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(معادل دو واحد درس زبان تخصصی) قابل استفاده دانشجویان پزشکی و پیراپزشکی 2017 تألیف :دکتر مسعود سیرتی نیر 0 page CONTENTS Chapter 1 The Analyzing Medical Terms ……………………………………… 2 Chapter 2 The Common Suffixes and Prefixes in Medical Terms ….…..……… 7 Chapter 3 The Body's Organization ……………………………….…….……… Chapter 4 The integumentary system ………………………….……………. Chapter 5 The Musculoskeletal System …………………………………….. Chapter 6 The Cardiovascular and Lymphatic Systems …..…………………….. Chapter 7 The Respiratory system ……………….……………..…………… Chapter 8 The Digestive System …………………………………………….. Chapter 9 The Endocrine System …………………..……………………….. Chapter 10 The Immune System ………………………………………..…….. Chapter 11 The Urinary system ……………………………………………….. Chapter 12 The Reproductive System ………………………….…………….. Chapter 13 The Nervous System ………………….………………………….. Chapter 14 The Special Sense ……………………….……………………….. Chapter 15 Diagnosis and Treatment; Surgery …………………………….. Chapter 16 Directional Terms, Anatomical Planes , Regions & Additional Terms …………………………………………….….. 1 11 21 22 42 64 77 91 100 1O8 123 115 147 160 172 Chapter 1 The Analyzing Medical Terms Learning Objectives I. Combining Word Elements II. Common Roots in Medical Terms III. Common Suffixes in Medical Terms IV. Additional Suffixes V. Exercises General Aims : The unit is designed to help you learn Combining Word Elements, Common Roots and Suffixes in Medical Terms, also Additional Suffixes , it will be sufficient for you to be exposed to their meanings without learning roots that are better left for introduction in those later chapters. Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Name Combining Word Elements. List Common Roots in Medical Terms. List Common Suffixes in Medical Terms. Define Additional Suffixes. 2 Analyzing Medical Terms Most medical terms have Latin or Greek roots, and for that reason, some people think that medical terminology is internationally recognized, like metric symbols. However, that notion is false. Medical terms are always part of the language that includes them, and they often vary when translated. For example, the word artery is English. Nevertheless, learning the Latin and Greek elements that make up medical terms is a useful way to study them. In fact, such knowledge will enable you to decipher some terms the first time you encounter them. Here are six examples of terms ending with the word element -logy, which means “study of.” Most readers will probably know psychology and cardiology. Psych (from the Greek word for “mind”) coupled with -logy tells us that psychology is the study of mental processes and behavior. Card (from the Greek word for “heart”) indicates that cardiology is the medical specialty dealing with the heart. The roots path, hem, derm, and ger mean, respectively, disease, blood, skin, and old age. The good news is that there are only about 300 Latin and Greek word elements, from which thousands of medical terms may be formed. Once you have learned those word elements, you can forget about Greek and Latin, since medical terms are, as already stated, English words. In learning medical terminology, you are not studying a foreign language. Combining Word Elements You may have noted that one or more vowels, or a vowel-consonant combination, appears between each root and the word element -logy. Those letters are required to make medical terms pronounceable. 1. psych + o + logy =psychology 2. path + o + logy =pathology 3. hemat + o + logy =hematology 4. cardi + o + logy =cardiology 5. dermat + o + logy=dermatology 6. ger + onto + logy =gerontology A suffix, which by definition comes last in a word, will be preceded by a hyphen. Thus, the suffix –logy, when it appears by itself in this book, will be written -logy, with the hyphen indicating that one or more word elements will always come before it. 1 When a prefix is present in a word, it comes first, and this book therefore presents it with a following hyphen to indicate that one or more word elements normally follow. For example, the pre- in prefix is itself a prefix meaning “before,” a meaning that may help you remember the meaning of the word prefix: namely, a word element that comes before. TABLE 1-1 Common Roots of medical Terms Root Refers to card/i/o Heart derm/o, dermat/o Skin ger/o, geront/o Aged hem/o, hemat/o Blood neur/o a nerve cell, the nervous system oste/o Bone path/o Disease psych/o Mind TABLE 1-2 Common Suffixes in Medical Terms Suffix Meaning -algia Pain -derm Skin -dynia Pain -it is Inflammation -logy study of, specialty of -path/y Disease Additional Suffixes The suffixes given in the following table will come into play when you study the terminology concerned with individual body systems. TABLE 1-3 Additional Suffixes Suffix Meaning -cyte Cell -edema excessive fluid in intracellular tissues (edema is a word and, technically, not a suffix) -emesis Vomiting -globin the protein of hemoglobin (globin is a word and, technically, not a suffix) -iasis a suffix used to convert a verb to a noun indicating a condition 4 -ism -lith -lysis -mania -opsy -pathy -phobia -poiesis -sclerosis -sis -stasis -stenosis -stomy -tome a noun-forming suffix indicating a condition, practice, or doctrine a stone, calculus, calcification Disintegration a morbid impulse toward a specific object or thought visual examination Disease a word meaning fear, often appearing as a suffix producing or formation not really a suffix, but a root meaning “hard” that sometimes combines with other roots to indicate a condition of hardness Condition level; unchanging narrowed, blocked permanent opening instrument for cutting Exercise 1-1 Matching Word Elements with Meanings Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. 1. itis A. a suffix meaning “pain” 2. neur/o B. another suffix meaning “pain” 3. algia C. a root meaning “skin” 4. logy D. a suffix meaning “the study of” 5. hemat/o E. a root referring to the mind 6. dynia F. a suffix meaning “inflammation” 7. psych/o G. a root referring to the nervous system 8. dermat/o H. a root meaning “blood” 9. path/o J. a root meaning “bone” 10.oste/o K. a word root that can also be a suffix Exercise 1-2 Complete the following medical terms to end each sentence. 1. removal of a nerve is neurـ 2. large numbers of immature,cancerous white blood cells is a blood condition known as leukـ 3. an X-ray record of a joint is arthrـ 4. study of the kidney is nephrـ 5. tumor of the liver is hepatـ 1 6. visual examination of the abdomen is laparـ 7. an incision of a joint is called arthrـ 8. abnormal condition of the skin is dermatـ 9. inflammation of the skin is dermatـ 10. a specialist in the study of blood is a hematـ Answers key : Exercise 1-2 1-f 2-g 6- a or b 7-e 3-a or b 8-c Exercise 1-2 1. neurectomy 2. leukemia 3. arthrogram 4. nephrology 5. hepatoma or hepatocellular carcinoma 6 4-d 9-k 5-h 10-j 6. laparoscopy 7. arthrotomy 8. dermatosis 9. dermatitis 10. hematologist Chapter 2 The Common Suffixes and Prefixes in Medical Terms Learning Objectives I. Common Suffixes in Medical Terms II. Suffixes That Denote Adjectives III. Common Prefixes in Medical Terms IV. Prefixes of time or speed V. Prefixes of direction and position VI. Prefixes of Size or Number VII. Exercises General Aims : The unit is designed to help you learn Combining Word Elements, Common Roots and Suffixes in Medical Terms, also Additional Suffixes , it will be sufficient for you to be exposed to their meanings without learning roots that are better left for introduction in those later chapters. Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Name Combining Word Elements. List Common Roots in Medical Terms. List Common Suffixes in Medical Terms. Define Additional Suffixes. 7 Common Suffixes The word suffix comes to us from the Latin word suffixum, which may be translated “to attach under or to the end of.” By definition, then, the word element called a suffix must come at the end of the word. Although the suffix is last in a medical term, it most often comes first in its definition. For example, appendicitis means “inflammation(-itis) of the appendix.” So the suffix, in this case -itis, provides us with the first word of the defining phrase. That fact also gives us a reason for learning suffixes before learning roots and prefixes. Categories of Suffixes Dividing suffixes into functional categories makes them easier to learn. Here are the four divisions: suffixes that signify medical conditions. suffixes that signify diagnostic terms, test information, or surgical procedures. suffixes associated with a medical specialty or specialist. suffixes that convert a noun to an adjective. TABLE 2-1 SUFFIXES THAT SIGNIFY MEDICAL CONDITIONS Suffix Refers to -algia pain -cele protrusion, hernia -dynia pain -ectasis, -ectasia expansion or dilation -emia blood -iasis presence of; formation of -itis inflammation -malacia softening -megaly enlargement -oma tumor -osis condition -penia reduction of size or quantity -plasia abnormal formation -plegia paralysis -ptosis downward displacement -rrhage flowing forth, as occurs in a hemorrhage: hem/a/t/o 2 -rrhea -rrhexis -spasm -pnea (blood) + -rrhage discharge rupture muscular contraction breath, respiration TABLE 2-2 Suffixes that signify diagnostic terms, test information, or surgical procedures Suffix Refers to -centesis surgical puncture -desis surgical binding -ectomy surgical removal -gen, -genic, origin, producing genesis -gram written or pictorial record -graph device for graphic or pictorial recording -graphy act of graphic or pictorial recording -meter device for measuring -metry act of measuring -pexy surgical fixation -plasty surgical repair -rrhaphy Suture -scope device for viewing -scopy act of viewing -tomy incision -tripsy crushing Suffixes That Denote Adjectives The suffixes -ac,-al,-aneous,-ar,-ary,-derm ,-eal,-eous,-iatric,-ic,-oid,-otic,ous,-tic,-ular convert root nouns to adjectives. Common Prefixes A prefix is a word element that comes at the beginning of a word. You may have noticed that the word prefix itself contains a prefix, namely, “pre-.” The second part of the word prefix is “fix,” and that additional fact gives us a perfect definition of prefix: something attached (fixed) in front of or before (pre-) something else. Most of the prefixes occurring in medical terms are also found in everyday English. That is, you probably already use most of the prefixes contained in this chapter. Even so, you may not be aware of their exact meanings or even 9 that they are prefixes, since most English speakers have no reason to analyze the words they use. For example, when we are admitted to an anteroom, we may not stop to think that the prefix ante- means “before” and that an anteroom is so called because it is a room we enter before entering another room. Likewise, when we say, “My workday starts at 8 AM,” most of us don't realize that AM is an abbreviation for ante meridiem. In that word, antemeans “before” and meridiem means “noon.” More often than not, medical terms do not include a prefix. But when one is present, it always comes at the very beginning of the word and is critical to its meaning. For example, hyper glycemia (“high blood sugar”) and hypo glycemia (“low blood sugar”) name conditions that are exact opposites. Categories of Prefixes Dividing prefixes into functional categories, just as we did with suffixes, makes them easier to learn. There are four logical divisions: prefixes of time or speed prefixes of direction prefixes of position prefixes of size or number TABLE 2-3 Prefixes of Time or Speed Prefix Refers to ante-, preBefore bradyabnormally slow rate of speed neoNew postAfter tachyrapid, abnormally high rate of speed TABLE 2-4 Prefixes of Direction Prefix Refers to Prefix Refers to abaway from, outside of, beyond adtoward, near to con-, sym-, With syncontraAgainst diaacross, through 10 TABLE 2-5 prefixes of position Prefix Refers to ecOutside ectoOutside enInside endoWithin epiupon, subsequent to exOutside exoOutside extraBeyond hyperabove, beyond normal hypobelow, below normal infrainside or below interBetween intraInside mesoMiddle metaBeyond panall or everywhere paraalongside, like retrobackward, behind TABLE 2-6 Prefixes of Size or Number Prefix Refers to biTwo hemi-, semiHalf macroBig microSmall monoOne olig-, oligoa few panall or everywhere quadriFour triThree uniOne EXERCISE 2-1 Matching Suffixes with Meanings Choose the letter next to the Column 2 definition corresponding to each suffix in Column 1 and write it in the space provided. Column 1 Column 2 11 1. 2. 3. 4. -cyte -edema -emesis -globin 5. -iasis 6. -ism 7. -lith 8. -mania 9. -opsy 10. -pathy 11. -phobia 12. -poiesis 13. -sis 14. 15. 16. 17. 18. 19. -stasis -tenosis -stomy -tome -lysis -sclerosis A. a morbid impulse toward a specific object or thought B. a noun-forming suffix indicating a practice or a doctrine C. a stone, calculus, calcification D. a suffix used to convert a verb to a noun indicating a condition E. disease F. a word meaning fear, often appearing as a suffix G. cell H. condition J. excessive fluid in intracellular tissues K. instrument for cutting L. level: unchanging M. narrowed; blocked N. not really a suffix, but a root meaning hard that sometimes combines with other roots or prefixes to indicate a condition of hardness O. permanent opening P. producing Q. the protein of hemoglobin R. disintegration S. visual examination T. vomiting EXERCISE 2-2 Select from the following terms to complete the sentences below: Angiography Colocolostomy Mammogram Angioplasty Colostomy Oophorectomy Bronchoscopy Hysterectomy Phlebotomy Chemotherapy Laryngoscopy thoracentesis 1. surgical repair of a blood vessel using a catheter (tube), balloon, and stent is…… 2. treatment using chemical to destroy malignant cells is…… 3. X- ray record of the breast is a (an)…… 4. Surgical puncture to remove fluid from the chest is…… 5. A new opening of the large intestine to the outside of the body is a (an)… … 6. A new internal connection (anastomosis) between two parts of the large bowel (intestine) is a (an)… … 7. Removal of the uterus is a (an)… … 8. Process of recording X-ray images of blood vessels after injecting contrast is…… 9. Visual examination of the voice box is…… 10. Incision of a vein to withdraw blood is…… 12 EXERCISE 2-3 Write the medical term for the following: 1. Bursting forth of blood 2. Hardening of fatty plaque (in the lining of the arteries) 3. Pertaining to time ( occurring over a long period of time) 4. X- ray record of the spinal cord 5.Sharp, sudden, brief 6. treatment using cold temperatures 7. record of electricity in the brain 8. surgical puncture to remove fluid the membrane surrounding the fetus 9. muscle pain 10. malignant tumor of bone marrow 11. enlargement of the heart 12. abnormal condition of the death of cells 13. disease condition of the kidney 14. incision of the skull EXERCISE2-4 Provide the terms for the following procedures: 1. Excision of the gallbladder 2. Excision of the appendix 3. Excision of a breast 4. Excision of the uterus 5. Excision of an ovary 6. Excision of the voice box 7. Excision of a kidney 8. Excision of a gland 9. Excision of the large intestine 10. Excision of a fallopian tube 11. Excision of tonsils 12. Excision of the skull 13. Excision of the abdomen 14. Excision of the chest 15. Opening of the windpipe to the outside of the body 16. Opening of the colon to the outside of the body 17. Surgical puncture to remove fluid from the chest 18. Surgical puncture to remove fluid from a joint 19. Incision of a vein 20. Visual examination of the voice box 11 Answers key : EXERCISE 2-1 1-g 2-j 3-t 4-q 5-d 11-f 12-p 13-h 14-l 15-m EXERCISE2-2 1. angioplasty 5. colostomy 2. chemotherapy 6. colocolostomy 3. mammogram 7. hysterectomy 4. thoracentesis EXERCISE 2-3 1.hemorrhage 2. atherosclerosis 3. chronic 4. myelogram 6-b 16-o 7-c 17-k 8-a 18-r 9-s 19-n 8. angiography 9. laryngoscopy 10. phlebotomy 7. electroencephalogram 8. amniocentesis 9. myalgia 10. myeloma or multiple myeloma 11. cardiomegaly 12. necrosis 13. nephropathy 14. craniotomy EXERCISE 2-4 1.cholecystectomy 2.appendectomy 3. mastectomy 4.hysterectomy 5.oophorectomy 6.laryngectomy 8.adenectomy 9.colectomy 10.salpingectomy 11.tonsillectomy 12.craniectomy 13.laparectomy 15.tracheostomy 16.colostomy 17.thoracentesis 18.arthrocentesis 19.phlebotomy 20.laryngoscopy 7.nephrectomy 14.thoracectomy 5. acute 6. cryotherapy 14 10-e Chapter 3 The Body's Organization Learning Objectives I. Introduction II. Study of the Body III. Basic Structure IV. Characteristics of Living Matter V. Cells VI. Tissues VII. Organs VIII. Systems IX. Exercises General Aims : The unit is designed to help you learn basic structure and characteristics of living matter such as cells, tissues, organs, systems to increase your reading comprehension and to prepare you for reading similar passages. Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Describe the main methods used in examination of a patient. List the main components of a medical history. Name seven forms of treatment. Describe how staging is used in treatment of cancer. Name and describe eight imaging techniques. Identify and use the roots and suffixes pertaining to diagnosis and surgery Define additional medical terms pertaining to diagnosis and treatment include surgery. 11 Interpret abbreviation used in diagnosis and treatment. The Body's Organization To begin building medical terms, we must first come to understand how the human body is constructed and how it works. The first distinction to be made is between the terms anatomy and physiology. Briefly, anatomy is the study of the body, and physiology is the study of the body's functions. Insofar as construction is concerned, the body is like all other material objects. It is made up of atoms that can combine to become chemical molecules. The human body has a chemical basis, and the chemicals act together to form cells and to power the biologic “machinery” contained within them. This machinery processes the food we eat and the air we breathe. It carries away unwanted substances and enables cells to reproduce themselves, each cell according to the DNA code it contains. The wonder of all this activity becomes even more mind-boggling when one discovers that the average adult human body contains about 70 trillion cells. The cell is the smallest unit of life from which tissues, organs, and systems ore constructed (cyt-is the root for cell). Cells similar in structure and function form a mass called a tissue. Groups of different tissues combine to form an organ of the body (for example the liver, heart or lungs), each of which performs a special function. The organs are grouped into systems for the forming specific and more complicated functions. Six branches of science deal with the study of the body. They are anatomy, physiology, pathology, embryology, histology, and biology: Anatomy, which literally means cutting apart, is the study of the structure of the body and the relationship of its parts. It derives its name from the fact that the structure of the human body is learned mainly from dissection. Physiology is the study of the normal functions and activities of the body. Pathology is the study of the changes caused by disease in the structure of functions of the body. Embryology is the study of the origin and development of an organism. After conception, the period from the second through the eighth week is called the embryonic stage. After this, the developing organism is referred to as the fetus. Histology is the microscopic study of the minute structure, composition, and function of normal cells and tissues. Biology is the study of all forms of life. The Major Body Cavities The two major body cavities, one in the front of the body and one in the back, are divisible into subcavities. The front body cavity is called the ventral 16 cavity. The Latin word venter means “belly,” and the English adjective ventral consists of a shortened version of that Latin word combined with the suffix al, which you learned in past Chapter. The cavity in the back of the body is called the dorsal cavity, from the shortened Latin word dorsum, which means “back,” and the suffix -al. The ventral cavity is subdivided into the thoracic and abdominopelvic cavities. The dorsal cavity is subdivided into the cranial and spinal cavities. TABLE 3-1 The Two Major Body Cavities and Their Subdivisions Ventral Cavity Dorsal Cavity Subcavities Subcavities 1. thoracic 1. cranial 2. abdominopelvic 2. spinal TABLE 3-2 New Roots related to Body Cavities Root Origin Meaning abdomin/o abdomen (French for “abdomen”) abdomen crani/o cranium (from Greek kranion) skull thorac/o thorax (Greek for breastplate) chest TABLE 3-3 Directional Adjectives Anatomic Position Direction anterior or ventral toward the front and away from the back of the body distal away from the attachment point of a limb (arm or leg) inferior away from the head lateral away from the middle of and toward the side of the body medial toward the middle of the body posterior or dorsal toward the back and away from the front of the body proximal toward the attachment point of a limb (arm or leg) superior or cranial toward the head Body Systems Apart from their locations in body cavities, each of the organs, tissues, bones, and so on, belongs to one or more specific body system, in which they work together to carry out physiologic functions. The body systems are as follow: Integumentary System, Skeletal System, Muscular System, Heart, Blood and Blood Vessels, Respiratory System, Digestive System, Endocrine 17 System, Immune System, Urinary ystem, Reproductive System, Nervous System, Eye, and Ear. TABLE 3-4 NEW ROOTS RELATED TO BODY SYSTEMS Root System Meaning angi/o blood and immune vessel my/o muscular muscle pneum/o, respiratory lung pneumon/o, pneumat/o 3.The Body's Organization EXERCISE 3-1. Supply the correct medical term for the following: 1. A stroke is a cerebro- (two words). 2. A heart attack is a myo- (two words). 3. Use of a machine that filters wastes from the blood is hemo-. 4. Injection if fluid into the abdominal cavity and then withdrawal of them fluid (containing waste material) is peri- (two words). 5. A noncancerous tumor of muscle is a myo6. A cancerous tumor of muscle is a myoـ 7. High levels of wastes (urea) in the blood is ur8. Blood in the urine is hemat9. High numbers of malignant (cancerous) white blood cells is leuk10. Slightly elevated numbers of white blood cells due to an infection in the body is leukoـ 11. Normal discharge of blood during menstruation is menـ 12. Excessive bleeding during menstruation is menـ 13. Hardening of arteries is called arterioـ 14. Use of high- energy rays to treat cancerous tumors is radioـ EXERCISE 3-2. Circle the term that best completes the meaning of the sentences: 1. After routine breast self- examination, Nora felt a small lump in her breast. She consulted her doctor who scheduled a diagnostic (mammoplasty, mastectomy, mammogram). The examination showed a stellate (star- shaped) mass and a (biopsy, necropsy, laparoscopy) revealed an infiltrating ductal carcinoma. Nora decided to have her breast removed (hysterectomy, mastectomy, salpingectomy), although her physician gave her the option of having humpectomy followed by (cryotherapy, thiractomy, radiotherapy). 2. in addition to her surgery, Nora had a sentinel node biopsy of a (an) (inguinal, 12 thoracic, axillary) lymph node to determine whether the cancer had spread. Ingection of contrast revealed the primary (sentinel) lymph node, which was removed and microscopically examined. 3. Sylvia had irregular bleeding in between her periods. She was 50 years old and beginning menopause. On pelvic exam, Dr. Hawk felt a large, lobulated uterus. Biopsy revealed a large fibroid, which is a benign (noncancerous) tumor of muscle tissue (myeloma, myoma, hematoma). The doctor suggested a total abdominal (gastrectomy, hysterectomy, cholecystectomy). 4. Victoria had never been comfort with the bump on her nose. She saw a plastic surgeon, who performed (mammoplasty, rhinoplasty, angioplasty). 5. sam was experiencing cramps, diarrhea, and a low- grade fever. He was diagnosed with ulcerative (colitis, meningitis, laryngitis) and had several bouts of (uremia, menorrhagia, septicemia) caused by inflammation and rupture of the bowel wall. 6. Bill felt chest pain every time he climbed a flight of stairs. He went to his doctor, who did a coronary (myelogram, angiogram, dialysis) that revealed (adenocarcinoma, nephrosis, atherosclerosis) in one of his coronary arteries. The doctor recommended (angioplasty, thoracentesis, amniocentesis). This would prevent futher (myosarcoma, ischemia, leukocytosis) and help bill avoid a (peritoneal, vascular, myocardial) infarction, or heart attack, in the future. EXERCISE 3-1 1.cerebrovascular accident ـclot or hemorrhage in an artery of the brain leads to decreased blood flow (ischemia) to brain tissue and necrosis (death of brain cells). 2. myocardial infarction ـischemia to heart muscle leads to infarction (death or necrosis of heart muscle cells). 3. hemodialysis complete separation of waste material from the blood using a machine that receives the patients blood and after filtration sends the blood back into the patients body. 4. peritoneal dialysis fluid is introduced into the abdominal cavity and then removed after wastes have passed into the fluid from the peritoneal blood vessels. 5. myoma benign muscle tumors occurring in the uterus are fibroids. 6. myosarcoma malignant tumors of connective or flesh tissue are sarcomas. 7. uremia this indicates failure of the kidneys to eliminate nitrogen- containing wastes, such as urea, creatinine, and uric acid from the bloodstream. 8. hematuria this indicates bleeding in the urinary tract. 9. leukemia immature, cancerous white blood cells are produced in excess from the bone marrow or lymph nodes. 10. leukocytosis normal, mature white blood cells are produced to fight infection. 11. menorrhea lining of the uterus breaks down due to changes in hormone 19 levels. 12. menorrhagia long or heavy menstrual periods; often caused by bengin muscle tumors or fibroids in the uterus. 13. arteriosclerosis the most common type is atherosclerosis or collection of fatty plagues in arteries. 14. radiotherapy using high energy X-ray, gamma rays, or protons to destroy cancerous cells. EXERCISE 3-2 1. mammogram, biopsy, mastectomy, radiotherapy 2. axillary 3. myoma, hysterectomy 5. colitis, septicemia 6. angiogram, atherosclerosis, angioplasty, ischemia, myocardial 20 Chapter 4 The Integumentary system Learning Objectives I. Word Elements related to the Integumentary System II. Common Disorders and Procedures Associated with the Integumentary System III. Sublayers of the Epidermis IV. Surgical Terms V. Case History VI. Exercises General Aims : The unit is designed to help you learn Word Elements, Common Disorders and Procedures, Sublayers of the Epidermis, Surgical Terms and Diagnostic Procedural Terms of Integumentary system and to increase your reading comprehension and to prepare you for reading similar passages. Behavioral Objectives : Upon completion of this chapter it’s expected that student will be able to: Build, analyze, define, pronounce, and spell the surgical terms related to the Integumentary System. 21 The Integumentary System Integumentum is Latin for “covering” or “shelter,” and thus the skin, nails, and hair covering our bodies is called, collectively, the integumentary system. There are only two layers of skin, the epidermis and the dermis. The epidermis is divisible into five sublayers and the dermis into two sublayers, the names of which will be given later. The following lists word elements that are used in forming terms related to the integumentary system. I. Word Elements related to the Integumentary System word of Element Type Refers to corium (KO-ree-uhm) Latin word for “skin” synonym for dermis cutis Latin word meaning “skin”; skin cutaneous, which refers to the skin. cyan/o Root blue -cyte Suffix cell derm/o; dermat/o Root skin epiprefix upon follicul/o Root follicle kerat/o Root horn-like leuk/o Root white melan/o Root black onych/o Root nail -phyte Suffix plant pil/o Root hair subprefix below sudor/i Root sweat xer/o Root dry The Skin The skin is said to be the body's largest organ, and since the skin covers the entire body more than 20 square feet on average and weighs about 24 pounds, the claim would seem to be true. As already noted earlier, the skin is composed of two parts: the epidermis is the outer layer, and the dermis is the inner layer. 22 The Epidermis The epidermis protects the body from the outside world, a pretty big job for something only three one-thousandths of an inch thick. The epidermis on the palms of our hands and the soles of our feet is somewhat thicker than that, but even there, it is only about two one-hundredths of an inch thick. The epidermis is divisible into five sublayers. III. Sublayers of the Epidermis Epidermal Skin Layer Brief Description stratum corneum the tough, waterproof outer sublayer of the skin stratum lucidum the transparent, barely discernible sublayer just below the stratum corneum stratum the grainy sublayer between the stratum lucidum and granulosum stratum spinosum stratum spinosum the spiny sublayer just below the stratum ganulosum; contains cells that create an immune response to protect the body against foreign bodies that get through the first three outer sublayers of skin stratum the innermost sublayer of skin, which butts against the loose germinativum connective tissue of the dermis; forms epidermal ridges that connect with the dermis Subcutaneous Tissue A layer of subcutaneous tissue, located just beneath the dermis, is composed of connective tissue. Synonyms for subcutaneous tissue include hypodermis, subfascia, and the fat layer because subcutaneous tissue stores lipids. The Latin word cutis, which means “skin,” gives us the English adjectives cutaneous and subcutaneous. Keratin and Melanin Composed of keratinocytes, keratin is a protein that toughens the outer layer of skin and is a key component in the formation of hair and nails. Melanin, a pigment composed of melanocytes present in the dermis, gives the skin its color and provides protection against the sun's ultraviolet (UV) rays. Hair and nails are both composed of epithelial cells filled with keratin. Keratinocytes and melanocytes are simply the cells that make up keratin and melanin. 21 The Structure of Hair and Nails A hair follicle is a mass of cells that forms a cavity, out of which a hair grows. The word follicle is derived from a Latin word meaning “small sac.” Most sebaceous glands are located close to, but are not part of, hair follicles. Although they are distinct from hair follicles, sebaceous glands share hair follicle ductwork to transmit their oily secretions to each hair and its adjacent skin. Certain hairless areas of skin, mostly on the face, chest, or back, contain sebaceous glands that have their own follicles and ductwork. Nails are composed of layers of hardened cells of the stratum corneum (the outermost sublayer of the epidermis). IV. Common Disorders and Procedures Associated with the Integumentary System Term Definition dermatitis inflammation of the skin dermatoma skin tumor dermatomegaly excessive skin, often hanging in folds dermatomycosis fungal infection of the skin dermatopathy any disease of the skin dermatoplasty plastic surgery performed on the skin epidermitis inflammation of the epidermis melanoma tumor of the melanocytes onychectomy surgical removal of a nail onychomalacia softening of the nails onychomycosis fungal infection of a nail onychopathy any disease of the nails onychoplasty surgical repair of a nail onychotomy incision into a nail paronychia infection around a nail IV. Surgical Terms TERM (built from word parts) 1. biopsy(BI-op-se) DEFINITION view of life (the removal of living tissue from the body to be viewed under the microscope) 24 2. dermatoautoplasty (der- ma- to- AW- toplas- te) 3. dermatoheteroplasty (der- ma- to- HET- ero- plas- te) 4.dermatoplasty (DER- ma- to- plas- te) 1. onychectomy (on- i- KEK- to- me) 2. rhytidectomy (rit-i- DEK- to-me) 3. Rhytidoplasty 4. (RIT-i-do- plas- te) Plastic repair using patient’s own skin for the skin graft Plastic repair using skin from others for the skin graft Plastic repair on the skin Excision of a nail Excision of wrinkles Plastic repair of wrinkles IV. Case History: 50- year- old white female presents in the dermatologist’s office with a complaint of changes in nevus located in medial aspect of left eyebrow. Changes include hair loss, “crusty” surface, and some enlargement of lesion. Nevus has been present for approximately 3 years. Hair loss present for 2 years. Patient has past history of actinic keratosis and current of nonrelated eczema bilaterally on both foreams. Biopsy revealed basal cell carcinoma, nodular, transected at base. V. Operative Report: Patients operative site was prepped with betadine. Xylocaine 1% with epinephrine was used as local anesthesia. Skin was incised at superior pole of lesion. Lesion was then excised as diagnosed, including a margin of clinical normal dermis. Specimen submitted to pathology. The superior pole was sutured. Hemostasis achieved with electrocautery. Two “A” to “T” flaps were then constructed on superior aspect of upper eyelid. Flaps and upper eyelid undermined 2 to 3 mm. flaps sutured with 6/0 vicryl, followed by 6/0 nylon for closure. Pressure dressing applied. Exercise 4-1 Matching Terms with Definitions Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. Term Definition 1. _____ melanin A. oil-producing glands 2. _____ epidermis B. protein that toughens the outer layer of the skin 3. _____ lunula C. physician who specializes in dermatology and 21 diagnoses and treats skin abnormalities 4. _____ sebaceous D. responsible for pigment or color of skin 5. _____ dermatologist E. the outer layer of the skin 6. _____ stratum corneum F. the white, crescent-shaped area of the nail 7. _____ avascular G. BSA 8. _____ keratin H. without vessels or veins 9. _____ sudoriferous glands I. the outermost sublayer of the epidermis 10._____ body surface area J. sweat-producing glands EXERCISE 4-2 Analyze and define the following surgical terms. 1. rhytidectomy 2. biopsy 3. dermatoautoplasty 4. onychectomy 5. rhytidoplasty 6. dermatoheteroplasty EXERCISE 4-3 Build surgical terms for the following definitions by using the word parts it’s expected that studenthave learned. 1. excision of wrinkles 2. view of life(the removal of living tissue from the body) 3. Plastic repair using skin from others 4. excision of a nail 5. plastic repair of wrinkles 6. plastic repair on the skin Answers key : EXERCISE 4-1 1 2 3 D E F 4 A 5 C 6 I 7 H 8 B 9 J 10 G EXERCISE 4 - 2 WR S 1. rhytid/ectomy WR S 2. bi/opsy WR CV WR CV S 3.dermat/o/aut/o/plasty WR S 4. onych/ectomy WR CV S excision of wrinkles view of life (removal of living tissue) plastic repair using patient’s own skin for the skin graft excision of a nail 26 5. rhytid/o/plasty WR CV WR CV S 6.dermat/o/heter/o/plasty plastic repair of wrinkles plastic repair using skin from others for the skin graft EXERCISE 4 - 3 1. rhytid/ ectomy 2. bi/opsy 3. dermat/o/heter/o/plasty 4. onych/ectomy 5. rhytid/o/plasty 6. dermat/o/plasty 27 Chapter 5 The Musculoskeletal System Learning Objectives I. Common Roots II. Shoulder Muscles III. Muscle Action in the Aarms and hands IV.Common Disorders and Procedures V. Surgical Terms VI.Diagnostic Procedural Terms VII. Case History VIII.Operating report IX.Finding X.Exercises General Aims : The unit is designed to help you learn Common Roots, Shoulder Muscles, Muscle Action in the arms and hands, Common Disorders, Surgical and Diagnostic Procedural Terms of Musculoskeletal System and Operating report to increase your reading comprehension and to prepare you for reading similar passages. Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Build, analyze, define, pronounce, and spell the surgical terms related to the Musculoskeketal System. Build, analyze, define, pronounce, and spell the diagnostic procedural terms related to the Musculoskeketal System. 22 The Muscular System There are approximately 206 bones in the human body. The total number of muscles is harder to calculate because of the various ways to distinguish them. But it is safe to say that there are many more muscles than bones. In fact, muscles make up about half of the average person's total body weight. Muscles are necessary for all the obvious activities, such as lifting objects, running, jumping, throwing a ball, and swinging a bat. However, muscles are also needed for seeing, talking, eating, digesting, breathing, smiling, frowning, blinking, and so on. And then, of course, there is the heart muscle. I. Common Roots related to the Muscular System Word Roots Refers to kine; kinesi/o movement ligament/o ligament muscul/o muscle my/o muscle tend/o; tendin/o tendon Muscle Types There are three kinds of muscles: skeletal, cardiac, and smooth. Skeletal muscles are distinguished not only by the jobs they do, but also by their large size in comparison with the cardiac and smooth muscles. Skeletal muscles are sometimes referred to as striated (from the Latin verb striare, which means “to groove”) because their fibers run parallel to each other. The cardiac muscle contains striated fibers, too, but they are much shorter and not as obvious. The third type, smooth muscles that (like the heart) work involuntarily, include the sphincter muscles and others that surround internal organs such as the esophagus. Since muscles serve in so many different ways, they occur in many different sizes, shapes, and forms, and include the ligaments and tendons. Ligaments, from the Latin noun ligament, meaning “string,” connect muscles to bones, cartilage, or other tissue structures. They contain a protein called elastin, which makes them regain their shape after being stretched, much in the same way an elastic band does. Tendons are similar to ligaments and are located with the muscles of the appendicular skeleton. The Achilles tendon is an example with which nearly everyone is familiar. The name tendon comes from the Latin verb tendo, which means “stretch.” In this chapter, we will look at some of the skeletal muscles within the axial 29 skeleton, along with the main ones associated with the appendicular skeleton. Muscles Associated with the Axial Skeleton Facial Muscles A muscle called the orbicularis oris enables us to move our lips and to open and close our mouths. Another called the corrugator supercilii allows us to move our eyebrows. Supercilium means “eyebrow” in Latin. Another muscle, called the orbicularis oculi, makes it possible for us to close our eyes. Muscles beginning with the word orbicularis are to be found “around” something. The orbicularis oris is around the mouth, and an orbicularis oculi is to be found around each eye . Muscles of the Tongue The tongue has four muscles ending with the word element glossus, which comes from a Greek word glossa, meaning “language.” The word root gloss/o also means “tongue,” and can be combined with many of the suffixes you already know, e.g., glossodynia. The names of the four tongue muscles are as Genioglossus, Hyoglossus, Palatoglossus, Styloglossus. Muscles Surrounding the Spinal Column The spinal column includes spinal extensors, also called the erector spinae, which enable one to move the head and neck and to extend and flex the spine. In addition, the trapezius and latissimus dorsi cover the back and facilitate movement of the trunk of the body. Muscles Associated with the Appendicular Skeleton Shoulder Muscles The trapezius muscles, mentioned earlier in connection with the axial skeleton, are actually part of both the axial and appendicular skeletons, in that they start at the neck and extend to the clavicles and the scapulae. Thus, they can help to move not only the neck and body trunk but also the shoulder girdle, depending on the action of associated muscles. II. Shoulder Muscles Muscles serratus anterior levator scapulae pectoralis minor rhomboideus (both major and minor) subclavius Movement upward or upward rotation upward or upward rotation downward or downward rotation downward or downward rotation downward or downward rotation 10 Arm and Hand Muscles The main muscles of the arm start with the deltoid, where the arm joins the shoulder. The biceps brachii and triceps brachii, work in conjunction with the brachialis. In common speech, the words biceps and triceps are used indiscriminately to refer to the biceps and triceps in the arm. However, the leg also contains biceps and triceps. The muscles associated with the ulna are the flexor carpi ulnaris and extensor carpi ulnaris. A similar pair, the flexor carpi radialis and the extensor carpi radialis longus, are associated with the radius. All these names contain “carpi,” which means “wrist” or “hand,” because they flex or extend the hand, depending on whether the name begins with “flexor” or “extensor.” Similarly, any muscle that contains the word element digiti or digitorum will affect finger movement of some kind, and any muscle with pollicis (pollex is the Latin word for “thumb”) in its name has to do with the thumb. Prominent terms include theextensor digitorum and the abductor pollicis longus. III. Muscle Action in the Aarms and hands Muscle Name Action biceps brachii flexes the upper arm and forearm brachialis flexes the forearm deltoid rotates the arm sideways triceps brachii extends the forearm flexor carpi ulnaris flexes and curls the hand inward flexor carpi radialis flexes and curls the hand outward extensor carpi radialis longus extends and curls the hand outward extensor carpi ulnaris extends and curls the hand inward Muscles of the Lower Extremities The gluteus maximus, the muscle located within each buttock, helps to rotate the thigh. Beneath the gluteus maximus lies the gluteus medius and beneath that, the gluteus minimus, both of which facilitate walking by supporting the pelvis. The major muscles in the front (anterior) of the thigh, known collectively as the quadriceps femoris, comprise the vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris, all of which serve to extend the leg. The longest muscle in the leg (and in the whole body, by the way) is the sartorius, which flexes and rotates the thigh. This motion is the one we use to cross our legs when we are sitting down. The posterior of the thigh contains a muscle group commonly called the 11 hamstring. The hamstring is made up of three muscles: the biceps femoris, the semitendinosus, and the semimembranosus. Together, they flex the leg and extend the thigh. The anterior muscles controlling the feet are the tibialis anterior, the peroneus tertius, and the peroneus longus. The posterior muscle group controlling the foot is called the triceps surae. The anterior muscles controlling the toes are the extensor hallucis longus and theextensor digitorum longus. The posterior muscles controlling toe movement are the flexor hallucis longus and the flexor digitorum longus. Just as “pollicis” is derived from pollex (“thumb”), “hallucis” is derived from hallux (“great toe”). IV. Common Disorders and Procedures associated with the Muscular System Term Definition kinesalgia; kinesialgia pain caused by muscle movement kinesiology study of movement myasthenia muscular weakness myectomy excision of part or all of a muscle myelitis inflammation of a muscle myocele protrusion of muscle tissue through a tear in its outer sheath myodynia muscle pain myogenesis formation of muscle cells myoid adjective meaning “resembling a muscle” myology study of muscles myoma benign neoplasm of muscle tissue myomalacia softening of muscle tissue myositis inflammation of a muscle myospasm muscle contraction tenodynia, tenontodynia pain in a tendon tendonitis inflammation of a tendon tenontoplasty reparative or plastic surgery of the tendons tenorrhaphy suturing of a tendon tenotomy, tendotomy surgical division of a tendon The Skeletal System The human skeleton begins to form about 6 weeks after fertilization and continues to grow and develop until the person is 25 years old. The human skeleton, which includes approximately 206 bones, performs many duties. It 12 serves as a rigid but articulating (which means “allowing for movement”) framework for all our muscles and other tissues. It also protects our vital organs by forming a shield to ward off blows. Its less obvious jobs are to produce and store essential minerals and to make blood cells. In this chapter, you will learn that the skeleton may be divided into two parts: the axial and appendicular skeletons. The axial skeleton consists of the skull and the chest bones, along with those of the spinal column, and the appendicular skeleton includes all the bones found in the shoulders, limbs, and pelvic area. Common Roots related to the Skeletal system Root Refers to arthr/o joint brachi/o arm carp/o wrist chondr/o cartilage cost/o rib crani/o cranium dactyl/o finger, toe oste/o bone orth/o correct spondyl/o vertebrae vertebr/o vertebrae Cranial Bones The six main cranial bones are the frontal bone, two parietal bones (one on each side), two temporal bones (one on each side), and the occipital bone. These cranial bones are joined by sutures, which are fibrous membranes that occur between the bones. Facial Bones The main facial bones are the nasal bone, zygomatic bones (two), maxilla, and mandible. The nasal bone forms the bridge of the nose, and the two zygomatic bones form the cheeks. The maxilla is the upper jawbone and the mandible is the lower jawbone. Thoracic Bones The adjective thoracic is formed from the word thorax, which is Latin for “breastplate” (chest armor), and thus thoracic refers to the chest area. The thoracic bones, which include the sternum, the ribs, and associated cartilage, 11 are known collectively as the thoracic cage . It is a cage not in the sense of an enclosure to keep an animal from escaping, but is rather more akin to a roll cage on a car, in that it has the purpose of protecting that which is inside. At the back (posterior), each of the 12 pairs of ribs is attached to its correspondingly numbered vertebra. The anterior (front) rib attachments are to the sternum, but rib pairs 11 and 12 “float,” which means that they do not attach to the sternum, but only to the vertebrae. The Spinal Column The spinal column includes 33 vertebrae (singular: vertebra). The first 24 are numbered consecutively according to their positions along the first three sections of the body axis. The seven beginning with the letter C are the cervical vertebrae, so named because they are part of the neck (cervix is Latin for “neck”). Lumbus is Latin for “loin,” and thus the lumbar region is part of the lower back. The Joints A joint (from the Latin junctio, meaning “junction”) is simply a “meeting place” between bones. Some joints are highly movable (articulating), e.g., the knee and elbow joints, and some are capable of little or no movement. A joint with no movement is called a synarthrosis, and one with little movement is called an amphiarthrosis. Any of the suture joints in the cranium would be a good example of a synarthrosis, and the vertebral bodies within the spinal column are examples of amphiarthroses. A joint that has free movement is called a diarthrosis or a synovial joint. The spaces within each synovial joint are filled with a viscous (thick) liquid called synovial fluid. Bursae, found wherever tendons or ligaments impinge on other tissues, consist of spaces within connective tissue that are filled with synovial fluid. Bursitis is a common English word that means “inflammation of a bursa,” which may be, but is not always, connected to a joint cavity. Cartilage is classified as connective tissue, but the term is included here because cartilage enables movement (articulation) in the synovial joints. Joints are often named for the bones they join together; for example, the humeroulnar joint (the conjoining bones are the humerus and ulna) and the humeroradial joint (the conjoining bones are the humerus and radius) together make up the elbow. 14 One other term that you should know in connection with joints is patella, a Latin word meaning “small dish.” The common name for the patella is kneecap. Bones of the Arms and Hands The long bone extending from the shoulder and ending at the elbow is called the humerus, not because it is the “funny bone” but because humerus is the Latin word for “shoulder.” There is a connection with the word humorous, however. The phrase funny bone was coined as a joke because the ulnar nerve, which causes the pins-and-needles sensation when it is struck, is located where the humerus joins the elbow. The ulna and radius extend from the elbow down to the wrist . The wrist includes eight bones called carpals, from the Greek word karpos, meaning “wrist.” The Pelvic Girdle The pelvic girdle, so named because it surrounds and protects the pelvic organs, consists of the twohip bones, right and left, along with the sacrum, noted earlier in connection with the spinal column. The hip bone, also called the os coxae, is a fusion of three bones: the ilium, the ischium, and the pubis . Bones of the Legs The femur, Latin for “thigh,” extends from the hip to the knee, and the tibia and fibula carry on from the knee to the ankle. The tibia, Latin for “shin,” is the shin bone or heavy bone of the lower leg; the fibula, from the Latin word figibula, meaning “fastener,” does not bear the body's weight, but together with the tibia, it is connected to the talus (ankle bone). Bones of the Ankles and Feet Tarsus (from the Greek tarsos, “a flat surface”) is sometimes used as a technical name for the ankle. Whatever one chooses to call it, the ankle is a complex mechanism, as any reader who has suffered a broken ankle already knows. The ankle includes seven bones as talus, calcaneus (heel bone), cuboid, navicular,cuneiform bones (the name of three bones, respectively, preceded by the adjectives lateral, intermediate, andmedial). The tarsals and metatarsals of the ankle and foot correspond with the carpal and metacarpal bones of the wrist and hand.The bones making up the fingers and toes are both called phalanges. V. Surgical Terms TERM DEFINITION 11 1. aponeurorrhaphy…… suture of an aponeurosis (ap o nu RO R a fe ) 2. arthroclasia………… surgical breaking of a (stiff) joint (ar thro KLA zhe a) 3. arthrodesis…………. surgical fixation of a joint (ar thro DE sis) 4. arthroplasty………… surgical repair of a joint 5. arthrotomy…………. incision of a joint 6. bursectomy………… excision of a bursa 7. bursotomy……………. incision of a bursa 8. carpectomy………….. excision of a carpal bone 9. chondrectomy……… excision of a cartilage 10. chondroplasty……… surgical repair of a cartilage 11. costectomy………… excision of a rib 12. cranioplasty………. surgical repair of the skull ( AR thro plas te ) (ar THROT o me ) (bur SEK to me ) (bur SOT o me ) (kar PEK to me ) (kon DREK to me ) ( KON dro plas te ) (kos TEK to me ) (KRA - ne - o - plas - te) 13. craniotomy……….. (kra - ne - OT - o - me) incision into the skull (as for surgery of the brain) 14. diskectomy…………. excision of an intervertebral disk 15. laminectomy……… (lam i NEK to me ) excision of the lamina (often done to relieve the symptoms of a ruptured disc) 16. maxillectomy……….. excision of the maxilla 17. meniscectomy…….. excision of the meniscus (performed for a torn cartilage) surgical repair of a muscle (dis KEK to me ) (mak is LEK to me ) (man i SEK to me ) 18. myoplasty………… (MI o plas te ) 19. myorrhaphy………. suture of a muscle 16 (mi OR a fe ) 20. ostectomy…………. excision of bone 21. osteoclasis………… 22. osteoplasty………….. surgical breaking of a bone (to correct a deformity) surgical repair of the bone 23. osteotome………… instrument used for cutting the bone (os TEK to me ) (os te OK la sis) (OS te o plas te ) (OS - te - o - tom) 24. osteotomy………… incision of the bone 25. patellectomy……… excision of the patella (os te OT o me ) (pat - e - LEK - to - me) 26. phalangectomy…… excision of a finger or toe bone 27. rachiotomy……….. incision into the vertebral column 28. spondylosyndesis… (spon di lo SIN de sis) fusing together of the spine (spinal fusion) 29. synovectomy……… (sin o VEK to me ) excision of the synovial membrane (of a joint) 30. tarsectomy………... excision of one or more tarsal bones 31. tenomyoplasty……… surgical repair of the tendon and muscle 32. tenorrhaphy………… suture of a tendon ( fal an JEK to me ) (ra ke OT o me ) (tar SEK to me ) (ten o MI o plas te ) (ten - OR - a - fe) 33. tenotomy…………… (ten OT o me ) incision of the tendon VII. Diagnostic Procedural Terms TERM DEFINITION (built from word parts) 1. surgical puncture of a joint to arthrocentesis……………………... aspirate fluid (ar thro sen TE sis) 2. arthrogram…………………… x-ray film of a joint 17 ( AR thro gram) 3. arthroscopy…………………….. visual examination inside a joint (ar THROS ko pe ) 4. electromyogram………………... record of the (intrinsic) electric activity in a (skeletal) muscle (e lek tro MI o gram) VII. Case History : This 37-year-old married African-American male is admitted to the orthopedic service of the hospital. He complains of pain when walking and golfing. He says that his knees have "been painful" for many years since he quit playing semiprofessional football. But the pain has become very severe in the last six months. He is scheduled for arthroscopy. His preoperative diagnosis is degenerative arthritis, left knee, with possible tear, medial meniscus. VIII. Operative Report: After induction of spinal anesthetic, patient was positioned on the operating table and a tourniquet applied over the upper left thigh. Following positioning of the leg in a circumferential holder, the end of the table was flexed to allow the leg to hang freely. The patient’s left leg was prepped and draped in the toumiquet was inflated to 300 mm Hg. The knee was inspected using anterolateral and anteromedial parapatellar port holes. IX. Findings: The synovium in the suprapatellar pouch showed moderate to severe inflammatory changes with villi formation and hyperemia. The undersurface of the patella showed loss of normal articular cartilage on the lateral patellar facet with exposed bone in that area and moderate to severe chondromalacia of the medial facet. Similar changes were noted in the intercondylar groove. In the medial compartment. the patient had smooth articular cartilage on the femur and moderate chondromalacia of the tibial plateau. The lateral meniscus appeared normal with examination and probing were repeated with no additional pathology being identate until the bleeding was showed. The wounds were steri-stirpped closed, a sterile bandage with an external Ace wrap applied, and the patient returned to the postoperative recovery area in stable condition. 12 Exercise 5-1 Matching Terms with Definitions Place the letter of the definition in the right column in the space next to the matching term in the left column. Term 1. _____ latissimus dorsi Definition A. the middle muscle of the buttock 2. _____ gluteus medius 3. _____ deltoid 4. _____ extensor 5. _____ tendonitis 6. _____ myodynia 7. _____ adduction B. the study of movement C. a “three-headed” muscle located in the upper arm D. moving inward E. a muscle that extends the fingers F. a muscle around the mouth G. the triangular-shaped arm muscle that joins with the shoulder H. muscles that wrap around the side and back J. pain in a muscle K. inflammation of a tendon 8. _____ triceps brachii 9. _____ kinesiology 10. _____ orbicularis oris Exercise 5-2. Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. Term Definition 1. sutures A. rib pairs one through seven 2. costae fluctuantes B. inflammation of a joint 3. diarthrosis/synovial C. the lower jawbone joint 4. zygomatic bones D. the breastbone 5. arthritis E. fibrous membranes that occur between cranial bones 6. sternum F. the bone formed from five fused vertebrae near the base of the spinal column 7. costae verae G. a joint that has free movement or articulation 8. cartilage H. the “cheek” bones 9. sacrum I. connective tissue 10. mandible J. “floating ribs” (they are not attached at the sacrum) 11. phalanges K. the heel bone 12. calcaneus L. the wrist bones 13. clavicle M. the bones making up the fingers and the toes 14. tibia N. the collarbone 15. carpals O. the shin bone EXERCISE 5-3. Build surgical terms for the following definitions by using the word parts it’s expected that studenthave learned. 1. surgical breaking of a bone (to correct a deformity) WR 19 CV S 2. excision of bone WR 3. surgical repair of the bone WR 4. incision of the bone WR 5. instrument used for cutting the bone WR 6. surgical breaking of a (stiff) joint WR S CV S S CV S CV S 7. surgical fixation of a joint WR CV S 8. surgical repair of a joint WR CV S 9. incision of a joint WR S 10. excision of a cartilage WR S 11. surgical repair of a cartilage WR CV S 12. surgical repair of a muscle WR CV S 13. suture of a muscle WR 14. surgical repair of a tendon and muscle WR CV S WR CV 15. inscision into the tendon WR S 16. suture of a tendon WR S 17. excision of a rib WR S 18. excision of the patella WR S 19. suture of an aponeurosis WR S 20. excision of a carpal bone WR S 21. exision of a finger or toe bone WR S 22. exision of the meniscus WR 23. fusing together of the spine WR 24. excision of the lamina CV WR 40 S S P S S 25. excision of a bursa WR S 26. incision of a bursa WR S 27. incision into the skull WR S 28. surgical repair of the skull WR S 29. excision of the maxilla WR S 30. incision into the vertebral column WR S 31. excision of one or more tarsal bones WR S 32. excision of the synovial membrane WR S 33. excision of an intervertebaral disk WR S Answers key : EXERCISE 5-1 1 H 2 A 3 G 4 E 5 K 6 J 7 D 8 C 9 B 10 F EXERCISE 5- 2 1 E 2 J 3 G 4 H 5 B 6 D 7 A 8 I EXERCISE 5- 3 1. oste/o/clasis 2. ost/ectomy 3. oste/o/plasty 4. oste/otomy 5. oste/o/tome 6. arthr/o/clasia 7. arthr/o/desis 8. arthr/o/plasty 9. arthr/otomy 10. chondr/ectomy 11. chondr/o/plasty 12. my/o/plasty 13. my/orrhaphy 14. ten/o/my/o/plasty 15. ten/otomy 9 F 10 C 11 M 12 K 18. patell/ectomy 19. aponeur/orrhaphy 20. carp/ectomy 21. phalang/ectomy 22. menisci/ectomy 23. spondyl/o/syn/desis 24. lamin/ectomy 25. burs/ectomy 26. burs/otomy 27. crani/otomy 28. crani/o/plasty 29. maxilla/ectomy 30. rachi/otomy 31. tars/ectomy 32. synov/ectomy 41 13 N 14 O 15 L 16. ten/orrhaphy 17. cost/ectomy 33. disk/ectomy Chapter 6 The Cardiovascular and Lymphatic Systems Learning Objectives I. Common Word Elements related to the Heart II. Common Disorders and Procedures associated with the Heart, Blood and Blood Vessels III. Common Abbreviations IV.Surgical Terms V. Diagnostic Procedural Terms VI.Case History VII. Exercises General Aims : The unit is designed to help you learn Common Word Elements, Common Disorders and Procedures associated with the Heart, Common Abbreviations Component Parts of Surgical Terms, Diagnostic Procedural Terms of Cardiovascular & Lymphatic Systems and to increase your reading comprehension and to prepare you for reading similar passages. Behavioral Ojectives : Upon completion of this chapter students are expected to be able to: Build, analyze, define, pronounce, and spell the surgical terms Related to the Cardiovascular and Lymphatic System. Define, pronounce, and spell other surgical terms related to the Cardiovascular and Lymphatic System. Build, analyze, define, pronounce, and spell the diagnostic procedural terms related to the Cardiovascular and Lymphatic System. Define, pronounce, and spell other diagnostic procedural terms 42 related to the Cardiovascular and Lymphatic System. The Heart The heart, which is part of the cardiovascular system, pumps blood to every cell in the body. That job is critical, because without the oxygen and nutrients that the blood delivers, body cells quickly die. This chapter introduces terms relating to the structure, function, and disorders of the heart, along with those that name some of the procedures and treatments that keep it working when it malfunctions. I. Common Word Elements related to the Heart Word or Word Element Type Refers to aort/o Root aorta atri/o Root atrium bradyprefix slow card/i/o Root heart corona from the Latin word for the adjective form “coronary” is “crown” sometimes used to describe anatomic structures. echo English word from Greek a reverberation of sound; not mythology properly called a root, such as echogram and echocardiography) electr/o Root electrical endoprefix inner, inside -gram Suffix written record my/o Root muscle periprefix around, surrounding -stenosis Suffix a narrowing tachyprefix fast valv/o, Root valve valvul/o ventricul/o Root ventricle The Location of the Heart The heart is encased in and separated from the walls of the pericardial cavity by three linings: the epicardium, which forms the outer part of the heart; the 41 pericardial sac; and the pericardium. The heart fits tightly inside the pericardial cavity, a subcavity of the thoracic cavity. The pericardial cavity is lined with a serous (thin) membrane called the pericardium, and the heart is within yet a second lining called the pericardial sac. This sac contains about half an ounce of fluid, which lies between it and the heart's outer lining. The Structure of the Heart The membrane forming the outer lining of the heart is called the epicardium. Immediately beneath the epicardium is the myocardium, comprising the muscles, blood vessels, and nerve tissue that make up the bulk of the heart. The heart's inner surface is called the endocardium. The heart has four chambers: the right atrium, the right ventricle, the left atrium, and the left ventricle. They are separated by septa(singular,septum). The names and locations of the septa are easy to remember because they include the names of the parts they separate. They are the interventricular septum (separates the two ventricles) and the interatrial septum (separates the two atria). Also, each atrium is divided from each ventricle by an atrioventricular septum, which contains various valves. The right atrioventricular valve, also sometimes called the tricuspid valve, leads from the right atrium into the right ventricle. The pulmonary semilunar valve connects the right ventricle to the lungs, which also connect to the left ventricle through the left atrium by way of the left atrioventricular valve, also sometimes called the bicuspid ormitral valve. The aortic semilunar valve leads out of the left ventricle. Blood Flow through the Heart The best way to understand how blood flows through the heart is to keep the heart's job in mind. When blood comes back to the heart after having delivered oxygen and other nutrients to the body's cells, it needs to be replenished before going out again. It re-enters the heart at the right atrium. From there it moves into the right ventricle, from which it is pumped into the lungs. After being recharged with oxygen, the blood moves back into the heart through the left atrium and into the left ventricle, from which it is pumped out for yet another trip through the body. Heart Disorders and Procedures The heart can be compared to a mechanical device that relies on electricity for its operation. Electrical impulses emitted within the heart stimulate the heart to pump. When the electrical system malfunctions, the heart will beat too fast, 44 too slow, at an irregular pace, or not at all, depending on the nature of the malfunction. Arrhythmia is most often defined as an irregular heartbeat at any speed. When the heart pumps too fast, defined as any rate greater than 100 beats per minute, the condition is called tachycardia. The Greek word for “fast,” tachys, gives us the prefix tachy- and also the common English word tachometer. A heart that is pumping too slow, which is defined as any rate less than 60 beats per minute, exhibits a condition known as bradycardia. The prefix brady- is also of Greek origin, coming from the word for “slow”: bradys. Tachycardia is also called tachyarrhythmia, and bradycardia is called bradyarrhythmia. II-1. Common Disorders and Procedures associated with the Heart Term Definition atriomegaly enlargement of an atrium atrioseptoplasty surgical repair of an atrial septum bradycardia also called bradyarrhythmia; abnormally slow heartbeat cardiac arrest abbreviated CA, describes the sudden cessation of heart activity cardiodynia heart pain cardiogram a graphic trace of heart functions cardiograph (also a machine to electrically measure heart “myocardiograph,” functions as well as “electrocardiograph,”) cardiomalacia softening of the heart cardiomegaly enlargement of the heart cardiomyopathy disease of the heart muscle (myocardium) cardiomyoplasty a surgical procedure that involves engaging the latissimus dorsi muscle to stimulate the heart cardiopathy cardiorrhaphy cardiorrhexis cardiotomy carditis endocarditis myocardial infarction(MI) myocarditis pericardiorrhaphy pericardiotomy any heart disease suturing of the wall of the heart muscle rupture in the wall of the heart muscle incision into the heart inflammation of the heart inflammation of the endocardium heart attack inflammation of the heart muscle suturing of the pericardium incision into the pericardium 41 pericardiotomy pericarditis tachycardia valvoplasty; also valvuloplasty valvotomy; also valvulotomy valvulitis ventriculoplasty ventriculoscopy incision into the pericardium inflammation of the pericardium abnormally rapid heartbeat also called tachyarrhythmia; surgical repair of a heart valve surgical removal of a blocked heart valve (stenosis of a heart valve) by cutting into it inflammation of a heart valve surgical repair of a heart ventricle examination of a heart ventricle with an endoscope III.Common Abbreviations The Heart Abbreviation Meaning ACV acute cardiovascular [disease] CA cardiac arrest CAD coronary artery disease CCU cardiovascular care unit CHD cardiovascular heart disease CIPS cardiovascular imaging procedure CRFS cardiovascular risk factors CSU cardiovascular surgery unit CT cardiovascular technologist CVICU cardiovascular intensive care unit CVIS cardiovascular imaging systems EKG or ECG electrocardiogram; electrocardiograph; electrocardiography; cardiogram MI myocardial infarction The Blood and Blood Vessels Before studying the terms commonly associated with the blood, we will consider the vessels through which it travels. The reason for doing so is that blood vessels share with the heart the job of transporting blood to all the cells in the body. This chapter introduces the terms relating to blood vessels, constituents of blood, common diseases, and methods of diagnosis and treatment. Word Elements Specific to the Blood and Blood Vessels The word elements are shown in the following table often found in terms 46 relating to the blood and blood vessels. You will recognize them in many of the terms you will learn. I-I.Common Word Elements related to the Blood and Blood vessels Element Type Refers to ang/i/o Root vessel arteri/o Root artery ather/o Root gruel-like -ectasis Suffix dilation -emia Suffix blood hem/o; Root blood hemat/o phleb/o Root vein thromb/o Root clot varic/o Root dilated; from the Latin word varix (“a dilated vein”) vas/o Root vessel vascul/o Root vessel ven/o Root vein Capillaries, Arteries, and Veins Capillaries The capillaries (singular: capillary) are a good place to start in a study of the blood vessels, not because they are the largest of the vessels; on the contrary, they are the smallest. They are mentioned first, however, because they are the most numerous and because they deliver nutrients from the blood to the body's cells. The transfer of blood to the capillaries begins in large vessels and progresses through vessels of ever-diminishing size. Arteries Arteries (singular: artery) carry blood away from the heart and, eventually, to the capillaries. Arteries contain muscle tissue, which allows them to vary their diameters. Two terms are associated with this action: they are vasoconstriction (a narrowing of the artery's diameter) and vasodilation (an enlarging of the artery's diameter). When the muscle tissue contained within an artery contracts, vasoconstriction occurs, thereby producing a resistance that increases blood pressure. When the muscle tissue relaxes, vasodilation occurs to effectively lower the blood pressure. All arteries have this capability, but in varying degrees, depending on their function. 47 The arteries nearest the heart must be able to accommodate the large volume of blood it pumps out with each beat. Artery diameters become smaller as they get nearer to the capillaries. The three kinds of arteries are conducting arteries, muscular arteries, and arterioles. Conducting Arteries Conducting arteries, sometimes called elastic arteries, can have an inside diameter as great as an inch. The aorta is an example of a conducting artery. The pulmonary artery and the aortic trunk are examples of conducting arteries, which move blood away from the heart. Three major conducting arteries branch from the aortic arch. They are the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery. Both the right subclavian artery and the right common carotid artery attach to the brachiocephalic trunk. Medium-Size Arteries Medium-size arteries, sometimes called muscular arteries (because they contain a lot of muscle tissue), typically have an inside diameter of about onesixth of an inch—roughly the height of the letters h and l in this sentence. The external carotid artery in the neck is an example of a medium-size artery. Arterioles Arterioles are the smallest arteries, with an average inside diameter of 0.0018 of an inch, or about 1/100 the size of a medium-size artery. Arteries and arterioles connect to the capillaries, which can be as tiny as one blood cell (or about one-fourth the size of an arteriole) in diameter. Veins Veins carry blood back to the heart. They follow the same path as the arteries (with blood flowing in the reverse direction, of course). Also, like the arteries, they vary in diameter, becoming larger as they approach the heart because of the increasing volumes of blood they must carry. The vein counterparts of the conducting arteries are the superior vena cava and the inferior vena cava. Together, they are known as the venae cavae, the Latin plurals for vena and cava. All the other large veins of the body system drain into one or the other of these. The counterparts of the muscular arteries and arterioles are the medium veins and venules. As its name implies, the superior vena cava drains blood from the upper body, including the head, neck, shoulders, and arms. The inferior vena cava, likewise, receives blood from the lower body, the dividing line being the diaphragm. 42 The Superior Vena Cava The superior vena cava collects the blood returning from the cranium from smaller veins, such as the great cerebral vein and the internal jugular vein, which runs alongside the common carotid artery. The brachiocephalic veins collect returning blood from the vertebral vein and then connects up with the azygos vein, which in turn connects to the superior vena cava, often referred to by its abbreviation: SVC. The Inferior Vena Cava Blood entering the inferior vena cava (IVC) includes that returning from the lower limbs, spinal cord, liver, kidneys, and reproductive organs. The names of these veins include the digital, tibial, femoral, and lumbar veins, all of which are familiar enough to you by now to indicate what parts of the body they serve. The gonadal, hepatic, and renal veins serve the following parts of the body: the reproductive organs, the liver, and the kidneys, respectively. You will learn more about the terminology associated with these organs in later chapters. Terminology of the Blood Whole blood is made up of plasma and the formed elements it contains. Blood Plasma Blood plasma, a yellowish liquid that is 90% water, also contains proteins and other nutrients in solution, such as water-soluble vitamins and minerals. In addition, it carries the formed elements that are a part of whole blood: namely, erythrocytes, leukocytes, and platelets. Thus, although whole blood remains a fluid, it is about five times denser than water. The three main classes of blood plasma proteins are albumins, globulins, and fibrinogens. Two other terms that name common blood proteins are antibodies(also known as immunoglobulins) and lipoproteins. Formed Elements (Erythrocytes, Leukocytes, and Platelets) Erythrocytes are red blood cells, abbreviated RBC, and leukocytes are white blood cells, abbreviated WBC. Red blood cells make up 99.9% of the formed elements in the blood. Hemoglobin, which is abbreviated Hb and binds only to RBCs, gives blood its red color. Each RBC contains approximately 280 million Hb molecules. A single drop of blood contains about 260 million red blood cells. The number of white blood cells present in a drop of blood is only 35,000 or so, although WBCs are not much larger than the RBCs. 49 White blood cells do not all do the same job and are not all the same size. However, all WBCs are at least slightly larger than RBCs. In fact, the WBCs of one category are double the size of RBCs. Platelets, which are very small in comparison to both RBCs and WBCs, are formed elements that are important in the coagulation process. They are produced in the bone marrow and vary somewhat in shape. II-I. Common Disorders and Procedures associated with Blood and Blood Vessels Term Definition aneurysm a bulge in an artery (or a heart chamber) angiitis (also vasculitis) inflammation of a blood vessel angiogram the printed record obtained through angiography angiography radiography of a blood vessel after injection of a contrast medium angiopathy (also vasculopathy) any disease of blood vessels angioplasty surgical repair of a blood vessel angiorrhaphy suture of a vessel angiospasm spasm in blood vessels angiostenosis narrowing of a blood vessel angiotomy incision into a blood vessel arteriolitis inflammation of the arterioles arteriopathy any disease of the arteries arterioplasty surgical repair of an artery arteriorrhexis rupture of an artery arteriorrhaphy suturing of an artery arteriosclerosis hardening of the arteries arteriospasm spasm of an artery arteriostenosis narrowing of an artery arteriotomy an incision into an artery arteriovenous adjectival form of “arteries and veins” arteritis inflammation of an artery or arteries hemolysis change or destruction of red blood cells hemopathy any disease of the blood hemophilia congenital disorder affecting the coagulation process hemorrhage discharge of blood hemorrhagic fever category that includes a number of viral diseases, one of which is Ebola fever 10 vasculitis (also angiitis) vasculopathy (also angiopathy) vasoparalysis vasoparesis vasospasm inflammation of a vessel any disease of blood vessels paralysis of blood vessels similar to but less severe than vasoparalysis spasm in blood vessels (angiospasm) III-I.Common Abbreviations: The Blood and Blood Vessels Abbreviation Meaning Hb hemoglobin HDL high-density lipoprotein IVC inferior vena cava LDL low-density lipoprotein RBC red blood cells SVC superior vena cava WBC white blood cell IV. Surgical Terms TERMS (built from word parts) 1. angioplasty……………… (AN-jē-ō-plas-tē) 2. 3. 2. angiorrhaphy……………. (an-jē-ŌR-a-fē) 3. endarterectomy 4. (end-ar-ter-EK-tō-mē) 5. 6. 4. pericardiostomy (par-i-kar-dē-OS-tō-mē) 5. phlebectomy 7. (fle-BEK-tō-mē) 8. 6. phlebotomy (fle-BOT-ō-mē) 7. splenectomy (sple-NEK-tō-mē) 8. splenopexy (SPLE- nō-peks-ē) DEFINITION surgical repair of a blood vessel suturing of a blood vessel excision of the thickened interior (intima) of an artery creation of an artificial opening in The outer (double)layer of the heart excision of a vein incision into a vein to remove blood or to give blood or intravenous fluids, also called venipuncture excision of the spleen surgical fixation of the spleen 11 9. thymectomy (thī-MEK-tō-mē) excision of the thymus gland Other Surgical and Treatment Terms TERM DEFINTION 1. aneurysmectomy surgical excision of the ballooning of a weakened (an-ū-riz-MEK-tō-mē) blood vessel wall 2. bone marrow transplantinfusion of normal bone marrow cells from a donor with matching cells and tissue to a recipient with a certain type of leukemia or anemia type of leukemia 3. cardiac pacemaker battery-powered or nuclear-powered apparatus implanted under the skin to regulate heart rate 4. coronary artery bypass surgical technique to bring a new blood supply to graft (CABG) heart muscles by detouring around blocked arteries 5. defibrillation application of an electric shock to the myocardium (dē-fib-ri-LĀ-shun) through the chest wall to restore normal cardiac 6. embolectomy surgical removal of an embolus or clot (em-bō-LEK-tō-mē) 7. femoropopliteal bypass surgery to establish an alternate route from (FEM-or-ō-pop-li-TĒ-al) femoral artery to popliteal artery to bypass obstructive portion 8. hemorrhoidectomy excision of hemorrhoids, the varicosed veins (hem-(m (hem-ō-royd-EK-tō-mē) in the rectal region 9. intracoronary thrombolytic therapy an injection of a medication in a blocked (in-tra-KOR-ō-na-rē) coronary vessel to dissolve blood clots (thrombol LI-tik) 10. laser angioplasty (LĀ-zer) (AN-jē-ō-plas-tē) 11. mitral commissurotomy (mi -tral)(kom-(Mī-tral) (kom-i-shūr-OT-ō-mē) the use of light amplification by simulated radiation or laser beam to open blocked arteries especially in lower extremities surgical procedure to repair a stenosed mitral valve by breaking apart the leaves (commissures) of the valve 12 12. percutaneous transluminal coronary angioplasty (PTCA) (per-kū-TĀ-nē-us) (trans-LŪM-in-al) (KOR-ō-na-rē) 13. vein ligation and stripping (li-GA-shun) procedure in which a balloon is passed through a blood vessel to the area in which plaque is formed. Inflation of the balloon then flattens the plaque against vessel wall and allows the blood to circulate more freely. surgical method of tying off a varicose vein and removing it V. Diagnostic Procedural Terms HEART AND BLOOD VESSELS TERM 1.angiography (an-jē-OG-ra-fē) 2.angioscope (AN-jē-ō-skōp) 3. angioscopy (an-jē-OS-kō-pē) 4.aortogram (ā-ŌR-tō-gram) 5. arteriogram (ar-TE-rē-ō-gram) 6. echocardiogram (ek-ō-KAR-dē-ō-gram) 7. electrocardiograph (e-lek-trō-KAR-dē-OG-ra-fē) 9. electrocardiography (e-lek-trō-kar-dē-OG-ra-fē) 10.phlebography (fle-BOG-ra-fē) 11.phonocardiogram (fō-nō-KAR-dē-ō-gram) 12.sphygmocardiograph (sfig-mō-KAR-dē-ō-graf) 13.stethoscope (STETH-ō-skōp) 14.venogram (VĒ-nō-gram) DEFINITION process of x-ray filming a blood vessel (after an injection of contrast medium; the procedure named for the vessel to be studied, such as a femoral angiography). instrument used to visualize a blood vessel. visual examination of a blood vessel x-ray film of the aorta (made after an of contrast medium) x-ray film of an artery (taken after an injection of contrast medium) record made of the structure and motion heart using sound waves of the heart instrument used to record the electrical activity of the heart process of recording the electrical activity of the heart process of x-ray filming a vein (filled with contrast medium) graphic record of heart sound instrument used to measure pulse waves and heart beat instruument used to listen to listen to chest sounds produced by heart and lungs x-ray film of the veins (taken after an injection of dye) 11 15.hematocrit (HCT) (he-MAT-ō-krit) 16.leukocyte count (WBC) (LŪ-kō-sīt) 17.lymphadenography (lim-fad-e-NOG-ra-fē) 18.lymphangiogram (lim-FAN-jē-ō-gram) 19.lymphangiography (lim-fan-jē-OG-ra-fē) separated blood (volume percentage of erythrocytes in whole blood after separation by centrifuge) white blood cell count (number of white blood cells per cubic millimeter of blood) process of x-ray filming the lymph nodes and glands (after an injection of contrast medium) x-ray film of the lymphatic vessels process of x-ray filming the lymphatic vessels (after an injection of contrast medium) Blood and Lymphatic System 1.complete blood count(CBC) basic blood screening that includes tests on hemoglobin, hematocrit, red blood cell morphology (size and shape), leukocyte count and white blood cell differential (types of WBCs) 2. coagulation time blood test to determine the time it takes for (kō-ag-ū-LĀ-shun) blood to form a clot 3. hemoglobin (Hgb) oxygen-carrying components in red blood (HĒ-mō-glō-bin) cells, responsible for giving blood its color 4. prothrombin time(PT) test to determine certain coagulation (prō-THROM-bin) activity defects; also used to monitor anticoagulation therapy 5. bone marrow biopsy needle puncture to remove bone marrow for study, usually from the sternum or ilium , to determine certain blood cell diseases, such as leukemia and anemia VI. CASE History: This is the third hospitalization for this 76-year-old widowed Filipino female who was admitted for recurrent angina. The patient has a long history of stable angina pectoris and had a positive treadmill test in 1988. A thallium treadmill test in 1991 showed reversible apical ischemia. In may of 1992. she underwent cataract surgery. She developed severe chest pain postoperatively. The EKG at that time showed ischemic ST changes in the anterior leads. A subsequent coronary angiography revealed a 90% focal left anterior descending stenosis. The patient then underwent angioplasty of this lesion. The 90% stenosis was dilated to a 20% stenosis. The patient had an 14 uncomplicated course and discharged home. Over the last 10 days the patient has had at least 5 episodes of chest pain, all relieved by rest or a single nitroglycerin tablet. She had a episode yesterday while gardening, which lasted almost 20 minutes before subsiding after a second nitroglycerin. She came to her cardiologist’s office today. An electrocardiogram was done which showed marked anterior T wave inversion in the anterior leads and she was immediately sent to this hospital for an evaluation. Atherogenic risk factors include hypercholesterolemia for which she is now taking lovastatin. She is also hypertensive and smokes one pack per day. She is not diabetic. Current medications are lovastatin 20 mg daily,enalaprill, 20 mg bid, nifedipine 10 mg tid, nitroglycerin prn. Recommendations: Patient is being admitted on an urgent basis for emergency cardiac catheterization and redilatation if necessary. Serial EKGs and enzymes will be obtained to rule out a myocardial infarction. EXERCISE 6 – 1 Build surgical terms for the following definitions by using the word parts which have been learned. 1. excision of the thickened interior of an artery P WR S 2. surgical fixation of the spleen WR CV S 3. suturing of a blood vessel WR 4. incision into a vein S WR S 5. excision of the thymus gland WR 6. creation of an artificial opening in the outer layer of the heart S P WR 7. surgical repair of a blood vessel S WR CV 8. excision of a spleen WR S 9. excision of a vein WR S EXERCISE 6-2 Fill in the blanks with the correct terms. 11 S 1. Surgical excision of hemorrhoids is called a(n) . 2. The surgical method of tying off a varicosed vein and removing it is called . 3. The procedure in which a balloon is passed through a blood vessel to flatten plaque against the vessel wall when the balloon is inflated is called . 4. To regulate the heart rate, the physician may insert a(n) under the patients' skin. 5. A mitral is the name of the surgery performed to repair a stenosed mitral valve. 6. The surgery performed to detour blood around a blocked artery so that a new blood supply can be given to heart muscles is called . 7.The surgical excision of an aneurysm is called a(n) . 8. A(n) is the name of the surgery performed to establish an alternate route from femoral artery to popliteal artery to bypass obstructive portion. 9. is the name of the procedure to open blocked arteries with a laser beam. 10. An injection of a medication into a blocked coronary coronary vessel to dissolve blood clots is called therapy. 11. is the application of electric shock to the myocardium through the chest wall to restore cardiac rhythm. 12. is a procedure to transfuse bone marrow cells to recipient from donor with matching tissue and cells. 13. is the surgical removal of embolus or clot. EXERCISE 6- 3 Match the first column with the correct definitions in the second column one. 1. aneurysmectomy a. pressing plaque against a blood vessel wall 2. coronary artery by inflating a balloon passed through the graft bypass blood vessel 3. femoropopliteal bypass b. tying off and removal of a varicose vein 4. hemorrhoidectomy c. application of electric shock to 5. cardiac pacemaker myocardium through chest wall to restore 6. mitral commissurotomy cardiac rhythm 7. percutaneous d. apparatus implanted under the skin to transluminal coronary regulate heart beat 8. vein ligation and e. procedure performed to open blocked stripping arteries using a laser beam 9. defibrillation f. diverts blood past a blocked artery in the heart 10. laser angioplasty g. use of a medication to dissolve blood clots in blocked coronary vessel 11. bone marrow transplant h. excision of a weakened ballooning blood vessel wall 16 12. intracoronary thrombolytic therapy i. 13. embolectomy j. k. I. m. n. normal bone marrow cells infused from donor with matching tissues and cells into recipient with leukemia surgical removal of an embolus surgical procedure to establish an alternate route from femoral artery to popliteal artery to bypass obstructive portion surgical excision of varicose veins in the rectal area surgical procedure to break apart the leaves of the mitral valve surgical removal of a thickened artery EXERCISE 6 – 4 Build diagnostic procedural terms for the following definitions by using the word parts it’s expected that studenthave learned. For example : instrument used to record the electrical activity of the heart WR 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. CV WR CV S instrument used to record the electrical activity of the heart instrument used to listen to chest sounds x-ray film of an artery (taken after an injection of contrast medium) x-ray film of the veins(taken after an injection of contrast medium) process of making an x-ray film of a blood vessel record of the electrical activity of the heart record made of the structure and motion of the heart using sound waves graphic record of heart sounds instrument used to measure pulse waves and heart beat x-ray film of the aorta (taken after an injection of contrast medium) process of recording the electrical activity of the heart separated blood (volume percentage of erythrocytes in whole blood after separation by centrifuge) x-ray film of lymphatic vessels white blood cell count(number of cells per cubic millimeter of blood) process of x-ray filming the lymph nodes and glands red blood cell count (number of cells per cubic millimeter of blood) process of x-ray filming the lymphatic vessels instrument used to visually examine a blood vessel process of x-ray filming a vein visual examination of a blood vessel 17 EXERCISE 6 – 5 Fill in the blanks with the correct terms. 1. A device for measuring blood pressure is called a (n) . 2. is the name of the blood test that determines the time it takes for blood to form a clot. 3. A test, performed to diagnose coronary artery disease, in which the patient while an EXERCISE cardiogram is recorded is a (n) 4. is the name of a basic blood-screening test. 5. the name of the study in which ultrasound is used to determine the velocity of flow of blood within vessels is called . 6. two-dimensional photographic representation of the heart taken after the introduction of radioactive material is called a (n) 7. is the name given to a procedure performed to determine certain blood diseases, such as leukemia. 8. A blood test performed to determine certain coagulation defects and to monitor anticoagulation therapy is called . 9. is the name given to a procedure in which a catheter is introduced into the heart to determine pathology in the heart or its vessels. 10. The oxygen-carrying component in the red blood cells is called 11. A measures venous flow to the limbs. test. . . EXERCISE 6- 6 Match the terms in the first column with the correct definitions in the second column. 1. cardiac catheterization a. device used for measuring arterial blood pressure 2. cardiac scan b. test during which an EXERCISE electrocardiogram is made 3. complete blood count c. test to determine certain coagulation activity defects 4. coagulation time d. passage of a tube into the heart to determine disease within the heart 5. hemoglobin e. two-dimensional photograph of heart 6. doppler flow studies f. measures venous flow to the limbs 7. prothrombin time g. responsible for the red color of blood 8. sphygmomanometer h. basic blood screening test 9. bone marrow biopsy i. determines the time it takes for blood to clot 10. treadmill stress test j. study in which ultrasound is used to determine the velocityof the flow of blood within vessels 12 f 11. impedance plethysmography k. performed to determine certain blood cell diseases, such as leukemia l. test to determine the number of red blood cells Exercise 6- 7 Read each statement, then indicate whether you think it is true or false. Statement True 1. The term for inflammation of the pericardium is valvulitis. ___ 2. Atriomegaly is enlargement of an atrium. ___ 3. MI is the abbreviation that stands for an abnormally rapid heartbeat. ___ 4. Tachycardia is an abnormally rapid heartbeat. ___ 5. Cardiotomy is the surgical repair of an atrial septum. ___ 6. Softening of the heart is termed cardiomalacia. ___ 7. A myocardiograph is used to examine a heart ventricle. ___ 8. Cardiorrhaphy is a surgical repair of a heart valve. ___ 9. The surgical procedure that involves engaging the latissimus dorsi muscle ___ to stimulate the heart is a pericardiotomy. 10.Arrhythmia is the general term for an irregular heartbeat. ___ False ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Exercise 6-8 Place the letter of the definition in the right column in the space next to the matching term in the left column. Term Definition 1. ______ myocardial infarction A. a separation between the two ventricles of the heart 2. ______ aortic semilunar valve B. inflammation of the pericardium (the serous membrane lining the pericardial cavity) 3. ______ intraventricular septum C. the heart muscle, which includes the nerves and blood vessels 4. ______ endocardium D. the valve leading from the right atrium to the right ventricle 5. ______ left ventricle E. the serous membrane forming the outer lining of the heart 6. ______ cardiologist F. the heart's inner surface 7. ______ myocardium G. a heart specialist 8. ______ epicardium H. heart attack 9. ______ pericarditis J. the heart chamber responsible for pumping oxygenated blood out to the body 10.______ right atrioventricular K. the valve leading out of the left ventricle (tricuspid) valve 11.______ troponin L. enlargement of the heart 12.______ septum M.coronary artery disease, which refers to narrowing and/or blockages of the heart muscle 13.______ cardiomegaly N. a heart rate less than 60 beats per minute 14.______ tachycardia O. a protein released into the blood-stream when an MI occurs 15.______ stenosis P. disease of the heart muscle 16.______ CAD Q. a thin wall that separates cavities or masses 17.______ atrioseptoplasty R. a heart rate over 100 beats per minute 19 18.______ cardiomyopathy 19.______ bradycardia 20.______ cardiac arrest S. sudden cessation of heart activity, not necessarily a result of MI T. surgical repair of an atrial septum U. a narrowing and/or blockage Exercise 6-9 Place the letter of the definition in the right column in the space next to the matching term in the left column. Noun Definition 1. _____ hemoglobin A. carries blood back to the heart 2. _____ arteriole B. the smallest but most numerous of the blood vessels, responsible for transferring nutrients directly to the cells 3. _____ erythrocytes C. the blood plasma proteins that are also known as antibodies 4. _____ capillary D. contains muscle tissue and carries blood away from the heart 5. _____ leukocytes E. the protein that gives blood its red color 6. _____ platelets F. a large venous vessel that drains blood from the upper body to be transported to the heart 7. _____ immunoglobulin G. red blood cells 8. _____ vein H. the smallest of the arteries, connecting with the capillaries 9. _____ superior vena J. white blood cells cava (SVC) 10._____ artery K. a formed element found in whole blood, which is important in the coagulation process 11._____ angiostenosis L. surgical repair of a blood vessel 12._____ vasculopathy M.discharge of blood 13._____ aneurysm N. a congenital disorder affecting the coagulation process, causing excessive bleeding 14._____ angioplasty O. “hardening” of the arteries 15._____ HDL P. the narrowing of a blood vessel 16._____ angiography Q. a bulge in an artery or a heart chamber 17._____ LDL R. radiography of a blood vessel after injection of a contrast medium 18._____ arteriosclerosis S. any disease of the blood vessels 19._____ hemorrhage T. “good cholesterol”; picks up “dead” cholesterol from cells and removes it 20._____ hemophilia U. “bad cholesterol”; delivers cholesterol to the body Exercise 6-10 Read each statement, then indicate whether you think it is true or false. 1. A vein that connects brachiocephalic veins with the superior vena cava is the renal vein. 2. Conducting arteries are the largest of the arteries and nearest the heart. 3. Vasoparalysis is the paralysis of blood vessels. 4. Vasculitis is any disease of blood vessels. 5. Hemopathy is any disease of the blood. 60 True ___ False ___ ___ ___ ___ ___ ___ ___ ___ ___ 6. Erythrocytes are white blood cells. ___ ___ 7. The vein in the neck that runs alongside the common carotid ___ ___ artery is the vertebral vein. 8. Lumbar veins are in the kidneys. ___ ___ 9. The great cerebral vein is in the cranium. ___ ___ 10.The three main blood plasma proteins include the femorals, ___ ___ globulins, and albumins. Exercise 6-11 Choose the term in the right column that correctly completes the sentence. Sentence Origin 1. is the inflammation of a vessel. angiitis; angina pectoris; arteriosclerosis; arteriospasm 2. Hardening of the arteries is referred to as angiitis; angina pectoris; arteriosclerosis; arteriospasm 3. The phrase means a pain in the chest. angiitis; angina pectoris; arteriosclerosis; arteriospasm 4. A change in or destruction of red blood cells is known as hemolysis; hemopathy; hemophilia; hemorrhage 5. is a congenital disorder affecting the coagulation process. hemolysis; hemopathy; hemophilia; hemorrhage 6. Any disease of the blood may be referred to as hemolysis; hemopathy; hemophilia; hemorrhage 7. An incision into a blood vessel is called angiography; angioplasty; angiorrhaphy; angiotomy 8. X-raying a blood vessel after injection of a contrast medium angiography; angioplasty; is called angiorrhaphy; angiogram 9. is the surgical repair of a blood vessel. angiography; angioplasty; angiorrhaphy; angiotomy 10.A printed record obtained through angiography is an. angiography; angioplasty; angiorrhaphy; angiogram Answers key : EXERCISE 6 - 1 1. end/arter/ectomy 2. spleen/o/pexy 3. angi/orrhaphy 4. phleb/otomy 5. thym/ectomy EXERCISE 6- 2 1. hemorrhoidectomy 2. vein ligation and stripping 3. percutaneous transluminal coronary angioplasty 6.peri/cardi/ostomy 7. angi/o/plasty 8. splen/ectomy 9. phleb/ectomy 8. femoropopliteal bypass 9. laser angioplasty 10. intracoronary thrombolytic 61 4. pacemaker 5. commissurotomy 6. coronary artery bypass graft 7. aneurysmectomy EXERCISE 6 - 3 1. h 3. k 2. f 4. l 5. d 6. m 11. defibrillation 12. bone marrow transplant 13. embolectomy 7. a 8. b 9. c 10. e EXERCISE 6 - 4 1. electr/o/cardi/o/graph 2. steth/o/scope 3. arteri/o/gram 4. ven/o/gram 5. angi/o/graphy 6. electr/o/cardi/o/gram 7. ech/o/cardi/o/gram 8. phon/o/cardi/o/gram 9. sphygm/o/cardi/o/graph 10. aort/o/gram 13.j 11.electr/o/cardi/o/graphy 12. hemat/o/crit 13. lymph/angi/o/gram 14. leuk/o/cyte 15. lymph/aden/o/graphy 16. erythr/o/cyte 17. lymph/angi/o/graphy 18. angi/o/scopy 19. phleb/o/graphy 20. angi/o/ scopy EXERCISE 6-5 1. sphygmomanometer 2. coagulation time 3. treadmill stress 4. complete blood count 5. doppler flow studies 6. cardiac scan Exercise 6- 6 1 2 d e 11 f 11. i 12. g 7. bone marrow biopsy 8. prothrombin time 9. cardiac catheterization 10. hemoglobin 11. impedance plethysmography 3 h 4 i 5 g 6 j 7 c 8 a 9 k 10 b Exercise 6- 7 1 2 False True 3 False 4 True 5 True 6 True 7 False 8 False 9 False 10 True Exercise 6- 8 1 2 H J 11 12 N P 3 A 13 K 4 F 14 Q 5 I 15 T 6 G 16 L 7 C 17 S 8 E 18 O 9 B 19 M 10 D 20 R 62 Exercise 6- 9 1 2 E H 11 12 O R 3 G 3 P 4 B 14 K 5 I 15 S 6 J 16 Q 7 C 17 T 8 A 18 N 9 F 19 L 10 D 20 M Exercise 6- 10 1 2 False True 3 True 4 False 5 True 6 False 7 False 8 False 9 True 10 False Exercise 6- 11 1 angitis 6 hemopathy 2 arteriosclerosis 7 angiotomy 3 angina pectoris 8 angiography 61 4 hemolysis 9 angioplasty 5 hemophilia 10 angiogram Chapter 7 The Respiratory system Learning Objectives I. Surgical Terms II. Diagnostic Procedural Terms III. Case History IV. Pulmonary consultation V. Exercises General Aims : The unit is designed to help you learn Surgical Terms and Diagnostic Procedural Terms of Respiratory system and Pulmonary consultation to increase your reading comprehension and to prepare you for reading similar passages. Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Build, analyze, define, pronounce, and spell the surgical terms related to the Respiratory system. Build, analyze, define, pronounce, and spell the diagnostic procedural terms related to the Respiratory system. 64 The Respiratory System You have already learned that the heart pumps blood through the circulatory vessels, from which it delivers oxygen and other important nutrients to all parts of the body. For the blood to obtain the oxygen it carries, our lungs must first make it available by extracting it from the air we breathe. That is the job of the respiratory system. Most of the oxygen (98.5%) goes into hemoglobin and the rest is absorbed by plasma. The process has to be continuous because the body's tissues cannot store oxygen. Because the respiratory system is the source of oxygen for the whole body, one can hardly overestimate the importance of keeping it in good working order. In this chapter, you will learn terminology associated with the respiratory system and its common disorders, along with terms that name some of the procedures currently available for diagnosis and treatment. Word Elements Specific to the Respiratory System The roots and suffixes shown in the following table are often found in terms related to the respiratory system. You will recognize them in many of the terms you will learn in this chapter. TABLE 7-1 Common Word Elements related to the Respiratory System Root or Suffix Refers to bronchi/o bronchus laryng/o larynx nas/o, rhin/o nose pharyng/o pharynx phren/o diaphragm -pnea (suffix) breathing (a suffix used in such terms as dyspnea, which means “difficulty in breathing”) pneum/o, pneumon/o, pulmon/o lung sinus/o sinus cavity trache/o trachea Breathing Our lungs are the biggest of our respiratory organs. Air flows into the lungs through the nose, nasal passage, pharynx, larynx, trachea, and bronchi. The 61 best way to understand the whole system, and thus remember its terminology, is to divide it into two parts: the upper respiratory system and the lower respiratory system. The Upper Respiratory System The upper respiratory system is composed of the nose, nasal cavity, and pharynx, which together act as a series of passageways to move air toward the lungs. The Nose Air that enters through the nose encounters the body's first line of defense against contaminants in the air. Any large particulate matter contained in air entering the nose is filtered out by the hairs inside the nose. The Nasal Cavity The nasal cavity is the second line of defense against any foreign material trying to get into the respiratory system. The mucus that coats the lining of the nasal cavity filters out particles that are too small to be picked up by the hairs in the nose. Also, incoming air is warmed and moistened as it passes through the nasal cavity, while outgoing air gives up its heat and water vapor. To maintain good health, it is essential to keep the lower respiratory system warm and humidified. The Pharynx Incoming air passes out of the nasal cavity into the pharynx, where it is further purified and filtered to eliminate germs and unwanted chemicals. The Lower Respiratory System The Larynx The larynx marks the beginning of the lower respiratory system. Its job, apart from its other major task of providing us with a means of speech, is to pass the now purified air into the trachea. Along with the epiglottis, which is technically part of the digestive system, the larynx also prevents food and drink from entering the trachea. The Trachea and Bronchi The trachea is often called the windpipe because air flows through it into the bronchi. Leaving the bronchi, incoming air passes into the lungs. The trachea is a bit more than 4 inches long, and the bronchi start at about shoulder level. 66 The bronchi become smaller and smaller as they move into the lungs, and both secondary (second-order) and tertiary (third-order) bronchi are terms you should become familiar with, along with bronchioles, which are somewhat like the capillaries in the cardiovascular system. That is, they get smaller and smaller as they extend deeper into the lungs, eventually reaching a diameter of about half a millimeter. The Lungs The right lung looks something like half of a bigger-than-normal football with the tip, called the apex, pointing upward and the bottom part, called the base, resting on top of the diaphragm. The left lung looks almost the same except for an indentation on its inner side to accommodate the heart. As air flows deep inside the lungs, it branches off from the bronchioles into tiny passageways and sacs called alveoli (singular: alveolus). The alveoli contained in the lungs receive oxygen from the air so that it can be picked up by the blood in the capillaries associated with them. Since alveoli occur in other parts of the body, you should use the adjective pulmonary when speaking or writing of those in the lungs. The lungs also contain arteries and veins, which are preceded by the adjective pulmonary to indicate their location in the lungs. The Diaphragm Although the diaphragm is located at the very bottom of the respiratory system, it initiates the breathing process. When the diaphragm moves downward, the partial vacuum thus formed draws air into the lungs. When it pushes upward, air is expelled from the lungs. Common Abbreviations: The Respiratory System Abbreviation Meaning AARC American Association for Respiratory Care AART American Association for Respiratory Therapy AIURT acute infections of the upper respiratory tract ALR acute lower respiratory infection CNRD chronic nonspecific respiratory diseases ERV expiratory reserve volume (as measured with test equipment) IRV inspiratory reserve volume (as measured with test equipment) PFT pulmonary function test 67 RV T&A TLC TV SOB COPD residual volume (as measured with test equipment) tonsils and adenoids (also tonsillectomy and adenoidectomy) total lung capacity (as measured with test equipment) tidal volume (as measured with test equipment) shortness of breath chronic obstructive pulmonary disease TABLE 7-2 Common Disorders and Procedures associated with the Respiratory System Term Definition apnea absence of breathing asthma a lung disease characterized by reversible inflammation and constriction bronchial pneumonia inflammation of the smaller bronchial tubes (bronchopneumonia) bronchiolitis inflammation of the bronchioles bronchiostenosis narrowing of the bronchial tubes bronchitis inflammation of the mucous membrane of the bronchial tubes bronchomalacia degeneration or softening of the bronchi bronchoplasty surgical repair of a bronchus bronchopneumonia inflammation of the smaller bronchial tubes (bronchial pneumonia) bronchorrhaphy suturing of a bronchus bronchorrhea excessive mucus production by a bronchus bronchoscope a device used for visual inspection of the interior of a bronchus bronchoscopy inspection with a bronchoscope bronchospasm abnormal contraction of bronchi bronchostenosis chronic narrowing of a bronchus bronchotomy incision into a bronchus dyspnea difficult breathing emphysema condition in which the alveoli are inefficient because of distension laryngectomy excision of the larynx laryngitis inflammation of the larynx laryngology study of the larynx and its abnormalities laryngoplasty surgical repair of the larynx 62 laryngoscope laryngoscopy laryngospasm laryngostenosis laryngotomy pharyngitis pharyngocele pharyngoplasty pharyngoplegia pharyngoscope pharyngoscopy pharyngospasm pharyngostenosis pharyngotomy phrenalgia phrenoplegia pneumolith pneumonectomy pneumonia, pneumonitis pneumonopexy pneumonorrhaphy pneumonotomy rhinalgia rhinitis rhinodynia rhinology rhinopathy rhinoplasty rhinorrhea rhinoscope rhinoscopy rhinostenosis rhinotomy instrument with a light at the tip to aid in visual inspection of the larynx visual inspection of the larynx with the aid of a laryngoscope involuntary contraction of the larynx a narrowing of the larynx incision into the larynx inflammation of the pharynx a hernia or diverticulum in the pharynx surgical repair of the pharynx paralysis of the pharynx instrument with a light at the tip to aid in the visual inspection of the pharynx visual inspection of the pharynx with the aid of a pharyngoscope involuntary contraction of the pharynx narrowing of the pharynx surgical incision into the pharynx pain in the diaphragm paralysis of the diaphragm calculus in a lung removal of pulmonary lobes from a lung inflammation of a lung caused by infection, chemical inhalation, or trauma surgical fixation of a lung suturing of a lung incision into a lung pain in the nose inflammation of the inner lining of the nasal cavity rhinalgia; pain in the nose study of the nose and its abnormalities any disease of the nose surgery performed on the nose discharge from the rhinal mucous membrane a small mirror with a thin handle; used in rhinoscopy visual inspection of the nasal areas narrowing or obstruction occurring in the nasal passages surgical incision into the nose 69 sinusitis sinusotomy tracheitis tracheomalacia tracheomegaly tracheoplasty tracheorrhagia tracheostenosis tracheotomy inflammation of the sinuses incision into a sinus inflammation of the trachea softening (degeneration) of tracheal tissue abnormal dilation of the trachea surgical repair of the trachea hemorrhage of the trachea abnormal narrowing of the trachea incision into the trachea I. Surgical terms TERM (built from word parts) 1. adenoidectomy………….……. (ad-e-noyd-EK-to-me) 2. bronchoplasty……………........ (BRON-ko-plas-te) 3. laryngectomy………………..... (lar-in-JEK- to-me) 4. laryngocentesis………………. (lar-in-go-sen-TE-sis) 5. laryngoplasty……………….… (lar-IN-go-plas-te) 6. laryngostomy…………………. (lar-in-GOS-to-me) 7. laryngotracheotomy…………... (lar-in-go-ira-ke-OT-o-me) 8. lobectomy…………………….. (lo-BEK-to-me) 9. pleurocentesis……………….... (plur-o-sen- TE-sis) 10. pleuropexy…………………... (plu-ro-PEK-se) 11. pneumobronchotomy………... (nu-mo-bron-KOT-o-me) 12. pneumonectomy…………....... (nu-mon- EK-to-me) DEFINITION excision of the adenoids surgical repair of a bronchus excision of the larynx surgical puncture of the larynx to aspirate fluid surgical repair of the larynx creation of an artificial opening into the larynx incision of the larynx and trachea excision of a lobe of the lung surgical puncture to aspirate fluid from pleural space surgical fixation of the pleura incision of lung and bronchus excision of a lung 70 13. rhinoplasty………..…………. (RI-no-plast-e) 14. septoplasty………………….. (sep-to-PI-AS- te) 15. septotomy………………......... (sep-TOT-o-me) 16. sinusotomy………………....... (si- nu- SOT-o-me) 17. thoracocentesis………............. (tho-rak-o-sen-TE- sis) 18. thoracotomy……………......... (tho-rak-OT-o-me) 19. tonsillectomy……………….. (ton- sil-EK-to-me) 20. tracheoplasty……………....... (TRA-ke-o- plas-te) 21. tracheostomy……………........ (tra-ke-OS-to-me) 22. tracheotomy……………......... (tra-ke-OT-o-me) surgical repair of the nose surgical repair of the (nasal) septum incision into the (nasal) septum incision of a sinus surgical puncture of chest cavity to aspirate fluid (also called thoracentesis) incision into the chest cavity excision of the tonsils surgical repair of the trachea creation of an artificial opening into the trachea incision of the trachea II. Diagnostic Procedural Terms TERM DEFINITION (built from word parts) 1.bronchogram …………... x-ray film of the bronchi (BRON-ko-gram) 2.bronchography ………… process of x-ray filming the bronchi (bron-KOG-ra-fe) 3.bronchoscope…………… instrument used for visual examination of (PRON-ko-skop) the bronchi 4.bronchoscopy …………. (bron-KOS-ko-pe) 1. endoscope …………..… (EN-do-skop) 6. endoscopic ……………. visual examination of the bronchi instrument used for visual examination within a hollow organ or body cavity (Current trend is to use endoscopes for surgical procedures as well as for viewing.) visual examination of a hollow organ or 71 (EN-do-skop-ic) body cavity (Used to describe the current practice of performing surgeries using endoscopes.) 6. laryngoscope …..……… instrument used for visual examination of (lar-IN-gos-ko-pe) the larynx 8.laryngoscopy…………….. visual examination of the larynx (lar-in-GOS-ko-pe) 7. oximeter ………………. instrument used to measure oxygen (ok-SIM-e-ter) (saturation in the blood) 8. spirometer……………… instrument used to measure breathing (or (spi-ROM-e-tre) lung volumes) 9. Thoracoscope ……..….. (tho-RA-ko-skop) 10.Thoracoscopy……….. (tho-ra-KOS-ko-pe) instrument used for visual examination of the thorax visual examination of the thorax III. Case History: This 55-year-old Asian male was admitted to the hospital with complaints of recent cough, dyspnea, and shortness of breath. He denies hemoptysis, chest pain, or night sweats. Complains of weight loss and chronic cough of 6 months duration, Moderate clubbing of fingers. History of smoking 2 packs/day for 40 years. Referred for pulmonary consult. IV. Pulmonary Consultation: Chest x-ray reveals a suspicious lesion in the left upper lobe proximal to the left bronchus, and diffuse interstitial fibrotic lesions. Indirect laryngoscopy shows edematous vocal cords with no obvious nodules; however at entry of the left bronchus a lesion is observed which partially obstructs the opening. Blood gases show alveolar hypoventilation of moderate degree and significant hypoxemia for age. Evaluating the overall situation for this man, it is my feeling this patient may have bronchogenic carcinoma. My approach to the workup would be to obtain full pulmonary function tests, including lung volumes and diffusing capacity, and to obtain a biopsy of the lesion in the bronchus. The question also arises as to his having pulmonary hypertension, but he doesn't seem to demonstrate any overt evidence of cor pulmonale at this time. I will also obtain a gallium scan to see if there is active inflammation in other locations in the lung not shown in the above workup. 72 Exercise 7-1 Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. Term Definition 1.______ pulmonary A.the “indentation” in the right lung that makes way for alveoli the heart 2.______ diaphragm B.this helps prevent food and drink from entering the trachea, and acts as the “voice box” 3.______ pulmonary C.referring to the upper tip of each lung 4.______ trachea D.accomplishes the mechanical process of breathing by means of its upward and downward movements 5.______ cardiac arch E.tiny “sacs” in the lungs that receive oxygen from the bronchioles and transfer it to the capillaries 6.______ base F.the “windpipe”; air flows through it to the bronchi 7.______ larynx G.its epithelium purifies air coming from the nasal cavity 8.______ bronchioles H.referring to the bottom of each lung 9.______ apex I.indicating something in or associated with the lungs 10.______ pharynx J.the smallest extensions of the bronchi, which pass air directly to the alveoli 11.______ emphysema K.a lung disease characterized by reversible inflammation and constriction 12.______ bronchitis L.surgery performed on the nose 13.______ dyspnea M.narrowing of a bronchial tube 14.______ tracheotomy N.inflammation of the mucous membrane of the bronchial tubes 15.______ O.inflammation of a lung, caused by infection, chemical bronchiostenosis inhalation, or trauma 16.______ apnea P.inspection using a bronchoscope 17.______ rhinoplasty Q.absence of breathing 18.______ R.condition in which the alveoli are inefficient due to bronchoscopy distension 19.______ asthma S.incision into the trachea 20.______ pneumonia, T.difficult breathing pneumonitis 71 EXERCISE 7-2 Build surgical terms for the following definitions by using the word parts it’s xpected that studenthave learned. EXAMPLE Pleur WR o CV 1. surgical repair of the trachea 2. incision of larynx and trachea pexy S WR CV WR CV WR 3. surgical puncture of the pleural cavity to remove fluid 4. incision into the chest cavity S WR CV WR 5. creation of an artificial opening into the trachea 6. excision of the tonsils S S S WR S WR S WR S 7. incision of the trachea 8. surgical repair of a bronchus WR CV S 9. excision of the larynx WR 10. surgical puncture of the larynx to aspirate fluid 11. surgical repair of the nose S WR CV S WR CV S 12. incision of a sinus WR 13. surgical puncture of a chest cavity to aspirate fluid 14. excision of the adenoids WR S CV WR S S 15. surgical repair of the larynx WR CV S 16. excision of a lobe of the lung WR 17. incision of lung and bronchus 74 S WR 18. creation of an artificial opening into the larynx 19. excision of a lung CV WR S WR S WR S 20. incision into the septum WR S 21. surgical repair of the septum WR CV S EXERCISE 7-3 Build diagnostic procedural terms for the following definitions by using the word parts it’s expected that studenthave learned. EXAMPLE: instrument used to measure oxygen ox / i / meter WR CV S 1. visual examination of the larynx WR CV S 2. instrument used to measure breathing WR CV S 3. x-ray film of the bronchi WR CV S 2. instrument used for visual examination of the larynx WR CV S 5. visual examination of the bronchi WR CV S 6. measurement of breathing WR CV S 7. instrument used for visual examination of the bronchi WR CV S 8. process of x-ray filming the bronchi WR CV S 9. visual examination of a hollow organ or body cavity P S(WR) 10. instrument for visual examination of the thorax WR CV S 11. instrument used for visual examination of a hollow organ or body P S(WR) cavity 12. visual examination of the thorax WR CV S 71 Answers key: EXERCISE 7-1 1 2 E D 11 12 R N 3 I 13 T EXERCISE 7- 2: 1. trache/o/plasty 2. laryng/o/trach/otomy 3. pleur/o/centesis 4. thorac/otomy 5. trache/ostomy 6. tonsil/ectomy 7. trache/otomy 8. bronch/o/plasty 9. laryng/ectomy 10. laryng/o/centesis EXERCISE 7-3: 1. layng/o/scopy 2. spir/o/meter 3. bronch/o/gram 4. laryng/o/scope 5. bronch/o/scopy 6. spir/o/metry 4 F 14 S 5 A 15 M 6 H 16 Q 7 B 17 L 8 J 18 P 9 C 19 K 11. rhin/o/plasty 12. sinus/otomy 13. thorac/o/centesis or thora/centesis 14. adenoid/ectomy 15. laryng/o/plasty 16. lob/ectomy 17. pneum/o/bronch/ otomy 18. laryng/ostomy 19. pneumon/ectomy 20. sept/otomy 21. sept/o/plasty 7. bronch/scope 8. bronch/o/graphy 9. endo/scopic 10. thorac/o/scope 11. endo/scope 12. thorac/o/scopy 76 10 G 20 O Chapter 8 The Digestive System Learning Objectives I. Common Word Elements and Procedures II. Common Disorders and Procedures III. Surgical Terms IV. Diagnostic Procedural Terms V. Case History VI. Exercises General Aims : The unit is designed to help you learn Surgical Terms snd Diagnostic Procedural Terms of digestive system and to increase your reading comprehension and to prepare you for reading similar passages. Behavioral Objective : Upon completion of this chapter students are expected to be able to: Build, analyze, define, pronounce, and spell the surgical terms related to the Digestive System. Define, pronounce, and spell other surgical terms related to the Digestive System Build, analyze, define, pronounce, and spell the diagnostic procedural terms related to the Digestive System. Define, pronounce, and spell other diagnostic procedural terms related to the Digestive System 77 The Digestive System In this Chapter, you learned how blood transports oxygen to all the body's cells. You may also recall that, besides oxygen, the blood transports nutrients to the cells, which use the food we eat as fuel to do all their various jobs. But before that can happen, the food must be converted into a usable form. The digestive system does this job in somewhat the same way that a refinery converts crude oil into special carbon molecules that can fuel a car engine. The difference is that the digestive system's products are proteins, fats, and carbohydrates. The digestive system may be considered according to the functions of its parts. The first part consists of the muscular apparatus that food travels through to become converted into usable form, and the second includes the various glands and organs that provide the chemicals needed for the process. Like the heart and respiratory system, the digestive system operates continuously. This chapter introduces the terms associated with the anatomy and physiology of the digestive system, along with those of its common disorders, diagnostic tests, and treatments. Word Roots Specific to the Digestive System The word roots shown in the following table are often found in terms related to the digestive system. You will recognize them in many of the terms you will learn in this chapter. I. Common Word Elements related to the Digestive System Root or Suffix Refers to cholecyst/o gallbladder colon/o colon duoden/o duodenum enter/o small intestine esophag/o esophagus gastr/o stomach hepat/o liver ile/o ileum jejun/o jejunum pancreat/o pancreas 72 phag/o sial/o -scope -scopy eating; swallowing salivary glands suffix meaning “device for visual examination” suffix meaning “visual examination” The Muscular Apparatus of the Digestive System Digestion starts in the mouth and proceeds through the pharynx, esophagus, stomach, small intestine, and large intestine. The “apparatus” as a whole has several names: alimentary canal, digestive tract, and gastrointestinal (abbreviated GI) tract. The operation of the digestive tract has two terms that describe how it moves its contents along from one part to the next. The process begins with swallowing, the technical word for which is deglutition. Peristalsis, which refers to the involuntary muscle contractions within the rest of the tract, takes over after we swallow. The Pharynx You encountered the pharynx in the respiratory system, but the pharynx has “dual citizenship.” It belongs to both the respiratory and digestive systems because it is a passageway for both air and for food and drink. Liquid and chewed (masticated) food enters the pharynx from the oral cavity, and muscular action sends it on to the esophagus. The Esophagus Because the esophagus is about a foot long, it has to get through the diaphragm to reach the stomach. It does so by passing through an opening called the esophageal hiatus in the diaphragm. That opening is properly part of the diaphragm and not the esophagus, and the term is mentioned here only because of its name. The Stomach The stomach is the center of the system, both physically and functionally. Its four main areas are the fundus, cardia, body, and antrum. The stomach's first job is to act as a temporary storage place for the food we eat, which allows time for its second job: secreting acid and enzymes to help break down proteins, fats, and carbohydrates. Digestion thus includes not only mechanical changes, such as the reduction of particle size and liquefaction (converting solids to liquids), but also the chemical changes needed to produce fuel for the body's cells. After 3 or 4 hours, the contents of the stomach, which by that 79 stage is a liquid called chyme (pronounced kyme), begin to enter the small intestine. The Small Intestine Ninety percent of nutrient absorption occurs in the small intestine, and the other 10% occurs in the large intestine. The first 10 inches of the small intestine is called the duodenum, which comes from the Latin word duodeni, meaning “twelve each,” the reference being to its length of 12 finger-breadths. The adjective duodenal may already be familiar to you since the phrase duodenal ulcer is fairly common. Even though the duodenum is attached to the stomach, a duodenal ulcer is technically a condition of the small intestine. The segment coming right after the duodenum is the jejunum, which is about 8 feet long. That name comes from the Latin word jejunus, which means “fasting” (i.e., abstaining from taking in food and thereby becoming empty). The jejunum is the segment from which most nutrients are emptied into the bloodstream. The final segment of the small intestine is called the ileum, which is about 12 feet long. The Large Intestine Besides absorbing 10% of nutrients, the large intestine compacts waste material for elimination. The term colon is sometimes used as a synonym for the large intestine, which can be subdivided into the ascending colon, transverse colon, descending colon, and sigmoid colon. Other Organs of Digestion To enable the digestive tract to complete its work, many chemicals are needed. Some of these come from the stomach, of course, but they are also supplied by the salivary glands, the pancreas, the liver, and the gallbladder. The Salivary Glands As mentioned earlier, digestion starts in the mouth, where it is aided by the salivary glands, so-called because they produce saliva. There are three separate pairs of salivary glands, located in different parts of the oral cavity. They are called the parotid, sublingual, and submandibular salivary glands. Although saliva is more than 99% water, it contains essential enzymes that break down complex carbohydrates. Saliva also contains antibodies that kill bacteria. 20 The Pancreas The pancreas acts as both an endocrine and an exocrine gland. The pancreas provides insulin directly to the bloodstream (endocrine function) and secretes a fluid containing enzymes into the small intestine (exocrine function). Both of these pancreatic secretions are essential to digestion. The Liver Although nearly all nutrients are absorbed in the small and large intestines, blood from the digestive tract also absorbs some of those nutrients, which are then passed on to the liver. The liver extracts and stores these nutrients for later use. In this way, the liver keeps the body's metabolism balanced and promotes good health by releasing fat-soluble vitamins, such as A and D, when the body needs them. The liver also produces bile, which helps in breaking down the lipids (fats) so that they will mix with the other liquids. After bile does its work in the small intestine, it goes back to the liver where it is recycled and used again. The Gallbladder Although the liver produces and recycles bile, the gallbladder, which is located in a depression under the liver, stores, condenses, and delivers the bile to the small intestine. The gallbladder is also sometimes referred to as the cholecystis or cholecyst, yielding the word root cholecyst/o. Disorders of the Muscular Apparatus Enterology is the medical specialty concerned with the intestinal tract. Therefore, enterologists discover and treat many ailments of the digestive system, including those with names that include enter/o as a root. Among those ailments are enteralgia (enterodynia), enteritis, enterorrhagia, enterospasm, and enterostenosis. By now, you should be able to define those terms without looking them up. The term that encompasses all of them is enteropathy. Disorders of the Salivary Glands, Pancreas, and Liver The same conditions that affect other parts of the body can affect glands such as the salivary glands. Therefore, sialostenosis, sialorrhea, and sialography are terms you can most likely define without looking them up. The general term referring to diseases of the pancreas is pancreatopathy. When the pancreas fails to produce insulin in the required amounts, a 21 condition known as diabetes occurs. There are many subcategories of this condition, the best known of which is diabetes mellitus. The root hepat/o will serve you well in your efforts to decipher liver abnormalities. Simply begin with hepatopathy, which includes all abnormal conditions, and then apply your knowledge of the many other suffixes you now know. Likewise, cholecyst/o is the root you will encounter in the names of many abnormal gallbladder conditions. II. Common Disorders and Procedures associated with the Digestive System Term Definition cholecystectomy excision of the gallbladder cholecystitis inflammation of the gallbladder cholecystopathy any disease of the gallbladder cholecystotomy incision into the gallbladder colectomy excision of all or part of the colon colitis inflammation of the colon colonoscope device used in colonoscopy colonoscopy visual inspection of the colon with a colonoscope colopexy fixation of the colon colorrhagia abnormal discharge from the colon colostomyII surgical establishment of an opening into the colon colotomy incision into the colon duodenectomy excision of the duodenum duodenitis inflammation of the duodenum duodenorrhaphy suture of the duodenum duodenoscopy visual inspection of the duodenum with the aid of an endoscope duodenostomy surgical establishment of an opening in the duodenum duodenotomy incision of the duodenum enteralgia abdominal pain enterectomy excision of part of the intestine enteritis inflammation of the intestine enterodynia abdominal pain enterogastritis inflammation of the intestine and stomach enterohepatitis inflammation of the intestine and liver enteropathy any intestinal disease enteropexy surgical fixation of part of the intestine enterorrhagia bleeding in the intestinal tract 22 enterorrhaphy enterospasm enterostenosis esophagology gastrectomy gastritis gastrocele gastrocolitis gastroduodenitis gastroenteritis hepatitis hepatocele suturing of the intestine painful peristalsis narrowing within the intestinal tract study of the structure and diseases of the esophagus excision of part of the stomach inflammation of the stomach hernia of the stomach inflammation of the stomach and colon inflammation of the stomach and duodenum inflammation of the stomach and intestine inflammation of the liver protrusion of a part of the liver through an adjacent structure hepatopathy any disease of the liver hepatopexy fixation of the liver hepatorrhaphy suturing of the liver hepatorrhexis rupture of the liver hepatoscopy examination of the liver ileopexy surgical fixation of the ileum jejunectomy excision of all or part of the jejunum jejunitis inflammation of the jejunum jejunoplasty surgical repair of the jejunum jejunotomy incision into the jejunum pancreatalgia pain in the general area of the pancreas pancreatitis inflammation of the pancreas pancreatopathy any disease of the pancreas pancreatotomy incision into the pancreas sialoadenitis inflammation of a salivary gland sialoadenectomy excision of a salivary gland sialoadenotomy incision of a salivary gland sialoangiitis inflammation of a salivary duct sialography radiography of the salivary glands and ducts sialorrhea excessive production of saliva sialostenosis an narrowing of a salivary duct Common Abbreviations: The Digestive System Abbreviation Meaning DM diabetes mellitus GB gallbladder GBS gallbladder x-ray series 21 GERD gastroesophageal reflux disorder GI gastrointestinal NGT nasogastric tube S&D stomach and duodenum UGI upper gastrointestinal III. Surgical Terms TERM DEFINITION (built from word parts) 1. addominoplasty……… plastic repair of the abdomen (ab-DOM-i-nō-plas-tē) 2. anoplasty……………… surgical repair of the anus (Ā-nō-plas-tē) 3. antrectomy………….…… excision of the antrum (an-TREK-tō-mē) 4. appendectomy…………… excision of the appendix (ap-en-DEK-tō-mē) 5. celiotomy………………… incision into the abdominal cavity (sē-lē-OT-ō-mē) 6. cheilorrhaphy……….…… suture of the lips (kī-LOR-a-fē) 7. cholecystectomy……….... excision of the gallbladder (rō-lē-sis-TEK-tō-mē) 8. choledocholithotomy …… incision into the common bile duct to (kō-led-ō-kō-li-THOT-ō-mē) remove a stone 9. choledocholithotripsy….. surgical crushing of a stone in the (kō-led-ō-kō-LITH-ō-trip-sē) common bile duct 10. colectomy……………… excision of the colon (kō-LEK-tō-mē) 11. colostomy…………... . artificial opening through the abdominal (kō-LOS-tō-mē) wall into the colon (used the passage of stool, it is performed for cancer of the colon) 12. diverticulectomy………… excision of a diverticulum (dī-ver-tik-ū-LEK-tō-mē) 13. enterorrhaphy……………. suture of the intestine (en-ter-ŌR-a-fē) 14. esophagogastroplasty……… surgical repair of the esophagus and the (ē-sof-a-gō-GAS-trō-plas-tē) stomach 15. gastrectomy………………… excistion of the stomach (gas-TREK-tō-mē) 24 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. gastrojejunostomy…………. (gas-trō-je-jū-NOS-tō-mē) gastrostomy………………… (gas-TROS-tō-mē) gingivectomy……………… (jin-ji-VEK-tō-mē glossorrhaphy……………… (glo-SŌR-a-fē) herniorrhaphy……………… (her-nē-ŌR-a-fē) ileostomy………………….. (il-ē-OS-tō-mē) creation of an artificial opening between the stomach and jejunum creation of an artificial opening through the abdominal wall into the stomach surgical removal of gum tissue suture of the tongue suturing (to repair) of a hernia creation of an artificial opening through the abdominal wall into the ileum laparotomy………………… incision into the abdominal wall (lap-a-ROT-ō-mē) palatoplasty………………… surgical repair of the palate (PAL-a-tō-plas-tē) polypectomy………………… excision of a polyp (pol-ē-PEK-tō-mē) pyloromyotomy……………… incision into the pylorus muscle (pī-lor-ō-mī-OT-ō-mē) pyloroplasty…………………. surgical repair of the pylorus (pī-LOR-ō-plas-tē) uvulectomy…………………… excistion of the uvule (ū-vū-LEK-tō-mē) uvulopalatopharyngoplasty..… surgical repair of the uvula, palate, and (UPPP) pharynx (ū-vū-lō-pal-a-tō-phar-in-GŌplas-tē) Other Surgical Terms TERM 1. abdominoperineal resection…. (ab-dom-in-ō-pēr-i-NĒ-el) 2. anastomosis…………………. (a-nas-tō-MŌ-sis) 3. vagotomy……………………. DEFINITION removal of the colon and rectum surgical connection between two normally distinct structures cutting of certain branches of vagus nerve, performed with gastric surgery to reduce the amount of gastric acid produced and thus reduce the recurrence 21 of ulcers IV. Diagnostic Procedural Terms TERM (built from word parts) 1.cholangioram (ko LAN je o gram) 2. cholecystogram (ko le SIS to gram) ……….. 3. colonoscope (ko LON o sko p) …………….. 4. colonscopy (ko lon OS ko pe ) …………… 5. endoscope ( EN do sko p) ……………………. 6. endoscope (en DOS ko pe ) ……………….. 7. esophagogastro duodenoscopy (EGD) ……….. ( e sof a go gas tro du od e NOS ko pe ) 8. esophagoscope e SOF a go sko p ………… 9. esophagoscopy e sof a GOS ko pe …….. 10. gastroscope GAS tro sko p …………………. 11. laparoscope LAP a ro sko p ………........... 12. laparoscopy lap a ROS ko pe …………. 13. gastroscopy gas TROS ko pe …………….. 14. proctoscope PROK to sko p …………........... 15. proctoscopy prok TOS ko pe ………........ 26 DEFINITION x-ray film of bile ducts, x-ray film the gallbladder(also known as a G.B. Series) instrument used for visual examination of the colon visual examination of the colon instrument used for visual examination within hollow organ visual examination within a hollow organ visual examination of the esophagus, stomach, and duodenum instrument used for visual examination of the esophagus visual examination of the esophagus instrument used for visual examination of the stomach instrument for visual examination of the abdominal cavity visual examination of the abdominal cavity visual examination of the stomach instrument used for visual examination of the rectum visual examination of the rectum 16. sigmoidoscope sig MOY do sko p …......... 17. sigmiodoscopy sig moy DOS ko pe …....... instrument used for visual examination of the sigmoid colon visual examination of the sigmoid colon Other Diagnostic Procedural Terms TERM DEFINITION (built from word parts) 1. lower GI(gastrointestinal series of x-ray films taken of the large series…………………….. intestine after a barium enema has been administered(also called barium enema) 2. upper GI (gastrointestinal) series of x-ray films taken of the stomach and series…………………….. duodenum after barium has been swallowed V. Case History: This is a 40-year- old Africa-American female who was referred to endoscopy clinic for evaluation. Patient complains of persistent nausea and vomiting with upper abdominal pain. She has also had a problem with dyspepsia but denies any hematemesis. She has not used any alcohol or salicylates. She is currently on several medications but they do not appear to be ulcerogenic. Esophagogastroduodenoscopy: The partient was prepared for the procedure by being given 2 mg of intravenous versed along with Hurricaine spray. After the patient was placed in the left lateral decubitus positionthe Olympus. Gastroscope was passed into the esophagus without any difficulty. The esophagus in its entirely was essentially free of mucosal abnormalities. No evidence of reflux. The stomach was entered ; some gastric juices were aspirated. The stomach, the body, the cadia, and antrum, proximally, were all free of mucosal abnormalities. In the distal antral area some mild erythematous changes were noted. The pylorus had normal peristaltic activity in opening. The first part of the duodenum however, revealed evidence of ulcerations, both anterosuperiorly as well as posteroinferiorly, with surrounding tissue irritation noted. These ulcers were less than 1 mm in size. The second part of the duodenum, however, was free of mucosal abnormalities. Withdrawing the scope confirmed the findings upon entry. The patient, in fact, tolerated the procedure quite well. Vital sign will be taken every half hour for the next two hours. Postup Diagnosis: Gastritis, Duodenal ulcerations. 27 Exercise 8-1 Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. Term Definition 1. _____ fundus A. branch of medicine concerned with the GI tract 2. _____ cholecystis B. secretion of the pancreas essential in digestion 3. _____ duodenum C. opening in the diaphragm through which the esophagus passes to get to the stomach 4. _____ lipid D. the digestive tract 5. _____ alimentary canal E. name given to the first 10 inches of the small intestine 6. _____ ileum F. one of the four parts making up the stomach 7. _____ esophageal hiatus G. the gallbladder 8. _____ enterology H. the final 12-foot-long segment of the small intestine 9. _____ enzyme I. to chew 10. _____ masticate J. a fat-soluble particle 11. _____ hepatitis K. incision into the jejunum 12. _____ colonoscopy L. excision of the gallbladder 13. _____ enteralgia M. inflammation of the liver 14. _____ cholecystitis N. inflammation of the stomach and intestine 15. _____ cholecystectomy O. painful peristalsis 16. _____ gastroenteritis P. surgical establishment of an opening into the colon 17. _____ colostomy Q. inflammation of the gallbladder 18. _____ sialoangiitis R. abdominal pain 19. _____ jejunotomy S. visual inspection of the colon 20. _____ enterospasm T. inflammation of a salivary duct Exercise 8-2 Circle the term in the Choices column that correctly answers each of the following questions. 1. What is the name of the area of the stomach between the fundus and 2. its main body? a) cardia b) diaphragm c) duodenal What part of the digestive tract is located between the pharynx and stomach? a) esophagus b) fundus c) ileum 3. What is the name of the chronic metabolic disease characterized by the body's decreased ability to utilize carbohydrates and its enhanced ability to utilize proteins and lipids? a) cholecystitis b) fundus c) diabetes mellitus 4. What is the name for a narrowing within the intestinal tract? 22 a) enterorrhagia b) enterostenosis c) enteropathy 5. What is the term that means bleeding in the intestinal tract? a) enterorrhagia; b) enterostenosis; c) enteropathy 6. What generic term refers to an intestinal disease? a) enterorrhagia; b) enterostenosis; c) enteropathy 7. What term means hernia of the stomach? a) gastritis b) gastrocele c) gastrocolitis 8. What term means inflammation of the stomach and colon? a) gastritis b) gastrocele; c) gastrocolitis gastrocolitis 9. What term means inflammation of the stomach? a) gastritis; b) gastrocele c) gastrocolitis 10. What term means inflammation of the stomach and intestine? a) gastroduodentis b) gastroenteritis c) sialoangiitis EXERCISE 8-3 Read each statement, then indicate whether you think it is true or false. Statement TrueFalse 1. The part of the stomach near the entry to the duodenum is called the ____ ____ alimentary canal. 2. Chyme is the term given to the liquefied food entering the ____ ____ duodenum. 3. The word deglutition, from the Latin word “deglutio,” simply ____ ____ means to swallow. 4. The longest segment of the small intestine that leads into the large ____ ____ intestine is called the jejunum. 5. The digestive organ composed of the fundus, cardia, body, and ____ ____ antrum is called the pancreas. 6. Colitis is an abnormal discharge from the colon. ____ ____ 7. The word element “-itis” in the word enterohepatitis (inflammation ____ ____ of the intestine and liver) means “liver.” 8. Visual examination of the intestines is accomplished with an ____ ____ enteroscope. 9. Excision of part of the intestine is a duodenotomy. ____ ____ 10. Excision of a salivary gland is a sialoadenectomy. ____ ____ EXERCISE 8- 4 Test your knowledge on diagnostic procedural terms by circling the letter of each correct answer. 1. The physician did a visual examiniation of the vagina and cervix to note changes in the cells and capillary network. The procedure takes 10 minutes and is called a 29 a. coloscopy b. colposcope c. sigmoidoscope d. colposcopy e. coloscope 2.The physician ordered x-ray films large intestine to rule out the presence of a tumor. He or she ordered a(n) a. upper GI series b. mammogram c. cholecystogram d. intravenous pyelogram e. barium enema 3. The patient was experiencing hematuria. To locate and control the source of the bleeding the doctor performed a a. bronchoscopy b. culdoscopy c. cystoscopy d. intravenous pyelogram e. barium enenma 4. The patient was scheduled for an x-ray film of a blood vessel, or a. arteriogram b. angiogram c. aortogram d. venogram e. nephrogram 5. A record of the electrical impulses of the heart is a (n) a. electrocardiogram b. echocardiogram c. electrocardiograph d. phonocardiograph e. electrocardiography Answers key: EXERCISE 8-1 1 2 3 F G E 11 12 13 M S R 4 J 14 Q EXERCISE 8-2 1 2 cardia esophagus 6 enteropathy 7 gastrocele EXERCISE 8-3 1 2 3 False True True EXERCISE 8 4 1. d 2. e 4 False 5 D 15 L 6 H 16 N 7 C 17 P 8 A 18 T 9 B 19 K 10 I 20 O 3 diabetes mellitus 8 gastrocolitis 4 enterostenosis 5 enterorrhagia 9 gastritis 10 gastroenteritis 5 False 7 False 3. c 6 False 4. b 90 8 True 5. a 9 False 10 True Chapter 9 Endocrine System Learning Objectives I. Common Roots and Suffixes II. Surgical Terms III. Case History IV. Exercises General Aims: The unit is designed to help you learn Surgical Terms of Endocrine System and to increase your reading comprehension and to prepare you for reading similar passages. Behavioral Objectives : Upon completion of this chapter students are expected to be able to: 91 Build, analyze, define, pronounce, and spell the surgical terms related to the Endocrine System. The Endocrine System The cells in our bodies have not one but two ways of communicating with one another. The two communication systems are the endocrine system and the nervous system, and they work in similar ways. That is to say, both rely on chemicals for the messages they send. The endocrine system is a bit like email or the telephone, while the nervous system is even . The endocrine system works so well that few people are even aware of it. If you are confronted by a sudden emergency, your brain relays messages to your adrenal glands from your senses, and adrenal secretions make it possible for you to react. However, sometimes the system doesn't work as it's supposed to, and that's why there are endocrinologists, practitioners of endocrinology. Word Elements Specific to the Endocrine System The roots and suffixes shown in the following table are often found in terms related to the endocrine system. You will recognize them in many of the terms you will learn in this chapter. I. Common Roots and Suffixes related to the Endocrine System Root or Suffix Refers to aden/o gland adren/o; adrenal/o adrenal glands endocrin/o endocrine hypophys/o pituitary gland parathyr/o; parathyroid/o parathyroid gland ren/o kidney thyr/o; thyroid/o thyroid gland -ine suffix used in the formation of names of chemical substances -tropin (Greek word suffix meaning “nourishment” or “stimulation” trophe) Hormones and Glands The endocrine system encompasses hormones and the glands that produce them. However, many endocrine secretions come from glands that belong to 92 other systems. While these so-called “mixed-function” organs are mentioned in the following discussion, this chapter focuses mainly on the four glands that have endocrine functions only. Even among those four endocrine glands, however, two have dual status; they are the pituitary and pineal glands, both of which also belong to the nervous system. And the hypothalamus, another part of the nervous system, is one of the “mixed-function” organs mentioned above. Chemically speaking, there are only three kinds of hormones: amino acid derivatives, peptide hormones, and lipid derivatives, but each can serve a wide variety of purposes. As you already know, the root aden/o can refer to any gland in the body. Thus, adenectomy, adenitis, and adenotomy might mean removal of, inflammation of, or incision of any gland. When referring to a particular gland, use a different root to clarify which one. For example, use adrenalitis to mean inflammation of the adrenal glands and adenohypophysitis to mean inflammation of the pituitary gland. The Four Exclusively Endocrine Glands The glands that have endocrine secretions as their only job are the pineal gland, the pituitary gland, the thyroid glands, and the adrenal glands. The adjective endocrine indicates that a particular gland's secretions are internal, rather than external; that is, secretions are not expelled through a duct. Glands that do expel their secretions through a duct are called exocrine glands. Perspiration is an example of an exocrine secretion, and epinephrine, also known as adrenaline, is an example of an endocrine secretion. The Pineal Gland The pineal gland secretes the hormone melatonin. Studies using animals as subjects indicate that melatonin may have a regulatory effect on the reproductive system. It is also an antioxidant and as such is beneficial. But researchers also think it may be a factor in seasonal affective disorder (SAD), which affects people who live in areas with long, dark winters. The Pituitary Gland The pituitary gland, also known as the hypophysis, is really two glands: the anterior pituitary and the posterior pituitary. The anterior pituitary, also known as the adenohypophysis, produces seven different hormones. Anterior pituitary secretions Term Definition Corticotropin stimulates the adrenal 91 Abbreviation ACTH gonadotropins follicle-stimulating hormone interstitialcell-stimulating hormone leuteinizing hormone (lutropin) melanocyte-stimulating hormone prolactin somatotropin thyrotropin glands stimulates estrogen production stimulates testosterone production stimulates ovulation stimulates melanin production stimulates milk production stimulates growth stimulates the thyroid FSH ICSH LH MSH PRL GH TSH The Thyroid and Parathyroid Glands The thyroid and parathyroid glands help regulate growth and metabolism. The thyroid secretes thyroxine (T4) and triiodothyronine (T3). Although the thyroid secretes more T4 than T3, it is the T3 that does most of the work of regulating metabolism. Other organs and tissues can, and do, convert T4 to T3 as needed. The thyroid also secretes calcitonin (CT), a hormone secreted to prevent too much calcium from absorption into the bones. The parathyroid secretes parathyroid hormone (PTH), which also slows the constant calcium loss from bone tissue. The Adrenal Glands The adrenal glands, located at the top of each kidney, secrete epinephrine and norepinephrine whenever the brain indicates that immediate physical action is needed. Epinephrine is a synonym for adrenaline, which is the common term. Norepinephrine is a synonym for noradrenaline, which is not as common as its synonym. As you may already know, these two hormones not only increase one's heart rate and blood pressure, they also increase blood sugar and release fats from the tissues. In short, these hormones give the body what it needs for quick action. The adrenal glands also secrete several dozen steroids. These hormones, known as corticosteroids, are essential to life. One of them is called aldosterone, which helps the body retain the correct number of sodium ions. Common Endocrine System Disorders and Procedures Adrenal Gland Disorders The common disorders of the adrenal glands contain suffixes you have encountered many times in previous chapters and yield terms such as 94 adrenalectomy, adrenalopathy, and adrenalomegaly, which you can probably define. Pituitary Gland Disorders As you learned in the previous chapter, another name for the pituitary gland is the hypophysis. Accordingly, the root hypophys/o is used to form terms associated with disorders of the pituitary gland, such as hypophysectomy and hypophysitis. Any pituitary dysfunction can be simply called pituitarism. Hypopituitarism names a condition that inhibits the secretion of pituitary hormones, and hyperpituitarism names a condition that leads to the excessive secretion of hormones. Thyroid Disorders The term for excision of the parathyroid gland is, as one might expect, parathyroidectomy, and thyromegaly is the term signifying an enlarged thyroid. Those and other common thyroid disorders are listed in the following table. Common Endocrine System Disorders and Procedures Term Definition adenectomy excision of a gland adenitis inflammation of a gland adenogenous originating in a gland adenohypophysitis inflammation of the anterior pituitary gland adenotomy incision of a gland adrenalectomy surgical removal of one or both adrenal glands adrenalitis inflammation of the adrenal glands adrenalopathy any disorder of the adrenal glands (adrenopathy) adrenomegaly enlarged adrenal glands goiter chronic enlargement of the thyroid gland caused by insufficient iodine in the diet hyperglycemia excessive sugar in the blood hyperpituitarism excessive hormone secretion by the pituitary gland hyperthyroidism condition caused by an overactive thyroid; usually caused by an immune system disorder known as Graves disease hypophysectomy excision of the pituitary gland 91 hypophysitis hypopituitarism parathyroidectomy pituitarism thyroaplasia thyroidectomy thyroiditis thyromegaly thyroparathyroidectomy thyrotomy inflammation of the pituitary gland a condition characterized by inadequate secretion of one or more of the anterior pituitary hormones excision of a parathyroid gland any pituitary dysfunction congenital condition characterized by insufficient thyroid secretion excision of the thyroid gland inflammation of the thyroid gland enlargement of the thyroid gland excision of the thyroid and parathyroid glands incision of the thyroid Common Abbreviations: The Endocrine System Abbreviation Meaning ACTH corticotrophin ADH antidiuretic hormone BS blood sugar DM diabetes mellitus FBS fasting blood sugar FSH follicle-stimulating hormone GH growth hormone ICSH interstitial cell–stimulating hormone IDDM insulin-dependent diabetes mellitus (Type 1) LH leuteinizing hormone MSH melanocyte-stimulating hormone NIDDM non–insulin-dependent diabetes mellitus (Type 2) PRL prolactin TSH thyrotropin II. Surgical Terms TERM (built from word parts) 1. adrenalectomy……………………...... ad re nal EK to me ) 2. parathyroidectomy……………….….. DEFINITION excision of an adrenal gland excision of a parathyroid gland pa r a thI royd EK to me ) 3. thyroidectomy……………………….. 96 excision of the thyroid gland (thI royd EK to me ) 4. thyroidotomy………………………… incision into the thyroid gland (thI royd OT o me ) 5. thyroparathyroidectomy……………… excision of the thyroid and (thI ro pa r a thI royd EK to me ) parathyroid glands III. Case History: This 53-year-old female Mexican-American executive secretary presents to the clinic with complaints of excessive urination and thirst for the last month. She has also lost about ten pounds. History and Physical: Chief Complaint: polyuria, polydipsia History of Present lllness: This patient presented to emergency room following an episode of syncope at work. She was oriented ×3, but responses to questions were sluggish. Routine lab work was ordered. Blood sugar was discovered to be over 600. Urinalysis showed moderate ketonuria. For the past four weeks she had been experiencing polyuria and polydipsia, drinking 3-4 quarts of water daily for the past ten days. This has also resulted in nocturia. She denies anorexia, nausea, vomiting, or any abdominal pain. Past medical history: No allergies; no previous hospitalizations. Does not smoke or drink. She has had no recent illnesses. Family History; Social History: Mother died of a cerebrovascular accident at age 78. Father is still living at the age of 85, but has had diabetes mellitus for twenty years. She has two brothers, no sisters. She has no children and has never been married. Review of Systems: Essentially unmarkable, except for occasional headaches and blurred vision. No chest pain , hematochezia, although has lost ten pounds in the past month. Admission Physical Examination: A 53-year-old female in no acute distress. BP 120/84, respiratory rate of 22, pulse rate of 76. Heent : Clear, nonicteric sclerae. Pupils equal, round, reactive to light; funduscopic examination is benign. Chest : Clear to auscultation and percussion. Hesrt: JVD is flat; PMI fifth left intercostals space, left midclavicular line; S1 and S2 are appreciated, no S3 or S4. No murmurs. No lifts, heaves, or thrills. Sinus rhythm. Extrimities : Negative for clubbing, cyanosis, or edema. Pulses intact. Abdomen : soft, nontender, bowel sounds normal, without evidence of organomegaly. 97 Rectal : Unremarkable, guaiac negative. Neurologic : Alert, oriented to time, person, and place; cranial nerves ll through XII are grossly within normal limits. Assessment : Diabetic ketoacidosis, cause needs to be ascertained. Most likely adult onset diabetes mellitus. EXERCISE 9-1 Matching Terms with Definitions Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. Term Definition 1.______ gonadotropin A. synonym for epinephrine, which is an (FSH) adrenal hormone secreted when immediate physical action may be needed by the body 2.______ melatonin B. thyroid-stimulating hormone, secreted by the anterior pituitary 3.______ adenogenous C. one of the corticosteroids produced by the adrenal glands, which helps the body retain the correct amount of sodium ions 4.______ antidiuretic D. an anterior pituitary hormone that hormone stimulates estrogen production 5.______ adrenalin E. synonym for pituitary gland 6.______ hypophysis F. hormone secreted by the thyroid to prevent excessive calcium absorption into the bones 7.______ calcitonin G. originating in a gland 8.______ aldosterone H. pineal gland hormone, which is an antioxidant 9.______ parathyroid gland I. hormone secreted by the posterior pituitary to prevent the kidneys from expelling too much water 10.______ thyrotropin (TSH) J. secretes PTH (parathyroid hormone), which slows the loss of calcium from bone 11.______ thyromegaly K. disease of the adrenal glands 12.______ L. condition of diminished hormone secretion adenohypophysitis from the anterior pituitary gland 13.______ goiter M. originating in a gland 14.______ pituitarism N. inflammation of the anterior pituitary gland 15.______ O. chronic enlargement of the thyroid, caused thyroparathyroidectomy by insufficient iodine in the diet 16.______ adenogenous P. excessive pituitary secretion 17.______ adrenalopathy Q. enlargement of the thyroid gland 92 18.______ hypopituitarism 19.______ adenectomy 20.______ hyperpituitarism R. excision of a gland S. any pituitary dysfunction T. excision of the thyroid and parathyroid glands EXERCISE 9-2 Build surgical terms for the following definitions by using the word parts it’s expected that studenthave learned 1. excision of the thyroid gland WR S 2. excision of the thyroid and parathyroid glands WR CV WR S 3. excision of the adrenal gland WR S WR S WR S 4. excision of the parathyroid gland 5. incision into the thyroid gland Answers key: EXERCISE 9-1 1 2 3 D H G 11 12 13 Q N O 4 I 14 S 5 A 15 T 6 E 16 M EXERCISE 9- 2 1. thyroid/ectomy 3. thyr/o/parathyroid/ectomy 5. thyroid/otomy 7 F 17 K 8 C 18 L 2. adrenal/ectomy 4. parathyroid/ecomy 99 9 J 19 P 10 B 20 R Chapter 10 The Immune System Learning Objectives I. Common Word roots II. Common Disorders and Procedures III. Surgical Terms IV. Exercises General Aims: The unit is designed to help you learn Common Word roots, Common Disorders and Procedures, Surgical Terms of Immune System and to increase your reading comprehension and to prepare you for reading similar passages. Behavioral Objectives : Upon completion of this chapter students are expected to be able to: 100 Build, analyze, define, pronounce, and spell the common word roots surgical terms related to the immune system. The Immune System The immune system enables the human body to ward off many kinds of assaults. If you fall off your skateboard and bruise your knee, the immune system sends whatever is needed to heal the wound and to prevent infection at the site. If you find yourself in a classroom or some other public place with a lot of people who are coughing and sneezing, your immune system will be alert for and react to the pathogens you breathe in. The specialists who diagnose and treat immune system disorders are called immunologists, and the specialty itself is called immunology. The following paragraphs introduce terms that name parts of the immune system, along with those relating to common disorders, diagnosis, and treatment. Word Roots Specific to the Immune System The roots shown in the following table are often found in terms related to the Immune System. You will recognize them in many of the terms you will learn in this chapter. I. Common Word roots related to the Immune System Root Refers to lymph/o; lymphat/o lymph or lymphatic system lymphangi/o lymph vessels immun/o immune system lymphaden/o lymph nodes splen/o spleen tonsill/o lymph node, usually palatine tonsil thym/o thymus Phagocytes Phagocytes are often the first immune system cells on the scene when injury occurs. They prevent infection by cleaning away pathogens and debris. Two types of phagocytes are microphages and macrophages. Microphages, which constantly circulate in the bloodstream, are more plentiful than macrophages but are short-lived. Macrophages live longer than microphages, and they 101 reside in critical areas, such as the pleural and abdominal cavities, as firstresponse defenders. Lymphocytes When leukocytes (white blood cells) in the bloodstream are needed to fight infection, they leave the blood and enter the lymphatic system; they are then called lymphocytes. The average human body contains one trillion lymphocytes, which include three different types: NK cells, T cells, and B cells. NK Cells NK (natural killer) cells travel throughout the body, constantly looking for cells with unusual components in their membranes. When NK cells find these “foreign” cells, they destroy them using proteins called perforins. Natural killer cells can combat viral infection and even destroy malignant cells. T Cells T cells make up about 80% of the total number of lymphocytes. They are so named because they depend on the thymus for activation. They go to work only after being prompted by a specific antigen, a substance that induces sensitivity. Antigens also stimulate the immune system to generate antibodies, which can produce immunity from future attacks by the same type of antigen. Although most antigens signal a disease-causing agent, some do not. For example, antigens in red blood cells (RBCs) determine each person's specific blood type. Individuals whose RBCs contain only the A antigen have Type A blood, while those with only the B antigen have Type B blood. Those with neither A nor B antigens have Type O blood, and those with both the A and B antigen have Type AB blood. As this example indicates, our individual immune systems discriminate between antigens that are normal to us (“good” antigens), and those that are not (“bad” antigens). It also shows why blood transfusions can be dangerous in certain circumstances. For instance, if a Type A patient receives blood from a Type B donor, the B antigens in the transfused blood will signal the Type A patient's immune system to attack. Unlike NK cells, which roam the body looking for intruders, T cells attack only when they recognize a specific antigen, and then only after receiving instructions from special T cells that distinguish between good and bad antigens. B Cells 102 B cells are derived from bone marrow. Like NK cells, they roam the body looking for intruders. But unlike NK cells, they stop in lymph tissue to seek out foreign antigens. However, they do not attack until the special T cells instruct them to do so. The Lymphatic System The lymphatic system comprises the vessels through which lymphocytes travel, the lymph in which they travel, and the organs necessary to direct their functions. Lymph Like blood plasma, lymph is a fluid that consists mostly of water. It also contains a low concentration of proteins in solution and, of course, lymphocytes. The word lymph is also used as an adjective in naming lymph vessels, lymph nodes, etc. Lymph Vessels Lymph vessels, also called lymph ducts, return cells back into the bloodstream. The largest of the lymph vessels, which correspond to the largest of the circulatory system veins, are the thoracic duct and the right lymphatic duct. Both NK cells and B cells originate in bone marrow. Some lymph cells find their way into the thymus, where they are eventually converted into T cells. The lymphatic capillaries are similar in some ways to the capillaries of the circulatory system. In fact, blood capillaries and lymphatic capillaries are physically joined together. The Thymus The thymus gland, located behind the sternum, secretes hormones, known collectively as thymosin, which help T cells develop. The thymus is most active in children and gradually and continuously loses some of its function with maturation and further aging. The Spleen The spleen, which contains phagocytes, removes damaged red blood cells and recycles and stores reclaimed iron from others. 101 Lymph Nodes Lymph nodes are structures of variable size that contain macrophages that filter out disease-causing antigens and other debris as the lymph flows through. These antigens are then exposed to lymphocytes to start the immune response. Most lymph nodes are quite small, about 1/25th of an inch in diameter. The larger lymph nodes can be about an inch in diameter and are sometimes called lymph glands. Swollen glands are the result of large numbers of phagocytes and lymphocytes in the node; this condition may also reveal the presence of an infection or injury in the area of the swollen gland. Also, any collection of lymph tissue can be called a tonsil. Common Abbreviations: The Immune System Abbreviation Meaning Ab antibody ADCC antibody-dependent cell-mediated cytotoxicity Ag antigen AIDS acquired immune deficiency syndrome APC antigen-presenting cell BCR B cell (antigen) receptor (Ig) BM bone marrow CBC complete blood count CD celiac disease (allergy to gluten) ELISA enzyme-linked immunosorbent assay ESR erythrocyte sedimentation rate HIV human immunodeficiency virus HLA human leukocyte antigen (MHC) Ig immunoglobulin (antibody) LFA leukocyte functional antigen LGL large granular lymphocyte (NK cell) NK natural killer cell RA rheumatoid arthritis SLE systemic lupus erythematosus (usually shortened to lupus), an autoimmune disorder TCR T-cell (antigen) receptor Common Immune System Disorders and Procedures Some disorders are caused when the immune system targets a person's own cells. This condition is known as autoimmunity. Graves disease, which was introduced in next Chapter, is an example of an autoimmune disease, which is 104 organ-specific, affecting the thyroid gland. However, autoimmunity can affect nearly any part of the body. Lymphatic System Disorders The general term for all the lymph vessel and node diseases is lymphopathy. These conditions range from lymphatitis (inflammation of nodes or vessels) to lymphoma (tumor of the lymph tissue). The root for lymph nodes is usually lymphaden/o, while the one for the vessels is lymphang/i/o. Thymus and Spleen Disorders The roots for thymus and spleen are thym/o and splen/o, which yield terms such as thymitis and splenomalacia. Disorders of the Tonsils A common disorder and procedure related to the tonsils is tonsillitis (inflammation of the tonsils) and tonsillectomy (excision of the tonsils), nearly always referring to the palatine tonsils in both instances. However, tonsillitis usually does not signal the need for a tonsillectomy. II. Common Disorders and Procedures associated with the Immune System Term Definition autoimmunity immune to oneself lymphadenopathy any disease of the lymph nodes; chronic or excessively swollen lymph nodes lymphadenectomy excision of lymph nodes lymphadentitis inflammation of a lymph node (or nodes) lymphangiectomy excision of a lymph vessel lymphangitis inflammation of lymph vessels lymphoma tumor of lymph tissue lymphangiography radiography of the lymph vessels lymphangioplasty surgical repair of lymph vessels lymphangiotomy incision of lymph vessels lymphatitis inflammation of the lymph vessels or nodes lymphopathy any disease of the lymph vessels or nodes immunodeficiency impairment of the immune system splenitis inflammation of the spleen splenectomy excision of the spleen splenomalacia softening of the spleen splenomegaly enlargement of the spleen splenopathy any disease of the spleen 101 splenorrhagia hemorrhage from a ruptured spleen splenorrhaphy suture of a ruptured spleen splenotomy incision of the spleen tonsillitis inflammation of a tonsil tonsillectomy excision of a tonsil tonsillotomy incision of a tonsil thymectomy excision of the thymus thymitis inflammation of the thymus Exercise 10-1 Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. Term Definition 1. ______ thymus A. protein that NK cells use to kill invading cells 2. ______ tonsil B. substance that induces sensitivity or an immune response 3. ______ lymph node C. cells that make up about 80% of lymphocytes, the “T” denoting their work with the thymus 4. ______ perforin D. immune system gland, located behind the sternum 5. ______ spleen E. fluid that flows through the lymphatic system 6. ______ T cell F. type of lymphocyte; “natural killer” cell 7. ______ lymph G. structures of variable size that contain macrophages, which filter out disease-causing antigens and other debris as the lymph flows through 8. ______ antigen H. collection of lymph tissue (in common understanding, the lingual, pharyngeal and the palatine) 9. ______ B cell I. lymphocytes that work with T cells to fight off infection 10.______ NK cell J. immune system organ that gets rid of damaged red blood cells and reclaims and stores iron 11.______ lymphoma K. hemorrhage from a ruptured spleen 12.______ splenomegaly L. impairment of the immune system 13.______ thymitis M. tumor of lymph tissue 14.______ N. inflammation of a tonsil (commonly the palatine) lymphadenopathy 15.______ O. radiography of the lymph vessels immunodeficiency 16.______ splenorrhagia P. inflammation of lymph vessels 17.______ Q. chronic or excessively swollen lymph nodes or any lymphangiography disease of the lymph nodes 18.______ tonsillitis R. any disease of the spleen 19.______ splenopathy S. inflammation of the thymus 20.______ lymphangitis T. enlargement of the spleen 106 Exercise 10-2 Multiple Choice Circle the term in the Choices column that correctly answers each of the following questions.. 1.What is the substance that induces sensitivity or an immune response in the form of antibodies? antigen autoimmunity immunology 2. What is the term that means literally, “immune to oneself”? immunology autoimmunity antigen 3. What is the name for the medical specialty that deals with the immune system? antigen autoimmunity immunology 4. Name the immune system organ that gets rid of damaged red blood cells and reclaims and stores iron. lymphadentitis lymphangitis spleen 5. What is the term that describes the inflammation of a lymph node (or nodes)? lymphadentitis lymphangitis spleen 6. What is the term that describes the inflammation of the lymph vessels? lymphadentitis lymphangitis spleen 7. What term would you use to request an x-ray of a patient's lymph vessels? lymphangiectomy lymphangiography lymphangioplasty 8.What is the word that means “excision of a lymph vessel”? lymphangiectomy lymphangiography lymphangioplasty 9.What is the term for a surgical repair of a lymph vessel (or vessels)? lymphangiectomy splenotomy lymphangioplasty 10.What term means “incision of the spleen”? lymphangiectomy splenotomy lymphangioplasty Answers key: Exercise 10-1 1 2 D H 11 12 M T 3 G 13 S Exercise 10-2 1.antigen 2. autoimmunity 3. immunology 10. splenotomy 4 A 14 Q 5 J 15 L 6 C 16 K 4. spleen 5. lymphadentitis 6. lymphangitis 7 E 17 O 8 B 18 N 7. lymphangiography 8. lymphangiectomy 9. lymphangioplasty 107 9 I 19 R 10 F 20 P Chapter 11 The Urinary system Learning Objectives Chapter Sections I. Word Elements II. Surgical Terms III. Diagnostic Procedural Terms IV.Additional Terms V. Case History VI.Discharge summary VII. Excercises General Aims : The unit is designed to help you learn Surgical Terms and Diagnostic Procedural Terms of Urinary system and to increase your reading comprehension and to prepare you for reading similar passages. Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Build, analyze, define, pronounce, and spell the Word Elements related to the Urinary System. 102 surgical terms related to the Urinary System. Build, analyze, define, pronounce, and spell diagnostic procedural terms related to the Urinary System. Define, pronounce, and spell the Additional terms related to the Urinary System. The Urinary System The urinary system removes wastes and toxins from the body. It also regulates the amount of water in the body and the amount and kinds of electrolytes that it contains. Urinary system malfunctions can occur at any time throughout the lifespan, but their likelihood increases with age because of decreased general muscle tone and the kidneys' reduced capacity to function. Word Elements Specific to the Urinary System The word elements shown in the following table are found in terms related to the urinary system. You will recognize them in many of the terms you will learn in this chapter. I. Word Elements related to the Urinary System Word Elements Refers to cyst/o bladder lith/o stone nephr/o, ren/o kidney olig/o little, few pyel/o pelvis py/o pus ureter/o ureter urethr/o urethra urin/o urine polyprefix meaning “much” or “many” -iasis suffix meaning “condition” or “state” An Overview of the Urinary System The urinary system is composed of the kidneys, urinary bladder, ureters, and urethra. Kidneys As vital organs, the kidneys share some physical characteristics with the heart. For example, each kidney has layers. A thin covering called the renal capsule encloses and gives shape to the kidney. A thicker layer of fatty tissue, called the perirenal fat, surrounds the renal capsule. Finally, a thin layer of connective tissue, called the renal fascia, forms each kidney's protective outer covering. The hilum is the indented, or narrowest, part of the kidney, where blood vessels and nerves enter. 109 The kidneys produce urine, which is water that contains other substances in solution. In producing urine, the kidneys remove two natural products of metabolism, urea and uric acid, along with other waste products from the blood. The kidneys also filter, reabsorb, and secrete non-waste products back into the system. The kidneys contain about 2.5 million nephrons, tiny structures in which the urine-making process begins. The capillary network found inside each nephron is called a glomerulus, which assists in filtration. The English word calculus (plural: calculi) is also a Latin word meaning “small stone or pebble.” A calculus in a kidney is commonly called a kidney stone and in the gallbladder a gallstone. However, renal calculus, rather than kidney stone, is the medical phrase one would likely find in a medical report. In forming medical terms having to do with calculi in the kidneys and gallbladder, the Greek root lith/o is often used in preference to the roots based on the Latin word calculus. Thus, a nephrolithotomy would be an incision into a kidney to remove a renal calculus. Ureters After urine is produced and processed in the kidneys, it is transported by two tubes, called ureters, one extending from each kidney to either side of the urinary bladder. Peristalsis, or involuntary muscle contractions, moves the urine through the ureters and into the urinary bladder. Urinary Bladder The urinary bladder collects urine so that it can be expelled in significant quantities at intervals. The process of urine expulsion, called urination or micturition, begins when a circular muscle called the internal sphincter relaxes, thus permitting urine to enter the opening of the urethra. This first section of the urethra extends only a few inches and is met at the other end by another circular muscle called the external urethral sphincter. Common Abbreviations: The Urinary System Abbreviation Meaning Abdo abdomen Abdo E&S abdomen erect and supine (lying face upwards) AXR abdominal x-ray BPH benign prostatic hypertrophy GFR glomerular filtration rate IVP intravenous pyelogram (same as IVU): contrast is injected into a vein and is excreted by the kidney to show the urinary system IVU intravenous urogram (same as IVP) KUB kidneys, ureter, and bladder; also an archaic reference to a frontal x-ray of the abdomen PCN Percutaneous nephrostomy: Investigation of the urinary tract by direct needle puncture, often before insertion of a drainage catheter PSA prostate-specific antigen UTI urinary tract infection 110 Common Urinary System Disorders and Procedures The following table provides a quick reference for the meanings of the terms naming disorders and procedures associated with the urinary system. Disorders and Procedures associated with the urinary System Term Definition cystalgia pain in a bladder, most often used to signify the urinary bladder cystectomy excision of either the urinary bladder or the gallbladder; (excision of the gallbladder is properly, and most often, called a cholecystectomy; since cyst also means “cyst,” a cystectomy can also refer to the surgical removal of a cyst) cystopexy surgical fixation of either the gallbladder or the urinary bladder; this term is included because it is typical of the dual use of cysto nephralgia pain in the kidneys nephrectomy removal of a kidney nephritis inflammation of the kidneys nephrolithotomy incision into the kidney to remove a calculus (kidney stone) nephromegaly enlargement of one or both kidneys; renomegaly nephropathy any disease of the kidney nephrorrhaphy suture of the kidney nephrotomy incision into a kidney renal calculus a kidney stone renal hypoplasia an abnormally small kidney renomegaly enlargement of one or both kidneys; nephromegaly renopathy any disease of the kidney; the preferred term is nephropathy ureteralgia pain in a ureter ureterectomy excision of part or all of a ureter ureteritis inflammation of a ureter ureterography radiography of the ureter ureterolithotomy incision into the ureter to remove a calculus (stone) ureteroplasty surgical repair of a ureter ureterorrhaphy suture of a ureter urethralgia pain in the urethra (sometimes also called urethrodynia) urethrectomy excision of all or part of the urethra urethritis inflammation of the urethra urethrostenosis narrowing of the urethra urinalysis analysis of urine II. Surgicl Terms TERM (built from word parts) 1. cystectomy …………….. (sis-TEK-to-me) 11. cystolithotomy …………. DEFINITION excision of the bladder incision of the bladde to remove a stone 111 (sis-to-THOT-o-me) 3.cystoplasty ……………… (SIS-to-plas-te) 4.cysorrhaphy …………… (sist-OR-a-fe) 5.cystostomy ……………… (sis-TOS-to-me) 6. cystotomy or vesicotomy (sis-TOT-o-me) (ves-i-KOT-o-me) 7. cystotrachelotomy …….. (sis-to-tra-ke-LOT-o-me) 8. lihotripsy ……………… (LITH-o-trip-se) 9. meatotomy ……………. (me-a-TOT-o-me) 10. nephrectomy ………….. (ne-FREK-to-me) 11. nephrolysis …………… (ne-FROL-i-sis) 12.nephropexy …………….. (NEF-ro-peks-e) 13.nephrostomy …………… (nef-ROS-to-me) 14.pyelolithotomy ……….. (pl-el-o-lith-OT-o-me) 15.pyeloplasty …………….. (PI-Ei-o-plas-te) 16.pyelostomy …………… (pi-el-OS-to-me) 17.ureterectomy……………… (u-re-ter-EK-to-me) 18. ureterostomy ……………. (u-re-ter-OS-to-me) 19.ureterotomy ……………… (u-re-ter-OT-to-me) 20. urethropexy …………… (u-RE-thro-pek-se) 21.urethroplasty …………….. (u-RE-thro-plas-te) 22. urethrostomy ………….. plastic repair of the bladder suturing the bladder creation of an artificial opening into the bladder incistion of bladder incision of the neck of the bladder surgical crushing of a stone incision of the meatus excision of a kidney separating the kidney (from other body structures) surgical fixation of the kidney creation of an artificial opening into the kidney incision of the renal pelvis to remove a stone plastic repair of the renal pelvis creation of an artificial opening into the renal pelvis excision of a ureter creation of an artificial opening into the ureter incision of a ureter surgical fixation of the urethra plastic repair of the urethra creation of an artificial opening into the 112 (u-re-THROS-to-me) 23. urethrotomy ………….. (u-re-THROT-o-me) 24. vesicourethral suspension ……………. (ves-i-ko-u-RE-thral) urethra incision in the urethra surgical suspension pertaining to the urethra and bladder III. Diagnostic Procedural Terms TERM DEFINTION (built from word parts) 1.cystograim ………………….. (SIS-to-gram) 2.cystography ………………… (sis-TOG-ra-fe) 3.cystopyelogram …………..…. (sis-to-pi-EI-o-gram) 4.cystopyelography ……………. (sis-to-pi-e-LOG-ra-fe) 5.cystoscope ……………….…. (SIS-to-skop) 6. cystoscopy ……………..….. (sis-TOS-ko-pe) 7.cystoureterogram ……..…….. (sis-to-u-RE-ter-o-gram) 8.cystourethrogram …………… (sis-to-u-RE-thro-gram) 9. intravenous pyelogram …..… (in-tra-VE-nus)(PI-e-Io-gram) (IVP) 10. meatoscope …………..…… (me-AT-o-skop) 11. meatoscopy ………….…… (me-a-TOS-ko-pe) 12. nephrogram ………………... (NEF-ro-gram) 13.nephrography ………………. (ne-FROG-ra-fe) 14.nephroscopy ………………. (ne-FROS-ko-pe) x-ray film to the bladder process of x-ray filming the bladder x-ray film of the bladder and the renal pelvis process of x-ray filming the bladder and the renal pelvis instrument used for visual examination of the bladder visual examination of the bladder x-ray film of the bladder and the ureters x-ray film of the bladder and the urethra x-ray film ot the renal pelvis with contrast medium injected intravenously instrument used for the visual examination of a meatus visual examination of a meatus x-ray film of the kidney process of x-ray filming the kidney visual examination of the kidney 111 15.nephrosonography …………. ( nef-ro-so-NOG-ra-fe) 16.nephrotomogram …………... (nef-to-TO-mo-gram) 17. pyelogram ………………… (PI-el-o-gram) 18. renal biopsy ……………….. (RE-nal) (BI-op-se) 19.renogram…………………... (RE-no-gram) 20. retrograde pyelogram …….. (RET-ro-grad) (PI-e-lo-gram) 21. reterogram…………………. (u-RE-ter-gram) 22. urethrometer ……..………... (u-re-THROM-e-ter) 23.urethroscope………………… (u-RE-thro-skop) 24. urinometer………………..… (u-ri-NOM-e-ter IV. Additional Terms TERM 1. catheter………………. (kath-e-ter) process of recording the kidney with (ultra) sound sectional x-ray film of the kidney x-ray film of the renal pelvis to view a portion of living kidney tissue (graphic) record of the kidney (produced by radioactivity after injecting a radiopharmaceutical, or radioactive, material in to the blood ) x-ray film of the renal pelvis (retrograde means to move in a direction opposite from normal) with contrast medium injected through the urethra x-ray film of the ureters instrument used to measure the urethra instrument used for visual exam or the urethra instrument used to measure for determining the specific gravity of urine DEFINITION flexible, tubelike device, such as a urinary catheter, for withdrawing or instilling fluids 2. urinary catheterization….... (kath-e-ter-i-ZĀ-shun) passage of a catheter into the urinary bladder to withdraw urine 3. distended………...... (dis-TEN-ded) stretched out (a bladder is distended when filled with urine) 4. diuretic……………….. (dī-ū-RET-ik) 5. enuresis…………….…. (en-ū-RĒ-sis) agent that increases the amount of urine involuntary urination (bed wetting) 114 6. fulguration……………. (ful-gū-RĀ-shun) destruction of living tissue with an electric spark (a method commonly used to remove bladder growths) 7. hemodialysis…………. (hē-mō-dī-AL-i-sis) procedure for removing impurities from the blood because of an inability of the kidneys to do so inability to control bladder and/or bowels 8. incontinence………….. (in-KON-ti-nens) 9. lithotrite………………. (LITH-ō-tīt) instrument used to crush a stone in the urinary bladder 10. micturate……………… (MIK-tū-rāt) 11. peritoneal dialysis…….. (pār-i-tō-NĒ-al)(dī-AL-i-sis) to urinate or void 12. renal transplant……… (RE-nal)(trans-PLANT) surgical implantation of a donor kidney to replace a non-functioning kidney 13. resectoscope……….. (rē-SEK-tō-skōp) 14. specific gravity…….. (spe-SIF-ik) (GRAV-i-tē) instrument used for removing prostate gland tissue through the urethra a measurement that indicates concentrating or diluting ability of the kidneys (a test on urine) 15. stricture……………. (STRIK-chū-r) 16. urinal………………. (Ū-rin-al) 17. urinalysis………….. (ū-rin-AL-is-is) 18. urodynamics……… (ū-rō-dī-NAM-iks) 19. void………………. (voyd) abnormal narrowing, such as a urethral stricture receptacle for urine procedure for removing toxic wastes when kidney is unable to do so; the peritoneal cavity is used as the receptacle for the fluid used in the dialysis laboratory examination of urine pertaining to the force and flow of urine within the urinary tract to empty or evacuate waste material, especially urine V. Case History: This 32-year-old married white male, appearing his stated age, was admitted to the hospital after presenting himself to the emergency room in acute distress. He 111 complained of intermittent pain in the right posterior lumbar area radiating to the right flank. He has a family history of pyelolithiasis and has been treated for this condition several times in the past 10 years. VI. Discharge summary: This patient was admitted to the urology unit from emergency room, complaining of severe intermittent pain in the back and right flank. His KUB showed a calculus in the region of the right renal pelvis. Laboratory data were all normal except for slight microscopic hematuria. Intravenous pyelography showed three stones in the right kidney with minimal hydronephrosis. Cystoscopy with a right retrograde pyelogram confirmed presence of three stones in the right kidney. Minimal ureteral obstruction was present. Pyelolithotomy was completed with no complication. A ureteral catheter was inserted as was an indwelling foley catheter. Drainage from the right kidney was pale yellow in forty-eight hours. The foley and ureteral catheters were removed three days postoperatively. At discharge, the patient is voiding without difficulty, is afebrile, and ambulatory. The stones were sent to the laboratory for analysis. The report indicated that they were calcium oxalate. He is discharged to his home on restricted activity for the next two weeks. He is advised to drink copious amounts of fluids. He will be followed in the office in 3 weeks. EXERCISE 11- 1 Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. Term Definition 1. _____ nephron A. capillary network found inside each nephron 2. _____ urethra B. urination 3. _____ external sphincter C. muscle that controls the release of urine from the bladder into the first section of the urethra 4. _____ glomerulus D. tube that conducts urine away from the bladder for expulsion 5. _____ micturition E. electricity-producing compound in solution 6. _____ uric acid F. narrow part of the kidney where blood vessels and nerves enter 7. _____ ureters G. tiny structure within the kidney in which the urineproduction process begins 8. _____ hilum H. two tubes that transfer urine from the kidneys to the urinary bladder 9. _____ electrolyte I. muscle that controls the release of urine from the first section of the urethra for subsequent expulsion 10._____ internal sphincter J. natural waste product of metabolism excreted in the urine 11._____ nephralgia K. a kidney stone 116 12._____ urinometry 13.______ urethrostenosis 14.______ cystalgia 15.______ nephroureterocystectomy 16.______ ureterography 17.______ renal calculus L. excision of a kidney, ureter, and at least part of the urinary bladder M. adjective denoting urine production N. narrowing of the urethra O. any disease of the kidney P. pain in the kidneys Q. incision into the kidney to remove a calculus (stone) 18.______ urinogenous R. test of urine for specific gravity 19.______ nephrolithotomy S. radiography of the ureter 20.______ nephropathy T. pain in the bladder EXERCISE 11- 2 Circle the term in the Choices column that correctly answers each of the following questions. 1. What term means an excess of urea in the blood? hematuria uremia glomerular 2. What is the name of the capillary network found inside each nephron? globular; glomerulus glomerular 3. What is the name of the pair of organs that excrete urine? internal sphincters kidneys nephrons 4. What are the tiny structures within the kidneys in which the urine-production process begins? internal sphincters kidneys nephrons 5. What is the term for an enlargement of one or both kidneys? nephropathy nephromegaly nephrolithotomy 6. What is the term for any disease of the kidney? nephropathy nephromegaly nephrolithotomy 7. What is the term for the tube that conducts urine away from the bladder for expulsion? ureter urethra urethalgia 8. What is the term for pain in the urethra? urethritis urethra urethalgia 9. What is the term for excision of part or all of a ureter? ureterorrhaphy urethra ureterectomy 10. What is the term for suture of a ureter? ureterorrhaphy urethra ureterectomy EXERCISE 11- 3 Build surgical terms for the following definitions by using the word parts it’s expected that studenthave learned. 1. incision of the urethra WR S WR S 2. excision of a kidney 3. incision of the renal pelvis to remove a stone WR CV 117 WR S 4. surgical fixation of the urethra WR CV WR S WR CV WR S S 5. suturing of the bladder 6. separating of the kidney (from other structures) 7. creation of an artificial opening into the kidney 8. incision of a ureter S WR S 9. plastic repair of the urethra WR CV S WR S WR S WR S WR S WR CV S WR CV WR WR S 10. excision of the bladder 11. incision of the meatus 12. creation of an artificial opening into the urethra 13. incison of the bladder 14. plastic repair or the renal pelvis 15. incision of the neck of the bladder S 16. excision of the ureter 17. surgical fixation of the kidney WR 18. creation of an artificial opening into the renal pelvis WR 19. incision into the bladder to remove a stone WR 20. creation of an artificial opening into the ureter WR 21. plastic repair of the bladder WR 22. surgical crushing of a stone WR 23. surgical suspension of the bladder and urethra WR 24. creation of an artificial opening into 112 CV S CV S CV WR S S CV S CV S CV WR S the bladder WR S EXERCISE 11- 4 Build diagnostic terms for the following definitions by using the word Parts it’s expected that studenthave learned. 1. vsual examination of the bladder WR CV S 2. x-ray film of the bladder and ureters WR CV WR CV S 3. instrument used to measure the urethra WR CV S 4. sectional x-ray film of the kidney WR CV WR CV S 5. x-ray film of the bladder and the renal pelvis WR CV WR CV S 6. x-ray film of the renal pelvis with contrast medium injected intravenously P WR S 7. instrument used for visual examination of a of a meatus WR CV S 1. 8. instrument used for visual examination of the urethra WR CV S 9. process of x-ray recording the kidney using (ultra) sound WR CV WR CV S 10. x-ray film of the bladder WR CV S 11. visual examination of a meatus WR CV S 12. x-ray film of the ureters WR CV S 13. x-ray film of the renal pelvis WR 14. instrument used for visual examination of the bladder 15. x-ray film of the bladder and the urethra 16. process of x-ray filming the bladder CV WR WR CV S CV S WR CV S WR CV S WR CV S 17. x-ray film of the kidney 18. instrument used to measure 119 for determing the specific gravity of Urine 19. (graphic) record of the kidney (produced by radioactivity after Injecting a radiopharmaceutical material into the blood) 20. process of x-ray filming the bladder and the renal pelvis 21. process of x-ray filming the kidney WR CV WR WR 21. x-ray film of the renal pelvis (withcontrast medium injected through theurethra in a direction opposite from normal) 23. (a procedure) to view a portion of living kidney tissue 24. visual examination of the kidney S CV CV S WR CV WR CV WR S WR CV S S WR S S WR CV S EXERCISE 11-5 . Match the terms in the first column with the correct definitions in the second column. 1. Catheter a. increases the amount of urine 2. Urinary catheterization b. overdevelopment of the kidney 3. Distended c. inability to control bladder and/ 4. Diuretic or bowels 5. Fulguration d. process for removing impurities 6. Hemodialysis from the blood when the kidneys 7. Incontinent are unable to do so. 8. Void e. flexible, tubelike device for 9. Renal transplant urine from the bladder f. stretched out g. surgical implantation of a donor kidney h. passage of a tubelike device kidney the urinary bladder I. evacuation or empty waste material, especially urine J. destruction of living tissue with an electric spark EXERCISE 11- 6 120 Match the terms in the first column with the correct definitions in the second column. 1. lithotrite a. to void liquid waste 2. micturate, or urinate b. receptacle for urine 3. peritoneal dialysis c. instrument used for crushing a 4. resectoscope stone in the urinary bladder 5. stricture d. laboratory examination of urine 6. urinal e. force and flow of urine within 7. urinalysis urinary tract 8. enuresis f. instrument used for removing 9. specific gravity prostate gland tissue through the 10. urodynamics urethra g. indicates concentration of urine h. absence of urine i. use of peritoneal cavity to hold dialyzing fluid in the removal of toxic wastes j. involuntary urination k. narrowing Answers key: EXERCISE 11-1 1 2 G D 11 12 P R EXERCISE 11-2 1 uremia 6 nephropathy EXERCISE 11 -3 1.urethr/otomy 2. nephr/ectomy 3. pyel/o/lith/otomy 4. urethra/o/pexy 5. cyst/orrhaphy 6. nephr/o/lysis 7.nephr/ostomy 8. ureter/otomy 9. urethra/o/plasty 10.cyst/ectomy 3 I 13 N 4 A 14 T 2 glomerulus 7 urethra 5 B 15 L 6 J 16 S 3 kidneys 8 urethralgia 7 H 17 K 8 F 18 M 4 nephrons 9 ureterectomy 13. a. cyst/otomy b. vesic/otomy 14. pyel/o/plasty 15. cyst/o/trachel/otomy 16. ureter/ectomy 17. nephr/o/pexy 18. pyel/ostomy 19. cyst/o/lith/otomy 20. ureter/ostomy 21. cyst/o/plasty 121 9 E 19 Q 10 C 20 O 5 nephromegaly 10 ureterorrhaphy 11. meat/otomy 12. urethr/ostomy 22. lith/o/tripsy 23. vesic/o/urethra/al 24. cyst/ostomy EXERCISE 11 - 4 1. cyst/o/scopy 2. cyst/o/ureter/o/gram 3. urethra/o/meter 4. nephr/o/gram 5. cyst/o/pyel/o/gram 6. intra/ven/ous pyel/o/gram 7. meat/o/scope 8. urethra/o/scope 9. nephr/o/son/o/graphy 10. cyst/o/gram 11. meat/o/scopy 12. ureter/o/gram EXERCISE 11 - 5 1. e 2. h 3. f EXERCISE 11- 6 1. c 2. a 3. i 4. a 4. f 13. pyel/o/gram 14. cyst/o/scope 15. cyst/o/urethr/o/gram 16. cyst/o/graphy 17. nephr/o/gram 18. urin/o/meter 19. ren/o/gram 20.cyst/o/pyel/o/graphy 21. nephr/o/graphy 22. retrograde pyel/o/gram 23. ren/al bi/opsy 24.nephr/o/scopy 5. j 5. k 6. d 6. b 122 7.d 7. c 8. j 8. i 9. g 9.g 10.e Chapter 12 Reproductive System Learning Objectives I. Surgical Terms II. Other Surgical Terms III. Diagnostic Procedural Terms IV. Case History V. Exercises General Aims : The unit is designed to help you learn Surgical Terms snd Diagnostic Procedural Terms of Female Reproductive System`and to increase your reading comprehension and to prepare you for reading similar passages. 121 Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Build, analyze, define, pronounce, and spell the surgical terms related to the Female Reproductive System. Define, pronounce, and spell other surgical terms related to the Female Reproductive System. Define, pronounce, and spell diagnostic procedural terms related to the Female Reproductive System. Reproductive System The reproduction process begins with fertilization, which occurs when a male gamete (also called a sperm or spermatozoon; plural: spermatozoa) fertilizes a female gamete (also called an ovum; plural: ova). The collective name for any female or male organ that produces a gamete is gonad. The single cell formed at fertilization is called a zygote, which contains a full complement of chromosomes carrying the DNA of a unique new person. The period of gestation is the time lapse between the formation of the zygote and birth. In the paragraphs, illustrations, and tables that follow, you will encounter key terms used in describing the reproduction process, along with a few terms associated with genetics, one of several related specialties. Word Roots Specific to the Reproductive System The roots shown in in the following table are often found in terms related to the reproductive system. You will recognize them in many of the terms you will learn in this chapter. TABLE 11-1 Common Roots related to the Reproductive System Root Refers to cervic/o; trachel/o cervix colp/o; vagin/o vagina men/o menses oo egg oophor/o ovary (also egg) orch/i/o; orchid/o testes ovari/o ovary salping/o tube (sometimes a reference to the uterine tube) spermat/o sperm 124 uter/o; hyster/o; metr/o uterus The Male Reproductive Cycle The male reproductive cycle comprises the production of the male gametes. This process, called spermatogenesis, involves a cell-division process known as meiosis, which produces haploid cells having only the chromosomes of the potential male parent. Male gamete production occurs in the testes (singular: testis), and the dynamics of the process rely on the secretion of androgens, which are male sex hormones. The most significant of these is testosterone. After spermatogenesis is complete, the spermatozoa (singular: spermatozoon) travel to the epididymis, an organ adjacent to the testes, where they become functional. In summary, the testes produce and store the spermatozoa; the epididymis stores and develops them into a functional state; and the prostate gland produces, stores, and secretes a fluid medium called prostatic fluid. The combination of the gametes and their associated glandular secretions, along with the prostatic fluid, is called semen. Leaving the epididymis, spermatozoa enter the ductus deferens, also called the vas deferens, and eventually find their way into the urethra, which is part of both the male urinary and male reproductive systems. The Female Reproductive Cycle The Fertilization Stage Like the male reproductive cycle, the female reproductive cycle provides gametes for fertilization. But it does a great deal more by also providing an environment suitable for development of the zygote. The female counterpart to spermatogenesis is oogenesis, which occurs in the ovaries (singular: ovary). Stimulated by follicle-stimulating hormone (FSH), the ovaries begin the process of oogenesis, which continues with the secretion of other required hormones, called progestins, the principal one of which is progesterone. As a result, the ovaries produce oocytes, which are haploid cells that eventually become the gametes. Hormonal activity controls all phases of the reproduction cycles in both men and women, but in women, it also controls something called the uterine cycle or menstrual cycle, which has three phases: secretory (secretion of hormones), proliferative (proliferation of the ovum), and menses (the end of one cycle and the beginning of another). If male spermatozoa are present during ovulation, which occurs during the proliferative phase, the possibility of fertilization exists. 121 The Gestation Stage Gestation, a synonym for pregnancy, comes from the Latin verb gesto, meaning “to bear.” When the single-cell zygote divides the first time, it is called an embryo. This term is used until approximately the eighth week of gestation. Between the eighth week and birth, which under normal circumstances occurs between weeks 38 to 40, the term fetus is used. This process of cell division is called mitosis. Like meiosis, mitosis is a process of cell division, but each cell produced contains a full complement of both maternal and paternal chromosomes and is thus called a diploid cell. Mitosis occurs many billions of times during gestation . Diagnostic tests and procedures associated with pregnancy include amniocentesis, involving the extraction of amniotic fluid from the amniotic sac, which surrounds the fetus inside the uterus. Amniocentesis is most commonly employed to discover, or rule out, the presence of a genetic disorder, but it can also help in determining fetal lung maturity, which bears on the safety of an early delivery, or whether the mother's immune system is adversely affecting the fetus. TABLE 11-2 Common Disorders and Procedures associated with the Reproductive system Term Definition amniocentesis extraction and diagnostic examination of amniotic fluid from the amniotic sac cervicectomy; also, excision of the uterine cervix rarely, trachelectomy cervicitis; also inflammation of the uterine cervix trachelitis cervicoplasty surgical repair of the uterine cervix OR the neck cervicotomy; also incision of the uterine cervix; tracheotomy is the term trachelotomy used to denote an incision into the neck (trachea), but trachelotomy refers to the uterine cervix and is synonymous with cervicotomy hysteralgia; also pain in the uterus hysterodynia hysterectomy surgical removal of the uterus hysteropathy any disease of the uterus hysteropexy surgical fixation of the uterus hysteroplasty surgical repair of the uterus hysterotomy incision of the uterus 126 mammography oophorectomy oophoritis oophoroplasty oophorotomy orchialgia orchiectomy orchiopathy orchioplasty orchiotomy orchitis ovarialgia ovariectomy ovariotomy ovaritis Pap test uteropexy uteroplasty uterotomy examination of the breast by means of an imaging technique, such as radiography ovariectomy inflammation of an ovary surgical repair of an ovary incision into an ovary pain in the testes removal of one or both testes (less commonly orchidectomy) any disease of the testes surgical repair of a testis incision into a testis inflammation of a testis pain in an ovary excision of one or both ovaries incision of an ovary inflammation of an ovary (oophoritis) microscopic examination of cells from a mucosal surface, especially the uterine cervix surgical fixation of the uterus (hysteropexy) surgical repair of the uterus (hysteroplasty) incision of the uterus (hysterotomy) Common Abbreviations: The Reproductive System Abbreviation Meaning BPH benign prostatic hyperplasia CS Cesarean section D&C dilation and curettage DNA deoxyribonucleic acid (the genetic code) DUB dysfunctional uterine bleeding HSG hysterosalpingogram IVF in vitro fertilization OB obstetrics PID pelvic inflammatory disease PSA prostate-specific antigen TURP transurethral resection of the prostate I. Surgical Terms TERM DEFINITION 127 1. cervicectomy……………. (ser-vi-SEK-tō-mē) 2. colpoperineorrhaphy……. (rōl-pō-pār-i-nē-OR-a-fē) excision of the cervix suture of the vagina and perineum (performed to mend perineal vaginal tears) plastic repair of the vagina 3. colpoplasty……………… (KOL-pō-plas-tē) 4. colporrhaphy……………. (rōl-PŌR-a-fē) 5. episioperineoplasty……… (e-piz-ē-ō-pār-i-nē-o-PLAST-ē) 6. episiorrhaphy……………. (ē-piz-ē-ŌR-a-fē) 7. hymenectomy……………. (hī-men-EK-tō-mē) 8. hymenotomy…………….. (hī-men-OT-ō-mē) 9. hysterectomy……………. (his-te-REK-tō-mē) 10. hysteropexy……………. (HIS-ter-ō-pek-sē) 11. hysterosalpingooophorectomy……..……. (his-ter-ō-sal-ping-gō-ō-of-ō PEK-tō-mē) 12. mammoplasty………….. (MAM-ō-plas-tē) suture of the vagina plastic repair of the vulva and perineum suture of (a tear in) the vulva excision of the hymen incision of the hymen excision of the uterus surgical fixation of the uterus excision of the uterus, fallopian tubes, and ovaries plastic repair of the breasts (performed to enlarge or reduce in size, to lift, or to reconstruct after removal of a tumor) surgical removal of a breast 13. mastectomy……………. (mas-TEK-tō-mē) 14. oophorectomy…………. 15. oophorosalpingectomy… (ō-of-ō-rō-sal-pin-JEK-tō-mē) 16. perineorrhaphy…………. (pā-r-i-nē-ŌR-a-fē) 17. salpingectomy………….. (sal-pin-JEK-tō-mē) 18. salpingostomy………….. (sal-ping-GOS-tō-mē) excision of an ovary excision of the ovary and fallopian tube suture of (a tear in) the perineum excision of a fallopian tube creation of an artificial opening in a fallopian tube (performed to 122 restore patency) excision of the vulva 19. vulvectomy…………….. (vul-VEK-tō-mē) II. Other surgical Terms TERM DEFINITION 1. anterior and posterior colporrhaphy (A & P repair) when a weakened vaginal wall results in a cystocele (protrusion of the bladder against the anterior wall of the vagina) and a rectocele (protrusion of the rectum against the posterior wall of the vagina), an A & P repair corrects the condition 2. dilatation and curettage (D & C)……………… dilation of the cervix and scraping (dil-TĀ-shun and kū-Reof the endometrium with an TAHZH) instrument called a curette. It is performed to diagnose disease, to correct bleeding, and to empty uterine contents. laparoscopy or laparoscopic Surgery……….…… visual examination of the abdominal (lap-ROS-kō-pē) cavity, accomplished by insertion of a laparoscope through a tiny incision near the umbilicus. It is used for surgical procedures such as tubal sterilization (blocking of the fallopian tubes) or biopsy or the ovaries. It may also be used to diagnose endometriosis 3. myomectomy……………. excision of a fibroid tumor (myoma) (mī-ō-MEK-tō-mē) from the uterus 4. stereotactic breast biopsy. a new technique that combines (ster-ē-ō-TAC-tic) mammography and computer assisted biopsy to obtain tissue from a breast lump 5. tubal ligation……………. closure of the fallopian tubes for (lī-GĀ-shun) sterilization III. Diagnostic Procedural Terms TERM DEFINITION 129 1. colposcope……………. instrument used for visual examination ( KOL-pō-skōp) of the vagina (and cervix) 2. colposcopy……………. visual examination (with a magnified (kol-POS-kō-pē) view) of the vagina (and cervix) 3. culdocentesis…………… surgical puncture to remove fluid from (kul-dō-sen-TĒ-sis) the Douglasُ cul-de-sac 4. culdoscope……………… instrument used for visual examination (KUL-dō-skōp) of the Douglasُ cul-de-sac 5. culdoscopy……………… visual examination of the Douglasُ cul(kul-DOS-kō-pē) de-sac 6. hysterosalpingogram…… x-ray film of the uterus and the fallopian (his-ter-ō-sal-PING-go-gra-m) tubes 7. hysteroscope………….... instrument used for visual examination (HIS-ter-o-skōp) of the uterus 8. hysteroscopy…………… visual examination of the uterus (his-ter-OS-kō-pē) 9. mammography………… process of recording (x-ray) of the breast (ma-MOG-ra-fē) 10. mammogram………… x-ray film of the breast (MAM-ō-gram) IV. Case History: A 48-year-old Puerto Rican female is referred for follow-up after a suspicious mass in the left breast was discovered in routine mammography. She has a positive family history (motherُ s sister) of carcinoma of the breast. She also has had a hysterectomy for adenomyosis and endometriosis. She elects to have the biopsy in the outpatient surgery department. Pathology Report: GROSS DESCRIPION: Received labeled "breast biopsy" is an ovoid mass of predominantly adipose breast tissue measuring 4.5 × 3.0 × 1.3 cm. Sectioning reveals a focal area of suspicious induration. Frozen section reveals fat necrosis and evidence of invasive malignancy in an area measuring 0.25 cm in the center of the specimen.The surgeon is so informed. MICROSCOPIC DESCRIPTION: Microscopic examination of the frozen section specimen confirms the presence of fat necrosis. There is a focal duct epithelial hyperplasia exhibiting a papillomatous pattern. In this area is found a well-differentiated adenocarcinoma. Occasional breast parenchymal fragments are also identified are show fibrocysticchanges. These are predominantly nonproliferative, although in slide D a small radial scar containing ducts showing proliferative fibrocystic changes with significant atypia and adjacent sclerosis adenosis is identified. 110 DIAGNOSIS: left breast biopsy: 1. radial scar 2. nonproliferative and proliferative fibrocystic changes with significant atypia 3. papillary duct adenocarcinoma 4. focal sclerosing adenosis Exercise 11-1 Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. Term Definition 1. _____ ductus deferens A. combination of male gametes, their associated secretions, and prostatic fluid 2. _____ prostate gland B. removal of one or both testes 3. _____ spermatogenesis C. organs that produce and store male gametes 4. _____ epididymis D. duct leading out of the epididymis (also called the vas deferens) 5. _____ orchiectomy E. production of sperm 6. _____ haploid cell F. male gland that produces and stores prostatic fluid, a fluid medium that is part of semen 7. _____ semen G. pain in the testes 8. _____ testosterone H. cell containing only one set of chromosomes (those of either the potential mother or potential father) 9. _____ orchalgia I. organ in which the male sperm become functional 10._____ testes J. androgen prominent in male gamete production 11._____ hysterectomy and K. inflammation of an ovary bilateral oophorectomy 12._____ salpingectomy L. excision of the uterine cervix 13._____ ovarialgia M. surgical fixation of the uterus 14._____ uteropexy or N. release of the female gamete that occurs hysteropexy during the proliferative stage of the uterine cycle 15._____ period of gestation O. surgical removal of a fallopian tube 16._____ cervicectomy or P. the female gamete trachelectomy 17._____ ovaritis or oophoritis Q. surgical removal of the uterus and right and left ovaries 111 18._____ uterine cervix 19._____ ovum 20._____ ovulation R. pain in the ovary S. the “neck” located at the lower end of the uterus T. time lapse between zygote formation and birth View Answer Exercise 11-2 Put an X in the True or False column next to each statement. Statement True False 1. Fertilization is the development that occurs between the ____ ___ formation of the zygote and birth of the child. 2. The tubes between the ovaries and the uterus are called the _____ ___ fallopian tubes. 3. The joining of the male and female gametes is called ovulation. _____ ___ 4. The process of cell division by which one cell becomes two is _____ ___ known as oogenesis. 5. The term for release of the female gamete that occurs during the _____ ___ proliferative stage of the uterine cycle is proliferation. 6. The male ductwork that acts as a part of both the male urinary _____ ___ and male reproductive systems is called the urethra. 7. Hysteralgia is pain in the uterus. _____ ___ 8. Obstetrician is the medical specialty concerned with the medical _____ ___ care of women during the pregnancy and childbirth. 9. Endometriosis is a difficult or painful menses. _____ ___ 10.Mammography is the microscopic examination of cells from a _____ ___ mucosal surface, especially the uterine cervix. EXERCISE 11-3 Build surgical terms for the following definitions by using the word parts it’s expected that studenthave learned. 1. suture of the vaginal 2. excision of the cervix 3. suture of the vulva 4. plastic repair of the vulva and perineum 5. plastic repair of the vagina 6. suture of the vagina and perineum 7. excision of the uterus,ovaries, and fallopian tubes 8. surgical fixation of the uterus 9. excision of the hymen 112 10. incision of the hymen 11. excision of the uterus 12. excision of the ovary 13. surgical removal a breast 14. excision of a fallopian tube 15. suture of the perineum 16. excision of the ovary and fallopian 17. creation of an artificial opening in the fallopian tube 18. excision of the vulva 19. plastic repair of the breasts EXERCISE 11-4 Match the surgical procedures in the first column with the corresponding organs in the second column. It’s expected that studentmay use the answers in the second column more than once. 1. dilatation and curettage a. fallopian tubes 2. laparoscopy sterilization b. vagina 3. tubal ligation c. uterus 4. A & P repair d. ovaries 5. myomectomy e. vulva 6. stereotactic breast biopsy f. mammary glands EXERCISE 11-5 Build diagnostic procedural terms for the following definitions by using the word parts it’s expected that studenthave learned. For example : 1. x-ray film of the uterus and fallopian tubes R CV WR 1. visual examination of the vagina (and cervix) 2. instrument used for visual examination of the vagina (and cervix) 3. visual examination of the uterus 4. x-ray film of the breast 5. instrument used for visual examination of the Douglasُ cul-de-sac 6. visual examination of the Douglas cul-de-sac 7. surgical puncture to remove fluid from the Douglasُ cul-de-sac 8. instrument used for visual examination of the uterus 9. process of recording the breast Answers key : EXERCISE 1 1 2 D F 11 12 O Q 3 E 13 R 4 I 14 M 5 B 15 T 6 H 16 L EXERCISE 2 111 7 A 17 K 8 J 18 S 9 G 19 P 10 C 20 N 1 False 2 True 3 False 4 False 5 False 6 True 7 True 8 False 9 False EXERCISE 3 2. colp/orrhaphy 11. hyster/ectomy 3. cervic/ectomy 12. oophor/ectomy 4. episi/o/rrhaphy 13. mast/ectomy 5. episi/o/perine/o/plasty 14. salping/ectomy 6. colp/o/plasty 15. perine/orrhaphy 7. colp/o/perine/orrhaphy 16. oophor/o/salping/ectomy 8. hyster/o/salping/o/ oophor/ectomy 8. hyster/o/pexy 18. mamm/o/plasty 19. mamm/o/plasty EXERCISE 4 1. c 2. a 3. a 4. b EXERCISE 5 1. hyster/o/salping/o/ gram 2. colp/o/scopy 3. colp/o/scope 4. hyster/o/scopy 5. mamm/o/gram 5. e 6. culd/o/scope 7. culd/o/scopy 8. culd/o/centesis 9. hyster/o/scope 10. mamm/o/graph 114 6. f 10 False Chapter 13 The Nervous System Learning Objectives I. Surgical Terms II. Diagnostic Procedural Terms III. Other Diagnostic Procedural Terms IV. Case History V. Exercises General Aims : The unit is designed to help you learn Surgical Terms and Diagnostic Procedural Terms of Nervous System and to increase your reading comprehension and to prepare you for reading similar passages. 111 Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Build, analyze, define, pronounce, and spell the surgical terms related to the Nervous System. Build, analyze, define, pronounce, and spell the diagnostic procedural terms related to the Nervous System. The Nervous System Although the nervous system is more sophisticated than even the most complex computer, at least one parallel with the computer is useful in understanding how the nervous system works as a whole. The brain functions in much the same way as a computer's central processor, since information to be processed in the brain must pass between it and other parts of the body through the spinal cord. The brain and spinal cord are together known as the central nervous system, abbreviated CNS. The parts of the nervous system found throughout the rest of the body make up the peripheral nervous system (PNS), which is somewhat like a computer's operating system. This chapter introduces terms related to the CNS and PNS, along with terms naming nervous system disorders and procedures. Word Elements Specific to the Nervous System The word elements shown in the following table are often found in terms related to the nervous system. You will recognize them in many of the terms you will learn in this chapter. TABLE 15-1 Common Word Elements of the Nervous system Word Element Refers to cephal/o; brain encephal/o cerebell/o the cerebellum cerebr/o the cerebrum; also, the brain in general cortic/o outer layer or covering gangli/o; ganglia (singular: ganglion) ganglion/o gli/o glue hydr/o water megal/o large mening/i/o a membrane 116 myel/o neur/o psych/o spin/o -mania -phobia in connection with the nervous system, refers to the spinal cord and medulla oblongata a nerve cell; nervous system the mind the spinal cord suffix meaning “morbid attraction to” or “impulse toward” suffix meaning “morbid or unreasonable fear” The Practice and the Practitioners Coupling the root neur/o with the suffix -logy yields the term neurology, which is the name of the medical specialty dealing with the nervous system. Specialists who treat nervous system disorders are called neurologists, neurosurgeons, psychiatrists, and psychologists. Anatomy of the Nervous System Nerve tissue, along with its associated connective tissue and blood vessels, makes up both the CNS and PNS. Nerve tissue is composed of fundamental units called neurons, which are separated, supported, and protected by neuroglia. The three principal parts of a neuron cell are the cell body, the dendrites, and the axon. Axons are protected by the myelin sheath, an envelope of glial cells providing protection and electrical insulation to neurons. Physiology of the Nervous System Dendrites, which project outward from the cell body, act as antennae that receive and transmit messages between the neuron and muscles, skin, or other neurons. The cell body passes these messages to the axon, which is a tail-like “process,” so called because it conducts electrical impulses away from the cell body. The connecting points for these message transfers are called synapses. Synaptic connections can occur between a neuron and a neuron or between a neuron and another cell. Within the connection, the cell that sends the message is called a presynaptic cell, and the cell receiving the message is the postsynaptic cell. The postsynaptic cell releases a chemical called a neurotransmitter. Hormones are typical neurotransmitters. When groups of neuron cell bodies occur within the CNS, each one is called a nucleus (plural: nuclei). However, when groups of neuron cell bodies occur within the PNS, each one is called a ganglion (plural: ganglia). Groupings of axons are called nerves, wherever they occur in the body. Neurons are 117 grouped because they work together to carry out the highly complex sensing and processing actions required for everything we do. Information travels in two directions through the nervous system: sensory information passes either from or through the spinal cord to the brain; and command information passes from the brain to or through the spinal cord to effect an action. We can know which kind of information (sensory or command) and the direction the information is traveling (to or from the brain) by referring to the last word element in the term naming the path along which it flows. For example, the information traveling along the spinothalamic pathway (or tract) carries sensory information from the spinal cord (spino) to the thalamus, which is part of the brain. If the adjective denoting the pathway ended with spinal instead, as in the corticospinal pathway, we would know that the message moving along that pathway is command information because it is going from the brain to the spinal cord. The Central Nervous System The Brain As the the body's “central processor,” the brain contains 98% of the body's neural (nerve) tissue. From the outside, the brain is separable into four lobes: the frontal, parietal, occipital, and temporal. The brain is divisible into the following major parts: cerebrum, cerebellum, diencephalon, and brain stem. Cerebrum The cerebrum, the largest part of the brain, is where memories and conscious thoughts are stored. It also directs some of our bodily movements. An outer layer of gray matter called the cerebral cortex protects the cerebrum, which is divided into two hemispheres. The term basal ganglia is commonly used when referring to the basal nuclei situated in the white matter of the cerebrum. Cerebellum The cerebellum, like the larger cerebrum situated above it, also has two hemispheres. The cerebellum helps us perform learned body movements smoothly and maintain our equilibrium. Diencephalon The diencephalon contains both the thalamus and the hypothalamus. The thalamus processes sensory information, and the hypothalamus, which is the hormone and emotion center of the brain, controls autonomic functions. Brain Stem 112 Both consciousness and some psychomotor responses also occur within the mesencephalon. The pons (Latin for “bridge”) passes information to the cerebellum and the thalamus to regulate subconscious somatic activities. The medulla oblongata sends sensory information to the thalamus to direct the autonomic functions of the heart, lungs, and other organs of the body. The cavities between the brain stem and the cerebrum are called ventricles. The Spinal Cord The spinal cord and the brain communicate continuously with one another. The messages that flow back and forth bring about all the actions and functions that make life pleasurable, painful, and even possible. In the average-size adult, the spinal cord is about a foot and a half long and a halfinch wide. It is surrounded by membranes called spinal meninges, which absorb physical shocks that could damage the neural tissue. The outer layer of the spinal cord consists of dura mater, a dense collection of collagen fibers located along its length. The spinal cord is further protected by ligaments, tendons, and muscles. The Peripheral Nervous System The PNS may be further divided into two subsystems: the autonomic nervous system and the somatic nervous system. Since some organs, such as the heart and lungs, work on their own, their performance is said to be autonomic. The word autonomy, which you may already know, is a common English word that means “self-sufficient.” Conscious and habitual actions, on the other hand, are called somatic, which comes from a Greek word meaning “body.” Like the CNS, the PNS contains neurons, neuroglia, and associated tissue. The PNS also consists of the cranial nerves and spinal nerves emanating from the CNS, along with receptors and effectors. Receptors, which reside in all parts of the body, sense stimuli and transmit them to the CNS. Effectors respond to motor impulses from the CNS. For example, many nerves, including the optic nerve, function together with the brain to create the sensation of sight. This process requires that a string of electrical messages, called nerve impulses, be exchanged between the PNS and CNS. These messages travel back and forth to the CNS from receptors and effectors by means of synapses and along axons. The cranial nerves are connected directly to the brain, but they are nevertheless part of the PNS. The 12 pairs of cranial nerves are the olfactory, optic, oculomotor, trochlear, trigeminal, abducent, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal. As part of the PNS, 119 these nerves are associated with bodily movements and functions within other systems. Common Abbreviations: The Nervous System Abbreviation Meaning ADHD attention deficit hyperactivity disorder EEG electroencephalography IQ intelligence quotient LP lumbar puncture MA mental age OBS organic brain syndrome OCD obsessive-compulsive disorder PERRLA pupils equal, round, and reactive to light and accommodation SAD seasonal affective disorder TENS transcutaneous electrical nerve stimulation WAIS Wechsler Adult Intelligence Scale WISC Wechsler Intelligence Scale for Children Nervous System Disorders and Procedures A neurosis is a fear of something that is not a hazard, at least not from a statistical point of view. Neuroses usually represent only a skewed perspective of reality, and although they can be debilitating, most people can overcome the anxiety such fears engender. Neuroses are often named by combining the suffix -phobia (“fear of something”) with a root or prefix identifying the object feared, such as pan-(“all”). Thus,panophobia means“fear of everything”(Table 13-2). A psychosis, on the other hand, represents a marked distortion of or sharp break from reality and is a serious personality disorder. Schizophrenia, a psychosis, involves delusions, such as believing that someone or something is controlling your thoughts. Another of its manifestations is hallucinations, most often “hearing” voices or other sounds. Paranoia, another personality disorder, is characterized by unreasonable suspicion or jealousy, along with a tendency to interpret everything others do as hostile. Some psychoses are indicated by the suffix -mania. Examples are megalomania (delusions of grandeur) and kleptomania (uncontrollable impulse to steal). TABLE 13-2 Common Phobias Term Definition 140 acrophobia agoraphobia arachnophobia claustrophobia xenophobia ankylophobia hemophobia panophobia xenoglossophobia fear of heights fear of being outside your own house fear of spiders fear of being in a closed airless space fear of foreigners fear of immobility of a joint fear of blood fear of everything fear of foreign languages TABLE 13-3 Disorders and Procedures Common to the Nervous System Term Definition agnosia loss of sensory input recognition Alzheimer disease; also a disease that may begin in late middle life; Alzheimer's disease characterized by progressive mental deterioration that includes loss of memory and visual and spatial orientation aphasia loss of speech cerebral thrombosis blood clot in the brain cerebral stroke an acute clinical event, related to impairment of cerebral circulation, lasting more than 24 hours cerebrovascular synonym for a cerebral stroke; an acute clinical event, accident (CVA) related to impairment of cerebral circulation, lasting more than 24 hours cerebrovascular disease brain disorder involving a blood vessel craniectomy excision of part of the skull craniotomy incision into the skull delirium impaired consciousness dementia impaired intellectual function dysphasia impaired speech encephalitis inflammation of the brain epilepsy CNS disorder often characterized by seizures glioblastoma a cerebral tumor occurring most frequently in adults glioma tumor of glial tissue hemiparesis partial paralysis of one side of the body hemiplegia paralysis of one side of the body Huntington disease hereditary disorder of the CNS characterized by (also involuntary muscle Huntington's disease) movements and dementia 141 hydrocephalus hyperesthesia meningioma meningitis multiple sclerosis excessive cerebrospinal fluid in the brain abnormal sensitivity to touch benign tumor of meninges inflamed meninges disease of the CNS; characterized by the formation of plaques in the brain and spinal cord myelitis inflamed spinal cord myelography radiography of the spinal cord and nerve roots neuralgia pain in a nerve neuropathy any disorder of the nervous system neuroplasty surgery to repair a nerve paralysis loss of motor control paraplegia paralysis of the lower extremities and, often, the lower trunk of the body paresthesia numbness Parkinson disease (also a neurologic condition characterized by difficulty in Parkinson's disease) controlling muscles plegia paralysis poliomyelitis inflamed gray matter in the spinal cord psychosis general term covering severe mental or emotional disorders quadriplegia paralysis of all four limbs sciatica pain in the sciatic nerve, located in the lower back and extending down the thigh seizure sudden disturbance in brain function, sometimes producing a convulsion syncope fainting I. Surgical Terms TERM (built from word parts) 1. ganglionectomy………… DEFINITION excision of a ganglion (also called gangliectomy) excision of a nerve ( gang gle on EK to me ) 2. neurectomy……………... (nu REK to me ) 3. neurolysis………………. separating a nerve (from adhesions) (nu ROI i sis) 4. neuroplasty……………… ( NU ro plas te ) surgical repair of a nerve 5. neurorrhaphy…………… 142 (nu RO R a te ) suture of a nerve 6. neurotomy…………….. (nu ROT o me ) incision into the nerves 7. radicotomy……………. (rad i KOT o me ) incision into a nerve root 8. rhizotomy……………… (ri ZOT o me ) incision into a nerve root II. Diagnostic Procedural Terms TERM (built from word parts) 1. cerebral angiography……………… (se RE bral) (an je OG ra fe ) 2. echoencephalography…………....... (ek o en sef a LOG ra fe ) 3. electroencephalogram(EEG)……… (e lek tro en SEF a lo gram) 4. electroencephalograph…………….. (e lek tro en SEF a lo graf ) 5. electroencephalography…………… (e lek tro en sef a LOG ra fe ) 6. myelogram………………………… (MI e lo gram) DEFINITION process of x-ray filming of the blood vessels in the brain (after an injection of contrast medium) process of recording brain structures by use of sound (also called ultrasonography) record of the electrical impulse of the brain instrument used for recording the electrical impulses of the brain process of recording the electrical impulses of the brain x-ray film of the spinal cord (after injection of dye into the spinal fluid that surrounds the spinal cord) III. Other Diagnostic Procedural Terms TERM DEFINITION 1. computed tomogtaphy of the process that includes the use of a brain………………….. computer to produce a series of (to MOG ra fe ) images of the tissues of the brain at any desired depth. The procedure is 141 noninvasive, painless, and particularly useful in diagnosing brain tumors. Also referred to as a CT scan or CAT scan for computed axial tomography. 2. lumbar puncture (LP) …. insertion of a needle into the ( LUM bar ) subarachnoid space between the third and fourth lumbar vertebrae. It is performed for many reasons, including the removal of cerebrospinal fluid for diagnostic purposes. 3. magnetic resonance imaging of A noninvasive technique that produces the head (MRI)... cross-sectional and vertical images of (mag NET ik ) cranial structures by use of magnetic waves. Unlike CT scan, MRI produces (re zo NANGE ) images without use of radiation or ( IM a jing ) contrast medium. 4. positron emission tomography of A new technique that permits viewing the brain (PET of a slice of the brain and gives scan)……………….. information about brain function such ( POS i tron) (e MI shun) as blood flow. The patient is injected with radioactive material. A special (to MOG ra fe ) camera records the radioactive decay within the brain. The information is transmitted to a computer which projects images onto a television screen. IV. Case History: This 30-year-old white male was initially injured in a train accident approximately 1 year ago when he jumped from a moving boxcar. X-ray showed a forced flexion injury to the cervical spine compressing C-7. Compression of spinal cord was evident with subsequent quadriplegia. His condition was first treated and stabilized in an acute care facility. He was transferred to this facility for rehabilitation. He has been referred to Collaborative Care for discharge planning. Collaborative Care Conference: Nurse Practitioner- this patient continues to have a chronic sacral decubitus, stage 2, Which has not resolved with Duoderm or with wet to dry dressings. He has a urinary tract infection that has been resolved with a negative urine 144 culture 1 week ago. His bladder spasms are well controlled at this time with Baclofen, Valium, and talwin. Occupational Therapy:His treatment regimen consists of activities encouraging functional range of motion and ADL tid. A tenodesis splint has been ordered for left upper extremity. Short-term goal: OT for increased functional use of left hand when patient’s tenodesis splint is completed. Physical Therapy-in addition to treatment regimen in OT, PT tid is given to increase vital capacity, which appears to have peaked at 60% to 67% of the expected norm. patient is independent in getting on and off the bus. Medical social Service: Patient will be discharged to home in 1 week with mother as primary caretaker. Home supportive services will be instated when he is discharged. He is on state disability and has been cleared for independent Living Centers. He knows how to contact these resources. Exercise 13-1 Circle the term in the Choices column that answers each of the following questions. Question Choices 1. What part of the brain controls functions that include heart rate, basal nuclei; cerebrum; breathing, and body temperature? brain stem 2. The axon is one of two processes that extend from a neuron effector; dendrite; cell body; what is the other? neurotransmitter 3. What is the term for the envelope of glial cells that provides cell body; CNS; myelin protection and electrical insulation for neurons? sheath 4. What part of the brain processes information from the sense of frontal lobe; occipital lobe; sight and other sensory and motor tasks? parietal lobe 5. What part of the brain stem passes information to the psychomotor; pons; receptor cerebellum and the thalamus to regulate subconscious somatic activities? 6. What is the term for a blood clot in the brain? cerebrospinal; cerebellum; cerebral thrombosis 7. What is the clinical term for impaired speech? dementia; dysphasia; delirium 8. What is abnormal sensitivity to touch? hypothalamus hydrocephalus; hyperesthesia; 9. What is the word for inflamed gray matter of the spinal cord? cerebral cortex; cerebrum; poliomyelitis 10.What term means lack of muscular coordination? ataxia; synapse; paraplegia EXERCISE 13-2 Build terms for the following definitions by using the word parts it’s expected that studenthave learned. 141 a. WR S b. WR S 2. excision of a nerve WR S 3. suture of a nerve WR S 4. excision of a ganglion WR S 5. incision into the nerves WR 1. incision into a nerve root S 6. separating a nerve (from adhesions) WR CV S 7. surgical repair of a nerve WR CV S Answers key: EXERCISE 1 1. brain stem 4. occipital lobe 7. dysphasia 10. ataxia 2. dendrite 5. pons 8. hyperesthesia EXERCISE 2 1. a. radic/otomy b. rhiz/otomy 2. neur/ectomy 3. neur/orrhaphy EXERCISE 3 1. ech/o/encephal/o/graphy 2. electr/o/encephal o/gram 3. electr/o/encephal/o/graph 3. myelin sheath 6. cerebral thrombosis 9. poliomyelitis 4. ganglion/ectomy 5. neur/otomy 6. neur/o/lysis 7. neur/o/plasty 4. electr/o/encephal/o/graphy 5. myel/o/gram 6. cerebr/al angi/o/graphy 146 Chapter 14 The Special Sense Learning Objectives I. Surgical Terms II. Other Surgical Terms III. Diagnostic Procedural Terms IV. Case History V. Exercises General Aims : The unit is designed to help you learn Surgical Terms and Diagnostic Procedural Terms of Eye and Ear to increase your reading comprehension and to prepare you for reading similar passages. 147 Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Build, analyze, define, pronounce, and spell the surgical terms related to the Eye and Ear. Define, pronounce, and spell other surgical terms related to the Eye and Ear. The Eye The eye works in conjunction with the nervous system, specifically the visual cortex of the brain. The process of vision begins when photoreceptors in the eye detect photons, which are basic units of visible light, and is completed by photon-generated impulses traveling along the optic nerves (one in each eye connecting to the brain) to the visual cortices of the cerebral hemispheres. The process depends on a highly complex series of physiologic events, but for ease of understanding it can be compared to the operation of a camera. For example, each eye has a lens, a mechanism for widening or narrowing the opening through which light is admitted, and ways of focusing on objects whether close by or far away. This chapter will introduce you to the main parts of the eye and acquaint you with the terms that name them. Words and Word Elements Specific to the Eye The words and word elements shown in the following table are often found in terms related to the eye. You will recognize them in many of the terms you will learn in this chapter. TABLE 14-1 Common Words and Word Elements related to the Eye Word or Root Refers to blephar/o eyelid conjunctiva (plural: mucous membrane covering the anterior conjunctivae) surface of the eyeball core/o pupil of the eye cornea (plural: corneas) the outer wall of the eye; reflector of light dacry/o tears dacryocyst/o lacrimal sac irid/o iris (plural: irides) 142 ocul/o ophthalm/o opt/o palpebra (plural: palpebrae) phak/o; phac/o retin/o scler/o uve/o -opia eye eye light eyelid lens retina sclera middle layer of the eye containing muscles and blood vessels suffix denoting vision; a condition of the eye The Practice and the Practitioners The root ophthalm/o means “eye,” and as you learned in past Chapter, the suffix -logy means “study of.” Coupling this root and suffix gives the term ophthalmology, which refers to the medical specialty dealing with the eye. Dropping the y from this term and adding the suffix -ist produces the term ophthalmologist, which refers to a physician who specializes in ophthalmology. An ophthalmologist (sometimes called an oculist) provides eye care ranging from prescribing corrective lenses to treating eye diseases or even performing ophthalmic surgery. The term optometry refers to the practice of examining eyes for impaired vision and other disorders. It derives from the root opt/o (“light”) and the suffix -metry (“act of measuring”). An optometrist “measures” a patient's ability to see and, like an ophthalmologist, can prescribe corrective lenses. An optician is a specialist in the field of optics, which deals with the nature and characteristics of light. An optician uses the prescription for corrective lenses from an ophthalmologist or optometrist to make eyeglasses that improve a patient's vision. Main Structures of the Eye The eyeball is a sphere filled with a jelly-like, transparent substance called the vitreous body. The outside of the eyeball has three distinctive outer layers or “coats”: the fibrous tunic, the vascular tunic, and the neural tunic (tunic is the Latin word for “coat”). The fibrous tunic is the outermost layer, which connects with eye muscles. It consists of the cornea and the sclera (plural: sclerae). The vascular tunic, also called the uvea, is in the middle. It contains the iris (plural: irides), along with blood vessels and other tissues. The neural tunic, the innermost layer, is composed of the retina, where the nerves and light receptors (called rods and cones) are located. 149 The photoreceptors in the eye, which detect the presence of light, are of two kinds: cones and rods. The cones receive those photons that are traveling opposite to the direction one is looking, while the rods pick up those photons that strike the eye from the side. Most visual information comes through the cones, which enable us to see in full color. However, the rods are much more sensitive to light, which makes them more valuable than cones when we are in the dark. Unfortunately, the rods provide only black and white images that lack sharpness. The visible parts of the eye include the pupil (the dark part in the very center of the eye), the iris (the colored part), and the sclera (the white part). The cornea, a transparent shield of tissue, covers the iris, and directly behind the iris is the lens. The sclera extends all the way around the eyeball to the optic nerve, which lies at the very back. The retina is a thin layer of tissue just inside the sclera. When light rays reflect off an object we are looking at, they travel through the cornea and lens, which focuses them onto photoreceptors in the retina. After receiving these light signals, the retina changes them into electrical impulses that travel through the optic nerve to the brain, where they are interpreted. Accessory Structures of the Eye Accessory structures of the eye comprise the eyelid and the lacrimal apparatus, which includes glands that produce tears, and the ducts and other cavities that contain tears. (Lacrima is the Latin word for “tears.”) The conjunctiva (plural: conjunctivae) is the skin-like mucous membrane that covers the inside of the eyelid and the anterior part of eyeball. Conjunctivitis is a common childhood malady often referred to as “pinkeye.” Common Abbreviations: The Eye AbbreviationMeaning ECCE extracapsular cataract extraction EOC extraocular movement ERG electroretinography ICCE intracapsular cataract extraction IOP intraocular pressure OD right eye OS left eye OU both eyes PVD posterior vitreous detachment (referring to the vitreous body) 110 TABLE 14-2 Common Conditions and Procedures associated with the Eye Term Definition aphakia without a lens astigmatism fuzzy vision caused by the irregular shape of one or both eyeballs blepharectomy surgical removal of part or all of an eyelid blepharitis inflammation of the eyelid blepharochalasis relaxation of the eyelid blepharoconjunctivitisinflammation of the palpebral conjunctiva blepharoplasty surgery to correct a defective eyelid blepharoplegia paralysis of an eyelid blepharoptosis drooping eyelid(s) blepharospasm involuntary contraction of the eyelid blepharotomy surgical incision of an eyelid conjunctivitis inflammation of the conjunctiva conjunctivoplasty surgery on the conjunctiva coreoplasty surgical repair of the pupil corepexy surgical fixation of the iris dacryocele lacrimal sac filled with fluid; often called a dacryocystocele, because dacryocyst is a synonym for lacrimal sac dacryocystalgia pain in the lacrimal sac dacryocystectomy surgical removal of the lacrimal sac dacryocystotomy incision into the lacrimal sac dacryolith a “stone” in the lacrimal apparatus dacryorrhea excessive secretion of tears emmetropia normal vision hyperopia farsightedness iridocele hernia of the iris iridomalacia softening of the iris iritis inflammation of the iris lacrimation synonym for dacryorrhea lacrimotomy synonym for dacryocystotomy myopia nearsightedness oculodynia pain in the eyeball oculopathy generic term for eye disease; synonym for ophthalmopathy ophthalmolith synonym for dacryolith ophthalmomalacia softening of the eyeball 111 ophthalmoscope ophthalmoscopy phacocele phacolysis phacomalacia presbyopia retinectomy retinitis retinopathy retinopexy retinotomy scleroiritis scleromalacia uveitis device for examining the interior of the eyeball by looking through the pupil examination of the eye with an ophthalmoscope hernia of the lens operative removal of the lens in pieces softening of the lens farsightedness resulting from loss of elasticity in the lens surgical removal of part of the retina inflammation of the retina disease of the retina procedure to repair a detached retina an incision through the retina inflammation of the sclera and iris softening of the sclera inflammation of the uvea The Ear The brain cannot “hear” sound waves. Therefore, the job of the ears is to detect sound waves and then change them to electrical waves that the brain can use to interpret information (music, spoken words, etc.). The word that names the process of changing energy from one form to another is transduction. The verb is tranduce, and the devices that do the conversion (such as our ears) are transducers. Although these words are not medical terms, knowing their meanings will help you understand how the ear works. Words and Word Elements Specific to the Ear The words and word elements shown in the following table are often found in terms related to the ear. You will recognize them in many of the terms you will learn in this chapter. TABLE 14-3 Common Words and Word Elements related to the Ear Word or Root Refers to audi/o sound; hearing aur/o ear auricul/o ear cerumen brownish-yellow, waxy secretion of the ceruminous glands in the external auditory canal myring/o tympanic membrane (eardrum) 112 ot/o tympan/o ear eardrum The Practice and the Practitioners Coupling the root audi/o with the suffix -logy yields the term audiology, which deals with hearing and hearing disorders. An audiologist, therefore, is a specialist who measures hearing efficiency and treats hearing impairment. An otologist is a specialist in otology, the branch of medical science concerned with the study, diagnosis, and treatment of diseases of the ear and its related structures. The Structure of the Ear The ear is divided into three parts: the external, middle, and inner ears . The External Ear The external ear has two subparts. The outermost part, composed of flesh and cartilage, is called the auricle or pinna (both mean the same thing, but auricle is more commonly used). The other subpart, called the external auditory canal, extends to the tympanic membrane, or eardrum. The tympanic membrane separates the external and middle ears. The external ear funnels sound waves into the finer apparatus within the middle and inner ears. It also protects the ear from injury and infection. The ear's chief infection fighter is cerumen, a wax-like substance secreted by glands in the external auditory canal. The Middle Ear The middle ear starts on the other side of the tympanic membrane and is called the tympanic cavity. The eustachian tube, or auditory tube, connects the middle ear to the nasal passages. The eustachian tube allows air on both sides of the tympanic membrane to stay at an equal pressure. When you have a bad cold, this tube sometimes gets blocked, which causes obstruction that adversely affects your hearing and makes your head feel heavy. Organisms in the nasal passages often travel through the eustachian tube, causing infection in the ears. The middle ear has three parts, which together are called the auditory ossicles. They consist of three bones: the malleus (hammer), the incus (anvil), and the stapes (stirrup) . The Inner Ear The inner ear picks up sound at the oval window (the opening to the inner ear) from the stapes and transfers it to the vestibular duct. Sound then travels through the membranous labyrinth, which is a collection of canals inside the bony labyrinth. Receptors in the cochlea then transduce the sound waves into electrical signals that our brains can interpret. 111 Common Ear Disorders and Procedures Hearing impairment may be divided into three categories: sensorineural, conductive, and presbyacusis. Sensorineural hearing loss, as the name suggests, is caused by a neural condition—specifically, a disorder of the auditory nerve or some other part of the inner ear. Conductive hearing loss is caused by interference with sound transmission in the external auditory canal, middle ear, or ossicles. Presbyacusis is the hearing loss that occurs with aging. Table 14-4 Common Disorders and Procedures associated with the Ear Term Definition audiogenic caused by sound audiogram automatically recorded results of a hearing test with an audiometer (an electrical device for measuring hearing) audiometer electrical device for measuring hearing audiometry measuring hearing with an audiometer cochlear implant surgically implanted hearing aid in the cochlea conductive hearing hearing loss caused by interference with sound loss transmission in the external auditory canal, middle ear, or ossicles myringoplasty surgical repair of the tympanic membrane (eardrum) myringotomy incision or surgical puncture of the eardrum otalgia pain in the ear otitis inflammation of the ear (otitis externa = the outer ear; otitis media = the middle ear; otitis interna = the inner ear) otodynia earache otogenic originating in the ear otopathy any disease of the ear otoplasty cosmetic surgery on the auricle otorrhea fluid discharge from the ear otosclerosis formation of spongy bone in the inner ear producing hearing loss otoscope device for looking into the ear otoscopy looking into the ear with an otoscope presbyacusis hearing loss that occurs with aging sensorineural hearing hearing loss caused by a neural condition; specifically, a loss disorder of the auditory nerve or some other part of the inner ear tinnitus sensation of noises (such as ringing) in the ears 114 tympanectomy tympanocentesis tympanoplasty tympanotomy; tympanostomy vertigo surgical removal of the eardrum puncture of the tympanic membrane with a needle to aspirate middle ear fluid surgery performed on the middle ear synonyms for myringotomy sensation of spinning or whirling; can be caused by infection or other disorder in the inner ear Common Abbreviations The Ear AbbreviationMeaning AD right ear AS left ear AU both ears BC bone conduction db or DB decibel TM tympanic membrane (eardrum) AC air conduction ENT ear, nose, and throat OM otitis media HL hearing level EXERCISE 14-1 Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. 1. 2. 3. Term ophthalmology uvea pupil 4. 5. 6. iris sclera cornea 7. ocular conjunctiva Definition A. transparent shield of tissue covering the iris B. adjective associated with tears C. a thin layer of tissue, just inside the sclera, where light rays entering the eye converge D. the “colored” part of the eye E. the dark part in the very center of the eye F. mucous membrane covering the anterior surface of the eyeball G. the vascular tunic in the middle of the eye 111 8. ophthalmoscope 9. retina 10. lacrimal H. part of the outermost layer of the eye, which is white in color I. a device for examining the interior of the eyeball by looking through the pupil J. name of the medical specialty dealing with the eye EXERCISE 14-2 Circle the term in the Choices column that answers each of the following questions. Question Choices 1. What is the adjective form of cornea? cataract; corneal; corneous 2. What is the name of the outermost layer of the eye, neural tunic; fibrous tunic; which consists of the cornea and sclera? vascular tunic 3. The colored part of the eye (the anterior part of the iris; pupil; cornea vascular tunic) is referred to as what? 4. What is the term for the innermost layer of the eye, ocular tunic; vascular composed of the retina, where the nerves and light tunic; neural tunic receptors are located? 5. What is the name for the middle layer of the eye ocular tunic; vascular which contains the iris, blood vessels, and other tunic; fibrous tunic tissues? 6. What is the name for the medical specialty dealing retinopathy; with the eye? ophthalmology; optometry 7. What is the term for an examination of the eye ophthalmology; with an ophthalmoscope? blepharectomy; ophthalmoscopy 8. What is the name for the science of the nature and optics; ocular; optometry characteristics of light? 9. What is the term for a condition not caused by an amblyopia; aphakia; ocular lesion and not fully correctable by an astigmatism artificial lens? 10.What term do we use to express the condition of glaucoma; presbyopia; farsightedness that results from loss of elasticity in strabismus the lens? EXERCISE 14-3 Put an X in the True or False column next to each statement. Statement TrueFalse 1. When a disorder is classified as “corneal” it signifies that it's ___ ___ situated outside the eye. 2. The abbreviations for the right eye and left eye are OD and OS, ___ ___ respectively. 3. The abbreviation for both eyes is OSD. ___ ___ 116 4. Photoreceptors are the retinal cones and rods. ___ 5. The dark part in the center of the iris through which light enters the ___ eye is called the retina. 6. The pupil is the light-sensitive membrane forming the innermost ___ layer of the eyeball. 7. The sclera is the outer surface of the eye (part of the fibrous tunic). ___ 8. Glaucoma is a complete or partial opacity of the ocular lens. ___ 9. Cataracts are a disease of the eye characterized by increased ___ intraocular pressure and atrophy of the optic nerve. 10.Lack of parallelism in the visual axes (crossed eyes) is called a ___ refraction. ___ ___ ___ ___ ___ ___ ___ EXERICISE 14-4 Fill in the blanks with the correct terms. 1. The procedure performed to repair tears in the retina is called 2. _ is the name given to the procedure in which the cataract is lifted from the eye by an extremely cold probe. 3. Surgical removal of an eye is called a(n)_______. 4. ____ is the name given to the procedure that breaks up the lens with ultrasound and then aspirates it. 5. An incision into the tendon of a muscle to relieve a crossed- eyed condition is a(n) ______ . 6. ____ is the surgical creation of a drain to reduce intraocular pressure. 7. An operation to repair a detached retina in which the sclera is folded or resected, an implant inserted, and sutures made to hold the sclera is called---. 8. Surgery in which spoke-like incisions are made to flatten the cornea thus correcting nearsightedness is called a __. 9. Surgery to remove vitreous fluid from the eye is called________. EXERCISE 14- 5 Match the terms in the first column with the correct definitions in the second column. 1. strabotomy a. a surgery to flatten the cornea thus correcting 2. enucleation nearsightedness 3. trabeculectom b. surgical creation of a permanent drain to reduce 3. trabeculectomy intraocular pressure 4. retinal photocoagulation c. procedure to repair tears in the retina 5. cryoextraction of lens d. procedure in which the lens is broken up by ultrasound and aspirated e. incision into muscle tendon to relieve crossed eyes 6. phacoemulsification f. surgical removal of an eye 117 7. scleral buckling surgery 8. radial keratotomy 9. vitrectomy g. surgical removal of vitreous fluid h. operation in which a cataract is lifted from the eye with an extremely cold probe g. surgical removal of vitreous fluid h. operation in which a cataract is lifted from the eye with an extremely cold probe i. detaced reina surgery is which the sclera is folded, an implant inserted, and sutures made to hold the sclera Exercise 14- 6 Match the numbers in Column 1 with the letters in Column 2 according to the corresponding terms and definitions they designate. Term Definition 1. audiologist A. the eardrum 2. cerumen B. the process of changing energy from one form to another 3. otoscope C. specialist treating abnormal hearing 4. tympanoplasty D. device for looking in the ear 5. transduction E. inflammation of the middle ear 6. auditory ossicles F. part of the bony labyrinth (inner ear) 7. otitis media G. wax-like secretion in the external auditory canal 8. tympanic membrane H. auditory tube, which connects the middle ear to the nasal passages 9. Eustachian tube I. surgery performed on the middle ear 10. cochlea J. three small bones in the inner ear, the malleus, incus, and stapes EXERCISE 14-7 Put an X in the True or False column next to each statement. Statement TrueFalse 1. The auricle is one of the two parts of the external ear (the other is ___ ___ the auditory canal). 2. The term for the middle ear is the tympanic membrane. ___ ___ 3. Hearing loss caused by interference with sound transmission in the ___ ___ external auditory canal, middle ear, or ossicles is called conductive hearing loss. 4. The otologist checks ears by looking into them with an audiometer. ___ ___ 5. To perform a surgical repair of the tympanic membrane, a doctor ___ ___ performs a myringoplasty. 6. The Rinne test is a hearing test that uses a tuning fork. ___ ___ 7. A tuning fork is an instrument that lights up when struck. ___ ___ 8. The Weber test is a hearing test that uses a tuning fork. ___ ___ 112 9. The common abbreviation for the right ear is “AS.” 10.The common abbreviation for both ears is ADAS. ___ ___ ___ ___ Answers key: EXERCISE 11 1 J 2 3 4 G E D EXERCISE 2 1 2 corneal fibrous tunic 6 7 ophthalmology ophthalmoscopy 1 False 2 True 3 False 5 H 6 A 3 iris 8 optics EXERCISE 6 1 2 C G EXERCISE 7 1 True 6 True 3. b 4. c 3 D 2 False 7 False 9 C 7 True 8 False 10 B 5 vascular tunic 10 presbyopia 9 10 False False 6. strabotomy 7. trabeculectomy 8. radial keratotomy 9. vitrectomy 5. h 6. d 4 I 8 I 4 neural tunic 9 amblyopia EXERCISE 3 4 5 6 True True True EXERCISE 4 1. retinal photocoagulation 2. cryoextraction of the lens 3. enucleation 4. phacoemulsification 5. strabotomy EXERCISE 5 1. e 2. f 7 F 5 B 7. i 8. a 6 J 3 True 8 True 119 7 E 9. g 8 A 4 False 9 False 9 H 10 F 5 True 10 False Chapter 15 Diagnosis and Treatment; Surgery Learning Objectives I. Diagnosis II. Imaging Techniques III. Treatment IV. Cancer V. Key Terms VI. Roots Pertaining to Physical Factors VII. Suffixes Pertaining to Diagnosis VIII. Suffixes Pertaining to Surgery IX. Additional Term X. Abbreviations XI. Exercises General Aims : The unit is designed to help you learn Diagnosis and Treatment; Surgery Terms to increase your reading comprehension and to prepare you for reading similar passages. 160 Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Describe the main methods used in examination of a patient List the main components of a medical history Name seven forms of treatment Describe how staging is used in treatment of cancer Name ant describes eight imaging techniques Identify and use the roots and suffixes pertaining to diagnosis and surgery Define additional medical terms pertaining to diagnosis and treatment, including surgery Interpret abbreviations used in diagnosis and treatment Diagnosis Medical diagnosis begins with a patient history. This includes a history of the present illness with a description of symptoms, a past medical history, and a family and social history. A physical examination of all the patient’s systems follows the history taking. Practitioners use techniques of inspection, palpation, percussion, and auscultation to perform physicals. Tools such as the stethoscope, ophthalmoscope otoscope and blood pressure apparatus are also mployed. Diagnosis is further aided by laboratory tests. These may include tests on blood, urine, and other body fluids, study of specimens taken by biopsy, and identification of infectious organisms. Additional tests may include studies of the electrical activity of tissues such as the brain and heart, examination of body cavities by means of an endoscope and imaging techniques. II. Imaging techniques Imaging techniques are methods used to visualize body structure or function. The most fundamental imaging method is radiography, which uses x-rays to produce a picture on sensitized film. The value of this method may be increased with a contrast medium, such as a barium mixture, to OUTLINE soft tissue. Imaging Techniques Method Radiography Ra-de-OG-ra-fe Description Use of x-rays passed through the body to make a visual record (radiograph) of internal structures on specially sensitized film; also called roentgenography 161 Fluoroscopy Flū-or-OS-kō-pē Use of x-rays to examine deep structures. The shadows cast by x-rays passed through the body are observed on a fluorescent screen. The device used is called a fluoroscope . Cineradiography Making of a motion picture of successive images Sin-e-rā-dē-OG-ra-fē appearing on a fluoroscopic screen computed tomography Use of a computer to generate an image from a (CT; CT scan) large number of x-rays passed at different angles Tō-MOG-ra-fē through the body. A three-dimensional picture of a cross-section of the body is obtained. Reveals more about soft tissues than simple x-rays; also called CAT (computerized axial tomography). Ultrasonography Generation of a visual image from the echoes of ul-tra-son-OG-ra-fe high-frequency sound waves traveling back from different tissues; also called sonography and echography (ek-OG-ra-fē) Scintigraphy Production of an image of the distribution of Sin-TIG-ra-fe radioactivity in tissues after internal administration of a radioactive substance (radionuclide). The images are obtained with a scintillation camera. The record produced is a scintiscan. magnetic resonance imaging Production of images through the use of a (MRI) magnetic field and radiowaves. The characteristics of soft tissue are revealed by differences in molecular properties; eliminates the need for x-rays and contrast media. positron emission Production of sectional body images by tomography (PET) administration of a natural substance, such as glucose, labeled with a positron-emitting isotope. The rays subsequently emitted are interpreted by computer to show the internal distribution of the substance administered. PET has been used to follow blood flow through an organ and to measure metabolic activity within an organ, such as the brain, under different conditions. III. Treatment 162 If diagnosis so indicates, treatment is begun. This may consist of counseling, drugs, surgery, radiation, physical therapy, occupational therapy, psychiatric treatment, or a combination of these. IV. Cancer The methods important in the diagnosis of cancer include physical examination, biopsy, imaging techniques, and laboratory tests for certain enzymes associated with the disease. Staging is a procedure for establishing the extent of tumor spread, both at the original site and in other parts of the body (metastases). Staging is important for selecting and evaluating therapy, and for estimating the outcome of the disease. The TNM system is commonly used. These letters stand for primary tumor (T), regional lymph nodes (N), and distant metastases (M). Evaluation in these categories varies for each type of tumor. Based on TNM results, a stage ranging in Roman numerats from I to IV in severity is usually assigned. The most widely used methods for treatment of cancer are surgery, radiation therapy, and chemotherapy, treatment with chemicals. V. Key Terms Auscultation (aws-kul-TĀ-shun) Biopsy (BĪ-op-sē) chemotherapy (kē-mō-THER-a-pē) Diagnosisn (di-ag-NO-sis) Endoscope (EN-do-skop) Excision (ek-SIZH-un) Incision (in-SIZH-un) Inspection (in-SPEK-shun) Ophthamoscope (of-THALmo-skop) Otoscope (O-to-skop) Listening for sounds within the body, usually within the chest of abdomen Removal of a small amount of tissue for microscopic examination The use of chemicals to treat disease The process of determining the cause and nature of an illness An instrument for examining the inside of an organ or cavity through a body opening or small incision. Most endoscopes use fiberoptics for viewing Removal by cutting A cut, as made for surgery; also the act of cutting Visual examination of the body An instrument for examining the interior of the eye An instrument for examining the ear 161 Palpation (pal-PA-shun) Percussion (per-KUSH-un) Prognosis (prog-NO-sis) Radionuclide (ra-de-o-NU-klid) Sign Staging Stethoscope (STETH-o-skop) Suture (SU-tum) Symptom (SIM-tum) Syndrome (SIN-drom) Therapy (THER-a-pe) Examining by placing the hands or fingers on the surface of the body Tapping the body lightly but sharply in order to assess the condition of the underlying part by the sounds obtained Prediction of the course and outcome of a disease A substance that gives of radiation; used for diagnosis and treatment; also called radioisotope or radiopharmaceutical An evidence of disease that can be observed or tested. Examples are fever, rash, high blood pressure, blood or urine abnormalities. An symptom The process of classifying malignant tumors for diagnosis, treatment, and prognosis An instrument used for listening to sounds produced within the body To unite parts by stitching them together; also the thread or other material used in that process or the seam formed by surgical stitching Any evidence of disease; sometimes limited to subjective evidence of disease, as experienced by the individual, such as pain, dizziness, weakness A group of signs and symptoms that together characterize a disease condition Treatment; intervention VI. Roots Pertaining to Physical Factors Root Meaning Example aer/o Air, gas aerobe A er ob bar/o pressure barotraumas bar o TRAW ma Chrom/o chromat/o Chron/o color, stain chromatic Definition organism that requires air (oxygen) to live injury (trauma) caused by pressure, as to the ear pertaining to color kro MAT ik Time synchronous occurring together SIN kro nus cry/o Cold cryoprobe Instrument used to apply Extreme cold to tissues KRI o prob 164 Electr/o electricity electroshock shock produced by electricity e LEK tro shok erg/o Work synergistic sin er JIS tik phot/o Light radi/o radiation, Radioactive x-ray ra de o AK tiv Sound ultrasonic son/o photosensitive fo to SEN si tiv ul tra SON ik Therm/o Heat, hypothermia temperaturehi po THER me a VII. Suffixes Pertaining to Diagnosis Suffix Meaning Example -graph instrument for Spirograph recording data SPI ro graf -graphy act of roentgenography rent gen OG ra fe recording Data -gramt A record of sonogram data SO no gram -meter instrument for Ergometer Measuring er GOM e ter -metry measurement Optometry op TOM e tre of -scope instrument for Cystoscope viewing or SIST-o-skop examining -scopy Examination Laparoscopy of Lap-or-OS-ko-p e acting together with increased effect like drugs in combination abnormally sensitive to ligtht giving off radiation pertaining to higth-frequency sound waves low body temperature Definition instrument used to record Breathing (spir/o) movements obtaining pictures with roentgen rays ,(x-ray); radiography record obtained by ultrasonography instrument for measuring work (erg/o) done measurement of vision (opt/o) for glasses endscope used to examine the Urinary bladder examination of the abdomen through the abdominal wall VIII. Suffixes Pertaining to Surgery Suffix Meaning Example Definition -centesis puncture,tap celiocentesis puncture of the abdomen Sē-lē-ō-sen-TĒ-sis -desis binding, fusion Pleurodesis binding the pleural membranes Plū-rō-DĒ-sis (around the lungs) 161 -ectomy excision, surgical ton-sillectomy -pexy Removal surgical fixation ton-sil-EK-tō-mē uteropexy Ū-ter-ō- PEKS-ē -tome plastic repair, reconstruction surgical repair, suture surgical creation of an opening instrument for -tomy incision of, -tripsy Crushing septoplasty sep-tō-PLAS0-tē herniorrhaphy her-nē-OR-a-fē colostomy kō-LOS-tō-mē dermatome DER-ma-tōm laparotomy lap-ar-OT-ō-mē lithotripsy LITH-ō-trip-sē -plasty -rhaphy -Stomy IX. Additional Terms symptoms clubbing colic(KOL-ik) cyanosis(ai-an-Ō-sis) Diaphoresis (di-a-fo-RE-sis) malaise(ma-LĀZ) nocturnal(nok-TUR-nal) pallor(PAL-or) prodrome(PRŌ-drōm) sequela(sē-KWĒ-la) syncope(SIN-kō-pē) excision of the fonsils (tonsil/o) surgical fixation of the uterus(uter/o) plastic repair of the nasal septum(partition) surgical repair of a hernia (herni/o) colon (col/o) instrument for cutting the skin surgical incision of the abdomen crushing of a stone Enlargement of the ends of the fingers and toes With curving of the nails. Seen in a variety of diseases, especially lung diseases and infection of the heart lining. Acute abdominal pain associated with smooth muscle spasms Bluish discoloration of the skin due to lack of oxygen Profuse sweating A feeling of discomfort or uneasiness, often indicative of infection Pertaining to or occurring at night (roots noct/i and nyct/o mean "night") Paleness; lack of color A symptom indicating an approaching disease A lasting effect of a disease (pl. sequelae) A temporary loss of consciousness due to inadequate blood flow to the braing; fainting 166 Diagnosis Alpha- fetoprotein (al-fa-fē-tō-prō-tēn)(AFP) Bruit (bruē) Facies (FĀ-shē-ēz) Febrile (FEB-ril) nuclear medicine Radiology(rā-dē-OL-ō-jē) Catheter (KATH-e-ter) Lavage(la-VAZH) Paracentesis (par-a-sen-TĒ-sis) prophylaxis (prō-fi-LAK-sis) Surgery drain exeresis(eks-ER-e-sis) extirpation (ek-ster-PA-shun) laser(LĀ-zer) ligature(LIG-a-chūr) resection(rē-SEK-shun) X. Surgical Instruments Instrument bougie BOO-zhē cannula A fetal protein that appears in the blood of adults with certain types of cancer A sound, usually abnormal, heard in auscultation The expression or appearance of the face Pertaining to fever The branch of medicine concerned with the use of radioactive substances (radionuclides) for diagnosis, therapy, and research The branch of medicine that uses radiation, such as x-rays, in the diagnosis and treatment of disease. A thin tube that can be passed into the body; used to remove fluids from or introduce fluids into a body cavity. The washing out of a cavity; irrigation Puncture of a cavity for removal of fluid Prevention of disease Device for allowing matter to escape from a wound or cavity. Common types include Penrose, (cigarette), T-tube, Jackson-Pratt (J-P), and Hemovac Surgical removal Complete removal of destruction of an organ of tissue A device that transforms light into a beam of intense heat and power; used for surgery and diagnosis A tie or bandage; the process of binding or tying (also called ligation) Partial excision of a structure Description slender, flexible instrument for exploring and dilating tubes tube enclosing a trocar that allows escape of fluid 167 KAN-ū-la elevator EL-e-vā-ter forceps FOR-ceps gigli’s saw JĒ-yēz hemostat HĒ-mō-stat lithotrite LITH-ō-trit Rasp rongeur Ron-ZHUR scalpel SKAL-pel sound sownd trocar TRO-kar or air after removal of the trocar instrument for lifting tissue or bone instrument for holding or extracting flexible wire saw small clamp for stopping blood flow from a vessel instrument for crushing bladder stones Surgical file gouge forceps surgical knife with a sharp blade instrument for exploring a cavity or canal sharp-pointed instrument contained in a cannula used to puncture a cavity XI. Abbreviations A. History and physical Examination BP blood pressure C celsius (centigrade) CC chief complaint c/o complains of EOMI extraocular muscles intact F fahrenheit HEENT head, eyes, ears, nose, nose, and throat h/o history of H&P history and physical HPI history of present illness I&O intake and output IPPA inspection, palpation, percussion, auscultation NAD no apparent distress P pulse PE physical examination PE(R) RLA pupils equal react to light and accommodation 162 PMH past medical history Pt patient R respiration R/O rule out ROS review of systems T temperature TPR temperature, pulse, respiration VS vital signs WD well developed WNL within normal limits B. Diagnosis and treatment ABC aspiration, biopsy, cytology AFP alpha-fetoprotein bx biopsy Ci curie (unit of radioactivity) C&S culture and (drug) sensitivity (of bacteria) CT computed tomography Dx diagnosis ICU intensive care unit I&D incision and drainage MET metastasis MRI magnetic resonance imaging PCA patient-controlled analgesia PET positron emission tomography Postop postoperative Preop preoperative RATx radiation therapy Rx drug, prescription, therapy TNM (primary) tumor, (regional lymph) nodes, (distant) metastases UV ultraviolet C. Views for X-ray AP anteroposterior LL left lateral PA posteroanterior RL right lateral EXERCISE 15-1 Match each of the following words with its meaning and write the appropriate letter (a-e) to the left of each number. ― 1. radiograph a. pertaining to high pressure 169 ― 2. thermometer ― 3. achromatic ― 4. phototherapy ― 5. hyperbaric b. treatment by light c. record produced by x-rays d. instrument for measuring temperature e. without color EXERCISE 15-2 Matching. Match the terms in each of these sets with their definitions and write the appropriate letter (a-e) to the left of each number. ― 1. Chronograph a.record of the heart’s acptivity ― 2. Ultrasonography b. instrument for recording time ― 3. Cardiogram c. measurement of the pelvis ― 4. pelvimeter d. use of sound waves to record data ― 5. pelvimetry e. instrument for measurement of the pelvis ― 6. Bronchoscope a. x-ray picture ― 7. Bronchoscopy b. examination of the bronchi ― 8. Microscope c. record of temperature variation ― 9. Radiograph d. instrument for examining the bronchi ― 10. thermogram e. instrument for examining very small objects EXERCISE 15-3 Match the words in the list with their meanings and write the appropriate letter (a-e) to the left of each number: ― 1. thoracentesis a. plastic repair of the hand ― 2. adenectomy b. excision of a gland ― 3. chiroplasty c. surgical puncture of the chest ― 4. gastrorrhaphy d. crushing of a nerve ― 5. neurotripsy e. suture of the stomach EXERCISE 15-4 Match the terms in each of these sets with their definitions and write the appropriate letter (a-e) to the left of each number: ― 1. palpation a. listening for body sounds ― 2. staging b. prediction of the outcome of disease ― 3. auscultation c. examination by touch ― 4. biopsy d. removal of tissue for microscopic examination ― 5. prognosis e. classification of malignant tumors ― 6. cryoextraction ― 7. chromatic ― 8. chemotherapy ― 9. photoreaction ― 10. radiologist a. response to light b. specialist in the use of x-rays c. removal by use of cold d. pertaining to color e. use of chemicals to treat disease 170 ― 11. roentgenogram ― 12. scintiscan ― 13. spirometer ― 14. endoscopy ― 15. arthroscope ― 16. paracentesis ― 17. lithotripsy ― 18. gastrectomy ― 19. resection ― 20. lavage a. examination of an organ or cavity with a lighted instrument b. radiograph c. image obtained with a radionuclide d. instrument for measuring breathing e. device for examining the inside of a joint a. surgical removal of all or part of part of the stomach b. washing out of a cavity c. puncture of a cavity for removal of fluid d. crushing of a stone e. partial excision ― 21. diaphoresis ― 22. colic ― 23. malaise ― 24. prodrome ― 25. syndrome a. feeling of discomfort b. acute abdominal pain c. group of symptoms that characterizes a disease d. profuse sweating e. symptom of an approaching disease ― 26. bid ― 27. qh ― 28. prn ― 29. ac ― 30. po a. every hour b. by mouth c. before meals d. twice a day e. as needed Answers key : EXERCISE 1 1-c 2-d 3-e 4-b EXERCISE 2 1. b 3. a 2. d 4. e EXERCISE 3 1-c 2-b 5-a 5. c 6. d 7. b 8. e 3-a 4-e 5-d EXERCISE 4 1-c 4-d 7. d 2-e 5-b 8. e 3-a 6-c 9. a 10. b 11. b 12. c 13. d 14. a 15.e 16.c 17.d 18.a 171 19.e 20.b 21.d 9. a 10. c 22.b 23.a 24.e 25.c 26.d 27.a 28.e 29.c 30.b Chapter 16 Directional Terms, Anatomical Planes , Regions, and Additional Terms Learning Objectives I. Introduction II. Body Directional Terms III. Anatomical Planes IV. Anatomical Abdominal Regions V. Additional Terms VI. Exercises General Aims : The unit is designed to help you learn Directional Terms, Anatomical Planes , Regions, and Additional Terms to increase your reading comprehension and to prepare you for reading similar passages. 172 Behavioral Objectives : Upon completion of this chapter students are expected to be able to: Define, pronounce, and spell the terms used to describe the body directions. Define, pronounce, and spell the terms used to describe the anatomical planes. Define, pronounce, and spell the terms used to describe the anatomical abdominal regions. Define, pronounce, and spell additional terms related to the body. Directional Terms, Anatomical Planes , Regions, and Additional Terms I. Introduction In the description of body directions and planes a position of reference is used. In the anatomical position, as it is called, the body is viewed as erect, arms at the side with the palms of the hands facing forward and feet placed side by side. Whether the patient is standing or lying down face up, the directional terms are the same. II. Body Directional Terms TERM 1. a. cephalic (head) (se FAL ik ) b. superior (above) (su PE R e or ) 2. a. caudal (tail) (CAW dal ) .….. DEFINITION toward the top of the body toward the lower end of the body b. inferior (below) (in FE R e or ) 3. a. anterior (an TE R e or ) … toward the front of the body (VEN tral ) 4. a. posterior ( pos TE R e or ) b. dorsal ( DO R sal) ……....…… toward the back of the body 5. medial (ME de al ) ………… 6. lateral ( LAT er al ) ……...…. toward the midline or middle toward the side 171 7. distal ( DIS tal ) ……………… away from the point of origin or from the beginning of a structure. at the distal end, the tibia joins the ankle. 8. proximal ( PROK si mal) …... closest to the point of origin or near the beginning of a structure. at the proximal end,the tibia joins the knee. III. Anatomical Planes Planes are imaginary flat fields used as points of reference to identify the position of parts of the body . TERM DEFINITION 1. frontal of coronal plane…. vertical field passing through the body ( KOR o nal ) from side to side, dividing the body into anterior and posterior portions 2. sagittal plane…………….. vertical field running through the body (SAJ i tal ) from front to back, dividing the body into right and left sides. Midsagittal divides the body into right and left halves. 3. transverse plane…………. horizontal field dividing the body into (trans VERS ) upper and lower portions. IV. Anatomical Abdominal Regions To assist medical personnel to locate medical problems with greater accuracy and for identification purposes, the abdomen is divided into regions. TERM DEFINITION 1. umbilical region………. around the navel (umbilicus) (um BIL i kal) 2. epigastric region…………directly above the umbilical region (ep i GAS trik ) 3. hypogastric region………directly below the umbilical region (hI po GAS trik ) 4. hypochondriac regions….to the right and left of the epigastric region (hI po KON dre ak ) 5. lumbar regions………… to the right and left of the umbilical region ( LUM bar ) 6. iliac regions……………. to the right and left of the hypogastric region ( IL e ak ) 174 V. Additional Terms TERM DEFINITION 1. extension…………… movement in which a limb is placed in a straight (ek STEN shun) position 2. flexion……………. movement in which a limb is bent ( FLEK shun) 3. afferent…………… conveying toward a center (for example, afferent ( AF er ent ) nerves carry impulses to the central nervous system) 4. efferent…………… conveying away from the center (for example, ( EF er ent ) efferent nerves carry information away from the central nervous system to muscles and glands) 5. plantar ( PLAN tar ) .. pertaining to the sole of the foot 6. palmar ( PAL mar) … pertaining to the palm of the hand 7. prone ( pro n) ….……. lying straight on one’s front;facedown 8. supine (de p) ……..…. lying straight on one’s back;faceup 1. Deep (de p) ……….…. situated far below the surface 10. superficial………... situated near the surface (su per FISH al ) 11. adduction………… state of drawing toward the middle (ad DUK shun) 12. abduction……..….. state of drawing away from the middle (ab DUK shun) 13. eversion…………… state of turning outward (e VER zhun) 14. inversion………… state of turning inward (in VER zhun) 15. bilateral…………. pertaining to both sides (bI LAT er al ) 16. unilateral………… pertaining to one side only (u ni LAT er al ) EXERCISE 16- 1 Match the terms in the first column with the correct definitions in the second column. The answers in the second column may be used more than once. 1. anterior a. toward the top 2. caudal b. toward the side 3. cephalic c. closest to the point of origin 171 4. distal 5. dorsal 6. inferior 7. lateral 8. medial 9. posterior 10. proximal 11. superior 12. ventral d. toward the front e. toward the back f. away from the point of origin g. toward the lower end h. toward the middle EXERCISE 16-2 Fill in the blanks with the correct terms. 1. The plane that divides the body into superior and inferior portions is the plane. 2. The plane that divides the body into right and left halves is the plane. 3. The plane that divides the body into anterior and posterior positions is the plane. EXERCISE 16-3 Fill in the blanks with the correct terms. 1. The regions to the right and left of the hypogastric region are the regions. 2. The region is directly above the umbilical region. 3. lnferior to the umbilical region is the region. 4. The are the regions to the right and left of the epigastric region. 5. superior to the hypogastric region is the region. 6. To the right and the left of the umbilical region are the region. EXERCISE 16-4 Match the terms in the first column with the correct definitions in the second column. _____ 1. epigastric a. inferior to the navel _____ 2. hypochondriac b. superior to the navel _____ 3. hypogastric c. right and left of the umbilical region _____ 4. iliac d. right and left of the epigastric region _____ 5. lumbar e. right and left of the hypogastric region _____ 6. umbilical f. below the hypogastric region g. inferior to the epigastric region EXERCISE 16-5 Match the terms in the first column with the correct definitions in the second column. _____ 1. abduction a. movement in which the limb is placed in a straight position _____ 2. adduction b. pertaining to the palm of the hand 176 c. lying straight on one’s front; facedown d. state of turning outward e. conveying away from center f. situated near the surface G. pertaining to both sides h. state of drawing toward the middle i. pertaining to the sole of the foot j. conveying toward the center k. lying straight on one’s back: faceup i. situated far below the surface m. state of turning in ward n. pertaining to one side only o. movement in which the limb is bent p. about the navel q. state of drawing away from the middle _____ 3. afferent _____ 4. bilateral _____ 5. deep _____ 6. efferent _____ 7. eversion _____ 8. extension _____ 9. flexion _____ 10. inversion _____ 11. palmar _____ 12. plantar _____ 13. prone _____ 14. superficial _____ 15. supine _____ 16. unilateral EXERCISE 16-6 Fill in the blanks with the correct terms. The italicized words refer to the correct answer. While examining the patient the physician did the following: 1. Brought the arm toward the middle of the body, or the arm. 2. Examined the patient’s eyes and found cataracts, or cataracts in both eyes. 3. Tested the reflexes on the sole, or side, of the foot. 4. Placed the patient on the examining table in a faceup, or , position. 5. Noticed small hemorrhages situated near the surface of the skin and noted on the chart that the hemorrhages were . 6. , or bent, the patient’s knee. 7. Turned the patient over in a facedown, or , position. Answers key: EXERCISE 1 1. d 3. a 2. g 4. f 5. e 6. g 7. b 8. h EXERCISE 2 1. transverse 2. midsagittal EXERCISE 3 1. iliac 3. hypogastric 177 9. e 10. c 11. a 12. d 3. coronal or frontal 5. umbilical 2. epigastric EXERCISE 4 1. b 2. d EXERCISE 5 1.q 2.h 9.o 10.m 3.j 11.b EXERCISE 6 1. adducted 2. bilateral 4. hypochondriac 6. lumbar 3. a 5. c 4.g 12.i 4. e 5.l 13.c 3. plantar 4. supine 6.e 14.f 6. g 7.d 15.k 8.a 16.n 5. superficial 6. flexed BIBLIOGRAPHY 1. Nie L, Akbari M, Li T, Chua T-S, editors. A Joint Local-Global Approach for Medical Terminology Assignment. MedIR@ SIGIR; 2014. 2. Brooks ML, Brooks DL. Exploring medical language: Elsevier Health Sciences; 2014. 3. Chabner D-E. Medical terminology: A short course: Elsevier Health Sciences; 2014. 4. Venes D. Taber's cyclopedic medical dictionary: FA Davis; 2013. 5. Collins CE. A short course in medical terminology: Lippincott Williams & Wilkins; 2013. 6. Steiner SS, Capps NP. Quick medical terminology: a self-teaching guide: John Wiley & Sons; 2011. 172