Chapter 1The 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.

Analyzing Medical Terms

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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 ElementsYou 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.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.

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TABLE 1-1 Common Roots of medical TermsRoot Refers tocard/i/o Heartderm/o, dermat/o Skinger/o, geront/o Agedhem/o, hemat/o Bloodneur/o a nerve cell, the nervous systemoste/o Bonepath/o Diseasepsych/o Mind

TABLE 1-2 Common Suffixes in Medical TermsSuffix Meaning-algia Pain-derm Skin-dynia Pain-it is Inflammation-logy study of, specialty of-path/y Disease

Additional SuffixesThe suffixes given in the following table will come into play when you study the terminology concerned with individual body systems.

TABLE 1-3 Additional SuffixesSuffix 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

-ism a noun-forming suffix indicating a condition, practice, or doctrine

-lith a stone, calculus, calcification-lysis Disintegration-mania a morbid impulse toward a specific object or thought

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-opsy visual examination-pathy Disease-phobia a word meaning fear, often appearing as a suffix-poiesis producing or formation-sclerosis not really a suffix, but a root meaning “hard” that

sometimes combines with other roots to indicate a condition of hardness

-sis Condition-stasis level; unchanging-stenosis narrowed, blocked-stomy permanent opening-tome instrument for cutting

Chapter 2The Common Suffixes and Prefixes in Medical Terms

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Learning ObjectivesI. Common Suffixes in Medical TermsII. Suffixes That Denote Adjectives III. Common Prefixes in Medical TermsIV. Prefixes of time or speedV. Prefixes of direction and positionVI. Prefixes of Size or NumberVII. 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.

Common SuffixesThe 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

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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 SuffixesDividing 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 CONDITIONSSuffix 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

(blood) + -rrhage-rrhea discharge-rrhexis rupture-spasm muscular contraction-pnea breath, respiration

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TABLE 2-2 Suffixes that signify diagnostic terms, test information, or surgical proceduresSuffix Refers to-centesis surgical puncture-desis surgical binding-ectomy surgical removal-gen, -genic, -genesis

origin, producing

-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 AdjectivesThe suffixes -ac,-al,-aneous,-ar,-ary,-derm ,-eal,-eous,-iatric,-ic,-oid,-otic,-ous,-tic,-ular convert root nouns to adjectives.

Common PrefixesA 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 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, ante- means “before” and meridiem means “noon.”

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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 PrefixesDividing 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 SpeedPrefix Refers toante-, pre-

Before

brady- abnormally slow rate of speedneo- Newpost- Aftertachy- rapid, abnormally high rate of speed

TABLE 2-4 Prefixes of DirectionPrefix Refers toPrefix Refers toab- away from, outside of, beyondad- toward, near tocon-, sym-, syn-

With

contra- Againstdia- across, through

TABLE 2-5 prefixes of positionPrefix Refers toec- Outsideecto- Outside

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en- Insideendo- Withinepi- upon, subsequent toex- Outsideexo- Outsideextra- Beyondhyper- above, beyond normalhypo- below, below normalinfra- inside or belowinter- Betweenintra- Insidemeso- Middlemeta- Beyondpan- all or everywherepara- alongside, likeretro- backward, behind

TABLE 2-6 Prefixes of Size or NumberPrefix Refers tobi- Twohemi-, semi- Halfmacro- Bigmicro- Smallmono- Oneolig-, oligo- a fewpan- all or everywherequadri- Fourtri- Threeuni- One

Chapter 3

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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. Interpret abbreviation used in diagnosis and treatment.

The Body's Organization

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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 CavitiesThe 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 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

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-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 SubdivisionsVentral Cavity Dorsal CavitySubcavities Subcavities1. thoracic 1. cranial2. abdominopelvic 2. spinal

TABLE 3-2 New Roots related to Body CavitiesRoot Origin Meaningabdomin/o abdomen (French for “abdomen”) abdomencrani/o cranium (from Greek kranion) skullthorac/o thorax (Greek for breastplate) chest

TABLE 3-3 Directional AdjectivesAnatomic Position Directionanterior or ventral toward the front and away from the back of the bodydistal away from the attachment point of a limb (arm or leg)inferior away from the headlateral away from the middle of and toward the side of the bodymedial toward the middle of the bodyposterior or dorsal toward the back and away from the front of the bodyproximal toward the attachment point of a limb (arm or leg)superior or cranial toward the head

Body SystemsApart 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 System, Immune System, Urinary ystem, Reproductive System, Nervous System, Eye, and Ear.

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TABLE 3-4 NEW ROOTS RELATED TO BODY SYSTEMSRoot System Meaningangi/o blood and immune vesselmy/o muscular musclepneum/o,pneumon/o,pneumat/o

respiratory lung

Chapter 4

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The Integumentary system

Learning ObjectivesI. Word Elements related to the Integumentary SystemII. Common Disorders and Procedures Associated with the Integumentary

SystemIII. Sublayers of the EpidermisIV. Surgical TermsV. Case HistoryVI. 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.

The Integumentary System

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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 Systemword of Element Type Refers tocorium (KO-ree-uhm) Latin word for “skin” synonym for

dermiscutis Latin word meaning “skin”;

cutaneous, which refers to the skin.

skin

cyan/o Root blue-cyte Suffix cellderm/o; dermat/o Root skinepi- prefix uponfollicul/o Root folliclekerat/o Root horn-likeleuk/o Root whitemelan/o Root blackonych/o Root nail-phyte Suffix plantpil/o Root hairsub- prefix belowsudor/i Root sweatxer/o Root dry

The SkinThe 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.

The Epidermis

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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 EpidermisEpidermal Skin Layer Brief Descriptionstratum corneum the tough, waterproof outer sublayer of the skinstratum lucidum the transparent, barely discernible sublayer just below the

stratum corneumstratum granulosum

the grainy sublayer between the stratum lucidum and 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 germinativum

the innermost sublayer of skin, which butts against the loose connective tissue of the dermis; forms epidermal ridges that connect with the dermis

Subcutaneous TissueA 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 MelaninComposed 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.

The Structure of Hair and Nails

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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 SystemTerm Definitiondermatitis inflammation of the skindermatoma skin tumordermatomegaly excessive skin, often hanging in foldsdermatomycosis

fungal infection of the skin

dermatopathy any disease of the skindermatoplasty plastic surgery performed on the skinepidermitis inflammation of the epidermismelanoma tumor of the melanocytesonychectomy surgical removal of a nailonychomalacia softening of the nailsonychomycosis fungal infection of a nailonychopathy any disease of the nailsonychoplasty surgical repair of a nailonychotomy incision into a nailparonychia infection around a nail

IV. Surgical TermsTERM(built from word parts)

DEFINITION

1. biopsy(BI-op-se) view of life (the removal of living tissue from the body to be viewed under the microscope)

2. dermatoautoplasty(der- ma- to- AW- to- plas- te)

Plastic repair using patient’s own skin forthe skin graft

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3. dermatoheteroplasty(der- ma- to- HET- er- o- plas- te)

Plastic repair using skin from others for the skin graft

4.dermatoplasty(DER- ma- to- plas- te)

Plastic repair on the skin

1. onychectomy(on- i- KEK- to- me)

Excision of a nail

2. rhytidectomy(rit-i- DEK- to-me)

Excision of wrinkles

3. Rhytidoplasty4. (RIT-i-do- plas- te)

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.

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Chapter 5The Musculoskeletal System

Learning ObjectivesI. Common RootsII. Shoulder MusclesIII.Muscle Action in the Aarms and handsIV.Common Disorders and ProceduresV. Surgical TermsVI.Diagnostic Procedural TermsVII. Case HistoryVIII.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.

The Muscular System

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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 SystemWord Roots Refers tokine; kinesi/o movementligament/o ligamentmuscul/o musclemy/o muscletend/o; tendin/o tendon

Muscle TypesThere 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 skeleton, along with the main ones associated with the appendicular skeleton.Muscles Associated with the Axial SkeletonFacial MusclesA muscle called the orbicularis oris enables us to move our lips and to open and

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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 TongueThe 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 ColumnThe 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 SkeletonShoulder MusclesThe 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 MusclesMuscles Movementserratus anterior upward or upward rotationlevator scapulae upward or upward rotationpectoralis minor downward or downward rotationrhomboideus (both major and minor) downward or downward rotationsubclavius downward or downward rotation

Arm and Hand MusclesThe main muscles of the arm start with the deltoid, where the arm joins the

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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 handsMuscle Name Actionbiceps brachii flexes the upper arm and forearmbrachialis flexes the forearmdeltoid rotates the arm sidewaystriceps brachii extends the forearmflexor carpi ulnaris flexes and curls the hand inwardflexor carpi radialis flexes and curls the hand outwardextensor carpi radialis longus extends and curls the hand outwardextensor carpi ulnaris extends and curls the hand inward

Muscles of the Lower ExtremitiesThe 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 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

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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 SystemTerm Definitionkinesalgia; kinesialgia pain caused by muscle movementkinesiology study of movementmyasthenia muscular weaknessmyectomy excision of part or all of a musclemyelitis inflammation of a musclemyocele protrusion of muscle tissue through a tear in its outer

sheathmyodynia muscle painmyogenesis formation of muscle cellsmyoid adjective meaning “resembling a muscle”myology study of musclesmyoma benign neoplasm of muscle tissuemyomalacia softening of muscle tissuemyositis inflammation of a musclemyospasm muscle contractiontenodynia, tenontodynia pain in a tendontendonitis inflammation of a tendontenontoplasty reparative or plastic surgery of the tendonstenorrhaphy suturing of a tendontenotomy, tendotomy surgical division of a tendon

The Skeletal SystemThe 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 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

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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 systemRoot Refers toarthr/o jointbrachi/o armcarp/o wristchondr/o cartilagecost/o ribcrani/o craniumdactyl/o finger, toeoste/o boneorth/o correctspondyl/o vertebraevertebr/o vertebrae

Cranial BonesThe 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 BonesThe 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 BonesThe 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, 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.

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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 ColumnThe 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 JointsA 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.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 HandsThe 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

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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 GirdleThe 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 LegsThe 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 FeetTarsus (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 TermsTERM DEFINITION1. aponeurorrhaphy……(ap−o−n u−R O R−a−f e )

suture of an aponeurosis

2. arthroclasia…………(ar−thr { o−KL { A ¿−zh { e¿−a )¿

surgical breaking of a (stiff) joint

3. arthrodesis………….(ar−thr { o−D E−sis )¿

surgical fixation of a joint

4. arthroplasty…………( AR−thr { o−plas−t e )¿

surgical repair of a joint

5. arthrotomy…………. incision of a joint

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(ar−THROT− o−me )6. bursectomy…………(bur−SEK−t o−m e )

excision of a bursa

7. bursotomy…………….(bur−SOT −o−m e )

incision of a bursa

8. carpectomy…………..(kar−PEK−t o−m e )

excision of a carpal bone

9. chondrectomy………(kon−DREK−t o−m e )

excision of a cartilage

10. chondroplasty………( KON−dr { o−plas−t e )¿

surgical repair of a cartilage

11. costectomy…………(kos−TEK−t o−m e )

excision of a rib

12. cranioplasty……….(KR { A -n { e¿−o -plas-t { e¿ )¿

surgical repair of the skull

13. craniotomy………..(kr { a -n { e ¿ -OT- { o¿ -m { e¿ )¿

incision into the skull (as for surgery of the brain)

14. diskectomy………….(dis−KEK− t o−m e )

excision of an intervertebral disk

15. laminectomy………( lam−i−NEK−t o−m e )

excision of the lamina (often done to relieve the symptoms of a ruptured disc)

16. maxillectomy………..(mak−is−LEK −t o−m e )

excision of the maxilla

17. meniscectomy……..(man−i−SEK−t o−me )

excision of the meniscus (performed for a torn cartilage)

18. myoplasty…………( M I −o−plas−t e )

surgical repair of a muscle

19. myorrhaphy……….(mi−OR−a−f e )

suture of a muscle

20. ostectomy………….(os−TEK−t o−me )

excision of bone

21. osteoclasis…………(os−t e−OK−la−sis)

surgical breaking of a bone (to correct a deformity)

22. osteoplasty…………..(OS−t e−o−plas−t e )

surgical repair of the bone

23. osteotome…………(OS-t { e−o -t { o¿m)¿

instrument used for cutting the bone

24. osteotomy………… incision of the bone

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(os−t e−OT− o−me )25. patellectomy………(pat-e-LEK-t { o -m { e ¿)¿

excision of the patella

26. phalangectomy……( fal−an−JEK−t o−me )

excision of a finger or toe bone

27. rachiotomy………..(ra−k e−OT −o−m e )

incision into the vertebral column

28. spondylosyndesis…(spon−di−l o−SIN−d e−sis)

fusing together of the spine (spinal fusion)

29. synovectomy………(sin−o−VEK−t o−m e )

excision of the synovial membrane(of a joint)

30. tarsectomy………...( tar−SEK −t o−m e )

excision of one or more tarsal bones

31. tenomyoplasty………( ten−o−MI− o− plas− t e )

surgical repair of the tendon and muscle

32. tenorrhaphy…………( ten- { OR-a-f { e¿)¿

suture of a tendon

33. tenotomy……………( ten−OT− o−me )

incision of the tendon

VII. Diagnostic Procedural TermsTERM(built from word parts)

DEFINITION

1. arthrocentesis……………………...(ar−thr { o−sen−T E−sis )¿

surgical puncture of a joint to aspirate fluid

2. arthrogram……………………( AR−thr { o−gram)¿

x-ray film of a joint

3. arthroscopy……………………..(ar−THROS−k o−p e )

visual examination inside a joint

4. electromyogram………………...( e−lek−tr { o−M I −o−gram)¿

record of the (intrinsic) electric activity in a (skeletal) muscle

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

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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.

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Chapter 6The Cardiovascular and Lymphatic Systems

Learning ObjectivesI. 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 TermsV. Diagnostic Procedural TermsVI.Case HistoryVII. 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

related to the Cardiovascular and Lymphatic System.

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The HeartThe 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 HeartWord or Word Element Type Refers toaort/o Root aortaatri/o Root atriumbrady- prefix slowcard/i/o Root heartcorona from the Latin word for

“crown”the adjective form “coronary” is sometimes used to describe anatomic structures.

echo English word from Greek mythology

a reverberation of sound; not properlycalled a root, such as echogram and echocardiography)

electr/o Root electricalendo- prefix inner, inside-gram Suffix written recordmy/o Root muscleperi- prefix around, surrounding-stenosis Suffix a narrowingtachy- prefix fastvalv/o, valvul/o Root valveventricul/o Root ventricle

The Location of the HeartThe 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 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.

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The Structure of the HeartThe 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 HeartThe 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 ProceduresThe 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, 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

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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 HeartTerm Definitionatriomegaly enlargement of an atriumatrioseptoplasty surgical repair of an atrial septumbradycardia also called bradyarrhythmia; abnormallyslow heartbeatcardiac arrest abbreviated CA, describes the sudden cessation

of heart activitycardiodynia heart paincardiogram a graphic trace of heart functionscardiograph (also “myocardiograph,”as well as “electrocardiograph,”)

a machine to electrically measure heartfunctions

cardiomalacia softening of the heartcardiomegaly enlargement of the heartcardiomyopathy disease of the heart muscle (myocardium)cardiomyoplasty a surgical procedure that involves engaging the

latissimus dorsi muscle to stimulate the heart

cardiopathy any heart diseasecardiorrhaphy suturing of the wall of the heart musclecardiorrhexis rupture in the wall of the heart musclecardiotomy incision into the heartcarditis inflammation of the heartendocarditis inflammation of the endocardiummyocardial infarction(MI) heart attackmyocarditis inflammation of the heart musclepericardiorrhaphy suturing of the pericardiumpericardiotomy incision into the pericardiumpericardiotomy incision into the pericardiumpericarditis inflammation of the pericardiumtachycardia abnormally rapid heartbeat also called

tachyarrhythmia;valvoplasty; also valvuloplasty surgical repair of a heart valvevalvotomy; also valvulotomy surgical removal of a blocked heart valve

(stenosis of a heart valve) by cutting into itvalvulitis inflammation of a heart valve

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ventriculoplasty surgical repair of a heart ventricleventriculoscopy examination of a heart ventricle with an

endoscope

III.Common Abbreviations The HeartAbbreviation MeaningACV acute cardiovascular [disease]CA cardiac arrestCAD coronary artery diseaseCCU cardiovascular care unitCHD cardiovascular heart diseaseCIPS cardiovascular imaging procedureCRFS cardiovascular risk factorsCSU cardiovascular surgery unitCT cardiovascular technologistCVICU cardiovascular intensive care unitCVIS cardiovascular imaging systemsEKG or ECG electrocardiogram; electrocardiograph;

electrocardiography; cardiogramMI myocardial infarction

The Blood and Blood VesselsBefore 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 VesselsThe word elements are shown in the following table often found in terms 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 vesselsElement Type Refers toang/i/o Root vesselarteri/o Root arteryather/o Root gruel-like

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-ectasis Suffix dilation-emia Suffix bloodhem/o; hemat/o

Root blood

phleb/o Root veinthromb/o Root clotvaric/o Root dilated; from the Latin

word varix (“a dilated vein”)vas/o Root vesselvascul/o Root vesselven/o Root vein

Capillaries, Arteries, and VeinsCapillariesThe 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.

ArteriesArteries (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.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 ArteriesConducting 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.

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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 ArteriesMedium-size arteries, sometimes called muscular arteries (because they contain a lot of muscle tissue), typically have an inside diameter of about one-sixth 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.

ArteriolesArterioles 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.

VeinsVeins 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.

The Superior Vena CavaThe 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 CavaBlood entering the inferior vena cava (IVC) includes that returning from the lower limbs, spinal cord, liver, kidneys, and reproductive organs. The names of these

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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 BloodWhole 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.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 VesselsTerm Definitionaneurysm a bulge in an artery (or a heart chamber)angiitis (also vasculitis) inflammation of a blood vesselangiogram the printed record obtained through

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angiographyangiography radiography of a blood vessel after injection

of a contrast mediumangiopathy (also vasculopathy) any disease of blood vesselsangioplasty surgical repair of a blood vesselangiorrhaphy suture of a vesselangiospasm spasm in blood vesselsangiostenosis narrowing of a blood vesselangiotomy incision into a blood vesselarteriolitis inflammation of the arteriolesarteriopathy any disease of the arteriesarterioplasty surgical repair of an arteryarteriorrhexis rupture of an arteryarteriorrhaphy suturing of an arteryarteriosclerosis hardening of the arteriesarteriospasm spasm of an arteryarteriostenosis narrowing of an arteryarteriotomy an incision into an arteryarteriovenous adjectival form of “arteries and veins”arteritis inflammation of an artery or arterieshemolysis change or destruction of red blood cellshemopathy any disease of the bloodhemophilia congenital disorder affecting the coagulation

processhemorrhage discharge of bloodhemorrhagic fever category that includes a number of viral

diseases, one of which is Ebola fevervasculitis (also angiitis) inflammation of a vesselvasculopathy (also angiopathy) any disease of blood vesselsvasoparalysis paralysis of blood vesselsvasoparesis similar to but less severe than vasoparalysisvasospasm spasm in blood vessels (angiospasm)

III-I.Common Abbreviations:The Blood and Blood VesselsAbbreviation MeaningHb hemoglobinHDL high-density lipoproteinIVC inferior vena cavaLDL low-density lipoprotein

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RBC red blood cellsSVC superior vena cavaWBC white blood cell

IV. Surgical TermsTERMS DEFINITION(built from word parts)1. angioplasty……………… surgical repair of a blood vessel(AN-jē-ō-plas-tē)

2.3. 2. angiorrhaphy……………. suturing of a blood vessel

(an-jē-ŌR-a-fē)3. endarterectomy excision of the thickened interior

4. (end-ar-ter-EK-tō-mē) (intima) of an artery5.6. 4. pericardiostomy creation of an artificial opening in

(par-i-kar-dē-OS-tō-mē) The outer (double)layer of the heart

5. phlebectomy excision of a vein7. (fle-BEK-tō-mē)8. 6. phlebotomy incision into a vein to remove blood or

(fle-BOT-ō-mē) to give blood or intravenous fluids,also called venipuncture

7. splenectomy excision of the spleen(sple-NEK-tō-mē)8. splenopexy surgical fixation of the spleen(SPLE- nō-peks-ē)9. thymectomy excision of the thymus gland(thī-MEK-tō-mē)

Other Surgical and Treatment TermsTERM DEFINTION1. aneurysmectomy(an-ū-riz-MEK-tō-mē)

surgical excision of the ballooning of a weakened blood vessel wall

2. bone marrow transplant infusion of normal bone marrow cells froma 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

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implanted under the skin to regulate heart rate4. coronary artery bypassgraft (CABG)

surgical technique to bring a new blood supply to heart muscles by detouring around blocked arteries

5. defibrillation (dē-fib-ri-LĀ-shun)

application of an electric shock to the myocardium through the chest wall to restore normal cardiac

6. embolectomy (em-bō-LEK-tō-mē)

surgical removal of an embolus or clot

7. femoropopliteal bypass (FEM-or-ō-pop-li-TĒ-al)

surgery to establish an alternate route from femoral artery to popliteal artery to bypassobstructive portion

8. hemorrhoidectomy (hem-(m (hem-ō-royd-EK-tō-mē)

excision of hemorrhoids, the varicosed veins in the rectal region

9. intracoronary thrombolytic therapy(in-tra-KOR-ō-na-rē)(thrombol LI-tik)

an injection of a medication in a blockedcoronary vessel to dissolve blood clots

10. laser angioplasty (LĀ-zer) (AN-jē-ō-plas-tē)

the use of light amplification by simulated emission of radiation or laser beam to open blocked arteries especially in lower extremities

11. mitral commissurotomy (mi -tral)(kom-(Mī-tral) (kom-i-shūr-OT-ō-mē)

surgical procedure to repair a stenosed mitral valve by breaking apart the leaves (commissures) of the valve

12. percutaneous transluminalcoronary angioplasty (PTCA)(per-kū-TĀ-nē-us)(trans-LŪM-in-al) (KOR-ō-na-rē)

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 the vessel wall and allows the blood to circulate more freely.

13. vein ligation and stripping (li-GA-shun)

surgical method of tying off a varicose vein and removing it

V. Diagnostic Procedural TermsHEART AND BLOOD VESSELS

TERM DEFINITION1.angiography(an-jē-OG-ra-fē)

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).

2.angioscope(AN-jē-ō-skōp)

instrument used to visualize a blood vessel.

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3. angioscopy (an-jē-OS-kō-pē)

visual examination of a blood vessel

4.aortogram(ā-ŌR-tō-gram)

x-ray film of the aorta (made after an of contrast medium)

5. arteriogram(ar-TE-rē-ō-gram)

x-ray film of an artery (taken after anof contrast medium)

6. echocardiogram(ek-ō-KAR-dē-ō-gram)

record made of the structure and motion heart using sound waves of the heart

7. electrocardiograph(e-lek-trō-KAR-dē-OG-ra-fē)

instrument used to record the electricalactivity of the heart

9. electrocardiography(e-lek-trō-kar-dē-OG-ra-fē)

process of recording the electrical activity of theheart

10.phlebography(fle-BOG-ra-fē)

process of x-ray filming a vein (filled with contrast medium)

11.phonocardiogram(fō-nō-KAR-dē-ō-gram)

graphic record of heart sound

12.sphygmocardiograph(sfig-mō-KAR-dē-ō-graf)

instrument used to measure pulse waves andheart beat

13.stethoscope(STETH-ō-skōp)

instruument used to listen to listen to chest sounds produced by heart and lungs

14.venogram (VĒ-nō-gram)

x-ray film of the veins (taken after an injectionof dye)

15.hematocrit (HCT)(he-MAT-ō-krit)

separated blood (volume percentage oferythrocytes in whole blood after separation bycentrifuge)

16.leukocyte count (WBC)(LŪ-kō-sīt)

white blood cell count (number of white bloodcells per cubic millimeter of blood)

17.lymphadenography(lim-fad-e-NOG-ra-fē)

process of x-ray filming the lymph nodes and glands (after an injection of contrast medium)

18.lymphangiogram(lim-FAN-jē-ō-gram)

x-ray film of the lymphatic vessels

19.lymphangiography(lim-fan-jē-OG-ra-fē)

process of x-ray filming the lymphatic vessels(after an injection of contrast medium)

Blood and Lymphatic System1.complete blood count(CBC) basic blood screening that includes tests

on hemoglobin, hematocrit, red blood cellmorphology (size and shape), leukocytecount and white blood cell differential

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(types of WBCs)2. coagulation time(kō-ag-ū-LĀ-shun)

blood test to determine the time it takes forblood to form a clot

3. hemoglobin (Hgb)(HĒ-mō-glō-bin)

oxygen-carrying components in red bloodcells, responsible for giving blood its color

4. prothrombin time(PT)(prō-THROM-bin)

test to determine certain coagulationactivity defects; also used to monitoranticoagulation therapy

5. bone marrow biopsy needle puncture to remove bone marrowfor study, usually from the sternum or ilium , to determine certain blood celldiseases, such as leukemia and anemia

VI. CASE History: This is the third hospitalization for this 76-year-old widowed Filipinofemale who was admitted for recurrent angina. The patient has a long hist-ory of stable angina pectoris and had a positive treadmill test in 1988. Athallium treadmill test in 1991 showed reversible apical ischemia. In mayof 1992. she underwent cataract surgery. She developed severe chest painpostoperatively. The EKG at that time showed ischemic ST changes in theanterior leads. A subsequent coronary angiography revealed a 90% focal leftanterior descending stenosis. The patient then underwent angioplasty of this lesion. The 90% stenosis was dilated to a 20% stenosis. The patient had anuncomplicated 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 yesterdaywhile gardening, which lasted almost 20 minutes before subsiding after asecond nitroglycerin. She came to her cardiologist’s office today.An electrocardiogram was done which showed marked anterior T waveinversion in the anterior leads and she was immediately sent to this hospitalfor an evaluation.Atherogenic risk factors include hypercholesterolemia for which she is nowtaking 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 catheteri-zation and redilatation if necessary. Serial EKGs and enzymes will beobtained to rule out a myocardial infarction.

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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.

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The Respiratory SystemYou 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 SystemThe 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 SystemRoot or Suffix Refers tobronchi/o bronchuslaryng/o larynxnas/o, rhin/o nosepharyng/o pharynxphren/o diaphragm-pnea (suffix) breathing (a suffix used in such terms as

dyspnea,which means “difficulty in breathing”)

pneum/o, pneumon/o, pulmon/olungsinus/o sinus cavitytrache/o trachea

BreathingOur lungs are the biggest of our respiratory organs. Air flows into the lungs through the nose, nasal passage, pharynx, larynx, trachea, and bronchi. The 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.

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The Upper Respiratory SystemThe 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 NoseAir 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 CavityThe 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 PharynxIncoming 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 SystemThe LarynxThe 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 BronchiThe 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.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.

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The LungsThe 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 DiaphragmAlthough 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 SystemAbbreviation MeaningAARC American Association for Respiratory CareAART American Association for Respiratory TherapyAIURT acute infections of the upper respiratory tractALR acute lower respiratory infectionCNRD chronic nonspecific respiratory diseasesERV expiratory reserve volume (as measured with test

equipment)IRV inspiratory reserve volume (as measured with test

equipment)PFT pulmonary function testRV residual volume (as measured with test equipment)T&A tonsils and adenoids (also tonsillectomy and

adenoidectomy)TLC total lung capacity (as measured with test equipment)TV tidal volume (as measured with test equipment)SOB shortness of breathCOPD chronic obstructive pulmonary disease

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TABLE 7-2 Common Disorders and Procedures associated with the Respiratory SystemTerm Definitionapnea absence of breathingasthma a lung disease characterized by reversible inflammation and

constrictionbronchial pneumonia (bronchopneumonia)

inflammation of the smaller bronchial tubes

bronchiolitis inflammation of the bronchiolesbronchiostenosis narrowing of the bronchial tubesbronchitis inflammation of the mucous membrane of the bronchial

tubesbronchomalacia degeneration or softening of

the bronchibronchoplasty surgical repair of a bronchusbronchopneumonia (bronchial pneumonia)

inflammation of the smaller bronchial tubes

bronchorrhaphy suturing of a bronchusbronchorrhea excessive mucus production by a bronchusbronchoscope a device used for visual inspection of the interior of a

bronchusbronchoscopy inspection with a bronchoscopebronchospasm abnormal contraction of bronchibronchostenosis chronic narrowing of a bronchusbronchotomy incision into a bronchusdyspnea difficult breathingemphysema condition in which the alveoli are inefficient because of

distensionlaryngectomy excision of the larynxlaryngitis inflammation of the larynxlaryngology study of the larynx and its abnormalitieslaryngoplasty surgical repair of the larynxlaryngoscope instrument with a light at the tip to aid in visual inspection

of the larynxlaryngoscopy visual inspection of the larynx with the aid of a

laryngoscopelaryngospasm involuntary contraction of the larynxlaryngostenosis a narrowing of the larynxlaryngotomy incision into the larynxpharyngitis inflammation of the pharynx

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pharyngocele a hernia or diverticulum in the pharynxpharyngoplasty surgical repair of the pharynxpharyngoplegia paralysis of the pharynxpharyngoscope instrument with a light at the tip to aid in the visual

inspection of thepharynx

pharyngoscopy visual inspection of the pharynx with the aid of a pharyngoscope

pharyngospasm involuntary contraction of the pharynxpharyngostenosis narrowing of the pharynxpharyngotomy surgical incision into the pharynxphrenalgia pain in the diaphragmphrenoplegia paralysis of the diaphragmpneumolith calculus in a lungpneumonectomy removal of pulmonary lobes from a lungpneumonia, pneumonitis

inflammation of a lung caused by infection, chemical inhalation, ortrauma

pneumonopexy surgical fixation of a lungpneumonorrhaphy suturing of a lungpneumonotomy incision into a lungrhinalgia pain in the noserhinitis inflammation of the inner lining of the nasal cavityrhinodynia rhinalgia; pain in the noserhinology study of the nose and its abnormalitiesrhinopathy any disease of the noserhinoplasty surgery performed on the noserhinorrhea discharge from the rhinal mucous membranerhinoscope a small mirror with a thin handle; used in rhinoscopyrhinoscopy visual inspection of the nasal areasrhinostenosis narrowing or obstruction occurring in the nasal passagesrhinotomy surgical incision into the nosesinusitis inflammation of the sinusessinusotomy incision into a sinustracheitis inflammation of the tracheatracheomalacia softening (degeneration) of tracheal tissuetracheomegaly abnormal dilation of the tracheatracheoplasty surgical repair of the tracheatracheorrhagia hemorrhage of the tracheatracheostenosis abnormal narrowing of the trachea

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tracheotomy incision into the trachea

I. Surgical termsTERM DEFINITION(built from word parts)1. adenoidectomy………….……. excision of the adenoids(ad-e-noyd-EK-to-me)2. bronchoplasty……………........ surgical repair of a bronchus(BRON-ko-plas-te)3. laryngectomy………………..... excision of the larynx(lar-in-JEK- to-me)4. laryngocentesis………………. surgical puncture of the larynx to aspirate

fluid(lar-in-go-sen-TE-sis)5. laryngoplasty……………….… surgical repair of the larynx(lar-IN-go-plas-te)6. laryngostomy…………………. creation of an artificial opening into the

larynx(lar-in-GOS-to-me)7. laryngotracheotomy…………... incision of the larynx and trachea(lar-in-go-ira-ke-OT-o-me)8. lobectomy…………………….. excision of a lobe of the lung(lo-BEK-to-me)9. pleurocentesis……………….... surgical puncture to aspirate fluid from

pleural space(plur-o-sen- TE-sis)10. pleuropexy…………………... surgical fixation of the pleura(plu-ro-PEK-se)11. pneumobronchotomy………... incision of lung and bronchus(nu-mo-bron-KOT-o-me)12. pneumonectomy…………....... excision of a lung(nu-mon- EK-to-me)13. rhinoplasty………..…………. surgical repair of the nose(RI-no-plast-e)14. septoplasty………………….. surgical repair of the (nasal) septum(sep-to-PI-AS- te)15. septotomy………………......... incision into the (nasal) septum(sep-TOT-o-me)16. sinusotomy………………....... incision of a sinus(si- nu- SOT-o-me)

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17. thoracocentesis………............. surgical puncture of chest cavity toaspirate fluid (also called thoracentesis)

(tho-rak-o-sen-TE- sis)18. thoracotomy……………......... incision into the chest cavity(tho-rak-OT-o-me)19. tonsillectomy……………….. excision of the tonsils(ton- sil-EK-to-me)20. tracheoplasty……………....... surgical repair of the trachea(TRA-ke-o- plas-te)21. tracheostomy……………........ creation of an artificial opening into

the trachea(tra-ke-OS-to-me)22. tracheotomy……………......... incision of the trachea(tra-ke-OT-o-me) II. Diagnostic Procedural TermsTERM DEFINITION(built from word parts)1.bronchogram …………...(BRON-ko-gram)

x-ray film of the bronchi

2.bronchography …………(bron-KOG-ra-fe)

process of x-ray filming the bronchi

3.bronchoscope……………(PRON-ko-skop)

instrument used for visual examination of the bronchi

4.bronchoscopy ………….(bron-KOS-ko-pe)

visual examination of the bronchi

1. endoscope …………..…(EN-do-skop)

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.)

6. endoscopic …………….(EN-do-skop-ic)

visual examination of a hollow organ or body cavity (Used to describe the current practice of performing surgeries using endoscopes.)

6. laryngoscope …..………(lar-IN-gos-ko-pe)

instrument used for visual examination of the larynx

8.laryngoscopy……………..(lar-in-GOS-ko-pe)

visual examination of the larynx

7. oximeter ………………. instrument used to measure oxygen

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(ok-SIM-e-ter) (saturation in the blood)8. spirometer………………(spi-ROM-e-tre)

instrument used to measure breathing (or lung volumes)

9. Thoracoscope ……..…..(tho-RA-ko-skop)

instrument used for visual examination of the thorax

10.Thoracoscopy………..(tho-ra-KOS-ko-pe)

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.

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Chapter 8The Digestive System

Learning ObjectivesI. Common Word Elements and ProceduresII. Common Disorders and ProceduresIII. Surgical TermsIV. Diagnostic Procedural TermsV. Case HistoryVI. 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

The Digestive System52

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 SystemThe 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 SystemRoot or Suffix Refers tocholecyst/o gallbladdercolon/o colonduoden/o duodenumenter/o small intestineesophag/o esophagusgastr/o stomachhepat/o liverile/o ileumjejun/o jejunumpancreat/o pancreasphag/o eating; swallowingsial/o salivary glands-scope suffix meaning “device for visual examination”-scopy suffix meaning “visual examination”

The Muscular Apparatus of the Digestive System

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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 PharynxYou 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 EsophagusBecause 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 StomachThe 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 stage is a liquid called chyme (pronounced kyme), begin to enter the small intestine.

The Small IntestineNinety 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

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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 IntestineBesides 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 DigestionTo 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 GlandsAs 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.

The PancreasThe 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 LiverAlthough 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

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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 GallbladderAlthough 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 ApparatusEnterology 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 LiverThe 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 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 SystemTerm Definitioncholecystectomy excision of the gallbladdercholecystitis inflammation of the gallbladdercholecystopathy any disease of the gallbladdercholecystotomy incision into the gallbladder

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colectomy excision of all or part of the coloncolitis inflammation of the coloncolonoscope device used in colonoscopycolonoscopy visual inspection of the colon with a colonoscopecolopexy fixation of the coloncolorrhagia abnormal discharge from the coloncolostomyII surgical establishment of an opening into the coloncolotomy incision into the colonduodenectomy excision of the duodenumduodenitis inflammation of the duodenumduodenorrhaphy suture of the duodenumduodenoscopy visual inspection of the duodenum with the aid of

an endoscopeduodenostomy surgical establishment of an opening in the

duodenumduodenotomy incision of the duodenumenteralgia abdominal painenterectomy excision of part of the intestineenteritis inflammation of the intestineenterodynia abdominal painenterogastritis inflammation of the intestine and stomachenterohepatitis inflammation of the intestine and liverenteropathy any intestinal diseaseenteropexy surgical fixation of part of the intestineenterorrhagia bleeding in the intestinal tractenterorrhaphy suturing of the intestineenterospasm painful peristalsisenterostenosis narrowing within the intestinal tractesophagology study of the structure and diseases of the esophagusgastrectomy excision of part of the stomachgastritis inflammation of the stomachgastrocele hernia of the stomachgastrocolitis inflammation of the stomach and colongastroduodenitis inflammation of the stomach and duodenumgastroenteritis inflammation of the stomach and intestinehepatitis inflammation of the liverhepatocele protrusion of a part of the liver through an adjacent

structurehepatopathy any disease of the liverhepatopexy fixation of the liver

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hepatorrhaphy suturing of the liverhepatorrhexis rupture of the liverhepatoscopy examination of the liverileopexy surgical fixation of the ileumjejunectomy excision of all or part of the jejunumjejunitis inflammation of the jejunumjejunoplasty surgical repair of the jejunumjejunotomy incision into the jejunumpancreatalgia pain in the general area of the pancreaspancreatitis inflammation of the pancreaspancreatopathy any disease of the pancreaspancreatotomy incision into the pancreassialoadenitis inflammation of a salivary glandsialoadenectomy excision of a salivary glandsialoadenotomy incision of a salivary glandsialoangiitis inflammation of a salivary ductsialography radiography of the salivary glands and ductssialorrhea excessive production of salivasialostenosis an narrowing of a salivary ductCommon Abbreviations:The Digestive SystemAbbreviation MeaningDM diabetes mellitusGB gallbladderGBS gallbladder x-ray seriesGERD gastroesophageal reflux disorderGI gastrointestinalNGT nasogastric tubeS&D stomach and duodenumUGI upper gastrointestinalIII. Surgical TermsTERM 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

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(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 stone9. choledocholithotripsy….. surgical crushing of a stone in the

(kō-led-ō-kō-LITH-ō-trip-sē) common bile duct10. 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) stomach15. gastrectomy………………… excistion of the stomach

(gas-TREK-tō-mē)16. gastrojejunostomy…………. creation of an artificial opening between

(gas-trō-je-jū-NOS-tō-mē) the stomach and jejunum17. gastrostomy………………… creation of an artificial opening through

(gas-TROS-tō-mē) the abdominal wall into the stomach 18. gingivectomy……………… surgical removal of gum tissue

(jin-ji-VEK-tō-mē19. glossorrhaphy……………… suture of the tongue

(glo-SŌR-a-fē)20. herniorrhaphy……………… suturing (to repair) of a hernia

(her-nē-ŌR-a-fē)21. ileostomy………………….. creation of an artificial opening through (il-ē-OS-tō-mē) the abdominal wall into the ileum 22. laparotomy………………… incision into the abdominal wall

(lap-a-ROT-ō-mē)

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23. palatoplasty………………… surgical repair of the palate(PAL-a-tō-plas-tē)

24. polypectomy………………… excision of a polyp(pol-ē-PEK-tō-mē)

25. pyloromyotomy……………… incision into the pylorus muscle(pī-lor-ō-mī-OT-ō-mē)

26. pyloroplasty…………………. surgical repair of the pylorus(pī-LOR-ō-plas-tē)

27. uvulectomy…………………… excistion of the uvule(ū-vū-LEK-tō-mē)

28. uvulopalatopharyngoplasty..… surgical repair of the uvula, palate, and (UPPP) pharynx (ū-vū-lō-pal-a-tō-phar-in-GŌ-

plas-tē)

Other Surgical TermsTERM DEFINITION

1. abdominoperineal resection…. removal of the colon and rectum(ab-dom-in-ō-pēr-i-NĒ-el)2. anastomosis…………………. surgical connection between two(a-nas-tō-MŌ-sis) normally distinct structures3. vagotomy……………………. cutting of certain branches of vagus

nerve, performed with gastric surgery toreduce the amount of gastric acidproduced and thus reduce the recurrenceof ulcers

IV. Diagnostic Procedural TermsTERM(built from word parts)

DEFINITION

1.cholangioram (k o−LAN− je−o−gram) x-ray film of bile ducts,2. cholecystogram(k o−l e−SIS−t o−gram)……….. x-ray film the gallbladder(also

known as a G.B. Series)3. colonoscope (k o−LON−o−sk { o p )¿…………….. instrument used for visual

examination of the colon4. colonscopy(k o−lon−OS−k o− p e )…………… visual examination of the

colon

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5. endoscope( EN−d o−sk { o p )¿……………………. instrument used for visual examination within hollow organ

6. endoscope (en−DOS−k o−p e )……………….. visual examination within a hollow organ

7. esophagogastro duodenoscopy (EGD) ………..(e−sof −a−g o−gas−tr { o−d u−od−e−NOS−k o−p e¿ )

visual examination of the esophagus, stomach, and duodenum

8. esophagoscope ( e−SOF−a−g o−sk { o¿ p )………… instrument used for visual examination of the esophagus

9. esophagoscopy ( e−sof −a−GOS−k o−p e )…….. visual examination of the esophagus

10. gastroscope(GAS−tr { o¿−sk { o¿ p )…………………. instrument used for visual examination of the stomach

11. laparoscope poskoraLAP ………........... instrument for visual examination of the abdominal cavity

12. laparoscopy( lap−a−ROS−k o−p e ) …………. visual examination of the abdominal cavity

13. gastroscopy ( gas−TROS−k o−p e ) …………….. visual examination of the stomach

14. proctoscope ( PROK−t o−sk { o¿ p )…………........... instrument used for visual examination of the rectum

15. proctoscopy ( prok−TOS−k o−p e )………........ visual examination of the rectum

16. sigmoidoscope ( sig−MOY −d o−sk { o¿ p ) …......... instrument used for visual examination of the sigmoid colon

17. sigmiodoscopy( sig−moy−DOS−k o−p e )…....... visual examination of the sigmoid colon

Other Diagnostic Procedural TermsTERM(built from word parts)

DEFINITION

1. lower GI(gastrointestinal series……………………..

series of x-ray films taken of the large intestine after a barium enema has been administered(also called barium enema)

2. upper GI (gastrointestinal) series……………………..

series of x-ray films taken of the stomach and duodenum after barium has been swallowed

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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.

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Chapter 9Endocrine System Learning ObjectivesI. Common Roots and SuffixesII. Surgical TermsIII.Case HistoryIV. 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:

Build, analyze, define, pronounce, and spell the surgical terms related to the Endocrine System.

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The Endocrine SystemThe 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 e-mail 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 SystemThe 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 SystemRoot or Suffix Refers toaden/o glandadren/o; adrenal/o adrenal glandsendocrin/o endocrinehypophys/o pituitary glandparathyr/o; parathyroid/o parathyroid glandren/o kidneythyr/o; thyroid/o thyroid gland-ine suffix used in the formation of names of chemical

substances-tropin (Greek word trophe)

suffix meaning “nourishment” or “stimulation”

Hormones and GlandsThe endocrine system encompasses hormones and the glands that produce them. However, many endocrine secretions come from glands that belong to 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.

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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 GlandsThe 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 GlandThe 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 GlandThe 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 secretionsTerm Definition AbbreviationCorticotropin gonadotropins

stimulates the adrenal glands

ACTH

follicle-stimulating hormone

stimulates estrogen production

FSH

interstitialcell-stimulating hormone

stimulates testosterone production

ICSH

leuteinizing hormone (lutropin)

stimulates ovulation LH

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melanocyte-stimulating hormone

stimulates melanin production

MSH

prolactin stimulates milk production PRLsomatotropin stimulates growth GHthyrotropin stimulates the thyroid TSH

The Thyroid and Parathyroid GlandsThe 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 GlandsThe 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 ProceduresAdrenal Gland DisordersThe common disorders of the adrenal glands contain suffixes you have encountered many times in previous chapters and yield terms such as adrenalectomy, adrenalopathy, and adrenalomegaly, which you can probably define.

Pituitary Gland DisordersAs 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

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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 DisordersThe 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 ProceduresTerm Definitionadenectomy excision of a glandadenitis inflammation of a glandadenogenous originating in a glandadenohypophysitis inflammation of the anterior pituitary glandadenotomy incision of a glandadrenalectomy surgical removal of one or both adrenal glandsadrenalitis inflammation of the adrenal glandsadrenalopathy (adrenopathy)

any disorder of the adrenal glands

adrenomegaly enlarged adrenal glandsgoiter chronic enlargement of the thyroid gland caused by

insufficient iodine in the diethyperglycemia excessive sugar in the bloodhyperpituitarism excessive hormone secretion by the pituitary glandhyperthyroidism condition caused by an overactive thyroid; usually

caused by an immune system disorder known as Graves disease

hypophysectomy excision of the pituitary glandhypophysitis inflammation of the pituitary glandhypopituitarism a condition characterized by inadequate secretion of

one or more of the anterior pituitary hormonesparathyroidectomy excision of a parathyroid glandpituitarism any pituitary dysfunctionthyroaplasia congenital condition characterized by insufficient

thyroid secretionthyroidectomy excision of the thyroid glandthyroiditis inflammation of the thyroid glandthyromegaly enlargement of the thyroid gland

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thyroparathyroidectomy

excision of the thyroid and parathyroid glands

thyrotomy incision of the thyroid

Common Abbreviations:The Endocrine SystemAbbreviation MeaningACTH corticotrophinADH antidiuretic hormoneBS blood sugarDM diabetes mellitusFBS fasting blood sugarFSH follicle-stimulating hormoneGH growth hormoneICSH interstitial cell–stimulating hormoneIDDM insulin-dependent diabetes mellitus (Type 1)LH leuteinizing hormoneMSH melanocyte-stimulating hormoneNIDDM non–insulin-dependent diabetes mellitus (Type 2)PRL prolactinTSH thyrotropin

II. Surgical TermsTERM DEFINITION(built from word parts)1. adrenalectomy……………………......ad=r e−nal−EK −t o−m e )

excision of an adrenal gland

2. parathyroidectomy……………….…..p a r−a−th { I−royd−EK−t o−me )¿

excision of a parathyroid gland

3. thyroidectomy………………………..( th { I−royd−EK−t o−m e )¿

excision of the thyroid gland

4. thyroidotomy…………………………( th { I−royd−OT−o−m e )¿

incision into the thyroid gland

5. thyroparathyroidectomy………………( th { I−r o−p a r−a−th { I ¿−royd−EK −t o−m e )¿

excision of the thyroid and parathyroid glands

III. Case History:

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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, polydipsiaHistory 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.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.

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Chapter 10The Immune System Learning ObjectivesI. Common Word roots II. Common Disorders and Procedures III.Surgical TermsIV. 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:

Build, analyze, define, pronounce, and spell the common word roots surgical terms related to the immune system.

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The Immune SystemThe 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 SystemThe 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 SystemRoot Refers tolymph/o; lymphat/o lymph or lymphatic systemlymphangi/o lymph vesselsimmun/o immune systemlymphaden/o lymph nodessplen/o spleentonsill/o lymph node, usually palatine tonsilthym/o thymus

PhagocytesPhagocytes 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 reside in critical areas, such as the pleural and abdominal cavities, as first-response defenders.

Lymphocytes

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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 CellsNK (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 CellsT 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 CellsB 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.

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The Lymphatic SystemThe lymphatic system comprises the vessels through which lymphocytes travel, the lymph in which they travel, and the organs necessary to direct their functions.

LymphLike 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 VesselsLymph 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 ThymusThe 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 SpleenThe spleen, which contains phagocytes, removes damaged red blood cells and recycles and stores reclaimed iron from others.

Lymph NodesLymph 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.

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Common Abbreviations:The Immune SystemAbbreviation MeaningAb antibodyADCC antibody-dependent cell-mediated cytotoxicityAg antigenAIDS acquired immune deficiency syndromeAPC antigen-presenting cellBCR B cell (antigen) receptor (Ig)BM bone marrowCBC complete blood countCD celiac disease (allergy to gluten)ELISA enzyme-linked immunosorbent assayESR erythrocyte sedimentation rateHIV human immunodeficiency virusHLA human leukocyte antigen (MHC)Ig immunoglobulin (antibody)LFA leukocyte functional antigenLGL large granular lymphocyte (NK cell)NK natural killer cellRA rheumatoid arthritisSLE systemic lupus erythematosus (usually shortened to lupus), an

autoimmune disorderTCR T-cell (antigen) receptor

Common Immune System Disorders and ProceduresSome 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 organ-specific, affecting the thyroid gland. However, autoimmunity can affect nearly any part of the body.

Lymphatic System DisordersThe 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

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The roots for thymus and spleen are thym/o and splen/o, which yield terms such as thymitis and splenomalacia.

Disorders of the TonsilsA 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 SystemTerm Definitionautoimmunity immune to oneselflymphadenopathy any disease of the lymph nodes; chronic or

excessively swollen lymph nodeslymphadenectomy excision of lymph nodeslymphadentitis inflammation of a lymph node (or nodes)lymphangiectomy excision of a lymph vessellymphangitis inflammation of lymph vesselslymphoma tumor of lymph tissuelymphangiography radiography of the lymph vesselslymphangioplasty surgical repair of lymph vesselslymphangiotomy incision of lymph vesselslymphatitis inflammation of the lymph vessels or nodeslymphopathy any disease of the lymph vessels or nodesimmunodeficiency impairment of the immune systemsplenitis inflammation of the spleensplenectomy excision of the spleensplenomalacia softening of the spleensplenomegaly enlargement of the spleensplenopathy any disease of the spleensplenorrhagia hemorrhage from a ruptured spleensplenorrhaphy suture of a ruptured spleensplenotomy incision of the spleentonsillitis inflammation of a tonsiltonsillectomy excision of a tonsiltonsillotomy incision of a tonsilthymectomy excision of the thymusthymitis inflammation of the thymus

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Chapter 11The Urinary system

Learning ObjectivesChapter SectionsI. Word ElementsII. Surgical TermsIII.Diagnostic Procedural TermsIV.Additional TermsV. Case HistoryVI.Discharge summaryVII. 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.

surgical terms related to the Urinary System. Build, analyze, define, pronounce, and spell diagnostic procedural

terms related to the Urinary System.

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Define, pronounce, and spell the Additional terms related to the Urinary System.

The Urinary SystemThe 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 SystemThe 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 SystemWord Elements Refers tocyst/o bladderlith/o stonenephr/o, ren/o kidneyolig/o little, fewpyel/o pelvispy/o pusureter/o ureterurethr/o urethraurin/o urinepoly- prefix meaning “much” or “many”-iasis suffix meaning “condition” or “state”

An Overview of the Urinary SystemThe 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. 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.

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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.

UretersAfter 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 BladderThe 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 SystemAbbreviation MeaningAbdo abdomenAbdo E&S abdomen erect and supine (lying face upwards)AXR abdominal x-rayBPH benign prostatic hypertrophyGFR glomerular filtration rateIVP intravenous pyelogram (same as IVU): contrast is injected into a vein and is

excreted by the kidney to show the urinary systemIVU intravenous urogram (same as IVP)KUB kidneys, ureter, and bladder; also an archaic reference to a frontal x-ray of the

abdomenPCN Percutaneous nephrostomy: Investigation of the urinary tract by direct needle

puncture, often before insertion of a drainage catheterPSA prostate-specific antigenUTI urinary tract infection

Common Urinary System Disorders and ProceduresThe following table provides a quick reference for the meanings of the terms naming disorders and procedures associated with the urinary system.

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Disorders and Procedures associated with the urinary SystemTerm Definitioncystalgia pain in a bladder, most often used to signify the urinary bladdercystectomy 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 kidneysnephrectomy removal of a kidneynephritis inflammation of the kidneysnephrolithotomy incision into the kidney to remove a calculus (kidney stone)nephromegaly enlargement of one or both kidneys; renomegalynephropathy any disease of the kidneynephrorrhaphy suture of the kidneynephrotomy incision into a kidneyrenal calculus a kidney stonerenal hypoplasia an abnormally small kidneyrenomegaly enlargement of one or both kidneys; nephromegalyrenopathy any disease of the kidney; the preferred term is nephropathyureteralgia pain in a ureterureterectomy excision of part or all of a ureterureteritis inflammation of a ureterureterography radiography of the ureterureterolithotomy incision into the ureter to remove a calculus (stone)ureteroplasty surgical repair of a ureterureterorrhaphy suture of a ureterurethralgia pain in the urethra (sometimes also called urethrodynia)urethrectomy excision of all or part of the urethraurethritis inflammation of the urethraurethrostenosis narrowing of the urethraurinalysis analysis of urine

II. Surgicl TermsTERM DEFINITION(built from word parts)1. cystectomy ……………..(sis-TEK-to-me)

excision of the bladder

11.cystolithotomy ………….(sis-to-THOT-o-me)

incision of the bladde to remove a stone

3.cystoplasty ……………… (SIS-to-plas-te)

plastic repair of the bladder

4.cysorrhaphy …………… suturing the bladder

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(sist-OR-a-fe)5.cystostomy ……………… creation of an artificial opening into the (sis-TOS-to-me) bladder6. cystotomy or vesicotomy(sis-TOT-o-me)(ves-i-KOT-o-me)

incistion of bladder

7. cystotrachelotomy …….. incision of the neck of the bladder(sis-to-tra-ke-LOT-o-me)8. lihotripsy ……………… surgical crushing of a stone(LITH-o-trip-se)9. meatotomy ……………. incision of the meatus(me-a-TOT-o-me)10. nephrectomy ………….. excision of a kidney(ne-FREK-to-me)11. nephrolysis …………… separating the kidney (ne-FROL-i-sis) (from other body structures)12.nephropexy …………….. surgical fixation of the kidney(NEF-ro-peks-e)13.nephrostomy …………… creation of an artificial opening into(nef-ROS-to-me) the kidney14.pyelolithotomy ……….. incision of the renal pelvis to remove(pl-el-o-lith-OT-o-me) a stone15.pyeloplasty …………….. plastic repair of the renal pelvis (PI-Ei-o-plas-te)16.pyelostomy …………… creation of an artificial opening into the(pi-el-OS-to-me) renal pelvis17.ureterectomy……………… excision of a ureter(u-re-ter-EK-to-me)18. ureterostomy ……………. (u-re-ter-OS-to-me)

creation of an artificial opening into the ureter

19.ureterotomy ……………… incision of a ureter(u-re-ter-OT-to-me)20. urethropexy …………… surgical fixation of the urethra(u-RE-thro-pek-se)21.urethroplasty …………….. plastic repair of the urethra (u-RE-thro-plas-te)22. urethrostomy ………….. creation of an artificial opening into the(u-re-THROS-to-me) urethra23. urethrotomy ………….. incision in the urethra(u-re-THROT-o-me)24. vesicourethral surgical suspension pertaining to the

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suspension ……………. (ves-i-ko-u-RE-thral)

urethra and bladder

III. Diagnostic Procedural TermsTERM DEFINTION(built from word parts)1.cystograim ………………….. x-ray film to the bladder(SIS-to-gram)2.cystography ………………… process of x-ray filming the bladder(sis-TOG-ra-fe)3.cystopyelogram …………..….(sis-to-pi-EI-o-gram)

x-ray film of the bladder and the renal pelvis

4.cystopyelography …………….(sis-to-pi-e-LOG-ra-fe)

process of x-ray filming the bladder and the renal pelvis

5.cystoscope ……………….….(SIS-to-skop)

instrument used for visual examination of the bladder

6. cystoscopy ……………..….. visual examination of the bladder(sis-TOS-ko-pe)7.cystoureterogram ……..…….. (sis-to-u-RE-ter-o-gram)

x-ray film of the bladder and the ureters

8.cystourethrogram …………… x-ray film of the bladder and the urethra(sis-to-u-RE-thro-gram)9. intravenous pyelogram …..… (in-tra-VE-nus)(PI-e-Io-gram) (IVP)

x-ray film ot the renal pelvis with contrast medium injected intravenously

10. meatoscope …………..……(me-AT-o-skop)

instrument used for the visual examination of a meatus

11. meatoscopy ………….……(me-a-TOS-ko-pe)

visual examination of a meatus

12. nephrogram ………………... (NEF-ro-gram)

x-ray film of the kidney

13.nephrography ………………. process of x-ray filming the kidney(ne-FROG-ra-fe)14.nephroscopy ………………. visual examination of the kidney(ne-FROS-ko-pe)15.nephrosonography …………. process of recording the kidney( nef-ro-so-NOG-ra-fe) with (ultra) sound16.nephrotomogram …………... sectional x-ray film of the kidney(nef-to-TO-mo-gram)

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17. pyelogram ………………… x-ray film of the renal pelvis(PI-el-o-gram)18. renal biopsy ……………….. to view a portion of living kidney tissue(RE-nal) (BI-op-se)19.renogram…………………... (RE-no-gram)

(graphic) record of the kidney (produced by radioactivity after injecting a radiopharmaceutical, or radioactive, material in to the blood )

20. retrograde pyelogram …….. (RET-ro-grad) (PI-e-lo-gram)

x-ray film of the renal pelvis (retrograde means to move in a direction opposite from normal) with contrast medium injected through the urethra

21. reterogram…………………. x-ray film of the ureters(u-RE-ter-gram)22. urethrometer ……..………... instrument used to measure the urethra(u-re-THROM-e-ter)23.urethroscope………………… instrument used for visual exam or(u-RE-thro-skop) the urethra24. urinometer………………..…(u-ri-NOM-e-ter

instrument used to measure for deter-mining the specific gravity of urine

IV. Additional TermsTERM DEFINITION1. catheter……………….

(kath-e-ter)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)

agent that increases the amount of urine

5. enuresis…………….…. (en-ū-RĒ-sis)

involuntary urination (bed wetting)

6. fulguration……………. (ful-gū-RĀ-shun)

destruction of living tissue with an electric spark (a method commonly used to remove bladder growths)

7. hemodialysis…………. procedure for removing impurities from

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(hē-mō-dī-AL-i-sis) the blood because of an inability of the kidneys to do so

8. incontinence………….. (in-KON-ti-nens)

inability to control bladder and/or bowels

9. lithotrite………………. (LITH-ō-tīt)

instrument used to crush a stone in the urinary bladder

10. micturate……………… (MIK-tū-rāt)

to urinate or void

11. peritoneal dialysis…….. (pār-i-tō-NĒ-al)(dī-AL-i-sis)

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

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)

instrument used for removing prostate gland tissue through the urethra

14. specific gravity…….. (spe-SIF-ik) (GRAV-i-tē)

a measurement that indicates concentrating or diluting ability of the kidneys (a test on urine)

15. stricture……………. (STRIK-chū-r)

abnormal narrowing, such as a urethral stricture

16. urinal………………. (Ū-rin-al)

receptacle for urine

17. urinalysis………….. (ū-rin-AL-is-is)

laboratory examination of urine

18. urodynamics……… (ū-rō-dī-NAM-iks)

pertaining to the force and flow of urine within the urinary tract

19. void………………. (voyd)

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 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:

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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.

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Chapter 12Reproductive System

Learning ObjectivesI. Surgical TermsII. Other Surgical TermsIII. Diagnostic Procedural TermsIV. Case HistoryV. 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.

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

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Reproductive System. Define, pronounce, and spell diagnostic procedural terms related to the

Female Reproductive System.

Reproductive SystemThe 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 SystemThe 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 SystemRoot Refers tocervic/o; trachel/o cervixcolp/o; vagin/o vaginamen/o mensesoo eggoophor/o ovary (also egg)orch/i/o; orchid/o testesovari/o ovarysalping/o tube (sometimes a reference to

the uterine tube)spermat/o spermuter/o; hyster/o; metr/o uterus

The Male Reproductive CycleThe male reproductive cycle comprises the production of the male gametes. This process, called spermatogenesis, involves a cell-division process known as

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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 CycleThe Fertilization StageLike 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.

The Gestation StageGestation, 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.

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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 systemTerm Definitionamniocentesis extraction and diagnostic examination of amniotic fluid from

the amniotic saccervicectomy; also, rarely, trachelectomy

excision of the uterine cervix

cervicitis; also trachelitis

inflammation of the uterine cervix

cervicoplasty surgical repair of the uterine cervix OR the neckcervicotomy; also trachelotomy

incision of the uterine cervix; tracheotomy is the term used to denote an incision into the neck (trachea), but trachelotomy refers to the uterine cervix and is synonymous with cervicotomy

hysteralgia; also hysterodynia

pain in the uterus

hysterectomy surgical removal of the uterushysteropathy any disease of the uterushysteropexy surgical fixation of the uterushysteroplasty surgical repair of the uterushysterotomy incision of the uterusmammography examination of the breast by means of an imaging technique,

such as radiographyoophorectomy ovariectomyoophoritis inflammation of an ovaryoophoroplasty surgical repair of an ovaryoophorotomy incision into an ovaryorchialgia pain in the testesorchiectomy removal of one or both testes (less commonly orchidectomy)

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orchiopathy any disease of the testesorchioplasty surgical repair of a testisorchiotomy incision into a testisorchitis inflammation of a testisovarialgia pain in an ovaryovariectomy excision of one or both ovariesovariotomy incision of an ovaryovaritis inflammation of an ovary (oophoritis)Pap test microscopic examination of cells from a mucosal surface,

especially the uterine cervixuteropexy surgical fixation of the uterus (hysteropexy)uteroplasty surgical repair of the uterus (hysteroplasty)uterotomy incision of the uterus (hysterotomy)

Common Abbreviations:The Reproductive SystemAbbreviation MeaningBPH benign prostatic hyperplasiaCS Cesarean sectionD&C dilation and curettageDNA deoxyribonucleic acid (the genetic

code)DUB dysfunctional uterine bleedingHSG hysterosalpingogramIVF in vitro fertilizationOB obstetricsPID pelvic inflammatory diseasePSA prostate-specific antigenTURP transurethral resection of the prostate

I. Surgical TermsTERM DEFINITION1. cervicectomy……………. excision of the cervix (ser-vi-SEK-tō-mē)2. colpoperineorrhaphy……. suture of the vagina and (rōl-pō-pār-i-nē-OR-a-fē) perineum (performed to mend

perineal vaginal tears)3. colpoplasty……………… plastic repair of the vagina (KOL-pō-plas-tē)4. colporrhaphy……………. suture of the vagina

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(rōl-PŌR-a-fē)5. episioperineoplasty……… plastic repair of the vulva and (e-piz-ē-ō-pār-i-nē-o-PLAST-ē) perineum6. episiorrhaphy……………. suture of (a tear in) the vulva (ē-piz-ē-ŌR-a-fē)7. hymenectomy……………. excision of the hymen (hī-men-EK-tō-mē)8. hymenotomy…………….. incision of the hymen (hī-men-OT-ō-mē)9. hysterectomy……………. excision of the uterus (his-te-REK-tō-mē)10. hysteropexy……………. surgical fixation of the uterus (HIS-ter-ō-pek-sē)11. hysterosalpingo- oophorectomy……..……. excision of the uterus, fallopian (his-ter-ō-sal-ping-gō-ō-of-ō tubes, and ovaries PEK-tō-mē)12. mammoplasty………….. plastic repair of the breasts (MAM-ō-plas-tē) (performed to enlarge or reduce

in size, to lift, or to reconstruct after removal of a tumor)

13. mastectomy……………. surgical removal of a breast (mas-TEK-tō-mē)14. oophorectomy…………. excision of an ovary15. oophorosalpingectomy… excision of the ovary and (ō-of-ō-rō-sal-pin-JEK-tō-mē) fallopian tube16. perineorrhaphy…………. suture of (a tear in) the perineum (pā-r-i-nē-ŌR-a-fē)17. salpingectomy………….. excision of a fallopian tube (sal-pin-JEK-tō-mē)18. salpingostomy………….. creation of an artificial opening (sal-ping-GOS-tō-mē) in a fallopian tube (performed to

restore patency)19. vulvectomy…………….. excision of the vulva (vul-VEK-tō-mē)

II. Other surgical TermsTERM DEFINITION

1. anterior and posterior colporrhaphy (A & P repair) when a weakened vaginal wall

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results in a cystocele (protrusion ofthe 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-Re- of the endometrium with anTAHZH) instrument called a curette. It is

performed to diagnose disease, tocorrect 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 fallopiantubes) 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 lump5. tubal ligation……………. closure of the fallopian tubes for

(lī-GĀ-shun) sterilization

III. Diagnostic Procedural TermsTERM DEFINITION1. 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 Douglas cul-de-sac4. culdoscope……………… instrument used for visual examination (KUL-dō-skōp) of the Douglas cul-de-sac

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5. culdoscopy……………… visual examination of the Douglas cul- (kul-DOS-kō-pē) de-sac6. hysterosalpingogram…… x-ray film of the uterus and the fallopian (his-ter-ō-sal-PING-go-gra-m) tubes7. hysteroscope………….... instrument used for visual examination (HIS-ter-o-skōp) of the uterus8. 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 (mother 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.DIAGNOSIS: left breast biopsy:

1. radial scar2. nonproliferative and proliferative fibrocystic changes with

significant atypia3. papillary duct adenocarcinoma4. focal sclerosing adenosis

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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.

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

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procedural terms related to the Nervous System.

The Nervous SystemAlthough 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 SystemThe 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 systemWord Element Refers tocephal/o; encephal/o

brain

cerebell/o the cerebellumcerebr/o the cerebrum; also, the brain in generalcortic/o outer layer or coveringgangli/o; ganglion/o

ganglia (singular: ganglion)

gli/o gluehydr/o watermegal/o largemening/i/o a membranemyel/o in connection with the nervous system, refers to the

spinal cord and medulla oblongataneur/o a nerve cell; nervous systempsych/o the mindspin/o the spinal cord-mania suffix meaning “morbid attraction to” or “impulse

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toward”-phobia suffix meaning “morbid or unreasonable fear”

The Practice and the PractitionersCoupling 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 SystemNerve 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 SystemDendrites, 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 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

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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 SystemThe BrainAs 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.

CerebrumThe 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.

CerebellumThe 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.DiencephalonThe 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 StemBoth 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

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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 half-inch 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 SystemThe 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, these nerves are associated with bodily movements and functions within other systems.

Common Abbreviations:The Nervous SystemAbbreviation MeaningADHD attention deficit hyperactivity disorderEEG electroencephalographyIQ intelligence quotientLP lumbar punctureMA mental age

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OBS organic brain syndromeOCD obsessive-compulsive disorderPERRLA pupils equal, round, and reactive to light

and accommodationSAD seasonal affective disorderTENS transcutaneous electrical nerve stimulationWAIS Wechsler Adult Intelligence ScaleWISC Wechsler Intelligence Scale for Children

Nervous System Disorders and ProceduresA 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 PhobiasTerm Definitionacrophobia fear of heightsagoraphobia fear of being outside your own housearachnophobia fear of spidersclaustrophobia fear of being in a closed airless

spacexenophobia fear of foreignersankylophobia fear of immobility of a jointhemophobia fear of bloodpanophobia fear of everythingxenoglossophobia fear of foreign languages

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TABLE 13-3 Disorders and Procedures Common to the Nervous SystemTerm Definitionagnosia loss of sensory input recognitionAlzheimer disease; also Alzheimer's disease

a disease that may begin in late middle life; characterized by progressive mental deterioration that includes loss of memory and visual and spatial orientation

aphasia loss of speechcerebral thrombosis blood clot in the braincerebral stroke an acute clinical event, related to impairment of cerebral

circulation, lasting more than 24 hourscerebrovascular accident (CVA)

synonym for a cerebral stroke; an acute clinical event, related to impairment of cerebral circulation, lasting more than 24 hours

cerebrovascular disease brain disorder involving a blood vesselcraniectomy excision of part of the skullcraniotomy incision into the skulldelirium impaired consciousnessdementia impaired intellectual functiondysphasia impaired speechencephalitis inflammation of the brainepilepsy CNS disorder often characterized by seizuresglioblastoma a cerebral tumor occurring most frequently in adultsglioma tumor of glial tissuehemiparesis partial paralysis of one side of the bodyhemiplegia paralysis of one side of the bodyHuntington disease (alsohereditary disorder of the CNS characterized by

involuntary muscleHuntington's disease) movements and dementiahydrocephalus excessive cerebrospinal fluid in the brainhyperesthesia abnormal sensitivity to touchmeningioma benign tumor of meningesmeningitis inflamed meningesmultiple sclerosis disease of the CNS; characterized by the formation of

plaques in the brain and spinal cordmyelitis inflamed spinal cordmyelography radiography of the spinal cord and nerve rootsneuralgia pain in a nerveneuropathy any disorder of the nervous systemneuroplasty surgery to repair a nerveparalysis loss of motor control

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paraplegia paralysis of the lower extremities and, often, the lower trunk of the body

paresthesia numbnessParkinson disease (also Parkinson's disease)

a neurologic condition characterized by difficulty in controlling muscles

plegia paralysispoliomyelitis inflamed gray matter in the spinal cordpsychosis general term covering severe mental or emotional

disordersquadriplegia paralysis of all four limbssciatica pain in the sciatic nerve, located in the lower back and

extending down the thighseizure sudden disturbance in brain function, sometimes

producing a convulsionsyncope fainting

I. Surgical TermsTERM(built from word parts)1. ganglionectomy…………( gang−gl { e−on−EK−t o−m e )¿2. neurectomy……………...(n u−REK−t o−m e )3. neurolysis……………….(n u−ROI−i−sis )4. neuroplasty………………( N U−r o−plas−t e )5. neurorrhaphy……………(n u−R O R−a−t e )6. neurotomy……………..(n u−ROT −o−m e )7. radicotomy…………….(rad−i−KOT−o−m e )8. rhizotomy………………(ri−ZOT− o−me )

DEFINITION

excision of a ganglion (also called gangliectomy)excision of a nerve

separating a nerve (from adhesions)

surgical repair of a nerve

suture of a nerve

incision into the nerves

incision into a nerve root

incision into a nerve root

II. Diagnostic Procedural TermsTERM DEFINITION

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(built from word parts)1. cerebral angiography………………(s e−R E−bral) ( an− j e−OG−ra− f e )

process of x-ray filming of the blood vessels in the brain (after an injection of contrast medium)

2. echoencephalography………….......(ek−o−en−sef −a−LOG−ra−f e )

process of recording brain structures by use of sound (also called ultrasonography)

3. electroencephalogram(EEG)………(e−lek−tr { o−en−SEF−a−l o−gram)¿

record of the electrical impulse of the brain

4. electroencephalograph……………..(e−lek−tr { o−en−SEF−a−l o−graf )¿

instrument used for recording the electrical impulses of the brain

5. electroencephalography……………(e−lek−tr { o−en−sef −a−LOG−ra− f e )¿

process of recording the electrical impulses of the brain

6. myelogram…………………………( M I −e−l o−gram )

x-ray film of the spinal cord (after injection of dye into the spinal fluid that surrounds the spinal cord)

III. Other Diagnostic Procedural TermsTERM DEFINITION1. computed tomogtaphy of the brain…………………..( t o−MOG−ra− f e )

process that includes the use of a computer to produce a series of images of the tissues of the brain at any desired depth. The procedure is 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) ….( LUM−bar )

insertion of a needle into the 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 the head (MRI)...(mag−NET −ik )(re−zo−NANGE )( IM−a− jing )

A noninvasive technique that produces cross-sectional and vertical images of cranial structures by use of magnetic waves. Unlike CT scan, MRI produces images without use of radiation or contrast

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medium.4. positron emission tomography of the brain (PET scan)………………..( POS−i−tron ) (e−MI−shun )( t o MOG−ra−f e )

A new technique that permits viewing of a slice of the brain and gives information about brain function such as blood flow. The patient is injected with radioactive material. A special 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 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.

Chapter 14The Special Sense

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Learning ObjectivesI. Surgical TermsII. Other Surgical TermsIII. Diagnostic Procedural TermsIV. Case HistoryV. 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.

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 EyeThe 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

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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 EyeThe 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 EyeWord or Root Refers toblephar/o eyelidconjunctiva (plural: conjunctivae)

mucous membrane covering the anterior surface of the eyeball

core/o pupil of the eyecornea (plural: corneas) the outer wall of the eye; reflector of lightdacry/o tearsdacryocyst/o lacrimal sacirid/o iris (plural: irides)ocul/o eyeophthalm/o eyeopt/o lightpalpebra (plural: palpebrae) eyelidphak/o; phac/o lensretin/o retinascler/o sclerauve/o middle layer of the eye containing muscles and

blood vessels-opia suffix denoting vision; a condition of the eye

The Practice and the PractitionersThe 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.

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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 EyeThe 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.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.

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Accessory Structures of the EyeAccessory 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 EyeAbbreviation MeaningECCE extracapsular cataract extractionEOC extraocular movementERG electroretinographyICCE intracapsular cataract extractionIOP intraocular pressureOD right eyeOS left eyeOU both eyesPVD posterior vitreous detachment (referring to the vitreous body)

TABLE 14-2 Common Conditions and Procedures associated with the EyeTerm Definitionaphakia without a lensastigmatism fuzzy vision caused by the irregular shape of one or both

eyeballsblepharectomy surgical removal of part or all of an eyelidblepharitis inflammation of the eyelidblepharochalasis relaxation of the eyelidblepharoconjunctivitis

inflammation of the palpebral conjunctiva

blepharoplasty surgery to correct a defective eyelidblepharoplegia paralysis of an eyelidblepharoptosis drooping eyelid(s)blepharospasm involuntary contraction of the eyelidblepharotomy surgical incision of an eyelidconjunctivitis inflammation of the conjunctivaconjunctivoplasty surgery on the conjunctiva

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coreoplasty surgical repair of the pupilcorepexy surgical fixation of the irisdacryocele lacrimal sac filled with fluid; often called a dacryocystocele,

because dacryocyst is a synonym for lacrimal sacdacryocystalgia pain in the lacrimal sacdacryocystectomy surgical removal of the lacrimal sacdacryocystotomy incision into the lacrimal sacdacryolith a “stone” in the lacrimal apparatusdacryorrhea excessive secretion of tearsemmetropia normal visionhyperopia farsightednessiridocele hernia of the irisiridomalacia softening of the irisiritis inflammation of the irislacrimation synonym for dacryorrhealacrimotomy synonym for dacryocystotomymyopia nearsightednessoculodynia pain in the eyeballoculopathy generic term for eye disease; synonym for ophthalmopathyophthalmolith synonym for dacryolithophthalmomalacia softening of the eyeballophthalmoscope device for examining the interior of the eyeball by looking

through the pupilophthalmoscopy examination of the eye with an ophthalmoscopephacocele hernia of the lensphacolysis operative removal of the lens in piecesphacomalacia softening of the lenspresbyopia farsightedness resulting from loss of elasticity in the lensretinectomy surgical removal of part of the retinaretinitis inflammation of the retinaretinopathy disease of the retinaretinopexy procedure to repair a detached retinaretinotomy an incision through the retinascleroiritis inflammation of the sclera and irisscleromalacia softening of the sclerauveitis inflammation of the uvea

The EarThe 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

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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 EarThe 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 EarWord or Root Refers toaudi/o sound; hearingaur/o earauricul/o earcerumen brownish-yellow, waxy secretion of the ceruminous

glands in the external auditory canalmyring/o tympanic membrane (eardrum)ot/o eartympan/o eardrum

The Practice and the PractitionersCoupling 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 EarThe ear is divided into three parts: the external, middle, and inner ears .The External EarThe 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

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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 EarThe 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.

Common Ear Disorders and ProceduresHearing 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 EarTerm Definitionaudiogenic caused by soundaudiogram automatically recorded results of a hearing test with an

audiometer (an electrical device for measuring hearing)audiometer electrical device for measuring hearingaudiometry measuring hearing with an audiometercochlear implant surgically implanted hearing aid in the cochleaconductive hearing loss

hearing loss caused by interference with sound 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 eardrumotalgia pain in the earotitis inflammation of the ear (otitis externa = the outer ear; otitis

media = the middle ear; otitis interna = the inner ear)otodynia earache

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otogenic originating in the earotopathy any disease of the earotoplasty cosmetic surgery on the auricleotorrhea fluid discharge from the earotosclerosis formation of spongy bone in the inner ear producing hearing

lossotoscope device for looking into the earotoscopy looking into the ear with an otoscopepresbyacusis hearing loss that occurs with agingsensorineural hearing loss

hearing loss caused by a neural condition; specifically, a disorder of the auditory nerve or some other part of the inner ear

tinnitus sensation of noises (such as ringing) in the earstympanectomy surgical removal of the eardrumtympanocentesis puncture of the tympanic membrane with a needle to aspirate

middle ear fluidtympanoplasty surgery performed on the middle eartympanotomy; tympanostomy

synonyms for myringotomy

vertigo sensation of spinning or whirling; can be caused by infection or other disorder in the inner ear

Common AbbreviationsThe EarAbbreviation MeaningAD right earAS left earAU both earsBC bone conductiondb or DB decibelTM tympanic membrane (eardrum)AC air conductionENT ear, nose, and throatOM otitis mediaHL hearing level

Chapter 15

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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.

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

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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 TechniquesMethod DescriptionRadiographyRa-de-OG-ra-fe

Use of x-rays passed through the body to make a visual record (radiograph) of internal structures on specially sensitized film; also called roentgenography

FluoroscopyFlū-or-OS-kō-pē

Use of x-rays to examine deep structures.The shadows cast by x-rays passed throughthe body are observed on a fluorescent screen.The device used is called a fluoroscope .

CineradiographySin-e-rā-dē-OG-ra-fē

Making of a motion picture of successive images appearing on a fluoroscopic screen

computed tomography(CT; CT scan)Tō-MOG-ra-fē

Use of a computer to generate an image from a large number of x-rays passed at different angles 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).

Ultrasonographyul-tra-son-OG-ra-fe

Generation of a visual image from the echoes of high-frequency sound waves traveling back from different tissues; also called sonography and

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echography (ek-OG-ra-fē)ScintigraphySin-TIG-ra-fe

Production of an image of the distribution of 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 (MRI)

Production of images through the use of a 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 tomography (PET)

Production of sectional body images by 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 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.

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The most widely used methods for treatment of cancer are surgery, radiation therapy, and chemotherapy, treatment with chemicals.

V. Key TermsAuscultation(aws-kul-TĀ-shun)

Listening for sounds within the body, usually within the chest of abdomen

Biopsy(BĪ-op-sē)

Removal of a small amount of tissue for microscopic examination

chemotherapy(kē-mō-THER-a-pē)

The use of chemicals to treat disease

Diagnosisn(di-ag-NO-sis)

The process of determining the cause and nature of an illness

Endoscope(EN-do-skop)

An instrument for examining the inside of an organ or cavity through a body opening or small incision. Most endoscopes use fiberoptics for viewing

Excision(ek-SIZH-un)

Removal by cutting

Incision(in-SIZH-un)

A cut, as made for surgery; also the act of cutting

Inspection(in-SPEK-shun)

Visual examination of the body

Ophthamoscope(of-THALmo-skop)

An instrument for examining the interior of the eye

Otoscope(O-to-skop)

An instrument for examining the ear

Palpation(pal-PA-shun)

Examining by placing the hands or fingers on the surface of the body

Percussion(per-KUSH-un)

Tapping the body lightly but sharply in order to assess the condition of the underlying part by the sounds obtained

Prognosis(prog-NO-sis)

Prediction of the course and outcome of a disease

Radionuclide(ra-de-o-NU-klid)

A substance that gives of radiation; used for diagnosis and treatment; also called radioisotope or radiopharmaceutical

Sign An evidence of disease that can be observed or tested. Examples are fever, rash, high blood pressure, blood or urine abnormalities. An symptom

Staging The process of classifying malignant tumors for diagnosis, treatment, and prognosis

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Stethoscope(STETH-o-skop)

An instrument used for listening to sounds produced within the body

Suture(SU-tum)

To unite parts by stitching them together; also the thread or other material used in that process orthe seam formed by surgical stitching

Symptom(SIM-tum)

Any evidence of disease; sometimes limited to subjective evidence of disease, as experiencedby the individual, such as pain, dizziness, weakness

Syndrome(SIN-drom)

A group of signs and symptoms that together characterize a disease condition

Therapy(THER-a-pe)

Treatment; intervention

VI. Roots Pertaining to Physical FactorsRoot Meaning Example Definitionaer/o Air, gas aerobe

A−er−o borganism that requires air(oxygen) to live

bar/o pressure barotraumasbar−o−TRAW−ma

injury (trauma) caused bypressure, as to the ear

Chrom/ochromat/o

color, stainchromatickr { o−MAT −ik ¿

pertaining to color

Chron/o Time synchronousSIN−kr { o−nus¿

occurring together

cry/o Cold cryoprobeKRI−o− prob

Instrument used to applyExtreme cold to tissues

Electr/o electricity electroshocke−LEK−tr { o−shok ¿

shock produced by electricity

erg/o Work synergisticsin−er−JIS−tik

acting together with increasedeffect like drugs in combination

phot/o Light photosensitivef o−t o−SEN −si− tiv

abnormally sensitive to ligtht

radi/o radiation, x-ray

Radioactiver a−d e−o−AK−tiv

giving off radiation

son/o Sound ultrasonicul−tra−SON−ik

pertaining to higth-frequencysound waves

Therm/o Heat, temperature

hypothermiah i−p o−THER−m e−a

low body temperature

VII. Suffixes Pertaining to DiagnosisSuffix Meaning Example Definition

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-graph instrument forrecording data

SpirographSP { I−r o−graf ¿

instrument used to recordBreathing (spir/o) movements

-graphy act of recordingData

roentgenographyrent−gen−OG−ra−f e

obtaining pictures with roentgenrays ,(x-ray); radiography

-gramt A record of data

sonogramS O−no−gram

record obtained by ultrasonography

-meter instrument forMeasuring

Ergometerer−GOM−e−ter

instrument for measuring work (erg/o) done

-metry measurement of

Optometryop−TOM−e−tr { e ¿

measurement of vision (opt/o) for glasses

-scope instrument forviewing or examining

CystoscopeSIST-o-skop

endscope used to examine theUrinary bladder

-scopy Examination of

LaparoscopyLap-or-OS-ko-pe

examination of the abdomen through the abdominal wall

VIII. Suffixes Pertaining to SurgerySuffix Meaning Example Definition-centesis puncture,tap celiocentesis puncture of the abdomen

Sē-lē-ō-sen-TĒ-sis-desis binding, fusion Pleurodesis binding the pleural

membranesPlū-rō-DĒ-sis (around the lungs)

-ectomy excision, surgical ton-sillectomy excision of the fonsils(tonsil/o)

Removal ton-sil-EK-tō-mē-pexy surgical fixation uteropexy

Ū-ter-ō- PEKS-ēsurgical fixation of theuterus(uter/o)

-plasty plastic repair,reconstruction

septoplastysep-tō-PLAS0-tē

plastic repair of the nasal septum(partition)

-rhaphy surgical repair,suture

herniorrhaphyher-nē-OR-a-fē

surgical repair of a hernia(herni/o)

-Stomy surgical creationof an opening

colostomykō-LOS-tō-mē

colon (col/o)

-tome instrument for dermatomeDER-ma-tōm

instrument for cutting theskin

-tomy incision of, laparotomylap-ar-OT-ō-mē

surgical incision of theabdomen

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-tripsy Crushing lithotripsyLITH-ō-trip-sē crushing of a stone

IX. Additional Termssymptomsclubbing 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.

colic(KOL-ik) Acute abdominal pain associated with smooth muscle spasms

cyanosis(ai-an-Ō-sis) Bluish discoloration of the skin due to lack of oxygen

Diaphoresis(di-a-fo-RE-sis)

Profuse sweating

malaise(ma-LĀZ) A feeling of discomfort or uneasiness, often indicative of infection

nocturnal(nok-TUR-nal) Pertaining to or occurring at night(roots noct/i and nyct/o mean "night")

pallor(PAL-or) Paleness; lack of colorprodrome(PRŌ-drōm) A symptom indicating an approaching diseasesequela(sē-KWĒ-la) A lasting effect of a disease (pl. sequelae)syncope(SIN-kō-pē) A temporary loss of consciousness due to

inadequate blood flow to the braing; fainting

DiagnosisAlpha- fetoprotein(al-fa-fē-tō-prō-tēn)(AFP)

A fetal protein that appears in the blood of adults with certain types of cancer

Bruit (bruē) A sound, usually abnormal, heard in auscultationFacies (FĀ-shē-ēz) The expression or appearance of the faceFebrile (FEB-ril) Pertaining to fevernuclear medicine The branch of medicine concerned with the use

of radioactive substances (radionuclides) for diagnosis, therapy, and research

Radiology(rā-dē-OL-ō-jē) The branch of medicine that uses radiation, such as x-rays, in the diagnosis and treatment of disease.

Catheter (KATH-e-ter) A thin tube that can be passed into the body; used to remove fluids from or introduce fluids into a body cavity.

Lavage(la-VAZH) The washing out of a cavity; irrigation

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Paracentesis(par-a-sen-TĒ-sis)

Puncture of a cavity for removal of fluid

prophylaxis(prō-fi-LAK-sis)

Prevention of disease

Surgery drain Device for allowing matter to escape from a wound or cavity. Common types include Penrose, (cigarette), T-tube, Jackson-Pratt (J-P), and Hemovac

exeresis(eks-ER-e-sis) Surgical removalextirpation(ek-ster-PA-shun)

Complete removal of destruction of an organ of tissue

laser(LĀ-zer) A device that transforms light into a beam of intense heat and power; used for surgery and diagnosis

ligature(LIG-a-chūr) A tie or bandage; the process of binding or tying (also called ligation)

resection(rē-SEK-shun) Partial excision of a structure

X. Surgical InstrumentsInstrument DescriptionbougieBOO-zhē

slender, flexible instrument for exploring and dilating tubes

cannulaKAN-ū-la

tube enclosing a trocar that allows escape of fluidor air after removal of the trocar

elevatorEL-e-vā-ter

instrument for lifting tissue or bone

forcepsFOR-ceps

instrument for holding or extracting

gigli’s sawJĒ-yēz

flexible wire saw

hemostatHĒ-mō-stat

small clamp for stopping blood flow from a vessel

lithotriteLITH-ō-trit

instrument for crushing bladder stones

Rasp Surgical filerongeurRon-ZHUR

gouge forceps

scalpelSKAL-pel

surgical knife with a sharp blade

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soundsownd

instrument for exploring a cavity or canal

trocarTRO-kar

sharp-pointed instrument contained in a cannula used to puncture a cavity

XI. AbbreviationsA. History and physical ExaminationBP blood pressureC celsius (centigrade)CC chief complaintc/o complains ofEOMI extraocular muscles intactF fahrenheitHEENT head, eyes, ears, nose, nose, and throath/o history ofH&P history and physicalHPI history of present illnessI&O intake and outputIPPA inspection, palpation, percussion, auscultationNAD no apparent distressP pulsePE physical examinationPE(R) RLA pupils equal react to light and accommodationPMH past medical historyPt patientR respirationR/O rule outROS review of systems T temperatureTPR temperature, pulse, respirationVS vital signsWD well developedWNL within normal limitsB. Diagnosis and treatmentABC aspiration, biopsy, cytologyAFP alpha-fetoproteinbx biopsyCi curie (unit of radioactivity)C&S culture and (drug) sensitivity (of bacteria)

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CT computed tomographyDx diagnosisICU intensive care unitI&D incision and drainageMET metastasisMRI magnetic resonance imagingPCA patient-controlled analgesiaPET positron emission tomographyPostop postoperativePreop preoperativeRATx radiation therapyRx drug, prescription, therapyTNM (primary) tumor, (regional lymph) nodes, (distant) metastasesUV ultraviolet

C. Views for X-rayAP anteroposteriorLL left lateralPA posteroanteriorRL right lateral

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Chapter 16Directional 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.

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

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I. IntroductionIn 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 TermsTERM DEFINITION1. a. cephalic (head)(se−FAL−ik )b. superior (above) (su−P E R− e−or )

toward the top of the body

2. a. caudal (tail)(CAW−dal ).…..

b. inferior (below)( in−F E R− e−or )

toward the lower end of the body

3. a. anterior(an−T E R− e−or )…

(VEN−tral )

toward the front of the body

4. a. posterior( pos−T E R− e−or )

b. dorsal ( D O R−sal )……....……

toward the back of the body

5. medial ( M E−d e−al)………… toward the midline or middle

6. lateral( LAT−er−al ) ……...…. toward the side

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 PlanesPlanes are imaginary flat fields used as points of reference to identify the position of parts of the body .TERM DEFINITION1. frontal of coronal plane….( KOR−o−nal )

vertical field passing through the body from side to side, dividing the body into anterior and posterior portions

2. sagittal plane…………….. vertical field running through the body

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(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………….( trans−VERS )

horizontal field dividing the body into upper and lower portions.

IV. Anatomical Abdominal RegionsTo assist medical personnel to locate medical problems with greater accuracy and for identification purposes, the abdomen is divided into regions.TERM DEFINITION1. umbilical region……….(um−BIL−i−kal )

around the navel (umbilicus)

2. epigastric region…………(ep−i−GAS−trik )

directly above the umbilical region

3. hypogastric region………(h I−p o−GAS−trik )

directly below the umbilical region

4. hypochondriac regions….(h I−p o−KON−dr { e−ak )¿

to the right and left of the epigastric region

5. lumbar regions…………( LUM−bar )

to the right and left of the umbilical region

6. iliac regions…………….( IL− e−ak )

to the right and left of the hypogastric region

V. Additional TermsTERM DEFINITION1. extension……………(ek−STEN −shun )

movement in which a limb is placed in a straight position

2. flexion…………….( FLEK−shun )

movement in which a limb is bent

3. afferent……………( AF−er−ent )

conveying toward a center (for example, afferent nerves carry impulses to the central nervous system)

4. efferent……………( EF−er−ent )

conveying away from the center (for example, 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 ( pr { o n)¿….……. lying straight on one’s front;facedown

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8. supine (d e p )……..…. lying straight on one’s back;faceup

1.Deep (d e p )……….…. situated far below the surface

10. superficial………...(s u− per−FISH−al )

situated near the surface

11. adduction…………(ad−DUK−shun)

state of drawing toward the middle

12. abduction……..…..(ab−DUK−shun )

state of drawing away from the middle

13. eversion……………( e−VER−zhun)

state of turning outward

14. inversion…………( in−VER−zhun )

state of turning inward

15. bilateral………….(b I−LAT−er−al)

pertaining to both sides

16. unilateral…………( u−ni−LAT−er−al )

pertaining to one side only

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