE-reez mag-NET-ik REH-zo-nants IM-aj-ing na-zo-GAS-trick in-to-BA-shun or-o-FAH-rinks pah-LAT-o-plas-te pan-cre-AH-tik pan-cre -ah-to-du-o-deh-NEK-to me par-ah-sen-TE-sis peh-re-o-DON-tal MEM-brayn pol-e-FA-je-ah prok-to-sig -moyd-OS-co-pe pi-LOR-ik steh-NO-sis pi-LOR-o-spasm REK-number kar-sih-NO-mah si-al-ah-deh-NEK-to-me SPLEN- ik FLEK-shur ste-ah-to-RE-ah Hocker COOL-chur Hocker GWI-ak sub-LING-wal UP-er gas-through-in-TEST-in-al SER-eez

evaluation sheet

Write meanings for the combinations of forms and suffixes in the spaces provided. Check your answers against the information in Chapter 5 and this chapter or the Glossary (Medical Word Parts - English) at the end of this book.

combine shapes

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COMBINATIONSFORM abdomin/o amyl/o an/o append/o appendic/o bil/i bilirubin/o bucc/o cec/o celi/o cervic/o cheil/o chlorhydr/o chol/e cholangi/o cholecyst/ o choledoch /o cib/o cirrh/o col/o, colon/o dent/i duoden/o enter/o esophag/o eti/o gastr/o gingiv/o gloss/o gluc/o, glyc/o glycogen/ o hem /o, hemat/o hepat/o hernia/o idi/o ile/o pancreat/o peritone/o pharyng/o proct/o prote/o py/o pylor/o rect/o sialaden/o milz/o Steat/ of Stomata/of Tonsill/of

IMPORTANCE ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

Suffix

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SUFFIX -ase -centesis -chezia -ectasia -ectasis -ectomy -emesis -emia -genesis -graphy -iasis -megaly -orexia -ptosis -rrhage -rrhagia -rrhaphy -rrhoe -scopy -spasm -stasis -stenosis -stomie -tomy - tresia

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CHAPTER 7

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Urinary System CHAPTER SECTIONS Introduction 204 Anatomy of Major Organs 204 Physiology: How the Kidneys Produce Urine 206 Vocabulary 209 Terminology: Structures, Substances, and Urinary Signs and Symptoms 211 Urinalysis 216 Pathological Terminology: Kidney, Bladder, and Associated Conditions 217 Laboratory Tests and Clinical Procedures 220 Abbreviations 225 Practical Applications 226 Personal: Kidney Transplantation 228 Exercises 229 Solutions to the Exercises 234 Pronunciation of Terms 236 Summary Sheet 238

CHAPTER OBJECTIVES • Name the major organs of the urinary system and describe their location and function. • Identify common pathological conditions affecting the urinary system. • Recognize how urinalysis is used and interpreted as a diagnostic test. • Define urinary system-related combination forms, prefixes and suffixes. • List and explain laboratory tests, clinical procedures, and acronyms related to the urinary system.

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• Understand medical terms in their proper context, such as: B. Medical reports and records.

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Introduction When protein-rich foods are consumed by body cells, nitrogenous waste products (urea, creatinine, and uric acid) are released into the bloodstream. The urinary system removes these nitrogenous wastes from the blood so they don't build up and become harmful. As blood flows through the kidneys, the kidneys filter nitrogenous waste to form urine (composed of water, salts, and acids). Urine leaves the body through the ureters, urinary bladder, and urethra. Every day, the kidneys process about 200 liters of blood to filter out 2 liters of urine. In addition to removing urea and other nitrogenous wastes from the blood, the kidneys maintain the proper balance of water, electrolytes, and acids in body fluids. Electrolytes such as sodium (Na+) and potassium (K+) are small molecules that conduct an electrical charge. Electrolytes are necessary for the proper functioning of muscle and nerve cells. The kidney adjusts the amounts of water and electrolytes by excreting some substances in the urine and retaining others in the bloodstream for use in the body. This is an example of homeostasis, which is the body's ability to maintain a balance within its internal environment. Home/o means equality. In addition to making and excreting (excreting) urine from the body, the kidneys secrete an enzyme called renin (RE-nin) and a hormone called erythropoietin (eh-rith-ro-POY-it-in). Renin increases blood pressure (to keep blood flowing through the kidneys). Erythropoietin (EPO) stimulates the production of red blood cells in the bone marrow. The kidneys also secrete calciferol, an active form of vitamin D necessary for the absorption of calcium from the intestines. The kidneys also break down hormones such as insulin and parathyroid hormone and eliminate them from the bloodstream. Box 7-1 gives an overview of the functions of the kidneys.

Box 7-1

Functions of the kidneys • Remove nitrogenous wastes: urea, creatinine, uric acid • Balance water and electrolytes (sodium, potassium) • Release substances: renin, erythropoietin, calciferol • Break down hormones and remove them from the bloodstream

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Anatomy of Major Organs The following sections describe the organs of the urinary system. Label Figure 7.1 as you identify each organ.

Figure 7-1 Male urinary system.

The kidney [1] is one of two bean-shaped organs behind the abdominal cavity (retroperitoneal) on either side of the spine in the lumbar region. Each kidney is protected by a pad of fatty tissue and fibrous connective tissue. Each kidney (about the size of a fist) weighs about 4 to 6 ounces. The kidneys consist of an outer cortical region (cortex means bark, like the bark of a tree) and an inner medulla region (medulla means marrow). The hilus is a depression at the medial edge of the kidney. Blood vessels and nerves run through the hilus.

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The ureter [2] is one of two muscular tubes (16 to 18 inches long) lined with mucous membrane. Ureters transport urine in peristaltic waves from the kidneys to the urinary bladder. The urinary bladder [3], a hollow muscular sac, is a temporary reservoir for urine. The trigone is a triangular region at the base of the bladder where the ureters enter and the urethra exits. The urethra [4] is a tube that carries urine from the urinary bladder to the outside of the body. The process of expelling urine through the urethra is called urination or voiding. The outer opening of the urethra is the urethra. The male urethra, about 8 inches long, extends down through the prostate gland to the urethra at the tip of the penis. In the female urinary system, the urethra, which is about 2 inches long, lies in front of the vagina. See Figure 7.2A, which depicts the female urinary system. When a patient cannot empty their bladder, a tube called a catheter is often inserted through the urethra to drain urine from the bladder. See Figure 72B.

Figure 7.2 A. Female urinary system. B. Urinary catheter placement.

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Physiology: How the Kidneys Make Urine Blood travels from the aorta to each kidney through the right and left renal arteries. After the renal artery enters the kidney (at the hilum), it branches into smaller and smaller arteries. The smallest arteries are called arterioles (Figure 7-3A).

Figure 7.3 A. Branching of the renal artery to form smaller arteries and arterioles and glomeruli. B, glomerulus and glomerular capsule. The afferent arteriole carries blood to the glomerulus (in this term af- is a form of ad-). Efferent arteriole carries blood (ef- is a form of ex-) away from the glomerulus.

Because the arterioles are small, blood flows slowly but steadily through them. Blood flow through the kidney is so important that the kidneys have their own special mechanism for maintaining blood flow. When the blood pressure in the vessels of the kidney falls, reducing blood flow, the kidney produces renin and releases it into the blood. Renin promotes the production of a substance that stimulates arterioles to contract. This increases blood pressure and restores normal blood flow in the kidneys. Each arteriole in the renal cortex empties into a mass of very small, tortuous, and intertwined smaller blood vessels called the glomeruli (see Figure 73A). Each glomerulus (singular) is a collection of tiny capillaries shaped like a small sphere. There are approximately 1 million glomeruli in the cortical region of each kidney. The kidneys produce urine by filtration. As blood flows through the many glomeruli, the thin walls of each glomerulus (the filters) allow water, salts, sugar, and urea (along with other nitrogenous wastes such as creatinine and uric acid) to escape from the bloodstream. These materials collect in a tiny, cup-like structure, a glomerular (Bowman's) capsule, that surrounds each glomerulus (Figure 7-3B). The walls of the glomeruli prevent large substances such as

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Proteins and blood cells that do not pass into the urine. These substances remain in the blood and do not usually appear in the urine. Attached to each glomerular capsule is a long, twisted tube called the renal tubule (Figure 7-3B; see also Figure 7-4). As water, sugar, salts, urea, and other wastes pass through the renal tubule, most of the water, sugar, and nearly all of the sodium return to the bloodstream through tiny capillaries that surround each tubule. This active process of absorption ensures that the body retains essential substances such as sugar (glucose), water and sodium, while allowing waste products to be excreted in the urine. The final process in urine formation is the secretion of some substances such as potassium, acids, and drugs from the bloodstream into the renal tubule. Each renal tubule, now containing urine (95% water and 5% urea, creatinine, salts and acids), is connected to a larger collecting tubule.

Figure 7-4 A, Three steps in the formation of urine: (1) glomerular filtration of water, sugar, wastes (urea and creatinine), and sodium; (2) tubular reabsorption of water, sugar and sodium; and (3) tubular secretion of acids, potassium and drugs. B, A nephron is the combination of a glomerulus and renal tubule.

See Figure 7-4A, which outlines the steps to create urine. Be aware that waste products from kidney failure build up in the body and can affect the functioning of vital organs, including the brain and heart. The combination of a glomerulus and renal tubule forms a unit called a nephron (Figure 7-4B). Each kidney contains about 1 million nephrons. All of the collecting tubes lead to the renal pelvis, a basin-like area in the central part of the kidney. Small, cup-like regions of the renal pelvis are

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Called chalices or chalices (singular: calyx or calix). Figure 7-5 is an x-ray of a kidney showing the renal pelvis, calyces, and ureter.

Figure 7.5 Renal pelvis, calyx and ureter as seen on CT urogram (intravenous dye was used).

The renal pelvis narrows into the ureter, which carries urine to the urinary bladder. The bladder, a muscular sac, temporarily stores urine. Sphincters control the exit area of the bladder to the urethra. As the bladder fills and the pressure at its base increases, a person notices an urge to urinate and voluntarily relaxes the sphincters. Consider the diagram in Figure 7.6, which traces the process of urine formation and excretion.

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FIGURE 7-6 Flow chart depicting the process of formation and excretion of urine.

vocabulary

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arteriole calciferol calyx oder calix (plural: calyces oder calices) katheter

small artery. Active form of vitamin D excreted by the kidneys. Cup-like collecting region of the renal pelvis. The term comes from the Greek, kalux, meaning a cup or case surrounding a flower bud.

Hose for injecting or draining liquids. A urinary catheter drains urine from the bladder. Cortex Outer area of an organ; The renal cortex is the outer region of the kidney (cortical means belonging to the cortex). Creatinine Nitrogenous waste excreted in the urine. Creatinine is a product of muscle metabolism. Creatinine clearance is a measure of the kidneys' efficiency in removing (excreting) creatinine from the blood. Electrolyte A chemical element that carries an electrical charge when dissolved in water. Electrolytes are necessary for the functioning of muscles and nerves. The kidneys maintain the proper balance of electrolytes and water in the blood. Potassium (K+) and sodium (Na+) are electrolytes. Erythropoietin Hormone secreted by the kidneys to stimulate red blood cell production. (EPO) Poietin means a substance that forms. EPO stimulates the bone marrow to produce red blood cells, thereby increasing the amount of oxygen delivered to the muscles. This improves athletic endurance. However, the use of EPO is a form of blood doping and is banned by the World Anti-Doping Authority (WADA). Filtration The process by which some, but not all, substances pass through a filter. Glomerulus Enclosing structure that surrounds each glomerulus. Also known as Bowman's capsule, the glomerular capsule collects the material that is filtered from the blood through the walls of the glomerulus. Glomerulus Tiny balls of capillaries (microscopic blood vessels) in the kidney. (plural: glomeruli) Hilus Depression in the kidney where blood vessels and nerves enter and exit. Hilum comes from Latin and means little. It is also used in the respiratory system to mark the depression in the lungs where blood vessels, bronchi, and lymphatics enter and exit. Kidney One of two bean-shaped organs on either side of the spine in the lumbar region. It filters nitrogenous waste from the bloodstream to form urine. Meatus opening or canal. Medulla Inner region of an organ. The renal medulla is the inner part of the kidney. Medullary means belonging to the marrow. The term comes from the Latin medulla and means marrow (inner part). Nephron functional unit of the kidney. It is the combination of glomerulus and renal tubule where filtration, reabsorption and secretion take place in the kidney. Each nephron is able to produce its own urine. There are about 1 million nephrons in a kidney. nitrogenous substance that contains nitrogen and is excreted in the urine. Examples of nitrogenous wastes are urea, uric acid and creatinine. Potassium electrolyte is regulated by the kidneys so that an adequate concentration in the blood is maintained. Potassium is important to enable muscle contraction and the (K+) conduction of nerve impulses. Reabsorption Process by which the renal tubules return materials needed by the body to the bloodstream. Renal artery Blood vessel that carries blood to the kidney. Renal pelvis Central collecting region in the kidney. Renal tubule Microscopic tube in the kidney where urine is formed after filtration. Renal vein Blood vessel that carries blood away from the kidney and to the heart. Renin Enzyme secreted by the kidney. It increases blood pressure by affecting vasoconstriction (narrowing of blood vessels). Sodium (Na+) Electrolyte regulated by the kidneys in the blood and urine. It is needed for the proper transmission of nerve impulses, cardiac activity, and other metabolic functions. A common form of sodium is sodium chloride (table salt).

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Trigone Urea Ureter Urethra Uric acid Bladder Urination (emptying)

Triangular area in the urinary bladder. Larger amounts of nitrogenous waste are excreted in the urine. One of the two tubes that lead from the kidneys to the urinary bladder. Tube leading from the urinary bladder to the outside of the body. Nitrogen waste excreted in the urine. Hollow, muscular sac that holds and stores urine. process of expelling urine; also called voiding.

Filtration of blood through the kidney

This process is sustained by the heart's work (25% of heart work goes to the kidneys) and adequate blood pressure to force blood through the glomerulus (filter). About 200 liters (189 L) of fluid is filtered daily, but 98% to 99% of the water and salts are returned to the blood. Only about 2 liters (1500 ml) of urine are excreted daily.

Terminology Structures, substances, and urinary signs and symptoms Write the meaning of the medical terms in the space provided.

structures

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COMBINING MEANING TERMINOLOGY MEANING FORM cali/o, calyx caliectasis ________________________________________calyx (chalice); cup-shaped cyst/o urinary cystitis __________________________________________ Bladder Bacterial infections often cause acute or chronic cystitis. In acute cystitis, the bladder contains blood as a result of mucosal hemorrhage (Figure 7-7). Cystectomy ______________________________________ Cystostomy ______________________________________ An opening is made in the bladder from the outside of the body. A catheter is inserted into the bladder for drainage. Glomerul/o Glomerulus Glomerular Capsule _________________________________ Flesh/o Meatus Meatal Stenosis ____________________________________ Nephr/o Kidney Paranephric _______________________ Nephropathy _______________________________________ (neh-FROP-ah-the) Nephroptosis ______________________________________ Downward displacement or descent of a kidney when its anatomical supports are weakened. Nephropexy (-pexy means fixation) is an operation that uses a "floating" kidney. Nephrolithotomy ___________________________________ Incision (percutaneous) in the kidney to remove a stone. Hydronephrosis ____________________________________ Obstruction of the flow of urine can be caused by kidney stones (Figure 7-8), compression of the ureter by a tumor, or hyperplasia of the prostate at the bladder base in males. Nephrostomy ______________________________________ Surgical opening to the outside (from the renal pelvis). This is necessary when a ureter is blocked and the blockage cannot be easily removed. The renal pelvis becomes distended with urine (hydronephrosis), necessitating a nephrostomy. Pyel/o Renal Pelvis Pyelolithotomy ____________________________________ Removal of a large calculus (stone) that contributes to the blockage of urine flow and the development of an infection. The renal pelvis is surgically opened. ren/o Kidney Renal Ischemia ____________________________________ Renal colic ________________________________________ Colic is intermittent pain spasms caused by inflammation and distention of an organ. In renal colic, pain is caused by stones in the kidney or ureter. trigon/o trigone trigonitis __________________________________________ (region of the bladder) Ureter/o ureter Ureteroplasty ______________________________________ Ureteroileostomy ___________________________________ After a cystectomy, the urological surgeon forms a pouch from a segment of the ileum that is used in place of the bladder to transport urine from the ureters out of the body (Figure 7-9). It's an ileal conduit. Urethr/o Urethra Urethritis ________________________________________Urethroplasty _____________________________________Urethral Stricture _________________________________ A stricture is an abnormal narrowing of an opening or passageway.

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COMBINING MEANING TERMINOLOGY MEANING SHAPE Vesicles/or Urine Intravesical __________________________________________ Bladder Do not confuse the term vesicle with the term vesicle, which is a small blister on the skin. Vesicoureteral Reflux ________________________________

Figure 7.7 Acute cystitis. Notice that the lining of the blister is red and swollen. Bladder and urinary tract infections are more common in women because the urethra is shorter, allowing for easier bacterial colonization of the urinary bladder. They usually occur without a known cause, but can be acquired during sexual intercourse ("honeymoon cystitis") or after surgery and urinary catheterization.

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Figure 7-8 A: Hydronephrosis caused by a stone (obstruction) in the proximal part of a ureter. Note the accumulation of excess fluid in the kidney. B: Hydroureter with hydronephrosis caused by a stone in the distal part of the ureter.

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Figure 7.9 Ileostomy and ileal conduit after cystectomy.

Substances and urinary signs and symptoms

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COMBINATION FORM OR MEANING UFFIX Albumin/o Albumin (a protein in the blood)

TERMINOLOGY

IMPORTANCE

Albuminuria ____________________________________ The suffix -uria means urinary condition. This finding may indicate kidney malfunction due to protein leaking from damaged glomeruli. Microalbuminuria is the leakage of very small amounts of albumin through the glomeruli. Azot/o-nitrogen azotemia ____________________________________ This toxic condition is characteristic of uremia. This is indicated by an elevated BUN (blood urea nitrogen) test. Bacteri/o Bacteria Bacteriuria ____________________________________ Usually a sign of a urinary tract infection (UTI). The bacteria in the urine are cultured (grown in a special nutrient environment) and then tested with antibiotics to see which inhibit growth. This is called culture and sensitivity testing (C&S). Dips/O Thirst Polydipsia ____________________________________ Often a sign of diabetes mellitus or diabetes insipidus. Polydipsia occurs when excessive urination (polyuria) signals the brain to cause thirst. kal/i Potassium hyperkalemia ____________________________________ Since potassium (K+) is normally excreted by the kidneys, it builds up in the blood in kidney failure. ket/o, keton/o Ketone Ketosis ____________________________________ Body Often referred to as ketoacidosis because of the build up of acids in the blood (keto acids and tissues). A patient's breath in ketosis has a sweet or "fruity" odor. This is caused by acetone (a ketone body) releasing acetone from the blood in the lungs and being exhaled through the mouth using a lot of water during high-endurance events. noct/o night nocturia ____________________________________ Frequent, excessive urination at night. olig/o scanty oliguria ____________________________________ -poietin substance that produces erythropoietin ____________________________________ py/o pus pyuria ____________________________________ -tripsy crushing lithotripsy _______________________ ur/o urine (urea) uremia ____________________________________ This toxic condition occurs when nitrogenous waste builds up abnormally in the blood. a state (-esis) of being "in the urine"; bed-we ing. Diuresis ____________________________________ Di- (from dia-) means complete. Caffeine and alcohol are known diuretics - they cause increased urination (diuresis). Antidiuretic Hormone ______________________________ Produced by the pituitary gland, this hormone normally acts on the renal tubules to promote water absorption. It is also called vasopressin and is abbreviated to ADH.

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COMBINATION FORM OR MEANING UFFIX urine/or urine

- Urine

Urinate; urine condition

TERMINOLOGY

IMPORTANCE

Urinary incontinence ________________________________ Incontinence literally means not (not) able to hold (tin) together (con-). This is a loss of control over the passage of urine from the bladder. Stress urinary incontinence occurs when the bladder opening is strained when you cough or sneeze. Urge incontinence occurs when urination cannot be held back when the urge to urinate is felt. Dysuria ___________________________________ Anuria ____________________________________ Commonly caused by kidney failure or urinary tract obstruction ____________________________________ A symptom of both diabetes insipidus and diabetes mellitus.

Enuresis/Nykturie

Don't confuse enuresis, which is involuntary, with nocturia, which is voluntary, frequent urination at night.

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Urinalysis Urinalysis is an examination of urine to determine the presence of abnormal elements that can indicate various pathological conditions. It's an inexpensive, non-invasive test that not only provides valuable information about the contents of urine, but also about diseases that affect the entire body. Urinalysis can be performed in an office with almost immediate results. See Figure 7-10.

Figure 7-10 Test sticks and urinalysis.

The following are some of the tests included in a urinalysis: 1. Color - The normal urine color is yellow (amber) or straw-colored. A colorless, pale urine indicates a large amount of water in the urine, while a smoky red or brown color of the urine indicates the presence of large amounts of blood. Foods like beets and certain medications can also cause urine to turn red. 2. Appearance - Normally urine should be clear. Cloudy or cloudy urine indicates a urinary tract infection with pus (pyuria) and bacteria (bacteriuria). 3. pH - Determining pH reveals the chemical nature of urine. It indicates the degree to which a solution is acidic or alkaline (basic) (Figure 7-11). Normal urine has a slightly acidic pH of 6.5. However, in some bladder infections, the pH of the urine can be alkaline, which is due to the action of bacteria in the urine, which break down urea and release ammonia (an alkaline substance).

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FIGURE 7-11

The pH scale. Pure water has a neutral pH.

4. Protein—Small amounts of protein are usually found in the urine, but not in sufficient amounts to produce a positive result with ordinary testing methods. When urine tests for protein come back positive, albumin is usually responsible. Albumin is the most important protein in blood plasma. When it is detected in the urine (albuminuria), it can indicate a leak in the glomerular membrane, which allows albumin to enter the renal tubules and escape into the urine. More sensitive tests can detect smaller abnormal amounts of albumin, revealing microalbuminuria when normal tests are negative. Microalbuminuria is considered to be the earliest sign of kidney involvement in diabetes mellitus. 5. Glucose - Sugar is not normally found in urine. If it occurs (glycosuria), in most cases this indicates diabetes mellitus. In diabetes mellitus there is an excess of sugar in the blood (hyperglycaemia), which causes sugar to “spill” into the urine. The renal tubules cannot absorb all of the sugar that is filtered out through the glomerular membrane. 6. Specific Gravity - The specific gravity of urine reflects the amounts of waste, minerals and solids in the urine. It is a comparison of the density of urine with that of water. The urine of patients with diabetes mellitus has a higher specific gravity than normal due to the presence of sugar. 7. Ketone Bodies - Ketones (or acetones, a type of ketone bodies) are formed when Fe acids are broken down in the liver. Ketones build up in the blood and urine when the body breaks down fat for fuel instead of sugar. Ketonuria occurs in diabetes mellitus when low-sugar cells must use their available fat for energy. When hungry, when sugar is not available, ketonuria and ketosis (ketones in the blood) occur as fat is broken down abnormally. Ketones in the blood are dangerous because they increase the acidity of the blood (ketoacidosis). In severe cases, this can lead to coma (loss of consciousness) and death. 8. Sediment and casts - The presence of abnormal particles in the urine is a sign of a pathological condition. Such particles that can settle as sediment at the bottom of a urine sample can include cells (epithelial cells, white or red blood cells), bacteria, crystals, and casts (cylindrical protein structures that often contain cellular elements). 9. Phenylketonuria (PKU) – This is a rare condition in which a baby is born unable to break down an amino acid, phenylalanine. Result

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High levels of phenylalanine in the blood (phenylketones are found in the urine) can lead to mental retardation. Although the PKU test was originally performed on urine samples, it is now performed by pricking the newborn's heel to obtain a small sample of blood. If phenylalanine is detected, the infant is put on a phenylalanine-free diet. Affected children remain on this diet into adulthood. 10. Bilirubin - A small amount of this pigment substance is present in urine, giving it its characteristic yellow color. Bilirubin is a product of the breakdown of red blood cells and increased levels in the urine (bilirubinuria) occur in patients with liver disease.

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Pathologic Terminology: Kidney, Bladder and Kidney Comorbidities

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Glomerulonephritis

Interstitial Nephritis

Nephrolithiasis

Nephrotisches Syndrom (Nephrose)

polycystic kidney disease (PKD)

Pyelonephritis

renal cell carcinoma

kidney failure

renal hypertension

Inflammation of the glomeruli in the kidney. This condition can follow a streptococcal infection or be associated with an autoimmune disease. It results in leaky glomeruli, hematuria, erythrocyte casts, albuminuria, and in severe cases, renal failure and uraemia. Medications can be useful to control inflammation, and dialysis or a kidney transplant may be needed if uremia occurs. Inflammation of the connective tissue that lies between the kidney tubules. The connective tissue between the renal tubules consists of interstitial renal cells. In addition to the essential main functional cells that form the parenchyma, interstitial cells are found in every organ. The parenchyma in the kidney consists of the glomeruli and the renal tubules (nephrons). Acute interstitial nephritis, an increasingly common condition, can develop after use of NSAIDs (nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen) and other drugs. It can be characterized by fever, rash, and eosinophils in the blood and urine. Kidney stones (kidney stones). Kidney stones are usually made up of uric acid or calcium salts. Stones often lodge in the ureter or bladder and renal pelvis and may need to be removed by lithotripsy (see page 222) or surgery. Group of clinical signs and symptoms caused by excessive loss of protein in the urine. Nephrotic syndrome can follow glomerulonephritis or exposure to toxins or certain drugs, immune disorders, and other pathological conditions such as diabetes mellitus and cancer. Two important signs of nephrotic syndrome are edema (swelling from fluid in the spaces between the tissues) and hypoalbuminemia. Both changes are caused by massive leakage of protein into the urine. Multiple fluid-filled sacs (cysts) in and on the kidney. There are two types of hereditary PKD. One type is usually asymptomatic (without symptoms) until middle age, when it is characterized by hematuria, urinary tract infections, nephrolithiasis, and renal failure. The other type of PKD occurs in infants or children and results in kidney failure. Figure 7-12A shows polycystic kidney disease. Inflammation of the lining of the renal pelvis and renal parenchyma. The parenchyma of an organ is its essential and distinctive tissue. Nephrons form the renal parenchyma. A bacterial infection of the urinary tract leads to the formation of pus in the kidneys, often with bacteria entering the bloodstream. Urinalysis shows pyuria. Treatment consists of antibiotics and surgical correction of any obstruction to the flow of urine. Kidney cancer in adulthood. This tumor (see Figure 7-12B) accounts for 2% of all adult cancers. Hematuria is the primary abnormal finding, and the tumor commonly metastasizes to bone and lung. Nephrectomy or partial nephrectomy is the primary treatment. The decrease in waste excretion results from an impaired filtration function. A large number of diseases, including hypertension, infections and diabetes, can lead to kidney failure, which can be acute (ARF) or chronic (CRF), reversible or progressive, mild or severe. A more recent classification of chronic kidney disease (CKD) classifies its severity according to the level of creatinine clearance and glomerular filtration rate (GFR), ranging from normal (stage 1) to end-stage renal failure or ESRF (stage 5), see Spotlight on CKD -Stadiums on page 225. High blood pressure due to kidney disease. Renal hypertension is a form of secondary hypertension (high blood pressure caused by an abnormal condition such as glomerulonephritis). However, the most common type of high blood pressure is essential

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Wilms-Tumor

Hypertension or primary hypertension. In essential hypertension, there is no obvious underlying medical condition. Chronic essential hypertension can damage blood vessels and potentially lead to stroke, myocardial infarction (heartbeat), heart failure, or kidney failure. Malignant tumor of the kidney that occurs in childhood. This tumor can be treated with surgery, radiation therapy, and chemotherapy.

Figure 7.12 A: Polycystic kidney disease. The kidneys contain masses of cysts. Typically, polycystic kidneys weigh 20 times their normal weight (150 to 200 grams). B, renal cell carcinoma.

bladder

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bladder cancer

Malignant tumor of the urinary bladder. Bladder cancer is more common in men (often smokers) and in people over 50 years of age, especially industrial workers who come into contact with dye and leather tanning agents. Signs and symptoms include gross (visible to the naked eye) or microscopic hematuria and dysuria. Cystoscopy with biopsy is the most common diagnostic procedure. Tumor staging is based on the depth to which the tumor invades the bladder wall and the presence of metastases. Superficial tumors are removed by electrocautery (burning). Cystectomy, chemotherapy, and radiation therapy are treatments for diseases that have spread deep into the bladder wall, to regional lymph nodes, or to distant organs.

Comorbidities Diabetes insipidus (DI)

Diabetes mellitus (DM)

The antidiuretic hormone (ADH) is not secreted or the kidneys are resistant to ADH. In DI, the kidney produces large amounts of dilute urine (polyuria). A deficiency in ADH prevents water from being reabsorbed into the blood through the renal tubules. Insipidus means tasteless, reflecting very dilute and watery urine, not sweet like in diabetes mellitus. The term diabetes comes from the Greek diabainein, meaning to go through. Both types of diabetes (insipidus and mellitus) are characterized by polyuria and polydipsia. Insulin is not secreted sufficiently or the tissues are resistant to its effects. The main signs and symptoms of diabetes mellitus are glycosuria, hyperglycemia, polyuria and polydipsia. Without insulin, sugar cannot leave the bloodstream and is not available to the body's cells for energy. Sugar stays in the blood (hyperglycemia) and passes into the urine (glycosuria). Mellitus means sweet and reflects the content of the urine. The term diabetes when used alone refers to diabetes mellitus. See Chapter 18 for more information on diabetes mellitus.

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Laboratory Tests and Clinical Procedures Laboratory Tests BUN (blood urea nitrogen) creatinine clearance

Measuring the level of urea in the blood. Normally, BUN (pronounced be-u-n) is low because urea is continuously excreted in the urine. However, if the kidney is diseased or failing, the BUN can be very high. Urea builds up in the blood (uraemia) and leads to unconsciousness and death. Measurement of the rate at which creatinine is removed from the blood by the kidneys. This is an important test to assess kidney function. A blood sample is taken and the creatinine concentration in the blood is compared with the amount of creatinine excreted in the urine over a specified period of time. When the kidneys are not working well in their job of removing creatinine from the blood, the amount of creatinine in the blood is high relative to the amount in the urine. Creatinine clearance is a useful indicator of glomerular filtration rate (GFR), which is typically 90 to 120 mL/minute.

Clinical procedures X-ray examinations CT urography

KUB (kidneys, ureters and bladder) Renal angiography Retrograde pyelogram (RP) Voiding cystourethrogram (VCUG)

X-rays obtained using computed tomography (CT) show several cross-sectional and other views of the kidney. CT scanners show multiple views of the kidney, taken with or without contrast. Two main indications are the detection of kidney stones and the evaluation of patients with hematuria (Figure 7-13A). X-ray examination (without contrast medium) of the kidneys, ureters and bladder. A KUB study (pronounced k-u-be) shows the size and location of the kidneys in relation to other organs in the abdominal and pelvic region. It can also show kidney stones. X-ray examination (with contrast) of the blood vessels of the kidney. This procedure helps diagnose an obstruction or narrowing of blood vessels leading to the kidney. The same changes can be seen on CT and MRI urography. X-ray of the renal pelvis and ureters after injection of contrast medium through a urinary catheter into the ureters from the bladder. This technique is useful for locating urinary stones and obstructions. X-ray image (with contrast) of the urinary bladder and urethra taken while the patient is voiding. See Figure 7-13B. The bladder is filled with contrast medium, followed by fluoroscopy (real-time X-ray imaging). Contrast reflux into the ureters is abnormal and may occur in recurrent urinary tract infections.

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FIGURE 7-13 A, Contrast-enhanced CT urography (axial view) showing a benign cyst on the kidney. It doesn't pick up on the contrast and is smooth and round. B: Voiding cystourethrogram showing a normal female urethra. (Courtesy of William H. Bush, Jr., MD, University of Washington, Seattle.)

Ultrasound scan Ultrasound

Imaging of urinary tract structures using high-frequency sound waves. Kidney size, tumors, hydronephrosis, polycystic kidney disease, and ureteral and bladder obstruction can be diagnosed using ultrasound procedures.

Radioaktive Studie Radioisotopen-Scan

Image of the kidney after injecting a radioactive substance (radioisotope) into the bloodstream. Images show the size and shape of the kidney (kidney scan) and its function (renogram). These studies can show narrowing of the blood vessels, diagnose an obstruction, and determine the individual function of each kidney.

Magnetic resonance imaging MRI urography

The changing magnetic field creates images of the kidney and surrounding structures in three planes of the body. The patient lies in a cylindrical magnetic resonance machine and images of the pelvic and retroperitoneal region are taken with magnetic waves. The test shows tumor invasion of blood vessels, lymph nodes, and adjacent tissues.

Other procedures

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zystoscopes

Direct visualization of the urethra and urinary bladder with an endoscope (cystoscope). The procedure can be performed in two ways. Flexible cystoscopy uses a thin fiberoptic cystoscope and is used to diagnose and control the urinary bladder. Rigid cystoscopy uses a hollow metal tube that is passed through the urethra and into the bladder. It is used to take biopsy samples, remove polyps, or perform laser treatments. Both tests can be performed in the office or in the operating room. See Figure 7-14A and B. Dialysis The process of removing nitrogenous waste from the blood. Dialysis is used to treat acute or chronic kidney failure and some cases of drug use. There are two methods: 1. Hemodialysis (HD) uses an artificial kidney machine that takes waste blood from the patient's bloodstream, filters it through an artificial porous membrane (dialyzer), and returns the dialyzed blood to the patient's body (Figure 7- 15A). ). An arteriovenous fistula (connection between an artery and a vein) is surgically created, often in the patient's arm, to allow easy access for hemodialysis (Figure 7-15B). 2. Peritoneal dialysis (PD) uses a catheter to introduce fluid into the abdominal (peritoneal) cavity. Waste materials such as urea in the capillaries of the peritoneum pass from the bloodstream into the fluid. The fluid (with waste) is then removed through a catheter. When treating patients with chronic kidney disease, PD can be performed by the patient continuously without mechanical assistance (CAPD—continuous ambulatory PD; Figure 7-16) or with the help of a mechanical device used at night during sleep. Lithotripsy urinary tract stones are shattered. The extracorporeal method uses shock waves that are directed from the outside of the body onto the stone (extra = outside, corpor/o = body). The patient is given light sedation or an anesthetic. Stones pass from the body into the urine after the procedure. The acronym is ESWL (Extracorporeal Shock Wave Lithotripsy). renal Dilatation of narrowed areas in the renal arteries. Angioplasty A balloon attached to a catheter is inserted into the artery and then inflated to enlarge the vessel's diameter. Stents (metal mesh tubes) can then be inserted to keep the vessel open. This procedure is used to treat renal hypertension and to maintain kidney function. Kidney biopsy Removal of kidney tissue for microscopic examination. The biopsy can be performed at the time of surgery (open) or through the skin (percutaneous or closed). In the later technique, the patient lies prone; then, after local anesthesia of the overlying skin and muscles of the back, the doctor inserts a biopsy needle into the kidney. Multiple samples are obtained for examination by a pathologist. renal Surgical transfer of a kidney from a donor to a recipient. Transplantation Patients with kidney failure can receive a kidney from a living donor, such as an identical twin (isograft) or another person (allograft), or from a patient at the time of death (cadaveric transplant). The best results are achieved when the donor is closely related to the recipient - 98% of transplanted kidneys survive 1 year or more (Figure 7-17). See Personal: Kidney Transplant on page 228. Urinary Tract Passage of a flexible, tubular instrument through the urethra into the catheterized urinary bladder. Catheters are primarily used for short or long-term drainage of urine. A Foley catheter is an indwelling catheter (remaining in the bladder) held in place by a fluid-filled balloon (Figure 7-18).

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Figure 7-14 Cystoscopy. A: Rigid cystoscope in the urethra. B, Flexible cystoscope.

FIGURE 7-15 Hemodialysis (HD). A, patient receiving HD. Conventional HD involves 3 to 4 hours of dialysis three times a week. Newer alternative modalities include slower and longer dialysis, nocturnal HD, and daily short HD. B, Arteriovenous fistula for hemodialysis.

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FIGURE 7-16 Continuous ambulatory peritoneal dialysis (CAPD). A: The dialysis solution (dialysate) flows from a collapsible plastic bag through a catheter (Tenckhoff peritoneal catheter) into the patient's abdominal cavity. The empty pouch is then folded and inserted into underwear. B, After 4 to 8 hours, the bag is unfolded and the liquid is drained into it by gravity. The full bag is discarded and a new bag of fresh dialysate is attached.

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FIGURE 7.17 Kidney transplantation. A: The donor's left kidney will be removed for transplantation. B, Kidney is transplanted into recipient's right pelvis (iliac fossa). The renal artery and vein of the donor kidney are connected to the artery and vein of the recipient kidney, and the end of the donor ureter is connected to the recipient's bladder (ureteral neocystostomy). The donor's health is not affected by the loss of a kidney. In fact, the remaining kidney can take over full function.

Figure 7.18 Foley catheter in the urinary bladder. The three-way catheter has three separate lumens: for draining urine, for inflating balloons in the bladder, and for introducing irrigation solutions into the bladder.

abbreviations

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ADH AKI BUN CAPD CNE

Antidiuretic hormone - vasopressin acute kidney injury blood urea nitrogen continuous ambulatory peritoneal dialysis chronic kidney disease - a condition in which serum creatinine and BUN levels rise, which can lead to impairment of all body systems - chloride - an electrolyte secreted by the kidney becomes Cl CrCl Creatinine clearance CRF Chronic renal failure - progressive loss of kidney function; such as CKD C&S culture and susceptibility test – to determine antibiotic efficacy against bacteria cultured from a patient’s urine sample cysto-cystoscopic examination eGFR estimated glomerular filtration rate ESRD end-stage renal disease ESWL extracorporeal shock wave lithotripsy HCO3− bicarbonate – an electrolyte conserved by the kidney HD- hemodialysis IC interstitial cystitis – chronic inflammation of the bladder wall; not caused by bacterial infection and unresponsive to conventional antibiotic therapy IVP intravenous pyelogram + potassium - one electrolyte K KUB kidney, ureter and bladder + sodium - one electrolyte Na PD peritoneal dialysis pH potential hydrogen; Acid or base scale PKD polycystic kidney disease PUL percutaneous ultrasound lithotripsy RP retrograde pyelography sp gr specific gravity UA urinalysis UTI urinary tract infection VCUG voiding cystourethrogram

CNE stages

The five stages of chronic kidney disease reflect the increasing severity of kidney disease: Stage 1: eGFR > 90 Stage 2: eGFR 60-90 Stage 3: eGFR 30-60 Stage 4: eGFR 15-30 Stage 5: eGFR 100 bacilli (rods) leukocyte casts

NORMAL FINDINGS amber clear 1.003-1.030 6.5 (range 4.6-8.0) neg neg neg neg 0 0 none

What is the probable diagnosis? a. Diabetes mellitus with glycosuria b. Glomerulonephritis with staph infection c. Nephrotic syndrome with albuminuria d. Urinary tract infection with pyelonephritis

Personal kidney transplant

This first-person narrative was written by a kidney donor. When my 64-year-old father-in-law told my wife and I that his kidney function was going down, we didn't really think that either of us might end up doing something to help him survive. Five years later, dialysis was taking its toll on his organ systems and there had been no success in obtaining a cadaver kidney. Things had gotten to the point where he required a kidney on a short-term basis before his health deteriorated to the point where he was no longer a candidate for a transplant. My wife's blood type ruled out the possibility of a direct donor, so I volunteered to be tested. It turned out that her father and I were a couple

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on 5 of the 7 key features – a really good fit! The next round of tests - blood count and my kidney function - could be carried out on site. I remember lugging around a sample container (on ice) and having to deliver a full liter of urine in 24 hours! The results of those tests were favorable, and two weeks later I drove just under an hour to the University of Virginia transplant center in Charlo Esville. While a transplant is actually a team of two - donor and recipient - the entire process at UVA was highly individualized. A transplant coordinator (an experienced nurse) was assigned specifically to our case, and I had a team of doctors and support staff dedicated solely to me, the donor. There was also a team that only took care of my father-in-law as the recipient. My visit included some more thorough blood work and heart work, mainly to determine if I was healthy enough for major surgery. My transplant team and I spent an entire afternoon discussing the implications of being a donor—the risk associated with any surgery, the potential impact on me and my family, the likely recovery time, and the possibility that despite all the preliminary testing, the transplant may not be successful . The discussions that afternoon only confirmed to me that I made the right decision. I had the opportunity to positively impact someone else's life with relatively little risk to my own health. The events surrounding the operation itself were fairly straightforward. The surgery is a more involved procedure for the donor than for the recipient, so I was brought back first. A nurse put on an IV and injected a mild sedative. From that point on I only remember one last hug for my wife and children and then the transfer from the stretcher to the operating table. When I woke up in recovery the news was all good. My surgery went well—four laparoscopic incisions, through which the surgeons did most of their work, and a lateral incision in my lower abdomen, through which the kidney was removed. Equally important, my father-in-law recovered well from his surgery and the kidney started working right away! I was discharged from the hospital on Sunday and was able to return home the following Friday, 8 days after the operation. As is usual after major surgery, it took me about 6 weeks to feel “normal” again. During those 6 weeks I had weekly blood tests to document the progress of my kidney function. After the 6 week mark, I returned for a routine follow-up for UVA. I recovered as expected and my remaining kidney actually grew in size and capacity. Blood work continued monthly until I was officially "released" from treatment at the transplant center 6 months after surgery. Now, 8 years after the transplant, both my father-in-law and I continue to do well. As my mother-in-law likes to say, I donated a "Rockstar" kidney which has allowed our family to enjoy many visits and create many cherished memories that will last a lifetime. My two children, now 20 and 17, have enjoyed their grandfather's love and guidance during some very important years of their lives. This is especially important to me since I lost my father

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before my wife and I started our family and our children missed the opportunity to meet and love a wonderful man. John Melson lives in Greensboro, North Carolina. He is pictured with his father-in-law, Rod Beckwith.

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Exercises Remember to check your answers carefully against the answers to the Exercises, pages 234 and 235.

A Use the following terms to trace the path of urine from the renal arterioles (bloodstream) to the point where the urine leaves the body. The first answer is given. Glomerulus capsule Glomerulus Renal pelvis Renal tubule Ureter Urethra Bladder Orifice of the urethra 1. Glomerulus__________________________ 2. ____________________________________ 3. _____________________________ 4. ___________________________________ 5. ___________________________________ 6. ___________________________________ 7. ___________________________________ 8. ___________________________________ B Match the term in column I to its definition or a term of similar meaning Column II. Write the correct letters in the spaces provided.

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SPALTE I

_______ 1. Voiding _______ 2. Trine _______ 3. Renal cortex 4. Renal medulla _______ _______ 5. Urea 6. Erythropoietin _______ _______ 7. Renin _______ 8. Electrolyte _______ 9. Hilus _______ 10. Calyx

COLUMN II A. Hormone secreted by the kidney that stimulates red blood cell production B. Notch on the surface of the kidney where blood vessels and nerves enter C. Urination; voiding D. Nitrogenous waste E. Cup-shaped collecting region of renal pelvis F. Small molecule carrying an electric charge in solution G. Inner region of kidney H. Enzyme produced by kidney; increases blood pressure I. Triangular area in bladder J. Outer section of kidney

C Give the meaning of the following medical terms. 1. Calyx ________________________________________________ _______ 2. Uric acid ________________________________________________ ________________ 3. Urethral stenosis ________________________________________________ _____ 4. Cystocele ________________________________________________ _________________ 5. Pyelolithotomy ________________________________________________ ____________ 6. Trigonitis ________________________________________________ _________________ 7. Urethrostomy ________________________________________________ _________ 8. Urethrostenosis

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9. Vesicoureteral reflux ________________________________________________ _________ 10. Creatinine ________________________________________________ _________________ 11. Medullary ___________________________________ _________________ 12. Cortical ________________________________________________ ___________________ 13. Calciferol ________________________________________________ ___________________ D The following terms all contain the suffix -uria, meaning urination. Write their meaning in the spaces provided. 1. Nocturia ________________________________________________ _________________ 2. Dysuria ________________________________________________ ____________________ 3. Oliguria ________________________________________________ _________________ 4. Polyuria ________________________________________________ _________________ 5. Anuria ________________________________________________ _____________________

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E In the following terms, -uria means urinary condition (substance in urine). What's in the urine? 1. Pyuria __________________________ 2. Albuminuria ___________________ 3. Hematuria _________________ 4. Glycosuria _________________ 5. Ketonuria _____________________ 6. Bacteriuria _____________________ Q Provide the meaning of the following terms related to urinary signs and symptoms. 1. Azotemia ________________________________________________ ______________________ 2. Polydipsia ________________________________________________ ____________ 3. Urinary incontinence ________________________________________________ __ 4. Enuresis ________________________________________________ ___________ 5. Urinary retention ________________________________________________ _______ 6. Ketosis ________________________________________________ _______ G Provide brief answers to the following questions. 1. What is the difference between hematuria and uremia? ____________

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2. What is diuresis? _____________________________________ 3. What is a diuretic? _____________________________________ 4. What is antidiuretic hormone? ________________________________ 5. What is hyponatremia? _____________________________________ 6. What is hyperkalemia? ____________________________________ 7. What is PKU? _________________________________ H Match the given urinalysis terms to their following meanings/descriptions. Albuminuria Bilirubinuria Glycosuria Hematuria Ketonuria pH Pyuria Sediment Specific Gravity 1. Abnormal particles in urine - cells, bacteria, casts and crystals ____________________ 2. Smoky red color of urine caused by the presence of blood ____________ 3. Cloudy (cloudy) urine caused by the presence of polymorphonuclear leukocytes and pus _______________________ 4. Sugar in the urine; a sign of diabetes mellitus and a consequence of hyperglycaemia _______________________

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5. Urine test reflecting the acidity or alkalinity of the urine _______ 6. High levels of acids and acetones build up in the urine as a result of abnormal fat breakdown _______________________ 7. Dark pigments that build up in the urine as a result of liver or gallbladder disease _______________________ 8. Urine test reflecting the concentration of urine _________ 9. Leaking glomeruli can cause protein buildup in the urine _________________ I Describe the following abnormal conditions affecting the kidney. 1. renal failure _______________________ 2. polycystic kidney _______________________ 3. interstitial nephritis _______________________ 4. glomerulonephritis _______________________ 5. nephrolithiasis _______________________ 6. renal cell carcinoma _______________________ 7. pyelonephritis _______________________ 8. Wilms tumor _______________________ 9. nephrotic syndrome __________________________ 10. renal J hypertension _______________________ the terms listed follow with their meanings/descriptions. Abscess catheter Diabetes insipidus Diabetes mellitus Edema

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Essential hypertension Nephroptosis Renal colic Secondary hypertension Stricture 1. Idiopathic hypertension ________________________________ 2. Swelling, fluid in tissues ______________________________________ 3. Narrowing in a tube _________________________________ 4. Collection of pus __________________________________________ 5. Inadequate insulin secretion or improper use of insulin leading to this condition __________________________________________ 6. Hypertension due to a Kidney disease or other disease __________________________________________ 7. Tubing used for fluid collection or administration __________________________________________ 8. Inadequate secretion or renal resistance to the effects of antidiuretic hormone ____________________________________ 9. Kidney prolapse __________________________________________ 10. Severe pain from a stone blocking a ureter or kidney _____________________________ _______ K Give the m meanings of the abbreviations in column I. Then, in column II, choose the letter of the sentence that represents the best association in each case.

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SPALTE I 1. CAPD __________________________ 2. BUN __________________________ 3. RP __________________________ 4. Cysto ____________ 5. UA __________________________ 6. UTI ____________ 7. CKD ____________ 8. K+ ___________ 9. VCUG ____________ 10. HD __________________________

_______ _______ _______ _______ _______ _______ _______ _______ _______ _______

COLUMN II A. Bacterial invasion leads to this condition; acute cystitis is an example. B. This electrolyte is excreted by the renal tubules into the urine. C. A machine removes nitrogenous waste from the patient's blood. D. High concentrations measured by this test suggest kidney disease. E. This endoscopic procedure examines the inside of the urinary bladder. F. Dialysate (liquid) is injected into the abdominal cavity and then drained. G. Contrast is injected into the bladder and ureters, and X-rays of the urinary tract are taken. H. X-rays of the bladder and urethra are taken while the patient is urinating. I. Parts of this test include specific gravity, color, protein, glucose and pH. J. This condition includes mild to severe renal failure.

L Match the procedures listed to the following definitions/meanings. Cystectomy Cystoscopy Cystostomy Lithotripsy Nephrectomy Nephrolithotomy Nephrostomy Ureterolithotomy Urethroplasty Ureteroileostomy 1. Excision of a kidney ___________________________ 2. Surgical incision into the kidney to remove a stone _______________________ 3. Visual examination of the bladder with an endoscope _____________ 4. Destruction of stones _____________________________________

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5. Reopening the ureters to a segment of the ileum (instead of the bladder) __________________________ 6. Surgical repair of the urethra _______________________________________ 7. Creating an artificial opening into the kidney (via catheter) from outside the body __________________________ 8. Surgically creating an opening from the bladder to the outside of the body _________________________ 9. Removal of the urinary bladder _______________________________________ 10. Incision of a ureter to remove a stone ____________________________________ M Circle the correct word to complete the following sentences. 1. After being diagnosed with renal cell carcinoma (made by kidney biopsy), Dr. Davis Donna that (nephrostomy, meatotomy, nephrectomy) would be necessary. 2. Ever since Bill was diagnosed with gout, he was warned that uric acid crystals could build up in his blood and tissues, which could lead to (pyuria, kidney stones, cystocele). 3. Voiding cystourethrogram showed blockage of urine flow from Jim's bladder and (hydronephrosis, renal ischemia, azotemia). 4. Narrowed arterioles in the kidney increase blood pressure, so (urinary incontinence, urinary retention, nephrosclerosis) often accompanied by hypertension. 5. Eight-year-old Willy constantly wet his bed while he slept at night. His pediatrician directed his mother

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Limiting Willy's fluid intake in the evening to discourage his (nocturia, oliguria, enuresis). 6. David's chronic type 1 diabetes eventually led to (nephropathy, meatal stenosis, urolithiasis) resulting in kidney failure. 7. After Sue's bilateral kidney failure, her doctor recommended dialysis and possibly (cystostomy, nephrolithotomy, kidney transplant). 8. When Maria's left kidney stopped functioning, her contralateral kidney was overdeveloped or (metastatic, atrophied, hypertrophied) to accommodate the increased workload. 9. A popular diet program recommends eating foods high in fat and protein. People on this diet check their urine for the presence of (ketones, glucose, amino acids). 10. Andrea's urinalysis revealed proteinuria and her ankles began to swell, indicating Pi ing, a condition known as (ascites, edema, stricture). Her (gastroenterologist, urologist, nephrologist) diagnosed Andrea's condition as (polycystic kidneys, nephrotic syndrome, bladder carcinoma) and recommended medication to heal leaky glomeruli and diuretics to reduce swelling.

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Solutions to the tasks A 1. Glomerulus 2. Capsule of the glomerulus 3. Renal tubule 4. Renal pelvis 5. Ureter 6. Bladder 7. Urethra 8. Urethral opening B 1. C 2. I 3. J 4. G 5. D 6 A 7. H 8. F 9. B 10. E C 1. belonging to a calyx (collecting bowl of the renal pelvis).

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2. nitrogenous waste excreted in the urine; high levels of uric acid in the blood are associated with gouty arthritis 3. Narrowing of the urethra 4. Hernia of the urinary bladder 5. Incision to remove a stone from the renal pelvis 6. Inflammation of the trigone (triangular area in the bladder where the ureters enter and the urethra exits ) 7. new opening between the ureter and the ileum (an anastomosis); Urine then leaves the body through an ileostomy; this operation (ileal conduit) is performed when the bladder has been removed 8. Narrowing (narrowing) of the urethra 9. Backflow of urine from the bladder into the ureter 10. Nitrogenous waste produced by muscle metabolism and excreted into urine 11. pertaining to the inner, middle section (the kidney) 12. pertaining to the outer section (the kidney) 13. active form of vitamin D excreted by the kidneys D 1. frequent nighttime urination 2. painful urination 3 .little urination 4. excessive urination 5. no urination E 1. pus

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2. Protein 3. Blood 4. Sugar 5. Ketones or acetones 6. Bacteria F 1. Excess nitrogenous waste in the bloodstream 2. State of intense thirst 3. Inability to hold urine in the bladder 4. Bedwetting 5. Inability to release urine from the bladder 6. abnormal condition of ketone bodies (acids and acetones) in the blood and body tissues circulatory system. Hematuria is a symptomatic condition of the urine (-uria), and uremia is an abnormal condition of the blood (-emia). 2. Diuresis is the excessive production of urine (polyuria). 3. A diuretic is a drug or chemical (caffeine or alcohol) that causes diuresis. 4. Antidiuretic hormone is a hormone produced by the pituitary gland that normally helps the renal tubules reabsorb water into the bloodstream. It works against diuresis to keep water in the blood.

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5. Hyponatremia is an abnormally low level of sodium in the bloodstream. 6. Hyperkalemia is an abnormally high concentration of potassium in the blood. The main cause is chronic kidney failure. 7. PKU is phenylketonuria. This occurs when there are high levels of phenylketones in the urine and phenylalanine in the blood. The disease causes mental retardation in infants. H 1. Sediment 2. Hematuria (blood in the urine) 3. Pyuria (pus in the urine) 4. Glycosuria (sugar in the urine) 5. pH 6. Ketonuria (ketone bodies in the urine) 7. Bilirubinuria (high levels of bilirubin in the urine ) 8. Specific gravity 9. Albuminuria I 1. Kidney does not excrete waste products 2. Several fluid-filled sacs form in and around the kidney 3. Inflammation of the connective tissue between the renal tubules (interstitium) 4 .Inflammation of the glomerulus of the kidney (can be a complication after a streptococcal infection) 5.Condition of kidney stones (kidney stones)

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6. Malignant tumor of the kidney in adults 7. Inflammation of the renal pelvis and parenchyma of the kidney (caused by bacterial infection, e.g. Escherichia coli, spreading from the gastrointestinal tract to the urinary tract) 8. Malignant tumor of the kidney in children 9th group of symptoms (proteinuria, edema, hypoalbuminemia) that occur when the kidney is damaged by disease; also called nephrosis 10. High blood pressure due to kidney disease J 1. Essential hypertension 2. Edema 3. Stricture 4. Abscess 5. Diabetes mellitus 6. Secondary hypertension 7. Catheter 8. Diabetes insipidus 9. Nephroptosis 10. Renal colic K 1 . continuous ambulatory peritoneal dialysis: F 2. blood urea nitrogen: D 3. retrograde pyelogram: G 4. cystoscopy: E

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5. Urinalysis: I 6. Urinary Tract Infection: A 7. Chronic Kidney Disease: J 8. Potassium: B 9. Voiding Cystourethrogram: H 10. Hemodialysis: C L 1. Nephrectomy 2. Nephrolithotomy 3. Cystoscopy 4. Lithotripsy 5. Ureteroileostomy 6. Urethroplasty 7 Nephrostomy 8. Cystostomy 9. Cystectomy 10. Ureterolithotomy M 1. Nephrectomy 2. Kidney stones - do not confuse a calculus (stone) with tartar, which is a build-up of hardened dental plaque 3. Hydronephrosis 4. Nephrosclerosis 5 .Enuresis

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6. Nephropathy 7. Kidney Transplantation 8. Hypertrophy 9. Ketones 10. Edema, Nephrologist, Nephrotic Syndrome Answers to Practical Applications Urologic Case Report

1. c 2. c 3. a 4. b 5. a 6. b Urinanalysebefund

1. Glucose 2. Bilirubin 3. Color 4. Protein 5. Sediment 6. pH 7. Specific Gravity 8. Ketones 9. Appearance Urological case study

The correct diagnosis is d.

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pronunciation of terms

The terms you learned in this chapter are presented here with their pronunciations. You can find the meaning of all terms in the mini-dictionary starting on page 897. You can also listen to each term on the Evolve website (h p://evolve.elsevier.com/Chabner/language/).

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TERM Acetone Albuminuria Antidiuretic hormone Anuria Arteriole Azotemia Bacteriuria BUN Calciferol Calyx Calyx Calyx; Pl. calyces catheter cortex cortical creatinine creatinine clearance CT urography cystectomy cystitis cystoscopy cystostomy diabetes insipidus diabetes mellitus diuresis dysuria edema electrolyte enuresis erythropoietin essential hypertension filtration glomerular capsule glomerulonephritis glomerulus; Pl. Glomeruli Glycosuria Hematuria Hemodialysis Hilum Hydronephrosis Hyperkalemia Hypernatremia Interstitial nephritis Intravesical ketonuria Ketosis Kidney KUB Lithotripsy Meatal stenosis Meatus Medulla Medulla MRI Urography Nephrolithiasis

AUSKUNFT AS-eh-tohn al-bu-min-U-re-ah an-di-di-u-RET-ik HOR-mohn an-U-re-ah ar-TE-re-ohl az-o-TE -me-ah bak-te-re-U-re-ah B-U-N kal-SIF-er-ol ka-lih-SE-al ka-le-EK-tah-sis KA-liks; KA-lih-seez KATH-et-er KOR-text KOR-tik-al cre-AH-do-neen cre-AH-do-neen KLE-ranz CT u-ROG-rah-fe sis-TEK-zu-mir sis-TI-tis sis-TOS-ko-pe sis-TOS-zu-mir di-ah-BE-teez in-SIP-ih-dus di-ah-BE-teez MEL-ih-tus di-u-RE -sis dis-U-re-a eh-DE-mah eh-LEK-tro-lite en-u-RE-sis eh-rith-ro-PO-eh-tin e-SEN-shul hi-per-TEN- meide fil-TRA-meide glo-MER-u-lar KAP-sul glo-mer-u-lo-nef-RI-tis glo-MER-u-lus; glo-MER-u-li gli-kohs-U-re-ah hem-ah-TU-re-ah he-mo-di-AL-ih-sis HI-lum hi-dro-neh-FRO-sis hi- per-my-LE-me-ah hi-per-na-TRE-me-ah inter-STIH-shul neh-FRI-tis in-trah-VES-ih-go foot-to-NU-re-ah foot- TO-sis KID-ne K-U-B LITH-o-trip-sieh mich-A-Zahlenstein-O-sis me-A-tus meh-DU-lah MED-u-lah-re MRT u-ROG-raf- e neh- fro-lih-AT-THE-sis

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TERM Nephrolithotomie Nephronnephropathie Nephroptose Nephrostomie Nephrotisches Syndrom Stickstoffhaltiger Abfall Nykturie Oligurie paranephrisches Parenchym Peritonealdialyse Phenylketonurie Polyzystische Nierenerkrankung Polydipsie Polyurie Kaliumpyelolithotomie Nierenarterie Pyelonephritis Pyurie Reabsorption Nierenangiographie Nierenangioplastie Nierenarterie Nierensteine Nierenzellkarzinom Nierentransplantation Nierentubulus Nierenvene Renin Retrogrades Pyelogramm Sekundäre Hypertonie Natriumstriktur Trigone Trigonitis Harnstoff Urämie Ureter Ureteroileostomie Ureteroneozystostomie Ureteroplastik Harnröhre Harnröhrenstriktur urethritis urethroplasty uric acid urinalysis urinary bladder urinary catheterization

AUSKUNFT neh-fro-lih-THOT-o-me NEH-von neh-FROP-ah-the neh-FROP-zu-sis neh-FROS-zu-mir neh-FROT-ik sin-drome ni-TROJ-en- wir verschwenden nok-TU-re-ah ol-ig-U-re-ah par-ah-NEF-rik pah-RENK-ih-mah per-it-o-NE-al di-AL-ih-sis fe- nil-ke-to-NU-re-ah pol-e-SIS-tik KID-ne dih-ZEEZ pol-e-DIP-se-ah pol-e-U-re-ah po-TAS-e-um pi-el -o-lith-OT-o-me pi-el-o-neh-FRI-tis pi-U-re-ah re-ab-SORP-meiden RE-at an-je-OG-rah-fe RE-at RE of AN-je-o-plas RE of AR-teh-re RE of KAL-ku-li RE of sel kar-sih-NO-mah RE of KOL-ik RE of FA-lyur RE- . nal hi-per-TEN-meiden RE-nal is-KE-me-ah RE-nal PEL-vis RE-nal trans-plan-TA-meiden RE-nal TU-bule RE-nal Rebe RE-nin RET-ro -grad PI-el-o-gram SEK-on-dah-re hi-per-TEN-shun SO-de-um STRIK-shur TRI-gohn tri-go-NI-tis u-RE-ah u-RE- me-ah U-reh-ter u-re-ter-o-il-OS-zu-mir u-re-ter-o-ne-o-sis-TOS-zu-mir u-re-ter-o- PLAS-die u-RE-thrah u-RE-thral STRIK-shur u-re-THRI-tis u-re-thro-PLAS-die U-rik Säure u-rin-AL-ih-sis U-rin-ar -e BLAD-er U-rin-ar-e kath-et-er-ih-ZA-shun

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TERM urinary incontinence urinary retention urinary urgency vesicoureteral reflux voiding voiding cystourethrogram Wilms tumor

EXPRESSIONS U-rin-ar-e in-KON-tin-en U-rin-ar-e re-TEN-vermeidet u-rin-A-vermeidet ves-ik-o-u-RE-ter-al stehend VOY-ding sis -to-u-RE-thro-gramm wilmz TU-wall

evaluation sheet

Write the meaning of the combination forms, suffixes and prefixes in the spaces provided. Check your answers against the information in the chapter or Glossary (Medical Word Parts - English) at the end of this book.

Kombinierende Formen KOMBINIERENDE FORM Albumin/o Angi/o Azot/o Bakteri/o Cali/o Calic/o Cyst/o Dips/o Glomerul/o Glycos/o Hydr/o isch/o Kal/i Ket/o Keton/o Lith /Ö

MEANING OF COMBINATION FORM ____________________ Meat/o ____________________ Natr/o ______ Necr/o ____________________ Nephr/o ______ Noct/o ______ Olig/o ______ Py/o ______ Pyel/o ______ Ren/o ____________________ Trigon/o ______ Ur/o ____________________ Ureter/ o ____________________ Urethra/o ______ Urine/o ______ Bladder/o ____________________

Suffixe SUFFIX -ektasie -ektomie -ämie -esis -gram -lithiasis -lithotomie -lysis -megaly -ole -osis

SUFFIX -Pathie -Plastik -Poetin -Ptosis -Rrhoe -Sklerose -Stenose -Stoma -Tomie -Tripsie -Urie

prefixes

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PREFIX a-, anantidiadysen-

IMPORTANCE ____________________ ____________________ ____________________ ____________________ ____________________

PREFIX hypoperipolyretro-

IMPORTANCE ____________________ ____________________ ____________________ ____________________

Anatomical terms Match the locations/functions in column I to the structures of the urinary system in column II. Enter the number of the correct structure in the gaps provided. COLUMN I Tiny structure surrounding each glomerulus; obtains filtered materials from blood. Tubes that carry urine from the kidneys to the urinary bladder. Tubules arising from the glomerular capsule. This is where urine is formed when water, sugar and salts are reabsorbed into the bloodstream. Inner (middle) region of the kidney. Muscular sac that serves as a urine reservoir. Cup-like departments of the renal pelvis that receive urine from the renal tubules. Tube that carries urine from the bladder to the outside of the body. Central urine collection basin in the kidney that narrows into the ureter. Collection of capillaries through which materials from the blood are filtered into the glomerular capsule. Outer region of the kidney.

COLUMN II ______ 1. Urethra 2. Cortex ______ 3. Capsule of glomerulus ______ 4. Calyces 5. Renal pelvis ______ 6. ______ Glomerulus ______ 7. Medulla 8. Renal tubules ______ 9. Bladder ______ 10. Ureters

Give the medical terms for the following diseases related to urine or substances in urine. 1. Sugar in the urine _____________________________________________ 2. Protein in the urine _____________________________________________ 3. Painful urination _____________________________________________ 4. Scanty urination ________________________________ 5. Bacteria in the urine _____________________________________________ 6. Excessive urination _____________________________________________ 7. Blood in the urine _____________________________________________ 8. Ketones in the urine _____________________________________________ 9. Not urinating __________________________________________ 10. Pus in the urine __________________________________________ 11. Excessive nighttime urination ___________________________

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CHAPTER 8

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Female Reproductive System CHAPTER SECTIONS: Introduction 242 Organs of the Female Reproductive System 242 Menstruation and Pregnancy 246 Vocabulary 250 Terminology 252 Pathology: Gynecology, Breast, Pregnancy and Newborn 258 Clinical Tests and Procedures 266 Abbreviations 272 Practical Applications 273 Personal: Prophylactic Mastectomy 275 Exercises 276 Exercise Solutions 284 Pronunciation of terms 286 Review sheet 289

CHAPTER OBJECTIVES • Name and locate female reproductive organs and learn their combination forms. • Explain how these organs and their hormones work in the normal processes of ovulation, menstruation and pregnancy. • Identify abnormal conditions of the female reproductive system and the newborn.

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• Describe important laboratory tests and clinical procedures used in OB/GYN and recognize related acronyms. • Apply your new knowledge to understand medical terms in their proper context, such as: B. Medical reports and records.

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Introduction Sexual reproduction is the union of the egg cell (female gamete) and the sperm (male gamete). Each sex cell, known as a gamete, has half of the chromosomes needed to create a new organism. At fertilization, the nuclei of the two gametes fuse into a single nucleus containing half of the chromosomes and genetic code from each parent. Special organs called gonads in males and females produce the egg and sperm cells. The female gonads are the ovaries and the male gonads are the testicles. After an egg leaves the ovary during ovulation, it travels down one of two fallopian tubes that lead to the uterus (womb). When coitus (copulation, sexual intercourse) has occurred, millions of sperm cells migrate into the fallopian tubes, but only one sperm cell can enter the egg cell. This is fertilization. The fertilized egg is then called a zygote. After many cell divisions, a ball of cells forms and the zygote is called an embryo (2 to 8 weeks) and finally a fetus (8 to 38 or 40 weeks). The developmental phase within the uterus is gestation or gestation. The female reproductive system consists of organs that produce egg cells (singular; ovum) and provide a place for the growth of the embryo. In addition, the female sex organs supply important hormones that contribute to the formation of female secondary sex characteristics (body hair, breast development, structural changes in bones and fat). The eggs, or ova, are present in the female ovary from birth, but begin to mature and are released from the ovary on a 21- to 28-day cycle as secondary sex characteristics develop. The occurrence of the first cycle is called menarche. Menstrual cycles last until menopause, when all the eggs have been released, hormone production decreases, and menstruation ends. If fertilization occurs in the years between menarche and menopause, the fertilized egg can grow and develop in the uterus. A new, blood-vessel-rich organ called the placenta (connected to the embryo by the umbilical cord) develops to nourish the embryo, which implants in the lining of the uterus. Various hormones are secreted from the ovary and placenta to stimulate the expansion of the placenta. If fertilization does not occur, hormonal changes cause the lining of the uterus to shed, causing bleeding or menstruation. The ovarian hormones, estrogen and progesterone, play important roles in the processes of menstruation and pregnancy, as well as in the development of secondary sex characteristics. the pituitary,

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located at the base of the brain and secretes other hormones that control the reproductive functions of the ovaries, breasts, and uterus. Gynecology is the science of the female reproductive system (organs, hormones and diseases); Obstetrics (lat. obstetrix means midwife) is a specialty that deals with pregnancy and the birth of the fetus; and neonatology is the study of the care and treatment of the newborn.

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Organs of the Female Reproductive System Uterus, Ovaries, and Associated Organs Annotate Figures 8-1 and 8-3 as you read the following description of the female reproductive system.

Figure 8-1 Organs of the female reproductive system, lateral view.

Figure 8-1 shows a side view of the female reproductive organs and their relationship to other organs in the pelvic cavity. The ovaries [1] (only one ovary is shown in this side view) are a pair of small almond-shaped organs located in the pelvis. The fallopian tubes [2] (only one shown in this view) lead from each ovary to the uterus [3], a fibromuscular organ that lies between the bladder and rectum. The uterus is usually pear-sized and shaped, about 3 to 4 inches long in a non-pregnant woman. Midway between the uterus and rectum is a region in the abdominal cavity known as the cul-de-sac [4]. The vagina [5], a tubular structure, extends from the uterus to the outside of the body. Bartholin's glands [6] are two small, rounded glands on either side of the vaginal opening. These glands produce a

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mucous secretion that lubricates the vagina. The clitoris [7] is a sensitive erectile tissue organ located in front of the vaginal opening (orifice) and in front of the urethral opening. The area between the vaginal entrance and the anus is the perineum [8]. The woman's external genitalia are collectively referred to as the vulva. Figure 8.2 shows the various structures that are part of the vulva. The labia majora, the outer labia of the vagina, surround the smaller, inner labia, the labia minora. The hymen, a thin membrane that partially covers the entrance to the vagina, is torn apart during the first episode of intercourse. The clitoris and Bartholin's glands are also parts of the vulva.

Figure 8.2 External female genitalia (vulva). The mons pubis (lat. mons, mountain) is a tissue pad that lies over the pubic symphysis. After puberty, it is covered with pubic hair.

Figure 8.3 shows a front view of the female reproductive system. Each ovary [1] is held on either side of the uterus by a uteroovarian ligament [2].

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Figure 8.3 Organs of the female reproductive system, anterior view.

Inside each ovary are thousands of tiny sacs - the ovarian follicles [3]. Each follicle contains an oocyte [4]. During ovulation, an egg cell matures; its follicle breaks through the surface and releases the ovum from the ovary. A ruptured follicle fills with a yellow, fat-like material. It is then called corpus luteum [5], meaning yellow body. The corpus luteum secretes hormones (both estrogen and progesterone) that sustain the very early stages of pregnancy. A fallopian tube [6] is about an inch long and is located near each ovary. Together, the fallopian tubes, ovaries, and supporting ligaments are the adnexa (accessory structures) of the uterus. The finger-like ends of the fallopian tube are the fimbriae [7]. They catch the egg after its release from the ovary. Ciliary hairs (small hairs) line the fallopian tube and transport the egg cell towards the uterus through their movement. Normally, the egg takes about 2 to 3 days to pass through the fallopian tube. If sperm are present in the fallopian tube, fertilization can occur (Figure 8-4). If there are no sperm cells, the egg cell remains unfertilized and eventually disintegrates.

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FIGURE 8-4 Fertilization. A, Once a single sperm cell has entered the egg cell, others are prevented from entering. B, Electromicrograph showing a sperm cell penetrating an ovule.

The fallopian tubes, one on each side, open into the uterus [8], a pear-shaped organ with muscular walls and a mucous membrane richly filled with blood vessels. The rounded top of the uterus is the fundus, and the larger, central section is the corpus (body of the organ). The inner layer, a specialized epithelial lining of the uterus, is the endometrium [9]; the middle muscular layer of the uterine wall is the myometrium [10]; and the outer, membranous layer of tissue is the perimetrium (serosa of the uterus) [11], a lining that produces a watery, serum-like secretion. The outermost layer of an organ in the abdomen or chest is also known as the serosa. The narrow, lowest part of the uterus is the cervix [12] (Latin cervix means neck). The cervical opening leads into a 3 inch long muscular, mucous membrane-lined canal called the vagina [13], which opens to the outside of the body.

The label of the breast (accessory reproductive organ) Figure 8-5 as you read the following description of breast structures.

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Figure 8.5 Views of the chest. A, sagittal. B, frontal. Note the numerous lymph nodes.

The breasts, located in the upper front part of the chest, consist mainly of mammary glands. Glandular tissue [1] contains mammary glands, which develop in response to hormones from the ovaries during puberty. The breasts also contain fibrous and feline tissues [2], special milk ducts (milk-carrying) ducts [3], and sinuses (cavities) [4] that transport milk to the nipple, which has small openings for the milk ducts to release their milk. The nipple is the mammary papilla [5], and the darkly pigmented area around the mammary papilla is the areola [6]. During pregnancy, hormones from the ovaries and placenta stimulate the glandular and other tissues in the breast to develop fully. After childbirth (birth), hormones from the pituitary gland stimulate normal milk secretion (lactation).

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Menstruation and Pregnancy Menstrual Cycle (Figure 8-6) Menarche, or the onset of menstruation with the first menstrual cycle, occurs at the time of puberty. An average menstrual cycle is 28 days, but it can be shorter or longer, and cycles can be irregular in length. These days can be divided into four periods useful to describe the events of the cycle. The approximate periods are as follows:

Figure 8.6 The menstrual cycle. Tip: Don't try to remember this number. Just get an overview! In the ovary, hormone levels increase as the egg cell matures, culminating in ovulation (day 13 and 14). At the same time, the uterine lining builds up in the uterus in anticipation of pregnancy. If pregnancy does not occur, hormone levels drop and menstruation begins.

Day 1 to 5 (menstrual period) Secretion of bloody fluid containing broken down endometrial cells, glandular secretions and blood cells. Days 6 to 12 After the bleeding stops, the endometrium begins to repair itself. The maturing follicle in the ovary releases estrogen, which aids in repair. During this time, the egg cell grows in the follicle. Day 13 and 14 (Ovulation) Around day 14 of the cycle, the follicle ruptures and the egg cell leaves the ovary (ovulation) and passes through the fallopian tube.

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Day 15 to 28 The empty follicle that just released the egg becomes a corpus luteum (Latin for yellow body) because of its color. The corpus luteum acts as an endocrine organ that continues to produce estrogen and now secretes the hormone progesterone into the bloodstream. Progesterone stimulates the formation of the endometrium in anticipation of fertilization of the egg and pregnancy. If fertilization does not occur, the yellow body in the ovary stops producing progesterone and regresses. At this point, decreased progesterone and estrogen levels are likely responsible for some women's symptoms, such as depression, breast tenderness, and premenstrual irritability. The combination of these symptoms is known as premenstrual syndrome (PMS). After 2 days of hormone drop, the uterine lining breaks down and menstruation begins (1st to 5th day). Note: Cycles vary in length, ranging from 21 to 42 days or longer. Ovulation typically occurs 14 days before the end of the cycle. A woman with a 42-day cycle will ovulate on day 28, while a woman with a 21-day cycle will ovulate on day 7.

Pregnancy When fertilization occurs in the fallopian tube, the fertilized egg travels to the uterus and implants in the endometrium of the uterus. The corpus luteum in the ovary continues to produce progesterone and estrogen. These hormones support the vascular and glandular development of the uterine lining. The placenta, a vascular organ, forms on the wall of the uterus. The placenta originates from the maternal endometrium and from the chorion, the outermost membrane that surrounds the developing embryo. The amnion, the innermost of the embryonic membranes, holds the fetus in an amniotic cavity surrounded by a fluid called amniotic fluid. Also known as the "water sac" or amniotic sac, the amnion with its fluid that ruptures (bursts) during labor. Maternal blood and fetal blood never mix during pregnancy, but essential nutrients, oxygen, and waste are exchanged because the fetal blood vessels (coming from the umbilical cord) lie side-by-side with the mother's blood vessels in the placenta. Figure 8.7A and B show implantation in the uterus and the relationship of the embryo to the placenta and the covering membranes (chorion and amnion).

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Figure 8-7 A: Embryo implantation in the endometrium. B, the placenta, with chorionic and amniotic membranes.

As the placenta develops, it produces its own hormone, human chorionic gonadotropin (hCG). When women test their urine with a pregnancy test kit, the presence or absence of hCG confirms or rules out that they are pregnant. This hormone stimulates the corpus luteum to continue producing hormones until about the third month of pregnancy, when the placenta takes over endocrine function and releases estrogen and progesterone. Progesterone keeps the placenta developing. Low progesterone levels can lead to spontaneous miscarriage in pregnant women and menstrual irregularities in non-pregnant women. The uterus normally lies within the pelvis. During pregnancy, the uterus expands as the fetus grows, and the upper part rises from the pelvic cavity to become an abdominal organ. After about 28 to 30 weeks, it occupies a large part of the abdominal and pelvic cavities and reaches the epigastric region (Figure 8-8).

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Figure 8-8 The growing uterus changes the pelvic anatomy during pregnancy, as shown here in sagittal section: A, non-pregnant woman, B, 20 weeks gestation, C, 30 weeks gestation.

The onset of labor is characterized by rhythmic contractions, dilation and thinning (effacement) of the cervix, and a discharge of bloody mucus from the cervix and vagina (the "gagging"). In a normal delivery position, the baby's head appears first (head image). After the baby is born vaginally, the umbilical cord is cut and the placenta follows (Figure 8-9). Figure 8.10A and B show photos of a newborn and the placenta with a painful umbilical cord, minutes after birth. The expelled placenta is the afterbirth.

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FIGURE 8.9 A: Skull ('crowning') presentation of the fetus during delivery from the vaginal (birth) canal. B: Usually within 15 minutes after labor (birth), the placenta detaches from the uterine wall. Vigorous contractions expel the placenta and the membranes attached to it, now called the afterbirth. The three stages of labor are (1) dilatation of the cervix, (2) expulsion or delivery of the infant, and (3) delivery of the placenta.

Figure 8.10 A: My newborn granddaughter Beatrix Bess (Bebe) Thompson and her mother, Dr. Elizabeth Chabner Thompson, minutes after Bebe's birth. Note that Bebe's skin is covered with vernix caseosa, a mixture of a fatty secretion from fetal sebaceous glands (oil) and dead skin. The cheese smear protects the delicate skin of the fetus from abrasions, cracking and hardening as a result of bathing in amniotic fluid. B, The placenta and umbilical cord shortly after expulsion from the uterus.

Hormonal Interactions

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The events of menstruation and pregnancy depend not only on hormones from the ovaries (estrogen and progesterone), but also on the pituitary gland. The pituitary gland releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH) after menstruation begins. As levels in the blood rise, FSH and LH stimulate egg cell maturation and ovulation. The increase in LH levels is called an LH surge. This triggers ovulation and development of the corpus luteum. The surge can last for a few hours or days, and ovulation usually occurs 24 hours after it begins. Home ovulation kits track urinary LH levels. After ovulation, LH influences the maintenance of the corpus luteum and its production of estrogen and progesterone. During pregnancy, the high levels of estrogen and progesterone from the ovaries and placenta cause the pituitary gland to stop producing FSH and LH. Therefore, while a woman is pregnant, additional egg cells do not mature and ovulation cannot occur. Oral contraceptives (birth control pills) work in the same way. Another female birth control method is an IUD (intrauterine device). A healthcare professional inserts the IUD, a small device designed to remain in the uterus. It works by preventing embryo implantation. Birth control pills and an IUD will not protect a woman from sexually transmitted infections such as those caused by HIV. See page 274 for a table of contraceptives and their properties.

How do birth control pills work?

Birth control pills contain a combination of estrogen and progesterone or just progesterone. When taken as directed, they increase the levels of these hormones in the woman's bloodstream. High levels of estrogen and progesterone send a signal to the pituitary gland to stop its secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). When these hormones are blocked, the ovaries do not release eggs and pregnancy cannot occur. During pregnancy, estrogen and progesterone levels are also high - and even then, the ovaries don't release eggs! The birth control pill effectively tricks the body into "thinking" that the woman is pregnant and her ovaries are no longer producing eggs. When all the eggs are released and estrogen secretion from the ovaries decreases, menopause begins. Menopause signals the gradual end of the menstrual cycle. Premature menopause occurs before age 40, while delayed menopause occurs after age 55. artificial menopause

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occurs when the ovaries are surgically removed or rendered non-functional as a result of radiation therapy or some forms of chemotherapy. During menopause, when estrogen levels fall, the most common signs and symptoms are hot flashes (brain temperature regulation is disrupted), insomnia, and vaginal atrophy (vaginal lining dries out and thins, leaving the woman vulnerable to irritation and discomfort during menopause sexual intercourse). Hormone replacement therapy (HRT), given by mouth or as a transdermal patch or vaginal ring, relieves these symptoms of menopause and delays the development of weak bones (osteoporosis). Using HRT may be associated with an increased risk of breast cancer, cancer of the lining of the womb, stroke or heart attack. This therapy should only be used after careful consideration of the potential risks and benefits. Table 8-1 provides an overview of the different female hormones, including where they are produced, their target organs, and how they affect the body. TABLE 8-1 SITE(S) OF PRODUCTION OF FEMALE HORMONES FSH Pituitary LH Pituitary Estrogen Ovary Placenta (during pregnancy) Progesterone Ovary (corpus luteum) Placenta (during pregnancy) hCG Placental HORMON

TARGET ORGAN Ovary Ovary Uterus Uterus

ACTION Stimulates the maturation of the egg cell Stimulates ovulation Builds up the uterine lining Supports the uterine lining and the placenta during pregnancy

Ovary (corpus sustains pregnancy luteum)

FSH, follicle stimulating hormone; hCG, human chorionic gonadotropin; LH, luteinizing hormone.

vocabulary

The following list gives an overview of many of the new terms introduced in the text. Brief definitions reinforce your understanding of the terms.

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Adnexa Uterus Amnion Areola Bartholin's glands

Fallopian tubes, ovaries and supporting ligaments. Innermost membrane that surrounds the embryo and fetus. Darkly pigmented area around the nipple. Small mucus-secreting exocrine glands at the vaginal opening (opening to the outside of the body). Caspar Bartholin was a Danish anatomist who described the glands in 1637. Cervix Lower, neck-like part of the uterus. Chorion Outermost membrane surrounding the embryo and fetus; it forms the fetal portion of the placenta. Clitoris Organ Sensitive erectile tissue in front of the opening of the female urethra. coition sexual intercourse; Copulation. The pronunciation is KO-ih-tus. Corpus Empty ovarian follicle that secretes progesterone after the ovum is released; luteum literally means yellow (luteum) body (corpus). Dead end region in the lower abdomen, midway between the rectum and uterus. embryo stage in prenatal development from 2 to 8 weeks. Endometrium Inner lining of the uterus. estrogen hormone produced by the ovaries; promotes female secondary sex characteristics. fallopian tube One of two ducts through which the ovum travels to the uterus; also called fallopian tube. The tubes were named after Gabriello Fallopia, an Italian anatomist. Fertilization Union of sperm cell and egg cell from which the embryo develops. Fetus stage in prenatal development from 8th week to birth. Fimbriae Finger-like or fringe-like processes at the end of the fallopian tubes. (Singular: fimbria) folliclesSecreted by the pituitary gland to stimulate maturation of the stimulating egg cell (ovum). Hormone (FSH) Gamete Male or female sexual reproductive cell; sperm cell or egg cell. genitals reproductive organs; also called genitals. Pregnancy period from fertilization of the ovum to delivery; Pregnancy. gonad Female or male reproductive organ that produces sex cells and hormones; ovary or testicle. Gynecology The study of the female reproductive system, including the breasts. Human hormone produced by the placenta to maintain pregnancy by stimulating the ovaries (chorionic tropin) to produce estrogen and progesterone. Gonadotropin (hCG) Hymen Mucous membrane that partially or completely covers the opening to the vagina. labia lips of the vagina; Labia are the larger, outermost lips and labia minora are the smaller, innermost lips. Milk tubes that carry milk from the mammary glands to the nipple. Channels luteinizing Secreted by the pituitary gland to promote ovulation. hormone (LH) nipple. A papilla is a small nipple-shaped protrusion. Papillary menarche Beginning of the first menstrual period and fertility. Menopause Gradual cessation of menstruation.

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Menstruation Monthly detachment of the uterine lining. The flow of blood and tissue that is normally drained during menstruation is called menstruation (lat. mensis means month). Myometrium muscle layer of the uterus. Neonatology The study of the medical care of the newborn (newborn). Obstetrics Branch of medicine and surgery concerned with pregnancy and childbirth. Opening An opening. Ovary The developing sac that encloses each egg cell in the ovary. Only about 400 follicles of these sacs mature in a woman's lifetime. Ovary One of two female organs (gonads) on each side of the pelvis. Ovaries are almond-shaped, about the size of large walnuts, and produce ova (ova) and hormones. Ovulation Release of the ovum from the ovary. Oocyte (plural: mature oocyte (female gamete). Oocytes develop from immature oocytes oocytes) called oocytes. birth act of birth. perimetrium outermost layer of the uterus; uterine pink. Perineum In women, the area between the anus and vagina. Pituitary Endocrine gland at the base of the brain. It produces hormones that stimulate the ovaries. The pituitary gland also regulates other endocrine organs. Placenta vascular organ a sore on the uterine wall during pregnancy. It allows the exchange of oxygen, nutrients, and fetal waste products between mother and fetus. pregnancy pregnancy. Progesterone Hormone produced by the corpus luteum in the ovaries and placenta of pregnant women. Puberty Period of adolescent development when secondary sexual characteristics appear and gametes are produced. Uterus Hollow, pear-shaped, muscular female organ in which the embryo and fetus develop and from which menstruation occurs. The upper part is the fundus; the middle part is the body; and the lowest neck-like part is the cervix (see Figure 8.3, page 244). Vagina Muscular, mucous membrane-lined canal that extends from the uterus to the outside of the body. Vulva External female genitals; includes the labia, hymen, clitoris and vaginal opening. Zygote stage in prenatal development from fertilization and implantation up to 2 weeks.

Terminology

Write the meaning of the medical terms in the spaces provided.

combine shapes

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COMBINING MEANING FORM Amnion Bartholin

Bartholin gland

zervical/o chori/o, chorion/o colp/o culd/o

cervix, neck chorion

episi/o

Vulva

galact/it

Milch

gynecologist

woman, female

Hysteria

womb, uterus

paint/o

Milch

Mother

Breast

Mast/o

Breast

Vagina dead end

TERMINOLOGY

IMPORTANCE

Amniocentesis ___________________________________ Amniotic fluid ___________________________________ Produced by fetal membranes and the fetus. Bartholinitis ___________________________________ A Bartholin's cyst is a fluid-filled sac caused by the blockage of a duct in the Bartholin's gland. If a bacterial infection occurs, an abscess can form. Endocervicitis ___________________________________ Chorion ___________________________________ Colposcopy ___________________________________ Culdocentesis ___________________________________ For diagnosis, a needle is inserted through the posterior wall of the vagina and fluid is removed. Episiotomy ___________________________________ An incision through the perineum widens the vaginal opening for delivery. The incision is repaired by perineorrhaphy. Galactorrhea ___________________________________ Abnormal, persistent milk discharge, common with pituitary tumors. Gynecomastia ___________________________________ Breast augmentation in a man. It often occurs with puberty or old age, or the condition may be drug-related. Hysterectomy ___________________________________ In a total abdominal hysterectomy (TAH), the entire uterus (including the cervix) is removed through an abdominal incision (Figure 8-11). Vaginal hysterectomy (VH) is removal through the vagina. Laparoscopic supracervical hysterectomy (see Figure 8-11) is a partial hysterectomy that preserves the cervix. Hysteroscopy ___________________________________ A gynecologist uses an endoscope (passed through the vagina and cervix) to view the uterine cavity. Lactation ___________________________________ Normal milk secretion. inframammary ___________________________________ Infra - means below. Mammoplasty ___________________________________ Includes reduction and augmentation (enlargement) surgeries. Mastitis ___________________________________ Usually caused by a streptococcal or staph infection. Mastectomy _____________________ Mastectomy procedures are discussed under Breast Cancer (see page 262).

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COMBINING MEANING TERMINOLOGY MEANING FORM men/o menses, amenorrhea _________________________________ menses Absence of menses for 6 months or for more than three of the patient's normal menstrual cycles. Dysmenorrhea ___________________________________ Oligomenorrhea ___________________________________ Infrequent menstruation or scanty menstruation. Menorrhagia ___________________________________ Unusually heavy or long periods. Fibroids (see page 260) are a major cause of menorrhagia. Metr/o, uterine metrorrhagia ___________________________________ Metr/o bleeding between menses. Possible causes of metrorrhagia include ectopic pregnancy, cervical polyps, and ovarian and uterine tumors. Menometrorrhagia ___________________________________ Excessive uterine bleeding during and between menstrual periods. my/o, fibroid/o muscle, myometrium _____________________ Muscle myomectomy ___________________________________ Tumor Removal of fibroids (fibroids) from the uterus. nat/i Birth Newborn ___________________________________ Obstetrics Pregnancy Obstetrics _____________________ and From Latin obstetrix, midwife. Birth o/o Egg Oogenesis _____________________ Ovum ___________________________________ Immature ovum. oophor/o ovary oophorectomy ___________________________________ Oophor/o means to carry eggs (phor/o) (o/o). In a bilateral oophorectomy, both ovaries are removed. ov/o Egg Ovum ____________________________________ Mature Ovum. Ovary/o Ovary Ovary _________________________________ Ovum/o Ovum Anovulatory ___________________________________ Perineum/o Perineorrhaphy ___________________________________ Phor/o Oophoritis to wear ___________________________________ Salping/o Fallopian tube Salpingectomy ___________________________________ Fallopian tube Figure 8-12 shows a total hysterectomy with bilateral salpingo-oophorectomy (BSO). Uterus/Outerus Uterine Prolapse _____________________ Vagina/Vagina Vaginal Opening ___________________________________ An opening is an opening. Vaginitis _________________________________ Bacteria and yeast (usually Candida) commonly cause this infection. Using antibiotic therapy can result in the loss of normal vaginal bacteria, resulting in an environment in which yeast can grow. Vulv/o Vulva Vulvovaginitis _____________________ Vulvodynia ___________________________________ Chronic pain (with no apparent cause) affecting the vulva area (labia, clitoris, and vaginal opening).

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Figure 8.11 Normal uterus and hysterectomy. Total hysterectomy is the removal of the entire uterus - fundus, corpus and cervix. This can be done via an abdominal incision or vaginally. In laparoscopic supracervical hysterectomy, the top of the uterus (above the cervix) is removed, leaving the cervix intact. Three to five small incisions are made in the abdomen and the uterus is removed using a laparoscope. Robotic hysterectomy (da Vinci surgery) is another option with small incisions, three-dimensional vision, and a magnified view of the surgical site.

Fig. 8.12 Total hysterectomy with bilateral salpingo-oophorectomy.

Suffix

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SUFFIX MEANING TERMINOLOGY MEANING -arche beginning menarche ____________________________________ -cyesis pregnancy pseudocyesis _________________________________ pseudo- means wrong. There is no pregnancy, but physical changes such as weight gain and amenorrhea do occur. pregnant primigravida ________________________________ gravida A woman during her first pregnancy (primi- means first). Gravida is also used to denote a pregnant woman, often followed by a number indicating the number of pregnancies (Gravida 1, 2, 3). -parous giving birth ___________________________________ bring An adjective describing a woman who has given birth to at least a fourth child. Para is also used as a noun, often followed by a number to indicate the number of births after the 20th week of pregnancy (paragraph 1, paragraph 2, paragraph 3). When a woman arrives at the birthing facility, her pregnancy and parity are important facts to include in the medical and surgical history. For example, G2P2 is a medical abbreviation for a woman who had 2 pregnancies and 2 deliveries. -Rrheic discharge Leukorrhoea ___________________________________ This vaginal discharge is normal or becomes yellower (pusy or contains pus) as a sign of infection. Menorrhea ___________________________________ Fallopian Pyosalpinx ___________________________________ Salpinx (Uterine) Tube - Tocia Labor, Obstetric Dystocia ___________________________________ Oxytocia ___________________________________ Oxy- means sharp or rapid. The pituitary gland releases oxytocin, which causes the pregnant uterus to contract (onset of labor). It also stimulates milk secretion from the mammary glands. Head Act Version ___________________________________ Version Rotating The fetus rotates so that the head is the part of the body closest to the cervix (version can occur spontaneously or be performed by the obstetrician). Fetal presentation is the way the fetus appears to the examiner during birth. A rump presentation is bu ocks first or feet first in a bootie rump; a head-down presentation is upside down.

prefixes

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PREFIX MEANING TERMINOLOGY MEANING Dyspainful dyspareunia ____________________________________ (dis-pah-RU-ne-ah) Pareunia means sexual intercourse. Endwithin Endometritis ____________________________________ Usually caused by a bacterial infection. inin involution of the uterus ________________________________ Vol- means to roll. The uterus returns to its normal non-pregnant size. IUD ____________________________________ Figure 8-13A shows an IUD. multi- many multipara ____________________________________ multigravida ____________________________________ A woman who has been pregnant more than once. nullino, not, nulligravida ____________________________________ none nullipara ____________________________________ para 0. Figure 8.13B shows the cervix of a nulliparous woman and the cervix of a pregnant woman (who had a vaginal delivery). prevor prenatal ____________________________________ primi- primipara ____________________________________ retrobackward retroversion ____________________________________ The uterus is abnormally tilted backwards. This occurs in 30% of women.

Figure 8.13 A: Intrauterine device (IUD) in place to prevent implantation of a fertilized egg. B: The cervix of a nulliparous woman (the os or opening is small and perfectly round) and the cervix of a parous woman (the os is wide and irregular). These views would be visible on colposcopic examination.

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Pathology: Gynecological, breast, pregnancy and neonatal uterine cervical cancer (carcinoma of the cervix)

Malignant cells in the cervix. Human papillomaviruses (HPV) are the cause and risk factor for the development of cancer. Other factors that can work in concert with HPV to increase the risk of developing cervical cancer are cigarette smoking, multiple sexual partners, and a compromised immune system (e.g., patients with AIDS). The human papillomavirus is the most common sexually transmitted infection worldwide. In countries with high rates of HPV infection, cervical cancer can become the most common cancer in adult women. There are over 200 types of HPV. Some cause genital warts (benign growths on the vulva, cervix, vagina, or anus), while others can cause cancer, most commonly of the cervix, vagina, vulva, anus, penis, or head and tail. Most HPV infections are cleared by a person's immune system. Persistent infection can lead to precancerous changes called cervical intraepithelial neoplasia (CIN). See Figure 8-14 which shows the CIN history. CIN is also known as cervical dysplasia (abnormal cell growth). Carcinoma in situ (CIS) is considered an early, localized, precancerous form of cervical cancer, and local resection (conization) of CIS may be necessary to prevent the development of an invasive cancer. Figure 8-15 shows a normal cervix and one with cervical cancer. Surgical treatment for cervical cancer requires a radical hysterectomy, in which the entire uterus is removed, along with the ligaments, supporting tissues, and the top third of the vagina. Radiation therapy and chemotherapy with cisplatin are used to treat disease that has spread beyond the cervix to nearby pelvic tissues and distant organs. Brachytherapy (radioactive seeds implanted in the cervix) can also be an effective treatment.

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Figure 8.14 Precancerous neoplastic lesions are referred to as cervical intraepithelial neoplasia (CIN). Pathologists diagnose such lesions using a Pap test (microscopic examination of cells scraped from the cervical epithelium) and classify them as CIN-1 to CIN-3. Cervical carcinoma in situ (CIS) corresponds to CIN-3. These are precancerous lesions that have not yet penetrated the substance of the cervix.

Figure 8.15 Normal cervix (A) and cervix with cervical cancer (B) as seen on colposcopy.

HPV vaccine

HPV vaccines are given in a series of three shots over 6 months to protect women and men from HPV infection. Girls can get this vaccine to prevent cervical, vulvar, and vaginal cancers

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genital warts. Boys receive the vaccine to prevent anal cancer and genital warts. The names of these vaccines are Cervarix, Gardasil and Gardasil 9. Cervicitis

Endometrial carcinoma (carcinoma of the womb lining)

endometriosis

fibroids

inflammation of the cervix. Bacteria such as Chlamydia trachomatis and Neisseria gonorrhoeae commonly cause cervicitis. In acute cervicitis, the cervix is red and may have exudate (discharge) or even ulceration. After the presence of malignancy has been ruled out (by Pap test or biopsy), cryocautery (destruction of tissue by freezing) of the diseased area and treatment with antibiotics may be indicated. Malignant tumor of the womb lining (adenocarcinoma). The most common sign of endometrial cancer is postmenopausal bleeding. This malignancy is more common in women who are exposed to high levels of estrogen, either from estrogen replacement therapy, estrogen-producing tumors, or obesity (estrogen is produced by adipose tissue). To diagnose, doctors do endometrial biopsy, hysteroscopy, and dilation (widening of the cervical canal) and healing age (scraping of the inner lining of the uterus). If the cancer is confined to the uterus, surgery (hysterectomy and bilateral salpingo-oophorectomy) is curative. Radiation oncologists perform radiation therapy as an additional treatment. Endometrial tissue outside the uterus. In endometriosis, endometrial tissue can be found in the ovaries, fallopian tubes, supporting ligaments, or in the small intestine, leading to inflammation and scar tissue. When the endometrium sheds and bleeds in its monthly cycle, it can cause dysmenorrhea or pelvic pain. Infertility (inability to get pregnant) and dyspareunia can also occur. Most cases are the result of the growth of pieces of menstrual endometrium that have passed backwards through the lumen (opening) of the fallopian tube and into the abdominal cavity. If endometriosis affects the ovaries, large cysts form that are filled with menstrual blood (“chocolate cysts”). Symptoms may not correlate with the extent of endometriosis. Women may have widespread disease but no symptoms, while others may have minimal endometriosis but severe symptoms. Treatment ranges from symptomatic pain relief and hormonal drugs that suppress the menstrual cycle to surgical removal of ectopic endometrial tissue and hysterectomy. Benign tumors in the uterus. Fibroids, also called leiomyomas or leiomyomas (lei/o = smooth, my/o = muscle and -oma = tumor), consist of fibrous tissue and muscle. If fibroids grow and cause symptoms such as metrorrhagia (irregular periods), pelvic pain, or menorrhagia (heavy periods), either myomectomy or hysterectomy is indicated. Fibroid ablation (destruction) without surgery can be achieved through uterine artery embolization (UAE), in which tiny globules (which act as emboli) are injected into a uterine artery, blocking the blood supply to fibroids, causing them to shrink. Figure 8.16A and B show the location of uterine fibroids.

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Figure 8.16 A. Location of uterine fibroids (leiomyomas). Stalked growths protrude on stalks. A subserous mass lies under the serous (outermost) layer of the uterus. A submucosal leiomyoma grows under the (innermost) layer of mucosa. Intramural (wall means wall) masses arise within the muscular wall of the uterus. B: Fibroids after hysterectomy.

ovaries

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Ovarian carcinoma

ovarian cysts

Malignant tumor of the ovary (adenocarcinoma). About 22,000 women in the United States are diagnosed with ovarian cancer each year. Two types of ovarian cancer are most common: serous (clear fluid) and mucinous (thick, pasty fluid) cystadenocarcinomas. The tumor is usually discovered at an advanced stage as an abdominal mass and may cause few symptoms in its early stages. If the disease has spread beyond the ovaries before diagnosis, ascites (accumulation of fluid in the abdominal cavity) is common. Treatment consists of surgery to remove as much of the tumor as possible (tumor debulking). This may include hysterectomy, bilateral salpingo-oophorectomy, and removal of the omentum (fairy tissue covering abdominal organs and often containing tumor debris). Surgery is followed by systemic drug therapy, which depends on the type of ovarian cancer. A protein marker CA 125 produced by tumor cells can be measured in the bloodstream to assess the effectiveness of the treatment. Inherited mutations (changes) in genes greatly increase the risk of developing ovarian and breast cancer. These mutations are BRCA1 and BRCA2 (short for breast cancer 1 and breast cancer 2). Women with a strong family history of ovarian cancer (several affected family members) may seek genetic counseling to determine if they should be tested for these inherited defects. Prophylactic (preventive) oophorectomy significantly reduces the likelihood of developing ovarian cancer when a woman is at high risk. Fluid-filled sacs in the ovary. Some cysts are benign and lined with typical ovarian cells. These cysts arise in unruptured ovarian follicles (follicular cysts) or in ruptured follicles that were immediately closed (luteal cysts). Other cysts are malignant and lined with tumor cells (cystadenocarcinomas). Doctors decide to remove these cysts to differentiate between benign and malignant tumors. Other benign ovarian cysts are dermoid cysts. They contain a variety of cell types, including skin, hair, teeth and cartilage, and arise from immature egg cells in the ovary. Because of the strange composition of tissue types in the tumor (Figure 8-17), this tumor is often referred to as a benign cystic teratoma (terat/o = monster) or mature teratoma. Surgical removal of the cyst will cure the condition.

Figure 8.17 Ovarian dermoid cyst showing hair, skin and teeth. (Courtesy of Dr. Elizabeth Chabner Thompson.)

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fallopian tube pelvic inflammatory disease (PID)

inflammation and infection of organs in the pelvis and abdomen; Salpingitis, oophoritis, endometritis, endocervicitis. PID is caused by sexually transmitted infections. Repeated episodes of these infections lead to the formation of adhesions and scarring in the fallopian tubes. After PGD, women have an increased risk of ectopic pregnancy and infertility. Signs and symptoms include fever, vaginal discharge, abdominal pain in the left and right lower quadrants (LLQ and RLQ), and tenderness to palpation (examination by touch) of the cervix. Antibiotics treat PID.

Sexually Transmitted Infections (STIs)

Examples of bacterial and viral STIs in women include:

• Gonorrhea (gonococcal bacteria) • Chlamydia (chlamydia bacteria) • Syphilis (spirochete bacteria) • Genital herpes (herpes simplex virus - HSV) • HPV infection and genital warts (human papillomavirus) Learn more about STIs in women and Men see page 302 .

Breast

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breast cancer

Malignant tumor of the breast (arising from mammary glands and milk ducts). The most common type of breast cancer is invasive ductal carcinoma (IDC). Invasive means that the tumor has spread to the surrounding breast tissue. Figure 8.18A shows the tumor on a mammogram. Figure 8-18B shows a section through an invasive ductal carcinoma. Other histopathologic (histo- means tissue) types are lobular and medullary carcinomas of the breast. Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer. It starts in the milk ducts and does not spread beyond its original location (in situ). DCIS can increase the risk of developing invasive breast cancer and is treated with lumpectomy. Breast cancer first spreads to lymph nodes in the armpit closest to the affected breast, and then to the skin and chest wall. It can also metastasize from the lymph nodes to other body organs, including the bones, liver, lungs, and brain. Diagnosis is initially made by biopsy, either core needle aspiration or surgical removal of the specimen (solid mass or area of microcalcification). A stereotactic punch biopsy is performed with the help of mammography for orientation. In the case of small primary tumors, the lump can be removed with the immediately surrounding tissue (lumpectomy). A sentinel node biopsy (SNB) is done to determine if the tumor has spread to lymph nodes. In this procedure, a blue dye or radioisotope is injected into the tumor site and directed to the axillary (armpit) lymph nodes. See Figure 8-19. The lumpectomy is then followed by radiation therapy to the breast and all involved lymph nodes to kill any remaining tumor cells. An alternative surgical procedure is mastectomy (Figure 8.20A), in which the entire breast is removed. After a lumpectomy or mastectomy, if lymph nodes are involved, or if the primary tumor was large, adjuvant (supportive) chemotherapy is given to prevent the tumor from coming back. Breast reconstruction is an option after mastectomy. See Figure 8-20B. In patients with large primary tumors, neoadjuvant chemotherapy (additional before surgery) may be given to reduce tumor mass and allow complete surgical removal of the tumor. Further treatment may be indicated after surgery to prevent recurrence. To determine which treatment is best, it is important to test the breast cancer tumor for the presence of estrogen receptors (ERs). Two thirds of breast cancers are ER positive (ER+). These receptor proteins indicate that the tumor is responsive to therapy that blocks estrogen stimulation of estrogen. Should metastases later develop, this information is valuable for the selection of further treatment. There are two types of drugs that block the effects of estrogen, thereby killing ER-positive breast cancer cells. Drugs of the first type directly block ER reception. An example is tamoxifen. Drugs of the second type block the production of estrogen by inhibiting the aromatase enzyme. These aromatase inhibitors are particularly useful in treating postmenopausal women. Examples are anastrozole (Arimidex) and letrozole (Femara). A second receptor protein, HER2, is found in some breast cancers and signals a high risk of tumor recurrence. Herceptin, an antibody that binds to and blocks HER2, is effective at stopping growth when used with chemotherapy. A new drug, pertuzumab, also targets HER2 and is effective in combination with Herceptin in the treatment of HER2-positive advanced breast cancer. Triple-negative tumors lack estrogen, progesterone, and HER2, and grow rapidly but respond well to chemotherapy. Testing for BRCA1, BRCA2, and PALB2 inherited mutations (partners and localizers of BRCA1 and BRCA2) is recommended for women with a strong family history of breast cancer. Some women who test positive for the breast

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fibrocystic breast disease

Cancer genes choose a prophylactic (preventive) bilateral mastectomy with reconstruction to eliminate the risk of developing a new breast cancer. See story “Personal: Prophylactic Mastectomy” on page 275. Numerous small fluid sacs surrounded by dense fibrous tissue strands in breast. Women with this common benign condition notice a nodular (lumpy) breast consistency that is often associated with premenstrual tenderness and fullness. Mammography and surgical biopsy are often indicated to distinguish fibrocystic changes from breast cancer.

FIGURE 8-18 A, Mammogram arrows indicate invasive breast cancer. A dense white calcium fragment is seen at 2 o'clock in the bulk; Calcifications like these are often a sign of cancer. B, Section through an invasive ductal carcinoma of the breast.

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Figure 8-19 Sentinel node biopsy. After injection of the dye or radioisotope, its path is visualized and the sentinel (first) lymph node is identified. It is the one most likely to contain a tumor when cells have left the breast. The sentinel lymph node is removed and biopsied. If it is negative for tumor cells, the breast cancer has not spread.

Figure 8-20 A Surgical scar, mastectomy, right breast. A modified radical mastectomy removes the breast and axillary lymph nodes (usually 20 to 30 nodes). B, Reconstruction of the right breast after skin-sparing mastectomy. A gel silicone implant was used. A second operation manipulated local tissue to create the appearance of an areola complex. The procedure was completed by tattooing color around the nipple. In this patient, the right breast tissue was removed prophylactically and a silicone implant was inserted through an underbreast incision. (A, courtesy of Dr. Elizabeth Chabner Thompson.)

pregnancy

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Placental solution

Chorionic carcinoma

ectopic pregnancy

multiple pregnancies

previous placenta

Preeclampsia

Premature separation of the normally implanted placenta. Abruptio placentae (Latin ab, away from; ruptus, torn) occurs due to trauma, such as a fall, or may be secondary to vascular insufficiency due to hypertension or preeclampsia (see page 265). Signs and symptoms of acute withdrawal include sudden searing (burning) abdominal pain and bleeding. It is an obstetric emergency. Malignant tumor of the placenta. This extremely rare cancerous tumor comes from cells that were part of the placenta in a normal pregnancy. Treatment of metastatic choriocarcinoma may include chemotherapy and radiation therapy to distant sites of cancer. Implantation of the fertilized egg outside the uterus. The condition occurs in 1-2% of all pregnancies, and most of these occur in the fallopian tubes (ectopic pregnancy). Rupture of the ectopic implant in the fallopian tube can result in massive abdominal bleeding and death. Surgeons can remove the implant or destroy it with a drug treatment (methotrexate), which preserves the fallopian tube before it ruptures. Other locations of ectopic pregnancy are the ovaries and abdominal cavity; Regardless of location, an ectopic pregnancy often presents a surgical emergency. Presence of more than one embryo developing in the uterus during pregnancy. Multiple births are increasing in the United States. This is due to assisted reproductive technology (ART) such as ovulation induction followed by intrauterine insemination (IUI) or in vitro fertilization (IVF). These pregnancies are at higher risk for premature birth, fetal growth restriction, high blood pressure and diabetes. Implantation of the placenta over the cervical orifice or in the lower portion of the uterus (Figure 8-21). Maternal signs and symptoms include painless bleeding, bleeding, and preterm labor. A cesarean section is usually recommended. Abnormal condition associated with pregnancy characterized by hypertension, proteinuria, edema and headache. Mild preeclampsia can be managed with bed rest and close monitoring of blood pressure. Women with severe preeclampsia need to be treated with medications like magnesium sulfate to prevent seizures, and the baby is delivered as soon as possible. The Greek word eklampein means "to shine" and refers to the cramps and high blood pressure -- typically with visual symptoms of flashing lights -- that accompany the condition. Eclampsia is the final and most severe phase of untreated preeclampsia. It often causes seizures and even death of both mother and child.

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Placenta previa. Previa means before or before. Three forms of this abnormal implantation of the placenta are: placenta accreta (on the wall but not in the muscle), placenta increta (in the uterine muscle), and placenta percreta (attachment to another organ). FIGURE 8-21

Newborns The following terms describe conditions or symptoms that may affect the newborn. The Apgar score (Figure 8-22) is a system for assessing an infant's physical condition 1 minute and again 5 minutes after birth. Heart rate, respiration, color, muscle tone, and response to stimuli are each scored 0, 1, or 2. The maximum total is 10. Infants with Apgar scores below 7 require immediate medical attention such as airway suctioning or oxygen to aid breathing.

(Video) The Language of Medicine Chapter 3: Suffixes and Combining Forms

Apgar Score Chart. This test is named after Virginia Apgar (1909-1974), an anesthetist who developed it in 1953. dr Joseph Butterfield introduced the acronym "APGAR" in 1963 as a Memonic Device: Appearance (color), Pulse (heart). frequency), grimacing (reaction to catheter in nostril), activity (muscle tone) and respiration (breathing effort). FIGURE 8-22

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Down Syndrome Hemolytic Disease of the Newborn (HDN) Infant Respiratory Distress Syndrome (IRDS) Hydrocephalus

Meconiumaspirationssyndrome

Pylorusstenose

A chromosomal abnormality (trisomy 21) results in mental retardation, delayed growth, and a flat face with a short nose, low-set ears, and slanted eyes. Destruction of red blood cells in the newborn, caused by blood group (Rh factor) incompatibility between the mother and the fetus. See explanation in Chapter 4, page 115. Acute lung disease commonly seen in preterm infants. This condition is caused by a lack of surfactant, a protein necessary for proper lung function. Surfactant can be administered to the newborn to cure the condition. This condition was formerly known as hyaline membrane disease. Accumulation of fluid in the spaces of the brain. In an infant with this condition, the entire head can enlarge because the bones of the skull do not fully fuse together at birth. Infants usually have a soft spot, or fontanel, between the bones of the skull that allows for some swelling during the baby's birth. Hydrocephalus occurs due to a problem with the circulation of fluid in the brain and spinal cord, resulting in fluid buildup. Abnormal inhalation of meconium produced by a fetus or newborn. Meconium, a thick, sticky, greenish to black substance, is the first discharge from the intestine (stool) of newborns. Intrauterine stress can cause it to pass into the amniotic fluid. Once the meconium has passed into the surrounding amniotic fluid, the fetus can inhale meconium into its lungs. It can cause breathing problems due to inflammation in the baby's lungs after birth. Narrowing of the stomach opening to the duodenum. This condition can be present at birth and is commonly associated with Down syndrome. Surgical repair of the pyloric opening may be necessary.

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Clinical Tests and Procedures Clinical Tests Pap Test (Pap smear)

Microscopic examination of stained cells removed from the vagina and cervix. After inserting a vaginal speculum (an instrument used to hold the vaginal walls apart), the doctor uses a small spatula to remove exfoliated (flaking and shedding) cells from the cervix and vagina (Figure 8-23). Microscopic analysis of the cell smear detects cervical or vaginal cell abnormalities. Pregnancy Blood or urine test to detect hCG. test

FIGURE 8-23 Method of obtaining a sample for a Pap test. The test is 95% accurate in the early detection of cervical cancer. It was invented by and named after a Greek doctor, Georgios Papanicolaou.

Procedure X-ray examinations

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Hysterosalpingography (HSG) mammography

X-ray imaging of the uterus and fallopian tubes after contrast medium injection. This radiological procedure is used to assess fallopian tube patency (adequate opening) and abnormalities in the uterine cavity. X-ray of the chest. Women are advised to have a baseline mammogram between the ages of 40 and 44 for later comparison, if necessary. The newest method of mammography is digital tomosynthesis. See Figure 8-24. In this procedure, an X-ray tube moves in an arc around the breast while multiple images are taken. These images are sent to a computer, resulting in clear, highly focused three-dimensional images. This procedure makes it easier to find breast cancer in dense breast tissue; also called 3D mammography.

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Figure 8-24 A, mammography. The machine compresses the breast and x-rays (top down and side to side) are taken. B, Comparison of mammography and digital tomosynthesis images.

Ultrasound examination and magnetic resonance imaging (MRI)

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Ultrasound imaging of the breast and MRI of the breast

Ultrasound of the pelvis

Technologies that use sound waves and a magnetic field to create images of breast tissue. These imaging tests confirm the presence of a mass and can distinguish a cystic mass from a solid mass. MRI is very useful in detecting masses in young women with dense breasts or in women with a strong family history of breast cancer and who are at high risk for the disease. Ultrasound imaging of the breast is useful for evaluating a specific area of cancer on a mammogram. Capturing images of sound waves bouncing off organs in the pelvic area. This technique can evaluate the size and anatomy of the fetus, as well as the position of the fetus and placenta. Uterine tumors and other pelvic masses, including abscesses, are also diagnosed by ultrasound. Transvaginal ultrasound allows the radiologist to get a closer and sharper look at the organs in the pelvis. The probe is placed in the vagina instead of over the pelvis or abdomen; This method is best for evaluating fluid-filled cysts.

Gynecological Procedures

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Kauterisation

Colposcopy

Konisation

cryosurgical culdocentesis

Dilatation (Dilation) and Healing Age (D & C)

Exenteration fine needle aspiration laparoscopy

It is tube bound

Destruction of tissue by burning. Destruction of abnormal tissue with chemicals (silver nitrate) or an electrically heated instrument. Cauterization is used to treat cervical dysplasia or cervical erosion. The loop electrocautery excision (LEEP) procedure (see Figure 8.26A) is used for further evaluation and frequent treatment of abnormal cervical tissue. Visual examination of the vagina and cervix using a colposcope. A colposcope is a lighted magnifying instrument that resembles small, mounted binoculars. Gynecologists prefer colposcopy for examining the pelvis when cervical dysplasia is present because it identifies the specific areas of abnormal cells. A biopsy can then be taken for a more accurate diagnosis (Figure 8-25). Removal of a cone-shaped section (cone biopsy) of the cervix. The doctor resects the tissue with a LEEP (loop electrocautery excision procedure) or with a carbon dioxide laser or surgical knife (scalpel). Figure 8-26A shows the conization with LEEP, and Figure 8-26B shows the surgically removed cone biopsy specimen. Use of cold to destroy tissue. A liquid nitrogen probe generates the freezing temperature (cry/o means cold). Also called cryocautery. Needle aspiration of fluid from the cul-de-sac. The doctor inserts a needle through the vagina into the dead end. The presence of blood can indicate a ruptured ectopic pregnancy or a ruptured ovarian cyst. Dilation of the cervix and scraping of the uterine lining. Dilation is achieved by inserting a series of dilators of increasing diameter. A curette (metal loop at the end of a long, thin handle) is then used to remove the lining of the uterus. This procedure helps diagnose uterine disorders and can temporarily stop prolonged or heavy uterine bleeding. When needed, a D&C is used to remove the tissue during spontaneous or therapeutic abortion (Figure 8-27). Removal of internal organs in a cavity. Pelvic exenteration is the removal of the organs and adjacent structures of the pelvis. Removal of fluid or tissue from a cyst or solid mass by suction with a needle. FNA is a valuable diagnostic technique for evaluating breast lumps. Visual examination of the abdominal cavity with an endoscope (laparoscope). In this procedure, a form of minimally invasive surgery (MIS), small incisions (5 to 10 mm long) are made near the woman's navel to insert the laparoscope and other instruments. Applications of laparoscopy include examination and removal of ovaries and fallopian tubes, diagnosis and treatment of endometriosis, and removal of fibroids. Laparoscopy is also used to perform subtotal (cervix left in place) and total hysterectomies (Figure 8-28). Morcellation (cutting off uterine tissue in the abdomen) is commonly done when the uterus or fibroids are removed laparoscopically. It is contraindicated in suspected or precancerous situations. Blocking the fallopian tubes to prevent fertilization. This sterilization process (which renders a person incapable of reproduction) is performed using laparoscopy or through a hysteroscope inserted through the cervix (opening). ligature means

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Ligating and does not refer solely to the fallopian tubes, which can be "tied off" with clips or ties, or by surgically cutting or cauterizing the tissue.

Figure 8-25 Colposcopy is used to examine a patient with an abnormal Pap test result. For this examination, the woman lies in the dorsal lithotomy position. This is the same position used to remove a urinary tract stone (lithotomy means incision to remove a stone).

Figure 8-26 A Cervical loop electrocautery excision (LEEP) procedure for cone biopsy. B, Surgical removal of cone biopsy specimen. (A, courtesy of Dr. A. K. Goodman, Massachusetts General Hospital, Boston.)

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Figure 8.27 Dilatation and curettage (D&C) of the uterus. A: The uterine cavity is probed with a uterine tube (a slender instrument used to measure the depth of the uterus) to prevent perforation during dilation. B, Uterine dilators (Hanks or Hagar) of graduated sizes are used to gradually dilate the cervix. C: The uterus is gently curetted and the specimens removed.

Figure 8.28 Laparoscopic oophorectomy. A, Note the ovary in a plastic bag. The pouch was inserted through the laparoscope and then opened and the ovary was placed inside. B: Both are extracted through the laparoscope leaving the uterus and the cut end of the fallopian tube. (Courtesy of Dr. A. K. Goodman, Massachusetts General Hospital, Boston.)

Procedures related to pregnancy

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Abortion (AB)

Termination of pregnancy before the embryo or fetus can exist on its own. Abortions are spontaneous or induced. Spontaneous abortions, commonly referred to as "miscarriages," occur for no apparent reason. Induced abortions can be therapeutic or elective. A therapeutic abortion is performed when the health of the pregnant woman is at risk. At the request of the woman, an elective abortion is performed. The main methods of abortion include vaginal evacuation by D&C or vacuum aspiration (suction), and stimulation of uterine contractions by injection of saline (saline) solution into the amniotic cavity (for second trimester pregnancies). Amniocentesis Needle puncture of the amniotic sac to collect amniotic fluid for analysis (Figure 8.29). The cells of the fetus that are in the fluid are cultured (grown), and cytological and biochemical studies are performed to check fetal chromosomes, levels of proteins and bilirubin, and fetal maturation. Caesarean Section Surgical incision of the abdominal wall and uterus to deliver a fetus. Section Indications for a cesarean section are pelvic-to-head disproportion (the baby's head is too large for the mother's birth canal), premature placental abruption or placenta previa, fetal distress (fetal hypoxia), and breech or shoulder presentation. The name comes from a law in the time of Julius Caesar that required the removal of the fetus before a dead pregnant woman could be buried. Chorionic removal of placental tissue (chorionic villi) for prenatal diagnosis. Villi. The tissue sample is taken using a catheter that is inserted into the sampling uterus. The procedure can be performed earlier than amniocentesis (CVS) at 10 or more weeks gestation. Fetal Continuous recording of fetal heart rate and monitoring of maternal uterine contractions to assess fetal status and labor progress. in vitro Egg and sperm cells are brought together outside the body in a laboratory fertilization dish (in vitro) to facilitate fertilization. (IVF) After an incubation period of 3 to 5 days, the fertilized eggs are injected through the cervix into the uterus. (Latin in vitro means in glass, as used for laboratory containers.) 30% to 50% of all IVF procedures today are associated with intracytoplasmic sperm injection (ICSI). This is the direct injection of sperm into retrieved eggs.

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Figure 8.29 Amniocentesis. The obstetrician inserts a long needle through the pregnant woman's abdominal wall into the amniotic cavity. Needle placement (avoiding the fetus and placenta) is guided by simultaneous ultrasound imaging performed with the transducer in the radiologist's hand. The yellow amniotic fluid is drawn into the syringe attached to the needle. This operation took place in the 16th week of pregnancy. The indication for amniocentesis was a low alpha-fetoprotein (AFP) level. This finding indicated a higher risk of Down syndrome in the baby. Karyotype analysis (obtained 10 days later) showed a normal chromosome configuration.

abbreviations

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AB AFP

Abortion Alpha-Fetoprotein – High levels in fetal amniotic fluid or maternal serum indicate an increased risk of neurological birth defects in the infant. ART assisted reproductive technologies including IVF and sperm donation BRCA1 breast cancer 1 and 2 - genetic mutations associated with increased risk of BRCA2 breast cancer BSE breast self-examination CA-125 protein marker increased in ovarian cancer Caesarean section, cesarean section CS CIN cervical intraepithelial neoplasia CIS carcinoma in situ CVS chorionic villus sampling sampling Cx cervix D&C dilatation (dilation) and age of healing DCIS ductal carcinoma in situ; a precancerous breast lesion suggesting a higher risk of invasive ductal breast cancer DUB dysfunctional uterine bleeding FHR fetal heart rate FNA fine needle aspiration FSH follicle stimulating hormone G gravida (pregnant) GnRH gonadotropin releasing hormone – secreted by the hypothalamus to stimulate the release of FSH and LH from the pituitary GYN gynecology hCG or human chorionic gonadotropin HCG HDN hemolytic disease of the newborn HPV human papillomavirus HRT hormone replacement therapy HSG hysterosalpingography IUD intrauterine device; Contraceptives IDC Invasive Ductal Carcinoma IRDS Infant Respiratory Distress Syndrome IVF In Vitro Fertilization LEEP Loop Electrocautery Excision Procedure LH Luteinizing Hormone LMP Last Menses Multip Multipara; multiparous OB obstetrics Para 2-0-1- woman's reproductive history: 2 term infants, 0 preterm infants, 1 abortion, and 2 2 living children pap test test for cervical or vaginal cancer PID pelvic inflammatory disease PMS premenstrual syndrome primip primipara; primipare SLN sentinel lymph node biopsy - blue dye or a radioisotope (or both) identifies the biopsy or the first lymph node draining the lymphatics of the breast SNB TAH-BSO total abdominal hysterectomy with bilateral salpingo-oophorectomy UAE embolization of the uterine artery VH vaginal hysterectomy

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Practical Applications

This section contains an actual surgical report and brief excerpts from other medical records with words you have studied in this and previous chapters. Explanations of more difficult terms are given in brackets.

Surgical Report Preoperative Diagnosis: Menorrhagia, Leiomyomas Anesthesia: General Material Forwarded to Laboratory for Study: A. Endocervical Healings B. Endometrial Healings Surgery Performed: Dilation and Healing of the Uterus Patient's age in dorsal lithotomy position [legs are flexed at the thighs, thighs are flexed at the abdomen and abducted] and sterile dissected and draped, manual examination of the uterus revealed a size of 6 to 8 weeks, retroflexed; no adnexal masses noted. The anterior lip of the cervix was then grasped with a tenaculum [a hook-like surgical instrument used to grasp and hold parts]. The cervix was dilated to a #20 Hank dilator. The uterus was probed to a depth of 4 inches [depth measured]. A sharp healing age of the endocervix showed only a small amount of tissue. Using a sharp curette, the uterus was healed clockwise, noting an irregularity in the posterior floor. A large amount of endometrial tissue was removed. The patient tolerated the procedure well. Surgical diagnosis: leiomyomata uteri Recommendation: hysterectomy for myomectomy

Sentences of medical terminology 1. Mammography report: The breast parenchyma [essential tissue] is bilaterally symmetrical. There are no abnormal masses or calcifications in either breast. The armpits are normal. 2. This is a 43 year old Gravida 3 Para 2 with Premature Ovarian Failure and now on HRT. She has a history of endocervical atypia [cells are not normal or typical] as a result of a chlamydial infection, which is now being treated.

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3. The patient is a 40-year-old pregnant 3, para 2, who was admitted for an exploratory laparotomy to remove and evaluate a 10 cm left adnexal tumor. Discharge diagnosis: (1) endometriosis, left ovary; (2) Benign cystic teratoma [dermoid cyst], left ovary. 4th story: 51-year-old G3 P3; LMP early 40s; on HRT up to age 49 if diagnosed with breast cancer; treated with mastectomy and tamoxifen. Followed by ultrasound scans showing a slightly thickened 9-10 mm endometrium. no bleeding Surgical findings: official endometrial biopsy, little tissue Clinical diagnosis: exclusion of hyperplasia

Surgical plan The surgical plan for a day in a large general hospital listed six different gynecological procedures. Match the surgical procedures in column I to the surgical indications in column II. Write the indication text in the gaps provided. See page 286 for answers. COLUMN I 1. Left oophorectomy 2. Vaginal hysterectomy with colporrhaphy 3. TAH-BSO, pelvic and periaortic lymphadenectomy 4. Exploratory laparotomy for uterine myomectomy 5. Cervical conization 6. Lumpectomy with SLN biopsy

COLUMN II _______ A. LLQ pain; Pelvic ovarian tumor _______ Ultrasound _______ B. Fibroids C. Endometrial cancer _______ D. Small invasive ductal carcinoma of the breast E. Suspected cervical cancer _______ F. Uterine prolapse _______

Contraceptive options Look at and compare the different contraceptive methods available today.

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METHOD 1. Abstinence - no intercourse 2. Cervical cap - inserted by doctor or nurse 3. Condom - male 4. Condom - female 5. Diaphragm (with spermicide) 6. Foil and foam (with spermicide) 7. Implant - placed in upper arm; releases hormones; effective for 3 years 8. Injectable - Depo-Provera is given every 3 months 9. Intrauterine device (IUD) 10. Oral contraceptives (birth control pills) 11. Patch - applied to the skin weekly 12. Ring - inserted into the vagina; Effective for 1 month 13. Sponge - used by women who have never given birth 14. Suppository - inserted into vagina (with spermicide) 15. Withdrawal

UNINTENDED PREGNANCY RATES: TYPICAL USE / PERFECT USE 0% / 0% 16% / 9% 15% / 2% 21% / 5% 16% / 6% 29% / 18% 0.05% / 0.05% 3% / 3% less under 1% 8% / 3% 8% / 3% 8% / under 1% 16% / 9% 29% / 15% 27% / 4%

Personal prophylactic mastectomy

Each time May comes I think of my surgery and the decision I made many years ago to have prophylactic mastectomies. I grew up in a family of strong women. They were determined to work, play sports,

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and raising their families, except they all had breast cancer. It was a slap in the face for each of them and by the age of 36 I had 4 children, a wonderful career and husband and abnormal mammograms. I had friends, vacations, and biopsies, and as a doctor (radiation oncologist) and daughter of a medical oncologist, I worried about my own health. When my mother tested negative for the BRCA gene, it didn't ease my anxiety. It just intensified it. What caused breast cancer in my family? Genetic consultants explained that only about 15% of breast cancer cases are due to the BRCA genes; the rest is caused by other "faulty genes" or simply changes in breast cells. I heard about a new procedure that doctors were pioneering - direct-on-implant breast reconstruction after a mastectomy. One step and one operation would reduce my risk from 40% to almost 2% or 3%. I could keep my anatomy and get rid of these breast cells that could one day kill me. It had a lot to do with my family and my job. I didn't want breast cancer. So, after much research and discussion, I decided to have a prophylactic mastectomy with reconstruction. I was operated on on a Tuesday in the first week of May 2006. My mother was there when I woke up from the anesthetic and I've never seen her so relieved. My husband looked after the children, closed the car doors for me and mowed the lawn for a while. I haven't discussed my surgery, especially with the freedom Angelina Jolie had in 2013. In 2006 nobody had heard about my surgery; they couldn't even pronounce the name of it. But I was convinced that I could very well "dodge a bullet" by doing so. Nine years later, I smile when I talk morning TV about the “Angelina Effect”—implants and breast reconstruction, nipples and risk reduction, all in the same story. It's wonderful that women can talk about their "flawed parts" without shame. It's also a great example for our daughters. In March 2015, Angelina wrote another comment talking about her oophorectomy and salpingectomy (removal of both ovaries and both fallopian tubes) surgery. Not only do women with BRCA genes have an increased risk of breast cancer, they also have an increased risk of ovarian cancer. And that was the disease that took the life of Angelina's mother. In contrast to breast cancer, ovarian cancer is often diagnosed at a very late stage. The majority of breast cancers are diagnosed at stage 1 or 2 or even at a 'precancerous' stage of DCIS [ductal carcinoma in situ]. Ovarian cancer, on the other hand, is often diagnosed after the cancer has already spread. Angelina also discussed another "taboo" topic: the removal of the ovaries and fallopian tubes in a premenopausal woman (Angelina was 39 at the time

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time of her operation) sends her into early menopause. Hot flashes, skin changes, dryness (you know where) are difficult topics to discuss in public. She placed it front and center to destigmatize the issue for all women. There is no history of ovarian cancer in my family and we are BRCA negative, so my genetic counselor did not recommend removing my ovaries and fallopian tubes. Rather, I do a pelvic ultrasound and blood test (CA-125) once a year to make sure there's nothing abnormal. Because of my decision to have a prophylactic mastectomy, I know my life has changed for the better. I'm not afraid of breast cancer. I have also chosen to dedicate my life's work to helping women recover with comfort, dignity and grace after being overwhelmed by the disease. Angelina Jolie says knowledge is power! It is incumbent upon us to learn as much as we can to prevent disease and proactively take care of that fragile, precious commodity we call our health. Elizabeth Chabner Thompson is CEO/Founder of Masthead, a company dedicated to providing innovative products for breast cancer patients. She is a doctor, swimmer, cross-country skier and proud mother of four children between the ages of 16 and 21.

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Exercises Be sure to check your answers carefully against the Answers to the Exercises, page 284.

A Match the following structure or tissue terms to their meanings below. amnion areola cervix chorion clitoris endometrium fallopian tube fimbriae labia mammary papilla ovaries perineum placenta perimetrium vagina vulva

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4. Finger-like ends of the fallopian tube _____________________________________ 5. Ducts through which the ovum passes from the ovary to the uterus _____________________________________ 6. Organ of the sensitive erectile tissue in women; in front of the mouth of the urethra ____________________ 7. Nipple ____________________________________ 8. Vascular organ that hurts against the wall of the uterus during pregnancy ____________________ 9. Lower, neck-like part of the uterus ____________________ 10. Innermost membrane around the developing embryo _____________________ 11. Outermost layer of membranes around the developing embryo and part of the placenta _____________________________________ 12. outermost layer surrounding the uterus _____________________________________ 13. lips of the vulva _____________________________________ 14. female gonads; Production of ova and hormones _____________________________________ 15. Includes perineum, labia and clitoris and hymen; External genitalia _____________________ 16. Muscular, mucous membrane-lined canal that extends from the uterus to the exterior of the body ___________________________________

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B Identify the following terms. 1. Fetus ___________________________________________ 2. Milk ducts _____________________________________ 3. Germ cells _____________________________________ 4. Gondola _____________________________________ 5. Adnexa uteri _____________________________________ 6. Dead end _____________________________________ 7. Genitals _____________________________________ 8. Bartholin's glands _____________________________________ 9. Ovarian follicle ________________ 1. Ovarian follicle _____________________________ Match the listed terms to the following Descriptions/Definitions too. Coitus Estrogen Fertilization Follicle Stimulating Hormone Human Chorionic Gonadotropin Luteinizing Hormone Menarche Myometrium Prenatal

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Progesterone 1. Hormone produced by the ovaries; promotes female secondary sex characteristics____________ 2. Hormone secreted by the pituitary gland to stimulate maturation of the ovum (ovum)_______________________ 3. Sexual intercourse _____________________________________ 4. Before childbirth _____________________________________ 5. Start of first menstrual period _____________________________________ 6. Hormone produced by the placenta is used to maintain pregnancy by stimulating the ovaries to produce estrogen and progesterone _____________________________________ 7. Muscle layer of the uterus _____________________________________ 8. Hormone produced by the corpus luteum in the ovaries and placenta of a pregnant woman_______________________ 9. Hormone produced by the produced by the pituitary gland to promote ovulation ___________________________ 10. Union of sperm cell and egg cell, from which the embryo develops _______________________ D Complete the following sentences with definitions. 1. galact/o and lact/o both mean ______________________________.

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2. colp/o and vagin/o both mean ______________________________. 3. mamm/o and mast/o both mean _____________________________. 4. Metr/o, Uter/o and Hyster/o all mean ____________________. 5. oophor/o and ovari/o both mean _____________________________. 6. o/o, ov/o and ovul/o all mean ______________________________. 7. in- and endo- both mean ___________________________________. 8. -cyesis and -gravida both mean _____________________________. 9. salping/o and -salpinx both mean ___________________________. 10. episi/o and vulv/o both mean _____________________________. E Match the terms listed to the following meanings/descriptions. bilateral salpingo-oophorectomy cervicitis chorionic culdocentesis lactation neonatology obstetrics oxytocin total hysterectomy

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Vulvovaginitis 1. Examination of the newborn ______________________________ 2. Hormone that stimulates the pregnant uterus to contract ______________________________ 3. Secretion of milk ______________________________ 4. Removal of the entire uterus ______________________________ 5. Inflammation of the cervix ______________________________ 6. Branch of medicine dealing with pregnancy and childbirth ___________________________ 7. Outermost membrane surrounding the fetus ______________________________ 8. Removal of both fallopian tubes and both ovaries _____________ 9. Inflammation of the external female genitalia and vagina ______________ 10. Needle puncture to remove fluid from the sac ______________________________ F Give the meaning of the following signs and symptoms. 1. Amenorrhea _____________________________________________ ______________________ 2. Dysmenorrhea ______________________________________________ ______________________ 3. Leukorrhea _____________________________________________

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________________________ 4. metrorrhagia _____________________________________________ _______________________ 5. galactorrhea _____________________________________________ ________________________ 6. menorrhagia ________________________________________ ________________________ 7. pyosalpinx ________________________________________ ________________________ 8. dyspareunia _____________________________________________ ____________________ 9. menometrorrhagia _____________________________________________ ____________________ 10. oligomenorrhagia _____________________________________________ ______________ 10. oligomenorrhagia _____________________________________________ ______________ 10. oligomenorrhagia _____________________________________________ ______________ G Answer. 1. After a total (complete) hysterectomy, a woman still has regular menstrual bleeding. ________________________________________________ ________________ 2. After a total hysterectomy, a woman can still produce estrogen and progesterone.

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___________________________________________ 3. Birth control pills prevent pregnancy by keeping estrogen and progesterone levels high. ________________________________________________ _______________________ 4. After a total hysterectomy with bilateral salpingo-oophorectomy, a doctor may order hormone replacement therapy. ________________________________________________ ______ 5. Human papillomavirus can cause genital warts and ovarian cancer. ________________________________________________ _________________ 6. A Pap test can detect cervical dysplasia. _______________________________________ 7. Human chorionic gonadotropin is produced by the ovaries during pregnancy. ________________________________________________ ________________________ 8. Gynecomastia is a common condition in pregnant women. ________________________________________________ ________________________ 9. The treatment of endometriosis is myomectomy of the uterus. ____________________________________ ________________________ 10. A pregnant woman 3 par. 2 is a woman who has given birth three times.

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________________________________________________ _____________________ 11. A nulligravida is a woman who has had multiple pregnancies. ________________________________________________ ___________________________ 12. Pseudocyesis is the same condition as an ectopic pregnancy. ________________________________________________ __________________________ 13. Fibrocystic changes in the breast are a malignant condition. ________________________________________________ ________________________ 14. Cystadenomas occur in the ovaries. ________________________________________________ _____________________ 15. FSH and LH are ovarian hormones. ________________________________________________ ____________________ H Give the meaning of the following terms. 1. Birth _____________________________________________ __ 2. Menopause _____________________________________________ __ 3. Menarche _____________________________________________ __

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4. Ovulation _____________________________________________ __ 5. Pregnancy _____________________________________________ __ 6. Anovulatory _____________________________________________ __ 7. Dilation ______________ 8. Lactation ______________ 9. Nullipara ____________ 10. Oophoritis _____________________________________________ __ 11. Bartholinitis _____________________________________________ __ 12. Vulvodynia _____________________________________________ __ with the following meanings/descriptions. Abruptio placentae cervical cancer

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Cervicitis Cystadenocarcinoma Endometrial cancer Endometriosis Leiomyoma Multiple pregnancy Placenta previa Preeclampsia 1. Malignant tumor of the ovary ___________________________ 2. Inflammation in the lower, neck-like part of the uterus ___________________________ 3. Condition during pregnancy or shortly thereafter characterized by hypertension, proteinuria and edema ___________________________ 4. Uterine tissue outside the Uterus - for example in the ovaries, cul-de-sacs, fallopian tubes or the peritoneum ___________________________ 5. premature separation of a normally implanted placenta _____________ 6. placenta implantation over the cervical opening _____________ 7 .more than one fetus in the uterus ___________________________ 8. malignant condition of the lower part of the uterus ___________________________ 9. Malignant condition of the inner lining of the uterus ___________________________ 10. Benign muscle tumor in the uterus he _____________ _____________

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J For each of the following descriptions, list the appropriate test or procedure. 1. Burning of abnormal tissue with chemicals or an electrically heated instrument: ____________________________________ 2. Contrast medium is injected into the uterus and fallopian tubes and X-rays are taken: _____________________ 3. Cold is used to destroy tissue: ________________________________ 4. Visual examination of the vagina and cervix: ____________________________________ 5. Dilation of the cervical opening and scraping of the lining of the uterus: ____________________________________ 6. Removal of fluid or tissue from a cyst or solid mass by suction with a needle: ____________________________________ 7. Procedure of recording x-rays of the breast: ____________________________________ 8. Removal of a conical section of the cervix to diagnose or treat cervical dysplasia: _____________________________________ 9. Surgical puncture to remove fluid 10. Echoes of sound waves create an ima of structures in the pelvic area:____________________________________ 11. Occlusion of the fallopian tubes to prevent fertilization: ____________________________________

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12. Visual examination of the abdominal cavity with an endoscope:_________________________________ 13. hCG is measured in urine or blood: ____________________________________ 14. Cells are scraped from the cervix or vagina for microscopic analysis:____________________________________ 15. Removal of internal gynecological organs and adjacent structures in the pelvis :____________________________________ K Give medical terms for the following definitions. Pay attention to the spelling. 1. Benign muscle tumors in the uterus ____________________________________ 2. No menses _____________________________________ 3. Removal of an ovary _____________________________________ 4. Condition of the female breast (in a male) _____________________________________ 5. Ovarian hormone that maintains pregnancy _________________________________ 6. Nipple-shaped bump on the breast _________________________________ L Order Match the terms obstetrics and neonatal to the following descriptions. • Abortion • Apgar Score

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• Skull position • Caesarean section • Fetal monitoring • Fetal presentation • Fontanel • Infant respiratory distress syndrome • Hemolytic disease of the newborn • Hydrocephalus • In vitro fertilization • Meconium aspiration syndrome • Pyloric stenosis 1. Rotate the fetus so that the head is presented during labor _________________________________ 2. The soft spot between the skull bones of the newborn _______________________ 3. The assessment of the physical condition of the newborn __________________________ 4. Premature termination of pregnancy _____________________________________ 5. Removal of the fetus by abdominal incision of the uterus ___________________________ 6. Acute lung disease in the preterm newborn: surfactant deficiency ____________________ 7 Use of a machine to electronically record fetal heart rate during labor ________ 8. Narrowing of the opening of the stomach to the small intestine in the infant ___________ 9. Rh factor incompati bel relationship between mother and fetus ______________________________________

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10. Accumulation of fluid in the brain spaces of a newborn ___________ 11. The way the fetus appears to the examiner during birth _________ 12. Thick, sticky green-black substance is released into the amniotic fluid and causes fetal lung problems _________ 13. Union of Egg and sperm cell in a laboratory dish ___________________________________________ M Indicate the meaning of the abbreviations in column I. Then select the letter with the correct designation from column II. COLUMN I 1. CIS __________________________ 2. FSH __________________________ 3. D&C __________________________ 4. Multip ___________________ 5. Caesarean _________________ 6. IVF ___________________ 7. Cx ____________ 8. TAH-BSO ________________ 9. Primip ___________________ 10. OB ___________________

_______ _______ _______ _______ _______ _______ _______ _______ _______ _______

COLUMN II A. This woman gave birth to more than one child. B. Egg and sperm cells are brought together outside the body. C. This woman gave birth to a child for the first time. D. Secretion from the pituitary stimulates the ovaries. E. This procedure helps diagnose uterine diseases. F. Localized cancerous growth. G. Surgical procedure to remove the uterus, fallopian tubes and ovaries. H. Surgical delivery of an infant through an abdominal incision. I. Branch of medicine dealing with pregnancy and the birth of infants. J. Inferior cervical region of the uterus.

N Match the following abbreviations in column I with the best description in column II.

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SPALTE I 1. Pap-Test 2. HSG 3. AB 4. HPV 5. DCIS 6. HRT

_______ _______ _______ _______ _______ _______

COLUMN II A. Precancerous lesion in breast B. X-ray of uterus and fallopian tubes C. Hormones given to menopausal women D. Diagnosis of cervical and vaginal cancer E. Termination of pregnancy; spontaneous or induced F. Cause of cervical cancer

O Circle the term in parentheses that best completes the meaning of each sentence. 1. dr Hanson found it important to have an annual exam (culdocentesis, Pap test, amniocentesis) on each of her GYN patients to screen for abnormal cells. 2. When Doris missed her period, her doctor tested Doris's urine for (LH, IUD, hCG) to determine if she was pregnant. 3. Ellen was 34 weeks pregnant and had severe headaches and blurred vision, with a weight gain of 10 pounds in 2 days. dr Murphy told her to go to the obstetric emergency room for a suspected condition (pre-eclampsia, pelvic inflammatory disease, fibroids). 4. Sally, 52, noticed increasing pain, bloating and swelling in her abdomen. She had a history of ovarian cancer so her doctor recommended it (sentinel node biopsy, pelvic ultrasound, colposcopy). 5. Clara knew not to ignore her fever and yellow discharge and the pain in her side. She had treated previous episodes of (PMS, PGD, HRT) with IV antibiotics. She worried that she might relapse. 6. After years of trying to conceive, Jill decided to talk to her (hematologist,

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gynaecologist, urologist) via in vitro (pregnancy, childbirth, fertilization). 7. To retrieve her eggs, Jill's doctor prescribed hormones to stimulate egg maturation and (coitus, lactation, ovulation). The oocytes were surgically removed and fertilized with sperm cells in a Petri dish. 8. Next, several embryos were implanted in Jill's (fallopian tubes, vagina, uterus) and she received hormones to ensure the survival of at least one embryo. 9. IVF was successful and after (Abdominal CT, Ultrasound) Jill was told she would have twins in months. 10. Jill went into labor at 37 weeks. With continuous (chorionic villus sampling, culture puncture, fetal monitoring), two healthy infants were delivered vaginally. 11. At the age of 41, Carol had a screening (hysterosalpingogram, mammography, conization) of her breasts. Results showed tiny calcifications or calcifications behind her (areola, chorion, adnexa uteri). A core needle (laparoscopy, colposcopy, biopsy) was performed and revealed cells that were an early sign of cancer (CIN, DCIS, DUB). Her surgical oncologist recommended (lumpectomy, TAH-BSO, chorionic villus biopsy) removal of the calcifications and surrounding tissue as treatment.

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Answers to Exercise A 1. Endometrium 2. Perineum 3. Areola 4. Fimbriae 5. Fallopian tube 6. Clitoris 7. Mammary papilla 8. Placenta 9. Cervix 10. Amnion 11. Chorion 12. Perimetrium 13. Labia 14. Ovaries 15. Vulva 16. Vagina B 1. Embryo from the third month (at 8 weeks) to birth 2. Tubes that carry milk in the breast 3. Sex cells; the egg and sperm cells

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4. Organs (ovaries and testicles) in both males and females that produce gametes 5. Ovaries, fallopian tubes and supporting ligaments (accessory parts of the uterus (genitals) 8. Small exocrine glands at the entrance to the vagina that secrete a lubricating fluid 9. Developing sac in the ovary enclosing the ovum 10. empty follicle secreting progesterone after ovulation C 1. estrogen 2. follicle stimulating hormone 3. coitus 4 prenatal 5. menarche 6. human chorionic gonadotropin 7. myometrium 8. progesterone 9. luteinizing hormone 10. fertilization D

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1. milk 2. vagina 3. breast 4. uterus 5. ovary 6. egg 7. in, within 8. pregnancy 9. fallopian tube 10. vulva (external female genitalia) E 1. neonatology 2. oxytocin 3. lactation 4. total Hysterectomy 5. Cervicitis 6. Obstetrics 7. Chorion 8. Bilateral salpingo-oophorectomy 9. Vulvovaginitis 10. Kudocentesis F 1. No menstrual flow

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2. painful menstrual flow 3. white discharge (usually from the vagina and also associated with cervicitis) 4. bleeding from the uterus at irregular intervals 5. abnormal discharge of milk from the breasts 6. heavy or prolonged menstrual periods that occur at regular intervals 7 pus in the fallopian tubes (uterus) 8. painful intercourse 9. heavy bleeding during and between menstruation 10. weak menstrual flow G 1. Incorrect. Total hysterectomy involves removing the entire uterus to stop menstruation. 2. True. A total hysterectomy does not mean that the ovaries have been removed. 3. True. Birth control pills contain estrogen and progesterone; high levels prevent ovulation and pregnancy. 4. True. This may be necessary to treat symptoms of estrogen loss (vaginal atrophy, hot flashes) and to prevent bone loss (osteoporosis). 5. Wrong. HPV produces genital warts, but not ovarian cancer. In some cases, HPV infection can lead to cervical cancer.

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6. True. A Pap test can detect abnormal changes in the cervix ranging from cervical dysplasia to cervical intraepithelial neoplasia (CIN) and CIS (carcinoma in situ). 7. Wrong. The hormone hCG is produced by the placenta during pregnancy. 8. Wrong. Gynecomastia is a condition of increased breast development in men. 9. Wrong. Myomectomy is the removal of muscle tumors (fibroids). Endometriosis is an abnormal localization of uterine tissue outside the lining of the uterus. 10. Wrong. A pregnant woman 3 par. 2 is a woman who has had two children and three pregnancies. 11. Wrong. A zero gravida had no pregnancies. A multigravida has had many pregnancies. 12. Wrong. A pseudocyesis is a pseudocytic pregnancy (no pregnancy occurs) and an ectopic pregnancy is an example of an ectopic pregnancy (pregnancy occurs in the fallopian tube, not the uterus). 13. Wrong. Fibrocystic changes in the breast are a benign condition. 14. True. Cystadenomas are glandular sacs lined with tumor cells; they occur in the ovaries. 15. Wrong. FSH and LH are pituitary hormones. Estrogen and progesterone are secreted by the ovaries. H 1. Act of Birth

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2. Gradual cessation of menstrual function 3. Beginning of first menstrual period in puberty 4. Exit of ovum from ovary 5. Pregnancy 6. Concerning no ovulation (egg is not released from ovary) 7. dilation 8. natural milk secretion 9. a woman who has never given birth 10. inflammation of the ovaries 11. inflammation of the Bartholin glands 12. pain in the vulva I 1. cystadenocarcinoma 2. cervicitis 3. preeclampsia 4. endometriosis 5. abortion of the placenta 6. placenta previa 7. multiple pregnancies 8. cervical cancer 9. endometrial cancer 10. leiomyoma

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J 1. Cauterization 2. Hysterosalpingography 3. Cryosurgery or cryocauterization 4. Colposcopy 5. Dilatation (dilatation) and healing age 6. Fine needle aspiration 7. Mammography 8. Conization 9. Kudocentesis 10. Pelvic sonography 11. Tubal ligation 12. Laparoscopy 13 Pregnancy test 14. Pap- Test 15. Pelvic exenteration K 1. Fibroids or leiomyomas 2. Amenorrhea 3. Ovariectomy 4. Gynecomastia 5. Progesterone 6. Mammary papilla

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L 1. Head shape 2. Fontanelle 3. Apgar score 4. Abortion 5. Caesarean section 6. Infant respiratory distress syndrome 7. Fetal surveillance 8. Pyloric stenosis 9. Hemolytic disease of the newborn 10. Hydrocephalus 11. Fetal presentation 12. Meconium aspiration syndrome 13 .In vitro fertilization M 1. Carcinoma in situ: F 2. Follicle stimulating hormone: D 3. Dilatation (dilatation) and age of healing: E 4. Multipara: A 5. Caesarean section: H 6. In vitro fertilization: B 7. Cervix: J

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8. Total abdominal hysterectomy with bilateral salpingooophorectomy: G 9. First birth: C 10. Obstetrics: I N 1. D 2. B 3. E 4. F 5. A 6. CO 1. Pap test 2. hCG 3. Preeclampsia 4 pelvic ultrasound 5. PGD 6. gynecologist; fertilization 7. ovulation 8. uterus 9. ultrasound examination 10. fetal monitoring 11. mammography; areola; Biopsy; DCIS; wide excision

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Answers to practical applications operational plan

1. A 2. F 3. C 4. B 5. E 6. D Pronunciation of terms

vocabulary and terminology

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TERM adnexa uteri amenorrhea amniocentesis amnion amniotic ﬂuid anovulatory areola Bartholin glands bartholinitis cephalic version cervix chorion chorionic clitoris coitus colposcopy corpus luteum cul-de-sac culdocentesis dysmenorrhea dyspareunia dystocia embryo endocervicitis endometritis endometrium episiotomy estrogen fallopian tube fertilization fetal presentation fetus ﬁmbriae follicle-stimulating hormone galactorrhea Gametes Genitalia Pregnancy Gonads Gynecology Gynecomastia Human Chorionic Gonadotropin Hysterectomy Hysteroscopy Inframammary IUD Regression Labia Lactation Milk Ducts Leucorrhea

AUSKUNFT ad-NEK-sah U-ter-i a-aber-o-RE-ah am-ne-o-spät-TE-sis AM-ne-on am-ne-OT-ik FLU-id an-OV- u-lah-tor-e ah-re-O-lah BAR-tho-lin Drüse bar-tho-lih-NI-tis seh-FAL-ik VER-zhun SER-viks KOR-e-on chor-e-ON -ik KLIH-tor-ist KO-it-us col-POS-ko-pe KOR-pus LU-te-um KUL-deh-sak kul-do-late-TE-sis dis-men-o-RE-ah dis-pah-RU-ne-ah dis-TO-se-ah EM-bre-o en-do-ser-vih-SI-tis en-do-meh-TRI-tis en-do-ME-tre-um eh-pe-ze-OT-o-me ES-tro-jen fah-LO-pe-an toob fer-tih-lih-ZA-meiden FE-number pres-en-TA-meiden FE-tus FIM-bre- e FOL-lik-il STIM-u-la-thing HOR-mone gah-lak-to-RE-ah GAM-eet jeh-nih-TA-le-ah jes-TA-shun GO-nad gi-neh-KOL -o-je gi-neh-ko-MAS-te-ah HU-man ko-re-ON- ik go-nad-o-TRO-pin HI-men his-ter-EK-zu-mir his-ter- OS-ko-pe in-frah-MAM-ar-e in-trah-U-ter-in de-VISE in-vo-LU-shun LA-be-ah lak-TA-shun lak-TIH-fer-us Channels Kopf-on-there-RE

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TERM luteinizing hormone mammary papilla mammoplasty mastectomy mastitis menarche menometrorrhagia menopause menorrhagia menorrhoea menstruation metrorrhagia multigravida multipara myomectomy myometrium neonatal neonatology nulligravida nullipara obstetrics oligomenorrhea oocyte oogenesis oophorectomy ovarian follicle oocyte; Pl. Oocytes Oxytocia Oxytocin Birth Perimetrium Perineorrhaphy Perineum Pituitary Placenta Pregnancy Prenatal Primigravida Primipara Primiparous Progesterone Pseudocyesis Puberty Pyosalpinx Retroversion Salpingectomy Salpingitis

AUSSPRACHE LU-teh-Tag-Morning HOR-mone MAH-meh-re pah-PIL-ah MAH-mo-plas-te mah-STEK-zu-mir mah-STI-tis meh-NAR-Fuß meh-no-meh -tro-RA-jah MEN-o-pawz men-o-RA-jah men-o-RE-ah men-stru-A-shun met-ro-RA-jah mul-tih-GRAV-ih-dah mul- TIH-pah-rah mi-o-MEK-zu-mir mi-o-ME-tre-um ne-o-NA-tal ne-o-na-TOL-o-je nul-leh-GRAV-ih-dah nul-LIH-pah-rah ob-STET-riks ol-ig-o-men-o-RE-ah o-o-SITE o-o-JEN-eh-sis oo-fo-REK-to-me oo-fo-RI- tis OR-ih-fis o-VAH-re-an o-VAH-re-an FOL-ih-kil O-vah-re ov-u-LA-maiden O-vum; O-va ox-e-TO-se-ah ox-se-TO-sin par-tu-RIH-meiden peh-rih-ME-tre-um peh-rih-ne-OR-ah-fe peh-rih- NE-um pih-TU-ih-tah-re Drüse plah-SEN-tah PREG-nan-se pre-NA-tal prih-mih-GRAV-ih-dah prih-MIP-ah-rah prih-MIP-pah- russia pro-JES-teh-rone su-do-si-E-sis PU-ber-te pi-o-SAL-pinks re-tro-VER-zhun hall-pin-JEK-to-me hall-pin-JI -das

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DEFINITION uterine prolapse uterus vagina vaginal opening vaginitis vulva vulvodynia vulvovaginitis zygote

AUSSPRACHE U-teh-rin PRO-laps U-ter-us vah-JI-nah VAH-jih-nal OR-ih-fis vah-jih-NI-tis VUL-vah vul-vo-DIH-ne-ah vul- vo-vah-jih-NI-tis ZI-gote

Pathological Conditions, Clinical Tests and Procedures

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TERM Abortion Abruptio placentae Apgar score Breast cancer Carcinoma in situ Cauterization Caesarean section Cervical cancer Cervical dysplasia Cervicitis Choriocarcinoma Chorionic villus sampling Colposcopy Conization Cryosurgery Kudocentesis Dermoid cysts Dilatation Dilatation and healing Alter Down's syndrome Tubal pregnancy Endometrial carcinoma Endometriosis Exenteration Fetal surveillance Fibrocystic breast disease Fibroid fibroids Aspiration Hemolytic disease of the newborn vitro fertilization respiratory distress syndrome in infants laparoscopy leiomyomas mammography meconium aspiration syndrome multiple pregnancy ovarian cancer ovarian cysts palpation pap test pelvic inflammatory disease pelvic ultrasonography placenta previa preeclampsia pregnancy test pyloric stenosis tubal ligation

AUSKUNFT ah-BOR-shun ah-BRUP-se-o plah-SEN-ta AP-gar Partitur brest KAN-ser kar-sih-NO-mah in SI-tu kaw-ter-ih-ZA-shun seh-ZAH- re-an SEK-shun SER-vih-kul KAN-ser SER-vih-kul dis-PLA-ze-ah ser-vih-SI-tis ko-re-o-kar-sih-NO-mah ko-re- ON-ik WILL-us SAMP-ling call-POS-co-pe ko-nih-ZA-shun kri-o-SUR-jer-e kul-do-sen-TE-sis THERE-moyd sists dih-lah-TA -shun di-LA-shun & kur-eh-TAZH Down SIN-drohm ek-TOP-ik PREG-nan-see en-do-ME-drei-al CAN-see en-do-me-three-O-sis ex-en-teh-RA-maiden FE-Number MON-es-or-ing fi-bro-SIS-tik Brust dih-ZEEZ FI-broydz fein NE-dil as-pih-RA-maiden he-mo-LIH- tic dih-ZEEZ des mutter drills hi-dro-SEF-ah-lus his-ter-o-sal-ping-OG-rah-fe in VE-tro fer-til-ih-ZA-shun IN-fant RES -pih- rah-tor-e dis-TRES SIN-drohm lap-ah-ROS-ko-pe li-o-mi-O-maz mah-MOG-rah-fe meh-KO-ne-um as-pih- RA-meiden SIN-drohm MUL-tih-pel jes-TA-vermeiden o-VAH-re-an CAN-ser o-VAH-re-an sists pal-PA-vermeiden Pap-Test PEL-vik in-FLAM-mah- tor- e dih-ZEEZ PEL-vic-ul-trah-son-OG-rah-fe plah-sen- tah PREH-ve-ah pre-e-KLAMP-se-ah PREG-n an-se-Test pi-LOR-ik steh-NO-sis TOOB-al li-GA-vermeiden

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evaluation sheet

Write the meaning of the word parts in the spaces provided and test yourself. Check your answers against the information in the chapter or glossary (Medical Word Parts – English) at the end of the book.

Kombinierende Formen KOMBINIERENDE FORM amni/o bartholin/o cephal/o cervic/o chori/o, chorion/o colp/o culd/o episi/o galact/o gynec/o hyster/o lact/o mamm/o, mast/ o men/o metr/o, metri/o my/o, myom/o nat/i geburtshilflich/o olig/o o/o, ov/o, ovul/o oophor/o, ovari/o perine/o phor/o py/o salping/outer/o vagina/o vulv/o

prefixes

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PREFIX bidysendoinintramultinullioxyperipreprimipseudoretrouni-

Suffixe SUFFIX -arche -cyesis -dynia -ectomy -flexion -genesis -gravida -itis -pareunie -parous -plasia -plasty -rrhagia -rrhaphy -rrhea -salpinx -scopy -stenosis -stomy -tocia, -tocin -tomy -version

Diagnostic procedures Match the diagnostic procedures in column I to their descriptions in column II. Check your answers against the information in the chapter.

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COLUMN I 1. Fine needle aspiration 2. Colposcopy 3. Culdocentesis 4. Hysterosalpingography y 5. Mammography 6. Pap test 7. Pregnancy test 8. Pelvic ultrasonography

_______ _______ _______ _______ _______ _______ _______ _______

COLUMN II A. The uterus and fallopian tubes are imaged (X-ray procedure). B. hCG is measured. C. X-rays are taken of the chest. D. Procedure for Biopsy of Breast Tissue. E. Removal of cervical and vaginal cells for analysis. F. Fluid is collected from the region between the rectum and uterus. G. Images of the hip region are obtained using sound waves. H. Microscopic visual examination of the vagina and cervix.

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CHAPTER 9

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Male Reproductive System CHAPTER SECTIONS: Introduction 292 Anatomy 293 Vocabulary 295 Terminology 297 Pathological Conditions; Sexually Transmitted Diseases 299 Laboratory Tests and Clinical Procedures 304 Abbreviations 306 Practical Applications 307 Personal: Prostate Cancer 309 Exercises 310 Exercise Answers 316 Term Pronunciation 318 Summary Sheet 320

CHAPTER OBJECTIVES • Name, locate and describe the functions of the organs of the male reproductive system. • Define abnormal conditions and infectious diseases affecting the male reproductive system. • Distinguish between several types of sexually transmitted infections. • Define combination forms used to describe the structures of this system. • Describe various laboratory tests and clinical procedures relevant to male reproductive system disorders and recognize related acronyms.

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• Apply your new knowledge to understand medical terms in their proper context, such as: B. Medical reports and records.

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Introduction The male gamete, the spermatozoon (sperm cell), is microscopic—only a third the size of a red blood cell in volume and less than 1/100,000th the size of the female egg. A relatively uncomplicated cell, the sperm consists of a head region, which contains nuclear genetic material (chromosomes), and a tail region, which consists of a flagellum (hair-like extension). The flagellum makes the sperm motile and makes it look like a tadpole. The spermatozoon cell contains relatively little food and cytoplasm because it only lives long enough (3 to 5 days) to travel from where it is released by the male to where the ovum is located in the female reproductive tract (fallopian tube) is located. Just one of the approximately 300 million sperm cells released during a single ejaculation (expulsion of sperm and fluid from the male urethra) can enter a single egg and lead to fertilization of the egg. Figure 9-1 shows a diagram of a sperm cell and a photo of sperm.

FIGURE 9-1 A, sperm cell. B, photograph of spermatozoa.

If more than one egg goes down the fallopian tube when sperm are present, multiple fertilization is possible and twins, triplets, quadruplets, etc. can occur. Twins that result from the fertilization of separate egg cells by separate sperm cells are called dizygotic twins. Fraternal twins who develop with separate placentas may be of the same sex or opposite sexes, and no more resemble each other than ordinary brothers and sisters. Fraternal partnerships are hereditary; the daughters of twin mothers can carry the gene.

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Identical twins result from the fertilization of a single egg by a single sperm. When the fertilized egg cell divides and forms many cells, it somehow divides and each part is further divided separately, each producing an embryo. Division usually occurs between the third and fifth day of embryonic development. Most identical twins have one placenta and two amniotic sacs. Identical twins share the same DNA and are therefore of the same sex and very similar in shape and features. The organs of the male reproductive system are designed to produce and release billions of sperm throughout a man's lifetime, beginning at puberty. In addition, the male reproductive system secretes a hormone called testosterone. Testosterone is responsible for the production of male physical characteristics (such as beard, pubic hair and deeper voice) and for the proper development of the male gonads (testes) and accessory organs (prostate and seminal vesicles), which secrete fluids that provide lubrication and viability of the sperm.

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Anatomy Label Figure 9-2 as you study the following description of the anatomy of the male reproductive system.

Figure 9-2 Male reproductive system, sagittal view.

Each male gonad is a testicle [1]. There are two testicles (plural), or testes, which develop in the abdomen at about the level of the kidneys before descending into the scrotum during embryonic development [2], a sac that encloses the testicles on the outside of the body. The scrotum, located between the thighs, exposes the testicles to a lower temperature than the rest of the body. This lower temperature is necessary for sufficient maturation and development of the sperm (spermatogenesis). The perineum [3] is located between the anus and scrotum at the floor of the pelvic cavity in men and is analogous to the perineal region in women. The interior of a testicle is made up of a large mass of narrow, tortuous tubules called the seminiferous tubules [4]. These tubules contain cells that produce sperm. The seminiferous tubules are the parenchymal tissue of the testicle, which means that they do the essential work of the organ (sperm formation). other cells in the testicle,

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lying next to seminiferous tubules are interstitial cells. They produce an important male hormone, testosterone. All body organs contain parenchyma, which performs the essential functions of the organ. Organs also contain supporting, connective, and structural tissues, such as blood vessels, connective tissue, and sometimes muscles. This supporting tissue is called the stroma (stromal tissue). After formation, the sperm cells move through the seminiferous tubules and collect in ducts that lead to a large tube, the epididymis [5], in the upper part of each testicle. The sperm mature, become mobile in the epididymis and are temporarily stored there. An epididymis runs the length of each testicle (the coiled tube is about 16 feet long) and then twists back up and becomes a narrow, straight tube called the vas deferens [6] or ductus deferens. Figure 9.3 shows the internal structure of a testicle and the epididymis. The vas deferens is about 60 cm long and carries the sperm into the pelvic region at the level of the urinary bladder, where they merge with the ducts of the seminal vesicles [7] to form the ejaculatory duct [8], which leads to the urethra. During a vasectomy, or sterilization, the urologist cuts and ties off each vas deferens by making an incision in the scrotum.

Figure 9.3 Internal structure of a testis and epididymis.

The seminal vesicles, two glands (only one shown in Figure 9-2) located at the base of the bladder, empty into the ejaculatory duct as it opens into the urethra [9]. They secrete a thick, sugary, yellowish substance that nourishes the sperm cells and forms part of the ejaculated semen. seed,

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a combination of fluid (semen) and sperm (sperm cells make up less than 1% of semen volume) is excreted from the body through the urethra. In contrast to women, men connect the genital opening with the urethral opening. The prostate [10] is located where the vas deferens enters the urethra and almost surrounds the upper end of the urethra. It secretes a milky-white liquid that's a mixture of sugars, enzymes, and alkaline chemicals. As part of semen, this fluid is nutritious for sperm cells, and after ejaculation into the vagina, the alkaline chemicals help sperm survive in the acidic environment of the vagina. Muscle tissue of the prostate helps expel fluid during ejaculation. Bulbourethral glands [11], which lie beneath the prostate, also secrete fluid into the urethra during ejaculation. The urethra runs through the penis [12] to the outside of the body. The penis is made up of erectile tissue and expands at its tip to form a soft, sensitive region called the glans [13]. Normally, a fold of skin called the prepuce or foreskin [14] covers the glans. The foreskin is a painful glans in uncircumcised babies. Between the ages of 2 and 10, the foreskin naturally detaches and can be pulled back from the glans. When an infant is circumcised, the foreskin is removed leaving the glans visible at all times. Erectile dysfunction (impotence) is the adult male's inability to achieve an erection. Viagra (Sildenafil), Cialis (Tadalafil), and Stendra (Avanafil) are drugs that increase blood flow to the penis and improve erectile function. Male infertility is any problem in a man that reduces the chances of his partner conceiving. The flowchart in Figure 9.4 traces the sperm's journey from its formation in the seminiferous tubules of the testicles to the outside of the body.

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Figure 9.4 The passage of sperm from the seminiferous tubules in the testes to the outside of the body.

vocabulary

This list repeats new terms introduced in the text. Short definitions strengthen your understanding.

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bulbourethral pair of exocrine glands located near the male urethra. They secrete fluid into the urethral glands. Also called Cowper's glands. Circumcision Removal of the foreskin (prepuce). It is a common elective procedure performed shortly after birth. Ejaculation Ejection of sperm and fluid from the male urethra. Vas deferens, through which the semen enters the male urethra. Epididymal Duct One of two long, tightly coiled tubes above each testicle. It stores and (plural: transports sperm from seminiferous tubules to the vas deferens. epididymis) erectile inability of an adult male to achieve an erection; Impotence. Dysfunction Flagellum Hair-like protrusion on a sperm cell that makes it motile (able to move). foreskin fold of skin covering the glans; Foreskin. Fraternal Two infants resulting from the fertilization of two separate eggs by sperm from two separate twins (Figure 9-5). Glans penis Sensitive tip of the penis; comparable to the clitoris in women. identical Two babies born from the division of a fertilized egg cell. Conjoined twins are incompletely separated identical twins. Infertility In a man, any problem that reduces the likelihood of his partner conceiving. interstitial specialized cells that lie adjacent to the seminiferous tubules in the testicles. Cells of the These cells produce testosterone and are also known as Leydig cells. Testicular parenchyma Essential characteristic cells of an organ. In the testicle, the seminiferous tubules that produce sperm are parenchymal. Penis Male external reproductive organ. Perineum The outer area between the anus and scrotum in men. Foreskin; Foreskin; Fold of skin covering the tip of the penis. Prostate Exocrine gland at the base of the male urinary bladder. The prostate secretes fluid that contributes to semen during ejaculation. TIP: Don't confuse prostate with prostate, which means lying down. Scrotum Outer sac that contains the testicles. Sperm Spermatozoa (sperm cells) and seminal fluid (prostate and seminal vesicle secretions) that exit the urethra during ejaculation. seminal Paired sac-like exocrine glands that secrete fluid (a major component of the seminal vesicles) into the vas deferens. seminiferous Narrow, tortuous tubules that produce sperm in the testicles. tubules spermatozoon sperm cell. (plural: spermatozoa) Sterilization Procedure that takes away a person's ability to produce or release reproductive cells; Testicular removal, vasectomy, and oophorectomy are sterilization procedures. Stromal tissue Supporting connective tissue of an organ as distinguished from its parenchyma. Also called stroma. Testicles (plural: male gonads (testicles), which produce spermatozoa and testosterone. Remember: testicles) Testis means one testicle, and testicles are two testicles. testosterone hormone secreted by the interstitial tissues of the testicles; responsible for male sexual characteristics. Vas deferens Small tubes (one on each side) that transport sperm from the epididymis to the urethra. Also called ductus deferens.

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Figure 9.5 Fraternal twins. A, Note the 6 week old embryos in two separate amniotic sacs. B, twins Marcos and Matheus Do Carmo are 16 years old. (Courtesy of Juliana Do Carmo.)

Damm/Peritoneum

Don't confuse the perineum, which is the area between the anus and scrotum in men and the anus and vagina in women, with the peritoneum, the membrane that surrounds the abdominal cavity!

Sperma/Sperma

Don't confuse semen with semen. Sperm is the thick, whitish secretion that is expelled from the urethra during ejaculation. Sperm (spermatozoa) are cells that develop in the testicles. Sperm contains sperm.

Sterilization/Impotence

Do not confuse sterilization, which can be performed on both men and women, with impotence, which is a man's inability to maintain an erection or achieve ejaculation.

Terminology

Write the meaning of the medical terms in the spaces provided.

combine shapes

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COMBINING MEANING FORM andr/o male balan/o

cry/o

Acorn (Greek balanos, means acorn) cold

Krypta/o

hidden

Nebenhoden/o

epididymis

gon/o

seed (Greek gone, seed) water, liquid

hydr/o orch/o, orchi/o, orchid/o

testicles, testicles

pretty much

Penis

Prostate

Prostatic hyperplasia

halb/i

Together, Together

Sperma/o, Spermat/o

Spermatozoen, Together

output

Monsters (Greek Terraces, Monsters)

test/o

testicles, testicles

TERMINOLOGY

IMPORTANCE

Androgen _______________________________________ Testosterone is an androgen. The testicles in men and the adrenal glands in both men and women produce androgens. Balanitis ________________________________________ Inflammation usually caused by overgrowth of organisms (bacteria and yeast) (Figure 9-6A). Cryosurgery _________________________________ Technique used to treat prostate cancer that uses freezing temperatures to destroy cancer cells. Cryptorchidism ___________________________________ In this congenital condition, one or both testes do not descend from the abdominal cavity into the scrotum at the time of birth (Figure 9-6B). Epididymitis _____________________________________ This is an inflammation usually caused by bacteria. Signs and symptoms include fever, chills, groin pain, and tender, swollen epididymis. Gonorrhea _______________________________________ See page 302. Hydrocele _______________________________________ See page 300. Orchiectomy _______________________________________ Castration in males. (Also called orchitis.) Orchitis ___________________________ Caused by injury or by the mumps virus, which also infects the salivary glands. penile _____________________________ -ile means relating to. Penoscrotal _____________________________________ Prostatitis ______________________________________ Bacterial (E. coli) prostatitis is often associated with urethritis and lower urinary tract infections. Prostatectomy ___________________________________ Robotic-assisted laparoscopic prostatectomy (RALP) is a treatment option for removing the prostate. Tubules ______________________________ The suffix -ferous means to carry, or to carry, or to carry. spermolytic _____________________________________ noun suffixes ending in -sis, such as B. -lysis, form adjectives by dropping the -sis and adding -tic. Oligospermia ____________________________________ Aspermia _______________________________________ Lack of semen (semen and fluid). One cause of aspermia is retrograde ejaculation (semen flows backwards into the bladder) as a result of prostate surgery. Teratoma _______________________________________ This tumor occurs in the testicles or ovaries and is made up of different types of tissue such as bone, hair, cartilage and skin cells. Teratomas in the testicles are malignant. Testicles _______________________________________ The term testicles comes from Latin and means witness. In ancient times, men would take an oath with one hand on their testicles, swearing by their manhood to tell the truth.

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COMBINING MEANING FORM varic/o varicose veins

Glas

vessel, pipe; vas deferens

Zoo

animal life

TERMINOLOGY

IMPORTANCE

Varicocele ________________________ Collection of varicose veins (swollen, twisted) over the testicles. See page 300. Vasectomy ______________________________________ See page 306. Remember: In this term, vas/o refers to the vas deferens and not to any other vessel or duct. Azoospermia __________________________ Deficiency of sperm in the semen. Causes include testicular dysfunction, chemotherapy, epididymal blockage, and vasectomy. NOTE: Azoospermia is semen with no semen, while aspermia is no semen at all.

Figure 9.6 A: Balanitis. The glans penis (or glans) is the sensitive bulbous area at the distal end of the penis. B, cryptorchidism.

Suffixes SUFFIX MEANING TERMINOLOGY MEANING formation spermatogenesis _________________________________ formation -a hormone testosterone ____________________________________ Ster/o indicates that it is a type of steroid compound. Examples of other steroids are estrogen, cortisol and progesterone. -Pexy fixation, orchiopexy ________________________ Position A surgical procedure used to correct cryptorchidism. -stoma new vasovasostomy ___________________________________ opening reversal of vasectomy; A urologist rejoins the cut ends of the vas deferens.

Derivation of orchid /o

This combination form derives from the Greek word orchis, which means testicles. The botanical name of the orchid, the flower, is also derived from the

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the same Greek word because of the fleshy bulbs of the plant.

Azoospermia and infertility

Male infertility is the cause of up to 40% of infertility problems. The most common causes of male infertility are azoospermia and oligoasthenozoospermia (low sperm count and poor motility). The combination form asthen/o means powerlessness.

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pathological conditions; Sexually Transmitted Infections Tumors and Anatomical/Structural Disorders Testicles Testicular Cancer (Testicular Cancer)

Malignant tumor of the testicles. Testicular tumors are rare except in the 15 to 35 age group. The most common tumor, a seminoma, arises from embryonic cells in the testes (Figure 9-7A). Other tumors are embryonic carcinoma (Fig. 97B), teratoma, choriocarcinoma and yolk sac tumor. Teratomas contain a mixture of mature tissues such as bone, hair, cartilage, and skin cells (terat/o means monster). Testicular cancer can be cured by surgery (orchiectomy) followed by chemotherapy. Seminomas are treated with radiation therapy and/or chemotherapy. Tumors produce the proteins human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP). Serum levels of these proteins are used as tumor markers to determine treatment success. cryptorchidism; undescended testicles Cryptorchidism orchiopexy is performed to bring the testicles into the scrotum if they do not descend on their own by the age of 1 or 2 years. Undescended testicles are associated with a high risk of sterility and an increased risk of developing testicular cancer. hydrocele pouch of clear fluid in the scrotum. Hydroceles (Figure 9-8) can be congenital or in response to infection or tumors. They are often idiopathic and can be distinguished from testicular tumors by ultrasound imaging. If the hydrocele doesn't resolve on its own, the sac fluid is suctioned out with a needle and syringe, or a hydrocelectomy may be needed. In this procedure, the sac is surgically removed through an incision in the scrotum. Testicular twisting of the spermatic cord (see Figure 9.8). Torsion The rotation of the spermatic cord cuts off the blood supply to the testicles. Torsion is most common in childhood. Surgical correction within hours of onset of symptoms can save the testicle. Varicocele Enlarged, dilated veins near the testicles. Varicocele (see Figure 9-8) can be associated with oligospermia and azoospermia. Oligospermic men with varicocele and scrotal pain should undergo varicocelectomy. In this procedure, the internal spermatic vein is ligated (the affected segment is excised and the ends tied off). This procedure can increase fertility.

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Figure 9.7 A: Seminoma of a testis. B, Embryonic carcinoma of a testicle. Unlike seminoma, which is a pale, homogeneous mass, embryonic carcinoma is a hemorrhagic mass.

Figure 9.8 Hydrocele, testicular torsion, and varicocele.

Testicular Cancer Detection

There may be no signs or symptoms of testicular cancer. However, regular testicular self-exams can help identify growths earlier, when the chance of successful treatment is greatest. A man should see a doctor if he notices any mass, pain, or swelling in the scrotum.

Prostatic hyperplasia

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benign prostatic hyperplasia (BPH)

Prostate cancer (carcinoma of the prostate)

Benign growth of cells in the prostate. BPH is a common condition in men over the age of 60. Symptoms include urinary blockage and an inability to completely empty the bladder. Figure 9.9 shows the prostate with BPH and with carcinoma. Surgical treatment by transurethral resection of the prostate (TURP) clears the obstruction, but the overgrowth of cells can recur over several years. In this procedure, an endoscope (resectoscope) is inserted into the penis and through the urethra. Prostate tissue is removed by an electrical hot loop attached to the resectoscope (see page 305). Several medications to relieve BPH symptoms have been approved by the FDA. Finasteride (Proscar) inhibits the production of a powerful testosterone that promotes prostate enlargement. Other drugs, alpha blockers like tamsulosin (Flomax), work by relaxing the smooth muscle of the prostate and bladder neck. Lasers can also be used to destroy prostate tissue and clear blockages. A Laser TURP or GreenLight PVP procedure uses a green light laser on the end of an endoscope (see page 305). Malignant tumor (adenocarcinoma) of the prostate. This cancer is common in men over the age of 50. A digital rectal exam (DRE) (Figure 9-10) can detect the tumor at a later stage, but early detection depends on finding high levels of a prostate-specific antigen (PSA) in the blood. PSA is released from tumor cells into the bloodstream. The normal PSA level is 4.0 ng/mL or less. Diagnosis requires finding a tumor in a needle biopsy of the prostate. Transrectal ultrasound (TRUS) guides the needle biopsy taken through the rectal wall. Multiple needle biopsy samples are taken through the rectal wall. Computed tomography (CT) detects lymph node metastases. Treatment consists of surgery (prostatectomy) or radiation therapy for a localized tumor. Hormone therapy is used in locally advanced or metastatic disease. Because prostate cells are stimulated to grow in the presence of androgens, antiandrogen drugs slow tumor growth. One such drug is Lupron, which lowers androgen levels in the bloodstream. Tumor cells can also be destroyed by brachytherapy (brachy = near), which means that radioactive seeds are implanted directly into the prostate gland. See the story Personal: Prostate Cancer on page 309.

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Figure 9.9 The prostate with carcinoma and benign prostatic hyperplasia (BPH). Cancer usually arises on the sides of the gland, while BPH arises in the center of the gland. Because prostate cancer is more peripherally located, it can be palpated on a digital rectal exam (DRE).

Figure 9.10 Digital rectal examination (DRE) of the prostate.

Penis

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Hypospadie

Peyronie's disease phimosis

Congenital anomaly in which the male urethral opening is at the base of the penis rather than at the tip. Hypospadias (-spadias meaning tearing or cuing) occurs in 1 in 300 live male births and can be corrected surgically (Figure 9-11A). Abnormal curvature of the penis This condition is fairly common and is caused by scar tissue in the connective tissue of the penis. Drug treatment can be effective by breaking down the buildup of fibrous tissue that causes penile curvature. Narrowing (stricture) of the opening of the foreskin over the glans. This abnormal condition (phim/o = snout) in adolescent and adult males can interfere with urination and cause secretions to pool under the foreskin, leading to infection. Treatment is circumcision (cutting around the foreskin to remove it) (Figure 9.11B).

Figure 9.11 A: Hypospadias. In surgical repair, the urethra is lengthened using surrounding tissue or a graft of tissue elsewhere in the body and brought to the exit at the tip of the penis. B, phimosis and circumcision to correct the condition.

Sexually Transmitted Infections Sexually transmitted infections (STIs) are infections that are transmitted through sexual or other genital contact. Also known as sexually transmitted diseases (STDs) or venereal diseases (from the Latin Venus, the goddess of love), they affect both men and women and are among the most common communicable diseases in the world.

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chlamydia

Tripper

Genital herpes

Human papillomavirus (HPV) infection Syphilis

Bacterial infection (by Chlamydia trachomatis) of the urethra and reproductive tract. Within 3 weeks of infection, men may experience a burning sensation when urinating and notice white or clear discharge from the penis. Infected women may notice yellowish vaginal discharge (from the endocervix), but often the disease is asymptomatic. Antibiotics will cure the infection, but if left untreated, this STI can cause salpingitis (pelvic inflammatory disease [PID]) and infertility in women. Inflammation of the lining of the genital tract caused by infection with gonococci (berry-shaped bacteria). Other body regions such as the eyes, oral mucosa, rectum and joints can also be affected. Signs and symptoms include dysuria and a yellow, mucopurulent (pus-filled) discharge from the male urethra (Figure 9-12A). The ancient Greeks mistakenly thought that this discharge was semen and called the condition gonorrhea, which means seminal discharge (gon/o = semen). Many women carry the disease asymptomatically, while others experience pain, vaginal and urethral discharge, and salpingitis (PID). Men and women can also get anorectal and pharyngeal gonococcal infections as a result of sexual activity. Chlamydia and gonorrhea often occur together. When treating these infections, doctors give antibiotics to both and treat both partners. Infection of the skin and genital mucosa caused by the herpes simplex virus (HSV). Most cases of genital herpes are caused by HSV type 2 (although some are caused by HSV type 1, which is often associated with oral infections such as cold sores or cold sores). The usual clinical picture is erythema with the formation of small, fluid-filled vesicles and ulcers (Figure 9-12B). Initial episodes may also include inguinal lymphadenopathy, fever, headache, and malaise. remissions and relapse periods occur; no drug is known to be a cure. Herpes in newborns affects infants born to women with active infection just before delivery. Gynecologists may deliver infants by caesarean section to prevent these babies from being infected by HSV. Studies suggest that women with genital herpes have a higher risk of developing vulvar and cervical cancer. Infection of the skin and mucous membranes in the anogenital area by the human papillomavirus. Some HPV types cause genital warts (see Figure 9-13A) and lead to cervical cancer and cancer in men. A vaccine that protects against nine types of HPV is available for young girls and boys. Chronic STI caused by a spirochete (spiral-shaped bacterium). A chancre (hard boil or sore) usually appears on the external genitalia a few weeks after bacterial infection (Figure 9-13B). Two to six months after the chancre disappears, secondary syphilis begins. Tertiary syphilis involves damage to the brain, spinal cord, and heart that can occur years after the earlier symptoms have disappeared. Syphilis (which used to be so deadly that it was known as "smallpox" - as opposed to the more commonly known smallpox) can be congenital in the fetus if transmitted from the mother during pregnancy. Penicillin is effective for treatment in most cases.

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FIGURE 9-12 A, gonorrhea. Discharge from the penis is seen. B, genital herpes. The classic bubbles (vesicles) are recognizable.

Figure 9.13 A: Genital warts. B, Primary syphilis with chancre on penis.

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Laboratory Tests and Clinical Procedures Laboratory Tests PSA Test Sperm Analysis

Measurement of prostate-specific antigen (PSA) in the blood. PSA is produced by cells within the prostate. Elevated PSA levels are associated with an enlarged prostate and can be a sign of prostate cancer. Microscopic examination of the ejaculatory fluid. Sperm are counted and examined for motility and shape. The test is part of fertility studies and is needed to determine the effectiveness of vasectomy. Men with sperm counts less than 20 million/mL of semen are usually sterile (non-fertile). Infertility can cause an adult male to contract mumps, an infectious disease that affects the testicles (inflammation causes sperm to deteriorate).

Clinical Procedures Castration

circumcision digital rectal examination (DRE) photoselective vaporization of the prostate (GreenLight PVP) transurethral resection of the prostate (TURP) vasectomy

Surgical removal of testicles or ovaries. Neutering can be done to reduce the production and secretion of hormones that stimulate the growth of malignant cells (in breast and prostate cancer). If a boy is castrated before puberty, he becomes a eunuch (Greek: eune, to lie; echein, to guard). Male secondary sex characteristics do not develop. Surgical procedure to remove the foreskin (foreskin) of the penis. See Figure 9-11B, page 303. Finger palpation through the anal canal and rectum to examine the prostate. See Figure 9-10, page 301. Tissue removal for treatment of benign prostatic hyperplasia (BPH) using a green light laser (“laser TURP”). In selected cases, this minimally invasive procedure replaces TURP for the treatment of BPH. Removal of parts of the prostate through the urethra. This procedure treats benign prostatic hyperplasia (BPH). An electric hot loop cuts the prostate tissue; the pieces of tissue (chips) are removed through the resectoscope (Figure 9-14). Bilateral surgical removal of part of the vas deferens. A urologist transects the vas deferens, removes a piece, and ligatures (connects and ties) the free ends with sutures (Figure 9.15); this is repeated on the opposite side. The procedure is performed under local anesthesia and through an incision in the scrotum. Since sperm cannot leave the body, the vasectomized man is infertile but not castrated. The normal hormone release, sex drive and potency (ability to have an erection) are intact. The body reabsorbs sperm that have not been expelled. In some cases, a vasovasostomy can successfully reverse the vasectomy.

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Figure 9.14 Transurethral resection of the prostate (TURP). A: The resectoscope contains a light, valves to control the irrigation fluid, and an electrical loop that cuts tissue and occludes blood vessels. B: The urologist uses a wire loop through the resectoscope to gradually remove clogged tissue. The pieces are carried into the bladder by the fluid and flushed out at the end of the surgery.

Figure 9.15 Vasectomy.

abbreviations

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BPH DRE ED GU HPV HSV NSU PID PIN PSA PVP RALP RPR STD STI TRUS

benign prostatic hyperplasia digital rectal examination erectile dysfunction urogenital human papillomavirus herpes simplex virus urethritis nonspecific (not due to gonorrhea or chlamydia) pelvic inflammatory disease prostatic intraepithelial neoplasia; a precursor of prostate cancer prostate specific antigen photoselective vaporization of the prostate; GreenLight PVP Robotic Assisted Laparoscopic Prostatectomy Rapid Plasma Reagin [Test]; a test for syphilis sexually transmitted disease sexually transmitted infection transrectal ultrasound [examination]; Test to assess the prostate and guide to accurate placement of a biopsy needle TUIP transurethral incision of the prostate; successful in less enlarged prostate and less invasive than TURP TUMT transurethral microwave thermal therapy TUNA transurethral needle ablation; Radiofrequency energy destroys prostate tissue Transurethral TURP resection of the prostate

Practical Applications

Reproduced here from actual medical records is a case report of a patient with post-TURP symptoms. Background data and explanations of more difficult terms are included in brackets. See page 317 for answers to questions. Also included for review is a recent surgical pathology report for a man diagnosed with prostate cancer and a summary of current knowledge of anabolic steroids.

Case Report: A Man with Post-Turp Symptoms The patient is a 70-year-old man who underwent TURP for BPH 5 years ago and now presents with severe obstructive urinary tract symptoms with a large post-void residual. At DRE, his prostate was found to be large, bulky, and nodular, with a palpable elongation of the left seminal vesicle. His PSA was 15 ng/ml [0 to 4 ng/ml is normal] and a bone scan was negative. A CT scan showed bilateral external iliac adenopathy with lymph nodes averaging 1.5 cm [normal lymph node size is less than 1 cm]. A prostate biopsy revealed a poorly differentiated adenocarcinoma. This patient most likely has at least stage T3 N+ disease [expansion into seminal vesicles and lymph node metastases]. Antitestosterone-hormonal drug treatment is recommended. Questions about the case report

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1. What type of surgery did the patient have five years ago? a. testicle removal b. perineal prostatectomy c. Partial prostatectomy (transurethral) 2. What was the reason for the operation at the time? a. cryptorchidism b. Benign growth of the prostate c. Testicular cancer 3. What is his symptom now? a. Burning pain when urinating b. urinary retention c. Premature ejaculation 4. During which examination was the doctor able to feel the tumor? a. Palpation with a finger inserted into the rectum b. CT scan c. Prostate specific antigen test 5. Where has the tumor spread? a. testicles b. Pelvic lymph node and left seminal vesicle c. Pelvic bones 6. What is likely to stimulate prostate adenocarcinoma growth? a. Hormonal drug treatment b. prostate biopsy c. Testosterone secretion 7. Stage T3 N+ means that the tumor a. Is located in the hip area b. is restricted to the prostate c. Has spread locally and beyond the lymph nodes 8. Why is tumor staging important? a. Classify the extent of tumor spread and plan treatment b. To make the initial diagnosis c. To make an adequate biopsy of the tumor

Surgical Pathology Report: Prostate Cancer/Hyperplasia Patient Name: Bill Sco DOB: 09/14/1942 (Age 78) Gender: M Clinical Records: ?Node, right side of prostate; PSA 7.1 Specimen(s): A. Right prostate biopsy B. Left prostate biopsy FINAL PATHOLOGICAL DIAGNOSIS

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A. Right prostate needle biopsy (six nuclei) ADENOCARCINOMA, MODERATE TO LOW DIFFERENTIATION Gleason score 4 + 3 = 7 Estimated tumor burden, 10% of prostate tissue Represented in both samples A and B B. Left prostate needle biopsy Benign hyperplasia of the gland

About Anabolic Steroids Anabolic steroids are male hormones (androgens) that increase body weight and muscle size and can be used by physicians to enhance growth in boys who are not physically maturing as expected for their age. Steroids can also be used by athletes to increase strength and increase performance; However, significant adverse side effects of these drugs have been noted: • High levels of anabolic steroids cause acne, liver tumors, and infertility (testicular atrophy and oligospermia). • In women, the androgenic effects of anabolic steroids result in male hairiness, deepening of the voice, amenorrhea, and clitoral enlargement. • Anabolic steroid use also causes hypercholesterolemia, high blood pressure, jaundice (liver abnormalities), and salt and water retention (edema).

Gleason-Score

The Gleason score (named after Dr. Donald Gleason, a pathologist who developed it in the 1960s) is based on the microscopic appearance of the prostate biopsy sample. Cancers with a higher Gleason score are more aggressive and have a worse prognosis. The pathologist assigns a grade (number) to the most common tumor cells and another to the second most common tumor cells. Adding these numbers gives the Gleason score. The score is based on a scale of 1 to 5. Well differentiated (near normal) cells receive a lower score and poorly differentiated (malignant) cells receive a higher score.

prostate cancer personally

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This is a first-person narrative of a man diagnosed with prostate cancer. As with many men in their late 50s, the prostate PSA lab test was always the first thing I looked at at my annual checkup. Over a couple of years the PSA had been gradually increasing, but nothing that seemed to indicate anything unusual. So I was somewhat surprised when my GP suggested that it was time for the slowly increasing results to undergo another medical review. The PSA was 4.37 ng/mL (4.0 or less is considered normal). Being in good general health, I expected that the follow-up exam and biopsy of the prostate would be routine. It was a big surprise that the prostate biopsy showed that 3 out of 12 samples were positive for cancer cells. My Gleason score was 6 (3 + 3). This situation was described to me as favorable, early stage cancer. Still, I had no idea about the available treatment options. I decided that the best way to make a decision on a treatment plan was to meet with the doctors at the Mass General Cancer Center Urogenital Clinic, where my situation would be reviewed and my options discussed. I realized that the options were very varied, including watchful waiting, external radiation, internal radiation, and prostate surgery (prostatectomy). In the end, the decision is yours when it comes to early stage prostate cancer, and that alone can leave you with a choice of doubt. After careful consideration and reviewing the information with my doctors and family, I decided on the internal radiation option, or brachytherapy, often referred to as radiation seed implantation. Until the surgery, I was left with the question of whether I made the right choice. Should I wait a while and just see how things develop? Are there side effects that are known for this procedure, such as B. Intestinal or bladder irritation? I had internal radiation done at MGH. The entire medical team there made the process from start to finish as easy as one could wish for. The best news was that my PSA levels started to drop after the procedure as the tumor disappeared.

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It's now a year and I'm happy to see that the PSA has continued to go down. The long-term side effects of the brachytherapy procedure have been associated with urination and erectile dysfunction. While urination was painful after the procedure, the discomfort went away within a week or so. Urinary control was a problem in the long term, but after a year it has definitely improved. Erectile dysfunction after any type of prostate surgery is a problem. I found it was a big effect early on, but less so as time went on. There is still the PSA test required to see that the tumor has not returned. But if you take warning signs seriously, educate yourself, and make an informed decision with the help of the best possible medical team, you will feel comfortable with your decisions. Kevin Mahoney is a US Veteran now working as a program manager. He enjoys spending time with his family including his wife, children and grandchildren.

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Exercises Be sure to compare your answers carefully with those in the Answers to Exercises, page 316.

A Complete the flow chart showing sperm passage using the terms below. epididymis ejaculation duct penis tubules urethra vas deferens

B Select from the list of terms that match the following descriptions. Bulbourethral glands Epididymis Foreskin

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prostate scrotum seminal vesicles seminiferous tubules spermatozoon testicles vas deferens 1. one of two long, tightly coiled tubes above each testicle; carries and stores sperm ________ 2. exocrine gland at the base of the male urinary bladder _______________________ 3. narrow convoluted tubules that produce sperm in the testicles ____________ 4. sperm cell ________________________________________________ _________________ 5. foreskin ________________________________________________ __________________________ 6. male gonad; produces testosterone and sperm cells _____________________________________ 7. pair of sac-like exocrine glands that secrete fluid into the vas deferens _____________________ 8. outer sac that contains the testes ___________________________________ ___ 9. narrow tube that transports sperm from the epididymis to the urethra ________ 10. pair of exocrine glands Glands near the male urethra; copper glands _______________________

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C Select from the list of terms that match the following descriptions. ejaculation ejaculatory duct erectile dysfunction flagellum dizygotic twins glans penis identical twins interstitial cells parenchymal tissue perineum 1. hair-like projection on a sperm cell that makes it motile ___________________________________ 2. sensitive tip of the penis ________________________________________________ ____________ 3. tube through which the semen enters the urethra __________________________________________ 4 .two infants resulting from the division of a fertilized ovum into separate embryos ______________ 5. outer region between anus and scrotum __________________________________________ 6. essential, characteristic cells of an organ ___________________________________ __ 7. two infants resulting from the fertilization of two ova by two sperm cells ______________________ 8. Inability of an adult male to achieve an erection; impotence ________________________________

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9. specialized cells that lie adjacent to the seminiferous tubules _______________ 10. Sperm and fluid expulsion from the urethra __________________________________________ D Match the given terms to the following descriptions. Aspermia Azoospermia Impotence Oligospermia Penis Semen sterilization Stromal tissue Testicles Testosterone 1. Male external reproductive organ __________________________________________ 2. Sperm cells and seminal fluid ______________________________________ __ 3. Hormone secreted by interstitial cells of the testicles _________________________________ 4. Supporting connective tissue of an organ ___________________________ 5. Deficiency of semen ________________________________________________ ______________ 6. Deficiency of sperm cells im Sperm ________________________________________________

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___ 7. Procedure that takes away a person's ability to produce or release reproductive cells _______ 8. Sperm with a low sperm concentration _____________________________________________ 9. Male gonad ________________________________________________ ________________ 10. Inability of a male to maintain or achieve an erection ________________________________ E Form medical terms for the following definitions. Parts of the words are indicated. 1. Inflammation of the testicles: __________________________itis 2. Inflammation of the tube that transports sperm to the vas deferens: _______________________________itis 3. Resection of the prostate: __________________________ectomy 4. Inflammation of the prostate: ____________itis 5. Process of formation (formation of) sperm cells: ______________________ Formation 6 Fixation of the undescended testicles: orchio______________ 7. Inflammation of the glans penis: _____________ inflammation 8. Lack of sperm: ____________ sperm 9. Lack of semen: a___________________________

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10. pertaining to a testicle: __________________________ar F Answer true or false: 1. ___________ Cryosurgery uses cold temperatures to destroy tissue. 2. ___________ Estrogen is an example of an androgen. 3. ___________ Castration (orchiectomy or oophorectomy) is an example of sterilization. 4. ___________ A teratoma is a benign tumor of the prostate. 5. ___________ Spermolytic means sperm production. 6. ___________ Balanitis is an inflammation of the testicles. 7. ___________ Azoospermia causes infertility. 8. ___________ Aspermia can result from retrograde ejaculation. 9. ___________ Tubules are the interstitial cells of the testicles. 10. ___________ Testosterone is produced by the parenchymal tissue of the testicles. 11. ___________ Vasectomy produces impotence. 12. ___________ Vasovasostomy is an anastomosis that can restore fertility (ability to reproduce offspring). G Match the term in column I to its meaning in column II. Write the correct letter in the space provided.

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COLUMN I 1. castration 2. semen analysis 3. ejaculation 4. pus 5. vasectomy 6. circumcision 7. ligature 8. cryosurgery 9. seminoma 10. phimosis

_______ _______ _______ _______ _______ _______ _______ _______ _______ _______

COLUMN II A. Tying or tying B. Removal of a piece of vas deferens C. Orchiectomy D. Removal of the foreskin E. Tissue destruction by freezing F. Pus-filling G. Fertility test (reproductive ability) H ■ Ejection of sperm and fluid from the urethra I. Narrowing (stricture) the opening of the foreskin over the glans penis J. Malignant tumor of the testicle

H From the terms listed, choose the appropriate terms for the following descriptions. Adenocarcinoma of the prostate Benign prostatic hyperplasia Cryptorchidism Gonorrhea Genital herpes HPV infection Hydrocele Hypospadias Syphilis Varicocele . Malignant tumor of the prostate ________________________________________________ 5. Enlarged, swollen veins near the testicles _________________________________

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6. Sexually transmitted disease in the primary stage characterized by chancre formation ___________ 7. Infection of the skin and mucous membranes in the anogenital area by human papillomavirus __________________________________________ 8. STI due to berry bacteria and characterized by inflammation of the genital mucosa and mucopurulent discharge ___________________________________ 9. Undescended testicles ________________________________________________ _____________ 10. Bag of clear fluid in the scrotum ________________________________________________ ______ I Write out the abbreviations in column I. Then match each abbreviation with the correct meaning from column II.

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SPALTE I

_______ 1. PSA ______________________________________________________________________

_______ 2. BPH _____________________________________________________________________

_______ 3. TURP ______________________________________________________________________

_______ 4. TRUS ______________________________________________________________________

_______ 5. DRE _____________________________________________________________________

_______ 6. HSV _____________________________________________________________________

_______ 7. STI ______________________________________________________________________

_______ 8. RALP ______________________________________________________________________

COLUMN II A. Manual diagnostic procedure to examine the prostate gland B. Removal of portions of the prostate gland through the urethra C. Etiological agent of a sexually transmitted disease characterized by blistering D. Benign enlargement of the prostate gland E. Chlamydia, gonorrhea and syphilis are examples for this general category of infections. F. Helpful procedure for guiding a prostate biopsy needle. G. High serum levels of this protein are indicative of prostate cancer. H. Assisted laparoscopic surgery to remove the prostate

J Give the meaning of the following parts of the word. 1. -one _____________________________ 2. -stomia _____________ 3. semin/i ___________________________ 4. -cele _____________________________ 5. -pexy _____________________________ 6. -genesis _____________

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7. -plasia _______________________ 8. prostat/o __________________________ 9. orch/o _____________________________ 10. terat/o ___________________________ 11. gon/o ______________ 12. hydr/o ______________ 13. pen/o _____________________________ 14. balan/o ___________________________ 15. balan /o ___________________________ /o ______________ 16. vas/o _______________ 17. test/o _____________________________ 18. zo/o _____________________________ 19. crypt/o _____________ 20. andr/o ____________________________ K Match the listed surgical procedures to the following reasons for performing them . Circumcision Hydrocelectomy Orchiectomy Orchiopexy Photoselective vaporization of the prostate Radical (complete) prostatectomy Varicocelectomy Vasectomy Vasovasostomy 1. Prostate cancer ____________________ 2. Cryptorchidism _________________________

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3. Sterilization (hormones are preserved and potency is unaffected) __________________________ 4. Benign prostatic hyperplasia __________________________ 5. Abnormal accumulation of fluid in a scrotum ____________________ 6. Reversal of the sterilization procedure ___________ 7. Embryonic carcinoma of the testicles ___________ 8. Phimosis ____________________ 9 Ligating swollen, twisted veins above the testicles __________________________ L Use the definitions provided to complete the terms. Check your answers carefully. 1. Gland at the base of the urinary bladder in males: per ___________ gland 2. Spiral tube on top of each testicle: epi ____________________ 3. Essential tissue of an organ: par _________________________ tissue 4. Foreskin: pre ____________________ 5. Bacterial infection that invades the urethra and the reproductive tract of males and females and is the main cause of nonspecific urethritis in males and cervicitis in females: ch ____________________ 6. Ulcer formed on genital organs after infection with syphilis: ch __________ 7. Androgen produced by the interstitial cells is produced of the testicle: Test __________________________

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8. Fluid secreted by male reproductive glands and ejaculated with semen: se ____________________ 9. Malignant testicular tumor: sem ____________________ 10. Concerning the penis: pen _________________________ M Circle the correct terms to complete the sentences below. 1. When Fred was a newborn, his doctors could only feel one testicle in the scrotum and recommended close monitoring of his condition (clap, cryptorchidism, benign prostatic hyperplasia). 2. Bob had many sexual partners, one of whom had been diagnosed with (testosterone, phimosis, chlamydia) a highly transmissible sexually transmitted disease. 3. At the age of 65, Mike was having some difficulty with urinary urgency and discomfort when urinating. His doctor performed a digital rectal exam (prostate, urinary bladder, vas deferens). 4. Shortly after Nick's birth, his parents had a difficult time deciding whether to TURP (TURP, castration, circumcision) their young son. 5. Ted noticed a hard ulcer on his penis and made an appointment with his doctor, a (gastroenterologist, gynecologist, urologist). The doctor looked at a sample of the ulcer under a microscope and did a blood test which showed that Ted had contracted it (gonor, genital herpes, syphilis) so the ulcer was a (bladder, chancre, seminoma). 6. After the birth of his fifth child, Art decided to have surgery (vasovasostomy, hydrocelectomy, vasectomy).

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prevent conception of another child. A/an (nephrologist, urologist, abdominal surgeon) performed the procedure of cutting and ligating the (urethra, epididymis, vas deferens). 7. Lance, 26, noticed a hard testicular mass. His doctor ordered a short test with (antibodies, antibiotics, painkillers) to rule out (sinitis, testicular cancer, varicocele). The mass remained and Lance underwent (epididymectomy, orchiectomy, prostatectomy). The mass was one (seminoma, prostate cancer, hydrocele). 8. Sarah and Steve have been trying to conceive a child for 7 years. Steve had a (digital rectal exam, TURP, semen analysis) which showed 25% normal sperm count with 10% motility. He was told he had (phimosis, azoospermia, oligospermia). 9. Steve was given (estrogen, testosterone, progesterone) to increase his sperm count. As a side effect, he got acne for several months (androgen, progestin, enzyme). 10. Sarah eventually got pregnant. Ultrasonography showed two embryos with two separate placentas and in separate (peritoneal, scrotal, amniotic fluid) sacs. Sarah gave birth to two healthy (identical, fraternal, perineal) twin girls.

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Answers to the tasks A 1. seminiferous tubules 2. epididymis 3. vas deferens 4. duct 5. urethra 6. penis B 1. epididymis 2. prostate 3. seminiferous tubules 4. spermatozoon 5. foreskin 6. testis 7. seminal vesicles 8. scrotum 9. Vas deferens 10. Bulbourethral (Cowper) glands C 1. Flagellum 2. Glans penis 3. Ejaculatory duct

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4. identical twins 5. perineum 6. parenchymal tissue 7. dizygotic twins 8. erectile dysfunction 9. interstitial cells 10. ejaculation D 1. penis 2. sperm 3. testosterone 4. stromal tissue 5. aspermia 6. azoospermia 7. sterilization 8 oligospermia 9 Testis 10. Impotence E 1. Orchitis 2. Epididymitis 3. Prostatectomy 4. Prostatitis 5. Spermatogenesis

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p g 6. Orchiopexy 7. Balanitis 8. Oligospermia 9. Aspermia 10. Testis F 1. Correct. 2. Wrong. Estrogen is a female hormone. Androgens are male hormones. Testosterone is an androgen. 3. True. 4. Wrong. Teratoma is a malignant tumor in the testicles. 5. Wrong. Spermolytic is the destruction of sperm. Spermatogenesis is the formation of sperm. 6. Wrong. Balanitis is inflammation of the glans penis. Orchitis is an inflammation of the testicles. 7. True. 8. True. The semen is released backwards into the urinary bladder and not ejaculated. 9. Wrong. The seminiferous tubules are the parenchymal tissue of the testicles. The interstitial cells of the testicle are the Leydig cells, which secrete testosterone. 10. Wrong. Testosterone is produced by the interstitial cells of the testicles. 11. Wrong. The vasectomy results in the sperm not being able to leave the body in the semen. It does not affect erectile dysfunction and does not cause impotence. 12. True.

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G 1. C 2. G 3. H 4. F 5. B 6. D 7. A 8. E 9. J 10. I H 1. Benign prostatic hyperplasia 2. Hypospadias 3. Genital herpes 4. Adenocarcinoma of the prostate (prostate cancer) 5. Varicocele 6. Syphilis 7. HPV infection 8. Gonorrhea 9. Cryptorchidism 10. Hydrocele I 1. Prostate specific antigen: G

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p p g 2. Benign prostatic hyperplasia: D 3. Transurethral resection of prostate: B 4. Transrectal ultrasound: F 5. Digital rectal examination: A 6. Herpes simplex virus: C 7. Sexually transmitted infection: E 8. Robotic laparoscopic prostatectomy : H J 1. Hormone 2. Orifice 3. Semen, semen 4. Hernia, swelling 5. Fixation 6. Formation 7. Formation 8. Prostate 9. Testicles 10. Monster 11. Semen 12. Water 13. Penis 14. Glans penis 15 Varicose veins 16. Vessel, duct, vas deferens

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17. testes, testicles 18. animal life 19. hidden 20. male K 1. radical (complete) prostatectomy 2. orchiopexy 3. vasectomy 4. photoselective vaporization of the prostate 5. hydrocelectomy 6. vasovasostomy 7. orchiectomy 8. circumcision 9. varicocelectomy L 1. Prostate 2. Epididymis 3. Parenchyma 4. Foreskin 5. Chlamydia 6. Chancre 7. Testosterone 8. Semen or seminal fluid 9. Seminoma

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10. Penis M 1. Cryptorchidism 2. Chlamydia 3. Prostate 4. Circumcision 5. Urologist; Syphilis; chancre 6. vasectomy; Urologist; Vas deferens 7. Antibiotics; epididymitis; orchiectomy; seminoma 8. semen analysis; oligospermia 9. testosterone; androgen 10. amniotic fluid; fraternal responses to practical applications Case Report: A Man with Post-TURP Complaints

1. c 2. b 3. b 4. a 5. b 6. c 7. c 8. a

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pronunciation of terms

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BEGRIFF Androgen Aspermie Azoospermie Balanitis Gutartige Prostatahyperplasie Bulbourethraldrüsen Kastration Schanker Chlamydien Beschneidung Kryogene Chirurgie Kryptorchismus Digitale rektale Untersuchung Ejakulation Ejakulationsgang Embryonales Karzinom Nebenhoden Epididymitis Erektile Dysfunktion Flagellum Zweieiige Zwillinge Eichel Gonorrhoe Herpes Genitalis Humaner Papillomavirus Hydrozele Unfruchtbarkeit Zellen eineriiger Zwillinge Hydrozele Hypospadie Ligation Oligospermie Orchiektomie Orchiopexie Orchitis Parenchymgewebe des Penis penis penoscrotale perineum peyronie's disease phimosis photoselective vaporization of the prostate foreskin prostate cancer prostate gland prostatectomy prostatitis purulent scrotum semen

AUSKUNFT AN-dro-jen a-SPER-me-ah a-zo-o-SPER-me-ah bal-ah-NI-tis be-NINE pros-TAH-tik hi-per-PLA-ze-ah bul- bo-u-RE-thrale Drüse kah-STRA-scheu SHANK-er klah-MID-e-ah sir-kum-SIZH-un kri-o-GEN-ik SUR-jer-e crypt-OR-kid-ism DIH -jeh-tal REK-tal ek-ZAM eh-jak-u-LA-shun eh-JAK-u-lah-tor-e dukt em-bre-ON-al kar-sih-NO-mah ep-ih-did -ih-miss ep-ih-did-ih-MI-tis e-REK-tile dis-FUNK-shun fila-JEL-um frah-TER-nal twinz glanz PE-nis gon-o-RE-ah HER-peez jen-ih-TAL-ist HU-man pap-ih-LO-mah-vi-rus HI-dro-seel hi-po-SPA-de-as i-DEN-tih-kal twinz IM-po-zelte in- fer-TIL-ih-te inter-STIH-shul selz des TES-tis li-GA-shun ol-ih-go-SPER-me-ah or-ke-EK-to-me or-ke-o -PEK- that other-KI-tis pah-RENK-ih-mal TIH-shu PE-nil PE-nis pe-no-SCRO-tal peh-rih-NE-um pah-RO-ne dih-zeez fih-MO -sis fo -see-LIKE-tiv va-by-ih-ZA-through the PROState PRE-pus PROS-you CAN-see PROS-many Drüse pros-tah-TAKE-to-me pros-tah-TI -tis PU-ru- very SCRO-tum SE-Manners

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CONCEPT Semen Analysis Seminal Vesicular Tubules Seminoma Spermatogenesis Spermatozoa Spermatozoon Spermolytic Sterilization Stromal Tissue Syphilis Teratoma Testis Testicular Cancer Testicular Torsion Testis Testosterone Transurethral Resection of the Prostate Varicocele Vasa Deferens Vasectomy Vasovasostomy

AUSKUNFT SE-men ah-NAH-lih-sis SEH-mih-nal VES-ih-kils seh-mih-NIF-er-us TOOB-ules seh-mih-NO-mah sper-mah-to-JEN-eh- sis sper-mah-zu-ZO-ah sper-mah-zu-ZO-en sper-mo-LIH-rik ster-ih-lih-ZA-shun STRO-mal TIH-shu SIF-ih-lis ter-ah- TO-mah tes-DO-ku-lar tes-DO-ku-lar CAN-see tes-DO-ku-lar TOR-maiden TES-tis tes-TOS-teh-rone tranz-u-RE-thral re-SEK -meiden the PROS-tight VAR-ih-ko-seel was DEF-er-enz was-EK-for-me was-or-was-OS-for-me

evaluation sheet

Write the meaning of the parts of the word in the spaces provided. Check your answers against the information in the chapter or glossary (Medical Word Parts – English) at the end of the book.

combine shapes

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KOMBINATIONSFORM andr/o balan/o cry/o crypt/o epididym/o gon/o hydr/o orch/o orchi/o orchid/o pen/o prostat/o semin/i sperm/o spermat/o terat/o test /o varic/o vas/o zo/o

Suffixe SUFFIX -cele -ectomy -gen -genesis -genic -lysis -lytic -one -pexy -plasia -rrhea -stomy -tomy -trophy

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CHAPTER 10

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Nervous System CHAPTER SECTIONS: Introduction 322 General Structure of the Nervous System 322 Neurons, Nerves, and Glial Cells 326 The Brain 328 Spinal Cord and Meninges 331 Vocabulary 333 Terminology 335 Pathology 340 Laboratory Tests and Clinical Procedures 349 Abbreviations 352 Practical Applications 352 Personal : Sciatica 356 Exercises 357 Exercise Solutions 364 Pronunciation of terms 367 review sheet 370

CHAPTER OBJECTIVES • Name, locate, and describe the major organs of the nervous system and their functions. • Learn about the combination forms of the nervous system and use them with suffixes and prefixes. • Define pathological conditions affecting the nervous system.

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• Describe nervous system-related laboratory tests, clinical procedures, and abbreviations. • Apply your new knowledge to understand medical terms in their proper context, such as: B. Medical reports and records.

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Introduction The nervous system is one of the most complex systems in the human body. More than 100 billion nerve cells are constantly working throughout the body to coordinate the activities we perform consciously and voluntarily, as well as unconsciously and involuntarily. We speak, move muscles, hear, taste, see and think. Our glands secrete hormones and we respond to danger, pain, temperature and touch. All of these functions are just a small part of the many activities controlled by the nervous system. Fibers emerging from microscopic nerve cells (neurons) are collected into macroscopic bundles called nerves, which carry electrical messages throughout the body. External stimuli as well as internal chemicals such as acetylcholine activate the cell membranes of nerve cells, causing electrical discharges in these cells. These electrical discharges, nerve impulses, can then traverse the length of the associated nerves. External receptors (sensory organs) and internal receptors in muscles and blood vessels receive these impulses and can in turn transmit impulses to the complex network of nerve cells in the brain and spinal cord. In this central part of the nervous system, impulses are detected, interpreted and finally transmitted to other nerve cells that extend to all parts of the body such as muscles, glands and internal organs.

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General Structure of the Nervous System The nervous system is divided into two main areas: the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system consists of the brain and spinal cord. The peripheral nervous system consists of cranial and spinal nerves, plexuses, and peripheral nerves throughout the body (Figure 10-1). Cranial nerves transmit impulses between the brain and the head and neck. The only exception is the tenth cranial nerve, which is called the vagus nerve. It carries messages to and from the throat, chest, and stomach. Figure 10.2 shows the cranial nerves, their functions, and the parts of the body to which they carry messages. Spinal nerves carry messages between the spinal cord and the chest, abdomen, and extremities.

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Figure 10.1 Brain and spinal cord, spinal nerves and plexuses. The femoral nerve is a lumbar nerve that goes to and from the thigh region (the femur is the thigh bone). The sciatic nerve is a nerve that begins in a region of the hip. The cauda equina (Latin for "horse's tail") is a bundle of spinal nerves below the end of the spinal cord.

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Figure 10.2 Cranial nerves (I through XII) radiating from the base of the brain showing the parts of the body they affect. Sensory or afferent nerves are colored blue and carry messages to the brain. Motor or efferent nerves are colored red and carry messages from the brain to muscles and organs. Some nerves (mixed) carry both sensory and motor fibers. Don't try to memorize this number! Just get an overview: cranial nerves carry messages to and from the brain to all parts of the head and neck, and also (in the case of the vagus nerve) to other parts of the body.

A plexus is a large nerve network in the peripheral nervous system. The cervical, brachial (brachi/o means arm), and lumbosacral plexuses are examples that include cervical, lumbar, and sacral nerves.

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Figure 10-1 illustrates the relationship between the brain and spinal cord and the spinal nerves and plexuses.

Plexus

There are other plexuses in the body - networks of intersecting blood vessels (vascular) and lymphatic vessels. • The lymphatic plexus is an interconnected network of lymphatic vessels. • Rectal plexus is a network of veins in the rectal region. • The vertebral plexus is a network of veins that connect to the spine. The spinal and cranial nerves are made up of nerves that help the body respond to changes in the outside world. These include sensory receptors for vision (eye), hearing and balance (ear), smell (olfaction), and touch (skin sensation), as well as sensory (afferent) nerves, which carry messages to the spinal cord and brain about changes in the environment. In addition, motor (efferent) nerves travel from the spinal cord and brain to the muscles of the body and tell them how to respond. For example, when you touch a hot stove, temperature and pain receptors in the skin stimulate afferent nerves, which carry messages to the spinal cord and brain. The message is immediately transmitted to efferent nerve cells in the spinal cord, which then activate voluntary muscles to pull your hand away from the stove. In addition to the spinal and cranial nerves (whose functions are primarily voluntary and involved in olfactory, gustatory, visual, auditory, and muscular movements), the peripheral nervous system also contains a large group of nerves that function involuntarily or automatically without conscious control. These peripheral nerves are part of the autonomic nervous system. This system of nerve fibers carries impulses to glands, the heart, blood vessels, involuntary muscles in the walls of tubes like the intestines, and hollow organs like the stomach and urinary bladder. Some autonomic nerves are sympathetic nerves and others are parasympathetic nerves. The sympathetic stimulates the body in times of stress and crisis. They increase heart rate and strength, widen (relax) the airways to allow more oxygen to enter, and increase blood pressure. In addition, sympathetic neurons stimulate the adrenal glands to release epinephrine (adrenaline) while inhibiting intestinal contractions to slow digestion. The parasympathetic nerves normally act to balance the sympathetic nerves. Parasympathetic nerves slow heart rate, lower blood pressure, and stimulate the gut

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Contractions to clear the rectum. Figure 10-3 shows the different effects between sympathetic and parasympathetic.

Figure 10.3 Parasympathetic and sympathetic actions.

Figure 10.4 summarizes the divisions of the central and peripheral nervous systems.

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Figure 10.4 Divisions of the central nervous system (CNS) and peripheral nervous system (PNS). The autonomic nervous system is part of the peripheral nervous system.

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Neurons, nerves and glial cells A neuron is a single nerve cell, a microscopic structure. Impulses are conducted along the parts of a nerve cell in a specific way and direction. The parts of a neuron are shown in Figure 10.5; Label it as you study the following.

Figure 10.5 Parts of a neuron and the trajectory of a nerve impulse. Neurons are the parenchymal (essential) cells of the nervous system. The framed drawing shows what happens in a synapse: vesicles store neurotransmitters in the terminal fibers of axons. Receptors on the dendrites pick up the neurotransmitters. Inactivators stop the activity of neurotransmitters when they have finished their job.

A stimulus initiates an impulse in the neuron's branching fibers called dendrites [1]. A change in the electrical charge of the

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Dendritic membranes it is started and the nerve impulse moves along the dendrites like the movement of falling dominoes. The impulse, which only travels in one direction, next reaches the cell body [2], which contains the cell nucleus [3]. Small collections of nerve cell bodies outside the brain and spinal cord are called ganglia (singular: ganglion). The axon [4] emanates from the cell body and carries the impulse away from the cell body. Axons can be covered with a Fay tissue called myelin. The purpose of this myelin sheath [5] is to insulate the axon and speed up the transmission of electrical impulse. Demyelination is the loss of the myelin that insulates the nerve fiber and is characteristic of multiple sclerosis, an acquired disease affecting the CNS. The myelin sheath gives the nerve fiber a white appearance — hence the term "white matter," as in parts of the spinal cord and the white matter of the brain and most peripheral nerves. The gray matter of the brain and spinal cord consists of the cell bodies of neurons, which appear gray because they are not covered by a myelin sheath. The nerve impulse passes through the axon to exit the cell via the terminal end fibers [6] of the neuron. The space where the nerve impulse jumps from one neuron to another is called the synapse [7]. Transmission of the impulse across the synapse depends on the release of a chemical substance called a neurotransmitter by the neuron that carries the impulse to the synapse. See the boxed diagram in Figure 10-5. Tiny sacs (vesicles) containing the neurotransmitter are located at the ends of the neurons and release the neurotransmitter into the synapse. Acetylcholine, norepinephrine, epinephrine (adrenaline), dopamine, serotonin, and endorphins are examples of neurotransmitters. While a neuron is a microscopic structure within the nervous system, a nerve is macroscopic and can be seen with the naked eye. A nerve is made up of many axons that converge like strands of rope. Peripheral nerves that carry impulses from stimulus receptors such as the skin, eye, ear, and nose to the brain and spinal cord are afferent or sensory nerves; Efferent or motor nerves are those that carry impulses from the CNS to organs that produce responses, such as muscles and glands. Neurons and nerves are the parenchyma of the nervous system. The parenchyma is the main distinguishing tissue of an organ. In the brain and spinal cord, neurons that conduct electrical impulses are the parenchymal tissue. Stroma of an organ is the connective and supporting tissue of an organ. The stromal tissue of the central nervous system is made up of glial (neuroglial) cells, which form its supportive framework and help it fight off infection. Glial cells do not transmit impulses. They are much more numerous than neurons and can multiply.

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There are four types of supporting or glial cells (see Figure 10.6). Astrocytes (astroglial cells) are star-shaped (astr/o means star) and transport water and salts between capillaries and neurons. Microglial cells are small cells with many branches (dendrites). As scavenger cells, they protect neurons from inflammation. Oligodendroglial cells (oligodendrocytes) have few (olig/o means few or sparse) dendrites. These cells form the myelin sheath in the CNS. In contrast, ependymal cells (Greek ependyma means outer clothing) line membranes in the brain and spinal cord, where CSF is produced and circulated.

Figure 10.6 Glial cells (neuroglial cells). These are the supporting, protective and connective tissue cells of the CNS. Glial cells are stromal (scaffolding) tissues while neurons carry nerve impulses.

Glial cells, especially astrocytes, are connected to blood vessels and regulate the passage of potentially harmful substances from the blood to the nerve cells of the brain. This protective barrier between blood and brain cells is called the blood-brain barrier (BBB). This barrier consists of special lining cells (endothelial cells) which, together with astrocytes, separate capillaries from nerve cells. Administration of chemotherapy drugs to treat brain tumors is therefore difficult because the BBB blocks drug access to brain tissues. Figure 10.6 shows glial cells.

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The brain The brain controls bodily activities. In adult humans, it weighs about 3 pounds and has many different parts, all of which control different aspects of the body's functions. The largest part of the brain is the "thinking area" or cerebrum. On the surface of the cerebrum, nerve cells lie in layers that make up the cerebral cortex. These sheets, arranged in folds called gyri, are separated from each other by grooves known as sulci. The brain is divided into two halves, a right and a left side, called the cerebral hemispheres. Each hemisphere is divided into four main lobes, named for the cranial bones that overlie them. Figure 10.7 shows these lobes—frontal, parietal, occipital, and temporal—as well as the gyri and sulci.

Fig. 10.7 Left hemisphere of the brain (side view). Gyri (convolutions) and sulci (fissures) are indicated. Note the lobes of the cerebrum and the functional centers that control language, vision, movement, hearing, thinking, and other processes. Neurologists believe that the two hemispheres have different abilities. The left brain is more concerned with language, mathematical functioning, logical thinking, and analytical thinking. The right hemisphere is more active in spatial relationships, art, music, emotions, and intuition.

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The cerebrum has many functions. It is responsible for thinking, judgment, memory, association and discrimination. In addition, sensory impulses are received via afferent cranial nerves and, when registered in the cerebral cortex, are the basis for perception. Nerve impulses from the cerebrum extend to muscles and glands, causing both movement and internal changes in the body. Figure 10.7 shows the location of some of the centers in the cerebral cortex that control language, sight, smell, movement, hearing, and thought processes. In the center of the cerebrum are cavities or channels called ventricles (see Figure 10.8). They contain a watery fluid that flows through the brain and around the spinal cord. This fluid is the cerebrospinal fluid (CSF) and protects the brain and spinal cord from shock by acting like a cushion. CSF is usually clear and colorless and contains lymphocytes, sugars, and proteins. Spinal fluid may be removed to diagnose or relieve pressure in the brain; This is called a spinal tap (LP). In this procedure, a hollow needle is inserted into the lumbar region of the spine, below the region where the nerve tissue of the spinal cord ends, and CSF is withdrawn.

Figure 10.8 Cerebrospinal fluid (CSF) circulation in the brain (ventricle) and around the spinal cord. CSF is made in the ventricles and circulates between the membranes around the brain and spinal cord. CSF enters the bloodstream through the membranes that surround the brain and spinal cord.

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Two other important parts of the brain are the thalamus and hypothalamus (Figure 10-9). The thalamus acts as a triage center. It decides what is important and what is not by selectively processing sensory information and relaying it to the cerebral cortex. The thalamus also plays an important role in maintaining consciousness and awareness. The hypothalamus (below the thalamus) contains neurons that control body temperature, sleep, appetite, sexual desire, and emotions such as fear and pleasure. The hypothalamus also regulates the release of hormones from the pituitary gland at the base of the brain and integrates the activities of the sympathetic and parasympathetic nervous systems.

Figure 10.9 Parts of the brain: cerebrum, thalamus, hypothalamus, cerebellum, midbrain, pons, and medulla oblongata. Note the location of the pituitary gland below the hypothalamus. The basal ganglia (a group of cells) regulate voluntary movements of the body. The corpus callosum lies at the center of the brain and connects the two hemispheres (halves).

The following structures within the brain lie at the back and below the cerebrum and connect the cerebrum to the spinal cord: cerebellum, midbrain, pons, and medulla oblongata. The midbrain, pons, and medulla are part of the brainstem. See Figure 10-9. The cerebellum serves to coordinate voluntary movements and maintain balance and posture.

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The midbrain is the top part of the brainstem. It contains pathways that connect the cerebrum to lower parts of the brain and structures involved in vision and hearing. The pons is a part of the brainstem that literally means bridge. It contains nerve fibers that connect the cerebellum and cerebrum to the rest of the brain. Here are nerves that affect the face and eye movement. The medulla oblongata, also in the brainstem, connects the spinal cord to the rest of the brain. Nerve pathways cross from right to left and from left to right in the medulla oblongata. For example, nerve cells that control the movement of the left side of the body are located in the right half of the cerebrum. These cells send out axons that pass (decuss) to the opposite side of the brain in the medulla oblongata and then travel down the spinal cord. In addition, the medulla oblongata contains three important vital centers that regulate the body's internal activities: 1. Respiratory center - controls the respiratory muscles in response to chemicals or other stimuli 2. Cardiac center - slows the heart rate even though the heart is beating fast 3. Vasomotor Center - affects (contracts or expands) the muscles in the walls of blood vessels, thereby affecting blood pressure. Table 10.1 gives an overview of the functions of these parts of the brain. TABLE 10-1 FUNCTIONS OF PARTS OF THE BRAIN Structure Cerebrum Thalamus

Function(s) Thinking, personality, sensations, movements, memory relay station ("triage center") for sensory stimuli; consciousness and mind control hypothalamus body temperature, sleep, appetite, emotions; control of the pituitary cerebellum coordination of voluntary movements and balance pons and connection of nerve and nerve fiber pathways, including those to the eyes midbrain and facial cord nerve fibers crossing, left to right and right to left; contains centers to regulate oblongata heart, blood vessels and respiratory system

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Spinal Cord and Meninges Spinal Cord The spinal cord is a column of nerve tissue that extends from the medulla oblongata to the second lumbar vertebra within the spine. Below the end of the spinal cord is the cauda equina (Latin for "horse's tail"), a fan of nerve fibers (see Figure 10-1, page 323). The spinal cord carries all the nerves to and from the limbs and lower part of the body, and it is the pathway for impulses going to and from the brain. A cross-sectional view of the spinal cord (Figure 10.10) shows an inner region of gray skin (containing cell bodies and dendrites) and an outer region of white skin (containing the nerve fiber pathways with myelin sheaths) that carry impulses to and from the brain.

Figure 10.10 The spinal cord showing gray and white matter (transverse view). Afferent neurons carry impulses from a sensory receptor (such as the skin) to the spinal cord. Efferent neurons conduct impulses from the spinal cord to effector organs (eg, skeletal muscles). The central canal is the space through which CSF travels.

Meninges The meninges are three layers of connective tissue membranes that surround the brain and spinal cord. Annotate Figure 10-11 as you study the following description of meninges.

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Figure 10.11 The meninges, posterior view.

The outermost membrane of the meninges is the dura mater [1]. This thick, tough membrane contains ducts (dural sinuses) that hold blood. The subdural space [2] lies below the dural membrane. The second layer surrounding the brain and spinal cord is the arachnoid [3]. The arachnoid (spider-like) membrane is loosely connected to the other meninges by web-like fibers, leaving a space for fluid between the fibers and the third membrane. This is the subarachnoid space [4], which contains CSF. The third layer of meninges closest to the brain and spinal cord is the pia mater [5]. It contains delicate (lat. pia) connective tissue with a rich supply of blood vessels. Most doctors refer to the pia and arachnoid together as the pia-arachnoid.

vocabulary

This list gives an overview of the new terms introduced in the text. Brief definitions reinforce your understanding of the terms. For help with unfamiliar or more difficult words, see the Term Pronunciation section.

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Acetylcholine afferent nerve Arachnoid astrocytes autonomic nervous system axon blood-brain barrier brainstem cauda equina cell body central nervous system (CNS) cerebellum cerebral cortex cerebrospinal fluid (CSF) cerebrum

Neurotransmitter chemical released at the ends of nerve cells. Transmits messages to the brain and spinal cord (sensory nerve). Aﬀerent comes from af- (a form of ad-, meaning towards) and -ferent (meaning to carry). Middle layer of the three membranes (meninges) that surround the brain and spinal cord. The Greek arachne means spider. Type of glial (neuroglial) cell that transports water and salts from capillaries in the nervous system. Nerves that control involuntary bodily functions of muscles, glands, and internal organs. Microscopic fiber that is part of a neuron and carries nerve impulses along a nerve cell. Protective separation between blood and brain cells. This makes it difficult for substances (e.g. cancer drugs) to penetrate the capillary walls and enter the brain. Back part of the brain that connects the cerebrum to the spinal cord; includes midbrain, pons and medulla oblongata. Collection of spinal nerves below the end of the spinal cord. Part of a nerve cell that contains the nucleus. brain and spinal cord. Rear part of the brain that coordinates muscle movements and maintains balance. Outer region of the cerebrum that contains layers of nerve cells; Grauma er of the brain. Circulates throughout the brain and spinal cord.

Largest part of the brain; responsible for voluntary muscle activity, vision, speech, taste, hearing, thinking and memory. Cranial nerves Nerves carry messages to and from the brain to all parts of the head and neck, and also (in the case of the vagus nerve) to other parts of the body. There are 12 pairs of cranial nerves. Dendrite Microscopic branching fiber of a nerve cell (neuron) that is the first part to receive the nerve impulse. Dura Mater Thickness, outermost layer of the meninges that surrounds and protects the brain and spinal cord. Latin for "tough mother". eﬀerent nerve Carries messages away from the brain and spinal cord; motor nerve. Eﬀerent comes from ef- (meaning away from) and -ferent (meaning to carry). Ependymal cell Glial cell that lines membranes in the brain and spinal cord and contributes to the formation of cerebrospinal fluid. Ganglion (plural: Collection of nerve cell bodies in the peripheral nervous system. Ganglia) Glial cell Supporting and connecting nerve cell that does not transmit nervous (neuroglial cells) impulses. Examples are astrocytes, microglial cells, ependymal cells and oligodendrocytes. Unlike neurons, glial cells can reproduce themselves. gyrus (plural: sheet of nerve cells that creates a rounded ridge on the surface of the gyri) cerebral cortex; Folding. Hypothalamus Part of the brain below the thalamus; controls sleep, appetite, body temperature and secretions from the pituitary gland. medulla part of the brain just above the spinal cord; controls respiration, heartbeat, oblongata and the size of blood vessels; This is where nerve fibers cross. Meninges Three protective membranes that surround the brain and spinal cord.

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Microglial cell Midbrain Motor nerve Myelin sheath Nerve Neuron Neurotransmitter

Oligodendroglial cell parasympathetic parenchyma

peripheral nervous system plexus mater pia (plural: plexus) pontine receptor sciatic nerve sensory nerve spinal nerves stimulus (plural: stimuli) stroma sulcus (plural: sulci) sympathetic nerves synapse thalamus

Phagocytic glial cell that removes waste products from the central nervous system. Top part of the brainstem. Carries messages from the brain and spinal cord to muscles and organs; efferent nerve. Sheath of white Fay tissue that surrounds and insulates the axon of a nerve cell. Myelin accelerates impulse conduction along the axons. Macroscopic cord-like collection of fibers (axons) that transmit electrical impulses. Nerve cell required for the transmission of impulses throughout the nervous system; parenchyma of the nervous system. Chemical messenger released at the end of a nerve cell. It stimulates or inhibits another cell, which may be a nerve cell, muscle cell, or gland cell. Examples of neurotransmitters are acetylcholine, norepinephrine, dopamine and serotonin. Glial cell that forms the myelin sheath that covers the axons. Also called oligodendrocytes. Involuntary autonomic nerves that regulate normal bodily functions such as heart rate, breathing, and muscles of the gastrointestinal tract. Essential, characteristic tissue of any organ or system. The parenchyma of the nervous system includes the neurons and nerves that transmit nerve impulses. Parenchymal cells of the liver are hepatocytes, and parenchymal tissue of the kidney includes the nephrons, where urine is formed. Note the pronunciation: păr-ĔN-kĭ-mă. Nerves outside the brain and spinal cord: cranial, spinal cord and autonomic nerves. Thin, delicate inner lining of the meninges. Large, intertwined nerve plexus. Examples are lumbosacral, cervical, and brachial (brachi/o means arm) plexuses. The term comes from the Indo-European plek and means to weave together. Part of the brain in front of the cerebellum and between the medulla and the rest of the midbrain. It's a bridge that connects different parts of the brain. Pons means bridge in Latin. Organ that receives a stimulus and transmits it to sensory nerves. Skin, ears, eyes and taste buds are receptors. Nerve that extends from the base of the spine through the thigh, lower leg, and foot. Sciatica is pain or inflammation along the course of nerves. Carries messages from a receptor to the brain and spinal cord; afferent nerve. Pairs of nerves that originate on each side of the spine. They transmit messages to and from the spinal cord. Agent of change in the internal or external environment that elicits a response. It can be light, sound, touch, pressure or pain. Connective and supporting tissue of an organ. Glial cells make up the stromal tissue of the brain. depression or groove in the surface of the cerebral cortex; Crack. Autonomic nerves that involuntarily influence bodily functions in stressful situations. Space through which a nerve impulse travels between nerve cells or between nerve and muscle or gland cells. From the Greek synapsis, a point of contact. main relay center of the brain. It conducts impulses between the spinal cord and the cerebrum; incoming sensory messages are forwarded

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the thalamus to appropriate centers in the cerebrum. Thalamus means space in Latin. The Romans, who gave their name to this structure, thought this part of the brain was hollow, like a small space. Vagus nerve Tenth cranial nerve (cranial nerve X). Its branches reach the larynx, trachea, bronchi, lungs, aorta, esophagus and stomach. Latin vagus means to wander. Unlike the other cranial nerves, the vagus exits the head and "wanders" into the abdominal and thoracic cavities. Ventricles of the ducts in the brain that contain cerebrospinal fluid. Ventricles are also brains in the heart - they are the two lower chambers of the heart.

Terminology

This section is divided into terms that describe organs and structures of the nervous system and those that relate to neurological signs and symptoms. Write the meaning of the medical terms in the spaces provided.

organs and structures

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KOMBINIERENDE BEDEUTUNG FORM cerebell/o cerebellum cerebr/o cerebrum

hart

brain/o

gli/o lept/o

my/o, my/o

my/o my/o

neuro/the point/the

TERMINOLOGY

IMPORTANCE

Cerebellum ______________________________________ CSF ______________________________________ Cerebral Cortex ______________________________________ Cortical means the cortex or outer area of an organ. subdural hematoma of the dura mater ______________________________________ Remember, hematomas are not blood tumors, they are collections of blood. epidural hematoma ______________________________________ Fig. 10.12 shows subdural, epidural and intracerebral hematoma. Cerebral encephalitis ______________________________________ Encephalopathy ______________________________________ Chronic traumatic encephalopathy (CTE) is a progressive degenerative disease associated with repeated brain trauma (concussion). Anencephaly ______________________________________ A congenital malformation of the brain; incompatible with life and can be detected by amniocentesis or ultrasound of the fetus. Glial Glioblastoma ______________________________________ This is a highly malignant tumor (-blast means immature). Gliomas are tumors of glial cells (neuroglial cells). thin, slender leptomeningeals ______________________________________ The pial and arachnoid membranes are called leptomeninges because of their thin, delicate structure. Membranes, meningeal ______________________________________ Meninges Meningioma ______________________________________ Slow-growing, benign tumor. Myelomeningocele ______________________________________ Neural tube defect caused by failure of the neural tube during embryonic development. This abnormality occurs in infants born with spina biﬁda. See page 341. Myoneural muscle ________________________ Spinal cord myelopathy ______________________________________ (meaning bone poliomyelitis ______________________________________ Bone marrow in polio- means gray matter. This viral disease affects the other gray matter of the spinal cord, causing paralysis of the muscles that are related). damaged neurons. Effective vaccines developed in the 20th century have made polio relatively rare. Neural Neuropathy ____________ Polyneuritis ____________________________________ Pons cerebellopontine ____________________________________ The suffix -ine means associated.

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COMBINING MEANING FORM radicul/o nerve root (of spinal nerves)

thalam/o thec/o

vague

TERMINOLOGY

IMPORTANCE

Radiculopathy ____________________________________ Sciatica is a radiculopathy that affects the root of the sciatic nerve in the back. A herniated disc is a common cause that leads to pain, weakness, or numbness in the leg. See Personal: Sciatica Story on page 356. Radiculitis ____________________________________ This condition often results in pain and loss of function. Thalamus Thalamus ____________________________________ Vaginal intrathecal injection (relating to the ______________________ meninges) Chemicals, such as B. chemotherapeutic agents, can be delivered into the subarachnoid space. Vagus nerve Vagus ____________________________________ (10th cranial nerve This cranial nerve branches to the head and neck nerve as well as to the chest.

Figure 10.12 Hematomas. A subdural hematoma results from tearing of veins between the dura and the arachnoid membranes. It is often the result of blunt trauma, such as being hit to the head in boxers or in elderly patients who have fallen out of bed. An epidural hematoma develops between the skull and dura as a result of a ruptured meningeal artery, usually after a skull fracture. An intracerebral hematoma results from bleeding directly into the brain tissue, as can occur with uncontrolled hypertension (high blood pressure).

signs and symptoms

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COMBINATION FORM OR MEANING TERMINOLOGY MEANING SUFFIX alges/o, sensitivity to pain ______________________________________ Algesia Pain Hypalgesia ______________________________________ Decreased sensitivity to pain. (Note that the o is dropped in hypo-.) Hyperalgesia is an increased sensitivity to pain. -Algia pain (see Neuralgia ______________________________________ page 355 for trigeminal neuralgia is lightning-like pain that radiates along the course of the trigeminal nerve (fifth cranial nerve). for pain headache ______________________________________ medication) Headaches can be caused by tension in the muscles of the neck and scalp. Cause/o Burning causalgia ______________________________________ Severe burning pain after injury to a sensory nerve. Comat/o deep sleep Coma ______________________________________ (Coma) A coma is a state of unconsciousness from which the patient cannot be awakened. Semicoma refers to a stupor (unresponsiveness) from which a patient can be awakened. In irreversible coma (brain death), there is complete insensitivity to stimuli, no spontaneous breathing or movement, and a flat electroencephalogram (EEG) recording. aesthesi/o, feeling, anesthesia ______________________________________ aesthesia nervous lack of normal sensitivity (e.g. missing sense of touch or pain sensation). Two common types of regional anesthesia are spinal and epidural (caudal) blocks (Figure 10-13). An anesthetist is a doctor who administers anesthesia. Anesthetics are agents that reduce or eliminate sensation. General and local anesthetics are listed in Table 21-2, page 829. Hyperesthesia ______________________________________ Abnormally intense sensation to a particular stimulus, such as B. a light touch with a needle. Reduced sensitivity to pain is called hypesthesia. Paraesthesia ______________________________________ Par- (from para-) means abnormal. Paresthesias include tingling, burning, and tingling. Kinesi/o, movement Bradykinesia ______________________________________ Kinesi/o Hyperkinesis ______________________________________ Kinesis, amphetamines (CNS stimulants) are used to treat kinesis, hyperkinesis in children, but the kinetic mechanism of action is not clear. Dyskinesia ______________________________________ Condition characterized by involuntary, spasmodic movements. Tardive (late onset) dyskinesia can develop in people who take certain antipsychotic drugs for a long time. akinetic ______________________________________ -lepsy epilepsy ______________________________________ See page 343. Narcolepsy ______________________________________ Sudden, uncontrollable compulsion to sleep (narc/o = drowsiness, sleep). Amphetamines and stimulants are prescribed to prevent Acks.

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COMBINATION FORM OR MEANING SUFFIX lex/o word, phrase -paresis

weakness

-phasie

Network

- Plegie

paralysis (loss or impairment of the ability to move parts of the body)

-practically

action

-Sthenie

Strength

Syncop/o

cut off, abbreviate

tax/o

order, coordination

TERMINOLOGY

IMPORTANCE

Dyslexia ______________________________________ This is a developmental reading disorder that occurs when the brain fails to properly recognize, process, and interpret language. Hemiparesis ______________________________________ Affects either the right or left side (half) of the body. Paresis is also used alone to mean partial paralysis or muscle weakness. Aphasia ______________________________________ Difficulty speaking. Motor (also Broca's or expressive) aphasia is present when the patient knows what he wants to say but cannot say it. The patient with sensory aphasia has difficulty understanding speech and can pronounce (articulate) words easily but use them inappropriately. Hemiplegia ______________________________________ Affects the right or left side of the body and results from a stroke or other brain injury. Hemiplegia is contralateral to the brain lesion because motor nerve fibers cross from the right hemisphere of the brain to the left side of the body (in the medulla oblongata). Paraplegia ______________________________________ Originally, the term paraplegia meant a stroke (paralysis) on one side (para). However, today the term means paralysis of both legs and the lower part of the body caused by an injury or disease of the spinal cord or cauda equina. Quadriplegia ______________________________________ Quadri- means four. All four extremities are affected. The injury is at the cervical level of the spinal cord. Apraxia ______________________________________ Movements and behavior are not goal-directed. A patient with motor apraxia cannot use an object or perform a task. Motor weakness is not the cause. Neurasthenia __________________________ Nervous exhaustion and fatigue, often after depression. syncopal ________________________ Syncope (SIN-ko-pe) means fainting; Sudden and temporary loss of consciousness caused by insufficient blood flow to the brain. The term comes from a Greek word meaning "to cut to pieces" - so fainting meant that one's power was "cut off". TIP: Syncopal means powerless and is an adjective. A patient may experience a syncopal episode. Ataxia ______________________________________ Condition of reduced coordination. Persistent unsteady feet can be caused by a disease of the cerebellum.

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Figure 10-13 A: Positioning a patient for spinal anesthesia. B, Cross-sectional view of spinal cord showing injection sites for epidural and spinal blocks (anaesthesia). Epidural (caudal) anesthesia is achieved by injecting an agent into the epidural space and is commonly used in obstetrics. Spinal anesthesia is achieved by injecting a local anesthetic into the subarachnoid space. Patients may experience loss of sensation and paralysis of the feet, legs, and abdomen.

myel/o und my/o

Do not confuse these combination forms. Myel/o means spinal cord or bone marrow while my/o means muscle. Another pair to look out for is pyel/o (renal pelvis of the kidney) and py/o (pus).

Neuropathien

Neuropathies are diseases of peripheral nerves. They can affect motor, sensory, and autonomic functions. Polyneuropathies affect many nerves, while mononeuropathies affect individual nerves.

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Pathology The bones of the skull, spine, and meninges that contain CSF form a hard box with an inner cushion around the brain and spinal cord. In addition, glial cells surrounding neurons form a blood-brain barrier that prevents many potentially harmful substances in the bloodstream from gaining access to neurons. However, these protective factors are offset by the extreme sensitivity of the nerve cells to a lack of oxygen (brain cells die within a few minutes if there is a lack of oxygen). Neurological disorders can be divided into the following categories:

• Congenital • Degenerative, exercise and seizures • Infectious (meningitis and encephalitis) • Neoplastic (tumors) • Traumatic • Vascular disorders (stroke) Congenital disorders Hydrocephalus

Spina bifida

Abnormal accumulation of fluid (CSF) in the brain. When the circulation of CSF in the brain or spinal cord is disturbed, fluid under pressure accumulates in the ventricles of the brain. To relieve pressure in the brain, a catheter (shunt) can be placed from the ventricle into the peritoneal cavity (ventriculoperitoneal shunt) or into the right atrium of the heart so that the liquor is continuously drained from the brain. Hydrocephalus can also occur in adults as a result of tumors and infections. Congenital defects of the lumbar spine caused by an incomplete connection of vertebral parts (neural tube defect). In spina biﬁda occulta, the vertebral defect is covered with skin and can only be seen by x-ray or other imaging studies. Spina biﬁda cystica is a more severe form with cyst-like protuberances. In meningocele, the meninges protrude from the body, and in myelomeningocele (or meningomyelocele), both the spinal cord and meninges protrude (Figure 10.14A and B). The etiology of neural tube defects is unknown. Defects develop in the early weeks of pregnancy as the spinal cord and vertebrae develop. Prenatal diagnosis is supported by imaging methods and the examination of maternal blood samples for alpha-fetoprotein.

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Figure 10-14 A, Spina bifida (neural tube defects). B, Spina bifida cystica with myelomeningocele.

Degenerative, locomotor and seizure disorders

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Alzheimer's disease (AD) (Alzheimer's)

Amyotrophe Lateralsklerose (ALS)

Epilepsy

Huntington

Brain disorder characterized by gradual and progressive mental deterioration (dementia), personality changes, and impairment of daily functioning. AD features include confusion, memory problems, disorientation, restlessness and speech disorders. Anxiety, depression and emotional disorders can also occur. The disease sometimes begins in middle age with mild memory and behavioral problems, but may worsen after age 70. Atrophy of the cerebral cortex and widening of the cerebral sulci, particularly in the frontal and temporal regions, are common at autopsy (Figs. 10-15A and B). Microscopic examination reveals senile plaques resulting from the degeneration of neurons and neurofibrillary tangles (bundles of fibrils in the cytoplasm of a neuron) in the cerebral cortex. Deposits of amyloid (a protein) occur in neurofibrillary tangles, senile plaques, and blood vessels. The cause of AD remains unknown, although genetic factors may play a role. A mutation on chromosome 14 has been linked to familial cases. There is no effective treatment yet. Degenerative disorder of motor neurons in the spinal cord and brainstem. ALS manifests in adulthood. Signs and symptoms include weakness and atrophy of the muscles in the hands, forearms, and legs; Difficulty swallowing, speaking, and dyspnea develop when the pharyngeal and respiratory muscles become involved. Etiology (cause) and cure for ALS are both unknown. A famous baseball player, Lou Gehrig, became a victim of this disease in the mid-20th century, hence the condition became known as Lou Gehrig's disease. Chronic brain disease characterized by recurrent seizure activity. Seizures are abnormal, sudden discharges of electrical activity in the brain. Seizures are often symptoms of underlying pathological conditions in the brain, such as B. brain tumors, meningitis, vascular disease or scar tissue from a head injury. Tonic-clonic seizures (grand mal or ictal events) are characterized by sudden loss of consciousness, falling, and then tonic contractions (muscle tightening) followed by clonic contractions (jerking and jerking movements of the limbs). These spasms are often preceded by an aura, which is a peculiar sensation experienced by the affected person before a seizure begins. Dizziness, deafness, and visual or olfactory (smell) disturbances are examples of an aura. Absence seizures are a type of seizure consisting of a temporary blurring of consciousness and loss of awareness of the person's surroundings. These include petit mal seizures in children. Drug therapy (anticonvulsants) is used to control epileptic seizures. Neurological symptoms, such as weakness, known as postictal events, may occur after seizures. In temporal lobe epilepsy, the seizures begin in the temporal lobes (on each side of the brain near the ears) of the brain. The most common type of seizure is a complex partial seizure. Complex means impaired consciousness and partial means not generalized. Often these patients have seizures that cause them to stop everything they do, become confused, and have memory problems. The term epilepsy comes from the Greek epilepsis and means to seize. The Greeks thought a seizure victim was gripped by a mysterious force. The word ictal comes from the Latin ictus, meaning blow or blow. Hereditary disorder characterized by degenerative changes in the

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Disease (Huntington)

Multiple Sklerose (MS)

Myasthenia gravis (MG)

paralysis

Parkinson's disease (Parkinson's)

cerebrum, causing sudden involuntary movements and mental decline. In this genetic disorder, symptoms typically begin in adulthood and include personality changes, along with choreatic (ie, dance-like) movements (uncontrollable, erratic, jerky movements of the arms and legs and grimacing of the face). It is also known as Huntington's chorea. The genetic defect in patients with Huntington's disease is on chromosome 4. Patients can be tested for the gene; However, there is no cure and treatment is symptomatic. Destruction of the myelin sheath on neurons in the CNS and their replacement with sclerotic (hard) tissue plaques. MS is a leading cause of neurological disability in people aged 20 to 40 and is a chronic disease often characterized by long periods of stability (remission) and deterioration (relapse). Demyelination (loss of myelin insulation) prevents the transmission of nerve impulses down the axon. See Figure 10-16A. Demyelination causes paresthesia, muscle weakness, unsteady gait (gait), and paralysis. Visual (blurred and double vision) and speech disturbances can also occur. MRI scans of the brain show areas of scarred myelin (plaques) (Figure 10-16B). The etiology is unknown but likely involves an autoimmune disease of lymphocytes that react against myelin. There are now many useful disease-modifying drugs available to treat MS. These drugs affect either the inflammation or the immunological abnormalities in the CNS associated with this disease. Autoimmune neuromuscular disease characterized by weakness of voluntary muscles. MG is a chronic autoimmune disease. Antibodies block the ability of acetylcholine (neurotransmitter) to carry nerve impulses from nerve to muscle cells. The onset of symptoms is usually gradual. Brainstem signs are prominent and include upper eyelid ptosis, double vision (diplopia), and facial weakness. Respiratory paralysis is the main clinical concern. Therapy to reverse symptoms includes anticholinesterase drugs, which block the enzyme that breaks down acetylcholine. Immunosuppressive therapy is used, including drugs such as corticosteroids (prednisone) and other immunosuppressive drugs. Thymectomy is also a treatment option and is beneficial for many patients. Paralysis (partial or complete loss of motor function). Cerebral palsy is partial paralysis and lack of muscle coordination caused by lack of oxygen (hypoxia) or blood flow to the cerebrum during pregnancy or the perinatal period. Bell's palsy (or Bell's palsy) (Figure 10.17) is paralysis on one side of the face. The likely cause is a viral infection, and treatment is directed against the virus (viral drugs) and nerve swelling (corticosteroids). Degeneration of neurons in the basal ganglia that occurs later in life, causing tremors, muscle weakness, and slowing of movement. This slowly progressive condition is caused by a lack of dopamine, a neurotransmitter made by cells in the basal ganglia (see Figure 10.9). Motor disorders include hunched posture, shuffling gait, and muscle stiffness (rigidity). Other signs include a typical “pill-rolling” hand tremor and a characteristic mask-like lack of facial expressions. See Figure 10-18. Therapy with drugs such as levodopa plus carbidopa (Sinemet) to increase levels of dopamine in the brain is palliative (relieving symptoms).

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Toure-e-Syndrome (Toure-e-Syndrome)

but not healing). Many patients may have clinical features of Parkinson's (parkinsonism) without having the disease itself. You would not benefit from antiparkinsonian drugs. Some patients with Parkinson's may benefit from stimulation provided by electrodes surgically placed in the brain. The implantation of fetal brain tissue containing dopamine-producing cells is an experimental treatment but has yielded uncertain results. Involuntary spasmodic, twitching movements; uncontrollable vocal noises; and inappropriate words. These involuntary movements, which usually begin with twitching of the eyelid and facial muscles, accompanied by verbal outbursts, are called tics. Although the cause of Toure-e syndrome is not known, it is associated with either an excess of dopamine or an oversensitivity to dopamine. Mental health problems don't cause Toure-e syndrome, but doctors have had some success treating it with the antipsychotic drug haloperidol (Haldol), antidepressants, and mood stabilizers.

Figure 10-15 A, Alzheimer's disease. A generalized loss of brain parenchyma (neuronal tissue) leads to narrowing of the brain gyri and widening of the sulci. B, Cross-sectional comparison of a normal brain and a brain of a person with Alzheimer's disease.

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Figure 10.16 Multiple sclerosis. A, demyelination of a nerve cell. B: This MRI scan shows multiple abnormal white areas corresponding to MS plaques (arrows). The plaques are scar tissue that forms when myelin sheaths are destroyed.

Figure 10-17 A: Bell's palsy. Note the paralysis on the left side of this man's face: the eyelid does not close properly, the forehead is not wrinkled as expected, and there is significant paralysis of the lower face. B: The paralysis resolved spontaneously after 6 months.

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Figure 10.18 Primary symptoms of Parkinson's disease are tremors in hands, arms, legs, jaw and face; stiffness or stiffness of the limbs and trunk; Bradykinesia (shuffling gait), hunched posture and mask-like facial features.

epilepsy and seizures

Epilepsy is a brain disorder in which two or more seizures occur spontaneously and recurrently. A one-off seizure does not mean the sufferer has epilepsy.

infectious diseases

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Herpes zoster (shingles)

Meningitis

Human immunodeficiency virus (HIV) encephalopathy.

Viral infection affecting peripheral nerves. Blisters and pain spread along peripheral nerves (see Figure 1019A) and are caused by inflammation caused by a herpes virus (herpes zoster), the same virus that causes chickenpox (varicella). There is a reactivation of the chickenpox virus (herpes varicella-zoster), which remains in the body after chickenpox. Painful blisters follow the underlying path of the cranial or spinal nerves. Shingrix is a vaccine used to prevent shingles. It is recommended for people over 50 years of age. inflammation of the meninges; leptomeningitis. This condition can be caused by bacteria (pyogenic meningitis) or viruses (aseptic or viral meningitis). Signs and symptoms include fever and signs of meningeal irritation such as headache, photophobia (sensitivity to light), and a stiff neck. Spinal taps are done to examine CSF. Doctors use antibiotics to treat the more serious pyogenic form and antivirals for the viral form. Brain disorders and dementia associated with AIDS. Many patients with AIDS develop neurological dysfunction. In addition to encephalitis and dementia (loss of mental function), some patients develop brain tumors and other infections.

Figure 10-19 A, Herpes zoster (shingles) at a typical site around the trunk. Zoster means girdle or girdle in ancient Greek. B, Glioblastoma as seen on MRI.

neoplastic diseases

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brain tumor

Abnormal growth of brain tissue and meninges. Most primary brain tumors arise from glial cells (gliomas) or the meninges (meningiomas). Types of glioma include astrocytoma (Figure 10-19B), oligodendroglioma, and ependymoma. The most malignant form of astrocytoma is glioblastoma multiforme (blast means immature) (see Figure 10.19B). Tumors can cause swelling (cerebral edema) and hydrocephalus. If CSF pressure is elevated, swelling near the optic nerve (at the back of the eye) may also occur. Other symptoms include severe headaches and new seizures. Gliomas can sometimes be surgically removed. Brain tumors are also treated with chemotherapy and radiation therapy. Steroids are used to reduce cerebral edema. Meningiomas are usually benign and encapsulated, but they can cause compression and distortion of the brain. Tumors in the brain can also be single or multiple metastatic growths. Most arise in the lungs, breast, skin (melanoma), kidney, and gastrointestinal tract and spread to the brain.

Traumatic disorders concussion

cerebral contusion

Type of traumatic brain injury caused by a blow to the head. There is usually no evidence of structural damage to brain tissue, and loss of consciousness may not occur. Rest is very important after a concussion as it allows the brain to heal. Doctors generally recommend avoiding strenuous mental and physical activity until symptoms have completely resolved. Bruising of brain tissue from direct trauma to the head. Brain contusion can be associated with edema and an increase in intracranial pressure. There may be a fractured skull. Subdural and epidural hematomas occur (see Figures 10-12), resulting in permanent brain damage with abnormalities such as memory or speech impairment and the development of epilepsy.

vascular diseases

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cerebrovascular accident (CVA)

migraine

disruption of the normal blood supply to the brain; Stroke. This condition, also known as a cerebral infarction, is the result of a disrupted supply of oxygen to the brain. There are three types of stroke (Figure 10-20): 1. Thrombotic - Blood clots (thrombus) in the arteries leading to the brain, causing occlusion (blockage) of the vessel. Atherosclerosis leads to this common type of stroke because the blood vessels become blocked over time. Before complete occlusion occurs, a patient may experience symptoms that indicate the gradual occlusion of blood vessels. These short episodes of neurological dysfunction are known as transient ischemic attacks (TIAs). 2. Embolism - an embolus (a loosened thrombus) travels to cerebral arteries and occludes a vessel. This type of stroke occurs very suddenly. 3. Hemorrhagic - an artery in the brain ruptures and bleeding occurs. This type of stroke can be fatal and results from advancing age, atherosclerosis, or high blood pressure, all of which lead to degeneration of the cerebral blood vessels. If the bleeding is small, the body will replenish the blood and the patient will recover well with only minor disability. In a younger patient, a brain hemorrhage is usually caused by a mechanical injury associated with a skull fracture or a ruptured arterial aneurysm (a weakened area in the wall of a blood vessel that balloons and can eventually rupture). See Figure 10-21. The main risk factors for stroke are high blood pressure, diabetes, smoking and heart disease. Other risk factors include obesity, substance abuse (cocaine), and high cholesterol. Thrombotic strokes are treated with anticoagulant or anticoagulant (clot-dissolving) therapies. Tissue plasminogen activator (tPA) can be started soon after the onset of a stroke. Surgical intervention with carotid endarterectomy (removal of the atherosclerotic plaque along with the inner lining of the affected carotid artery) is also possible. Severe, recurrent, unilateral, vascular headache. A migraine can be associated with an aura (peculiar sensations that precede the onset of the disease). Symptoms of the aura are temporary visual and sensory disturbances, including flashes of light and zigzag lines. Sensitivity to sound (phonophobia) and light (photophobia) are associated with the migraine itself. The etiology of migraine pain is not fully understood, but there are clear changes in cerebral blood vessels. Treatment to prevent a migraine attack includes drugs such as sumatriptan succinate (Imitrex), which target serotonin receptors on blood vessels and nerves. Drugs of this type reduce inflammation and limit the dilation of blood vessels.

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Figure 10.20 Three types of stroke: embolic, hemorrhagic, and thrombotic.

Fig. 10.21 Cerebral aneurysm.

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study department

The following list provides an overview of the new terms used in the pathology section. Practice spelling each term and know its meaning. absence aneurysm

Seizure type consisting of momentary clouding of consciousness and loss of awareness of surroundings. Enlarged, weakened area in an artery wall that can rupture, leading to bleeding and CVA (stroke). Astrocytoma Malignant brain tumor of the astrocytes (glial cells of the brain). Aura Peculiar symptom or feeling that occurs before the onset (prodromal) of a migraine attack or epileptic seizure. Dementia Mental decline and decline. Demyelination Destruction of myelin on axons of neurons (as in multiple sclerosis). Dopamine CNS neurotransmitter deficiency in patients with Parkinson's disease. Embolus A lump of material that travels through the bloodstream and suddenly blocks a vessel. gait type of walking. ictal event A sudden, acute onset, like the convulsions of an epileptic seizure. occlusion blockage. alleviate symptoms palliatively, but not cure them. Thymectomy Removal of the thymus (a lymphocyte-producing gland in the breast); used to treat myasthenia gravis. TIA Transient Ischemic Acknowledgment. TIAs can occur in all three types of stroke: thrombolytic, embolic, and even hemorrhagic (if minor). They are characterized by a temporary course of neurological deficits. Tic Involuntary movement of a small muscle group, as in the face; characteristic of Toure-e syndrome. Tonic-clonic severe (grand mal) seizure characterized by sudden loss of seizure awareness, muscle stiffness, and twitching and jerky movements.

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Laboratory tests and clinical procedures Laboratory tests CSF analysis

Samples of CSF are examined. The CSF analysis measures protein, glucose, and red (RBC) and white (WBC) blood cells and other chemical contents of the CSF. CSF analysis can also detect tumor cells (by cytology), bacteria and viruses. These studies are used to diagnose infections, tumors, or multiple sclerosis.

Clinical procedures X-ray tests cerebral angiography

Computed tomography (CT) of the brain

X-ray imaging of the arterial blood vessels in the brain after contrast medium injection. Contrast material is injected into the femoral artery (in the thigh) and X-ray films are taken. These images diagnose vascular diseases (aneurysm, occlusion, hemorrhage) in the brain. Computer-aided X-ray technology that produces multiple images of the brain and spinal cord. Contrast material can be injected intravenously to highlight abnormalities. The contrast medium penetrates through the blood-brain barrier from blood vessels into the brain tissue and reveals tumors, aneurysms, hemorrhages, brain injuries, skull fractures and blood clots. Operations are performed using the CT scan as a local road map. CT scans are also particularly useful for visualizing blood and bone.

Magnetic Resonance Techniques Magnetic Resonance Imaging (MRI)

Magnetic fields and pulses of radio wave energy create images of the brain and spinal cord. MRI is better than CT at assessing the brain parenchyma. It is great for viewing brain damage related to infection, inflammation, or tumors. It's also used to look for causes of headaches, diagnose a stroke, and detect bleeding problems and head injuries. Contrast material can be used to enhance images. Magnetic resonance angiography (MRA) creates images of blood vessels using magnetic resonance techniques.

The radionuclide study

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Positron emission tomography (PET) scan

Radioactive glucose is injected and then detected in the brain to map the metabolic activity of cells. PET scans provide valuable information about brain tissue function in patients to detect malignancy and assess brain abnormalities in Alzheimer's disease, stroke, schizophrenia, and epilepsy (Figure 10-22). Combined PET-CT scanners provide images that pinpoint the location of abnormal metabolic activity in the brain.

FIGURE 10.22 PET scans. A, Normal brain. B: Brain affected by Alzheimer's disease. Red and yellow areas indicate high neural activity. Blue and purple indicate low neural activity.

Ultrasound examination Doppler ultrasound examinations

(Video) Medical Terminology - Chapter 1 - Basic Word Structure

Sound waves detect blood flow in the carotid and intracranial arteries. The carotid artery carries blood to the brain. These studies detect occlusion in blood vessels.

Other procedures

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Electroencephalography (EEG) Lumbar puncture (LP)

Stereotactic radiosurgery

Recording the electrical activity of the brain. The EEG shows seizure activity resulting from brain tumors, other diseases, and injuries to the brain. It can also help define diffuse cortical dysfunction (encephalopathies). CSF is collected between two lumbar vertebrae for analysis (Figure 10-23). A device for measuring CSF pressure can be attached to the end of the needle after insertion. Injection of intrathecal drugs can also be administered. Some patients experience headaches after LP. An informal name for this procedure is "spinal tap." Using a specialized instrument to locate and treat targets in the brain. The stereotactic instrument is fixed to the skull and uses three-dimensional measurement to insert a needle. A Gamma Knife (high energy radiation) is used to treat deep and often inaccessible intracranial brain tumors and abnormal blood vessel masses (arteriovenous malformations) without surgical incision. Stereotactic proton radiosurgery (PSRS) delivers a uniform dose of proton radiation to a target while sparing surrounding normal tissue (Figure 10-24 A and B).

Figure 10.23 Lumbar puncture. The patient lies on his side with his knees drawn to his stomach and his chin lowered to his chest. This position increases the spaces between the vertebrae. The lumbar puncture needle is inserted between the third and fourth (or fourth and fifth) lumbar vertebrae and then advanced into the subarachnoid space.

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Figure 10-24 A Patient in position on a stereotactic proton unit, ready for an alignment x-ray. B, The stereotactic frame holds the patient's head in position for treatment with proton beam radiosurgery. (Courtesy of the Department of Radiation Therapy, Massachusetts General Hospital, Boston.)

abbreviations

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AD AFP

Alzheimer's disease alpha-fetoprotein; increased levels of amniotic fluid and maternal blood are associated with congenital anomalies of the nervous system such as anencephaly and spina biﬁda ALS amyotrophic lateral sclerosis - Lou Gehrig's disease AVM arteriovenous malformation; congenital tangle of arteries and veins in the cerebrum BBB blood-brain barrier CNS central nervous system CSF cerebrospinal fluid CTE chronic traumatic encephalopathy CVA stroke EEG electroencephalography GABA gamma-aminobutyric acid (neurotransmitter) ICP intracranial pressure (normal pressure is 5 to 15 mm Hg) LP lumbar puncture MAC monitored anesthetic care MG myasthenia gravis MRA magnetic resonance angiography MRI magnetic resonance imaging MS multiple sclerosis hemiparesis P PCA patient controlled analgesia PET positron emission tomography PNS peripheral nervous system PSRS proton stereotactic radiosurgery Sz seizure TBI traumatic brain injury TENS transcutaneous electrical nerve stimulation; Technique Using a Battery-Powered Device for Acute and Chronic Pain Relief TIA Transient Ischemic Stroke; transient disturbance of blood supply to the brain TLE temporal lobe epilepsy tPA tissue plasminogen activator; a clot-dissolving drug used to treat stroke

Practical Applications Case Study: A Patient's Report of Ulnar Nerve Neuropathy I am definitely not one of those ambidextrous people. I'm a true right-hander, so the "experiment" of making me left-handed out of necessity didn't go so well. Over the last ten years I had slowly lost feeling in my right pinky finger and quite a bit of function in my right hand. You may think that I should have taken care of the treatment when it initially presented with an electric shock down my arm from raising my "funny bone" over and over again. The "funny bone" isn't a bone at all, of course. It is the ulnar nerve that runs across the medial and posterior aspect

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the elbow as it wanders to the hand. See Figure 10-25. After several injuries to my elbow, my little finger just became useless and numb.

Fig. 10.25 Path of the ulnar nerve behind the elbow joint (middle epicondyle of the humerus) and towards the hand.

As a doctor, I found that my ulnar nerve was pinched and scarred from repeated injuries. Over the years I have tolerated this situation because other nerves had been untouched giving my hand sensation and function. It wasn't until I saw myself on video (my hand looked like a claw) that I realized how impaired hand function had become. During an examination by an orthopedic elbow specialist, tests revealed bad feeling and atrophy in my right hand muscles. My grip strength was also affected and was now stronger on my left rather than my right. Surgery was immediately scheduled in hopes of stopping the atrophy and scratching of my hand and regaining feeling in my little finger. My surgeon performed an Eaton procedure. He removed the scarred ulnar nerve from its vulnerable path and placed sutures to hold the ulnar nerve in its new place under the fascia (connective tissue) of my elbow. He created a little "curtain" with the fascia to keep the nerve from moving again. This eventually allowed the nerve to take a "short cut" on its way to my hand while relieving the injured nerve and keeping it away from the bony prominence of the elbow.

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When I woke up from the anesthesia, I immediately noticed that something was different about my hand. I had tingling in my previously numb fingers and soon had a warm feeling and even sweating in my palm. These findings indicated the return of the nerve's autonomic function, something that had also been compromised by the long-term injury. My arm was in a sling until my post-op appointment. Figure 10.26 shows my arm and scar just after the two-week postoperative check-up. A compression sleeve prevented swelling and reminded me not to overuse my arm.

Fig. 10.26 Postoperative scar after ulnar artery surgery.

3 months after the surgery I was back to my usual routine of typing, writing and using my hand. Sensation gradually returned to my little finger and function in my hand also improved, but very slowly. Injured nerves can regenerate as long as they are not severed or completely crushed. The nerve heals from proximal to distal (starting at the elbow to the tip of the finger). Doctors give the statistic of one millimeter per day for nerve regeneration, or about one inch per month. The feeling in my pinky is still not normal but it is improving and it is encouraging to see the progress. The muscles in my hand are also getting stronger. The real test is checking my grip strength when I return for my 6 month follow up appointment.

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I am grateful for the quick action and skillful surgery that was possible before my ulnar nerve was permanently damaged. I am also thankful that the body can heal itself if given the right help. I was so used to the numb feeling that I had no idea what was wrong! For answers to the following case report and case study questions, see page 366.

Case Report: Cerebral Infarction This patient was admitted on January 14 with a history of progressive right hemiparesis for the previous 1 to 2 months; fluctuating numbness of right arm, chest and buttocks; twitching of right leg ; periods of speech stagnation; decreased reading comprehension; and recent development of a hemiplegic gait. Given the gradual development of neurological problems, he was suspected to have a left parietal tumor. [The parietal lobes of the cerebrum are located under the roof of the skull on both sides.] Examinations performed prior to hospitalization included skull film, EEG, and CSF analysis, all of which were normal. After admission, an MRI in the left parietal region was abnormal, as was the EEG. An MRA study evaluating the cerebral blood vessels was rejected, but the patient became increasingly restless and agitated after sedation, so the procedure was discontinued. During the recovery period from sedation, the patient was alternately somnolent [drowsy] and violent, but was later shown to have developed almost complete aphasia and right hemiplegia. Over the next few days he became more alert, although he remained dysarthric [from the Greek arthroun meaning u er distinct] and paralyzed on one side. MRI and MRA with the patient under general anesthesia on January 19 showed complete occlusion of the left internal carotid artery with transverse filling of the left anterior and middle cerebral arteries from the right internal carotid circulation. Final Diagnosis: Left CVA caused by left internal carotid artery occlusion. [Figure 10.27 shows the carotid arteries and their branches in the head and brain.]

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Figure 10.27 Common carotid arteries and their branches.

Case Report Questions 1. The patient was admitted with a history of: a. Right-sided paralysis from a previous stroke b. Paralysis on the left side of the body c. Progressive paresis on the right side of the body 2. The patient also had episodes of: a. Aphasia and dyslexia b. Dysplastic gait c. Apraxia and aphasia 3. Where did the MRI show an abnormality after being admitted to the hospital? a. Right posterior area of the brain b. Left and right brain c. Left brain 4. Which test gave the definitive diagnosis? a. EEG for both hemispheres b. CSF analysis and cerebral angiography c. MRI and MRA 5. What was the final diagnosis? a. Stroke; ischemic injury to tissue in the left cerebrum caused by blockage of an artery b. Transverse filling of blood vessels from the left to the right cerebral hemisphere c. Cerebral palsy on the left side of the brain with cross filling of two cerebral arteries

Painkiller

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Pain is a major symptom in many diseases. Both the area of the injury and how the brain deals with it affect the perception of pain. Drugs used to relieve pain (analgesics) work in several ways: • Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain by stopping inflammation. Examples include over-the-counter medications such as ibuprofen (Advil, Motrin, Excedrin), aspirin (Anacin, Ascriptin, Bufferin), and naproxen (Aleve). Other NSAIDs that require a prescription include Toradol (ketorolac) and Feldene (piroxicam). • Acetaminophen (Tylenol) reduces fever and mild pain, but is not an anti-inflammatory drug. It is not clear how acetaminophen works. • Opioids (narcotics) relieve pain by affecting receptors in the brain to control pain perception. Examples are morphine, codeine, oxycodone and hydrocodone. Combinations of narcotics and acetaminophen include Vicodin (acetaminophen with hydrocodone) and Percocet (acetaminophen with oxycodone). Because of the addictive nature of this class of drugs, opioids are generally prescribed in limited amounts and used sparingly.

Neuropathic Pain with a Case Study Neuropathic pain is a unique type of pain associated with disease and trauma. Patients may describe this pain as: • radiating or spreading • an electric shock-like sensation • hot or burning • shooting, stabbing, shooting, or stabbing (lancinating) • abnormal skin sensations (paraesthesia): numbness, tingling, "tingling". ” • pain on light touch • extreme sensitivity to common, harmless stimuli • often unrelated to movement Case Study: A 68-year-old man woke up one morning with severe pain in his right shoulder. If he turned his head or raised his shoulder, he felt extreme discomfort and sharp pains. The pain was a sharp, searing ache that spread across his shoulder and down his right arm. It was difficult to find a comfortable position while lying down. A cervical MRI scan showed no bone abnormalities, while a

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The neurological examination revealed evidence of damage to several peripheral nerves. He developed weakness in his shoulder muscles and was unable to raise his right arm. The final diagnosis was brachial plexus neuritis [also known as Parsonage-Turner syndrome]. The cause of the condition is unknown, but it could be related to a flu shot he received 2 weeks earlier. Treatment consisted of painkillers and physical therapy to rehabilitate weakened muscles in his arm and shoulder. Case study questions 1. The cervical MRI study showed: a. damage to the cervical vertebrae b. Nerve entrapment in the upper spine c. Damage to multiple peripheral nerves d. Normal cervical vertebrae 2. Stabbing pain is: a. pain on light touch b. Characterized by paresthesias c. stabbing, stabbing, shooting d. Characterized by numbness and tingling 3. The patient's diagnosis is best described as follows: a. Inflammation of the cervical nerve roots affecting his shoulder and arm b. Inflammation of a nerve network in his shoulder that controls the muscles in his arm c. Early stages of a heart attack characterized by radiating arm pain d. Autoimmune disease affecting voluntary muscles in the shoulder and arm

In Person Sciatica This is a first-person account of a woman in her mid-40s living with sciatica. Twelve years ago I wouldn't have believed that reaching into a laundry basket could change my life. But in January 2009 the time had come. A few days earlier I had gotten my very first back pain after a long car ride. A google search directed me to apply ice for the first 48 hours and then heat if the pain persisted. My husband took care of the children's school life while I recovered. On that third morning, I could hear my younger son rummaging around for his favorite sweatshirt; I knew it was at the foot of my bed, waiting to be sorted. The moment it lasted

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As I reached into the laundry basket for this sweatshirt, my back went from a dull ache to a debilitating ache radiating down my left leg to the tip of my left foot. An MRI scan confirmed the diagnosis: herniated disc protruding onto the nerve roots of the sciatic nerve and causing my leg pain. With surgery as a last resort, I began a crash course in physical therapy, NSAIDs, oral steroids, muscle relaxants, epidural steroid injections, and lots and lots of patience. I saw gradual improvement for about three months to the point that I was able to resume a modified daily routine. Then the improvement stopped. Conventional treatment had taken its course. I was in the "last resort" phase. So I called "uncle" and asked for a surgical consultation. The surgeon ordered a follow-up MRI, which showed good news: the herniation had greatly improved. To my surprise, the MRI also showed that the nerve roots supplying the sciatic nerve were now free and impingement free. If the nerve was back to normal, why was I still in such pain? Because it turns out that the nerve was injured by his ordeal. Not unusual, I was reassured. This development took the surgical option off the table. After all, the aim of the operation would have been to relieve the affected nerve from the compression caused by the herniated disc. In my case even the relieved nerve caused problems and that meant no surgery but more patience. The wait began: to see if the nerve would repair itself - I was told it could take years - or worse, if I was facing permanent nerve damage. Three years later, the verdict seems clear: My sciatic nerve has suffered what appears to be permanent damage. To date, I have not fully recovered my left leg. In addition to chronic, dull pain, there is also paresthesia – simultaneous burning and numbness along the sciatic nerve, accompanied by constant involuntary muscle spasms. I've lost my Achilles jerk reflex and my left foot is so unresponsive that I don't feel it touching the ground when I walk. During those critical first few months, I thought my options were to fix the hernia with either surgery or no surgery. It never occurred to me that four years later the injury would remain unresolved. There's always a new treatment, specialist, or drug that shows promise or that has really worked for a friend of a friend. Until recently it felt like I was giving up hope if I didn't follow every lead. Now I'm more focused on adjusting to my new circumstances than on finding a "cure." I don't want my whole life to revolve around sciatica. I've found a medication that reduces chronic pain to a nuisance rather than a crisis (with occasional flare-ups).

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I missed my old life and wanted it back. At the risk of sounding like a nightly drug ad, I'm not giving up; I will continue. AUTHOR'S NOTE Every experience of sciatica is unique. I have also experienced the condition that results from a L4-L5 disc herniation. After 7 months of pain radiating into my right leg I had a microdiscectomy surgery which luckily relieved my pain and sciatica.

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Exercises Remember to check your answers carefully against the Answers to Exercises, page 364.

A Match the listed neurological structures to the following descriptions/definitions. Astrocytes Axon Cauda equina Cerebral cortex Dendrite Meninges Myelin sheath Neuron Oligodendroglial cell Plexus 1. Microscopic fiber leading from the cell body and directing nerve impulse along a nerve cell ____________________ 2. Large, intertwined nerve network ___________ 3. Three protective membranes surrounding the brain and spinal cord ____________________ 4. microscopic, branching fiber of a nerve cell, which is the first part to receive the nerve impulse ____________________ 5. outer region of most of the brain; from Grauma he _______________________

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6. Glial cell that transports water and salts between capillaries and nerve cells of the second lumbar vertebra _________________________ 10. fa y Tissue surrounding the axon of a nerve cell _________________________ B Give the meaning of the following terms. 1. Dura mater ____________________ 2. Central nervous system ____________________ 3. Peripheral nervous system ____________________ 4. Arachnoid ____________________ 5. Hypothalamus ____________________ 6. Synapse ___________ 7. Sympathetic nerves ___________ 8. Medulla oblongata ___________ 9. Pons _________ 1.______ 1.______ 1.______ 1. Pons __________ Thalamus ____________________ 12. Ventricles of the brain ___________ 13. Brainstem ____________________ 14. Cerebrum ____________________ 15. Ganglion _________________________

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C Match the following terms to the meanings below or related terms. Glial cells Gyri Motor nerves Neurotransmitters Parenchymal cells Pia mater Sensory nerves Subarachnoid space Sulci 1. Innermost meningeal membrane _____________________________ 2. Carrying messages away from the (eﬀerent) brain and spinal cord to muscles and glands ___________________ 3. Messages to (aﬀerent) the brain and spinal cord from receptors ______________________ 4 Grooves in the cerebral cortex _______________ 5. Contains CSF _______________ 6. Bumps in the cerebral cortex ___________________________ 7. Chemical released at the end of a nerve cell that stimulates or inhibits another cell (eg: acetylcholine) _____________________________ 8. Essential cell of the nervous system; a neuron _____________________________

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9. Connective and supporting tissue (stroma) _____________________________ D Circle the correct bold term for the definition given. 1. Disease of the brain (encephalopathy, myelopathy) 2. Part of the brain that controls muscular coordination and balance (cerebrum, cerebellum) 3. Collection of blood above the dura mater (subdural hematoma, epidural hematoma) 4. Inflammation of the pia and arachnoid membrane (leptomeningitis , causalgia) 5. State of absence of a brain (hypalgesia, anencephaly) 6. Inflammation of the gray skin of the spinal cord (poliomyelitis, polyneuritis) 7. Affects the membranes around the brain and spinal cord (cerebellopontine pons, meninges) 8. Disease of the nerve roots (the spinal nerves ) (neuropathy, radiculopathy) 9. Hernia of the spinal cord and meninges (myelomeningocele, meningioma) 10. Concerning the tenth cranial nerve (thalamic, vagal) E Give the meaning of the following terms. 1. Cerebral cortex _____________________________________________ ________________________ 2. Intrathecal _____________________________________________ ________________________

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3. Polyneuritis _____________________________________________ ________________________ 4. Thalamus _____________________________________________ __________ 5. Myelopathy _____________________________________________ _________ 6. Meningioma ________________________________________ __________ 7. Glioma _____________________________________________ _________ 8. Subdural hematoma _____________________________________________ ____________________ F Match the listed neurological symptoms to the following definitions/descriptions. Aphasia Ataxia Bradykinesia Causalgia Dyslexia Hemiparesis Hyperesthesia Motor apraxia Narcolepsy Neurasthenia

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paraplegia syncope 1. Reading disorder ________________________________ 2. State of decreased coordination ________________________________ 3. State of slow movement ________________________________ 4. State of heightened sensation ________________________________ 5. Sleep attack; uncontrollable urge to sleep ________________________________ 6. Difficulty speaking ________________________________ 7. Inability to perform a task ________________________________ 8. Weakness in the right or left side of the body ________________________________ 9. Severe burning pain from nerve injury ________________________________ 10. Paralysis in the lower part of the body ________________________________ 11. Fainting ________________________________ 12. Nervous Fatigue (lack of strength) and tiredness ________________________________ G Give the meaning of the following terms. 1. Analgesia __________________________________________ ___________________________

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2. motor aphasia _____________________________________________ _______________________ 3. paresis _____________________________________________ ____________________________ 4. quadriplegia _____________________________________________ _________________________ 5. asthenia _____________________________________________ _____________________________ 6. comatose _____________________________________________ __________________________ 7. paresthesia _____________________________________________ __________________________ 8. hyperkinesis _____________________________________________ _________________________ 9. anesthesia _____________________________________________ __________________________ 10. causalgia _____________________________________________ ___________________________ 11. akinetic _____________________________________________ _____________________________

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12. Hypalgesia _____________________________________________ ___________________________ 13. Dyskinesia _____________________________________________ ___________________________ 14. Migraine _____________________________________________ ___________________________ H Match the listed neurological pathological terms to the following descriptions. The terms in bold are hints! Alzheimer's disease Amyotrophic lateral sclerosis Bell's palsy Epilepsy Huntington's disease Hydrocephalus Multiple sclerosis Myasthenia gravis Parkinson's disease Myelomeningocele The spine is imperfectly connected (a vertebra splits) and part of the meninges and

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Spinal cord may erupt from spinal cavity: ________________________________ 4. Atrophy of muscles and paralysis from damage to motor neurons in spinal cord and brainstem: ________________________________ 5. Patient exhibits bizarre, abrupt, involuntary, dancing movements and decrease in mental function: ________________________________ 6. CSF accumulation in the head (in the ventricles of the brain): _________________ 7. Loss of muscle strength due to the inability of a neurotransmitter (acetylcholine) to transmit impulses from nerve cells to muscle cells: ________________________________ 8. Degeneration of the nerves in the basal ganglia, which occurs later in life and to tremors, shuffling gait and muscle stiffness; Lack of dopamine (neurotransmitter) in the brain: ________________________________ 9. Deterioration of mental performance (dementia); Autopsy shows cerebral cortical atrophy, cerebral sulci dilatation, and microscopic neurofibrillary tangles: ________________________________ 10. Unilateral facial palsy: ________________________________ I Give the meaning of the following terms for abnormal conditions. 1. Astrocytoma _____________________________________________ ________________________

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2. Pyogenic Meningitis _____________________________________________ _________________ 3. Toure-e Syndrome _____________________________________________ ___________________ 4. Contusion of the brain ___________________________________ _____ 5. Stroke _____________________________________________ ___________ 6. Concussion _____________________________________________ _________________ 7. Herpes zoster ________________________________ ___________ 8. Brain embolus _____________________________________________ ___________________ 9. Brain embolism _____________________________________________ ___________________ 9. Brain embolism _____________________________________________ ___________________ . Cerebral hemorrhage ______________________________________________ _________________ 11. Cerebral aneurysm _____________________________________________ _____

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12. HIV encephalopathy _____________________________________________ __________________ J Match the term in column I to the wording of its description or meaning in column II. COLUMN I 1. Ataxia 2. Aura 3. Transient ischemic Ack 4. Tonic-clonic seizure 5. Herpes zoster 6. Palliative 7. Dopamine 8. Occlusion 9. Absence seizure 10. Glioblastoma multiforme

_______ _______ _______ _______ _______ _______ _______ _______ _______ _______

COLUMN II A. palliative but not curative B. virus causing chickenpox and shingles C. uncoordinated gait D. neurotransmitter E. particular sensation experienced by patient before seizure begins F. malignant brain tumor of immature glial cells G. major epileptic seizure; ictal event H. cessation of blood flow to the brain for a short period of time I. mild epileptic seizure J. blockage

K Describe what happens in the following two methods. 1. Brain MRI: _____________________________________________ ______________________ 2. Gamma Knife Stereotactic Radiosurgery: ____________________________________________________ ___________________________________________ ___________________________________________ L Match these easily confused neurological pathology terms to the following meanings/descriptions. Analgesia Anesthesia Aphasia Apraxia Ataxia

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Dyskinesia Dyslexia Hyperkinesia Neurasthenia Paresis Paresthesia 1. Lack of nerve strength __________________________ 2. Inability to speak ____________________ 3. Inability to perform purposeful actions ___________ 4. State of insensitivity to pain ___________ 5. State of loss of feeling ___________ 6. Tingling, numbness, or "tingling" ____________________ 7. Lack of coordination ___________ 8. Excessive movement __________________________ 9. Abnormal, involuntary, convulsive movements ____________________ 10. Developmental disability in reading ___________ 11. Partial paralysis ____________________ M Write the abbreviations in column I, and then choose the letter with the best association in each one column II.

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SPALTE I 1. EEG ________________ 2. PET ________________ 3. AFP ________________ 4. MS ________________ 5. MRT ________________ 6. LP _________________ 7. CVA ________________ 8. AD _________________ 9. TIA _________________ 10. Liquor ________________

_______ _______ _______ _______ _______ _______ _______ _______ _______

COLUMN II A. Gradually progressive dementia. B. stroke; Embolus, hemorrhage and thrombosis are etiological factors. C. Intrathecal drugs can be administered by this method. D. This fluid is analyzed for abnormal blood cells, chemicals, and proteins. E. Methods for diagnosing abnormal electrical activity in the brain. F. Neurological symptoms and/or signs due to a temporary disturbance in the blood supply to the brain. G. High concentrations in amniotic fluid and maternal blood are associated with spina biﬁda. H. Diagnostic method that provides excellent visualization of soft tissues in the brain. I. Radioactive materials such as glucose are picked up by the brain and images are recorded. J. Destruction of the myelin sheath in the CNS occurs with plaques of hard scar tissue.

_______

N Circle the words in bold that complete the meaning of the sentences. 1. Maria had such a bad headache that she could only find relief with strong painkillers. Her condition (spina biﬁda, migraines, epilepsy) was debilitating. 2. Paul was in a coma after his high-speed car accident. His doctors were concerned that he had suffered an (paralysis, myelomeningocele, contusion and subdural hematoma) as a result of the accident. 3. Dick went to the emergency room complaining of dizziness, nausea, and a headache. The doctor suspected an elevated ICP, prescribed corticosteroids, and Dick's symptoms went away. However, they returned when the steroids were stopped. A/an (brain MRI, electroencephalogram, CSF analysis) showed a large brain lesion. It has been removed

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surgical and determined as a/an (embolus, glioblastoma multiforme, migraine). 4. Dorothy felt weakness in her hand and numbness in her arm and noticed blurred vision, all signs of (herpes zoster, meningitis, TIA). Her doctor requested (myelography, MRA, spinal tap) to assess damage to cerebral blood vessels and possible stroke. 5. When Bill noticed ptosis and muscle weakness on his face, he reported these symptoms to his doctor. The doctor diagnosed his condition as (Toure's Syndrome, Huntington's Disease, Myasthenia Gravis) and prescribed (dopamine, anticonvulsants, anticholinesterase drugs) which relieved his symptoms. 6. To rule out bacterial diseases (epilepsy, encephalomalacia, meningitis), Dr. Phillips, a pediatrician, that a (EEG, PET scan, LP) be performed on the febrile (febrile) child. 7. Eight-year-old Barry was turning his letters around and had trouble learning to read and write words. His family doctor diagnosed his problem as (aphasia, dyslexia, ataxia). 8. After his head hit the steering wheel in a recent car accident, Clark noticed (hemiparesis, paraplegia, hyperesthesia) on the left side of his body. A CT scan of the head revealed (narcolepsy, neurasthenia, subdural hematoma). 9. For her 35th birthday, Elizabeth's husband threw her a surprise party. She was so startled by the crowd that she felt muscle weakness and unconsciousness. Friends put them on

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her back in a horizontal position with her head down to improve blood flow to her brain. She soon recovered from her (myoneural, syncopal, hyperkinetic) episode. 10. Nearing his 65th birthday, Edward was having trouble remembering recent events. Over the next 5 years he developed (dyslexia, dementia, seizures) and was diagnosed (multiple sclerosis, myasthenia gravis, Alzheimer's disease). 11. The elderly Mrs Smith had been on an antipsychotic medication for 5 years when she began lip smacking and tongue flicking. Her doctor described her condition as (radiculitis, tardive dyskinesia, hemiparesis) and discontinued her medication. The condition acquired after taking the drug is taken into account (iatrogenic, congenital, ictal). O Complete the spelling of the following terms according to their meaning. 1. Part of the brain that controls sleep, appetite, temperature, and pituitary secretions: Hypo _____________________________________________ ___ 2. Fainting Concerning: syn _____________________________________________ ___ 3. Abnormal tingling: Par ___________________________ 4. Mild paralysis: Par _____________________________________________

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________ 5. Inflammation of a spinal nerve root: _____________________________________________ __ Inflammation 6. Inability to speak properly: a _____________________________________________ _ 7. Movements and behaviors that are not purposeful: a _______________________ 8. Lack of muscular coordination: a _____________________________________________ _________ 9. Reading disorder: dys _____________________________________________ ______ 10. Excessive movement: hyper _____________________________________________ _____________ 11. Paralysis in one side of the body (right or left): ___________________ Plegia 12. Paralysis in the lower half of the body: _________________________ Plegia 13. Paralysis in all four limbs: _____________________________________________ _____ Plegia 14. Nervous exhaustion and fatigue : new _____________________________

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Solutions to tasks A 1. Axon 2. Plexus 3. Meninges 4. Dendrites 5. Cerebral cortex 6. Astrocytes 7. Oligodendroglial cell 8. Neuron 9. Cauda equina 10. Myelin sheath B 1. Outermost meningeal layer, which surrounds the brain and spinal cord 2. Brain and spinal cord 3. Nerves outside the brain and spinal cord; cranial, spinal cord and autonomic nerves 4. middle meningeal membrane surrounding the brain and spinal cord 5. part of the brain below the thalamus; controls sleep, appetite, body temperature and secretions from the pituitary gland

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6. Space through which a nerve impulse is transmitted from one nerve cell to another nerve cell or to a muscle or gland cell 7. Autonomic nerves, which involuntarily influence bodily functions under stress 8. Part of the brain just above the spinal cord that controls breathing, the heartbeat and controls the size of the blood vessels 9. part of the brain in front of the cerebellum and between the medulla and the upper parts of the brain; connects these parts of the brain 10. posterior part of the brain that coordinates voluntary muscle movements 11. part of the brain below the cerebrum; Relay center that transmits impulses between the spinal cord and the cerebrum 12. Canals inside the brain that are filled with CSF 13. Lower part of the brain that connects the cerebrum to the spinal cord (including the pons and medulla) 14 . largest part of the brain; controls voluntary muscle movements, vision, speech, hearing, thinking, memory 15. Cluster of nerve cell bodies outside the brain and spinal cord C 1. Pia mater 2. Motor nerves

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3. Sensory nerves 4. Sulci 5. Subarachnoid space 6. Gyri 7. Neurotransmitters 8. Parenchymal cells 9. Glial cells D 1. Encephalopathy 2. Cerebellum 3. Epidural hematoma 4. Leptomeningitis 5. Anencephaly 6. Poliomyelitis 7. Meningeus 8 1. Radiculopathy 9 Myelomeningocele 10. Vagus E 1. Outer region of cerebrum (contains gray skin) 2. Within a sheath through the meninges and into the subarachnoid space 3. Inflammation of many nerves

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4. Thalamus related 5. Spinal cord disease 6. Meningeal tumor 7. Neuroglial cell tumor (a brain tumor) 8. Blood mass below the dura mater (outermost meninges) F 1. Dyslexia 2. Ataxia 3. Bradykinesia 4. Hyperesthesia 5. Narcolepsy 6 Aphasia 7. Motor apraxia 8. Hemiparesis 9. Causalgia 10. Paraplegia 11. Syncope 12. Neurasthenia but can understand speech and knows what she or he wants to say)

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3. Weakness and partial loss of movement 4. Paralysis in all four extremities (damage to the cervical part of the spinal cord) 5. Weakness (weakness) 6. Associated with coma (unconsciousness from which the patient cannot be awakened). ) 7. Condition with abnormal sensations (tingling, tingling, burning) 8. Excessive movement 9. Condition without sensation or nervous feeling 10. Severe burning pain from injury to peripheral nerves 11. Related to immobility 12. Decreased sensation of pain 13 Impaired ability to perform voluntary movements 14. Recurrent vascular headache with severe pain onset on one side and photophobia (sensitivity to light) 7. Myasthenia gravis

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8. Parkinson's disease 9. Alzheimer's disease 10. Bell's palsy I 1. Neuroglial brain cell (astrocytic) tumor 2. Meningitis (bacterial infection with pus formation) 3. Involuntary spasmodic, twitching movements (tics), uncontrollable vocalizations, and inappropriate words 4. Bruising of brain tissue as a result of direct trauma to the head 5. Disturbance of the normal blood supply to the brain; stroke or cerebral infarction 6. Traumatic brain injury caused by a blow to the head 7. Neurological disease caused by infection with the herpes zoster virus; Bubbles form along peripheral nerves 8. Blockage of a blood vessel in the cerebrum caused by material from another part of the body suddenly occluding the vessel 9. Blockage of a blood vessel in the cerebrum caused by a clot forming inside the vessel 10. Blood pooling in the brain (can cause a stroke) 11. Enlargement of a blood vessel (artery) in the cerebrum; the aneurysm can rupture and lead to a CVA

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12. Brain disease (dementia and encephalitis) caused by infection with AIDS virus J 1. C 2. E 3. H 4. G 5. B 6. A 7. D 8. J 9. I 10. F K 1. Use of magnetic waves to create an image (in frontal, transverse, or sagittal plane) of the brain 2. an instrument (stereotactic) is attached to the skull and locates a target by three-dimensional measurement; Gamma radiation or proton beams are used to treat deep brain lesions L 1. Neurasthenia 2. Aphasia 3. Apraxia

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4. Analgesia 5. Anesthesia 6. Paraesthesia 7. Ataxia 8. Hyperkinesia 9. Dyskinesia 10. Dyslexia 11. Paresis M 1. Electroencephalography: E 2. Positron Emission Tomography: I 3. Alpha-Fetoprotein: G 4. Multiple Sclerosis : J 5. Magnetic resonance imaging: H 6. Lumbar puncture: C 7. Stroke: B 8. Alzheimer's disease: A 9. Transient ischemic attack: F 10. CSF: D N 1. Migraine 2. Contusion and subdural hematoma 3. MRI of brain; glioblastoma multiforme

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4. TIA; MRA 5. Myasthenia gravis; Anticholinesterase drugs 6. Meningitis; LP 7. Dyslexia 8. Hemiparesis; Subdural hematoma 9. Syncope 10. Dementia; Alzheimer's disease 11. tardive dyskinesia; iatrogenes O 1. Hypothalamus 2. Syncope 3. Paresthesia 4. Paresis 5. Radiculitis 6. Aphasia 7. Apraxia 8. Ataxia 9. Dyslexia 10. Hyperkinesis 11. Hemiplegia 12. Paraplegia 13. Tetraplegia 14. Neurasthenia

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Answers to practical applications Case report: cerebral infarction

1st c 2nd a 3rd c 4th c 5th a Neuropathic pain and case study

1. d 2. c 3. b Pronunciation of terms

Vocabulary and combining forms and terminology

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BEGRIFF Acetylcholin aﬀerente Nerven Akinetische Analgesie Anenzephalie Anästhesie Aphasie Apraxie Arachnoidalmembran Astrozyten Ataxie Autonomes Nervensystem Axon Blut-Hirn-Schranke Bradykinesie Hirnstamm Cauda Equina Kausalgie Zellkörper Zentralnervensystem Kephalgie Kleinhirn Kleinhirnbrücke Kleinhirn Großhirnrinde Kleinhirn-Rückenmarksflüssigkeit Kleinhirn Koma Koma Komatose Hirnnerven eﬀerente Nerven Enzephalitis Enzephalopathie Ependymzelle Epiduralhämatom Ganglion; Pl. ganglia, glial cells, glioblastoma, gyrus; Pl. Gyri Hemiparesis Hemiplegia Hypalgesia Hyperaesthesia Hyperkinesis Hypothalamus Intrathecal injection Leptomeningitis Medulla oblongata

AUSKUNFT a-seh-til-KO-leen AH-fer-ent nervz a-kih-NET-ik ah-nal-JE-ze-ah an-en-SEH-fah-le an-es-THE-ze-ah ah-FA-ze-ah a-PRAK-se-ah ah-RAK-noyd MEM-brayn AS-tro-site a-TAK-se-ah aw-to-NOM-ik NER-vus SIS-tem AKS-on Blut-BRAYN BAH-re-er bra-de-kih-NE-se-ah BRAYN-Stamm KAW-dah eh-KWI-nah kaw-ZAL-jah sel BOD-e SEN-tral NER-vus SIS-tem seh- FAL-jah siehe-reh-BEL-ar siehe-reh-bel-o-PON-teen siehe-reh-BEL-um siehe-RE-bral KOR-text siehe-re-bro-SPI-nal FLU-id siehe- RE-brum KO-mah KO-mah-tohs KRA-ne-al nervz DEN-drite DUR-ah MAH-ter dis-kih-NE-ze-ah dis-LEK-se-ah EH-fer-ent nervz en- seh-fah-LI-tis en-seh-fah-LOP-ah-der eh-PEN-dih-mal sel ep-eh-DU-ral he-mah-TO-mah GANG-le-on; GANG-le-ah GLE-al sel gli-o-blah-STO-mah JI-rus; JI-re hem-e-pah-RE-sis hem-e-PLE-jah hi-pal-GE-ze-ah hi-per-es-THE-ze-ah hi-per-kih-NE-sis hi- po-THAL-ah-mus in-trah-THE-kal in-JEK-meiden lep-zu-Menschen-in-JE-al meh-DUL-ah ob-lon-GAH-tah

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BEGRIFF Meningeale Meningen Meningiom Mikrogliazelle Motorischer Nerv des Mittelhirns Myelinscheide Myelomeningozele Myelopathie Myoneuraler Narkolepsienerv Neuralgie Neurasthenie Neurogliazellen Neuron Neuropathie Neurotransmi er Oligodendrogliazelle Paraplegie Parasympathische Nerven Parenchymparese Parästhesie Peripheres Nervensystem Pia mater plexus Poliomyelitis Polyneuritis Pons Quadriplegie Radikulitis Nervus ciaticis Radikulitis Spinalnerven-Stimulus-Stroma subdurales Hämatom Sulcus; Pl. sulci sympathetic synapse syncope syncope thalamus thalamus trigeminal neuralgia vagus vagus nerve ventricles of the brain

AUSKUNFT meh-NIN-je-al meh-NIN-jeez meh-nin-je-O-mah mi-kro-GLE-al Zelle MID-Brayn MO-ter Nerve MI-eh-lin Scheide mi-eh-lo-meh -NIN-jo-seel mi-el-OP-ah-die mi-o-NUR-al NAR-ko-lep-se nerv nu-RAL-jah nu-ras-THE-ne-ah nu-ro-GLE- al selz NU-ron nu-ROP-ah-der nu-ro-TRANZ-mit-er ol-ih-go-den-dro-GLE-al sel par-ah-PLE-jah par-ah-sim-pah- THET-ik nervz pah-REN-kih-mah pah-RE-sis pah-res-THE-ze-ah peh-RIF-er-al NER-vus SIS-tem PE-ah MAH-ter PLEK-sus po-le -o-mi-eh-LI-tis pol-e-nu-RI-tis ponz kwod-rih-PLE-jah rah-right-u-LI-tis rah-right-u-LOP-ah-the re-SEPT -or si-AH-tik Nerve si-AH-tih-kah SEN-sor-e Nerve SPI-nal nervz STIM-u-lus STRO-mah sub-DU-ral he-mah-TO-mah SUL-kus; SUL-si sim-pah-THET-ik nervz SIN-aps SIN-ko-pal SIN-ko-pe THAL-ah-mik THAL-ah-mus tri-JEM-in-al nu-RAL-jah VA-gal VA -gus Nerve VEN-three-cols of the Gehirns

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pathology, laboratory tests and clinical procedures

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TERM Absence Anfall Alzheimer-Krankheit Amyotrophe Lateralsklerose Aneurysma Astrozytom Aura Bell-Lähmung Hirntumor Zerebrale Angiographie Gehirnerschütterung Gehirnkontusion Zerebrale Blutung Zerebralparese Zerebrospinalﬂüssigkeitsanalyse Zerebrovaskulärer Unfall Computertomographie Demenz Demyelinisierung Dopamin Doppler/Ultraschalluntersuchungen Elektroenzephalographie Embolus Epilepsie Gangart Glioblastom Herpes Zosterkrankheit HIV-Erkrankung Hydrozephalus Iktusereignis Lumbalpunktion Magnetresonanztomographie Meningitis Meningozele Migräne Multiple sclerosis myasthenia gravis occlusion palliative paralysis Parkinson's disease positron emission tomography shingles spina biﬁda stereotactic radiosurgery thrombus tic tonic-clonic seizure Touree syndrome transient ischemic ack

AUSKUNFT AB-sens SE-zhur ALZ-hi-mer dih-ZEEZ a-mi-o-TRO-fik LAH-ter-al skleh-RO-sis AN-ur-ih-zim as-tro-si-TO-mah AW-rah bel PAWL-ze BRAYN TU-mor seh-RE-bral an-je-OG-rah-fe seh-RE-bral kon-KUH-shun seh-RE-bral kon-TU-shun seh-RE-bral HEM-oder-ij seh-RE-bral PAWL-ze seh-re-bro-SPI-nal FLU-id ah-NAH-lih-sis seh-re-bro-VAS-cu-lar AK-sih-dent com- PU-ted to-MOG-rah-fe de-MEN-she-ah de-mi-eh-lih-NA-shun DO-pah-meen DOP-ler / UL-trah-sound STUD-eez eh-lek-tro -en-sef-al-OG-rah-fe EM-bo-lus EP-ih-lep-se Tor gle-o-blah-STO-mah HER-peez ZOS-ter HIV en-seh-fal-OP-ah -the HUN-thing-ton dih-ZEEZ hi-dro-SEH-fah-lus IK-tal e-VENT LUM-bar PUNK-shur mag-NET-ik REH-zo-nants IM-aj-ing meh-nin- JI-tis meh-NIN-jo-seel MI-grane MUL-das-jenseits skleh-RO-sis mi-as-THE-ne-ah GRAV-ist o-KLU-zhun PAH-le-ah-tiv PAWL-ze PAR-kin-sun dih-ZEEZ POS-ih-tron e-MIH-shun to-MOG-rah-fe SHING-ulz SPI-na BIF-ih-dah steh-re-o-TAK-tik ra-de-o -SUR-jer-e THROM-Bus TIK TON-ik-CLONE-ik SE-zhur tur-ET SIN-drohm TRAN-ze-ent ih-S KE eyes ah- REAL

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evaluation sheet

Write the meaning of the parts of the word in the spaces provided. Check your answers against the information in the chapter or glossary (Medical Word Parts – English) at the end of the book.

Kombinierende Formen KOMBINIERENDE FORM alges/o angi/o caus/o cephal/o cerebell/o cerebr/o comat/o crani/o cry/o dur/o encephal/o ästhesi/o gli/o hydr/o kines/o, kinesi/o lept/o lex/o mening/o, meningi/o my/o myel/o narc/o neur/o olig/o pont/o radicul/o spin/o syncop/o tax/o thalam/o thec /o troph/o vag/o

prefixes

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PREFIX a-, andysepihemihyperhypointramicroparapoliopolyquadrisub-

Suffixe SUFFIX -algesia -algia -blast -cele -Aesthetic -gram -graphy -ine -itis -kinesia, -kinesis -kinetic -lepsy -oma -ose -paresis -pathy -phagia -phasia -plegia -praxia -ptosis -sclerosis - sthenia-tomy-trophy

Match the neurological pathology terms and abbreviations in column I to the descriptions/definitions in column II.

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SPALTE I 1. Alzheimer 2. ALS 3. Epilepsie 4. MS 5. Parkinson 6. Herpes zoster 7. Glioblastoma multiforme

______ ______ ______ ______ ______ ______ ______

8. CV

______

COLUMN II A. Destruction of myelin sheath on neurons in CNS B. Stroke; disturbance of the normal blood supply to the brain C. shingles; viral infection affecting peripheral nerves D. progressive dementia; memory error; senile plaques and neurofibrillary tangles E. Brain tumor; malignant astrocytoma F. Degeneration of neurons in basal ganglia; tremors, bradykinesia and shuffling gait G. Recurrent seizure disorders; tonic-clonic and absence types H. Motor neuron degeneration in the spinal cord and brainstem; weakness and muscle atrophy

Books on Neurology The following list of books may be of interest to you. They deal with fictional characters or actual people coping with neurological disorders. Oliver Sacks, MD, the late professor of neurology at the NYU School of Medicine, has written extensively on neurological case histories, including The Man Who Mistaken His Wife for a Hat. Please contact me with your comments and other suggestions for a good read!

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Alzheimer's Disease Still Alice by Lisa Genova (story of a woman and her family who understands and deals with early Alzheimer's; also made into a film). Elegy for Iris by John Bayley (writer Iris Murdoch's story; written by her husband, who becomes her caretaker). Amyotrophic Lateral Sclerosis I Want to Live: A Journey Through Life with ALS by William Sinton (a story of coping with this disease). Tuesdays with Morrie by Mitch Albom (written by a student who spends time with his former teacher and learns valuable life lessons). Cerebral Palsy My Left Foot by Christy Brown (Brown was born in Dublin with cerebral palsy and this is his autobiography which was later made into a film). Epilepsy The Spirit Catches You and You Fall Down by Anne Fadiman (History of the Hmong people and how they deal with epilepsy after coming to the United States). The Spiral Staircase: My Climb out of Darkness by Karen Armstrong (how author Karen Armstrong deals with temporal lobe epilepsy). The Idiot by Fyodor Dostoevsky (Russian novel whose main character Prince Myshkin suffers from epilepsy like Dostoevsky himself). Huntington Disease Saturday by Ian McEwan (a novel whose main character has the disease). Parkinson's Disease Life in the Balance by Thomas Graboys with Peter Zheutlin (memoir by Graboys, a prominent Boston cardiologist who studies the disease). Stroke My Stroke of Insight by Jill Brotle Taylor, PhD (a brain researcher who had a stroke at age 37 writes about it). The Diving Bell and the Bu erfly by Jean-Dominque Bauby is the memoir of a 44-year-old man dealing with the effects of a rare stroke that left him paraplegic. His Mind is Unaffected (also filmed).

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CHAPTER 11

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Cardiovascular System CHAPTER SECTIONS: Introduction 374 Blood Vessels and Circulation 374 Anatomy of the Heart 378 Physiology of the Heart 381 Blood Pressure 382 Vocabulary 384 Terminology 385 Pathology: The Heart and Blood Vessels 388 Laboratory Tests and Clinical Procedures 401 Abbreviations 408 Practical Applications 410 Personal: Coronary Artery Bypass Graft -Operation 412 Exercises 413 Answers to the exercises 422 Pronunciation of terms 425 Summary sheet 429

CHAPTER OBJECTIVES • Name the parts of the heart and associated blood vessels and their circulatory functions. • Trace the path of blood through the heart. • Identify and describe major pathological conditions affecting the heart and blood vessels. • Define combinations that relate to the cardiovascular system.

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• Describe important laboratory tests and clinical procedures related to the cardiovascular system and identify relevant acronyms. • Apply your new knowledge to understand medical terms in their proper context, such as: B. in medical reports and records.

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Introduction Body cells depend on a constant supply of nutrients and oxygen. When the supplies are delivered and then chemically combined, they release the energy needed for each cell to work. How does the body ensure that all of its cells are supplied with oxygen and nutrition? The cardiovascular system, made up of the heart (a powerful muscular pump) and the blood vessels (fuel lines and transport network), does this important work. This chapter examines terminology related to the heart and blood vessels.

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Blood vessels and blood circulation Blood vessels There are three types of blood vessels in the body: arteries, veins and capillaries. Arteries are large blood vessels that carry blood away from the heart. Their walls are lined with connective tissue, muscle tissue, and elastic fibers, with an innermost layer of epithelial cells called the endothelium. Endothelial cells, found in all blood vessels, secrete factors that affect blood vessel size, reduce blood occlusion, and promote blood vessel growth. Because arteries carry blood away from the heart, they must be strong enough to withstand the high pressure of the heart's pumping action. Their elastic walls allow them to expand as the heartbeat pushes blood into arterial systems throughout the body. Smaller artery branches are arterioles. Arterioles are thinner than arteries and transport blood to the smallest blood vessels, the capillaries. Capillaries have walls only one endothelial cell thick. These fine, microscopic vessels carry nutrient-rich, oxygenated blood from the arteries and arterioles to the body's cells. Their thin walls allow the passage of oxygen and nutrients from the bloodstream into the cells. There, the nutrients are burned in the presence of oxygen (catabolism) to release energy. At the same time, waste products such as carbon dioxide and water enter the thin-walled capillaries from the cells. The blood, filled with waste, then flows back to the heart in small venules, which join to form larger vessels called veins. Veins have thinner walls compared to arteries. They carry blood (which has given up most of its oxygen) from the tissues to the heart. Veins have little elastic tissue and less connective tissue than is typical for arteries, and the blood pressure in the veins is extremely low compared to the pressure in the arteries. To keep blood flowing back to the heart, veins have valves that prevent blood from flowing backwards and allow blood to flow in one direction. Muscular activity also supports the movement of blood in the veins. Figure 11-1 illustrates the differences in blood vessels. Figure 11.2 gives an overview of their properties and their relationship to one another.

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Figure 11-1 Blood vessels. Observe the differences in wall thickness between an artery, a vein, and a capillary. All three vessels are lined with endothelium. Endothelial cells actively secrete substances that prevent clotting and regulate the tone of blood vessels. Examples of endothelial secretions are endothelium-derived relaxing factor (EDRF) and endothelin (a vasoconstrictor).

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Figure 11-2 Relationships and properties of blood vessels.

blood vessels and blood

What color is blood? Blood is bright red in the arteries (contains oxygen) and dark red (maroon) in the veins (contains carbon dioxide). From the outside, the blood in the veins appears blue because the color reflects off the skin. How much blood is in the body? The average adult has about 5 liters (4.7 liters) of blood in their body. How long are all blood vessels? The total length of all blood vessels in the body is 60,000 miles!

Blood Circulation Arteries, arterioles, veins, venules and capillaries, along with the heart, form a circulatory system for blood flow. Figure 11-3 is a more detailed representation of the entire circulatory system. Refer to it as you read the following paragraphs. (Note that the numbers in parentheses in the following sections correspond to those in Figure 11-3.)

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Figure 11-3 Schematic representation of the pulmonary circulation (blood flow from the heart to the pulmonary capillaries and back to the heart) and the systemic circulation (blood flow from the heart to the tissue capillaries and back to the heart).

On its way from the tissue capillaries to the heart, deoxygenated blood flows through two large veins, the vena cava [1]. The blood became deoxygenated at the tissue capillaries as oxygen left the blood and entered the body's cells. Deoxygenated blood enters the right side of the heart [2] and travels through that side into the pulmonary artery [3], a vessel that divides into two parts: one branch leads to the left lung and the other to the right lung. The arteries continue to divide and subdivide within the lungs, forming smaller and smaller vessels (arterioles) and finally reaching the pulmonary capillaries [4]. The pulmonary artery is unusual in that it is the only artery in the body that carries deoxygenated blood. When passing through the pulmonary capillaries (pulmonary capillaries), the blood picks up the oxygen that entered the body during inhalation. The newly oxygenated blood next returns immediately to the heart

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yg y g pulmonary veins [5]. The pulmonary veins are unusual in that they are the only veins in the body that carry oxygenated (oxygenated) blood. The circulation of blood through the vessels from the heart to the lungs and then back to the heart is the pulmonary circulation. Oxygen-rich blood enters the left side of the heart from the pulmonary veins [6]. The muscles on the left side of the heart pump blood out of the heart through the largest single artery in the body, the aorta [7]. The aorta first moves upwards (aorta ascendens), but then curves dorsally and runs downwards just before the spine (aorta descendens). The aorta divides into numerous branches called arteries [8], which transport oxygen-rich blood to all parts of the body. The names of some of these arterial branches will be familiar to you. The carotid arteries supply blood to the head and neck. Axillary, brachial (brachi/o means arm), splenic, and renal arteries are examples of arteries branching off the aorta. The relatively large arterial vessels branch further into smaller arterioles [9]. The arterioles, which still contain oxygen-rich blood, branch into smaller tissue capillaries [10] that are close to the body's cells. Oxygen leaves the blood and enters the body's cells through the thin capillary walls. There, food is broken down in the presence of oxygen and energy is released. This chemical process also releases carbon dioxide (CO2) as a waste product. Carbon dioxide exits the cell into the tissue capillaries while oxygen enters at the same time. Thus, the blood returning to the heart from tissue capillaries through venules [11] and veins [12] is filled with carbon dioxide but depleted of oxygen. When this deoxygenated blood enters the heart from the vena cava, the cycle completes. The blood path from the heart to the tissue capillaries and back to the heart is the systemic circulation. Figure 11-4 shows the aorta, selected arteries and pulse points. The pulse is the heartbeat that can be felt through the walls of the arteries.

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Figure 11.4 Aorta and arteries. Solid gold dots indicate pulse points in arteries. These are areas where the pulse expansion and contraction of a superficial artery can be felt.

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Heart Anatomy The human heart weighs less than a pound (300-450 grams), is about the size of an adult fist, and is located in the chest cavity, just behind the breastbone in the mediastinum (between the lungs). The heart is a pump made up of four chambers: two upper chambers called atria (singular: atrium) and two lower chambers called ventricles. It's actually a double pump attached to one organ and synchronized very carefully. Blood flows through each pump in a specific pattern. Pumping station number one, on the right side of the heart, sends deoxygenated blood to the lungs, where the blood picks up oxygen and releases its carbon dioxide. The newly oxygenated blood returns to the left side of the heart to pump station number two and does not mix with the deoxygenated blood in pump station number one. Pump station number two then pushes the oxygen-rich blood to all parts of the body. At the tissues of the body, the blood loses its oxygen, and on returning to the heart, to pumping station number one, deoxygenated (high-carbon dioxide) blood is sent to the lungs to begin the cycle again. Label Figure 11-5 as you learn the names of the parts of the heart and the vessels that carry blood to and from it.

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Figure 11.5 Structure of the heart. Blue arrows indicate deoxygenated blood flow. Red arrows indicate oxygenated blood flow.

The two largest veins in the body, the venae cavae, carry deoxygenated blood to the heart. The superior vena cava [1] drains blood from the upper part of the body and the inferior vena cava [2] carries blood from the lower part of the body. The venae cavae bring deoxygenated blood that has flowed through the entire body into the right atrium [3], the thin-walled upper right chamber of the heart. The right atrium contracts to push blood through the tricuspid valve [4] (cusps are the flaps of the valves) into the right ventricle [5], the lower right chamber of the heart. The leaflets of the tricuspid valve form a unidirectional passage designed to allow blood to flow in only one direction. When the right ventricle contracts to pump

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deoxygenated blood through the pulmonary valve [6] into the pulmonary artery [7], the tricuspid valve remains closed, preventing blood from flowing back into the right atrium. The pulmonary artery then branches to carry deoxygenated blood to each lung. The blood entering the pulmonary capillaries from the pulmonary artery soon releases its large amount of carbon dioxide to the lung tissue, and the carbon dioxide is expelled. At the same time, oxygen enters the capillaries of the lungs and is transported back to the heart via the pulmonary veins [8]. The newly oxygenated blood travels from the pulmonary veins to the left atrium [9] of the heart. The walls of the left atrium contract to push blood through the mitral valve [10] into the left ventricle [11]. The left ventricle has the thickest walls of all four chambers of the heart (three times the wall thickness of the right ventricle). It has to pump blood with great force to get the blood through the arteries to all parts of the body. The left ventricle drives blood through the aortic valve [12] into the aorta [13], which branches to carry blood throughout the body. The aortic valve closes to prevent backflow of aortic blood into the left ventricle. Notice in Figure 11.6 that the four chambers of the heart are separated by partitions called septa (singular: septum). (Label Figure 116 as you read these paragraphs.) The interatrial septum [1] separates the two upper chambers (atria), and the interventricular septum [2], a muscular wall, lies between the two lower chambers (ventricles).

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Figure 11.6 The septa (heart walls) and the 3 layers of the heart. Note that the apex of the heart is the conical (shaped like a cone) bottom tip of the heart.

Figure 11.6 also shows the three layers of the heart. The endocardium [3], a smooth layer of endothelial cells, lines the interior of the heart and heart valves. The myocardium [4], the middle muscular layer of the heart wall, is its thickest layer. The pericardium [5], a fibrous and membranous sac, surrounds the heart. It consists of two layers, the visceral pericardium, which is attached to the heart, and the parietal (parietal means wall) pericardium, which lines the outer fibrous covering. The pericardial cavity (between the visceral and parietal layers of the pericardium) normally contains 10 to 15 mL of pericardial fluid, which lubricates the membranes when the heart beats. Figure 11.7 shows the path of blood through the heart.

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Figure 11.7 Path of blood through the heart.

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Physiology of the Heart Heartbeat and Heartbeats There are two phases of the heartbeat: diastole (relaxation) and systole (contraction). Diastole occurs when the ventricular walls relax and blood flows into the heart from the vena cava and the pulmonary veins. The tricuspid and mitral valves open in diastole when blood flows from the right and left atria into the ventricles. The pulmonary and aortic valves close at the onset of diastole. (Figure 11-8).

Figure 11.8 Phases of the heartbeat: diastole and systole. During diastole, the tricuspid and mitral valves are open as blood enters the ventricles. During systole, the pulmonary and aortic valves are open as blood is pumped into the pulmonary artery and aorta. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

Next, systole occurs when the walls of the right and left ventricles contract to pump blood into the pulmonary artery and aorta. Both the tricuspid and mitral valves are closed during systole, preventing backflow of blood into the atria (see Figure 11.8). This diastole-systole cardiac cycle occurs between 70 and 80 times a minute (100,000 times a day). The heart pumps about 3 ounces of blood with each contraction. This means that about 5 liters of blood are pumped through the heart in 1 minute (75 gallons per hour and about 2000 gallons per day). Closing of the heart valves is associated with audible sounds such as "lubb-dubb" which are heard with a when listening to a normal heart

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Stethoscope. The "lubb" is associated with the closing of the tricuspid and mitral valves at the beginning of systole, and the "dubb" with the closing of the aortic and pulmonary valves at the end of systole. The "lubb" sound is called the first heart sound (S1) and "dubb" the second heart sound (S2) because the normal cycle of the heartbeat begins with the onset of systole. Sometimes the flow of blood through the valves can create an abnormal murmur known as murmur.

Conduction system of the heart What keeps the heart in its perfect rhythm? Although the heart has nerves that affect its rate, they are not primarily responsible for its beat. The heart begins beating in the embryo before it is supplied with nerves and continues to beat in laboratory animals even when the nerve supply is interrupted. Label Figure 11-9 as you read the following. A small region of specialized muscle tissue at the back of the right atrium is primarily responsible for starting the heartbeat, where an electrical impulse is generated. This is the sinus node (SA node) or pacemaker [1] of the heart. The electrical current generated by the pacemaker causes the walls of the atria to contract and force blood into the ventricles.

Figure 11.9 Conduction system of the heart.

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Much like ripples in a pool of water, when a stone is thrown, the electrical wave travels from the pacemaker to another region of the myocardium. This region is within the interatrial septum and is the atrioventricular (AV) node [2]. The AV node immediately sends the excitation wave to a bundle of specialized muscle fibers called the atrioventricular bundle or bundle of His [3]. Within the interventricular septum, the bundle of His divides into the left bundle branch [4] and right bundle branch [5], which form the conduction fibers that extend through the ventricular walls and contract upon stimulation. Thus, systole occurs and blood is pumped away from the heart. There is a short period of rest, and then the pacemaker begins again with the excitation wave over the heart. The recording used to detect these electrical changes in the heart muscle during the heartbeat is an electrocardiogram (EKG or EKG). The normal EKG tracing shows five waves, or traces, that represent the electrical changes as an excitation wave propagates through the heart. The excursions are called P, QRS, and T waves. Figure 11-10 shows P, QRS, and T waves on a normal ECG trace.

FIGURE 11-10 Electrocardiogram. P wave = propagation of the excitation wave across the atria just before contraction; QRS wave = propagation of the excitation wave across the ventricles as the ventricles contract; T-wave = electrical recovery and relaxation of the ventricles. A heart attack or myocardial infarction (MI) can be detected by an increase in the ST segment of the electrocardiographic recording. Thus, one type of MI is ST elevation MI (STEMI).

The heart rhythm (which originates from the SA node and travels through the heart) is called normal sinus rhythm (NSR). speed of the sympathetic nerves

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Increase heart rate during emotional stress or intense physical activity. Parasympathetic nerves slow the heart rate when no additional pumping is required.

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Blood pressure Blood pressure is the force that blood exerts on the walls of the arteries. This pressure is measured with a sphygmomanometer (Figure 11-11).

Figure 11.11 Blood pressure measurement with sphygmomanometer and stethoscope.

The blood pressure monitor consists of a rubber bag in a fabric cuff that is wrapped around the upper arm just above the elbow. The rubber bag is inflated with air using a handball pump. As the bag is inflated, the pressure within it increases and is measured on a recorder attached to the cuff. The brachial artery in the upper arm is compressed by the air pressure in the bag. When the air pressure in the bag is enough to stop blood flow, the pulse in the forearm (where the observer listens with a stethoscope) drops. The bag is then deflated and the pressure is slowly released, allowing the blood to find its way through the gradually opening artery. At the point when the listener with the stethoscope first hears the sound of the heartbeat, the display on the device attached to the cuff shows the higher, systolic blood pressure (pressure in the artery when the left ventricle contracts to to force blood pressure). blood in the aorta and other arteries). The further air escapes, the louder the noise becomes. Finally, when there is a change in tone from loud to soft, the observer notes the pressure on the recording device. This is the diastolic

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Pressure (pressure in the artery as the ventricles relax and the heart fills and receives blood from the vena cava and pulmonary veins). Blood pressure is expressed as a fraction - for example 120/80 mmHg, where the top number (120) is the systolic pressure and the bottom number (80) is the diastolic pressure. A new guideline lowers the target for treating hypertension (high blood pressure) to 130/80. Both the systolic and diastolic components of high blood pressure are associated with an increased risk of heart attack and stroke.

vocabulary

This list repeats new terms introduced in the text. Brief definitions reinforce your understanding of the terms. See page 425 of this chapter for the pronunciation of terms.

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Aortic tip of the cardiac arteriolar artery

Largest artery in the body. Lower tip of the heart. small artery. Largest type of blood vessel; transports blood away from the heart to all parts of the body. Note that artery and away start with an "a". atrioventricular Specialized muscle fibers that connect the atria to the ventricles and bundle (bundles used to transmit electrical impulses between them. His is pronounced His) “hiss”. atrioventricular Specialized tissue in the wall between the atria. Electrical impulses are conducted from the cardiac pacemaker (SA node) through the AV node and the atrioventricular bundle or bundle of His to the ventricles. Atrium (plural: atria) One of the two upper chambers of the heart. Capillary Smallest type of blood vessel. Materials pass to and from the bloodstream through the thin capillary walls. Carbon dioxide Gas (waste gas) released by body cells and carried through the veins to the heart (CO2) and then to the lungs for exhalation. Carotid arteries Two common carotid arteries, located on each side of the neck, branch off the aorta and supply blood to the head, neck and brain. The word carotid comes from a Greek word meaning stupor because pressure on these arteries creates unconsciousness. Coronary arteries Blood vessels that branch off the main artery and carry oxygen-rich blood to the heart muscle. deoxygenated blood Blood that is deoxygenated. Diastole Relaxation phase of the heartbeat. (From Greek diastole, dilatation.) Electrocardiogram Recording of the electrical activity of the heart. Electricity is represented by waves or deflections called P, QRS or T. Endocardium Inner lining of the heart. Endothelium Innermost lining of blood vessels. Mitral valve Valve between left atrium and left ventricle; two-pointed flap. Hiss Abnormal hissing sound caused by improper closing of the heart valves. Myocardium The muscular middle layer of the heart. normal sinus cardiac rhythm originating in the sinus node with a rate of 60 to 100 beats per minute in rhythmic patients at rest. Oxygen Gas that enters the blood through the lungs and travels to the heart to be pumped through the arteries to all cells in the body. Pacemaker Specialized nerve tissue in the right atrium that triggers the heartbeat (sinus node). An artificial pacemaker is an electronic device implanted in the chest to stimulate a weak and non-functioning heart muscle. Pericardium Double-layered membrane that surrounds the heart. Pulmonary artery Artery that carries deoxygenated blood from the heart to the lungs. Lung Flow Blood flow from the heart to the lungs and back to the heart. Circulatory pulmonary valve Valve between the right ventricle and the pulmonary artery. Pulmonary vein One of two pairs of vessels that carry oxygen-rich blood from the lungs to the left atrium of the heart. Pulse Heartbeat that can be felt through the walls of the arteries. Septum (plural: partition or wall separating a cavity; e.g. between right and left septum), atrium (interatrial septum), and right and left ventricle (interventricular septum). Sinus node (SA pacemaker of the heart. node)

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Sphygmomanometer Instrument for measuring blood pressure. Systemic circulation Blood flow from body tissues to the heart and then from the heart back to the body tissues. Systole contraction phase of the heartbeat. (From the Greek systole, contraction.) Tricuspid valve Located between the right atrium and right ventricle; it has three (tri) leaflets or bumps. Valve Structure in veins or in the heart that temporarily closes an opening so blood only ﬂows in one direction. Vein Thin-walled vessel that carries blood from body tissues and lungs back to the heart. Veins contain valves to prevent backflow of blood. Vena cava (plural: Largest vein in the body. The superior and inferior vena cavae, venae cavae) return blood to the right atrium of the heart. Ventricle One of the two lower chambers of the heart. Venule Small vein.

Terminology

Write the meaning of the medical term in the space provided.

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COMBINING MEANING DESIGNATION MEANING SHAPE Angi/o Vessel Angiogram ________________________ Angioplasty ____________________________________ Aort/o Aorta Aortic Stenosis ___________________________________ Arter/o, Artery Arteriosclerosis ___________________________________ Arteri/o Arterial Anastomosis ___________________________________ From the Greek anastomosis, forming a mouth. Arteriography ___________________________________ Endarterectomy ___________________________________ See page 407. ather/o yellowish atheroma _______________________________________ plaque, fa y The suffix -oma means mass or accumulation. Atheromas are accumulations of substance from plaque that protrude into the lumen (opening) of (Greek an artery, weakening of the muscle lining. athere means atherosclerosis _________________________________ pulp). The main form of atherosclerosis are deposits of yellow plaques (atheromas) containing cholesterol and lipids found in the lining of the artery (Figure 11.12). Atherectomy _____________________________________ Atri/o Atrium, atrial __________________________________________ Superior heart Atrioventricular chamber __________________________________________ Brachi/o Arm Brachial artery __________________________________________ cardi/o Heart Cardiomegaly ________________________________ Cardiomyopathy _________________________________ One form of cardiomyopathy is hypertrophic cardiomyopathy — abnormal thickening of the heart muscle, usually in the left ventricle. The ventricles of the heart have to work harder to pump blood. The condition can be inherited or develop over time due to high blood pressure or aging. Often the cause is unknown (idiopathic). Bradycardia _____________________________________ Slower than 60 beats per minute. The normal heart rate is around 60,100 beats per minute. Brady- means slow. Tachycardia _____________________________________ Faster than 100 beats per minute. Supraventricular tachycardia (SVT) involves rapid beats that come from the atria (above the ventricles) and cause palpitations (abnormal sensations in the chest). Tachy- means fast. cardiogenic shock ________________________________ Resulting from a failure of the heart's pumping capacity. Shock is a circulatory failure associated with an inadequate supply of oxygen and nutrients to body tissues. Cholesterol/o Cholesterol Hypercholesterolaemia _______________ (a lipid Statins are drugs that block a key enzyme in the substance) Production of cholesterol by the liver. coron/o Heart Coronary arteries _________________________________ These arteries extend over the apex of the heart like a crown (corona); See Figure 11-23A, page 402. Cyan/O-Blue Cyanosis _______________________________________ This bluish discoloration of the skin indicates low oxygen levels in the blood.

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COMBINING MEANING TERMINOLOGY MEANING FORM Myx/o-mucus Myxoma _______________________________________ A benign tumor of connective tissue origin, with cells embedded in soft mucoid stromal tissue. These rare tumors are most common in the left atrium. ox/o Oxygen hypoxia ________________________________________ Insufficient oxygen content in the tissues. Anoxia is an extreme form of hypoxia. Pericardium/o Pericardium Pericardial puncture ________________________________ Removal of excess fluid from the pericardial space. Phleb/o-Vein Phlebotomy _____________________________________ A phlebotomist is trained to open veins for phlebotomy. Thrombophlebitis ________________________________ Often shortened to phlebitis. When the affected vein is deep within a muscle, it is called deep vein thrombosis (DVT). Rhythm/o-rhythm Arrhythmia ______________________________________ Dysrhythmia is also used to describe an abnormal heart rhythm. Note that an "r" is omitted. Blood Pressure/O-Pulse Blood Pressure Monitor ______________________________ A blood pressure monitor measures pressure. steth/o chest stethoscope _______________________ A misnomer because the examination is performed by ear and not by sight. Auscultation involves listening to sounds in the body, typically with a stethoscope. Thromb/o clot thrombolysis ____________________________________ valvul/o, valve valvuloplasty ______________________ valv/o A balloon catheter widens a heart valve. Mitral valvulitis ___________________________________ Commonly associated with rheumatic fever, an inflammatory disease caused by inadequate treatment of a streptococcal infection. An autoimmune reaction occurs, leading to inflammation and damage to the heart valves. (See Figure 11-19, page 396.) Valvotomy ______________________________________ Vas/o vessel Vasoconstriction _________________________________ Constriction means to tighten or narrow. Vasodilation ___________________________________ Vascul/o Vessel Vessel ________________________________________ ven/o, ven/i vein venous __________________________________________ A venous cutdown is a small surgical incision to allow access to a collapsed vein. An intravenous infusion is the delivery of fluids into a vein. Venipuncture ___________________________________ This procedure is performed for phlebotomy or to start an intravenous infusion. Ventricul/o Ventricle, interventricular septum _____________________________ lower ventricle

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Figure 11.12 Atherosclerosis. Arrow points to accumulated plaque in the lumen of an artery. (Courtesy of Sid Murphree, MD, Department of Pathology, University of Texas Southwestern Medical School, Dallas, Texas.)

ather/o, arteri/o, arthr/o

These three combinations are easily confused. ather/o = yellowish plaque arteri/o = artery arthr/o = joint

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Pathology: the heart and blood vessels heart

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Arrhythmias

Heart rhythm disturbances (dysrhythmias). Arrhythmias are problems with the conduction, or electrical system, of the heart. More than 4 million Americans suffer from recurrent cardiac arrhythmias. Examples of cardiac arrhythmias are: 1. Bradycardia and failure of the proper conduction of impulses from the SA node heart block via the AV node to the atrioventricular bundle (bundles of (atrioventricular His) block) Damage to the SA node can cause its impulses to be weak to activate the AV node and the impulses do not reach the ventricles. The heart beats slowly and bradycardia occurs. If the failure occurs only occasionally, the heart periodically skips a rhythm (partial heart block). When impulses from the SA node do not reach the AV node, the ventricles contract more slowly than the atria and are uncoordinated. That's a complete heart block. Right bundle branch block and left bundle branch block (RBBB and LBBB) are common types of heart blocks. They involve a delay or failure of impulses traveling through the right and left bundle branches to the ventricles. The implantation of an artificial cardiac pacemaker overcomes arrhythmias and keeps the heart beating at the right rate. The pacemaker's power source is a generator that contains a computer and a lithium battery. It is implanted under the skin just below the collarbone, with leads (wires) to both chambers or one chamber on the right side of the heart. A newer type of pacemaker, called a biventricular pacemaker, treats delays and abnormalities in ventricular contractions (dysnergia) and may also relieve symptoms and improve quality of life in patients with congestive heart failure. It reduces exacerbations of heart failure that require hospitalization (Figure 11-13C). 2. Fluent Rapid but regular contractions, usually of the atria. The heart rate can reach up to 300 beats per minute. Atrial fibrillation is often symptomatic of heart disease and often requires treatment, such as medication, electrical cardioversion, or catheter ablation (see below under Fibrillation). 3. Fibrillation Very rapid, random, inefficient, and irregular contractions of the heart (350 beats per minute or more). Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, affecting 5% to 10% of people aged 70 to 80 and more than 15% of people in their 80s. Electrical impulses move randomly through the atria, causing the atria to quiver instead of contracting in a coordinated rhythm. Common symptoms include palpitations (uncomfortable chest sensations due to a lack of heartbeats), fatigue, and shortness of breath. Patients with paroxysmal atrial fibrillation (irregular heartbeats occur periodically and episodically) and permanent or persistent atrial fibrillation (irregular heartbeats last indefinitely) have a much greater risk of stroke. This is because ineffective atrial contractions can lead to the formation of blood clots in the left atrial appendage (the area where clots form), which can travel to the brain. Also, atrial fibrillation can sometimes cause the heart to beat very quickly for long periods of time, leading to a weakening of the heart muscle. The risk of stroke in atrial fibrillation can be reduced by 80% with the use of anticoagulants (blood thinners such as warfarin) and anticoagulants called DOACs (direct oral anticoagulants). Examples of DOACs are apixaban (Eliquis), dabiatran (Pradaxa),

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and rivaroxaban (Xarelto). Other drugs are used to reset the heart's rhythm or control its rate. In ventricular fibrillation (VF), electrical impulses travel randomly through the ventricles. This life-threatening situation can lead to sudden cardiac death or cardiac arrest (sudden stoppage of the heart's movement) if help is not provided immediately. With prompt treatment, VF can be interrupted by defibrillation (application of an electric shock). Defibrillation stops electrical activity in the heart for a brief moment, allowing the heart to return to its normal rhythm. An implantable cardioverter-defibrillator (ICD) is a small electrical device implanted in the chest (near the collarbone) to detect arrhythmias and terminate them with an electric shock. Candidates for ICDs are people who have had or are at high risk of ventricular tachycardia, ventricular fibrillation, and cardiac arrest. Automated external defibrillators (AEDs) can be found in workplaces, airports, and other public places, and are used in an emergency situation to reverse ventricular fibrillation. Catheter ablation is a minimally invasive treatment used to treat cardiac arrhythmias. The technique, which uses radiofrequency energy delivered from the tip of a catheter inserted through a blood vessel and into the heart, destroys tissue that causes arrhythmias. Supraventricular tachycardia (SVT), atrial ﬂuorescence, atrial fibrillation, and ventricular tachycardia (VT) can be treated with ablation when clinically indicated. This procedure can provide a permanent cure in many clinical situations. Abnormalities in the heart at birth.

Congenital Heart Defects The following conditions are congenital anomalies resulting from a failure in the development of the fetal heart. 1. Coarctation narrowing (narrowing) of the main artery. of the aorta (CoA) Figure 11-14A shows aortic isthmus stenosis. Surgical treatment consists of removal of the narrowing and end-to-end anastomosis of the aortic segments. 2. open ductus passage (ductus arteriosus) between aorta and arteriosus pulmonary artery remains open after birth (patent). (PDA) The ductus arteriosus normally closes after birth, but in this congenital condition it remains open (see Figure 11-14B), allowing oxygenated blood to flow from the aorta into the pulmonary artery. PDA occurs in preterm infants and causes cyanosis, fatigue, and rapid breathing. Although the defect often closes on its own within months after birth, treatment may be needed if patency persists. Treatments include using a drug (indomethacin) to promote closure; surgical intervention using catheterization (with coil embolization to "plug" the ductus); and ligature (tying off), which is performed through a small incision between the ribs. 3. Septal defect Small holes in the wall between the atria (atrial septal defect) or the ventricles (ventricular septal defect). Figure 11.15A shows a ventricular septal defect. Although many septal defects close spontaneously, others require open-heart surgery to close the hole between the heart's chambers, or they can be repaired through minimally invasive surgery, using a catheter inserted through a blood vessel leading to the heart. A heart-lung machine is connected to the patient's circulatory system

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4. Fallot-Tetralogie (fah-LO)

congestive heart failure (CHF)

during open-heart surgery to relieve the heart and lungs of pumping and oxygenating functions during surgery. Congenital malformation with four (tetra) different heart defects. The condition, named for Étienne-Louis Fallot, the French physician who described it in 1888, is shown in Figure 11.15B. The four defects are: • Pulmonary artery stenosis. Pulmonary artery is narrow or blocked. • Ventricular septal defect. Large hole between two ventricles allows unoxygenated venous blood to flow from the right ventricle to the left ventricle and out to the aorta. • Displacement of the aorta to the right. The aorta overrides the interventricular septum. Deoxygenated blood travels from the right ventricle to the aorta. • Hypertrophy of the right ventricle. The myocardium works harder to pump blood through a narrowed pulmonary artery. An infant with this condition is referred to as a "blue baby" due to the extreme degree of cyanosis that is present at birth. Tetralogy of Fallot surgery involves patch closure of the ventricular septal defect and removal of the pulmonary artery outflow obstruction. Other congenital disorders such as transposition of the great arteries (TGA) (pulmonary artery arises from the left ventricle and the aorta arises from the right ventricle) also cause cyanosis and hypoxia. Surgical correction of TGA involves an arterial crossover procedure (rejoining the pulmonary artery and aorta in their proper positions). The heart is unable to pump the required amount of blood. There are two types of congestive heart failure: systolic and diastolic. In systolic CHF there is a reduced ejection fraction (the amount of blood leaving the left ventricle). Less blood is pumped out of the heart. In diastolic CHF, fluid builds up in the lungs and other parts of the body. Symptoms of CHF include shortness of breath, exercise intolerance, and fluid retention. Pulmonary edema (fluid buildup in the lungs) and swelling or edema in the legs, feet, and ankles are common. Treatment includes reducing dietary sodium intake and using diuretics to promote fluid loss. Cardiac resynchronization therapy (CRT) devices can be used in patients with CHF with reduced ejection fraction and bundle branch block. These implanted devices consist of a pulse generator and thin, insulated wires and work like a normal pacemaker and defibrillation device. When drug therapy and lifestyle changes cannot control congestive heart failure, a heart transplant may be the only treatment option. While waiting for a transplant, patients may need a device that supports the heartbeat. A left ventricular assist device (LVAD) is a booster pump implanted in the abdomen with a cannula (tube) inserted into the left ventricle of the heart. It pumps blood from the heart to all parts of the body. LVAD can be used either as a "bridge to transplantation" or as a "target" therapy when heart transplantation is not an option. Due to the severe shortage of donor hearts, research efforts are directed towards the development of fully artificial hearts.

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coronary heart disease (KHK)

Endocarditis

Disease of the arteries surrounding the heart. The coronary arteries are a pair of blood vessels that originate from the aorta and supply oxygen-rich blood to the heart. After blood leaves the heart via the aorta, a portion is immediately returned across the heart's surface through the coronary arteries. CAD is usually the result of atherosclerosis. This is the deposition of Fey compounds on the inner lining of the coronary arteries (any other artery can be similarly affected). The normally smooth lining of the artery becomes roughened as atherosclerotic plaque builds up in the artery. The plaque initially causes a blockage of the coronary artery. Next, the roughened lining of the artery can rupture or cause abnormal blood occlusion, leading to thrombotic occlusion (blockage of the coronary artery by a clot). Blood flow is reduced (ischemia) or stopped altogether, causing part of the myocardium to die (necrosis). This sequence of events constitutes a myocardial infarction, or heartbeat, and the area of dead myocardial tissue is called an infarction. The infarcted area is eventually replaced by scar tissue. Figures 11-16 show coronary arteries branching from the aorta and illustrate coronary artery occlusion leading to ischemia and myocardial infarction. Figure 11-17 is a photograph of the myocardium after an acute myocardial infarction. Acute coronary syndromes (ACS) are diseases caused by myocardial ischemia. These conditions are unstable angina (chest pain at rest or chest pain with increasing frequency) and myocardial infarction (Figure 11-18). Patients with ACS benefit from early angiography (x-ray imaging of the coronary arteries) and PCI (percutaneous coronary intervention using balloon catheters and stents) or CABG (coronary artery bypass graft surgery) to improve blood flow to the heart muscle (revascularization). Medications used to treat ACS include anticoagulants and antiplatelet drugs such as aspirin and clopidogrel (Plavix), prasugrel (Eﬃent), and ticagrelor (Brilinta). For acute angina, nitroglycerin is given sublingually (under the tongue). This drug, one of several called nitrates, is a vasodilator that increases coronary blood flow and lowers blood pressure. Nitrates also create venous dilatation to reduce venous return and decrease myocardial oxygen consumption, both of which help decrease the heart's workload. Doctors advise patients to avoid risk factors such as smoking, obesity, and lack of exercise, and they prescribe effective medications to prevent CAD and ACS. These drugs include aspirin (to prevent platelets from clumping together), beta-blockers (to reduce the force and speed of the heartbeat and lower blood pressure), ACE inhibitors (to reduce high blood pressure and the risk of a future heart attack, even if you have it). this is the case in patients who do not have high blood pressure), calcium channel blockers (to relax the muscles in the blood vessels) and statins (to lower cholesterol levels). Heart surgeons perform open-heart surgery called coronary artery bypass graft surgery (CABG) to treat CAD by replacing blocked vessels. Interventional cardiologists perform percutaneous coronary intervention (PCI), in which catheterization with balloons and stents opens blocked coronary arteries. Inflammation of the inner lining of the heart.

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hypertensive heart disease

Mitralklappenprolaps (MVP)

mumble

Pericarditis

rheumatic heart disease

Damage to the heart valves by infection (bacterial endocarditis) creates lesions called vegetations (similar to cauliflowers) that erupt into the bloodstream as emboli (material that travels through the blood). The emboli can lodge in other vessels, which can lead to a transient ischemic ack (TIA) or stroke, or in small vessels in the skin, where multiple pinpoint hemorrhages known as petechiae (from the Italian petechio, flea bite) form . Antibiotics can cure bacterial endocarditis. High blood pressure affecting the heart. This condition results from narrowing of the arterioles, leading to increased pressure in the arteries. The heart is affected (left ventricular hypertrophy) because it pumps harder to overcome the increased resistance in the arteries. Improper closure of the mitral valve. This condition occurs because the mitral valve enlarges and prolapses into the left atrium during systole. On auscultation (listening with a stethoscope), doctors hear a mid-systolic click and occasionally mitral regurgitation (backflow of blood into the left atrium). Most people with MVP live normal lives, but severe valve prolapse can be associated with severe mitral regurgitation and, in rare cases, lead to infection (endocarditis). Extra heart sound heard between normal beats. Heart murmurs are heard with the help of a stethoscope and are usually caused by a valve defect or a disease that interferes with the proper flow of blood in the heart. They can also be heard in interseptal defects, where blood flows abnormally between chambers through holes in the septa. Functional noise is not caused by valve or septal defects and does not seriously endanger a person's health. A bruit (BRU-e) is a murmur heard on auscultation. It is the turbulent flow of blood through a vessel. Arousal, which is a vibration felt when the chest is palpated, is often accompanied by a noise. Inflammation of the membrane (pericardium) that surrounds the heart. In most cases, pericarditis results from a viral disease or the etiology may be idiopathic. Bacteria and viruses cause the condition, or the etiology can be idiopathic. Malaise, fever, and chest pain occur, and auscultation often reveals pericardial friction (audible as a scraping or grinding sound). Compression of the heart caused by a buildup of fluid in the pericardial cavity is cardiac tamponade (tăm-pō-NŎD). Treatment includes anti-inflammatory drugs and other pain relievers. If the pericarditis is infectious, antibiotics or antifungal drugs are prescribed, depending on the microorganisms detected in specimens obtained by pericardial puncture or blood tests. Heart disease caused by rheumatic fever. Rheumatic fever is a childhood illness that follows a streptococcal infection with a sore throat (pharyngitis). The heart valves can be damaged by inflammation and scarred with vegetation, preventing them from opening and closing normally (Figure 11.19A). Repeated streptococcal infection is believed to be required to produce heart disease, so children with a history of rheumatic fever are treated with monthly penicillin injections given intramuscularly until age 21.

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Mitral stenosis, atrial fibrillation, and congestive heart failure caused by weakening of the myocardium can also result from rheumatic heart disease. Treatment consists of decreased activity, drugs to control arrhythmias, surgery to repair a damaged valve, and anticoagulant therapy to prevent emboli from forming. Artificial heart valve implants and porcine valve implants can replace damaged heart valves (Figure 11-19B and C).

FIGURE 11-13 A: A dual-chamber rate-responsive pacemaker (shown in actual size) is designed to detect body movement and automatically increase or decrease the paced heart rate based on the level of physical activity. B, Pacemaker with electrodes in the right atrium and right ventricle, enabling it to sense and stimulate both ventricles of the heart. C: Biventricular pacemaker with electrodes in the right atrium and in the right and left ventricles to synchronize ventricular contractions.

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Figure 11-14 A: Aortic isthmus stenosis. A localized narrowing of the aorta reduces the blood supply to the lower part of the body. B, patent ductus arteriosus. The ductus arteriosus does not close after birth and blood from the aorta flows through it into the pulmonary artery.

Figure 11-15 A ventricular septal defect. Blood flows from the left ventricle into the right ventricle through a hole in the ventricular septum and into the lungs via the pulmonary artery. B, Tetralogy of Fallot with the four defects. The blood flow is indicated by the arrows.

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FIGURE 11-16 A, Ischemia and infarction induced by coronary artery occlusion. B, Internal view of the heart showing an area damaged by myocardial infarction.

Figure 11.17 Acute myocardial infarction (MI), 5 to 7 days old. The infarction is visible as a well-defined, pale yellow lesion in the posterolateral aspect of the left ventricle. The border of the infarction is surrounded by a dark red zone of acute inflammation.

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Figure 11.18 Acute coronary syndromes: sequence of pathological changes leading to a cardiac event. A: Atherosclerotic plaque forms from the lipid collection. B, Plaque rupture causing platelet aggregation on plaque. C: Nonocclusive thrombus forms and causes unstable angina pectoris or NSTEMI (non-ST elevation myocardial infarction). D, Alternatively, the formation of an occlusive thrombus leads to a myocardial infarction or STEMI (ST elevation myocardial infarction).

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Figure 11-19 A: Acute rheumatic mitral valvulitis with chronic rheumatic heart disease. Small vegetations are visible along the closure line of the mitral valve leaflet (arrows). Previous episodes of rheumatic valvulitis have caused fibrous thickening and fusion of the chordae tendineae of the valves. B, artificial heart valve. C, porcine xenograft valve. A xenograft valve (Greek xen/o means stranger) is tissue transferred from an animal of one species (pig) to another species (human).

How does a pacemaker work?

The pacemaker leads (wires) detect the heart's electrical activity and transmit this information to the generator (computer). The computer analyzes the signals from the heart and decides when and where to stimulate. When the frequency is slow, the generator will emit a signal to stimulate the contraction and increase the frequency. Multi-lead pacemakers can pace the atrium and ventricle in the correct order. Rate-responsive pacemakers have sensors that detect body movement and breathing to determine the best heart rate.

palpitations/palpation

Do not confuse palpitations with palpation, which means touching, feeling, or examining with hands and fingers.

blood vessels

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Aneurysm

deep vein thrombosis (DVT)

high blood pressure (HTN)

peripheral arterial disease (PAD)

Raynaud's (raNO) disease (Raynaud's disease)

varicose veins

Local widening (dilatation) of an arterial wall. An aneurysm (Greek aneurysm, expansion) is usually caused by arteriosclerosis and high blood pressure or a congenital weakness of the vascular wall. Aneurysms are common in the aorta but can also occur in peripheral vessels. The risk of an aneurysm is rupture and bleeding. Treatment depends on the vessel involved, the location, and the patient's medical condition. For small vessel aneurysms in the brain, treatment consists of occluding the vessel with small clips. For larger arteries such as the aorta, a stent-graft can be sewn into the affected vessel. Figure 1120A shows an abdominal aortic aneurysm (labeled "AAA") and Figure 11-20B shows a deployed stent graft. Note that the graft is anastomosed to the normal portion of the aorta and the aneurysm sac is closed around the graft to prevent fistula formation from the graft to the intestine. A blood clot (thrombus) forms in a large vein, usually in a lower extremity. This condition can lead to a pulmonary embolism (clot travels to the lungs) if not treated effectively. Examples of anticoagulants (blood thinners) include warfarin (Coumadin) and direct oral anticoagulants (DOACs). They are used to prevent DVTs and pulmonary embolisms (PEs). High blood pressure. High blood pressure is usually essential hypertension without an identifiable cause. Categories of blood pressure readings are listed in Table 11-1. Diuretics, ACE inhibitors, calcium channel blockers, and beta blockers are used to treat essential hypertension. Losing weight, limiting sodium (salt) intake, quitting smoking, and reducing fat in your diet can also lower blood pressure. In secondary hypertension, the increase in pressure is caused by another associated lesion, such as B. glomerulonephritis, pyelonephritis or vascular disease or disease of the adrenal glands. Blockage of arteries that carry blood to the legs, arms, kidneys, and other organs. Any artery can be affected, such as B. the carotid (neck), the femur (thigh) or the popliteal fossa (knee). A sign of PAD in the lower extremities is intermittent claudication (no pain or discomfort in one leg at rest, but pain, tenderness, and weakness after walking begins). Treatment consists of exercise, avoidance of nicotine (which causes vasoconstriction), and control of risk factors such as high blood pressure, hyperlipidemia, and diabetes. Surgical treatment includes endarterectomy and bypass grafting (from the normal proximal vessel around the diseased area to a distal normal vessel). Percutaneous treatments include balloon angioplasty, atherectomy, and stenting. Embolic protection devices are parachute-like filters used to collect embolic debris during stenting. Recurrent episodes of pallor and cyanosis, chiefly in fingers and toes. This is a rare condition of unknown cause that affects blood flow in the arteries. Raynaud is sometimes referred to as a disease, phenomenon or syndrome. It is characterized by brief episodes of intense narrowing and vasospasm of the arterioles in young, otherwise healthy women. See Figure 11-21. Episodes can be triggered by cold temperatures, emotional stress, or smoking cigarettes and caffeine. Raynaud can be controlled by protecting the body from cold and avoiding other triggers. Medications that increase blood flow to the hands and feet can relieve symptoms. Abnormally swollen and twisted veins, usually found in the legs.

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They come

This condition is caused by damaged valves that do not prevent backflow of blood (Figure 11-22A through C). The blood then pools in the veins, which expand to many times their normal size. Thrombosis can also occur due to the slow flow of blood in the varicose veins and frequent injury to the vein. Hemorrhoids (piles) are varicose veins near the anus. Doctors now treat varicose veins with sclerotherapy (injections of sclerotherapy solution) or laser and pulsed light treatments to seal veins. Surgical procedures such as vein stripping and ligatures are performed less frequently.

Figure 11-20 A, Abdominal aortic aneurysm (AAA). A dissecting aortic aneurysm is a split or dissection of the wall of the aorta by blood entering a tear or hemorrhage within the vessel walls. B, stentgraft in place. This stent graft procedure is an endovascular aneurysm repair, or EVAR.

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Figure 11.21 Raynaud's disease.

Figure 11-22 A Valve function in normal vein and varicose vein. B, varicose veins. C: The slow flow in veins increases susceptibility to thrombophlebitis (clotting), edema, and pigmented skin (collections of blood in the lower parts of the leg and fluid leakage from dilated small capillaries). If a thrombus detaches from its place in the vein, it can migrate to the lungs (pulmonary embolism) and block a blood vessel there.

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TABLE 11-1

Aortic aneurysms and Marfan syndrome

Aortic aneurysms are commonly associated with Marfan syndrome, a genetic condition characterized by long, thin fingers, large arm spans, dislocated lens of the eye, and loose joints. Abraham Lincoln is thought to have had Marfan syndrome, and the syndrome has also been diagnosed in basketball and volleyball players who died suddenly as a result of a ruptured aortic aneurysm.

Warfarin (Coumadin) and DOACs

While the oral anticoagulant warfarin is used to prevent or treat thromboembolic disease, treatment with warfarin requires careful monitoring and is complicated by drug or drug-food interactions. Direct oral anticoagulants (DOACs) such as apixaban (Eliquis), edoxaban (Savaysa), dabigatran (Pradaxa), and rivaroxaban (Xarelto) address these limitations and have been approved by the Food and Drug Administration (FDA) for anticoagulation therapy in non-valvular atrial fibrillation and for the prevention and treatment of DVTs and PEs.

study department

Practice spelling each term and know its meaning.

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akutes Koronarsyndrom (ACS) Angina pectoris Angiotensin-Converting-Enzym (ACE)-Hemmer Auskultation

Unstable angina and myocardial infarction (heartbeat) resulting from ruptured plaque in coronary arteries. Chest pain secondary to myocardial ischemia. Stable angina predictably occurs with exertion; Unstable angina is chest pain that occurs more frequently and with less effort. Blood pressure lowering drug that blocks the conversion of angiotensin I to angiotensin II, which causes blood vessels to dilate. It prevents heart attack, CHF, stroke and death. See Table 21-7 on page 835 for names of ACE inhibitors and other cardiovascular drugs.

Listening to sounds in blood vessels or other body structures, typically with a stethoscope. Beta blockers Medicines used to treat angina pectoris, high blood pressure and heart rhythm problems. It blocks the action of epinephrine (adrenaline) at receptor sites on cells, slowing the heartbeat and reducing the heart's workload. biventricular device that allows the ventricles to beat together (synchronously) so that more pacemaker blood is pumped out of the heart. bruit Abnormal blowing or hissing heard during auscultation of an artery or organ. Calcium Medicines used to treat angina pectoris and high blood pressure. It dilates blood vessels by blocking the flow of calcium into the muscle cells lining the vessels. Blocker cardiac arrest Sudden, unexpected cessation of heart activity, often leading to sudden cardiac death. Heart Pressure on the heart caused by fluid in the pericardial space. Tamponade claudication Pain, tension, and weakness in one leg after beginning to walk, but no pain at rest. Digoxin Drug that treats arrhythmias and strengthens the heartbeat. Embolus Clot or other substance that travels to a distant location and suddenly (plural: a blood vessel. embolus) block infarction area of dead tissue. Nitrates Medicines used to treat angina pectoris. They dilate blood vessels, increase blood flow and oxygen supply to the myocardial tissues. Nitroglycerin nitrate drug used to treat angina. Occlusion Closure of a blood vessel due to blockage. Palpitations Uncomfortable sensations in the chest associated with abnormal heart rhythms, such as B. Premature Ventricular Contractions (PVCs). patent pending. pericardial scratching or grinding sound heard on auscultation of the heart; suggesting frictional pericarditis. Petechiae Small, pinpoint bleeding. Statins Drugs used to lower cholesterol levels in the bloodstream. Thrill Vibration felt over an area of turbulent blood flow (like a blocked artery). Vegetations Accumulations of platelets, closure proteins, microorganisms, and red blood cells on diseased heart valves.

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Laboratory Tests and Clinical Procedures Laboratory Tests BNP Test

cardiac biomarkers

Lipidtests (Lipidprofil)

Lipoproteinelektrophorese

Measurement of BNP (Brain Natriuretic Peptide) in the blood. BNP is elevated in patients with heart failure and is useful in diagnosing CHF in patients presenting to the emergency department with dyspnea. Its presence also identifies patients at risk for complications of acute coronary syndromes (eg, myocardial infarction, unstable angina). It is secreted when the heart becomes overloaded and acts as a diuretic to restore heart function to normal. Cardiologists also measure NT-proBNP levels to assess the degree of heart failure. NT stands for N terminal. The reference to the brain in this term comes from the initial identification of the protein in the brain of a pig. Chemicals in the blood are measured as evidence of a heart attack. A damaged heart muscle releases chemicals into the bloodstream. The substances tested are troponin-I (cTnI) and troponin-T (cTnT). Troponin is a heart muscle protein that is released into the circulation after myocardial injury. C-reactive protein (CRP) is a biomarker of inflammation. Highly sensitive CRP (Hs-CRP) is useful in predicting the risk of heart attack, stroke, or other serious heart disease. Measurement of cholesterol and triglycerides (fats) in a blood sample. High lipid levels are associated with atherosclerosis. The general guideline for total blood cholesterol is less than 200 mg/dL. Saturated fats (of animal origin such as milk, fritters and meat) raise blood cholesterol levels, while polyunsaturated fats (of plant origin such as corn and safflower oil) lower blood cholesterol levels. Treatment for hyperlipidemia includes proper diet (low-fat, high-fiber intake) and exercise. Niacin (a vitamin) also helps reduce lipids. Drug therapy includes statins, which reduce the risk of heart attack, stroke, and cardiovascular death. Statins lower cholesterol by reducing its production in the liver. Examples include simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), and rosuvastatin (Crestor). Lipoproteins (combinations of fat and protein) are physically separated and measured in a blood sample. Examples of lipoproteins are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). High LDL levels are associated with atherosclerosis. The national guideline for LDL is less than 130 mg/dL in healthy individuals and less than 70 mg/dL in patients with CAD, PAD, and diabetes mellitus. High HDL levels protect adults from atherosclerosis. Factors that increase HDL are exercise and alcohol consumption in moderation.

Clinical procedures: X-ray and electron beam diagnostic tests

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Angiography Computed Tomography Angiography (CTA)

digital subtraction angiography (DSA) electron beam computed tomography (EBCT or EBT)

X-ray imaging of blood vessels after injection of contrast medium. Arteriography is X-ray imaging of arteries after injection of contrast material through a catheter into the aorta or an artery. Three-dimensional X-ray images of the heart and coronary arteries using computed tomography (64-slice CT). This newer technique takes hundreds of pictures of the heart per second. Sectional images are put together by computer to form a three-dimensional image. It is less invasive than angiography (contrast is injected into a small peripheral vein using a small needle) and provides an excellent view of the coronary arteries for diagnosing coronary artery disease (Figure 11-23A). Video machines and a computer produce X-ray images of blood vessels. After an initial X-ray is taken and stored in a computer, the doctor injects contrast media and takes a second image of that area. The computer compares the two images and subtracts the digital data for the first from the second, leaving an image of the vessels with contrast. Electron beam and CT identify calcium deposits in and around coronary arteries to diagnose early CAD. A coronary artery calcium score is derived to indicate future risk of myocardial infarction and stroke (see Figure 11-23B).

Figure 11-23 A: Computed tomography angiography (CTA) showing the coronary arteries. B, Electron beam computed tomography showing significant calcification (white areas) in the coronary arteries, suggesting advanced coronary artery disease. (A, courtesy of Massachusetts General Hospital, Boston.)

Koronararterien-Calcium-Score

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0-99 100-399 >400

low risk medium risk high risk

A calcium score >400 is associated with an almost 25% chance of having a heart attack or stroke within 10 years.

Ultrasound examination Doppler ultrasound examinations

Echocardiography (ECHO)

Sound waves measure blood flow in blood vessels. An instrument focuses sound waves onto blood vessels, and echoes are reflected off red blood cells. The examiner can hear various changes in blood flow caused by vascular obstruction. Duplex ultrasound combines Doppler and conventional ultrasound to allow doctors to map the structure of blood vessels and measure blood flow velocity. Carotid occlusions, aneurysms, varicose veins and other vascular diseases can be diagnosed with duplex ultrasound. Echoes produced by high-frequency sound waves produce images of the heart (Figure 11-24A). ECHOs show the structure and movement of the heart. In transesophageal echocardiography (TEE), a transducer placed in the esophagus provides ultrasound and Doppler information (Figure 11-24B). This technique detects heart masses, prosthetic valve function, aneurysms and pericardial fluid.

Figure 11-24 A, echocardiogram. Note that the ventricles are above the atria in this view. B, transesophageal echocardiography.

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Nuklearkardiologie Positronen-Emissions-Tomographie (PET) Scan Technetium Tc 99m Sestamibi Scan Thallium 201 Scan

The images show blood flow and myocardial function after ingestion of radioactive glucose. PET scans can detect CAD, myocardial function, and differences between ischemic heart disease and cardiomyopathy. Technetium-Tc-99m Sestamibi injected intravenously is taken up into the heart tissue where it is detected by scanning. This scan is used in people who have had an MI to assess the amount of damaged heart muscle. It is also used with an exercise tolerance test (ETT-MIBI). Sestamibi is a radioactive tracer compound used to define areas of poor blood flow in the heart muscle. The concentration of radioactive thallium is measured to get information about the blood supply to the heart muscle. Thallium studies demonstrate cardiac muscle viability. Infarcted or scarred myocardium presents as a "cold spot."

Magnetic Resonance Imaging (MRI) Cardiac MRI

Images of the heart are created using radio wave energy in a magnetic field. These multi-plane images provide information about left and right ventricular function, wall thickness and fibrosis, aneurysms, cardiac output and patency of peripheral and coronary arteries. The magnetic waves emitted during MRI could interfere with implanted pacemakers due to their metal content and heat generation, so it is currently contraindicated for a patient with a pacemaker to undergo cardiac MRI. However, new MRI-safe pacemakers have been approved. Magnetic resonance angiography (MRA) is a type of MRI that provides very detailed images of blood vessels. Doctors use MRA to view arteries and blockages in arteries. Gadolinium is the most commonly used contrast agent for MRI procedures.

Other diagnostic procedures

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cardiac catheterization

Electrocardiography (ECG)

Holter monitoring

stress test

A thin, flexible tube is inserted into the heart through a vein or artery. This procedure detects pressures and blood flow patterns in the heart. Contrast media can be injected and X-rays of the heart and blood vessels taken (Figure 11-25). This procedure can be used to diagnose and treat heart disease (see Percutaneous Coronary Intervention [PCI] on page 407). At the time of catheterization, the interventional cardiologist may also perform intravascular ultrasound (IVUS) to assess the severity of the vasoconstriction. It also measures fractional flow reserve (FFR) to determine the effect of coronary artery blockage on blood flow. Recording the current flow through the heart. The continuous monitoring of a patient's heart rhythm in hospitals is carried out via telemetry (electronic data transmission - tele/o means remote). Sinus rhythm begins in the SA node and the normal rate is between 60 and 100 beats per minute. Figure 11-26 shows ECG strips for normal sinus rhythm and various types of dysrhythmias (abnormal rhythms). An EKG machine is worn over a long period of time to detect abnormal heart rhythms. Rhythm changes are correlated with symptoms, which are recorded in a diary. The exercise stress test (ETT) determines the heart's response to physical exertion (stress). A common protocol uses 3-minute increments at set speeds and heights on a treadmill. Continuous monitoring of vital signs and ECG rhythms is important in the diagnosis of CAD and left ventricular function.

Figure 11.25 Transradial cardiac catheterization. The catheter is inserted retrograde (backward) from the radial artery into the aorta and then into the left ventricle.

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FIGURE 11.26 ECG rhythm strip showing normal sinus rhythm and dysrhythmias (arrhythmias).

Clinical Procedures: Treatment

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Katheterablation

Koronararterien-Bypass-Operation (CABG)

Defibrillation

Endarteriectomy

extracorporeal circulation

Herztransplantation

Percutane Coronary Intervention (PCI)

Brief delivery of radiofrequency energy to ablate (remove) areas of heart tissue that can cause arrhythmias. A catheter is passed through a leg vein to the vena cava and into the heart. The abnormal current path is located and ablated (destroyed) using the energy delivered by the catheter. See Figure 1127A. Arteries and veins are anastomosed with coronary arteries to avoid blockages. Internal thoracic (chest) and radial (arm) arteries and saphenous (leg) vein grafts are used to supply oxygenated blood to the myocardium (Figure 11-27B). Cardiac surgeons perform minimally invasive CABG surgery using smaller incisions instead of the traditional sternotomy to open the chest. Vein and artery grafts are also removed endoscopically through small incisions. Although most surgeries are performed with a heart-lung machine (“on pump”), an increasing number of surgeries are performed “off pump” with the heart beating. See Personal: Coronary Artery Bypass Surgery, page 412. Brief electrical discharges are applied across the chest to stop abnormal rhythms (ventricular fibrillation). In patients at high risk of sudden cardiac death from ventricular arrhythmias, an implantable cardioverter defibrillator (ICD) or automated implantable cardioverter defibrillator (AICD) is placed in the upper chest. Cardioversion is another technique that uses lower energy to treat atrial fibrillation, atrial fibrillation, and supraventricular tachycardia. Surgical removal of plaque from the inner lining of an artery. Fay deposits (atheromas) and thrombosis are removed to open clogged arteries. Carotid artery endarterectomy is a procedure to remove plaque buildup in the carotid artery to reduce the risk of stroke. The heart-lung machine drains blood from the heart and lungs while the heart is repaired. The blood leaves the body, enters the heart-lung machine, where it is oxygenated, and then returns to a blood vessel (artery) to circulate through the bloodstream. The device uses the technique of extracorporeal membrane oxygenation (ECMO). The donor heart is transferred to a recipient. While awaiting a transplant, a patient may need a left ventricular assist device (LVAD), which is a booster pump implanted in the chest or abdomen with cannulas (flexible tubing) from the left ventricle to the ascending aorta. A balloon-tipped catheter is inserted into a coronary artery to open the artery; Stents are used. An interventional cardiologist places the catheter in the femoral or radial artery and then inserts it up the aorta into the coronary artery. Stents (expandable, slidable metal tubes that serve as permanent scaffolding devices) create wide lumens and make restenosis less likely. Drug-eluting stents (DESs) are coated with polymers that release (release) anti-inflammatory and anti-proliferative drugs to prevent the formation of scar tissue that leads to restenosis (Figure 11-28). Other devices are bioabsorbable vascular scaffolds (BVSs) made from dissolvable material and drug coated balloons (DCBs) that release paclitaxel. PCI techniques include percutaneous transluminal coronary angioplasty (PTCA), stent placement, laser angioplasty (a small laser

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thrombolytic therapy

Transcatheter aortic valve replacement (TAVR)

plaque vaporizing at the tip of a catheter) and atherectomy. Drugs to dissolve blood clots are injected into the bloodstream of patients with coronary thrombosis. Tissue plasminogen activator (tPA) and streptokinase restore blood flow to the heart and limit irreversible damage to the heart muscle. The drugs are given within 12 hours of the onset of a heart attack. Thrombolytics reduce the mortality rate in patients with a heart attack by 25%. Placement of a balloon-expandable aortic heart valve into the body via a catheter. The catheter is passed into the heart through the femoral artery and a stent valve device is inserted using the catheter. This is a newer, minimally invasive, catheter-based technology for treating aortic stenosis.

Figure 11-27 A, catheter ablation. SVT, atrial flutter, AF, and VT can be treated with ablation when clinically indicated. B, Coronary artery bypass graft (CABG) surgery with anastomosis of vein and artery grafts. (1) A section of vein is removed from the leg and anastomosed (reversed due to its directional valves) to a coronary artery to bypass an area of atherosclerotic blockage. (2) An internal mammary artery is transplanted to a coronary artery to bypass a blockage.

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Figure 11.28 Placement of a drug-eluting stent in the coronary artery. A: The stent is positioned at the site of the lesion. B: The balloon is inflated, expanding the stent and compressing the plaque. C: When the balloon is withdrawn, the stent supports the artery and releases a drug to reduce the risk of restenosis. Stents are scaffolding devices made of stainless steel that help keep arteries such as the coronary, renal, and carotid arteries open.

abbreviations

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AAA ACE-Hemmer ACLS ACS ADP

Angiotensin converting enzyme inhibitors for abdominal aortic aneurysm

extended cardiac life support; CPR plus drugs and defibrillation acute coronary syndrome adenosine diphosphate; ADP blockers are used to prevent cardiovascular death, heart attack and stroke, and after all stenting procedures. AED automatic external defibrillator AF, a-fib atrial fibrillation AICD automatic implantable cardioverter-defibrillator AMI acute myocardial infarction ARB angiotensin II receptor blocker ARVD arrhythmogenic right ventricular blocker dysplasia AS aortic stenosis ASD atrial septal defect AV, atrioventricular AV AVR aortic valve replacement BBB bundle branch block BNP brain natriuretic peptide; increased in congestive heart failure BP blood pressure CABG coronary artery bypass graft surgery CAD coronary artery disease CCTA coronary computed tomography angiography CCU coronary ward Kath catheterization CHF congestive heart failure CK creatine kinase; enzyme CoA released after myocardial injury coarctation of the coarct CPR cardiopulmonary resuscitation CRT cardiac resynchronization therapy; biventricular pacing and defibrillation devices CTNI or cardiac troponin-I and cardiac troponin-T; Troponin is a protein released in cTnI; CTNT Blood circulation after myocardial injury or cTnT DES Drug-eluting stent DOAK direct oral anticoagulant DSA digital subtraction angiography TVT deep vein thrombosis ECG; also electrocardiography as ECG ECHO echocardiography ECMO extracorporeal membrane oxygenation EF ejection fraction; measuring the amount of blood pumped out of the heart with each beat EPS electrophysiological study; Electrode catheters inserted into veins and threaded into the heart to measure electrical conduction (tachycardias are provoked and analyzed) ETT stress test ETT-MIBI stress test combined with a radioactive tracer (Sestamibi) Scan EVAR Endovascular aneurysm repair FFR Fractional Flow Reserve HDL high-density lipoprotein; High blood levels mean a lower incidence of coronary artery disease

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hsCRP

highly sensitive C-reactive protein; Inflammation biomarkers to predict heart attack risk HTN hypertension (high blood pressure) IABP intra-aortic balloon pump; to assist patients in cardiogenic shock ICA invasive coronary angiography ICD implantable cardioverter defibrillator IVUS intravascular ultrasound LAD left anterior descending (coronary artery) LBBB left bundle branch block LDL low-density lipoprotein; high blood levels lead to cholesterol accumulation in arteries LMWH low molecular weight heparin LV left ventricle LVAD left ventricular assist system LVEF left ventricular ejection fraction LVH left ventricular hypertrophy MI myocardial infarction MUGA multiple-gated acquisition scan; a radioactive test of cardiac function MVP mitral valve prolapse NSR normal sinus rhythm NT-proBNP N-terminal propeptide of BNP NSTEMI non-ST elevation MI PAC premature atrial contraction PAD peripheral artery disease PCI percutaneous coronary intervention PDA patent ductus arteriosus PE pulmonary embolism PVC ventricular extrasystole RBBB right bundle branch block SA, S-A Sinus node Node SCD Sudden cardiac death SOB Shortness of breath SPECT Single photon emission computed tomography; used for myocardial imaging with Sestamibi scans STEMI ST elevation myocardial infarction SVT supraventricular tachycardia; rapid heartbeats originating from the atria causing palpitations, SOB and dizziness TAVR transcatheter aortic valve replacement TEE transesophageal echocardiography TEVAR thoracic endovascular aneurysm repair TGA transposition of the great arteries tPA tissue plasminogen activator; a drug used to prevent thrombosis UA unstable angina pectoris; chest pain at rest or with increasing frequency VF ventricular fibrillation VSD ventricular septal defect VT ventricular tachycardia WPW Wolff-Parkinson-White syndrome; abnormal ECG pattern associated with paroxysmal tachycardia

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Practical Applications

For practical application answers, see page 425.

Surgical Plan: General Hospital Match the surgical treatment in Column I to the appropriate surgical indication (diagnosis) in Column II. COLUMN I 1. Coronary artery bypass graft surgery 2. Left carotid artery endarterectomy 3. Sclerosing injections and laser treatment 4. LV aneurysmectomy 5. Atrial septal defect repair 6. Left ventricular assist device 7. Pericardiocentesis 8. Aortic valve replacement 9. Pacemaker implantation 10. Femoral-popliteal bypass surgery

COLUMN II _______ A. Heart failure B. Cardiac tamponade (fluid in the space surrounding the heart _______) C. Atherosclerotic occlusion of a major artery leading _______ to the head D. Congenital hole in the wall of the upper chamber _______ of the heart _______ E. Obstruction from angina Pectoris and widespread _______ Coronary arteriosclerosis despite drug therapy F. Peripheral vascular disease _______ G. Heart block _______ H. Varicose veins I. Bulging of the wall of an inferior ventricle _______ J. Aortic stenosis _______

New and important cardiovascular drugs Platelet aggregation inhibitors: These drugs are used after stenting or after ACS (acute coronary syndrome). • Clopidrogrel (Plavix) • Prasugrel (Eﬃent) • Ticagrelor (Brilinta) DOACs (direct oral anticoagulants): These drugs are used to prevent strokes associated with atrial fibrillation and clot formation. • Apixaban (Eliquis) • Dabidatran (Pradaxa) • Edoxaban (Savaysa) • Rivaroxaban (Xarelto) Entresto: Exciting new combination drug for the treatment of heart failure. It has outperformed conventional angiotensin converting enzyme (ACE) inhibitors in a large clinical trial and has been shown to reduce mortality from heart failure • Valsartan/Sacubitril

Clinical cases: what is your diagnosis?

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Case 1: A 24-year-old woman presents to the hospital with a history of palpitations [the heartbeat is unusually strong, fast, or irregular for the patient to be aware of] and vague chest pain. With the patient lying supine, you will hear a mid-systolic click followed by a level 3/6 [moderately loud - 6/6 is loud and 1/6 is quiet] honking murmur. 1. Your diagnosis is: a. Tetralogy of Fallot b. mitral valve prolapse c. Raynaud's disease d. Heart Failure Case 2: Mr. Smith is urgently rushed to the emergency room due to persistent chest pain. His EKG showed ST segment elevation in the anterior leads and he was then transferred to the cardiac catheterization lab. An angiogram shows 100% blockage of the left anterior descending (LAD) coronary artery. PCI with a stent is recommended. 1. What did the ECG reveal? a. NSTEMI and unstable angina b. Aortic aneurysm c. CHF d. STEMI 2. Your diagnosis for this patient is: a. Heart a ack b. Rheumatic heart disease c. Unstable angina pectoris d. Patent ductus arteriosus 3. What treatment is recommended? a. Coronary Artery Bypass Graft b. Catheterization with placement of a drug-eluting stent c. defibrillation and cardioversion d. Thrombolytic Drugs Case 3: A 42-year-old runner recovering from an upper respiratory tract infection presents to the emergency department complaining of sharp and persistent chest pain that gets worse when she lies down and relieves when she sits up and leans forward. Serum troponin levels rule out acute MI. The ED doctor auscultates a pericardial friction rub. 1. What is your diagnosis for this patient? a. myocardial ischemia b. Unstable angina and NSTEMI

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c. endocarditis d. Pericarditis 2. The danger of this disease is the risk of progression to: a. cardiac tamponade b. aneurysm c. pulmonary embolism d. claudication

Personal coronary artery bypass surgery

Possible heart ack? You must be kidding. I didn't have any of the supposed symptoms - shortness of breath or chest pain. Instead, I had intermittent bouts of atrial fibrillation for several months. I got tired quickly and could feel my blood pressure dropping. After lying down for about an hour I was fine so in November 2010 I decided to get it checked out. My cardiologist decided to do a stress test. He put me on a treadmill for what seemed like forever and then he did an ultrasound on me. I train on a treadmill and a recumbent bike every day, so the test on

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The treadmill wasn't that difficult, although I loved the words "just a few seconds to go." The cardiologist at Johns Hopkins told me after the stress test that I appeared to have a mild artery blockage. No problem, I thought. Angioplasty was recommended. A catheter was inserted into my right arm during the angioplasty and although I was lightly sedated I still felt it, especially when the doctor encountered a problem and needed to make a slight correction. I was confident that they would put a stent in me and I would be home by the weekend. "No," said my doctor. "You have three blockages and need bypass surgery." I thought he was talking about someone else. That can't be me! The blockages did not require immediate surgery. At least I was pain free and asymptomatic. Despite this, I requested an early surgery date, which was set for January 11, 2011. (That was 1/11/11. How odd.) The triple coronary artery bypass graft opened me up like a stranded tuna and made me an official member of the Zipper Club. Atrial fibrillation was corrected with radiofrequency ablation. After the operation I had to lie on my back, which meant minimal sleep for a week. Lasix (a diuretic) was my biggest problem, along with a dozen pills that I had to take way too often. According to my surgeon, who visited me a day later, everything was going well and I was on my feet and walking the aisles of Hopkins with the help of a nurse and a walker. I went home in a week. Oddly enough, the hardest part of the ordeal was trying to get to the bathroom on time and the bumpy ride home. These bumps prompted me to keep the pillow [for tummy support] as close as possible. Ouch. After I returned home, two home care nurses came and they were fabulous. I lost about 20 pounds before the surgery and another 17 pounds afterwards. I went from 210 pounds to about 173 pounds. Today I don't eat red meat, nothing with fritters and as little fat and salt as possible. That means I mainly eat fish. I exercise every day (between 30 and 60 minutes) and have regular check-ups with my cardiologist. I was fortunate that the atrial fibrillation alerted my doctors to an underlying problem that could have led to a heart attack or even death. Second, I've been fortunate to have some true professionals on hand to get me through the darkest days of my life. Many people who have had bypass surgery have told me that I would have more energy after the surgery because of my new plumbing. This happened within 6-7 months after my surgery. Stan Ber was born in Maine and is a graduate of Bowdoin College. He retired as a sports editor and columnist for the Columbia Flier and Howard County Times in December 2014 after 44 years. He was admitted

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Inducted into the Howard County Sports Hall of Fame in 2009 and recognized by the Maryland State Legislature.

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Exercises Be sure to check your answers carefully against the Answers to the Exercises, page 422.

A Match the listed structures to the following descriptions. Aorta Arteriole Atrium Capillary Inferior vena cava Mitral valve Pulmonary artery Pulmonary vein Superior vena cava Tricuspid valve Ventricle vein 1. Valve that lies between the right atrium and right ventricle of the heart _________ 2. Smallest blood vessel _________ 3. Carrying oxygen-rich blood from the lungs to the heart _______________________ 4. Largest artery in the body _______________________ 5 .brings deoxygenated blood from the upper parts of the body to the heart _________________ 6. Upper ventricle _______________________

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B Trace the path of blood through the heart. Begin when the blood from the vena cava enters the right atrium (and close the valves in the heart). 1. Right atrium______________________ 2. ________________________________ 3. ________________________________ 4. ________________________________ 5. ________________________________ 6. Capillaries of the lungs___________ 7. ______________________________ 8. ________________________________ 9. ___________________________ 10. ______________ 11. __________________________ 12. Aorta___________ C Complete the following sentences. 1. The pacemaker of the heart is the ___________________________________________.

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2. The sac-like membrane surrounding the heart is the _____________________________. 3. The wall of the heart between the right and left atria is the _____________________. 4. The relaxation phase of the heartbeat is denoted as ___________________________________. 5. Specialized conductive tissue in the wall between the ventricles is the _______________. 6. The inner lining of the heart is the __________________________________________. 7. The contraction phase of the heartbeat is denoted as ___________________________________. 8. A gas released as a metabolite of catabolism is _____________________________. 9. Specialized conductive tissue at the base of the wall between the two upper chambers of the heart is the _____________________. 10. The inner lining of the pericardium, which wraps tightly around the heart, is the ____________________. 11. An abnormal heart sound due to improper closing of the heart valves is a _____________________. 12. The heartbeat felt through the walls of the arteries is referred to as _____________________. D Complete the following terms with the given definitions. 1. Hardening of the arteries: Arterio _____________________ 2. Disease state of the heart muscle: Cardio _____________________

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3. Enlargement of the heart: Cardio _____________________ 4. Phlebitis: Phleb _____________________ 5. Fast heartbeat condition: _____________________ Cardia 6. Slow heartbeat condition: _____________________ Cardia 7. High blood cholesterol: Hyper _____________________ 8. Surgical repair of a valve: valvulo _____________________ 9. Hypoxic state: hyp _____________________ 10. Concerning an upper chamber of the heart: _____________________ al 11. Mitral valve constriction: mitral _____________________ 12. Dissolution of a clot: thrombo _____________________ E Give the meanings of the following terms. 1. Cyanosis _____________________________________________ ___ 2. Phlebotomy _____________________________________________ ___ 3. Arterial anastomosis _______________________________________ ___

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4. cardiogenic shock _____________________________________________ ___ 5. atheroma _____________________________________________ ___ 6. arrhythmia _______________ 7. sphygmomanometer _____________________________ ___ 8. stethoscope _____________________________ ___ 9. mitral valve inflammation _____________ ___ 10. atherosclerosis __________________________________________ __ 11. vasoconstriction ______________________________ ___ 12. the following pathological conditions of the heart with their following meanings. Aortic septal defect Aortic isthmus stenosis

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congestive heart failure coronary heart disease endocarditis fibrillation fibrillation hypertensive heart disease mitral valve prolapse patent ductus arteriosus pericarditis tetralogy of fallot 1. inflammation of the inner lining of the heart ___________ 2. rapid but regular atrial or ventricular contractions ___________ 3. small hole between the upper chambers of the heart; congenital anomaly ________________________ 4. improper closure of the valve between the left atrium and ventricle during systole ____________________ 5. blockage of the arteries surrounding the heart, causing ischemia ___________ 6. hypertension affecting the heart ___________ 7. rapid, random, ineffective, and irregular Contractions of the heart __________________________ 8. Inflammation of the sac around the heart __________________________

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9. inability of the heart to pump the required amount of blood ___________ 10. congenital malformation involving four different heart defects ____________________ 11. congenital narrowing of the large artery leading away from the heart ___________ 12. a duct between the aorta and the pulmonary artery which usually closes soon after of birth, remains open __________________________ G Give the meaning of the following terms. 1. Heart block _____________________________________________ _________________________ 2. Cardiac arrest _____________________________________________ _______________________ 3. Rapid heartbeat __________________________________________ _________ 4. Artificial cardiac pacemaker _______________________________________ ___________ 5. Thrombotic occlusion ________________________________________________ ________________ 6. Angina pectoris _________________________________ ___________ 7. Myocardial infarction ___________________________

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8. necrosis _____________________________________________ __________________________ 9. infarction _____________________________________________ __________________________ 10. ischemia _____________________________________________ __________________________ 11. nitroglycerin _____________________________________________ _______________________ 12. digoxin _____________________________________________ __________________________ 13. bruit _____________________________________________ __________________________ 14. thrill _____________________________________________ __________________________ 15. acute coronary syndromes _____________________________________________ _____________ 16. pericardial friction rub _____________________________________________ _______________ 17 . tiefe Venenthrombose _____________________________________________ ______________

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18. biventricular pacemaker _____________________________________________ _____________ H Match the following terms to their descriptions. Aneurysm Auscultation Claudication Emboli Essential hypertension Heart murmur Peripheral artery disease Petechiae Raynaud's disease Rheumatic heart disease Secondary hypertension Vegetations 1. Lesions that form after infection damage to the heart valves ______________ 2. Clots that travel to a blood vessel and suddenly block it _____________________ 3. Small, pinpoint bleeding ____________________________________ 4. an extra heart murmur heard between normal beats caused by a valvular defect or condition that interferes with the smooth flow of blood through the heart _____________________________ 5. listening with a stethoscope _____________________________________

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6. Heart disease caused by rheumatic fever ________________________ 7. Hypertension in the arteries when the etiology is idiopathic _______________________ 8. Hypertension associated with kidney disease ________________________ 9. Episodes of pallor, numbness and cyanosis in fingers and toes caused by a transient narrowing of arterioles ____________________________________ 10. Local dilation of an artery ____________________________________ 11. Pain, tension and weakness in a limb after beginning to walk __________________________ 12. Blockage of arteries in the lower extremities; Etiology is atherosclerosis ______________ I Provide brief answers to the following questions. 1. Types of drugs used to treat acute coronary syndromes include _____________________________________________ ___________________________________________. 2. When damaged venous valves fail to prevent backflow of blood, a condition develops (swollen, twisted vein) which is ____________________________________. 3. Swollen, twisted veins in the rectal region are referred to as _________________________________. 4. Name the four defects in tetralogy of Fallot based on their descriptions:

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a. Narrowing of the artery leading from the heart to the lungs _______________________ b. Crack in the wall between the ventricles __________________________________________ c. the great vessel emanating from the left ventricle moves across the interventricular septum __________ d. Overdevelopment of the wall of the lower right ventricle _____________________________________________ ____________________________________ J Select from the list of cardiac tests and procedures to complete the definitions below. Angiography (arteriography) cardiac biomarkers cardiac MRI coronary artery bypass graft surgery defibrillation echocardiography electrocardiography endarterectomy lipid testing (profile) lipoprotein electrophoresis stress test thallium 201 scan 1. Surgical removal of plaque from the inner lining of an artery in the chest to stop ventricular fibrillation and pulselessness

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ventricular tachycardia ___________________________________ 3. Measurement of levels of fay substances (cholesterol and triglycerides) in the bloodstream ____________________ 4. Measurement of the response of the heart to physical exertion (patient monitored while jogging on a treadmill) _________________________________ 5. Measurement of troponin-T and troponin - I after myocardial infarction _____________________ 6. Contrast medium injection into vessels and X-ray imaging ___________________________________ 7. Recording of electricity in the heart ________________________________ 8. Intravenous injection of a radioactive substance and measurement of its accumulation in the heart muscle ________________________________ 9. Using echoes of high-frequency sound waves to create images of the heart _____________ 10 Separation of HDL and LDL from a blood sample ____________________ 11. Anastomosis of vascular grafts to existing coronary arteries to maintain blood supply Applic tion to the myocardium ___________________________________ 12. Beaming of magnetic waves to the heart to produce images of its structure _________________ K Give the meaning of the following terms. 1. Digital subtraction angiography _____________________________________________

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2. Heart transplantation ________________________________________ __________ 3. ETT-MIBI ________________________________________ __________ 4. Doppler ultrasound _____________________________________________ __________ 5. Holter monitoring ________________________________________ __________ 6. Thrombolytic therapy ________________________________________ __________ 7. Extracorporeal circulation ________________________________________ __________ 8. Cardiac catheterization ________________________________________ 9. Percutaneous circulation ______________ .. Drug Eluting stent _____________________________________________ _________ 11. Electron beam computed tomography ______________ ___ 12. CT angiography _____________

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__________ L Identify the following cardiac arrhythmias by their abbreviations. 1. AF _____________________________________________ ___ 2. VT _____________________________________________ ___ 3. VF _____________________________________________ ___ 4. PVC _____________________________________________ ___ 5. PAC _____________________________________________ ___ M Identify the following cardiac abnormalities by their abbreviations. 1. CHF _____________________________________________ _ 2. VSD _____________________________________________ _ 3. WED _____________________________________________ _

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4. PDA _____________________________________________ _ 5. MVP _____________________________________________ _ 6. AS _____________________________________________ _ 7. CAD _____________________________________________ _ 8. ASD _____________________________________________ _ N Match the listed cardiac test and procedure abbreviations to the following explanations/descriptions. BNP CRT cTnI or cTnT ECHO ECMO ETT ETT-MIBI ICD LDL LVAD RFA

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TEE 1. Heart serum enzyme testing for myocardial infarction _______ 2. Booster pump implanted in abdomen with cannula leading to heart as “bridge to transplant” _____________________ 3. Ultrasound imaging of heart using transducer inside esophagus _____________________ 4. Device implanted in chest that detects and corrects arrhythmias by shocking the heart _______ 5. Catheter delivery of high-frequency current to damage a small portion of the heart muscle and reverse an abnormal heart rhythm _______ 6. Method of determining the heart's response to exercise (stress) ___________________ 7 Cardiac imaging using high-frequency sound waves pulsed through chest wall and reflected off cardiac structures _____________________ 8. Radioactive testing of heart function with stress test _____________________ 9. Technique with heart-lung machine to drain blood from heart and lungs while the heart is re parrying _______ _____________ 10. Biventricular pacing to correct severe abnormal ventricular rhythms _____________________ 11. Lipoprotein sample measured _________ 12. Brain chemistry measured to identify patients at risk for complications from MI and with CHF

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_____________________ O Spell the term correctly based on its definition. 1. concerning the heart: __________________________ 2. abnormal heart rhythm: arr ____________ 3. abnormal bluing: ____________ osis 4. relaxation phase of the heartbeat: ____________ tole 5. chest pain: ____________ pectoris 6. inflammation a vein: __________________________ inflammation 7. vasodilatation: vaso __________________________ 8. Enlargement of the heart: cardio __________________________ 9. Hardening of the arteries with Fayplaque: ____________ sclerosis 10. Swelling of the veins in the rectum: ____________ oids P Match the listed terms to cardiovascular interventions with the following meanings/descriptions. Aneurysmorrhaphy Atherectomy BNP test CABG Catheter ablation Embolectomy

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Endarterectomy PCI Pericardiocentesis STEMI Thrombolytic Therapy Valvotomy 1. Incision of a heart valve __________________________ 2. Removal of a clot that has migrated into a blood vessel and suddenly caused a blockage __________________________ 3. Coronary artery bypass graft surgery (to relieve ischemia) ____________ 4. Surgical puncture to Removing fluid from the pericardial space __________________________ 5. Inserting a balloon-tipped catheter and stenting into a coronary artery ____________________ 6. Removing the inner lining of an artery to widen it ____________ 7. Suturing (repairing) a distended portion of an artery __________________________ 8. Removing plaque from an artery ____________ 9. Type of acute coronary syndrome ____________ 10. Use of streptokinase and tPA to dissolve blood clots ____________ 11. Brief delivery of radio frequency energy to destroy areas of heart tissue for treatment of arrhythmias ____ ________________________

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12. measures an elevated peptide in patients with heart failure __________________________ F Select the terms in bold that best complete each sentence. 1. Bill had pain in his chest radiating up his neck and down his arm. He called his GP, who said Bill should go to the local hospital's emergency room (ED) immediately. The first test performed in the ER was a/an (stress test, ECG, CABG). 2. dr Kelly explained to the family that her observation of baby Charles' bluish complexion helped her diagnose a defect (thrombotic, aneurysmal, septal) in the baby's heart, which needed to be diagnosed immediately. 3. Mr. Duggan had a fever of unknown origin. When doctors did an echocardiogram and saw vegetations on his mitral valve, they suspected (bacterial endocarditis, hypertensive heart disease, angina pectoris). 4. Claudia's fingers turned white or bluish when she was out in the cold or stressed. Her doctor thought it worthwhile to examine her for (varicose veins, Raynaud's disease, intermittent claudication). 5. Daisy's heart felt like it was beating every time she drank coffee. Her doctor suggested that she wear one (Holter monitor, LVAD, CABG) for 24 hours to assess the nature of the arrhythmia. 6. Paola's father and grandfather died of heart attacks. Her doctor tells her that she has inherited a

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Tendency to accumulate fats in their bloodstream. Blood tests show high levels of (enzymes, lipids, nitroglycerin). Discussing her family history with her (gynecologist, hematologist, cardiologist), she understands that she has family problems (hypocholesterolemia, hypercholesterolemia, cardiomyopathy). 7. During training, Bernard felt pain (cramps) in his calf muscle. The pain went away as he rested. After performing (Holter monitoring, Doppler ultrasound, echocardiography) on his leg to assess blood flow, Dr. Shaw firm (stenosis, fibrillation, endocarditis) indicating poor perfusion. She recommended a daily exercise program, a low-fat diet, careful foot care and drug therapy with antiplatelet agents to treat Bernard's intermittent illness (palpitations, high blood pressure, claudication). 8. Carol noticed that her 6 week old son Louis had a slight bluish or (jaundice, cyanotic, diastolic) complexion. She consulted a pediatrician (dermatologist, hematologist, cardiologist) who performed (echocardiography, PET scan, endarterectomy) and diagnosed Louis' condition as (endocarditis, congestive heart disease, tetralogy of Fallot). 9. 78-year-old John Smith had suffered from coronary artery disease and high blood pressure for 10 years. His history included an acute myocardial infarction or (MI, PDA, CABG). He was often tired and complained of (dyspnea, nausea, migraine) and swelling in his ankles. His doctor diagnosed his condition as (aorta

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p y g aneurysm, congestive heart failure, congenital heart disease) and recommended salt intake restriction, diuretics and a (ACE inhibitor, antibiotic, analgesic). 10. Sarah had a routine examination (auscultation, vasoconstriction, vasodilation) of her chest with a (catheter, stent, stethoscope) to listen to her heart. Your doctor noticed a mid-systolic murmur characteristic of (TVT, MVP, LDL). An echocardiogram confirmed the diagnosis.

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Answers to exercises A 1. tricuspid valve 2. capillary 3. pulmonary vein 4. aorta 5. superior vena cava 6. atrium 7. pulmonary artery 8. arteriole 9. mitral valve 10. inferior vena cava 11. venule 12. ventricle B 1 . right atrium 2. tricuspid valve 3. right ventricle 4. pulmonary valve 5. pulmonary artery 6. capillaries of the lungs 7. pulmonary veins

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8. left atrium 9. mitral valve 10. left ventricle 11. aortic valve 12. aorta C 1. sinus node (SA) 2. pericardium 3. interatrial septum 4. diastole 5. atrioventricular bundle or bundle of His 6. endocardium 7. systole 8. Carbon dioxide (CO2) 9. atrioventricular (AV) node 10. visceral pericardium (the outer lining is the parietal pericardium) 11. heart murmur 12. pulse D 1. atherosclerosis 2. cardiomyopathy 3. cardiomegaly

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4. phlebitis 5. tachycardia 6. bradycardia 7. hypercholesterolemia 8. valvuloplasty 9. hypoxia 10. atrium 11. mitral stenosis 12. thrombolysis E 1. bluish discoloration of the skin due to lack of oxygen in the blood 2. cut of a vein 3 .new connection between the arteries 4. Circulatory failure due to poor heart function 5. Mass of yellowish plaque (Fay substance) 6. Abnormal heart rhythm 7. Instrument for measuring blood pressure 8. Instrument for listening to sounds in the chest 9. Inflammation of the mitral valve 10. Hardening of the arteries with a yellowish, pale substance (plaque) 11. Narrowing of a vessel 12. Widening of a vessel

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F 1. Endocarditis 2. Fluff 3. Atrial Septal Defect 4. Mitral Valve Prolapse 5. Coronary Artery Disease 6. Hypertensive Artery Disease 7. Fibrillation 8. Pericarditis 9. Congestive Heart Failure 10. Tetralogy of Fallot 11. Aortic Stenosis 12. Patent Ductus Arteriosus G 1. Disturbance of proper conduction of conduction by the AV node to the atrioventricular bundle (His bundle) 2. Sudden unexpected cardiac arrest 3. Chest discomfort associated with arrhythmias 4. Ba ery- powered device placed in the chest and wired to deliver electrical Send current to the heart to restore normal sinus rhythm. 5. Blockage of a vessel by a clot

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6. Chest pain due to insufficient oxygen supply to the heart muscle (ischemia) 7. Area of necrosis (tissue death in the heart muscle; heart attack) 8. Abnormal state of death (dead tissue) 9. Damage or death of tissue due to lack of oxygen 10. Blood is retained by an area of the body 11 Nitrate drug used to treat angina pectoris 12. Drug treating arrhythmias and increasing heartbeat 13. Abnormal murmur (noise) on auscultation 14. Vibration on palpation of chest 15. Consequences of plaque rupture in coronary arteries; MI and unstable angina 16. Scratching or crunching sounds on auscultation of heart; indicates pericarditis 17. Clot formation in a large vein, usually in the lower extremities 18. Device that allows the ventricles to beat synchronously; cardiac resynchronization therapy H 1. vegetations 2. emboli 3. petechiae 4. murmur

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5. Auscultation 6. Rheumatic heart disease 7. Essential hypertension 8. Secondary hypertension 9. Raynaud's disease 10. Aneurysm 11. Claudication 12. Peripheral arterial disease I 1. Beta blockers, ACE inhibitors, statins, aspirin, calcium channel blockers 2. Varicose veins 3 .Hemorrhoids 4. a. pulmonary artery stenosis b. ventricular septal defect c. Displacement of the aorta to the right d. Right ventricular hypertrophy J 1. Endarterectomy 2. Defibrillation 3. Lipid tests (profile) 4. Exercise test 5. Cardiac biomarkers

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6. Angiography (arteriography) 7. Electrocardiography 8. Thallium-201 scan 9. Echocardiography 10. Lipoprotein electrophoresis 11. Coronary artery bypass graft 12. Cardiac MRI K 1. Video machines and a computer create X-ray images of blood vessels by using them take two images (without and with contrast) and subtract the first image (without contrast) from the second. 2. A donor heart is transferred to a recipient. 3. Exercise tolerance test combined with a radioactive tracer scan. 4. An instrument that focuses sound waves onto a blood vessel to measure blood flow. 5. A compact version of an electrocardiograph is worn for a 24-hour period to detect cardiac arrhythmias. 6. Treatment with drugs (streptokinase and tPA) to dissolve blood clots after a heart attack. 7. A heart-lung machine is used to drain blood from the heart and lungs during the operation. The machine oxygenates the blood and sends it back into the bloodstream.

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8. A catheter (tube) is inserted into an artery or vein and threaded into the chambers of the heart. Contrast media can be injected to take X-rays, see blood flow patterns, and take blood pressure readings. 9. A balloon-tipped catheter is inserted into a coronary artery to open the artery; Stents are used. 10. Stents are expandable tubes that are placed in arteries during PCI. They release polymers that prevent plaque from forming again. 11. E-beam and CT identify calcifications in and around coronary arteries to diagnose CAD. 12. X-ray images of the heart and coronary arteries obtained with CT technology. L 1. atrial fibrillation 2. ventricular tachycardia 3. ventricular fibrillation 4. premature ventricular contraction 5. premature atrial contraction M 1. congestive heart failure 2. ventricular septal defect 3. myocardial infarction 4. patent ductus arteriosus

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5. Mitral valve prolapse 6. Aortic stenosis 7. Coronary artery disease 8. Atrial septal defect N 1. cTnI or cTnT: cardiac troponin I and troponin T 2. LVAD: left ventricular assist device 3. TEE: transesophageal echocardiography 4. ICD: implantable cardioverter defibrillator 5. RFA : high frequency catheter ablation 6. ETT: exercise tolerance test 7. ECHO: echocardiography 8. ETT-MIBI: exercise tolerance test with Sestamibi scan 9. ECMO: extracorporeal membrane oxygenation 10. CRT: cardiac resynchronization therapy 11. LDL: low density lipoprotein; high values indicate risk of CAD 12. BNP: Brain natriuretic peptide O 1. Coronary 2. Arrhythmia 3. Cyanosis 4. Diastole

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5. Angina pectoris 6. Phlebitis 7. Vasodilation 8. Cardiomegaly 9. Atherosclerosis 10. Hemorrhoids P 1. Valvotomy 2. Embolectomy 3. CABG 4. Pericardiocentesis 5. PCI 6. Endarterectomy 7. Aneurysmorrhaphy 8. Atherectomy 9. STEMI (ST- segment elevation myocardial infarction) 10. thrombolytic therapy 11. catheter ablation 12. BNP test Q 1. ECG 2. septum 3. bacterial endocarditis

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4. Raynauds 5. Holter monitor 6. Lipids; cardiologist; hypercholesterolemia 7. Doppler ultrasound; stenosis; limp 8. cyanotic; cardiologist; echocardiography; Tetralogy of Fallot 9th MI; dyspnea; congestive heart failure; ACE inhibitors 10. Auscultation; Stethoscope; MVP Answers to Practical Applications Operation Plan

1. E 2. C 3. H 4. I 5. D 6. A 7. B 8. J 9. G 10. F Clinical cases: what is your diagnosis?

Fall 1 1. b

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Case 2 1st d 2nd a 3rd b Case 3 1st d 2nd a Pronunciation of terms

vocabulary and terminology

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TERM angiogram angioplasty anoxia aorta aortic stenosis cardiac apex arrhythmia arterial anastomosis arteriography arterioles atherosclerosis artery atherectomy atheroma atherosclerosis atrium atrioventricular bundle atrioventricular node atrium; Pl. Atria Brachial artery Bradycardia His bundle Capillary carbon dioxide Cardiogenic shock Cardiomegaly Cardiomyopathy Coronary arteries Cyanosis Oxygenated blood Diastole Electrocardiogram Endocardium Endothelium Hypercholesterolemia Hypoxia Interventricular septum Mitral valve Mitral valve inflammation Myocardium Myxoma Normal sinus rhythm Oxygen Pacemaker Pericardiocentesis Pericardium Phlebotomy Pulmonary artery Heart valve Pulmonary circulation

AUSKUNFT AN-je-o-gram AN-je-o-plas-te ah-NOK-se-ah a-OR-tah a-OR-tik steh-NO-sis A-pex des Herzens a-RITH-me - ah ar-TE-re-al ah-nas-to-MO-sis ar-TE-re-OG-rah-fe ar-TE-re-ohl ar-te-re-o-skleh-RO-sis AR - teh-re ath-eh-REK-zu-mir ath-äh-O-mah ath-er-o-skleh-RO-sis A-tre-al a-tre-o-ven-TRIK-u-lar BUN - dil a-drei-o-ven-TRIK-u-lar-Knot A-drei-um; A-tre-ah BRA-ke-al AR-ter-e bra-de-KAR-de-ah BUN-dil von Zischen KAP-ih-lah-re KAR-bon di-OX-ide kar-de-o- JEN-ik Schock kar-de-o-MEG-ah-le kar-de-o-mi-OP-ah-the KOR-o-nair-e AR-teh-reez si-ah-NO-sis de-OX -ih-jeh-NA-ted blood di-AS-to-le eh-like-thin-KAR-de-o-gram en-do-KAR-de-um en-do-THE-le-um hi-per -ko-les-ter-ol-E-me-ah hi-POX-e-ah inter-ven-TRIK-u-lar SEP-tum MI-tral Valve MI-tral val-vu-LI-tis mi -o -KAR-de-um mik-SO-mah NOR-mal SI-nus RIH-thim OX-ih-jen PACE-ma-ker peh-rih-kar-de-o-sen- TE-sis peh-rih -KAR -de-um fleeh-BOT-o-me PUL-mo-nair-e AR-teh-re PUL-mo-nair-e ser-ku-LA-shun PUL-mo-nair-e Valve PUL-mo -nair -e Weinhülsenfrucht

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TERM septum; Pl. septa sinus node sphygmomanometer stethoscope systemic circulation systole tachycardia thrombolysis thrombophlebitis tricuspid valve valve valvotomy valvuloplasty vascular vasoconstriction vasodilation vein vena cava; Pl. venae cavae venipuncture venous ventricle venule

PRONOUNCES SEP-Zweck; SEP-ta si-no-A-drei-al The knot sfig-mo-mah-NOM-eh-ter STETH-o-Scope sis-TEM-ik see-ku-LA-shun SIS-to-le tah-ke- KAR-de-ah throm-BOL-ih-sis throm-bo-fieh-BI-tis tri-KUS-pid Valve Valve val-VOT-o-me val-vu-lo-PLAS-te VAS-ku-lar vaz -o-kon-STRIKE-maid vaz-o-the-LA-maid Rebe VE-nah KA-vah; VE-ne KA-ve ve-nih-PUNK-chur VE-nus VE-trih-kel VE-ule

pathology, laboratory tests and clinical procedures

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TERM ACE inhibitors acute coronary syndrome aneurysm angina pectoris angiography atrial fibrillation atrioventricular block auscultation beta-blockers biventricular pacemaker BNP test bruit calcium channel blockers cardiac arrest cardiac biomarkers cardiac catheterization cardiac MRI cardiac tamponade cardioversion catheter ablation claudication coarctation coarctation stenosis computed tomography angiography congenital heart disease decompensated heart failure coronary artery bypass graft surgery digital subtraction angiography digoxin Doppler ultrasound arrhythmia echocardiography electrocardiography electron beam computed tomography embolus; Pl. embolism endarterectomy endocarditis extracorporeal circulation fibrillation fluff heart block heart transplant hemorrhoids holter monitoring hypertension hypertensive heart disease implantable cardioverter defibrillator infarction ischemia

AUSKUNFT ACE in-HIB-ih-tor a-KYOOT KOR-o-nair-e SIN-drohms AN-yoo-rih-zim an-JI-nah an-je-OG-rah-fe A-tre-al fib- rih-LA-shun a-tre-o-ven-TRIK-u-lar block aw-school-TA-shun BA-tah BLOCK-er bi-ven-TRIK-u-lar PACE-maker GDP test BRU- e ENG -se-um CHA-nel BLOCK-er KAR-de-ak KAR-de-ak BI-o-mar-kerz KAR-de-ak kath-eh-ter-ih-ZA-shun KAR-de-ak KAR- de-ak tam-po-NADE kar-de-o-VER-zhun KATH-eh-ter ab-LA-shun klaw-deh-KA-shun ko-ark-TA-shun there a-OR-tah come- PU -ted to-MOG-rah-fe an-je-AND-rah-fe con-JEN-ih-tal heart dih-ZEEZ con-JES-tiv heart FAIL-deine KOR-o-nair-e AR- sie sind BI -pass GRAF-ding KOR-o-nair-e AR-sie sind dih-ZEEZ deep wine throm-BO-sis de-fib-rih-LA-shun DIJ-ih-tal sub-TRAK-shun an-je- OG -rah-fe dih-JOK-sin DOP-ler UL-trah-sound dis-RITH-me-ah ek-o-kar-de-OG-rah-fe eh-lek-tro-kar-de-OG- rah -fe eh-LEK-thron beam come-PU-ted to-MOG-rah-fe EM-bo-lus; EM-bo-li en-dar-ter-EK-to-me en-do-kar-DI-tis ex-trah-chor-POR-e-all see-cow-LA-shun fib-rih-LA-shun FLUH-ter Herzblock Herz tranz-plan-TA-shun HEM-uh-roydz HOL-ter MON-ih-teh-ring hi-per-TEN-shun hi-per-TEN-siv Herz dih-ZEEZ im-PLANT- ah -bul kar-de-o-VER-ter de-FIB-rihla-tor in-FARK-shun is-KE-me-ah

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TERM Linksherzunterstützungssystem Lipidtests Lipoproteinelektrophorese Mitralstenose Mitralklappenprolaps Herzgeräusch Myokardinfarkt Nitrate Nitroglyzerin Okklusion Palpitationen Patent Patent Ductus arteriosus Perkutane Koronarintervention Perikardreibung Reiben Perikarditis Periphere arterielle Verschlusskrankheit Petechien Positronenemissionstomographie des Herzens Raynaud-Krankheit Rheumatische Herzkrankheit Septumdefekte Statine Stresstest Technetium Tc99m Sestamibi Scan Telemetrie Tetralogie von Fallot Thallium 201 Scan Nervenkitzel Thrombolysetherapie Thrombotischer Closure transcatheter aortic valve replacement varicose veins vegetations

AUSSPRACHE links ven-TRIH-ku-lar ah-SIST de-vise LIH-pid tested li-po-PRO-teen eh-lek-tro-für-E-sis MI-tral steh-NO-sis MI-tral Valve PRO - Round MUR-mer mi-o-KAR-de-al in-FARK-shun ni-TRAYTS ni-tro-GLIS-er-in o-KLU-zhun pal-pih-TA-shunz PA-Zelt PA-Zelt DUK -tus ar-te-re-O-sus per-cow-TA-ne-us KOR-in-air-e inter-FRIEND-like peh-rih-KAR-de-al FRIK-like rub peh-rih -car -DI-tis peh-RIH-fer-al ar-TE-re-al dih-ZEEZ peh-TE-ke-i pos-ih-throne e-MIH-maiden to-MOG-rah-fe des Herzens ra-NO you-ZEEZ ru-MAT-your heart your-ZEEZ SEP-Number DE-Facts STAT-inz STRESS test take-NE-she-um Tc99m ses-tah-MIH-be scan tel-EM-et-re teh -TRAH- lo-je von fah-LO THAL-e-um 201 scan thril throm-bo-LIT-ik THERE-ah-pe throm-BOT-ik o-KLU-zhun tranz-KATH-eh-ter a-OR -Tick Valve Re-PLAYS-ment VAR-ih-Cost Vines road-eh-TA-shunz

evaluation sheet

Write the meaning of each part of the word in the space provided. Check your answers against the information in the chapter or glossary (Medical Word Parts – English) at the end of the book.

combine shapes

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COMBINATION FORM Aneurysm/o Angi/o Aort/o Arter/o, Arteri/o Ather/o Atri/o Axill/o Brachi/o Cardi/o Cholesterol/o Coron/o Cyan/o Isch/o My/o Myx/ der Ox/pericardium/phleb/lung/rhythm/blood pressure/steth/thrombus/valve/flap/vas/vascul/vein/the, ven/i ventricul/o

Suffixes SUFFIX -Constriction -Dilation -Emie -Graphic -Lyse -Megaly -Meter -Oma -Ose -Plastic -Sclerosis -Stenosis -Tomie

prefixes

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PREFIX a-, anbradydedysendohyperhyperhyperperitachytetratri-

Use the cardiovascular anatomy terms listed to complete the attached table.

Aorta inferior vena cava left atrium left ventricle pulmonary capillaries mitral valve pulmonary artery pulmonary vein right atrium right ventricle superior vena cava tricuspid valve

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CHAPTER 12

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Respiratory System CHAPTER SECTIONS: Introduction 432 Respiratory Anatomy and Physiology 432 Vocabulary 436 Terminology 437 Pathology 443 Clinical Procedures 450 Abbreviations 455 Practical Applications 457 Personal: Recurrent Pneumonia 458 Exercises 459 Answers to Exercises 466 Term Pronunciation 468 Summary Sheet 471

CHAPTER OBJECTIVES • List the organs of the respiratory system and their location and function. • Identify pathological conditions affecting the respiratory system. • Learn medical terms related to breathing. • Describe important clinical procedures related to the respiratory system and identify relevant acronyms. • Apply your new knowledge to understand medical terms in their proper context, such as: B. Medical reports and records.

785

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Introduction By respiration we usually understand the mechanical process of respiration, the exchange of air between the lungs and the outside environment. This exchange of air in the lungs is called external respiration. When inhaled, oxygen from the environment (inhaled air contains about 21%) enters the alveoli and blood capillaries of the lungs. At the same time, when you exhale, carbon dioxide, a gaseous waste product produced when oxygen and food combine in cells, moves from the capillary blood vessels into the air sacs of the lungs to be exhaled. While external respiration occurs between the external environment and the capillary blood of the lungs, another form of respiration occurs between each body cell and the tiny capillary blood vessels that surround them. This is internal (cellular) respiration, which involves gas exchange at the cellular level in all organs of the body. Oxygen gets from the tissue capillaries into the body cells. At the same time, carbon dioxide moves from the body cells into the tissue capillaries to go to the lungs for exhalation. See Figure 12-1.

FIGURE 12-1

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Anatomy and Physiology of Respiration Label Figure 12-2 as you read the following sections describing the respiratory organs and their functions.

Figure 12.2 Organs of the respiratory system.

Air enters the body via the nose [1] through two openings called nostrils or nostrils. The air then flows through the nasal cavity [2], which is lined with mucous membrane and fine hairs (cilia), in order to filter out foreign bodies and to warm and humidify the air. Paranasal sinuses [3] are hollow, air-containing spaces within the skull that communicate with the nasal cavity. They also have a mucous membrane lining. In addition to producing mucus, a lubricating fluid, the sinuses loosen up the bones of the skull and help produce sound. After passing through the nasal cavity, the air next enters the pharynx (pharynx). There are three divisions of the pharynx. The first is the nasopharynx [4]. It contains the adenoids, or adenoids [5], which are collections of lymphoid tissue. They are more prominent in children and, when enlarged, can block the airway. Below the nasopharynx and closer to the mouth is the second division of the pharynx, the oropharynx [6]. The tonsils [7], two rounded masses of lymphoid tissue, are located in the oropharynx. The third section of the pharynx, the laryngopharynx [8],

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serves as a common passageway for food from the mouth and air from the nose. It divides into the larynx (larynx) [9] and the esophagus [10]. The esophagus leads into the stomach and transports the food to be digested. The larynx contains the vocal cords and is surrounded by pieces of cartilage to support it and keep the airway open. The thyroid cartilage is the largest and is commonly referred to as the Adam's apple in males. As the expelled air passes the vocal cords, they vibrate to produce sound. The tension of the vocal cords determines the high or low pitch of the voice. Since food entering from the mouth and air entering from the nose mix in the throat, what prevents food or drink from entering the larynx and airways when swallowed? Even if a small amount of solid or liquid enters the airways, ingested food can cause irritation in the lungs and breathing may stop. The epiglo is [11], a cartilaginous flap that hurts at the root of the tongue and prevents choking or aspiration of food. It serves as a lid over the opening of the larynx. During swallowing, as food and liquid flow down the throat, the epiglo closes over the larynx, preventing material from entering the lungs. Figure 12-3 shows the larynx from above.

Figure 12.3 The larynx seen from above (top view).

On its way to the lungs, air travels through the larynx to the trachea (trachea) [12], a vertical tube about an inch long and 1 inch in diameter. The trachea is held open by 16 to 20 C-shaped rings of cartilage separated by fibrous connective tissue that stiffens the front and sides of the tube. The mediastinum [13] is a space in the middle of the chest. In the mediastinal region, the trachea divides into two branches, the right and left bronchi or bronchi [14] (singular: bronchus). The bronchi are tubes composed of delicate epithelium surrounded by rings of cartilage and a muscular wall. Each bronchus leads to a separate lung [15] where it divides and subdivides into smaller and finer tubes, somewhat like the branches of a tree. The small bronchial branches are the bronchioles. Each terminal bronchiole [16] narrows into alveolar ducts that terminate in collections of air sacs called alveoli [17] (singular: alveolus). It is estimated that there are about 300 million alveoli in both lungs. The total area of the alveoli is about the size of a tennis court. Each alveolus is lined with a unicellular layer of epithelium. This very thin wall enables gas exchange between the alveolus and the capillary surrounding it [18]. Blood flowing through the capillary picks up oxygen from the alveolus while releasing carbon dioxide into the alveolus. Red cells [19] in the blood transport oxygen away from the lungs to all parts of the body and carbon dioxide back to the lungs for exhalation.

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Each lung is covered by a double-layered membrane called the pleura. The outer layer of this membrane, closer to the ribs, is the parietal pleura [20] and the inner layer, closer to the lungs, is the visceral pleura [21]. A serous (thin) secretion moistens the pleura and facilitates lung movements in the chest (thorax). The two lungs are not quite mirror images of each other. The slightly larger right lung is divided into three lobes, while the smaller left lung has two lobes. A lobe of lung can be removed without significantly affecting lung function. The top of the lungs is the apex and the bottom is the base. The hilum of the lungs is the midline region where blood vessels, nerves, lymphatic tissue, and bronchi enter and exit. The lungs extend from the collarbone to the diaphragm [22] in the chest cavity. The diaphragm is a muscular partition that separates the chest from the abdomen and supports the breathing process. It contracts and lowers with each inhalation (inspiration) and relaxes and rises with each exhalation (exhalation). The downward movement of the diaphragm increases the area in the chest cavity and reduces internal air pressure, allowing air to flow into the lungs to equalize the pressure. When the lungs are full, the diaphragm relaxes and rises, reducing the area in the chest cavity and increasing air pressure in the chest. Air is then expelled from the lungs to equalize the pressure; that is breathing out (breathing out). Figure 12-4 shows the position of the diaphragm during inspiration and during expiration.

FIGURE 12-4 Diaphragm position during inhalation (inspiration) and exhalation (expiration).

Figure 12.5 is a flow diagram of the airway from the nose, where air enters the body, to the capillaries of the lungs, where oxygen enters the bloodstream.

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Figure 12.5 Airway from the nose to the pulmonary capillaries.

vocabulary

This list repeats the terminology introduced in the previous section. Brief definitions and additional information will deepen your understanding. See Term Pronunciation on page 468 for help with difficult or unfamiliar words.

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Polyps Alveolus (plural: alveoli) Apex of the lungs Base of the lungs Bronchioles Bronchus (plural: bronchi) Carbon dioxide (CO2) Ciliaries

lymphatic tissue in the nasopharynx; adenoids. air sac in the lungs. Apex or top part of the lungs. An apex is the top of a structure. Apical means pertaining to or located at the apex. Lower part of the lungs; from the Greek base, foundation. Basilar means situated at or in the base. Smallest branches of the bronchi. Terminal bronchioles give rise to alveolar ducts. branch of the trachea (trachea), which is a passageway into the lungs; bronchial tube. Gas produced by body cells when oxygen and carbon atoms from food combine; exhaled through the lungs.

Thin hairs hurt on the mucosal epithelium lining the airways. They remove bacteria and foreign matter from the lungs. Cigarette smoke impairs the function of the cilia. Diaphragm Muscle that separates the chest and abdomen. It contracts to pull air into the lungs and relaxes to push air out. Epiglo is a lid-like piece of cartilage that covers the larynx and prevents food from entering the larynx and trachea when swallowed. exhale exhale; Process. glo is a slit-like opening to the larynx. Hilus The midline region where the bronchi, blood vessels, and nerves enter and exit the lungs. Hilar-lung means referring to (at) the hilum. inhalation inhalation; Inspiration. larynx voice box; contains the vocal cords. lobe division of a lung. Mediastinum Region between the lungs in the chest cavity. It contains the trachea, heart, lymph nodes, large blood vessels, esophagus, and bronchi. Nostrils Openings through the nose that bring air into the nasal cavities; nostrils. Oxygen (O2) Gas that makes up 21 percent of the air we breathe. It enters the bloodstream from the lungs and travels to all cells in the body. Palate One of two almond-shaped accumulations of lymphoid tissue in the oropharynx (palate means tonsils belonging to the palate). paranasal One of the air cavities in the bones near the nose. Parietal sinus Outer layer of the pleura, closer to the ribs and chest wall. pleura pharynx throat; including nasopharynx, oropharynx and laryngopharynx. Pleura Double-layered membrane that surrounds each lung. Pleural space between the layers of the pleura. Lung Cavity Essential parts of the lungs responsible for breathing; bronchioles and alveoli. Parenchymal respiration Exchange of gases (oxygen and carbon dioxide) at the pulmonary capillaries (external respiration or respiration) and at the tissue capillaries (internal respiration). trachea trachea. visceral Inner layer of the pleura closer to the lung tissue. pleura

Terminology

Write the meaning of the medical terms in the spaces provided.

combine shapes

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COMBINING MEANING SHAPE Polyps/o Adenoids Alveolus/o Bronch/o Bronchi/o

bronchiol/o capn/o coni/o cyan/o epiglo /o laryng/o

lob/o Mediastin/o nas/o orth/o

ox/o pector/o pharyng/o phon/o wood/o pleur/o

Alveole, air sac bronchial tube, bronchus

Bronchiole, small bronchus carbon dioxide dust

TERMINOLOGY

IMPORTANCE

Adenoidectomy ___________________________________ Adenoid Hypertrophy ___________________________________ Alveolar __________________________________ Bronchospasm ___________________________________ This narrowing of the bronchi and smaller bronchi (bronchioles) is a major feature of bronchitis. Bronchiectasis ___________________________________ Caused by weakening of the bronchial wall from infection. Bronchodilator ___________________________________ This drug works by dilating or enlarging the opening of a bronchus or bronchiole to improve ventilation of the lungs. An example is albuterol, which is administered via an inhaler. bronchopleural ___________________________________ A bronchopleural fistula is an abnormal connection between the bronchial tube and the pleural cavity (space). As a result of lung disease or a surgical complication, this can lead to an air leak into the pleural space. Bronchiolitis ___________________________________ This is an acute viral infection that occurs in infants under 18 months of age. Hypercapnia ___________________________________

Pneumoconiosis ___________________________________ See page 447. Blue cyanosis ___________________________________ Caused by lack of oxygen in the blood. Epiglo is an epigloitis ___________________________________ characterized by fever, sore throat and an erythematous, swollen epiglo is. Larynx, voice Larynx ___________________________________ box Laryngospasm ___________________________________ Spasm of the muscles of the larynx, closing the larynx. Laryngitis Lobectomy Lobe ___________________________________ Lung Figure 12-6 shows four different types of lung resections. Mediastinal Mediastinoscopy ___________________________________ An endoscope is inserted through an incision in the chest. Nose Paranasal sinuses ___________________________________ Para- in this term means near. See Figure 12-7. nasogastric intubation ___________________________________ straight, orthopnea ___________________________________ upright An abnormal condition in which breathing (pnea) is easier in an upright position. A major cause of orthopnea is congestive heart failure. Doctors assess the degree of orthopnea by the number of pillows a patient needs to sleep comfortably (e.g., two-pillow orthopnea). Oxygen hypoxia ___________________________________ Tissues have a reduced amount of oxygen, which can lead to cyanosis. Chest discharge ___________________________________ Coughing up or spitting up secretions from the airways. This sputum can contain mucus, blood, cell debris, pus, and microorganisms. Pharynx, pharynx ___________________________________ Laryngeal voice dysphonia ___________________________________ Hoarseness or other voice impairment. Phrenic nerve ___________________________________ The motor nerve of the diaphragm. pleura pleurodynia ___________________________________ The suffix -dynia means pain. The intercostal muscles or pleura are inflamed and cause pain when breathing. Pleural Effusion ___________________________________ An effusion is the leakage of fluid from blood vessels or lymphatic vessels into a cavity or interstices of tissue.

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COMBINING MEANING FORM pneum/o, air, lung pneumon/o

lungs/resp

rhin/o sinus/o spir/o

Tel./o

Thorax/o tonsils/o trachea/o

TERMINOLOGY

IMPORTANCE

Pneumothorax ___________________________________ The suffix -thorax means chest. Due to a hole in the lung, air collects in the pleural cavity between the layers of the pleura (Figure 12.8).

Pneumonectomy ___________________________________ Lungs ___________________________________ The pulmonary circulation carries deoxygenated (de-oxygenated) blood from the heart to the lungs and then carries oxygen-rich blood back to the heart for circulation throughout the body. Nose Nose Surgery ___________________________________ Rhinorrhea ___________________________________ Commonly known as “runny nose”. Paranasal sinuses, sinus infection ___________________________________ Respiratory spirometer ___________________________________ Procedure ___________________________________ Note that the s is omitted (when preceded by an x). Breathing ___________________________________ Cheyne-Stokes breathing is characterized by rhythmic changes in the depth of breathing (rapid breathing and then cessation of breathing). The pattern occurs every 45 seconds to 3 minutes. It can be caused by heart failure or brain damage, both of which affect the respiratory center in the brain. complete atelectasis ___________________________________ collapsed lung; incomplete expansion (ectasis) of a lung (Figure 12.9). Atelectasis can occur after surgery when a patient experiences pain and does not take a deep breath, preventing the lungs from fully expanding. Thoracic thoracotomy ___________________________________ Thoracic ___________________________________ tonsil tonsillectomy ___________________________________ The oropharyngeal (palatine) tonsils are removed. Trachea, tracheotomy ___________________________________ Tracheal stenosis of the trachea ___________________________________ Injury to the trachea from trauma, burns, or severe infection can result in scarring and contractions that restrict airflow. For example, leaving an endotracheal tube in place for an extended period of time can result in injury to the trachea or scar tissue formation. lung

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Figure 12.6 Lung resection. A, Wedge resection is the removal of a small, localized area of diseased tissue near the surface of the lung. Lung function and structure are relatively unchanged after healing. B, Segmental resection is the removal of a bronchiole and its alveoli (one or more lung segments). The remaining lung tissue expands to fill the space previously occupied. C, Lobectomy is the removal of an entire lobe of the lung. After the lobectomy, the remaining lung expands to fill the space in the chest cavity. D, Pneumonectomy is the removal of an entire lung. Techniques such as removing ribs and raising the diaphragm are used to reduce the size of the empty chest cavity.

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Figure 12.7 Paranasal sinuses. These are in pairs of 4, air-filled in the bones of the skull surrounding the nasal cavity. Sinusitis is inflammation of the sinuses due to viral, bacterial, or fungal infections or allergic reactions.

Fig. 12.8 Pneumothorax. Air collects in the pleural cavity, causing the lungs to collapse. When this happens, the lungs cannot fill with air, breathing becomes more difficult, and the body gets less oxygen. The onset of a pneumothorax is characterized by sudden, sharp chest pain with difficulty breathing.

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Figure 12.9 Two forms of atelectasis. A, Bronchial obstruction prevents air from reaching the distal airways and alveoli collapse. The most common cause is a blockage of a bronchus by a mucous or muco-purulent (pus-containing) plug, which can occur postoperatively. B, Accumulations of fluid, blood, or air in the pleural cavity collapse the lungs. This can occur with congestive heart failure (poor blood flow causing fluid to build up in the pleural cavity), pneumonia, trauma, or a pneumothorax.

Suffixes SUFFIX MEANING TERMINOLOGY MEANING -ema condition empyema ______________________________________ Em- at the beginning of this term means in. Empyema (pyothorax) is a collection of pus in the pleural cavity. -Osmia odorlessness ______________________________________ -Pnea respiratory apnea ______________________________________ Sleep apnea is a sudden cessation of breathing during sleep. It can lead to hypoxia, leading to cognitive impairment, hypertension and arrhythmias. Obstructive sleep apnea (OSA) is a narrowing or occlusion of the upper airways. Continuous positive airway pressure (CPAP) is a gentle ventilatory support used to keep the airway open (Figure 1210). Dyspnea ______________________________________ Dys- here means abnormal and is associated with shortness of breath (SOB). Paroxysmal (sudden) nocturnal (nighttime) dyspnea can occur in patients with congestive heart failure when they are reclined in bed. Patients often describe the feeling as “air hunger”. Hyperpnea ______________________________________ An increase in the depth of breathing, usually associated with physical exertion and abnormal in any condition in which the supply of oxygen is inadequate. Tachypnea ______________________________________ Tachy- means fast. Excessively rapid and shallow breathing; hyperventilation. -ptysis spi ing hemoptysis ______________________________________ Blood is coughed up from the bronchi and lungs; occurs with bronchitis or pneumonia, but also with tuberculosis, cancer, bronchiectasis and pulmonary embolism. Pulse Asphyxia ______________________________________ Sphyxia This condition, which literally means lack of pulse, is severe hypoxia, resulting in hypoxemia, hypercapnia, unconsciousness, and death. -thoracic pleural hemothorax ______________________________________ cavity, pyothorax ________________________ chest empyema of the chest.

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Figure 12.10 This man sleeps with a nasal CPAP (continuous positive airway pressure) mask. The pressure of the air coming from the compressor opens the oropharynx and nasopharynx.

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Pathology Diagnostic Terms Auscultation

Drums

rub pleura

Rattling (crackling) rhonchi (singular: rhonchus) sputum

Stridor

pants

hear sounds in the body. This procedure, performed with a stethoscope, is used primarily to listen to the flow of air in and out of the lungs and to listen to heart sounds. It is useful to diagnose diseases of the lungs, pleura, heart and abdomen, as well as to determine the condition of the fetus during pregnancy. Tapping on a surface to determine the difference in density of the underlying structure. Tapping over a solid organ produces a dull sound with no resonance. Percussion over an air-filled structure such as the lungs produces a resonant, hollow tone. When the lungs or pleural space fills with fluid and becomes dense, as in pneumonia, the resonance is replaced by dullness. Scratching sound caused by pleural surfaces rubbing against each other. Pleural friction (also called frictional friction) occurs when the pleurae are roughened and thickened by inflammation, infection, scarring, or neoplastic cells. It can be heard on auscultation and felt by placing fingers on chest wall. Auscultatory (when breathing in) audible fine crackling with liquid in the alveoli. These popping or clicking sounds can be heard in patients with pneumonia, bronchiectasis, or acute bronchitis. The French word rale means ra le. Loud rumbling sounds heard on auscultation of bronchi obstructed with sputum. These coarse buzzing noises are similar to snoring and are usually caused by secretions in larger bronchi. Material expelled from the bronchi, lungs, or upper airways by spitting. Purulent (pus-containing) sputum is often green or brown. It results from an infection and can occur with asthma. Bloody sputum indicates tuberculosis or malignancy. For sputum culture, the sample is maintained in a nutrient medium to promote the growth of a pathogen. Culture and sensitivity testing (C&S) identifies the sputum pathogen and determines which antibiotic is effective in destroying or reducing its growth. Tense, high-pitched sound heard on inspiration caused by an obstruction in the pharynx or larynx. Common causes of stridor include pharyngeal abscess, airway injury, croup, allergic reaction or epigloitis, and laryngitis. Continuous high-pitched whistling sounds produced during breathing. Wheezing is heard when air is forced through narrowed or blocked airways. Patients with asthma or emphysema often experience wheezing as the bronchi constrict and constrict.

diseases of the upper respiratory tract

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Kruppdiphtherie

Epistaxis

whooping cough

Acute viral infection in infants and children with laryngeal obstruction accompanied by barking cough and stridor. The most common pathogens are influenza viruses or respiratory syncytial virus (RSV). Acute infection of the throat and upper respiratory tract caused by the diphtheria bacterium (Corynebacterium). Inflammation occurs and a leathery, opaque membrane (Greek diphthera, sclera) forms in the throat and trachea. The immunity against diphtheria (through the formation of antibodies) is induced by the administration of weakened toxins (antigens) from the sixth to eighth week of life. These injections are usually given as a combination vaccine with whooping cough and tetanus toxins and are therefore called DPT injections. nosebleeds. Epistaxis is a Greek word meaning drop. It often results from irritation of the nasal mucosa, trauma, vitamin K deficiency, abnormal closure, blood-thinning medications (such as aspirin and warfarin), or high blood pressure. Whooping cough; highly contagious bacterial infection of the throat, larynx and trachea caused by Bordetella pertussis. Whooping cough is characterized by paroxysmal (violent, sudden) spasms of coughing that end in a loud "whooping cough."

Bronchial diseases asthma

Chronic inflammatory disease with obstruction of the airways by bronchial and bronchiolar edema and narrowing. Associated signs and symptoms of asthma include dyspnea, wheezing, increased mucus production, and coughing. The etiology can include allergy or infection. Triggers for asthma attacks include exercise, strong smells, cold air, stress, allergens (eg, tobacco smoke, pet dander, dust, mold, pollen, food), and medications (aspirin, beta-blockers). Treatments for asthma are: • Fast-acting agents for acute symptoms; Example is an albuterol inhaler (bronchodilator). • Long-term active ingredients for long-term control; Examples include glucocorticoids (inhaled), oral steroids (anti-inflammatory drugs), and leukotriene blockers such as montelukast (Singulair). Other conditions such as gastroesophageal reflux disease (GERD), sinusitis, and allergic rhinitis can make asthma worse. Bronchiectasis Chronic dilatation of a bronchus, usually secondary to an infection. This condition is caused by chronic infection with loss of elasticity of the bronchi. Secretions puddle and do not drain normally. Signs and symptoms include cough, fever, and expectoration of foul-smelling, purulent (pus-containing) sputum. Treatment is palliative (not curative) and includes antibiotics, mucolytics, bronchodilators, respiratory therapy, and surgical resection when other therapies are ineffective. long-lasting chronic inflammation of the bronchi; Type of chronic obstructive pulmonary disease (COPD). Infection and cigarette smoking are etiological factors. Signs and symptoms include excessive secretion of often infected mucus, a productive cough, and airway obstruction. Chronic bronchitis and emphysema (lung disease in which the air exchange in the air sacs in the lungs is severely impaired) are forms of chronic obstructive pulmonary disease (COPD). Cystic Fibrosis Inherited disease of the exocrine glands resulting in thick mucinous secretions in the airways (CF) that do not drain normally. This is a genetic disorder caused by a mutation in a gene. It can be diagnosed through newborn screening blood test, sweat test and genetic testing. CF affects the epithelium (cells lining) the airways, resulting in chronic airway obstruction, infection, bronchiectasis, and sometimes respiratory failure. It also affects exocrine glands such as the pancreas (inadequate secretion of digestive enzymes leads to poor growth) and sweat glands (salty-tasting skin). There is no known cure, but therapy includes antibiotics, aerosol drugs, chest physiotherapy, and pancreatic enzyme replacement. A new drug called ivacaftor (Kalydeco) helps prevent thick mucus from building up in the lungs. Some patients require a lung transplant. It can restore lung function and prolong life.

lung diseases

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Atelectase

collapsed lung; incomplete dilatation of the alveoli (Figure 12-9, page 441). In atelectasis, the bronchioles and alveoli (lung parenchyma) resemble a collapsed balloon. Emphysema Hyperinflation of the air sacs with destruction of the alveolar walls (Figure 12.11A and B). Loss of elasticity and collapse of the alveolar walls result in restriction of expiratory flow. There is a strong association between cigarette smoking and emphysema. As a result of the destruction of the lung parenchyma, including the blood vessels, the pulmonary artery pressure increases and the right side of the heart has to work harder to pump blood. This leads to right ventricular hypertrophy and right heart failure (cor pulmonale). Emphysema and chronic bronchitis are both forms of COPD. Lung Cancer Malignant tumor originating in the lungs and bronchi (Figure 12-12). This group of cancers, commonly associated with cigarette smoking, is the most common fatal malignancy. Lung cancer is divided into two general categories: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC accounts for 90% of lung cancers and includes three main types: adenocarcinoma (derived from mucus-secreting cells), squamous cell carcinoma (derived from the lining cells of the upper airways), and large cell lung cancer. When lung cancer is diagnosed, doctors assess the stage of the tumor (determined by its size, lymph node involvement, and distant spread) to create a treatment protocol. For localized tumors, surgery can be curative. The grading of NSCLC by assessment of the mediastinal lymph nodes is critical. If the nodes are negative and there are no other medical problems, the patient is a good candidate for surgery. If the nodes are positive, multimodal treatment (chemotherapy and radiation) with or without surgery may be an option. Doctors treat metastases (in the liver, brain, and bones) with palliative chemotherapy and/or radiation therapy. In some patients, often nonsmokers, NSCLC can be caused by a mutation (change) in the epithelial tissue of the lungs. An example is a mutation in the epidermal growth factor receptor (EGFR), which is sensitive to treatment with EGFR inhibitors (Iressa and Tarceva). This is an example of targeted drug therapy for cancer. Examples of tumors treatable by interfering with mutant gene products are increasing. SCLC originates from small, round cells ("oat" cells) found in the epithelium of the lungs. It grows rapidly and spreads quickly outside the lungs. Treatment with surgery, radiation therapy, and/or chemotherapy can lead to remissions. Pneumoconiosis Abnormal lung condition caused by exposure to certain dusts; with chronic inflammation, infection, and bronchitis (Figure 12.13A). Different forms are named after the type of dust particles inhaled: anthracosis - coal dust (anthrac/o) (black lung disease); Asbestosis - asbestos (asbestos/o) particles (in shipbuilding and construction); Silicosis - Silica (silic/o = stones) or glass (sanding disease). Pneumonia Acute inflammation and infection of the air sacs in the lungs, which fill with pus or products of the inflammatory reaction. Etiological pathogens are pneumococci, staphylococci and other bacteria, fungi or viruses. Infection damages the alveolar membranes, so exudate (fluid, blood cells, and debris) consolidates the alveoli (the sacs become "glued" together, making air exchange less effective). An infiltrate is a fluid-filled area in the lungs, as seen on a chest X-ray or CT scan. Lobar pneumonia (see Figure 12.13B) affects an entire lobe of the lung. Bronchopneumonia is a localized form of infection that produces patchy solidifications (abscesses) in the lung parenchyma. Treatment includes appropriate antibiotics and, if necessary, oxygen and mechanical ventilation in severe cases. See In Person: Recurring Pneumonia, page 458. Community-acquired pneumonia results from a contagious infection of the airways caused by a variety of viruses and bacteria (including pneumococci and mycoplasma bacteria). It is usually treated at home with oral antibiotics. Hospital-acquired pneumonia or nosocomial pneumonia is acquired during a hospital stay (Greek nosokomeion means hospital). For example, patients can contract pneumonia while on mechanical ventilation or as a hospital-acquired infection. Aspiration pneumonia is caused by material, such as food or vomit, becoming lodged in the bronchi or lungs. It is a danger for the elderly, Alzheimer's patients, stroke victims and people with esophageal reflux and feeding tubes. For X-rays of a normal chest and a chest with pneumonia, see page 450. Pneumonia Large accumulation of pus (bacterial infection) in the lungs. Abscess of lung fluid in the air sacs and bronchioles. Edema This condition is most often caused by the heart's inability to pump blood (congestive heart failure). Blood builds up in the blood vessels of the lungs and fluid

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pulmonary embolism (PE)

pulmonary fibrosis sarcoidosis

Tuberkulose (TB)

seeps into the alveoli and bronchioles. Acute pulmonary edema requires immediate medical attention, including medication (diuretics), high concentrations of oxygen, and keeping the patient in a sitting position (to reduce venous return to the heart). Clot or other material lodges in pulmonary vessels (Figure 12-14A and B). The clot (embolus) travels from distant veins, usually in the legs. Occlusion can create an area of dead (necrotic) tissue; this is a pulmonary infarction. LE often causes acute pleuritic chest pain (pain when breathing in) and may be associated with blood in the sputum, fever, and respiratory failure. CT angiography is the primary diagnostic tool for pulmonary embolism. Formation of scar tissue in the connective tissue of the lungs. This condition can be primary (idiopathic) or secondary to chronic inflammation or irritation caused by tuberculosis, pneumonia, or pneumoconiosis. Chronic inflammatory disease in which small nodules (granulomas) develop in the lungs, lymph nodes, and other organs. The cause of sarcoidosis is unknown. Bilateral hilar lymphadenopathy or pulmonary involvement is visible on chest radiographs in most cases. Many patients are asymptomatic and retain adequate lung function. Sarcoidosis can affect the brain, heart, liver, and other organs. Other patients have more active disease and reduced lung function. Glucocorticoids are used to prevent the disease from progressing. Infectious disease caused by Mycobacterium tuberculosis; usually the lungs are affected, but any organ in the body can be affected. Rod-shaped bacteria called bacilli enter the lungs and produce small tubercles (from Latin tuber, a swelling) of the infection. Early-stage TB is usually asymptomatic and detected on routine chest x-rays. Signs and symptoms of advanced disease include cough, weight loss, night sweats, hemoptysis, and pleuritic pain. Antituberculosis chemotherapy (isoniazid, rifampin) is effective in most cases. Immunocompromised patients are particularly vulnerable to antibiotic-resistant TB. It is important and often necessary to treat TB with multiple drugs at the same time to prevent drug resistance. The PPD skin test (see page 454) is performed by most hospital and medical workers because TB is highly contagious. A positive PPD test indicates exposure to TB, and isoniazid treatment is required even in the absence of lung infection.

Figure 12.11 A: Normal lung tissue. B, emphysema. Note the overinflation of the air sacs and the destruction of the alveolar walls.

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Figure 12.12 Lung cancer. The grey-white tumor tissue infiltrates the lung substance. This tumor was identified as squamous cell carcinoma. Squamous cell carcinomas arise in the large bronchi and spread to local hilar lymph nodes.

Figure 12-13 A, anthracosis or black lung disease. Note the dark black coal dust deposits in the lungs. B, Lobar pneumonia (at autopsy). Note that the condition affects one lobe of the lung. The patient's signs and symptoms included fever, chills, cough, dark sputum, rapid, shallow breathing, and hypoxia. If diagnosed early, antibiotic therapy is successful.

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Figure 12.14 Pulmonary embolism (A and B).

Atelectasis Common causes • Obstruction of the bronchi - from secretions or tumor • Complications after surgery - poor ability to breathe • Chest wounds - air (pneumothorax), fluid (pleural effusion), or blood (hemothorax) accumulates in the pleural cavity

Pleuraerkrankungen Mesotheliom Pleuraerguss Pleuritis (Pleuritis) Pneumothorax

Rare malignant tumor that arises in the pleura. Mesothelioma originates from mesothelium, which forms the lining of the pleural surface. These tumors are usually caused by exposure to asbestos. Abnormal accumulation of fluid in the pleural space (cavity). Two types of pleural effusions are exudates (fluid from tumors and infections) and transudates (fluid from congestive heart failure or cirrhosis). inflammation of the pleura. This condition causes pleurodynia and dyspnea, and in chronic cases, pleural effusion. Accumulation of air in the pleural space. A pneumothorax can occur with lung disease (emphysema, carcinoma, tuberculosis, or lung abscess) when air leaks into the pleural space through a break in the surface of the lung. This allows communication between an alveolus or bronchus and the pleural cavity. It can also follow trauma and chest wall perforation or prolonged high-flow oxygen delivery from a ventilator in an intensive care unit (ICU). Pleurodesis (-desis means to bind) is the artificial creation of adhesions between the parietal and visceral pleura for the treatment of persistent pneumothorax and severe pleural effusion. This is accomplished through the use of talcum powder or medications such as antibiotics, which cause irritation and scarring of the pleura.

study department

Practice spelling each term and know its meaning.

804

Anthracosis Asbestosis Bacilli (singular: Bacillus) Chronic obstructive pulmonary disease (COPD) Cor pulmonale exudates

Coal dust accumulates in the lungs. Asbestos particles accumulate in the lungs. rod-shaped bacteria.

Chronic condition of persistent obstruction of airflow through the bronchi and lungs. COPD is caused by smoking, air pollution, chronic infections and, in a minority of cases, asthma. Patients with chronic bronchitis COPD predominance may be described as “blue bloat” (cyanotic, stocky build), while patients with predominant emphysema as “pink puffers” (shortness of breath but with near-normal blood oxygen levels and no change in skin color). Failure of the right side of the heart to pump enough blood to the lungs because of an underlying lung disease. Fluid, cells, and other substances (pus) filtering from cells or capillaries seep into lesions or inflamed areas. Infiltrate Collection of fluid or other material in the lungs, as seen on a chest film, CT scan, or other radiological image. Palliative Relief of symptoms but not cure of the disease. paroxysmal Refers to a sudden event, such as B. a seizure or seizure; oxysm/o means suddenly. pulmonary area of necrosis (death of lung tissue). Infarction purulent Contains pus. silicosis disease caused by quartz or glass dust in the lungs; occurs in mining occupations.

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Clinical procedures X-ray examinations Chest X-ray (CXR) Computed tomography (CT) scan of the chest

X-ray of the chest cavity (breast film). Chest X-rays are taken in the frontal (coronal) plane as posteroanterior (PA) or anteroposterior (AP) views and in the sagial plane as lateral views. Figure 12.15A and B show a normal chest film and a chest x-ray showing pneumonia. Computer-generated series of X-ray images show thoracic structures in cross-section and in other planes. This test is used to diagnose lesions that are difficult to assess with conventional x-rays, such as: B. in the lungs, mediastinum and pleura. CT lung angiography (CTPA) is the combination of CT scan and angiography. When diagnosing a pulmonary embolism, it is useful to examine the pulmonary circulation.

Figure 12-15 A: A plain chest X-ray. The image is taken from the posteroanterior (PA) view (X-ray beam is posterior to anterior). The back L in the top corner is placed on the film to indicate the left side of the patient's chest. A, membrane; B, costophrenic angle; C, left ventricle of heart; D, right atrium of heart; E, aortic arch; F, superior vena cava; G, trachea. Air-filled lung spaces appear black. B, Pneumonia of the right lung shown on a chest x-ray.

Magnetic resonance imaging Magnetic resonance imaging (MRI) of the chest

Magnetic waves produce detailed images of the chest in the frontal, lateral (sagial) and cross-sectional (axial) planes. This test is helpful in identifying mediastinal tumors (such as those of Hodgkin's disease) that are difficult to assess by CT scans.

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Positron emission tomography (PET) scan of pulmonary ventilation perfusion (V/Q) scan

Radioactive glucose is injected and images show metabolic activity in the lungs. With this scanning technique, malignant tumors that have a higher metabolic activity can be identified. It's also used to evaluate small nodules seen on a CT scan. Detector records radioactivity in the lungs after intravenous injection of a radioisotope and inhalation of a small amount of radioactive gas (xenon). This test can identify areas of the lungs that don't receive adequate airflow (ventilation) or bloodflow (perfusion), as well as areas where airflow (V) and bloodflow (Q) do not match. Airflow without matched bloodflow indicates a pulmonary embolism.

Other procedures

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Bronchoscopy

Fiberoptic endoscopic examination of the bronchi. A doctor inserts the bronchoscope into the bronchi through the throat, larynx, and trachea for diagnosis, biopsy, or collection of secretions. During bronchoalveolar lavage (bronchial flushing), fluid is injected and withdrawn again. In bronchial brushing, a brush is inserted through the bronchoscope and used to scrape tissue (Figure 12-16). Endobronchial ultrasound (EBUS) is performed during bronchoscopy to diagnose and categorize lung cancer. An EBUS-guided biopsy allows sampling of small (

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