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Medical Terminology Course

Margaret Boyd*

This section comprises the edited notes for a course in medical terminology given at the DL W.W. Cross Institute, Edmonton, Canada.

The glossary and assignment exercises will be found in subsections 18 and 19 respectively.

Acknowledgements The writer thanks the Administration of the Provincial Cancer Hospitals Board, Edmonton, Alberta, Canada, for their cooperation in allowing time off for the staff to attend the initial courses, as well as for the clerical assistance, especially in the preparation of the revised series. The clerical work was carried out by Ms. Linda Cousins.

The revision of a series of lecture notes, used some years previously, necessitated the search of many well-known reference books to determine the source of material, and where possible, authors were given credit.

The work was organized from existing sources and from the writer's personal experience. Many medical works have been consulted and heavy reliance has been placed on Dorland's Illustrated Medical Dictionary and Tabe?s Cyclopedic Medical Dictionary. Other books which have been consulted rather extensively are The Standard Nomenclature of Diseases and Operations, pub- lished by the American Medical Association, and Essentials of by DL Hj. Van Peenen. All reference material is listed in the bibliography and in footnotes.

The writer, Margaret L. Boyd, Reg. N., B.Sc.N., M.H.S.A., was the first Director of Nursing for the Provincial Cancer Hospitals Board, including the Dr. W.W. Cross Cancer Institute, from the years 1968-1972. Leaving to complete her post-graduate education, she subsequently was employed by the Misericordia Hospital, Edmonton, Alberta as the Assistant Executive Director, Patient Care Services. Retirement from that position in March, 1975 made possible the completion of this revised material.

* @1976 Unpublished copyright material, printed with permission from the author. 2 Medical Terminology Course

MEDICAL TERMINOLOGY COURSE The main difference in medical terminology is that most word elements are derived from (L) or Greek (Gr). Introduction 1.1 Combined Word Elements Not all word elements are required to com- There are important rules which govern the plete medical terms. For example, the word formulation of most medical terms. In this oliguria is made up of a prefix and a suffix, olig course, medical terms commonly in use in originating from the Greek meaning few or cancer centres will be introduced. small and uria also Greek pertaining to Many medical terms are derived from other (ur), thus oliguria means that a scanty or small and everyday English does not amount of urine is being produced. always apply. Thus it is important to recognize Some medical terms combine a prefix and a word elements and their meanings. : , pronounced EN/do/derm, In this course, for ease in pronunciation, prin- derived from the Greek root derin meaning cipal accents are written in capital letters and , thus, the inside skin layer. slashes are used to divide syllables, e.g. col LOS/to/my. At times the same root may be combined with Some words are pronounced differently in dif- a suffix: dermalgia, pronounced DERM/al/gia, ferent countries. Some examples are the differ- combines demi with a Latin suffix algia mean- ing pronunciations of a few rather common ing pain, thus dermalgia means painful skin. words: Bronchoscopy, pronounced BRONCHIo/ scopy, combines the Greek bronchos meaning AB/do/men windpipe with the Greek scop which means to ab/DO/men look at or observe, hence the meaning is to look at the windpipe. migraine MI/graine ME/graine Sometimes two roots are combined to describe a disease or treatment with more accuracy. For neurasthaenia NEUR/as/then/ia example osteoncus - (OS/te/oncus). The Greek NEUR/as/thenia osteo meaning combines with the Greek root oncos meaning mass or tumour. This word 1. WORD ELEMENTS is synonymous with a more common term osteoma (OS/te/oma) however orna is a Greek To make medical terminology simpler, terms suffix pertaining to tumour may be broken down into several smaller A more common example of a term with two words or word elements. The three primary roots is bronchopneumonith BRON/cho/ word elements are prefixes, roots and suffixes. pneurnon/itis where the Greek root bronchos Roots, also known as stems, are usually the combines with the Greek root pneumo mean- main parts of the word. Prefixes are word ele- ing , however a Greek suffix defines the ments which, when combined with a root, word even further by the addition of , alter or augment the meaning. Prefixes pre- which means of thus a word cede the root. Suffixes also alter or augment meaning inflammation of the windpipe and the meaning of a root element and follow the . root or stem. Note that the adjective inflamed - has only Examples: one m but the term inflammation, derived from the Latin inflammere which means to Root: content flame within has two m's. New Words: discontent prefix = dis 1.2 Word variations discontented suffix = ed Root: kind Words formed from several different word ele- ments may add, change or omit certain letters New Words: kindness suffix = ness to conform with rules of spelling and pronun- unkind prefix = un ciation, for example demi (at), broncho (s), oste (o). Medical Terminology Course

Table 1. Summary of new terms Word Pronunciation Prefixes Roots Suffixes oliguria O/lig/ur/ia olig uria endoderm EN/do/derm end(o) derm derrnalgia DERM/al/gia derm algia bronchoscopy BRONCHIo/scopy broncho(s) scopy osteonctis OS/te/ oncus oste(o) + oncus osteoma OS/te/orna oste(o) orna broncho- BRON/cho/ broncho(s) + itis pneumonitis pneumon/itis pneurnon

Table 2. Elements of similar spelling or sound Element Meaning Origin Example Meaning of Word ante before L. antepyretic before patient becomes febrile anti against Gr. antipyretic used against a negative L. adipsia absence of thirst prefix ad towards L. adrenal near the a, an negative L. arioxaemia absence of oxygen in ano anus L. Anorectal pertaining to anus and ad towards L. Adriexa appendages or adjunct parts aden(o) Gr. glandular tumour cyto Gr. Cytolymph hyalin substance in a cell cysto bladder Gr. Cystolith di two L. Diamine containing two amino groups dia through Gr. Diathermy heat treatments through the tis- sues dis away from L. dislocation displacement of a part, especially a bone dys bad or Gr. dyslochia disordered lochial discharge improper en in Gr. encranial located in the cranium entero intestines Gr. enterology study of intestines gram record Gr. electroencepha- record of brain waves logram graph machine Gr. electroencepha- instrument used to make record lograph graphy process Gr. electroencepha- process of making records loraphy haem(at) blood Gr. hemangioma tumour consisting of blood vessels hemi half Gr. henuglossal involving half the haemo blood Gr. haemoglobin oxygenpigment carrying red blood cells hyper above Gr. hyperchro-mato- increased staining capacity sis Medical Terminology Course

Table 2. Elements of similar spelling or sound hypo below Gr. hypochro- mato- fading or disappearance of chroma- sis tin from a cell ile(o) L. ileocaecal pertaining to the ileum and cae- cum illo bone L. iiosacrum pertaining to the and inter between L. intervertebral between two contiguous vertebrae intra inside L. intravenous within the macr(o) large Gr. macrodontia large teeth micro small or Gr. microdontia abnormal smallness of teeth minute my(o) muscle Gr. myocyte a cell of the muscle myel(o) marrow Gr. cell necr(o) corpse Gr. necrotic state of tissue death nephr(o) kidney Gr. nephrotic kidney condition caused by neph- rosis neur(o) Gr. neurotic nervous condition or(al) mouth Gr. oropharyngeal pertaining to the mouth and aur(al) L. auralgia ear pain ost(eo) bone Gr. osteoscierosis abnormal hardening of bone ot(o) ear Gr. otosclerosis formation of spongy bone in the middle ear per through L. percutaneous through the skin peri around Gr. periglottis around the tongue pre before L. precordium region in front of the py(o) pus Gr. pyogenesis formation of pus pyr(o) fire Gr. pyrogen fever producing substance (ec)tomy to remove Gr. surgical removal of bladder (os)tomy to make a L.& Gr. cystostomy surgical opening into bladder mouth (o)tomy to incise or Gr. cystotomy surgical incision into bladder open Medical Terminology Course 5

Also, many word elements with which you Dorsal - back or posterior part of the must be familiar are similar in sound or even body spelling but have very different meanings Ventral - front or anterior part of the (Table 2). body For example, a patient who has advanced car- Inferior - lower or under cinoma of the bladder may require a cystec- Superior - upper or higher tomy, however sometimes when temporary Antero (anterior) - in front of drainage of the bladder is required, a cys- behind tostomy is performed. However, the surgeon Postero (posterior) - who only incises the bladder, for example to Dextro - to the right of remove a stone, and sutures it prior to ending Levo - to the left of , has performed a cystotomy. Latero - to the side of Mes —medi —in the middle of 2. BASIC AND Opisth -backward PHYSIOLOGY 2.1 Definitions 2.4 Cell structure Anatomy - the science which deals with the Tissue fluid surrounds cell and all cells are structure of the body composed of protoplasm.

Physiology - the science dealing with body Diagram 1. Cell structure functions 2.2 Plan of the body The contains the cranial cavity which is Cell formed by the and encloses the brain. Membrane The trunk is composed of the thoracic, abdom- Cytoplasm inal and pelvic cavities. The is formed by , and . The floor is formed by Nucleus the diaphragm. The organs or viscera in the (with thoracic cavity are the heart, lungs, chromatin Tissue fluid network) and oesophagus. surrounds The abdominal cavity is formed by the verte- cell bral column, and layers of muscle which sup- port the viscera. The viscera in the abdominal cavity are the , small and large intes- (1) General properties of : tines, , , , , and (a) Osmosis kidneys. The is enclosed by the bony pel- materials in solution on one side of a vis. The viscera in the pelvic cavity are the uri- semipermeable cell membrane attract nary bladder, organs of reproduction, sigmoid fluid from the other side. colon and rectum. (b) Selective permeability is continuous with the cranial The the cavity and lies within the backbone. It the ability to pass through, e.g. retain certain encloses the . kidney units (glomeruli) substances and let others filter 2.3 Anatomical position through. The individual is considered to be in the ana- (c) Diffusion of a gas or liquid tomical position when standing erect with until evenly distributed on both sides at the side and palms turned forward. of a membrane, e.g. oxygen diffuses Apex - top or upper part from the lung alveoli into the blood Distal - farthest away from the body and in the tissues from the blood into Proximal - nearest to the body the cells. 6 Medical Terminology Course

(2) Process of living cells cumstances, illness (heat stroke) due to salt loss may occur. Metabolism - the sum of all physical and chemical changes that take place 2.7 Tissues within an . When groups of cells (cyto) become special- (a) Catabolism - breaking up ized in the work they perform in the body, they are called tissues. (b) Anabolism - building up There are five main types of tissue: (3) Functions of specialized body cells (1) Epithelial tissue covers the surface of the (a) body and lines cavities. Examples are the production of substances from the skin and lining of the thoracic and materials in the blood, e.g. glandular abdominal cavities, the pleura and peri- cells in the stomach secrete digestive toneum. Epithelial cells are packed enzymes. closely together with little space between. (c) Contractility (2) supports, anchors and changing in response to nervous stimu- holds other tissues together. Examples lation, e.g. muscle cells contract and are , , , bone relax. and . (c) Conduction (3) Muscular tissue possesses the ability to transfer of an impulse, e.g. nerve cells. contract. The all or none law. A to a There are three types of : nerve or muscle causes it to respond to (a) skeletal (voluntary) its greatest extent or not at all. Impulses all travel at the same rate but (b) smooth (involuntary) only respond to a threshold stimulus. (c) cardiac (heart) 2.5 Water (4) Nerve tissue receives and cames sensa- Approximately 66% of the body is water, tions to and from the brain and spinal which is contained: cord from various parts of the body. (1) within the cells (5) carries and oxygen (2) surrounding the cells (tissue fluid) to cells, removes waste, and fights infec- tion. Blood and make up vascu- (3) in blood vessels (principal component lar tissues. of blood). Fat, known as , is a con- Water has several functions in the body. It is nective tissue which: used: (1) serves as a covering under the skin, (1) asa solvent cushioning and protecting parts (2) for ionisation of adds, bases and salts exposed to pressure. (3) to absorb heat and therefore to regulate (2) being a non-conductor of heat, prevents temperature too rapid heat loss through the skin. (4) as a vehicle; permitting exchange, (3) supports and protects various organs, excretion, and secretion through cell for example, the and kidneys. membranes. (4) fills up space in the tissues affording 2.6 Electrolytes support to delicate structures such as blood vessels and nerves. Electrolytes are chemicals which carry electri- cal impulses. Water and electrolyte balance is (5) constitutes an important reserve of food important. For example, on a hot day we per- when needed by the body. Bears hiber- spire and deplete the salts in our body. The nating can survive only if they have a water depletion causes us to feel thirsty, but if sufficient fat reserve to last through the we fail to replace the salt also, in severe dz- period of hibernation. Medical Terminology Course 7

2.8 Organs 3.2 Different kinds of tissue form organs (viscera). The dermis beneath the is made up For example, the stomach is an com- of dense, irregular connective tissue, with posed of epithelial, connective, muscular, dense bundles of fibrous tissue between the nerve and vascular tissues. Every organ has cells. In the dermis are found sweat , some special function to perform, working in blood and lymph vessels, nerves and nerve co-ordination with other organs. endings, follicles and sebaceous (sebum = Groups of organs which act together are called tallow) glands. (Diagram 2). systems. There are nine primary body systems: 3.3 Sweat glands integumentary, endocrine, musculo-skeletal, respiratory, circulatory, digestive, nervous, un- Sweat glands are small tubes that run spirally to the surface of the skin from a coiled end nary, and reproductive. deep in the dermis. The opening on the skin is SYSTEM called a pore. Surrounding the end are capil- 3. INTEGUMENTARY laries from which the gland removes water The consists of the skin and waste products. These are forced out on and mucous membranes. The word integu- the surface of the skin to form (L. mentary is derived from a prefix and a root. per = through + spirare, to breathe). Normally The prefix "in" means just that, and the root the amount perspired in twenty-four hours is from the Latin word tegere means to cover. approximately one litre. 3.1 Epidermis The sweat glands help to regulate body tem- perature. When the water on the skin evapo- The epidermis is the thin outer protective rates, heat is lost from the body. layer, however on the soles of the feet or the palms of the , the epidermis is thick The 3.4 Hair epidermis can be divided into four layers. The Hair is distributed over most of the body with stratum cornewn is composed of keratinized the exception of the palms of the hands and cells with no visible nucleus. The stratum luci- the soles of the feet. have their roots in dum is composed of flattened cells and nuclei hair follicles. These follicles widen at the base are not visible. Where hair is present, there is a to enclose a capillary tuft which provides thin and the stratum luci- nourishment for the growth of hair. If the fol- dum is usually absent. licle is damaged, the patient may suffer from In the third layer, or stratum granuloswn, gran- (Gr.) or a loss of hair; nies and nuclei can be seen in the cytoplasm. alopecia, AL/o/pe/shia this may be generalized following some can- The innermost layer, known as the stratum geT- minathwn or Maiphigian layer is the part of cer chemotherapy or localized following the skin where new cells are germinated. radiotherapy. Young cells which are pigmented contain mel- The is placed obliquely to the skin anin which protects the underlying tissues. and a small muscle (the arrector muscle) is

Diagram 2. The Skin

STRATUM CORN EL3M ST. GRANULOSUM

EPIDERMIS MALPIGHIAN LAYER

DERMIS

H YPODERMIS 8 Medical Terminology Course fastened to the side causing it to stand up in Eczema cold or fright. The portion of the hair extend- irregular, dry, itchy and scaly patches ing above the skin surface is called the shaft. of the skin. 3.5 Sebaceous glands Erosion The oil or sebaceous glands are small sacs with dead epidermis (e = Out) (rodere = to ducts which usually empty into the hair folli- gnaw) des, although some open directly on the skin Erysipelas surface. The sebaceous glands secrete an oil which lubricates the skin and keeps it soft and (erythro = red) (pella = skin), pliable and makes the hair glossy, within the skin. 3.6 Nails Excoriation Nails are tightly packed cells of the epidermis (ex = out) (corium = skin) the skin that protect the and tips and help in breaks out in a rash. handling and picking up objects. Fissure 3.7 Functions of skin (L. fissura) ulcer or crack-like sore. (1) Forms a protective covering over the Furuncle body. (L. furunculus) a . (2) Eliminates waste products from the Gangrene body in the form of perspiration. (3) Helps to regulate body temperature (the death of tissue caused by interference evaporation of perspiration) wiule lay- with blood supply. Associated with diabetes and circulatory disorders. ers of fat serve as insulation (4) Provides us with the sensation of touch Macule because of the nerve endings in the der- (L macula = spot) ff115. Mycosis 3.8 Signs, symptoms and diseases of the (mykes = fungus) (osis = condition of) integumentary system fungal infection of skin or other fis- vulgaris sues. simple acne (vulgaris = simple). Papule Carbuncle elevated spot (from L. papula = pim- (L. Carbunculus = little coal) painful pie). local inflammation of the skin with formation of pus. (Gr. para = beside) (Gr. onyx = claw) Cicatrix infection of marginal structures about scar left by healed wound. the . Contact Pediculosis inflammation of the skin caused by caused by parasites called pedi- external irritants such as poison cull or lice in the hair, body or pubic cosmetics, detergents, sprays, etc. region. Their eggs or flits appear as white specs on hairs. Decubitus ulcers Pruritis (decumbero = to lie down) ulcers due to poor circulation (L. prurire = to itch) (itching) a symp- tom of some general disease condi- Dermatophytosis fions. athlete's (tinea pedis), a fungus infection. (Gr.) a chronic disease characterized Dermoid by eruptions in circular patches coy- benign tissue in a in the skin. ered with dry, silvery scales. Medical Terminology Course 9

Scabies 4.2 Functions of the or skeleton (L. scabere = to scratch) due to micro- The skeleton: scopic parasites (Acarus scabei) that (1) gives general shape and proportion to burrow under the outer layer of the the body; skin. (2) provides attachment for muscles and Steatoma forms levers on which the muscles act to move the body; (Gr. steat = fat + oma = tumour) "wen' or . (3) forms cavities for the protection of vital organs. Urticaria Bones are not always hard. Some originate as (L. urtica = nettles) hives, oedematous cartilage and then become hard. Bones are raised pinkish areas that itch. usually completely hardened by about twenty Varicella years of age through the deposit of and phosphorus from food. Some remain as chicken pox (L. varicella = a tiny spot). cartilage, however, for example, the end of the Variola nose, the and the anterior part of the ribs smallpox (L. variola = a small spot). attached to the sternum. Vesicle 4.3 elevated lesion with fluid (L. vesica = a Where two bones glide over one another in bladder). semi-attachment, joints (arthro) are formed. Where the surfaces of the ends of the bones come together they are covered with a thin 4. THE SKELETAL SYSTEM layer of cartilage. Between them layers of The skeleton consists of a number of bones, fibrous tissue called ligaments are formed. held together by bands or ligaments to form Inside, the cells of the lining of the give joints, which allow movement between them. out a small amount of slippery fluid () which keeps them lubricated and allows free movement. Joints have: 4.1 Structure of bones (1) no movement, for example, the flat The periosteum is a membrane that covers bones of the skull; every pone. It contains blood vessels which (2) slight movement, for example, the bod- carry nutrients to the bone cells. In the long ies of the vertebrae; bones of the extremities the shaft or diaphysis (3) free movement, for example, the joints is the hard compact portion, the epiphysis or at the and hip. end is spongelike and covered by a shell or harder bone and the metaphysis or growing Ties of freely movable joints portion lies between them. The diaphysis and epiphysis do not fuse until growth has ceased. (1) Ball and socket Bone cells multiply rapidly in early years but A joint in which a rounded head is later on only dead cells are replaced or injured received into a cup-like socket, for ones are repaired. Bones get harder and more example, the shoulder joint, formed brittle with age. Bones differ in size and shape. by the head of the and the Long bones give support, flat bones provide glenoid cavity of the . protection for delicate organs and irregular (2) Hinge bones allow for more motion. The outer por- Movement is permitted in one plane tion of bones is hard, however the hollow only, for example, the or inner part is filled with soft marrow (Gr. myelo = marrow). Yellow marrow is found in long jO]1 bones, whereas red marrow is found in the (3) Pivot end of long bones as well as in ribs and bodies One bone rotates around another of the vertebrae. The latter is responsible for which remains stationary, for example, the manufacture of red blood cells, some of the first cervical pivots on the the white blood cells and . second. 10 Medica' Terminology Course

(4) Gliding does not move. The facial bones form the The articulating surface of one bone sockets and the nasal and oral cavities. slides on that of another to a limited Bones of the cranium extent, for example, joints between the Two parietal bones, one occipital carpal and tarsal bones. bone, and one frontal bone form a 4.4 Kinds of movement covering for the brain. Two temporal (1) Flexion bones contain the ear cavities, the organs of balance, and the mastoid A is flexed when it is bent, for cells. One sphenoid bone is located in example, bending the at the elbow. the centre and forms the base of the (2) Extension skull. One ethmoid bone is found in A limb is extended when it is straight- the roof of the . ened out, for example straightening the arm at the elbow. Bones of the (3) Abduction Two nasal bones form the upper part Movement away from the midline, for of the of the nose. One vomer example, raising the arm from the side. bone divides the nasal cavity. Two inferior turbinate bones in the nostrils (4) Adduction form the outer walls of the nasal cav- Movement toward the midline, for ity. Two lacrimal bones form a small example, lowering the raised arm to the part of the medial wall of the eye side. orbit. Two zygomatic or malar bones (5) Circumduction form the prominence of the . Circular movement in which the bone Two palatine bones form the roof of outlines a cone, for example, swinging the mouth. Two maxillae form the the arms. upper and one forms (6) Rotation the lower . The turning of bones on their axes, for Sinuses example, rotation of the (1st verte- bra) on the (2nd vertebra) to turn Four pairs of cavities in the cranial the head. bones make the skull lighter and return the sound of the voice. Named (7) Supination after the bones in which they lie, Moving to the supine position with the there are 2 frontal sinuses, 2 maxillary arms hanging down and the palms fac- sinuses, 2 ethmoid sinuses, and 2 ing forward. sphenoid sinuses. (8) Pronation Sinusitis Moving to the prone position with the arms hanging down and the palms fac- The effect of swollen epithelial tissue ing backwards. which blocks drainage channels and (9) Eversion thereby prevents normal in the sinuses The of the foot outward. 4.6 Vertebral or spinal column 4.5 The skull cranium The thirty-three bones comprising the spinal The skull consists of the bones of the column are called vertebrae. These are divided and of the face. They fit together to form a into five groups according to their distinguish- cavity for the protection of the brain. The ing characteristics. skull is made up of twenty-two bones closely fitted together without movable joints, with (1) (7 in number) the exception of the lower jaw or mandible. The first, called the atlas, forms a joint This is attached to the skull by a hinge joint with the base of the skull and permits on either side that permits movement of the the nodding movement; the second mandible up and down. The upper jaw is called the axis permits the side to side called the maxilla. It is firmly attached and movement of the head. Medical Terminology Course 11

(2) Thoracic vertebrae (12 in number) Diagram 4. Vertebra The twelve pairs of ribs are attached to Spinous process these. (3) (5 in number) Articula and Spinal canal These are large vertebrae that allow free Surface

movement to the spinal column. Tranverse (4) The sacrum process The sacrum is a single wedge-shaped bone consisting of five vertebrae fused together. It is situated between the two .,~),Bodyof vertebrae pelvic bones and forms part of the pel- vic girdle. (5) The The flat part of the body of the vertebra bears most of Situated below the sacrum consists of the weight. An arch is formed, providing an opening or four small bones fused together. spinal canal throughwhich the spinal cord passes (Diag. 4). Functions of the spine: Fingerlike extensions called transverse process serve to anchor tendons and ligaments. - forms the central support for the body. Intervertebral discs are plates of cartilage between the vertebrae which make the joints flexible and help to - ensures flexibility of the trunk, break the of any sudden force.

- protects the spinal cord,

- absorbs shock,

- provides attachment for the ribs, 4.7 Ribs and Sternum

- supports the weight of the trunk There are twelve ribs on each side connected and transmits it to the lower limbs, in pairs to the thoracic vertebrae behind and, with the exception of the last two pairs, to the - forms a strong posterior boundary for the and abdomen and sternum ( bone) in front. The ribs are helps to maintain erect posture. not bony throughout their entire length, but at a short distance from the front, cartilage The spine normally curves anteriorly takes the place of bone. The upper seven pairs and posteriorly. (Diagram 3). are called true ribs and are attached by their cartilage directly to the sternum. The lower Diagram 3. Curves of the spine five pairs are called false ribs. The upper three pairs of false ribs are attached by their cartilage to the directly above and thence to the sternum. The last two Cervical pairs are unattached to the sternum and are called floating ribs. The sternum is a long flat, dagger-shaped thoraoc -abnormal bone with the point downwards. Three parts curvature of the thoracic make up the sternum, known as the manu- "—spine is known as brium, body and .

lumbar -abnormal curvature of the 4.8 Bones lumbar spine is known as lordosls (1) Bones of the upper extremities The scapulae or shoulder blades are two large flat, triangular bones lying upon the ribs posteriorly. A promi- nent ridge or spine at the back forms an attachment for back and arm mus- cles. At the outer and upper part the glenoid cavity receives the rounded head of the humerus. 12 Medical Terminology Course

The are two slender bones The and are parallel bones which extend horizontally across the of the lower leg. The tibia or shin bone upper part of the thorax above the extends from the knee to the first ribs. They articulate with the medially. The fibula extends from the scapulae and sternum, knee to the ankle laterally. The humerus is the bone of the upper The seven tarsal bones comprise the arm. It consists of a shaft and two ankle and are united by ligaments. enlarged ends. The proximal end is They are larger and more irregular the smooth rounded head which fits than the . The largest is into the glenoid cavity of the scapula. the bone or calcaneus. The distal end has bone surface which The metatarsals are five long bones articulates with the to form the that comprise the foot. elbow joint. The tarsals join the metatarsals to The and ulna are parallel bones form two arches - longitudinal and located in the . The radius metatarsal. extends from the elbow to the on the lateral side. The ulna extends The phalanges in the resemble from the elbow to the wrist on the those in the both in number and medial side. The radius articulates general arrangement. with the ulna just below the elbow. The carpal bones comprise the wrist, 5. made up of eight bones arranged in two rows of four. 5.1 Introduction The phalanges are the finger bones. The appearance of human muscular tissue is Three phalanges comprise the , roughly comparable to the lean of butcher's and two the . meat. Muscle cells are arranged in fine elastic (2) Bones of the lower extremities threads or fibres, wrapped together in bundles. Several bundles make a muscle. Every muscle The is formed by six bones, two is covered by a sheath, the ends of which form ilia, two ischia and two pubic. One of tendons attached to bones. each form two large flat irregular Muscles are attached to bones at the point that bones (the innominate) that become will give best leverage. Muscles tend to work in one when adulthood is reached pairs; for some movements groups of muscles which, together with the sacrum, con- are used. Each muscle is connected to the cen- stitute the pelvic girdle. tral by a motor nerve which car- There is a hollow on the outer side of ries messages from the brain, causing the each inriominate bone which forms muscle to contract. the acetabulum, a socket to articulate Bursae are small sacs lined with syn- with the upper end of the . ovial membrane and are found wher- The femur is the bone of the . It ever pressure is exerted by ligaments extends from the acetabulum to the over moving parts (singular noun - knee. It is the longest and strongest bursa). bone of the body. Proximally the 5.2 Functions of muscles smooth rounded head fits into the acetabulum. The of the femur is (1) The maintenance of erect posture and a weak point. It joins the head to the holding the head, body and extremities shaft. The distal end of the femur has in a variety of positions. two bony masses by means of which it (2) Movements and locomotion, to secure articulates with the tibia and food and shelter and communicate by and forms the knee joint. speech. The patella is a small flat triangular (3) An elastic support for certain organs, for bone placed in front of the knee joint example, the floor of the pelvis is sup- which it serves to protect. port for the pelvic contents. Medical Terminology Course 13

5.3 Kinds of muscles (L. pectus = breast). The is a large triangular muscle muscles are under the control (1) Voluntary extending to the humerus which draws of the will and are capable of rapid and the arm forward and downward. The complicated movements; for example, pectoralis minor, beneath the pectoralis walking, talking, or swallowing. major extends to the scapula, lowers it, (2) Sphincters are special voluntary muscles and depresses the shoulder. which guard body openings. Both of these muscles are removed (3) Involuntary muscles are not under the during a radical mastectomy. The control of will and are capable of slow mastectomy patient must learn exer- and mechanical movement only. They are found in the walls of blood vessels cises to accommodate the loss of the and in most of the internal organs. Car- pectoral muscles. diac muscle is found only in the heart (5) The serratus anterior (L. serratus = and is a special form of involuntary toothed) are the anterior chest muscles muscle. The working of the involuntary arising from the ribs by separate slips. muscles is controlled by a special set of Inserting into the scapula, the muscles nerves known as the autonomic nervous elevate the ribs and assist in . system. The serratus anterior also rotates the scapula. 5.4 Some important muscles (6) The large muscles of the shoulder, pos- There are 325 muscles in the body - we will terior chest and back are the trapezius consider only a few groups. and the latissimus dorsi. When the tra- (1) The diaphragm lies between abdominal pezius contracts, the head is drawn back and chest cavities. Contraction and and to the side and the scapula is relaxation is part of the respiratory rotated. The latissimus dorsi originating mechanism. in the thoracic, lumbar and sacral verte- (2) The intercostal muscles are found brae and the insert into the between the ribs. They assist the respira- groove below the biceps on the tory process. humerus for adduction and rotation of (3) The abdominal muscles are flat bands the arm. which stretch from rib to pelvis and (7) The paired form the support the abdominal organs. There (Gr. gloutos = buttock) and are are four sets of abdominal muscles: called the , medius (a) the internal oblique muscle - and minimus. These muscles insert into ascending; the greater trochanter of the femur per- mining thigh movement. (b) the external oblique muscle - descending; (8) Major muscles associated with the ante- rior aspect of the thigh are the quadri- (c) the transversus abdominus - across femoris quadri = four + ceps the abdomen; ceps (L from caput = head, thus a four headed (d) the rectus abdominus muscle - ver- muscle) originating in the iscbial tuber- tically. osity on the pelvis and inserting into A hernia is a protrusion of a portion of the femur. The quadriceps causes exten- the contents of a . There sion of the leg. are weak places where herniae may (9) In the posterior part of the thigh are the occur. These are places where blood muscles, including the gTaci- vessels and other structures normally lis, sartorius, biceps femoris, and semi- extend through the muscles. tendinous muscles which cause flexion The inguinal ring, , and of the thigh. umbilicus are common sites. When the sartorius contracts it allows (4) The pectoralis muscles, major and the legs to flex and cross. It is thus minor are large anterior chest muscles named the tailor's muscle (L sartor = 14 Medical Terminology Course

tailor). The sartorius is the longest mus- 5.5 Signs, symptoms and diseases of the de in the body. musculoskeletal system The grads flexes and adducts the leg Definition: orthopaedics is the special and adducts the thigh. Originating on branch of concerned with the the pelvis, it inserts into the medial sur- preservation and restoration of the face of the shaft of the tibia. functions of the skeletal system. The following list includes some of the (10) Large muscles of the lower leg and foot more commonly used tenus related to The tibialis anterior elevates and flexes diseases of muscles and bones. the foot. Originating in the upper tibia, Achondroplasia it inserts in the ankle and foot bones. is a congenital anomaly resulting in The of the leg contains the gastroc- dwarfism due to abnormally short long neinius, the largest muscle which bones. extends the foot and helps to flex the Dislocation knee or the thigh. Originating on the the ligaments at the joint give away femur, this muscle inserts by the Achil- completely and the bone is displaced les into the calcaneus. from its socket. Other muscles in the calf of the leg are Fibrositis the soleus and . The soleus (L solea = sole of foot) extends inflammation of and muscle and rotates the foot. It inserts along sheaths. with the gastrocnemius into the Achil- Fractures les tendon. The peroneus longus extends, abducts and everts the foot. a fracture is a break in a bone. It may be complete or partial. The types of frac- (11) Large muscles of the shoulder and arm tures are: The deltoid muscle (shaped like the (1) Simple fracture, a crack or clean Greek letter delta) which moves the break occurs. upper arm outwards from the body, rais- Compound fracture, the skin is bro- ing and rotating the arm has its origin (2) ken and the bone protrudes through. in the and scapula. It is inserted into the shaft of the humerus. (3) Comminuted fracture, the bone is broken into several pieces. The biceps flexes and supinates the arm. It has two sources of origin, the short (4) Greenstick fracture, a bending and head rising from the process of cracking of the bone without a com- the scapula and the long head from the plete break, occurs in immature bones scapula above the glenoid fossa. Inser- of childhood. tion is into the radius (bi-ceps = two Torticollis or stiff neck ). in which the neck muscles are affected. The triceps muscle acts in opposition to (Tortus = twisted. Collum = neck). the biceps. It also originates on the scap- ula but also has two heads coming from Kyphosis the humerus. Inserted into the ulna, it is an abnormal curvature of the thoracic extends the forearm and arm (tri-ceps = spine convexly and posteriorly. three heads). Legg-Calve Perthes disease (12) Muscles in the forearm are used to allow is of the head of the action in the wrist, hand and fingers. femur. For example, the flexor poilas longus, which allows us to flex our , orig- inates in the radius and inserts into the abnormal curvature of the lumbar spine terminal phalanx of the thumb. convexly and anteriorly. Medical Terminology Course 15

Myasthenia gravis lower lumbar vertebrae, usually on the is exhibited by rapid fatigue of muscles sacrum with pelvic deformity. without pain. Sprains Myositis the ligaments that support joints are is inflammation of muscles, stretched or deformans Tenosynovitis inflammation of a tendon sheath. (Pagets disease) the enlargement and distortion of bones in older age. 6. THE NERVOUS SYSTEM (von Recklinghausen's disease) - bony 6.1 Introduction manifestation caused by hyperparathy- The nervous system is the system which pro- roidism. vides the integration and control of body pro- Osteoarthritis cesses. It consists of the brain and spinal cord, linked to the peripheral part connected with Hypertropic or degenerative arthritis. A tissues and organs. grad- disease of older people resulting in Sensory nerve fibres carry messages from tis- uai wearing out of the joint. sues and organs to the brain and spinal cord. Osteochondritis Motor nerve fibres carry messages to tissues and organs, from the brain and spinal cord. inflammation of bones and cartilage. 6.2 Cerebrum The cerebrum is the largest part of the human softening of the bones. brain. It is made up of two cerebral hemi- spheres (hemi = half) each of which is divided inflammation of bone caused by a pyo- into lobes. The folds on the surface of the genic (pusforming) organism. It is most brain are known as convolutions. Grey matter common among children. forms the outer layer, or cerebral . It con- tains the cell bodies or neurons. The inner Paralysis white matter is made up of nerve fibres. the control of muscles by the nervous The anterior commissure is made up of nerve system has been affected. Paralysed fibres linking the two cerebral hemispheres. muscles gradually atrophy. Deep in the substance of the cerebral hemi- spheres there are additional masses of gray Rheumatoid arthritis matter which, together with the cerebrum, a chronic disease affecting many joints form the forebrain: which results in deformity. It is com- (1) the basal ganglia, concerned with the monly diagnosed between 20 and 50 modification and coordination of vol- years of age. untary muscle movement; Rickets (2) the thalamus, an important relay centre the bone hardening process does not for sensory fibres on their way to the proceed normally because of a lack of cerebral cortex; crude sensation and Vitamin D. The bones get out of shape pain may be felt here; when weight bearing, and finally (3) the hypothalamus, contains the centres harden in the deformed state. for the . 6.3 The midbrain an S-shaped abnormal lateral curvature The midbrain receives impulses from the eye of the spine. and ear. It serves as a centre for visual and auditory reflexes. Cranial nerves Ill and 1V stem from the midbrain. The grey matter of spondylos = vertebrae, olithesis = for- the midbrain consists of the bodies of the lIIrd ward slipping, a forward slipping of the and lVth cranial nerves, and the red nucleus.

16 Medical Terminology Course

The midbrain controls skilled muscular move- 6.4 The hindbrain ments. The white matter of the midbrain car- The hindbrain consists of the pons, the cere- nes sensory and motor fibres, linking the red bellum and the oblongata. The pons nucleus with the forebrain, the hindbrain and (L. pons = bridge) bridges the cerebrum and the spinal cord. cerebellum. It contains nerve fibres which link Diagram 5. Left cerebral hemisphere the cerebral cortex with the medulla oblon- gata and the spinal cord (L. medulla = mar- External (Lateral) aspect ) Central sulcus nuclei of the cranial nerves V, VI, VII are (Rolando) The Parietal situated in the pons. Frontal The medulla oblongata consists of neurons Lobe which form the nuclei of the cranial nerves VIII, IX, X, XI and XII. ) ' The cerebellum has centres which are con- cerned with balance and equilibrium. The function of the cerebellum is to coordinate 17-1 groups of muscles so that they work together LateralZ ,/s.n____ smoothly. S Fissure ccIPital / 6.5 The spinal cord / Parieto- The spinal cord extends from the medulla Temporal Lobe occipital oblongata to the lumbar vertebrae. There are sulcus 31 pairs of spinal nerves both motor and sen- sory. The spinal cord also serves as a reflex cen- Motor tre. Judgement Sensory Abstraction 6.6 The nerve cells The nerve fibres outside the central nervous system in the peripheral nervous system are covered with a myelin sheath. An outer thin- ner covering over this myelin sheath is called neuTilemma. The presence of the myelin sheath allows the nerve fibre to regenerate. This is a slow process. Nerve tissue in the brain and spinal cord has no myelin sheath and does not regenerate. Speech A itory Visual Diagram 7. Nerve cell Diagram 6. Mid-Sagittal section-selected structures Dendrite — conduct impulses to cell body.

\ _..enirite — conduct impulses to cell body Cerebrum Caudate callosum _—, 5c ux \ \ _Cell Body Thalamus Axon — conduct impulses away I, from cell body / \f Myelin sheath Extent of basai Neurilemma (outer covering) ganglia Midbrain Terminai Axon Pons Medulla Medical Terminology Course 17

6.7 Meninges Diagram 8: Mid-saggital section showing Three membranes comprise the meninges. The ventricles dura mater is a thick tough membrane lining the skull. The pia mater is a thin tissue cover- ing the outermost layer of brain. The arachnoid gyrus 'NCorpus mater lies between the two; it is a thin cover- ing and contains the blood vessels.

6.8 Mid-brain The cerebrospinal fluid is produced by the of the two lateral and 3rd and 3rd ventricle 7k! Pons 4th ventricles. It flows from the lateral ventri- ventricle cles through the foramen of Monro to the Medulla third ventricle. From the third ventricle it flows through the aqueduct of Sylvius to the fourth ventricle. Leaving the fourth ventricle, it bathes the brain and spinal cord in the sub- Bell's palsy ara chnoid space between the aracimoid and is facial paralysis caused by a lesion of the pia mater. It is absorbed by the great venous With cranial nerve. durai sinuses, especially the superior saggital 6.10 Peripheral nervous system sinus. The peripheral nervous system consists of the 6.9 The cranial nerves nerves arising from the spinal cord and run- The cranial nerves carry impulses to or from ning to or from the whole of the body with the brain. the exception of areas served by the cranial

Table 3. Cranial nerves Cra- Name Motor function Sensory function niai nerve I Olfactory Smell II Optic Sight III Oculomo- All eye muscles except the superior tor oblique and the external rectus. Also innervates the iris and diary body IV Trochlear Superior oblique m. V Trigeminal Muscles of mastication Transmits ordinary sensations from eye, face, sinuses and teeth. VI Abducens External rectus m. VII Facial Facial muscles, sub-maxillary and Tactile and taste sensations from the sublingual salivary glands anterior 2/3 of the tongue and the soft palate. VIII Acoustic (2 branches) Cochlear Vestibular LX Glossopha- Pharyngeal muscles and the parotid Tactile and taste sensations from the ryngeal gland posterior 1/3 of the tongue, the ton- sils, pharynx and the carotid sinuses. X Vagus Heart, lungs, bronchi and digestive Sensation from the heart, lungs, bron- tract. chi, trachea, pharynx, digestive tract and external eat XI Spinal Sternomastoid, trapezius and con- accessory sthctor muscles of the pharynx, lar- ______ynx and soft palate. XII Hypoglos- Strap muscles of the neck and the sal I tongue muscles. 18 Medical Terminology Course nerves and the autonomic nervous system. The external ear Peripheral nerves are connected to the spinal The pinna (L. pinna = wing) is made up of car- cord by two roots: the anterior or motor root tilage covered by skin. It collects the sound and the posterior or sensory root (Diagram 9). which is transmitted through the auditory canal, leading to the tympanic membrane or (Gr. tympanon = drum). The audi- Diagram 9: The Peripheral nerve eardrum, tory canal contains hairs and ceruminous Nerve ganglion () glands. Posterior The middle ear root The middle ear lies in a cavity in the temporal bone. It is connected with the nasopharynx by the Eustachian tube, which opens upon Anteriôr root swallowing to allow air to enter the middle ear, thus equalizing pressure on both sides of the tympanic membrane. The peripheral nervous system is responsible There are three small bones in the middle ear for the innervation of all voluntary muscles called auditory ossides which are connected (except those controlled by cranial nerves) to form a small lever between the tympanic and the transmission of sensory impulses from membrane and the oval window (fenestra the whole of the body (with the exception of ). the face). The auditory ossides are named according to It is largely under conscious (cerebral) control. their shapes - the , (Latin = hammer), Division, or disease of peripheral nerves the (Latin = anvil), and the (Latin thus usually results in both sensory and motor = stirrup). Two small muscles, the tensor tym- loss. However, as already indicated, eventual pani connected to the malleus and the stape- recovery is possible providing the nerve is thus connected to the stapes, contract as a largely intact or the ends of the divided nerve protective mechanism during excessively loud are placed dose together. noise. Sound vibrations set the tympanic membrane 6.11 Autonomic nervous system in motion and move the ossides. This ampli- fies and transmits the sound across the middle The autonomic nervous system controls and ear so that the foot plate of the stapes moves regulates the action of glands, the heart and backwards and forwards in the oval window tissue, for example, smooth which is in contact with the cochlear fluid, in muscle in the intestines and which vibrations are established. These vibra- walls. tions stimulate receptors in the Organ of Autonomic nerves arise at different central Corti, and nerve impulses are sent to the vagus (Xth nervous system, ranging from the sound centre in the brain. cranial parasympathetic nerve) to the sacral area of the spinal cord. The autonomic nerves The arising from the spinal cord comprise the sym- The cochlea (Gr. Kochlias = a spiral) is the pathetic system. part of the inner ear. It is a spiral canal The sympathetic and parasympathetic nerves containing a receptor for hearing called the counterbalance one another. to which is attached the cochlear branch of the auditory nerve, it has 7. THE SPECIAL ORGANS hair cells which pick up impulses transmitted from the middle ear. 7.1 The ear The semicircular canals form the organ of bal- The ear has two main functions, those of hear- ance. The superior, posterior and lateral semi- ing and equilibrium (or balance). There are circular canals each connect by an ampulla (L. three parts to the ear: the external ear, the ampulla = a jug) to the utricle (L utriculus = a middle ear and the inner ear. Each of the three small sac), from which impulses travel to the parts serves a definitive function in hearing; brain by the vestibular branch of the VUth cra- however, the inner also functions in balance. nial nerve. Medical Terminology Course 19

Diagram 10: The ear in coronal section

Semi-circular canals and cochlea

coustic nerve

-- stachian tube round nthL

Pinna Tympanic membrane

7.2 The eye Fundus oculi The eye is set in a bony socket, the orbit The the posterior part, or back of the eye, seen visible portion of the eye is covered by a thin through an ophthalmoscope. transparent membrane called the conjunc- tiva. Fovea centralis a tiny pit in the center of the macula lutea (1) Rectus muscles: composed of slim elongated cones. It is the area of dearest vision - the external rectus rotates the eyeball outward Blind spot - the internal rectus rotates the eyeball The optic papilla where the optic nerve inward; the eyeball. - inferior rectus rotates the eyeball down- Diagram 11: The eye in sagittal section ward; - superior rectus rotates the eyeball upward Optic nerve Iris (2) The inferior oblique muscle rotates the / civa eyeball upwards and outwards. (3) The superior oblique muscle rotates the ' Posterior chamber eyeball downwards and outwards. "Anterior chamber _Pupil (4) Levator palpebrae superioris raises the Vitreous upper . humour - (5) Orbicularis oculi: a muscle which encir- ' cles the orbit and doses the eye, and uspensory ligaments which also compresses the lacrimal body (tear) sac. Sciera Other important parts of the eye Aqueous humor 7.3 Smell the fluid produced in the eye, occupying the anterior and posterior chambers. The olfactory located in the supe- rior deft of the nostrils contains the receptors Vitreous humor for smell. These receptors respond to chemical a watery substance, resembling aqueous stimuli. The is transmitted via humor contained within the space of the vit- the olfactory nerve to the smell centre located reous body (the main body of the eye). in the parietal lobe of the cerebrum. 20 Medical Terminology Course

Table 4. Coats of the eyeball

Structure Function Outer Sciera, tough fibrous tissue Preserves shape of eyeball Cornea, transparent Allows passage of light rays Extrinsic muscles attached to sclera Permit and limit eyeball movement Middle or Vascular Contains and . Pigmented Coat Circular opening at front (pupil) Colored muscular ring - iris - sur- Controls size of pupil and amount rounds pupil (intrinsic muscle) of light entering eye Ciliary body Produces aqueous humor Chary muscle Contracts and moves forward Suspensory Alters curvature of lens - rays Suspends crystalline lens brought to focus in retina Choroid - post 5/6 of eyeball, the pigmented vascular coat Inner or nervous Retina - lines back of eye, contains Light-sensitive layer. coat receptors for vision. Converts light energy to nerve Rods - dim light impulses to optic nerve Cones - bright and colored light

7.4 Taste Astigmatism irregular curvature of the eyeball. The organ of taste is the tongue. There are four types of taste buds, these being sweet, sour, Cataract salt and bitter. Substances enter solution and opacity of the lens of the eye. stimulate the gustatory cells. Nerve impulses are relayed via the facial and glossopharyngeal small hard tumour similar to sebaceous cyst, nerves to the parietal lobe in the opposite side on the eyelid. of the cerebrum. 7.5 Definitions inflammation of the conjunctiva. Ophthalmology Diktyoma a study of disease or conditions of the eye. a ciliary epithelial tumour. Ectropion Ophthalmologist eversion of the eyelid margin, sometimes one who studies the eye and relative diseases seen and conditions. in the elderly. Otology Entropion a study of the ear. inversion of the eyelid margin. Otorhinolaryngologist Glaucoma one who specializes in the treatment of dis- disease of the eye characterized by increase eases or conditions of the ear, nose and . intraocular pressure. Hordeolum 7.6 Signs, Symptoms and diseases of the inflammation of of the eye- special sense organs lid - a sty. Accommodation Hypermetropia the adjustment of the lens to form a clear impairment of near vision. Parallel rays come image. to focus behind the retina due to a flattening Achromatopia of the globe of the eye or refraction error. colour blindness. Iridocyclitis Acoustic neuroma inflammation of the iris and ciliary body. a tumour of the auditory nerve. Medical Terminology Course 21

Malignant melanoma (eye) limbs. It returns to the right auricle a pigmented mole or tumour arising from the () of the heart via the systemic uveal tract. veins. Mastoiditis Food is absorbed, passes into the capil- inflammation of the mastoid process, gener- lary bed in the digestive tract and is car- ally as an extension of otitis media. ried by the portal vein to the hepatic or Meniere's disease portal circulation. disturbance in the labyrinth, with sudden In the : deafness, nausea, vomiting onset of tinnitus, blood flows from the right ventricle to and dizziness. the lungs where oxygen is taken up by Myopia the blood and carbon dioxide (CO2) is defect in vision so that objects can only be given off. The blood then returns to the seen distinctly when very close to the eyes - left auricle (atrium). caused by elongation of the globe of the eye. Nystagmus involuntary rapid movement of the eyeball. 8.2 The heart Otalgia pain in the ear. The heart has four chambers which are lined with (endocardium). It has thick Otitis media walls of muscle called myocardium. Heart mus- inflammation of the middle ear. cle is supplied with blood from the coronary Perichondritis (ear) arteries that branch off from the aorta. inflammation of the skin covering the carti- The heart is enclosed in a two-layered mem- lage of the ear. brane, the . A thin film of fluid Presbyopia separates the layers of the pericardium. defect of vision in advancing age (synonym= The cardiac muscles of the atria are completely farsightedness). separated from the cardiac muscle of the ven- Retinal detachment tricle by a ring of fibrous tissue at the atrio- the retina detaches - usually due to haemor- ventricular groove. (A-V groove). Extensions rhage behind the retina from disease or from this ring form the heart valves. AN trauma. valves are attached by thin chordae tendinae to extensions of cardiac muscle called the papil- Retinoblastoma lary muscles. The papillary muscles contract a tumour arising from the retinal germ cells, a when the ventricles contract. They pull on the malignant glioma of the retina. chordea so that the valve flaps cannot be Strabismus everted, therefore in health, blood can flow in the optic axes cannot be directed towards the one direction only. same object due to lack of muscle coordina- The human heart is really a double pump. The tion (squint). right atrium receives blood from the body Tinnitus tissues with its oxygen supply diminished via ringing in the ears. the inferior and . This Vertigo blood passes into the right ventricle which pumps it to the lungs via the pulmonary arter- dizziness. ies to obtain a fresh oxygen supply. The blood received back from the lungs via the pulmo- 8. CARDIOVASCULAR SYSTEM nary veins passes via the left atrium to the left ventricle, which pumps it to the rest of the 8.1 The circulation body via the aorta. The systemic circulation: 8.3 The cardiac cycle flows from the left ventricle to the aorta and thence via other arteries to the cap- The cardiac cycle consists of diastole and sys- illary beds in the head, neck, trunk and tole. In diastole, there is a period of relaxation 22 Medical Terminology Course

Diagram 12: Pictorial representation of from the auricular muscles is picked up by blood circulation another mass of nodal tissue, the atrio-ventric- ular node and relayed by Purkinje tissue, in Lungs the Bundle of His and its branches lying beneath the endocardium on the interventric- Pulmonary arteries ular septum to the muscles of both ventricles veins which then contract together, while the atria are relaxing. R. atrium An electrocardiograph records the electrical L. atrium Superior & infe- changes in heart muscle caused by contraction nor vena cava i W Mitral and relaxation. Triuspid valve J'~ .J"'4~ valve Although the heart initiates its own impulse to contract, the body's changing needs are controlled by nervous impulses discharged from controlling centres in brain and spinal Right \\ Myocardiuni //Left cord. Sympathetic nerves increase the rate and ventricle \\ Al ventricle force of the heart beat. The parasympathetic nerves slow the heart and reduce the force of contraction.

8.6 Blood vessels Beginning at the heart, the blood is pumped into elastic arteries, then to muscular arteries. when first the atria then the ventricles fill. In From arteries the body has a system of arteri- systole there is a period of contraction. Auricu- oles like branches on a tree which end in capil- lar systole causes the ventricles to be com- laries which surround body cells. Venous pletely filled and stretched which is followed blood is transferred back from the capillaries by ventricular systole when the semilunar into venules which unite to form muscular valves are forced open and blood is ejected veins that empty into the great veins and into the pulmonary and the aorta thence to the heart. Only from capillaries can simultaneously. The semilunar valves prevent blood give up food and oxygen to tissues and backflow from the and the receive waste products and carbon dioxide aorta. from tissues. 8.4 Heart sounds 8.7 Coats of blood vessel walls The A-V valve flaps dose at the beginning of (1) ventricular systole, causing the first heart sound. The semilunar valves close at the - endothelium beginning of ventricular diastole, causing the - internal elastic lamina second heart sound. Heart murmurs will be (2) Tunica media heard if blood is forced forward through nar- - smooth muscle rowed valves or leaks backwards through incompetent valves. - fibrous tissue 8.5 Origin and conduction of the heart - external elastic lamina beat (3) Tunica

The rhythmic contraction of the heart is called - fibrous tissue the heart beat. The impulse to contract is gen- 8.8 Blood pressure erated rhythmically in specialized NODAL TIS- SUE in the wall of the right atrium, the SINO- The pressure within the aorta is highest as the AURICULAR NODE (the pacemaker). blood leaves the left ventricle at the end of sys- The wave of excitation spreads throughout the tole and lowest as the blood drains into the muscles of both atria which then contract. right auricle at the end of diastole. The heart beat is not transmitted from the Arterial blood pressure is measured in man by auricles to the ventricles directly. The impulse means of a sphygmomanometer. Medical Terminology Course 23

8.9 The pulse Congenital pulmonary born with a narrowing of the opening As blood is pumped from the heart during sys- between the pulmonary artery and the right tole, the distention and increase in pressure ventricle. which starts in the aorta passes along the whole arterial system as a wave - the pulse Coronary occlusion wave. a blockage of a coronary artery, cutting off blood supply to a portion of the heart. 8.10 Venous return Coronary sclerosis (1) Adequate blood volume and adequate a hardening of the coronary arteries. tone of smooth muscle in blood vessel Coronary thrombosis walls is essential for normal venous a thrombus formation in a coronary artery. return of blood to the heart Dextrocardia (2) Unidirectional valves are present in location of the heart in the right hemithorax muscular veins to prevent backflow of often with accompanying transposition of blood in the system. abdominal viscera. (3) The cardiac pump exerts a residual force Endocarditis which is imparted by the heart's con- inflammation of the endothelium lining the traction. heart. (4) Contractions of skeletal muscles help to Haemopericardiuxn squeeze veins and move blood towards blood in the pericardial sac. the heart Hypertension (5) Respirations act as a pump by the cre- high blood pressure. ation of negative intrathoracic pressure which creates a suctioning pull in the Hydropericardium veins in the thorax, and the descent of an abnormal accumulation of serous fluid in the diaphragm increases the intra- the pericardial cavity. abdominal pressure which forces blood upwards in the abdominal veins. the formation of a dead area in the heart mus- (6) Gravity allows blood to drain from the de due to interruption of blood supply. head and neck. Myocarditis 8.11 Signs, symptoms and diseases of the inflammation of the muscular walls of the cardiovascular system heart. Pericarditis Angina pectoris inflammation of the lining around the heart. pain felt in the centre of the thorax on exer- tion due to anoxia of the myocardium. Phlebothrombosis thrombus formation in a vein generally due to Arteriosclerosis stasis. a condition marked by loss of elasticity, thick- Thromboangiltis obliterans (Buerger's ening and hardening of the arteries. disease) Atherosclerosis an obliterative disease of the blood vessels of ischaemia and gan- a lesion of large and medium-sized arteries the extremities leading to with deposits of yellowish plaques in the grene. intima ( material). Thrombophiebitis inflammation of a vein with thrombus forma- Cardiac hypertrophy tion. enlargement of the heart tissue. Varicose veins Cerebral vascular accident enlarged and tortuous veins. broken blood vessel in the cerebrum. 24 Medical Terminology Course

9. BLOOD AND THE BLOOD- released to the general circulation as FORMING ORGANS required as a haematopoietic factor which stimulates the production of red cells (erytbro- 9.1 Composition of the blood poiesis) in the red bone marrow.Other factors In the adult, the average amount of blood is 5 necessary for include iron, and litres or approximately 7.7% of the body . The red cells circulate for weight. The comprises approxi- 120 days and are then broken down (proba- mately 55% of the blood. It is almost clear, a bly in the spleen) to release iron for further straw-coloured fluid of which approximately use. Haemoglobin without iron is excreted as 90% is water (Table 5). bile pigments via the liver. The various mechanisms responsible for 9.2 Cells in the blood producing white blood cells (except lym- There are three main types of blood cells, red phocytes) in the red bone marrow are less blood cells, white blood cells and platelets well understood. (Table 6). 9.5 Blood groups 9.3 Blood Present in the plasma of some individuals are Blood does not normally clot Within healthy antibodies which can cause agglutination (the blood vessels. When vascular tissues are clumping together) and subsequent haemoly- damaged, blood undergoes a series of sis (breakdown) of the red blood cells received changes which result in clot formation: in blood transfusions. The platelets cling to the intersections of the When such reactions occur, the bloods are fibrin threads. Adhesions form, the clot said to be incompatible. Clumps of cells may shrinks with the expression of serum. block small blood vessels in the lungs or brain 9.4 - blood formation causing serious complications. Haemolysis may result in the passage of haemoglobin via Various substances taken in the diet (includ- the kidneys into the urine, and may lead to ing iron and other minerals, vitamin B12 and death. and ) are absorbed (vitamin B12 only in the presence of an intrinsic factor The type of antigen present in the red blood secreted by the ) and taken to cells of the donor's blood, which reacts with the liver. Here vitamin B12 is stored and the antibodies in the plasma of the recipient help to identify four blood groups (Table 7)

Table 5. Substances in the blood plasma Substance Associated functions Plasma (6- Serum albumin To exert osmotic pressure of 25-30 mm I-1g 7%) 4% Carries iron and copper. (formed chiefly in Serum globulin Associated with antibody production. liver) 2.7% Fibrinogen The precursor of fibrin which forms the frame- 0.3% work of blood clot. Regulatory and pro- Chemical messengers from endocrine glands. tective proteins Antibodies Important in immunity. Enzymes Catalysts in chemical reactions. Inorganic sub- Sodium, potassium, cal- Fluid and electrolyte balance, body develop- stances (electro- cium, chlorides, bicarbon- ment and function. lytes) (0.9 %) ates, iodine and iron

Organic substances Waste material - urea, uric Products of tissue activity, transported from the acid, xanthine, creatine, tissues to the kidney and skin for excretion. creatinine, ammonia Absorbed from the gut, are transmitted to the Nutritive materials - amino tissues for utilization and storage. acids, , and cho- lesterol Respiratory gases (02) Oxygen Small amounts of oxygen remain in solution; (CO2) Carbon dioxide carbon dioxide in solution as bicarbonate is carried to the lungs for expiration. Medical Terminology Course 25

Table 6. Blood cells

Cell naine Normal Nucleus Function number/mm3 (or 4.5 - 6.0 x 106 per None Oxygen and carbon dioxide trans- corpuscle) mm3 port. (or 5,000 - 10,000 per Granular: Body defence against . corpuscle) MM3 - Play a role in allergic reactions - Useful in heparin formation.

- Body defence against bacteria. Non Granular: - Important in antibody formation. -

Platelet 200,000 - 800,000 None Play an important role in blood clot- I ting per mm3

Diagram 13. Blood coagulation

(enyzme liberated by damaged cells)

acts on

Prothrombin Calcium (which maintains In the presence of (a plasma protein formed a suitable medium in which in the liver coagulation can occur)

to Iproduce

Fibrin (insoluble threads), clot framework)

Thrombin

which I activates

plus platelets Fibronogen (a soluble protein found in the liver)

Blood clot 26 Medical Terminology Course

Table 7. Blood Groups Blood type Antigen Antibody O None Anti A & B (universal donor) (can receive only O) A A Anti B (can receive A or O) B B Anti A (can receive B or O) AB A and B None (universal recipient) (can receive A, B, AB or O)

9.6 Rhesus factor material or harmful bacteria. Lymph nodes.- The Rhesus factor may be absent or present in manufacture which produce glob- an individual's blood. Eighty-five percent of ulin associated with antibody formation and people are Rh positive, that is, they have the immunity reactions. Efferent lymphatic ves- Rh antigen. Rh negative persons have no Rh sels receive lymph after it has passed through antigen. the lymph nodes. Valves within the vessels If the Rh antigen is transfused to an Rh nega- prevent backflow. Lymphatic vessels unite to tive person, the production of anti-Rh factor form larger and larger vessels into the blood (antibody) is stimulated. Should more Rh anti- via the superior vena cava. gen be transfused, the Rh antigen combines There are other lymphoid tissues in the body. with the anti-Rh antibody reacting to cause The gland, the , adenoids, and agglutination and haemolysis. spleen are examples. Lymph nodules exist in If a mother who is Rh negative has anti-Rh the mucous membranes of the intestinal tract antibodies present in her blood, and is carry- and lungs. Aggregated nodules in the small ing a foetus who is Rh positive, the transfer of intestine form patches of lymphoid tissue antigens - antibodies between the maternal known as Peyer's patches. The latter may be 5- and foetal circulations can cause agglutination 7 cm, 2-3 inches long. of the blood cells in the foetus. This destruc- The lymphatic tissue of the body forms an tion of foetal erythrocytes is a condition important part of the body's defence against known as ei-ythroblastosis foetalis or haemo- invading and their . These lytic disease of the newborn. act as antigens stimulating antibody forma- tion which can subsequently destroy or neu- tralize the antigen. 9.7 All cells are bathed by tissue fluid, which dif- fuses from the capillaries. Some of this fluid returns to the capillaries, some drains into 9.8 The spleen thin walled lymphatic vessels. The fluid which The spleen is a vascular organ weighing about takes this route is then known as lymph, 200 grams. it is situated on the left side of the which is similar to plasma but contains less abdomen, behind the stomach and above the protein. kidney. The splenic artery and vein and their A network of lymphatic vessels drains the tis- branches terminate in arterioles that are sur- sue spaces throughout the body, with the rounded by collections of lymphatic tissue exception of the central nervous system. In (white pulp) which produce lymphocytes. The the case of the larger vessels, lymph is filtered red pulp is a framework of reticular tissue through lymph nodes. Afferent lymphatic ves- which acts as a reservoir for blood. Phagocytic sels pour their lymph into a reticular frame- cells destroy worn out red blood cells and work of loose sinus tissue in the lymph nodes. other foreign particles. During foetal life, the Here , (large cells) ingest foreign spleen forms both red and white blood cells. Medical Terminology Course 27

9.9 Signs, symptoms, diseases of the haemocbromatosis deposition of haemosiderin in paren- (1) Anaemia chymal cells; Anaemia is a decrease in the amount of haemosiderosis circulating red blood cells and/or the total red blood cell haemoglobin. (Nor- iron found in macrophages, due to mal = 14-15 g per 100 ml of blood), blood transfusion and increased Microcytic - hypochromlc anaemia - haemolysis. occurs if iron stores are inadequate, also (2) Myeloproliferative disorders seen in chronic blood loss anaemia. Macrocytic anaemia Agranulocytosis is caused by toxins or an arrest in the formation of mature red poisons. Thrombocytopenia (a de- blood cells, accompanied by megalo- crease in the number of circulating blasts (large and nucleated) found platelets) accompanies bone marrow mainly in bone marrow, caused by defi- depression and a decrease in polymor- dencies of dietary protein, folic add, phonuciear cells is noted. vitamin B12 and/or the intrinsic factor. Polycythaemia vera involves bone Pernicious anaemia marrow proliferation with an increase a form of macrocytic anaemia caused by in the production of red cells, white lack of intrinsic factor. It is macrocytic, cells and platelets causing increased hypercbromic with some megaloblasts, blood volume, increased blood viscosity with a high degree of anisocytosis and and may lead to heart failure. poikilocytosis. It is accompanied by Leukaemia involves the overproduc- bone marrow hyperplasia. tion and liberation of neoplastic white Normochromic - normocytic cells; if , monocytic leu- anaemias kaemia, if lymphocytes, lymphatic leu- are secondary to other diseases, for kaemia; if polymorphonudear ele- example, chronic renal disease, or can ments, myeloid leukaemia. occur if the erythropoietic tissue in the leukaemia may be acute or chronic. bone marrow is crowded out, either by Monocytic leukaemia is generally acute. fibrosis (myelofibrosis), or bone forma- tion (osteosderosis), or metastatic can- Acute leukaemia is commonly lym- cer. It also occurs in diseases of the phoblastic in childhood and myeloge- haemopoietic system such as lympho- nous in young adults. The precursor mas or . cells are primitive cells called blasts. Aplastic anaemia Chronic myelogenous leukaemia is a complete failure of the bone mar- The predominant immature neoplastic row to undergo erytiiropoiesis. it is usu- white cell is the myelocyte. It mainly leucopenia. ally accompanied by affects patients between 25 and 60 years cause may be drug toxicity. of age. The spleen characteristically is Haemolytic anaemia greatly enlarged. involves lysis of normal red cells due to antibodies, drugs or poisons, or as a sec- ondary result of other conditions, such Cells present in the peripheral blood are as lymphoma, lupus erythematosus, or largely mature lymphocytes. The dis- chronic lymphocytic . ease generally occurs in older people, Words to Note: 55-80 years of age. Lymphocyte infiltra- acytosis lion may be found in all viscera but especially in bone marrow, liver, spleen cells vary markedly in size; and lymph nodes. Lymph nodes are pOikilOcytOSis enlarged as are the liver and spleen cells vary markedly in shape; (hepatosplenomegaly) 28 Medical Terminology Course

(3) Reficuloendothelial Multiple myeloma Giant follicular lymphoma is a of the bone marrow where abnormal plasma cells (myeloma confined to lymph nodes and spleen, cells) occur sometimes in many small causing enlargement, with compres- areas throughout the marrow (ribs, ver- sion but not obliteration of the sinuso- tebrae, skull). Myeloma causes dyspro- The ids and reticuloendothelial . teinaemia which can be diagnosed by a capsule of the is not usu- test for Bence Jones protein in the urine ally invaded. and myeloma proteins in the blood. Lymphosarcomas are primary malignant lesions of lym- 10. phatic tissue, lymph nodes and spleen. Neoplastic cells are not usually found in 10.1 Introduction peripheral blood smears. All living cells must obtain oxygen and dis- Lymphocytic lymphosarcoma pose of carbon dioxide. There are two different types of respiration, internal and external. the entire lymph node, follicle and Internal or cellular respiration is the exchange is replaced by a dense mass of stroma, of gases between the tissue cells and their fluid lymphocytes which appear normal. The environment. External respiration is the capsule is invaded with spread to neigh- exchange of gases between the lung alveoli bouring fat and other viscera, especially (singular - alveolus) and the external environ- the liver and bone marrow. ment. This is accomplished by the respiratory Lymphoblastic lymphosarcoma system. the lymphocytes are enlarged, with The respiratory passages comprise the nose, primitive nuclei, an increased amount , trachea and bronchi. of cytoplasm and invasion is aggressive. The lungs are housed in the thoracic cage to Reticulum cell which the respiratory muscles the intercostals, and the diaphragm are connected. here, mesenchymal cells with abundant cytoplasm and indented nuclei spread 10.2 Transportation of respiratory gases rapidly to all body organs. Oxygen in a small amount remains in solu- Although still used in the ICD, the tion in the blood plasma. A large amount of terms lymphosarcoma and reticulo-sar- oxygen enters into loose chemical combina- coma are increasingly becoming obso- tion with the haemoglobin in the red blood lete, being replaced by the generic term cells. Carbon dioxide also exists in small Non-Hodgkin lymphoma. amounts in solution in plasma, mostly as Within this grouping various types are bicarbonate and a small amount is linked to distinguished according to the predomi- the haemoglobin in red blood cells. nant histological cell type: 10.3 Pulmonary circulation Lymphocytic - well differentiated The blood lacking its full amount of oxygen Lymphocytic - poorly differentiated and containing an excess of carbon dioxide is Histiocytic pumped into the pulmonary artery. From the Mixed lymphocytic and histiocytic pulmonary artery, the blood enters the right Each type is further divided into Nodu- or left lung and eventually enters a capillary lar and Diffuse categories. All nodular which lies adjacent to an air sac (alveolus). types have a relatively good prognosis, Here by perfusion the blood becomes satu- rated with oxygen from the air in the alveolus as does the diffuse lymphocytic well dif- and gives off excess carbon dioxide. It then ferentiated type. leaves the capillary, and progresses through Hodgkin's disease larger veins until it enters one of the four large differs from the other lymphomas in pulmonary veins which carry blood to the left that the infiltrate is pleomorphic, that is, atrium. It will be noted that the pulmonary it contains cells of many different types, veins and venules are the only veins which and occurs in younger age groups. carry oxygenated blood. Medical Terminology Course 29

10.4 Air pathways passes into the trachea, is called the . When the cords are slack, there (1) The nose is a wide slit; in quiet respirations, air The entry to the nose is called the nares, moves in and out soundlessly. When or nasal orifices, the cords are taut, the slit is narrowed The nasal septum forms the medial wall so that sound is produced when air is and is composed of the vomer bone, the expelled from the lungs. perpendicular plate of the ethmoid and The mouth, nose, sinuses, throat and cartilage, chest act as resonators; they affect the The lateral walls of the nasal cavities are quality and volume of speech while the formed by three turbinates or conchae , tongue and teeth convert the which project into the nasal cavity. The sounds into speech. lateral space below each concha is called The muscles of the larynx are supplied a meatus. The superior and medial con- by two pairs of nerves, both branches of chae are part of the ethmoid bone. Four the vagus (Xth cranial nerve), called the pairs of paranasal sinuses and two naso- superior laryngeal and recurrent or infe- lacnmal ducts open into the lateral wall. nor laryngeal nerves. The recurrent The olfactory mucosa provides the sense laryngeal nerve lies very close to the of smell and is situated in the roof of inferior thyroid arteries. Nerve damage the nasal cavity, during thyroid surgery can result in The lining the nasal speech impairment. cavities serves to warm, moisten and . (4) The trachea ter the air we breathe. The trachea, approximately 11 an, 4.5 (2) The pharynx inches long, is located in the lower part of the neck and the upper part of the There are three parts of the pharynx, thorax, anterior to the oesophagus. It is the nasopharynx, the oropharynx and protected by cartilage in the shape of the laryngopharynx. The Eustachian incomplete rings. tube from the middle ear enters the nasopharynx. The oropharynx lies pos- (5) The bronchi and alveoli tenor to the oral cavity. The The main bronchi branch inferiorly gopharynx connects with the larynx, or from the trachea, one entering each voice box. lung. Overlapping plates of cartilage give support to the bronchi. Each bron- The larynx (3) chus branches into smaller tubes called The larynx is a cartilaginous bow-like bronchioli and finally ends in the ter- structure located in the neck. Posterior minai . The respiratory to the thyroid gland is the thyroid Cart- bronchioles branch into alveolar ducts lage. The cricoid cartilage which 15 which lead to the alveolar sacs, where shaped like a signet ring, with the broad respiration takes place. The alveoli are part lying posteriorly is inferior to the part of the lung tissue. . The is a - like structure located at the entrance of 10.5 The lungs and pleura the larynx, which doses off the The lungs differ in shape; the right lung entrance on swallowing. Two arytenoid has three lobes, the left has two lobes. , shaped like small pyramids Each lung has an apex, a base, a costal facilitate speech. Two other small paired surface and a mediastinal surface. on cartilages, associated with the arytenoid the mediastinal surface, there is an cartilages are named the cuneiform and opening called a hilus through which the comiculate cartilages, pass the blood vessels, bronchi, nerves lie between the thyroid and and lymphatics. These structures are arytenoid cartilages. The arytenoid bound together with connective tissue Wages move to separate or approximate and are called the . the vocal cords. The opening between Apart from the blood vessels responsi- the vocal cords, through which air ble for transporting gases to and from 30 Medical Terminology Course

the lung, the lung tissue also requires a Bronchiectasis blood supply. The blood vessels supply- destructive dilation of bronchi secreting ing lung tissue are the bronchial arteries large amounts of pus. which branch off from the aorta carry- Bronchitis ing oxygenated blood, via the root of the lung. The bronchial veins drain into inflammation of the bronchial mucous the innominate and axygos veins and membrane. eventually back to the superior vena Bronchogemc cava, malignancy believed to arise from bron- The is made up of two chiai epithelial tissue and synonymous layers; it is a potential space only. The with carcinoma of lung. visceral layer of the pleura is the outer- most covering of the lung and it reflects synonymous with coryza - an acute to adhere to the innermost part of the catarrhal inflammation of the nasal chest wall and diaphragm where it is mucous membranes. called the parietal (L paries = wall) pleura. The entire pleural cavity con- Croup tains only a small amount of serous a disease characterized by suffocative fluid for lubrication purposes in health. and difficult breathing, laryngeal spasm and sometimes membrane formation. 10.6 Nerve control of the respiratory system Dyspnoea The lungs are innervated by the auto- difficulty in breathing. nomic nervous system. Parasympa- Emphysema thetic fibres cause constriction of overdistention of alveoli and smaller smooth muscle tissue, while sympa- bronchial tubes with air. Results in dys- thetic fibres cause dilation. pnoea, cough, expectoration character- In normal breathing, the respiratory ized by short inspiration, prolonged rate and rhythm are influenced rhyth- expiration. mically by the Hering-Breuer reflex with- Empyema out any conscious muscular exertion. pus in the pleural cavity. The most important factor which regu- Epist xis lates the activity of the respiratory cen- nosebleed. tre is the level of carbon dioxide in the blood. An increase in the level will stim- Hamartoma ulate the respiratory rate; a decrease in a benign tumour due to new growth of in the blood will depress the respi- blood vessels, may be found as a symp- ratory centre in the medulla. tomless coin lesion in the lung. 10.7 Signs, symptoms and diseases of the Hay fever respiratory system an allergic disease of mucous passages of the nose and upper air passages induced Anthracosis by external irritation. a condition of the lungs due to coal dust Influenza inhalation. acute infection often involving catarrh Asthma of the . paroxysmal dyspnoea accompanied by Laryngitis adventitious sounds caused by spasm of inflammation of the larynx with apho- the bronchial tubes or swollen mucous nia. membranes. Lobar pneumonia Atelectasis inflammation of lungs involving spe- lack of air in the lungs. cific lobes. Medical Terminology Course 31

Pleurisy 11. DIGESTIVE SYSTEM inflammation of the pleura (synonym - 11.1 Introduction pleuritis). This chapter deals with the alimentary canal Pneumoconiosis and its associated glands. The function of the a condition of the lung due to inhala- digestive system is to: tion of dust particles (Gr. pneumon - ingest food and fluids; conis (dust)+ osis (disease)). - secrete enzymes which break large mol- ecules into simpler units; Pneumonia - digest or condense food by chemical inflammation of the lungs with and mechanical means; into the lung tissue. - absorb soluble substances and water into the ; a collection of air or gas in the pleural - reject undigested particles (excretion). cavity. 11.2 The mouth Pneumonitis The roof of the mouth is formed by the hard inflammation of the lung. palate and the soft palate which end in the Rhinitis uvula, a small soft structure hanging from the free edge of the soft palate, in the midline inflammation of the (GL above the root of the tongue. Upon swallow- rhin = nose). ing, it prevents food or fluid from refluxing Siderosis into the nasal cavity. The tongue is a muscular organ. The surface of disease of the lungs caused by inhala- the tongue has tiny projections called papillae tion of metallic dust (Gr. sidero = iron or which contain nerve endings for taste sensa- steel) tion. The frenulum is a fold of mucous mem- Silicosis brane which attaches the underside of the a condition caused by the inhalation of tongue to the floor of the mouth. small particles of stone or stone dust (L. The mouth is kept moist by secretions from silic = flint). the salivary glands, the parotid, submandibu- lar, and sublingual glands. Sinusitis The fauces are arches on each side where the inflammation of the accessory nasal mouth meets the pharynx. The two arches are sinuses. the glossopalatine arch anteriorly and the arch posteriorly, known as Tonsillitis pharyngopalatine the tonsillar fauces. (L tonsilla = almond) - inflammation of in the mouth involves both the faudal tonsils. mechanical and chemical processes. Mastica- Tracheo-oesophageal tion is under voluntary control, salivation is abnormal opening between the trachea controlled by the autonomic nervous system. and oesophagus. consists of ptyalin, water, and . Ptyalin is an enzyme which begins the process of splitting starch from dextrose to maltose (a a specific inflammatory disease caused simple sugar). Mucin is a thick secretion by the tubercle bacillus characterized by which lubricates the food and helps swallow- caseous granulomatous infiltration. ing. Wegener's granulomatosis 11.3 The oesophagus involves bronchi, trachea, nasophar- The oesophagus is a muscular tube about 25 ynx and lung-causing dissolution and an in length, which conveys food and fluid to necrosis of vessels, alveoli and bronchi, the stomach. severe pneumonitis, haemoptysis and There are four layers comprising the oesopha- death. gus. The inner mucosal lining is stratified 32 Medical Terminology Course squamous epithelium. The submucosal layer the pancreas is cradled in the curve of the contains glands which secrete lubricant. The duodenum. muscle coats of the oesophagus consist of an The exocrine from the pancreas joins inner circular and an outer longitudinal coat. with the common to form the The upper 1/3 of the oesophagus has striated ampulla of Vatei- which empties into the . The middle 1/3 is mixed skele- duodenum through the sphincter of Oddi. tal and smooth muscle, while the lower one The exocrine or pancreatic enzymes serve to: third is smooth muscle. The outermost coat of a) neutralize acid from the stomach (water the oesophagus is made up of connective tis- and alkaline salts); sue. Except during the passage of food, the b) split fats (); oesophagus is flattened and closed. C) split starch to maltose (amylose): The cardiac sphincter separates the oesophagus plus enter- and the stomach. d) split proteins (trypsinogen okinase; produces tiypsin for this pur- 11.4 The stomach pose); The lesser curvature is located superiorly; the e) complete protein digestion (peptidase). greater curvature, on the inferior surface; the The endocrine or internal secretions are fundus extends above the oesophagogastric produced by the islets of Langerhans. junction; the body is the largest part of the The hormones insulin and glucagon are stomach and pyloric portion is the narrow absorbed by capillaries which carry part which connects with the duodenum at these hormones to the blood stream for the pyloric sphincter. The mucosal lining has systemic circulation. special glands for the secretion of gastric juices. The outer wall of the stomach has three 11.6 The liver and gallbladder smooth muscle coats, longitudinal (outer), cir- The liver is situated in the upper right quad- cular (medial) and oblique (internal). rant of the abdominal cavity, directly under The functions of the stomach are to: the diaphragm. It consists of four lobes, the (1) Absorb water, alcohol and glucose into right, left, quadrate and quadrangular. A fis- porta hepatis the blood stream; sure of the liver, known as the permits hepatic arteries, the portai vein, the for example; (2) Secrete gastric enzymes - hepatic duct, nerves and lymphatics to enter rennin to clot ; lipase to initiate the and leave the liver. splitting of fats; pepsinogen, which in The gallbladder is a pear-shaped hollow organ, the presence of hydrochloric acid forms approximately 2.5 cm, 1 inch in diameter and pepsin to begin protein breakdown; 5 cm, 2 inches long. It consists of fundus, (3) To secrete hydrochloric acid (HC1) body and a cystic duct which joins with the which kills bacteria and changes some hepatic duct to form the common bile duct. It minerals to salts which are suitable for is composed of inner mucosa, smooth muscle absorption in the intestine (example, and an outer layer of connective tissue. calcium and iron); Bile is secreted continuously by the liver. It is (4) The gastric mucosa also produces the stored and concentrated in the gallbladder intrinsic factor which is necessary for and periodically, following the ingestion of the absorption of vitamin B12; fat, the gallbladder contracts discharging bile (5) The pyloric glands secrete an alkaline into the duodenum to aid fat digestion. Bile to neutralize the HC1. acts to emulsify fats, to activate the pancreatic (6) The strong muscular action of the stom- enzyme lipase and to promote the fat absorp- ach chums the food into a semi-liquid tion. substance and forces it through the Some bile pigments are reabsorbed from the pyloric sphincter into the duodenum. digestive tract to be recycled as bile. Some bile pigments enter the general circulation and are 11.5 The pancreas transformed to urobilinogen and urobilin and The pancreas is a large gland lying across the are subsequently excreted in the urine. Sterco-. posterior abdominal wall. It has two types of bun gives the faeces its brown pigmentation. secretions, enzymic and hormonal. It is com- Clay coloured stools are an indication of bil- posed of the head, body and . The head of iary obstruction. Medical Terminology Course 33

11.7 The 11.9 The rectum and anus The rectum is a pouch with transverse folds The small intestine is a long muscular tube while the anus has longitudinal folds. There approximately 6 m, twenty feet long, com- are two anal sphincters, the internal sphincter 25-30 an, 10-12 prising the duodenum consisting of smooth muscle, while the exter- the , approximately 2.4 m, 8 inches, nal sphincter consists of voluntary muscle. feet, and the ileum approximately 3.6 m, 12 feet. 11.10 The Four layers comprise the small intestine. The The peritoneum covers the viscera, known as outer serous coat of peritoneum is a delicate visceral peritoneum, and lines the abdominal membrane, the which suspends the cavity known as parietal peritoneum. intestines to the posterior abdominal wall. The The greater omentum hangs from the greater mesentery carries the mesenteric arteries and curvature of the stomach like an apron. The veins as well as lymphatic vessels which lesser omentum is a double fold of peritoneum empty into mesenteric lymph nodes, then which connects the lesser curvature of the into the thoracic duct. The muscular coat con- stomach to the surface of the liver. sists of circular and longitudinal smooth mus- des which cause by segmental Diagram 14. The digestive system contraction. The submucous layer contains blood vessels and fibrous tissue. The mucous Mouth Salivary glands provide an ge. coat is characterized by villi which Tongue Pharynx enormous absorptive surface. The crypts of Lieberkuhn secrete an alkaline enzyme known as succus entericus. Liver I LOesohagus In the small intestine, amino acids, sugars, - \Fundii minerals, glycerol, some fatty adds and vita- Gallbladder mins are absorbed. Glycerides and some fatty J Stomach adds and fat-soluble vitamins are absorbed Duodenum nis lacteals. Digestion and absorption of into the Common bile ducL- the resi- food are usually complete by the time Transverse colon due reaches the ileocaecal valve. 11.8 The Ascending colon DescDesceending The large intestine is approximately 1.8 m, six Ileum ::~(M) ~ ~ on feet, in length. It comprises the caecum, , ascending colon, transverse colon, colon descending colon and . Rectum The outer serous coat consists of peritoneum which carnes blood and lymph vessels and nerves. There are two muscular coats. The cir- 11.11 Signs, symptoms, conditions and cular limer muscular coat covers the entire diseases of the digestive system length of the colon; the longitudinal coat con- sists of three bands of muscle tissue. The sub- (1) Oral cavity: mucous coat lies between the muscular and Herpes simplex fever mucous layer. The mucous membrane of the blisters in the skin about the lips. colon is epithelial tissue supplied with numer- ous capillaries for the absorption of water. Goblet cells secrete mucus. with epithelial atrophy, found on mucosa of , tongue and The main function of the colon is to absorb inner cheek water and salts thereby conserving the body's fluids and drying the faeces to a normal con- sistency. Faeces are stored in the sigmoid , contains colon until defecation. masses of mucus. 34 Medical Terminology Course

Parotid gland tumour Gastritis usually mixed tumours, dense masses of inflammation of the stomach, acute or small cells interspersed with mucus, chronic. which can be cartilaginous and later Leiomyoma may calcify. May recur or spread. benign tumour of muscle layer of stom- Periodontitis ach. chronic inflammation of the gums. Leiomyosarcoma Peritonsifiar abscess may arise from leiomyoma, well differ- an abscess in the connective tissue of entiated - metastasizes late. the . Pectic ulcer Pyorrhea alveolaris a localized ulcer of the visceral mucosa which may cause (haemateme- a purulent inflammation of the dental sis) or perforation. periosteum. (4) Pancreas: pancreas invades locally and metastasizes to lymph nodes, common in lips, tongue a mucus-producing tumour often with and oral cavity. recognizable glands. Tonsillitis generalized abnormality of the secreting inflammation of the tonsil(s). glands such as those that manufacture Vincent's mucus and sweat. The pancreas and inflammation of the with lungs are involved. The mucus is thick large ragged superficial ulcers (synonym and sticky and the sweat glands have a - Vincent's angina). high concentration of salt. When the (2) Oesophagus: lungs are affected, bronchitis occurs, resulting in persistent cough, wheez- Oesophageal varices ing, dyspnoea, and emphysema. When varicose veins that may cause haemate- the pancreas is affected there is marked mesis. disturbance of the bowel, and glandular cells lining other organs may be Functional dysphagia affected. difficulty in swallowing without obvi- ous cause. Diabetes a disease where the islets of Langerhans Squamous cell carcinoma in the pancreas fail to produce sufficient obstructs the oesophagus causing dys- insulin. phagia. Local growth involves the medi- Islet cell adenoma astinum. causes oversecretion of gastrin. Most are (3) Stomach: benign, however some are invasive and Adenocarcinoma stomach metastasize. often presents as an ulcer with a hard, Pancreatitis rolled, firm white edge - infiltrates - acute inflammation of the pancreas. may involve the muscle wall. (5) Liver and gallbladder: Dyspepsia Acute catarrhal jaundice indigestion. synonymous with infectious hepatitis. Gastric polyp Cholangitis large projection overgrown with epithe- inflammation of the common bile duct. lium arranged around stalk which car- ries blood vessels and lymphatics - may Cholecystitis be premalignant. inflammation of the gallbladder. Medical Terminology Course 35

Cholelithiasis Paralytic ileus presence of stones in the gallbladder. complete absence of peristaltic . Cirrhosis of liver Parasitic diseases fibrosis of the liver, common infestations such as the pin- worm, Trichinella spiralis (from pork), Hepatoma beef tapeworms (Taenia saginata) or primary tumour of the liver, pork tapeworm (Taenia solium). Hepatitis Peritonitis inflammation of the liver. Different inflammation of the peritoneum may types include infectious hepatitis, serum be caused by rupture of an abdominal hepatitis. organ. Jaundice Regional enteritis yellow skin and sclera due to liver cell or Crohn's disease - necrosis and ulcer- changes and obstruction causing bile ation, usually involving the ileum, but pigment, bilirubin, to be diffused into it may spread to the jejunum or colon. the blood. Marked scarring may cause partial Obstructive biliary disease bowel obstruction. may be due to intrahepatic or extrahe- Steatorrhoea patic obstruction to bile flow, fatty stools. Portal hypertension Volvulus increased blood pressure in the portal a twisting of the mesentery causing venous system, a of cii' obstruction of the blood supply and rhosis of the liver, mechanical blockage of the of (6) Small intestine: the intestine. Adenocarcinoma (7) Large intestine: rare, but if they occur, are usually poly- Adenocarcinoma of colon poid or fungating lesions in the duode- epithelial in origin, involving the cae- cum, sigmoid and rectum predomi- Bacterial enteritis nantly. inflammation of the intestine caused by Adenomatous polyp Escherichia or Shi- bacteria, such as coli usually benign, and isolated. gella. inflammation of the appendix. a juvenile form of idiopathic sprue. tumour of appendix Duodenal ulcer a peptic ulcer of the duodenum. usually benign - adenocarcinoma of the appendix is rare, colloid in nature. If it Enteritis ruptures, the peritoneal cavity is filled any inflammatory condition of the with jelly-like substance (pseudomyx- small intestine, orna peiitonei). Idiopathic sprue Diverticulosis atrophy of the intestinal vil, usually in outpouching of mucosa from the the jejunum, with thinning mucosa - lumen due to defective musculature causes malabsorption syndrome. (diverticulitis) with subsequent inflam- Obstruction mation. of the intestine causes distention of the Familial polyposis visais above the lesion and collapse dis- large numbers of polyps throughout the tal to the lesion. Peristalsis and vomit- lumen of the colon, premalignant in ing are stimulated. nature, genetic in origin. 36 Medical Terminology Course

Infarction 12. death of part of the colon due to 12.1 Introduction obstruction of the blood supply to the area. The urinary system, consisting of two kidneys, Ulcerative colitis two , a and a , is an ulcerative disease of the colon char- part of the of the body, acterized by violent diarrhoeic episodes which also includes the respiratory; integu- with blood and mucus in the watery mentary and digestive systems. stool - a premalignant condition. 12.2 The kidney (8) Anus: The kidneys excrete waste products of metabo- Imperforate anus lism and toxic substances from the body. They congenital absence of an anal orifice. help maintain the fluid and electrolyte bal- Haemorrhoids ance. varicose veins of the anus. Each kidney is located laterally to the spinal Squamous cell carcinoma column, in the upper part of the abdomen. They are retroperitoneal, embedded in a mass may develop from the squamous epi- of fatty tissue, which is surrounded by a thelium of the rectum. fibrous covering called . (9) Mesentery: Diagram 15: The kidney Fat necrosis benign inflammatory condition - small RnI rith irnn numerous white lesions in mesentery. Calyx M Panniculitis (L pannus = cloth) inflammation of the fatty portion of the adipo- Pelvis sus, the superficial fasciae with fat in its areolar substance.

Urete

lia Cortex Diagram 16: unit Cortical

Afferent arteriole j - nephron CS triter-lobular artery

Thick loop of Inter-lobar artery vein

Thin

Diic of Bellini Medical Terminology Course 37

(1) The unless their concentration in the body Approximately 25% of the output from is too high. the left ventricle is distributed, in each "Medium threshold" substances such as cardiac cycle, to the kidneys for filtra- potassium may be reabsorbed but may don. The which branches be secreted in the distal convoluted from the aorta after several subdivisions tubule. Additional water is reabsorbed (Diagram 16) end in a cluster of capillar- in the and ies to form the . All the glom- partly in the collecting tubules. eruli lie in the kidney cortex. The urine passes out through the col- The glomerulus is surrounded by a lecting tubules at a rate of approxi- dosed end of a long tortuous renal mately 1.0 ml per minute, so that in tubule, the nephron. This dosed end is health we excrete about 1.5 litres of named Bowman's capsule. urine per day. Blood leaving the glomerulus flows to a 12.3 The ureters secondary capillary network around the Each kidney is connected to the urinary blad- before tubules of its own nephron der by a . These muscular tubes are draining into a vein. about ten inches (25 cm) in length, beginning (2) The nephron at the . The nephron (Diagram 16) or renal The wall of the ureter has three layers, an tubule, consists of Bowman's capsule, outer fibrous coat, a middle smooth muscle the proximal convoluted tubule, a loop layer which propels urine along the ureter and called "Henle's loop", the distal convo- an inner mucous membrane. luted tubule and the collecting tubules which empty into the renal pelvis at the 12.4 The urinary bladder calyx of the kidney. The urinary bladder is a hollow muscular The kidney has approximately one mil- organ which serves as a reservoir for urine. It lion . lies in the pelvis behind the pubic bone. Three openings mark off a triangular area. (3) Formation of urine These are the two ureters and the urethra. The Through the capillaries of the glomeruli trigone is smooth, even when the bladder is approximately 120 ml of water and salts empty and the remainder of the smooth mus- are filtered from the blood each minute. cle is in folds. Cells and plasma proteins are too large The bladder has three layers, with the excep- to pass through the capillary mem- tion of the superior and posterior aspects branes into the renal tubule in a healthy which are covered by peritoneum. These are a nephron. fibrous outer layer, a smooth muscle layer and a The filtrate contains glucose, salt, urea, mucous membrane lining the cavity. The uric acid, potassium, phosphates, sul- adult urinary bladder has a capacity of 300- fates, etc. in approximately the same 350 ml. proportions as blood plasma. However, the body must retain certain of these 12.5 The urethra substances for fluid and electrolyte bal- The urethra is a membranous tube which con- ance. Thus, as the filtrate passes along veys urine to the exterior. the tubule of the nephron, the filtrate is The proximal end consists of a circular concentrated and essential substances smooth muscle known as the internal sphinc- are returned to the circulation via the ter. It is controlled by the autonomic nervous second capillary network which sur- system. The external sphincter is a circular stri- rounds the tubule. ated muscle which is under voluntary control. Most of the water is reabsorbed into the urethra proximal convoluted tubules. Essential or "high threshold" substances are also The female urethra is approximately 4-5 an, reabsorbed here, including glucose, 1.5-2 inches long, the external sphincter sodium chloride and amino acids, being located midway in the urethra. 38 Medical Terminology Course

Male urethra 12.8 Signs, symptoms, conditions and diseases of the urinary tract The male urethra has three parts. The prostatic part which passes through the gland Acute oliguria is approximately 2.5 an, one inch, long, the Damage to the nepbron resulting in membranous part, which comprises the exter- and rapidly developing uraemia. It may be nal muscular section, approximately 2.5 cm, 1 caused by poisons or incompatible blood inch long and the penile part, 10-15 cm, 4-6 transfusions, and is also seen in traumatic inches long. shock. 12.6 Some constituents of urine Acute Urea May be of venereal origin formation - may a nitrogenous waste product of protein metab- cause stricture formation olism, urea is formed in the liver and enters Congenital anomalies the kidneys through the blood stream. Kidneys may be absent, have double ureters, Uric acid fused ureters or none, or placed ectopicaily in the abdominal cavity or pelvis. is formed from the breakdown of nucleopro- teins. Cystitis Inflammation of the urinary bladder may be Creatinine due to infection, trauma or urethral obstruc- is a nitrogenous waste product derived from tion. the breakdown of body tissues, the amount in the urine is not influenced by the amount of Lesions in the glomeruli with nephritis. Symp- dietary protein. toms and signs: haematuria, headache, dys- Ammonia uria, lethargy, hypertension, and periorbital as sodium is removed from the filtrate back oedema. (May be acute or chronic in nature). into the blood stream ammonia is formed. Haematuria Salts Blood in the urine. the amount of salt excreted depends on the amounts ingested in the diet. A collection of urine in the renal pelvis owing to obstructed outflow. 12.7 Common tests - urinary system Incontinence - (urinary) Urinalysis (1) Loss of sphincter control due to cerebral or chemical or microscopical analysis of spinal lesions. urine. Malignant tumours of the kidney (2) CystomeUography the graphic recording of the pressure (1) Adenocarcinoma exerted at varying degrees of filling of spreads commonly to lung and bones. the urinary bladder. May be cured by early resection. May also be called hypemephroma as its (3) structure may resemble that of the corti- direct visual examination of the urinary cal tissue of the . tract with an endoscope (Cysto + sko- pein (Gr.) = to examine). Transitional cell of the pel- vis also occur. (4) Intravenous (2) Wilms' tumour or embryoma (Infancy). dye is injected into the blood stream. This dye is excreted by the kidneys. X- rays of the kidney and ureter are taken Nephrolithiasis following the injection of dye. Stone formation which may be due to endo- (5) Retrograde pyelogram crine abnormalities or following pyelonephri- here the contrast media (dye) is injected ris. When the stone fills the renal pelvis and into the renal pelvis via the ureter, prior projects into the calyces, it is known as a stag- to roentgenography. horn calculus. Medical Terminology Course

Nephroptosis and female sex characteristics, such as voice, shape, bone structure, distribution of body Prolapse or downward kidney displacement. hair, etc. abscess Perinephric 13.2 The male An abscess in the tissue immediately sur- rounding the kidney. The testis Polycystic kidney disease The testes are two oval glands which produce large numbers of spermatozoa. They are sus- Numerous cysts form in the kidney, exerting pended below the in a sac of skin and pressure on normal tissue, causing atrophy muscle called the . and loss of function in the affected area. They also produce the male . The sperm is a microscopic cell with a whip-like (Gr. pyelo = pelvis + nephros = kidney + itis = tail and it swims very rapidly in the semen. inflammation). Inflammation of the kidney Millions of sperm are found in one drop of substance and pelvis, acute or chronic. seminal fluid. Renal calculi The Stone in the kidney causing paroxysmal renal . The epididymis is the tube along which the sperm cells travel from the testes. This tube is Primary - without inflammation prior to for- 20 feet (6 metres) long but very tiny. It lies mation. coiled along the top and the side of the testis. Secondary - developing alkaline urine due to inflammation. (Syn. nephrolithiasis). The seminal duct () Transitional cell carcinoma The seminal duct leads from the epididymis. Common neoplasm of bladder. May also The seminal duct passes through the inguinal occur in the ureter with obstruction of urinary canal into the abdominal cavity and contin- flow causing hydronephrosis and uraemia. ues over the top and down the posterior sur- Occasionally occurs in the renal pelvis. face of the bladder. Uraemia The A toxic condition due to urinary constituents in the blood, due to suppression or deficient The seminal vesicles are pouches which excretion of urine for any cause. secrete fluid and also store spermatozoa. The ducts which lead from them join the seminal ducts and pass through the prostate. Failure to expel urine from the bladder. Urinary suppression The prostate gland Failure of the kidneys to produce urine. The prostate is a musculo-glandular organ about the shape and size of a . 13. REPRODUCTIVE SYSTEM It lies just below the urinary bladder. The pros- tate produces a secretion which is added to 13.1 Introduction the seminal fluid. This increases the motility Living things perpetuate their species by of the sperm. As the duct leaves the prostate reproduction. The asexual method is not a gland, it joins the urethra from the bladder. common process in organisms. Certain very An enlarged prostate presses on the urethra, primitive forms of life multiply by this stopping a normal flow of urine. method which is also known as fission. In , as in all higher forms of life, the The bulbourethral (or Cowper's) glands sexual method or union of two sex cells The bulbourethral glands which lie just distal (known as gametes) is the method of repro- to the prostate add a thin lubricant viscid duction. The male and female gametes are secretion. symbolically designated as male, or female. The These gametes are produced in gonads. The union of the male sperm with the female The penis is a cylindrical shaped organ located ovum is known as fertilization. Other func- externally. it is made up of cavernous tissue tions of the gonads are to produce the male with cavern-like spaces. During sexual excite- 40 Medical Terminology Course ment blood fills these spaces, changing the secreted from glands within the walls. The soft, limp penis to an enlarged rigid organ. has three functions. These are to: The foreskin (prepuce) (a) receive the male organ during inter- At the end of the penis is a fold of loose skin course; which forms the foreskin or prepuce. Circum- (b) serve as an outlet for uterine secretions; cision, or cutting away of the foreskin, is fre- (c) form part of the canal through quently performed on babies to prevent which the baby passes during normal infection or irritation. delivery 13.3 The female reproductive system The External genitalia The external genitals or vulvar parts comprise The uterus is a hollow, pear-shaped muscular the: organ about three inches (8 cm) long, located in the centre of the pelvic cavity, posterior to (a) Mons , which is a prominence of the bladder and anterior to the rectum. It has fibrous and adipose tissue located in three parts, the fundus, the body and the neck front of the pubis. It is (). During , it expands many enclosed by skin. At , a thick times its original size. Lined by a specialized growth of hair covers the mons pubis. mucous membrane called the , (b) majora, which are two liplike the uterus functions to protect and nourish folds of skin extending down from the the growing foetus and to expel the foetus at mons pubis towards the anus; the time of delivery. (c) , which are two thin hair- Strong ligaments hold the uterus in position. less liplike folds found between the These are two broad ligaments, two cardinal ; ligaments as well as one anterior and one pos- (d) , which is a small organ (a ves- terior ligament. tige of the male penis) covered by mucous membrane. It is located at the The upper junction of the outer and inner labia; The are two greyish white puckered glands about the size of an almond, which lie (e) Vestibule, which is the triangular-like flat space enclosed by the labia minora. one on either side of the pelvic cavity, just The vaginal orifice is found in the lower below the brim of the pelvis. Their functions part of the vestibule, while the urethral are to: orifice lies directly superior to the vagi- (a) produce female germ cells: (the ova, sin- nal orifice; gular = ovum); (f) Hymen, which is a thin fold of mucous (b) secrete hormones that help regulate membrane which usually closes the reproduction; vaginal orifice in a virgin. It varies greatly in shape and extent and is (c) produce female sex hormones for the largely obliterated by sexual intercourse development of female characteristics. or childbirth; There are many ova in various stages of (g) , which is the tissue situated development in the ovaries and one between the vaginal orifice and the ovum is usually discharged every 28 anus. days from the menarche (11-14 years) to the . The ovaries consist The internal genitals are: of connective tissue covered with a spe- cialized epithelium in which are embed- The vagina ded thousands of Graafian follicles. The The vagina is a flattened tube about 3 inches Graafian follicle matures to produce an (8 cm) long. It opens into the externally. ovum. Upon maturation the Graafian At its upper end, the cervix or lower portion of follicle ruptures, discharging the ovum the uterus projects into it. The inner surface of into the pelvic cavity. This act is called the vagina is moistened by a fluid which is ovulation. Medical Terminology Course 41

The fallopian tubes disease, (P.I.D.). It may be due to gonor- infection. The fallopian tubes are two thin muscular rhoea or post abortal tubes which open into the uterus at its upper Epididymitis is an inflammation of the corners. At the proximal end, the tubes have epididynïis. hairlike projections (fimbria) which open into of breast is a benign the pelvic cavity near the ovaries. The func- tumour, usually occurring in young tion of the fallopian tubes is to carry the ova women. it is firm and relatively mobile from the ovaries to the uterus. Fertilization on palpation (breast ). normally takes place within these tubes. Fibrocystic disease of the breast is the 13.4 Signs, Symptoms, Conditions and development of cystic spaces character- Diseases of the Reproductive System ized by an overgrowth of fibrous tissue. Fibroid tumours of the uterus arise is an inflammation of glans Balanitis from muscle tissue. penis. is excessive develop- Carcinoma of the cervix is usually Gynaecomastia ment of the (male) mammary glands. squamous cell. The symptoms are leuk- orrhoea and vaginal spotting or bleed- Gynaecologist is a physician who spe- ing. cializes in treatment of the genital tract Carcinoma in situ of the cervix is a in women. pre-invasive stage of the natural history Gynaecology is a branch of medicine of carcinoma of the cervix detected by concerned with the genital tact in the pap smear. women. Chancre is the primary lesion of syphi- Hydatidiform mole is a hydropic lis. degeneration of the which Chorionepithelioma (endometrium) turns into grape-like fluid filled vesicles. is malignant, actively invading tropho- Hydrocele is a collection of fluid in the blasts. sac surrounding the testis. Congenital anomalies in the lower uri- Leiomyoma is a tumour of the muscu- nary tract are epispadias, hypospadias lar wall of the uterus, usually benign, and congenital vulvular stricture. but can become malignant (leiomyosar- Cryptorchism is a developmental coma). defect characterized by failure of the tes- Mastitis is inflammation of breast fis- tis to descend into the scrotum. sue. Cystocele is a pouch-like protrusion of Orchitis is inflammation of a testis. the bladder wall towards the vaginal ori- Ovarian cysts are usually simple and fice. benign (though they may reach a large Dilatation and curettage of the uterus size). is usually done for diagnostic purposes, Special types are: or incomplete abortion or retained (a) Serous c-ystadenoma - approximately 1/3 products of conception. are malignant, seeding onto the perito- is an extra-uterine neal surface causing ascites. pregnancy, often occurring in the Fallo- (b) Pseudomucinous - secretes pian tube (ectopic from the Greek ekto- a jelly like material into the perito- pos or displaced). neum. is a seeding of perito- neum with tissue which more or less Ovarian carcinoma resembles endometrium, the symp- The dassification is complex, terms toms tend to be cyclic paralleling men- used include serous, mucinous, endo- strual periods. metrioid, dear cell, epithelial and Endometritis is an inflammation of the undifferentiated. endometrium usually associated with Phimosis (phimos = a muzzle) is the inflammation of the Fallopian tubes tightening of the foreskin so that it can- and referred to as pelvic inflammatory not be drawn back over the . 42 Medical Terminology Course

Prostatic hypertrophy is benign hyper- already been described in sub-section 11.5, plasia - proliferation of prostatic while the endocrine functions of the ovaries and glands encroaches on the bladder and testis were described in section 13. neck and urethra. If severe, urinary 14.2 The retention results. The pituitary gland is controlled by the thala- Prostatitis is inflammation of the pros- mus. Located at the base of the brain behind tate gland. the eyes, it is the size of a pea but controls all Rectocele. The rectum pouches secretions of hormones within the body. The upward, pushing the vaginal wall in pituitary gland has two lobes. Each lobe has front of it. definite functions. Salpingitis is acute inflammation of the The functions of the anterior lobe are to pro- fallopian tubes. duce: Spermatocele is cystic dilatation of epi- (a) adrenocorticotrophic hormone (ACTH) didymis. (b) thyroid stimulating hormone MH) Sterility is the inability to procreate. (c) parathyroid stimulating hormone Testicular (d) gonad stimulating hormones (a) Seminoma (e) follicular stimulating hormones (b) Embryonal carcinoma - often a mixed (f) luteinizing hormone lesion, spreads early. (g) somatotrophic hormone (STH) (c) Choriocarcinoma -highly malignant. (d) - contains diverse tissues. The function of the posterior lobe is to pro- duce: Uterine bleeding (a) pitocin (pituitrin) and also (a) Menorrhagia .- excessive uterine bleed- (b) provide an antidiuretic function ing. (b) Metrorrhagia - uterine bleeding occur- ring at irregular intervals. 4.3 The thyroid gland (c) MenometTorrhagia - excessive menses at The thyroid gland, shaped like a bow necktie, irregular intervals. is located over the larynx and on either side of (d) Amenorrhoea - lack of menses the trachea. It produces the hormone thyroxin which helps control the rate of body metabo- Vaginitis is inflammation of the vagina. lism. Iodine is required to produce thyroxin. General causes include gonorrhoea, Tri- Hypothyroidism is caused by insufficient thy- chomonas vaginalis, and Candida roxin in the body. In childhood, the condition albicans (common in diabetes and preg- is known as cretinism; in the adult as myxe- nancy). dema. Varicocele is varicosities of the sper- Hyperthyroidism is caused by the overproduc- matic vein. tion of thyroxin. Symptoms of hyperthyroid- Vulvitis is inflammation of the vulva. ism are overactivity and underweight. 14. THE 14.4 The parathyroid glands There are four parathyroid glands located inti- 14.1 Introduction mately posterior to the thyroid gland; there is, The endocrine system is a series of ductless however, little correlation between their func- glands which manufacture an internal secre- tions. Each parathyroid is about the size of a tion. These internal secretions (or hormones) grain of rice. are absorbed directly by the blood stream. Their function is to secrete a hormone, par- There are eight important glands or groupings athormone, which maintains the calcium in the body, each with its own distinct func- level in the body at a normal level of 9-11 tion but all bearing an inter-relationship with mg%. each other. In the kidney, parathormone controls the The islets of Langerhans of the pancreas are excretion of phosphorus. In bone, parathor- part of the endocrine system. They have mone mobilizes calcium and phosphorus. It Medical Terminology Course 43 can also increase the absorption of calcium (c) chromophobe - inactive tumour of from the intestinal tract. pituitary. An excess of parathormone causes Von Reck- Adenomatous goitre linghausen s disease (osteitis flbrosa cystica) when calcium and other salt is taken from the enlargement of the thyroid caused by ade- bones. Pathological fractures may result. noma. 14.5 The Addison's disease The pineal gland is located in the brain. Its caused by hypofunction of the adrenal glands, function is unknown. characterized by bronze-like pigmentation of the skin, weakness progressing to prostration, 14.6 The adrenal glands anaemia, hypotension. There are two adrenal glands, the size of the last of the , located at the Aldosteronism upper poles of the kidneys (ad-renal). caused by adrenal cortical adenoma with an The adrenal medulla produces adrenaline, a increase in the amount of aldosterone, result- stress hormone used in emergency situations. ing in electrolyte and fluid imbalance. produces cortisone which The adrenal cortex Athyreosis regulates salts in the body, and aldosterone which promotes sodium retention and potas- the absence or inadequate functioning of the sium loss in the urine. The adrenal cortex also thyroid gland; (a - neg. + thyroid = thyroid + produces male and female hormones. osis). 14.7 Other hormones Craniopharyngioma The stomach wall secretes a hormone called (Ratlike's pouch tumour) - a tumour arising gastrin which stimulates the blood vessels and from the cell rests derived from the hypophy- secretions of the stomach glands. seal stalk. The upper part of the small intestine secretes a Cretinism hormone called seci-etin which stimulates the pancreas and causes the gall bladder to con- congenital lack of thyroxin. tract. Cushing's syndrome The placenta produces chorionotrophic hor- mones which help to maintain pregnancy. hypertrophy of basophil cells in the , marked by adiposity of face, neck 14.8 Endocrine tumours and trunk, kyphosis, amenorrhoea (in Tumours of the endocrine glands, if well dif- ), impotence (in males), dusky com- ferentiated, may produce hormones which plexion, hypertension, polycythaemia and may be effective, tend to be unregulated, and muscle weakness. may or may not be excessive. Benign tumours are more likely to be functional than malig- Diabetes insipidus nant. Tumour size does not necessarily dictate a disorder due to a decrease the degree of functional activity. in antidiuretic hormone (ADH). Polydipsia 14.9 Signs, symptoms, conditions and and are symptoms. diseases of the endocrine system Follicular carcinoma of the thyroid Acromegaly malignant cystlike tumour of thyroid gland, (Gr. akron = extremity; megale = great) - a con- filled with a colloid substance. dition characterized by hyperplasia of the extremities: the nose, jaws, fingers and toes. Fröhlich's syndrome defective geni- of anterior pituitary (dystrophia adiposogenitalis) tal development related to tumours of the (a) acidophilic - increased STH (soma- anterior pituitary. totrophic hormone) produces giantism or acromegaly; Gigantism (b) basophilic - increased ACTH produc- excessive size and stature, due to hyperpitu- tion, cause of Cushing's syndrome, q.v.; itarism. 44 Medical Terminology Course

Goitre a way that the nature or course of the disease is altered. These drugs are called an enlargement of the thyroid gland. "pharrnacodynarnic drugs". Hypoparathyroidism Drugs are used in all types of medical care and a condition produced by defective action of are commonly grouped according to the dis- the parathyroids or their removal; disturbed ease or symptom they treat or the body func- , fall in serum calcium tion they effect. It is important that you are resulting in tetany. familiar with the most common groups of medications. However, some drugs because Hashimoto's thyroiditis they affect different parts of the body, or dif- (synonym = struma lymphomatosa) a progres- ferent functions, can be used to treat a num- sive disease of the thyroid gland with replace- ber of different diseases. The charts on the ment by lymphoid and fibrous tissue. next few pages describe the major drug catego- latrogenic Cushing's disease ries for treating non-cancer diseases. They are not complete lists of categories, nor do they caused by the administration of corticoster- include all the possible uses for each drug. oids. 15.2 Chemotherapeutic drugs Myxoedema The term chemotherapy can be particularly (Gr. myxa = caused by hypothyroidism; confusing to a records officer in a cancer a condition char- mucus; iodema = swelling) - clinic, as in general medical practice it is used acterized by a dry waxy type of swelling and to define a group of drugs used to treat micro- distinctive facial changes, i.e. swollen lips and organisms causing disease. The same term thickened nose. "chemotherapy" is used for the groups of Phaeochromocytoma drugs that are used in anti-cancer chemother- a small vascular tumour of adrenal medulla apy, and to avoid confusion the words "anti- associated with hypertension. cancer" should as far as possible always be used to distinguish these drugs. A list of such drugs Simmond's disease (panhypopituitarism) used for cancer is given in Appendix 2.1 (Ch. a condition characterized by decreased 2). In this section only chemotherapy used to growth, decreased basal metabolic rate, loss of treat other diseases is considered. Micro-organ- libido and sexual infantilism, caused by non- isms are by definition too small to be seen functioning of the anterior pituitary - prema- without a microscope, and include viruses, ture senility - also known as hypophysial bacteria, fungi, protozoa, rickettsiae and spiro- cachexia. chetes. Many of these can be destroyed by Thyroiditis drugs. The most common groups of chemo- therapeutic drugs are as follows: inflammation of the thyroid gland.

15. PHARMACOLOGY (a) Antiseptics: these are chemical agents that inhibit growth and development of 15.1 Classification of medications micro-organisms, but do not necessarily Medication is one of the most effective meth- kill them. The term is usually restricted ods of treating many diseases. Drugs act in two to chemical agents used outside the basic ways: body and examples are: mercurochrome (1) They may destroy or render harmless and boric acid. cells that are normally not part of the (b) Disinfectants: these are chemical body, either derived from normal body agents that kill harmful micro-organ- constituents or external microorgan- isms; again these are generally used out- isms, which enter the body and cause side the body. Examples include: disease. Drugs acting in this way tend to phenol, formaldehyde and alcohol. be called chemotherapeutic drugs. (c) Antibiotics: these are chemical sub- (2) They may act on cells that are normally stances produced by micro-organisms part of the body and stimulate or that prevent the growth of, or destroy, depress normal body functions in such other micro-organisms. Examples Medical Terminology Course iR

include: penicillin, streptomycin, eryth- 15.3 Pharmacodynamic drugs romycin, the tetracyclines and ampidil- Diseases may be caused by the malfunction of lin. an organ or a body part. Pharmacodynarnic (d) Sulfonamides: these are chemical sub- drugs serve either to depress specific body stances that weaken susceptible bacte- functions or to stimulate them. The tables ria. They are commonly called "sulfa that follow list drugs commonly used for vari- drugs." Examples include: sulfadiazine ous conditions of different body systems. and sulfisoxazole. 15.4 Names of drugs Tuberculostatics: these are drugs that (e) The chemical name is a precise description of inhibit the growth of tuberde bacteria. isoniazid, paraami- the chemical constitution of a drug. Examples include: The generic name is usually proposed by the add (PAS) and ethionamide. nosalicylic company that has developed the drug. It is

Table 8. Drugs that affect the nervous system Category Comment Examples Stimulants Used to counteract depression Given for relief of pain without loss of consciousness

1.Narcotic analgesics Habit-forming analgesics Morphine, Codeine, Demerol Darvon 2. Non-narcotic analgesics Not usually habit-forming; no important action outside analgesia Aspirin, ACC's, ASA

3. -antipyretics In addition to pain-relieving this group reduces fever Hypnotics and sedatives Exert a depressant effect on the ner- vous system. Hypnotics produce sleep; when used in smaller doses they are called sedatives.

1.Barbiturates Can produce addiction Phenobarbital, secobarbital, pentobarbital 2. Non-barbiturate Paraldehyde, chloral hydrate hypnotics Tranquilizers Do not produce stupor even in Reserpine, Thorazine Mep- large doses robamate Anaesthetics 1.General Produces loss of sensation, accom- Nitrous oxide, cyclopropane panied by loss of consciousness

2. Basal Used as an adjunct to inhalation Sodium pentothal anaesthesia or alone for minor pro- cedures 3. Local Novocain, xylocaine Medical Terminology Course

Table 9. Drugs that affect the endocrine system Category Comment Examples Insulins Used in treating diabetes mellitus Regular Insulin,Protamine Zinc Insulin (PZI), Isophane Insulin (NPH) Oral hypoglycaemics Chemicals taken by mouth to Orinase, Diabenese, DBI lower the blood sugar Used in inflammatory conditions Cortisone, Hydrocortisone, Prednisone

Table 10. Drugs that affect the respiratory system Category Comment Examples Antitussives Given to relieve cough Codeine Expectorants Aid in the expulsion of sputum Potassium iodine

Table 11. Drugs that affect the gastrointestinal system Category Comment Examples Antacids Counteract the acidity of the Amphojel, Gelusil gastric contents Antiemetics Stops vomiting and relieves Compazine, Dramamine nausea Cathartics Aid in the production of a Milk of Magnesia, bowel movement Castor Oil, Cascara Sagrada Antidiarrheals Cause reduction in bowel Paregoric movements Antispasmodics Relieves spasms of the digestive Lomotil tract

Table 12. Drugs that affect the circulatory system Category Comment Examples Cardiotonics Improves the tone of myocar- Digoxin dium Diuretics Increase the flow of urine Diuril Vasoconstrictors Increase the tone of blood yes- Adrenalin sels Vasodilators Dilate the blood vessels Nitroglycerin, apresoLine Anticoagulants Inhibit blood dotting Heparin, dicumarol Medical Terminology Course 47

Table 13. Pharmaceutic abbreviations Name Abbreviation Naine Abbreviation Ampules Amp. Oil 01. Capsules Caps. Ointment Ung. Compound Comp. Pills Pu. Elixir Elix. Powder Pulv. Emulsion Emul. Solution Sol. Enteric-coated E.C. Spansules Spans. Extract Ext. Suppository Supp. Fluid extract Fldext. Syrup Syr. Liniment Lin. Tablets Tab. Liquid Liq. Tincture Tr., Tinct. Lotion Lot. Troches, lozenges Troch. Mixture I Mit.

then processed through the World Health 16.2 The body's response to injury Organization. Many hospitals require their Inflammation, the most common of all body pharmacies to label all medications with their reactions to injury, is a local reaction of body generic name. It is never capitalized. cells. The trade or brand name is the special name Injury may be produced by trauma, foreign given to a drug by each company manufactur- bodies, chemicals, electricity, heat, cold, ing it. pathogenic micro-organisms or pathogens, Most pharmaceutical preparations are indi- radiation. cated by an abbreviation In a simple inflammatory process such as a surgical incision, the blood supply to the area is increased. White blood cells and serum 16 PATHOLOGY leave the blood stream and suround the injured part. When no pathogens are present 16.1 Introduction inflammation subsides; the white blood cells Pathology is the branch of medicine con- devour dead cells () and return to cerned with the study of changes in cell struc- the blood stream. Excess fluid is reabsorbed, ture and function as a result of disease. the wound edges grow together and Causes of disease usually fail under one of two occurs. general headings: When inflammation is caused by pathogenic organisms, the same defensive reaction starts. Predisposing causes; After leaving the blood steam, the leukocytes (white blood cells) try to kill invading organ- isms. Antitoxins and antibodies are two 2. Specific or immediate causes. important immune substances which are car- i.e. a weak and malnourished person ried to the area by the blood. If immune sub- will more readily succumb to pneumo- stances and leukocytes are strong enough to ma than one who is healthy and able to kill the organisms, inflammation begins to resist an invasion of bacteria; in this disappear. When the body's resistance is too case the state of health was a predispos- weak, or the pathogens are too virulent, many ing cause, the bacteria the immediate tissue cells or leukocytes are killed. A collec- cause. tion of dead tissue cells, bacteria and dead white cells is called pus. The process of pus 48 Medical Terminology Course formation is called suppuration. The body a) Cocci (round) e.g. streptococcus, sta- attempts to build a wall of white blood cells phylococcus, pneumococcus; and tissue around the pus. This collection of b) Bacilli (rod-shaped) e.g. shigella, Escher- pus surrounded by a wall is known as an ichia coli, pseudomonas, abscess or a boil. Infectious particles which typhi; escape are picked up by the lymphatic system. C) Spirochetes (spiral or corkscrew) - syphi- When these reach the lymph nodes, special- lis. ized cells within the nodes try to render the The manner in which bacteria arrange bacteria harmless. themselves is also a means of classifying Local symptoms of inflammation are redness them. Some grow in pairs (diplococci); and swelling due to the increased blood sup- some in chains (streptococci); and some ply plus heat and pain. in dusters (staphylococci). General symptoms of inflammation are fever, Some bacteria produce toxins which are increased pulse and respiration rate, headache, poisonous substances. dry skin, flushed , increased white blood cell count and malaise. Viruses are extremely small, living pathogenic organisms. An electron 16.3 Specific causes of disease microscope is usually required to see Congenital: congenital diseases result them. Virus-caused diseases can spread from an abnormal development during very rapidly and produce epidemics. foetal life and are apparent at birth or Examples of virus which soon thereafter. affect the skin are smallpox, measles, to tissues: physical injury is and chickenpox. Poliomyelitis, rabies known as trauma. Chemical injuries are and encephalitis (sleeping sickness) are detrimental to the body's cells and tis- virus-caused diseases which affect the sues. central nervous system. Viruses attack Parasites: are organisms which live in the respiratory system. They produce or on another animal, depending on the common cold, influenza and viral the host for nourishment. pneumonia. Deficiency diseases: result from inade- Allergies are reactions employing quate intake of essential nutrients or defense mechanisms closely related to from the body's failure to properly uti- immunity. lize essential nutrients. The most com- Neoplasms are literally new growths. mon are vitamin deficiencies e.g. They may be benign or malignant. , rickets, pellagra. Benign neoplasms should not be Degenerative diseases: are due to dete- thought of as completely harmless. rioration in the function of organs from They may grow so large as to cause atrophy or even necrosis (death of tis- damage to nearby tissues and organs. sues). The term is usually restricted to Malignant growths are referred to as diseases of old age for which no specific . The cells of a malignant growth cause has been determined, for example interfere with and sometimes destroy arterial disease such as hardening of the the cells of normal tissue; they may arteries (arteriosclerosis). spread to other parts of the body from Infection: bacteria and viruses are the their original site as a "metastasis". most common causative agents in Tumour classification (Table 14) infections. Bacteria are microorgan- A carcinoma is a malignant change of isms, tiny living bodies visible only epithelial cells located in the skin, through a microscope. Micro-organisms mucous and serous membranes; for capable of producing disease in humans example, adenocarcinoma. are called pathogens. Those which are A sarcoma is a cancer of connective tis- usually not harmful to cells and tissues sue, e.g. bone cartilage, fat, tendons. For are called nonpathogenic organisms. example, an is a malig- are divided into nancy of the bone. A liposarcoma is a groups according to their shape: malignancy of fatty tissue. Medical Terminology Course 49

Table 14. Classification of neoplasms Tissue of origin Benign - - Malignant 1. Epithelial neoplasms a) Surface epithelium Basal cell carcinoma (Squamous and transi- Squamous cell carcinoma tional epithelium) Transitional cell carcinoma b) Glandular epithelium Adenoma Adenocarcinoma - liver Hepatoma Hepatocarcinoma - sweat glands Hidradenoid carcinoma 2. Connective tissue neoplasms a) Fibrous tissue - adult Fibroma - embryonal Myxoma Myxosarcoma b) Cartilage Chondroma Chondrosarcoma c) Bone Osteoma Osteosarcoma (osteogenic) d) Fat Lipoma Liposarcoma e) Blood vessels Hemangioma Hemangiosarcoma f) Lymph vessels Lymphangioma Lymphangiosarcoma g) Smooth muscle Lelomyoma Leiomyosarcoma h) Striated(skeletal muscle) Rhabdoinyoma Ithabdomyosarcoma 3. Haematopoietic tissue neoplasms a) Lymphoid tissue None recognized Lymphomas a) Hodgkin's disease b) Lymphosarcoma c) Follicular lymphoma d) Reticulum cell sarcoma b) Granulocytic tissue None recognized Myelogenous leukaemia c) Erythrocytic tissue Polycythernia vera d) Plasma cells Plasmacytoma Multiple myelomas 4. Neural tissue neoplasms a) Guai tissue Glioma (rare) Gliosarcoma b) Meninges Meningioma Meningeal sarcoma c) Peripheral neurons Ganglioneuroma d) Primitive neurons None recognized Neuroblastoma e) Retina None recognized Retinoblastoma f) Adrenal medulla Phaeochromocytoma None recognized g) Nerve sheath Neurileinmoma Neurilemmal sarcoma 5. Neoplasms of more than one tissue a) Breast Fibroadenoma Cystosarcoma phylloides b) Embryonic kidney Wilm's tumor c) Multipotent cells Teratoma Teratocarcinoma 6. Neoplasms which do not fit into one of the other groups easily a) Melanoblasts Pigmented naevus Malignant melanoma b) Placenta Hydatidiform mole Chorioepithelioma c) Ovary Serous cystadenoma Serous Endometroid carcinoma d) Testis Interstitial cell Seminoma Sertoli tumour Embryonal carcinoma e) Thymus Malignant thymoma 50 Medical Terminology Course

The type of cell of a tumour is also rate is known as bradycardia (below 60 beats important. is the loss of nor- per minute). mal or organiza- Respiration: Dyspnoea (difficult breathing) tion. Desmoplasia means that excessive may be accompanied by cyanosis, a bluish tint fibrous tissue formation is present in the to the skin, most noticeable around the lips tumour stroma. indicates a and fingernails. Apnoea is the absence of respi- change in the type of adult cell to one rations. Orthopnoea is a symptom where the not normally present in a tissue. Dys- patient cannot breath except in the upright plasia is an abnormal, atypical cellular position. proliferation which is not a tumour. Oedema: () is a swelling of a part of the body due to a collection of excess fluid in tis- Malignant tumours are further classified according to their cellular grade. sues. results from a collection of Tumours are often graded numerically Pulmonary oedema: fluid within the lungs. into five grades, the lowest number Drying up of the cells due to an implying the lowest degree of malig- : excessive loss of fluids. nancy. Nausea: Is a feeling of discomfort in the stom- ach region with an urge to vomit. Extreme Normal cells usually exhibit less than one nausea is usually accompanied by emesis mitosis per thousand cells, whereas malignan- (vomiting). cies may have as many as twenty mitotic cells Diarrhoea: Is the of frequent or watery per thousand cells. stools or both. Convulsions: May appear in many diseases Metastases especially with extremely high temperatures Usually routes of spread of tumour cells are via in childhood. lymphatic and blood vessels as emboli, via serous cavities (pleura and peritoneum), or through the spinal fluid. 16.5 Clinical laboratories Tumour cells may lodge in lymph nodes and NOTE: The normal levels given in this section grow in the regional node, invading the pulp may differ from those in your own laboratory. and stoma. Please check your own laboratory normal lev- When transported by the blood stream, cells els and amend accordingly. from an organ which normally drain into the portal vein system tend to lodge in the liver, 1. Urine whereas cells from organs which drain into - Routine urinalysis systemic veins usually cause secondary lung metastases. However malignant cells seem to - Colour be able to pass through the lungs, thus - Characteristics - amount, odour, metastases commonly occur in the brain, transparency bones and also in the liver from tumours - Reaction (pH) draining into systemic veins (presumably via - Specific gravity (sp. gr.) 1.015- the hepatic artery). 1.025 Vascularity is an important factor in the ability - Proteins (albumin) of a tumour to metastasize. - Sugar - glucose 16.4 Common symptoms of illness - Acetone Temperature: Fever is elevated temperature, a - Diacetic acid defence reaction of the body during an infec- - Microscope (Micro) for tion. - Red blood cells (RBC) Pulse: The pulse beat differs in individuals White blood ll depending upon age, activity and the need of - ce s(WBC) the body cells for oxygen. It increases in fever. - Bacteria (Bact.) A notable increase in the rate of the heart beat - Crystals - XIs (Amorphous) is called tachycardia. A slowing of the pulse - Casts Medical Terminology Course 51

Table 15a. Clinical analysis: urine Examination Abbreviation Normal Ammonia NH3 20-70 meqILI24 h Catecholamines Culture and sensitivity C & S Haemoglobin Hgb Negative Porphyrins Under 100 g Urea 10-15g. Urobilinogen Less than 4.0 mg/24 h 17-Ketogenic steroids 5-15 mg/24 h 1 7-Ketosteroids Men: 8-25 mg/24 h Women: 5-18 mg/24 h

2. Blood Table 15b. Clinical analysis: blood Examination Abbreviation Normal Erythrocytes RBC Eryths 4,500,000-5,000,000/cu mm Leukocytes WBC Leukos 5,000-10,000/cu mm Differential count: Myelos Negative Lymphocytes Lymphos 25-33% Monocytes Monos 2-6% Neutros 60-70% Los 1-3% Basos 0.5-1% Retics 0.5-1.5% RBC Platelets 150,000-400,000/cu mm Haemoglobin Fib Hgb Male: 14-17 g Female: 12-15 g Haemnatocrit Hct Male: 40-54% Female: 35-45% Acid phosphatase 0-2 UI/100 mi Alkaline phosphatase 50 I.U. Plasma proteins: Albumin - globulin ratio AG ratio 4:3 Albumin 4 g/100 ml Globulin 3 g/1 00 ml Total proteins 7g/100ml Amylase Less than 50 u/100 ml Anti streptolysin titre AST 150 u/mi serum Bilirubin 0.5-1.5 mg% Bleeding time 1-3 min Blood urea nitrogen BUN 10-20 mg% Bromsuiphalein BSP 45 min retention less than 5% Calcium Serum Ca. 10 mg% Electrolytes: Total CO2 CO2 24-26 meq/L 52 Medical Terminology Course

Table 15b. Clinical analysis: blood Examination Abbreviation Normal Chlorides Cl 95-105 meq/L Potassium K 3.5-5.5 meq/L Sodium Na 140 meq/L Cholesterol (varies with age) 150-250 mg% Circulation time (arm-tongue) 9-16s Creatinine 1.0-2.0 mg% Erythrocyte sedimentation rate ESR (Wintrobe) Male: 10 mm/h Female: 15 mm/h Fasting blood sugar FBS 80-105 mg% Glucose tolerance test (at 1-1+ and 2 h) 160 140 120 mg% Lee White clotting time 6-10 min Phosphorus 3.5 pg % Protein bound iodine PBI 4-8 p.gm% Prothrombin time 12-15 sec Serum glutamic oxalacetic SGOT 40 units transaminase Creatinine clearance 95-105 ml/min/1.73 cu mm Uric acid 4-6 mg% Venereal disease research labo- VDRL Negative ratory (Wasserman) Lactodehydrogenase LDH 160 I.U. Cortisol - 8:00 a.m. 16-32 g% - 8:00 p.m. 8-16 pg %

3. Miscellaneous specimens

Table 15c. Clinical analysis: miscellaneous specimens Examination Abbreviation Normal Stool: Culture and sensitivity C & S Up to 5 g/24 h Fat 0&P Uptol+ Guaiac - Mucus - Ova and parasites Gastric analysis: Guaiac Negative Sputum: Culture and sensitivity C & S Negative Vomitus: Guaiac Negative Cerebrospinal fluid: Protein CFS 15-45 mg% Glucose 40-60 mg% Cells Up to 5/cu mm Pressure 150-250 mm H20 Culture Negative Medical Terminology Course 53

17 SURGICAL PROCEDURES Nephrolithotomy 17.1 Incision incision of the kidney to remove a renal calcu- lus osteotomy cutting of a bone Incision - cutting into Pyelolithotomy (o)tomy tomos - cutting (o)stomy stoma - mouth removal of a calculus from the renal pelvis centese kentesis - puncture Pyloromyotomy (Ramstedt procedure, Fredet-Ramstedt proce- (1) Otomy - to cut into dure) - operation (for congenital stenosis of ) in which the thickened pylorus is (a) Exploratory incised: down to the mucosa the ), Laparotomy (lapara - - opening the peritoneal cavity for exploratory purposes incision through the chest wall (b) Removal of foreign bodies formation of an artificial opening into trachea Accidental Therapeutic (2) Ostomy - to cut to form an opening Pathological - e.g. removal of calculi (c) Division for investigation Examples of ostomy procedures: Transection of muscle - tendons - nerves Cholecystogastrostomy (d) Discission anastomosis between the gallbladder and the stomach to relieve obstruction to the flow of Needling of lens bile (e) Decompression Cholecystojejunostomy Craniotomy anastomosis between the gallbladder and the (t) Re-opening jejunum Examples of otomy procedures: Cholecystostomy Choledochotomy incision to drain the gallbladder incision of the common bile duct Choledochostomy formation of an opening in the common bile Chordotomy duct division of tracts of the spinal cord Colostomy Craniotomy establishment of an artificial opening into the procedure on the cranium in which the skull colon, e.g. colostomy, transverse - bringing a is opened loop of the transverse colon onto the abdomi- Cystotomy (suprapubic) nal wall, and making an opening in this loop cutting into the bladder by an incision just Enterostomy above the pubic symphysis artificial formation of a permanent opening into the small intestine (either an ileostomy Enterotomy or a jejunostomy) opening the small intestine for exploration Gastroenterostomy Episiotomy creation of an opening between the stomach incision of the perineum for obstetrical pur- and intestines poses Gastrojejunostomy Lithotomy an anastomosis between the stomach and the removal of a stone by cutting into an organ jejunum 54 Medical Terminology Course

Gastrostomy obliterare - to efface (close lumen) fingernail, an opening in the stomach for the introduc- (iii) Avulsion of tion of food avellere - to tear away (iv) Extraction of cataract Jejunostomy trahere - to draw insertion of a tube into the jejunum (y) Enucleation whole cleaning nucleus - nux (nut) shelling out eye drainage of the renal pelvis through the kid- (vi) Evisceration (eye) (leaving ney substance sciera) Oesophagogastrostomy viscera - bowels - an anastomosis between the oesophagus and insides the stomach (vii) Epilation - pilus -hair (viii) Ablation Ab - from of a tumour (3) Centesis - puncture or aspiration latus detached

(a)Aspiration - of free fluid Examples of ectomy procedures: (b)Puncture - thoracentesis, paracentesis (c)Trephination - of cornea Abdominoaortic aneurysm resection ligation and resection of an aneurysm of the Examples of centesis procedures: ; a Teflon graft is inserted. Cul-de-sac aspiration Abdominoperineal resection drainage of an abscess in the posterior cul-de- resection of the rectum and anus, with forma- sac through the vagina tion of a permanent colostomy. Paracentesis puncture of a cavity for drainage, e.g. paracen- removal of adenoid tissue. tesis abdominis Colectomy Thoracentesis left (Mikulicz procedure) tapping through the chest wall for the removal of a portion of the colon in a multi- removal of fluids ple-stage operation with resection of tumour. 17.2 Excision partial (with end-to-end anastomosis) Suffixes: resection of a segment of the colon with direct ectomy Gr. ektome a cutting out suture of the two ends. exerese Gr. exairesis removal right (1) Ectomy - to cut out a) ileocolostomy, end-to-side anastomosis (a) Partial, Subtotal - resection of terminal ileum and (j) Resection - subtotal gastrectomy ascending colon with anastomosis (ii) - bios - life - opsis - between them vision b) Side-to-side anastomosis (iii) Guttering - of bone the stumps of the terminal ileum and (iv) Saucerization - of bone transverse colon are dosed (y) Curettage - curette - spoon- Dilation and curettage shaped instrument (b) Complete, Total dilating or stretching the cervical canal for the purposes of exploration and scraping the uter- ine cavity with a curette. (j) Radical excision Mastectomy radix - root Embolectomy (ii) Obliteration Varicose veins removal of a blood clot from an artery.

Medical Terminology Course 55

Enucleation Mastoidectomy, radical removal of an organ, tumour, or other body removal of the infected bone of the mastoid completely. process. Evisceration removal of the viscera or the contents of a cav- removal of a kidney. ity. Nephrectomy, partial Fistulectomy removal of part of a kidney. excision of a fistula. Nephrectomy, transperitoneal Gastrectomy, subtotal removal of kidney through an abdominal removal of a large part of the stomach. incision. Gastrectomy, total removal of all of the stomach. removal of an ovary. Haemorrhoidectomy Oophorectomy, partial excision of haemorrhoids. removal of part of an ovary. Hydrocelectomy Orchectomy, Orchidectomy, Orchiectomy operation for the removal of a hydrocele. removal of . Pelvic exenteration , complete, and bilateral saip- removal of all pelvic viscera, hysterectomy, ingo-oophorectomy cystectomy with colostomy, and ureteral removal of the entire uterus, cervix, tubes and transplant. ovaries. Pilonidal cyst, excision of Hysterectomy removal of a pilonidal cyst (a cyst containing a) abdominal - removal of the uterus hairs behind the anus). through an abdominal incision. Pneumonectomy b) complete (or total) - removal of the body and cervix of the uterus removal of an entire lung. C) Porro - subtotal hysterectomy following Prostatectomy, perineal . removal of the prostate through a perineal d) subtotal or supracervical - removal of incision. the uterus, leaving the cervix uteri in place. Prostatectomy, retropubic e) vaginal - removal of the uterus through removal of the prostate anteriorly without the vagina. going through the bladder. Laminectomy Prostatectomy, suprapubic removal of the posterior arches of the verte- removal of prostate above the pubis and brae in order to expose the spinal cord. through the urinary bladder. Lobectomy Prostatectomy (transurethral resection) excision of one or more lobes of the lung. removal of obstructing tissue in small portions by means of an electrotome introduced into Mastectomy, radical the urethra. removal of a breast, all of the axillary con- Salpingectomy tents, the pectorails minor and major muscles. removal of a . Mastectomy, simple Salpingo-oophorectomy removal of a breast without the pectoral mus- des. removal of a tube and ovary. 56 Medical Terminology Course

Saphenous vein, excision of 17.5 Introduction ligation and excision of the saphenous vein. Intro = within, ducere = to draw or lead Sequestrectomy 1) Injections excision of a necrosed piece of bone. serum, air, radio-opaque substance, dye (jacere = to throw). excision of the spleen. 2) Transfusion Sympathectomy whole blood, plasma, serum (fundare = transection of the sympathetic nervous path- to pour). ways. 3) Implantation Thyroidectomy, partial radon. removal of a part of the thyroid gland. 4) Insertions Thyroidectomy, total radium, wire, nails, pins, tampons, cath- removal of the thyroid gland. eters, tubing, drains. Tonsillectomy removal of the tonsils. Examples of introduction procedures: Varicocele, excision of Myelography excision of varicose veins of the spermatic a gas or a radiopaque liquid is injected into the cord. subarachnoid space, usually in the lumbar area.

17.3 Exeresis Pneurnoencephalography To strip out. Example of exeresis procedures: visualization of the brain after injection of air or gases into the ventricles (Ventriculography). Neuroexeresis Retrograde aortography operation of tearing out of a nerve; synonym = neurexairesis insertion of dye through a intoab- dominai aorta via the femoral artery.

17.4 Amputation Pneumothorax artificial Amputation introduction of air into the pleural cavity to produce pulmonary collapse. cutting off Disarticulation at a joint 17.6 Endoscopy Dismemberment Endo = inside, scopy = to examine through a bone Examples of endoscopy procedures: Examples of amputation procedures: Cystoscopy amputation direct visual examination of the interior of un- of an extremity nary bladder through a cystoscope. Circumcision Cystoscopy and retrograde pyelography removal of the prepuce or foreskin. cystoscopy and radiography of the renal pelvis Hallux valgus and ureter through dye introduced into cathe- ters in the ureter. removal of the large bunion over the proximal great toe joint. Laryngoscopy examination of the interior of the larynx. Medical Terminology Course 57

Oesophagoscopy Tracheloplasty direct visualization of the oesophagus through repair of the cervix in which there is lacera- the oesophagoscope. tion or erosion (2) Desis Others include: Example: Epiphysiodesis Bronchoscopy, Gastroscopy, Otoscopy, Perito- repair of epiphysial separation due to injury. neoscopy, Proctoscopy, Rhinoscopy, Thoracos- copy, Tracheoscopy, Urethroscopy. Fusion operation of the knee arthrodesis planned to induce body ankylosis. Repair 17.7 Fusion operation of the spine Repair (plastics - to form) arthrodesis to unite several vertebrae. Plasty Ostomy Desis Pexy (3) Pexy (form) (a mouth) (a binding) (a fixing) Examples: (1) Plasty - a repair or reform Hysteropexy Ostomy - anastomosis - gastroenterostomy suspension of the uterus to correct displace- Desis - fusion - of a joint - arthrodesis - stabi- ment. lization Pexy - fixation - gastropexy - suspension - fixation of the kidney. hysteropexy Orchiopexy, Orchidopexy, Orchiorrhaphy Examples of repair procedures: suturing of an undescended testicle in the Anastomosis scrotum. joining of two ends of small intestine; three 17.8 Destruction methods: end-to-end, end-to-side lateral. breaking down Colpoperineoplasty Clasis - fracturing and refracturing - osteo- repair of the perineum and posterior vaginal clasis wall. Tripsy - crushing - neurotripsy Colpoplasty Lysis - to free - from adhesions - enterolysis anterior repair of the anterior vaginal wall. Also: Grafts, skin Cauterization skin which is detached from its original posi- tion and transplanted to another part of the sealing off bleeding points by heat. body. Fulguration (a) Thin grafts destruction of ulcerated tissue by electricity. Thin split graft (OUier-Thiersch). Debridement (b) Thick grafts Multiple small grafts, pinch graft, thick cleaning out dirty wounds and lacerations. split graft, full thickness graft, or pedun- Diathermy culated flap grafts. heating cells of tissues to point of destruction. Manchester procedure anterior-posterior vaginal repair and cervical Example of destruction procedures: amputation. Phrenic nerve operation Pyloroplasty when the phrenic nerves are divided, crushed, surgical repair of the pylorus. or injected paralysis of the corresponding side of the diaphragm is produced. Salpingoplasty and implantation 17.9 Suturing re-establishment of the patency of the fallo- pian tubes. (Gr. rhaphe - a seam) 58 Medical Terminology Course

Colporrhaphy, anterior Diagram 17. Abdominal regions repair of the anterior vaginal wall. Colporrhaphy, posterior repair of the posterior vaginal wall. Colpotomy, posterior drainage of an abscess through the vagina. Right hypo- - Herniorrhaphy Epigasftic region .J- Left hypo.. chondriac -. - chondriac region region repair of a hernia. / ._.._ I Right ft lumbar Perineorrhaphy lumbar region region IRIght Iliac Left iliac stitching of the perineum. gion region l'regi Saphenous vein, high ligation of . 1 11 1 ligation of the saphenous vein in the groin for varicosities of the saphenous system.

Trachelorrhaphy Diagram 18. Usual abdominal incisions stitching of a tom cervix uteri.

17.10 Manipulation Manipulation (handling) Tasis a stretching Subcostai Ectasia out, Epigasthc ek - tasis - stretched midline with Transverse lateral Tasis - of muscle - myotasis extension

McBumey Ectasia - dilatation - gastrectasis Pararectus Paramedian Closed reduction Midline application of plaster cast Medical Terminology Course

18 GLOSSARY Pronounce each word as if you were learning a 18.1 Introduction new . The following list of word elements is (1) Dorland's Illustrated Medical Dictionary, arranged alphabetically. A hyphen preceding a (London: W.B. Saunders Company, 1988) word element denotes a suffix. A more com- plete listing can be found in Dorland's ifius- trated Medical Dictionary(1).

18.2 Elements

Word Element Refers to or Means Example A-, AN- without, lack of, aseptic a/SEP/tic absent, deficient anoxia an/OX/ia AB-, ABS- from, away abduction ab/DUCT/ion absent ABS/ent AD- near, toward adnexia adINEX/ia ADENO gland adenoma ad/en/O/ma AERO air aerobic aer/O/bic ALB white albuminuria al/BU/min/UR/ia -ALGIA, pain neuralgia neur/AL/gia -ALGESIA AMBI- both ambiopia amfbi/OP/ia ANGIO vessel (blood or angiography an/gi/OG/raphy lymph) ANO anus anoscopy A/no/scopy ANTE- before antepartum an/te/PART/um ANTI- against antibiotic an/ti/BI/ /tic ARTERIO artery arteriogram ar/ter/i/O/gram ARTHRO joint arthrodesis arlthro/DE/sis -ASTHENIA weakness neurasthenia neur/as/THE/nia AUTO- self autogenous au/TO/genbous BI- two, twice bipolar BI/po/lar BRADY- slow bradylexia brad/yILEX/ia BRONCHO bronchogenic bron/CHO/genhic CARDIO heart pericardium per/i/CAR/di/um -CELE tumour, swelling, hydrocele HYD/ro/cele hernia, sac -CENTESIS puncture paracentesis par/a/cenTrElsis -CEPHALO head hydrocephalic hy/droICEPH/allic CHOLE gall cholelithotomy chol/e/lith/O/tomy CHOLECYSTO gallbladder cholecystostomy choleXcys/tost/o/my CHOLEDOCHO common bile duct choledochotomy chol/E/doch/o/tomy CHONDRO cartilage chondrosarcoma chon/DRO/sarc/oma -CIDE kill germicidal GERM/i/Cl/dal CIRCUM- around circumorescent cir/CUM/cre/scent -CISE cut incise in/CISE COLO colon colectorny co/LECT/om/y 29 Medical Terminology Course

Word Element Refers to or Means Example COLPO vagina colpodynia col/POldylnia CONTRA against contraindicant con/tra/IN/di/cant COSTO rib costochondral COS/toICHONIdral CRANIO skull cranium CRA/ni/um CYANO blue cyanosis cy/an/OS/is CYSTO urinary bladder cystometrogram CYS/to/MET/ro! gram CYTO cell leukocyte LEUK/o/cyte DE. down, from debrider de/BREDE DENTI dentist DEN/tist DERMO skin dermatologist derm/aITOL/o/gist DERMATO Dl- two diatomic di/a/TOM/ic DIA- through, between, diaphragm di/a/PHRAGM across DIS- apart dislocate dis/lo/CATE DYS. painful, difficult, dysphagia dys/PHAG/ia disordered ECFO- outer, on the outside ecITO/derm -ECTOMY surgical removal laminectomy lam/in/ECT/o/my -EMESIS vomiting hyperemesis hy/per/em/E/sis -EMIA blood anemia an/E/mi/a ENCEPHALO brain encephalitis en/ceph/a/LI!tis ENDO- within, inner, on the endoderm EN/do/derm inside ENTERO intestine gastroenterostomy gas/tro/EN/ter/ os! tomy EPI above, over epichondyle ep/i/CHON/dyle ERYTHRO red erythrocyte er/yth/RO/cyte -AESTHESIA sensation anaesthesia an/aes/THE/ si/a EX. out extropion ex/TRO/pion FEBR fever febrile FEB/rile FIBRO connective tissue fibrocystic FI/bro/cyst/ic GASTRO stomach gastrectomy gas/TRECT/o/my -GENE, -GENIC production, origin osteogenic os/TEO/gen/ic GLOSSO tongue glossitis gl/oss/I/tis GLUCO,GLYCO sugar, sweet glycolysis GLY/co/ly/sis -GRAM record pneumsencephalo- Pneum/o/en/CEPH/ gram a/b/gram -GRAPH machine electrocardiograph e/lec/tro/CARD/ i/o! graph -GRAPHY practice, process lymphography lymph/OG/ra/phy Medical Terminology Course 61

Word Element Refers to or Means Example GYNAE woman gynaecological gy/nae/COL/o/gi/cal HAEMA, HAE- blood haematocrit haemJat/O/crit MATO, HAEMO HEMI- half hemiparesis hem/i/PAR/e/sis 1-IEPA, HEPATO liver hepatitis hep/a/T1/tis HERNI rupture hemiorrhaphy her/ni/ORRH/a/phy HISTO tissue his/TOL/o/gy HYDRO- water hydrocele hy/dro/CELE -MANIA insanity kleptomaniac klep/to/MAN/iac MAST breast mastitis mas/TI/tis MEGA- large megacolon MEG/a/CO/ion MEN month menstrual men/stru/AL MESO middle MES/o/derm -METRE measure kilometer kil/OM/e/ter METRO uterus metroptosis met/rop,TO/sis MICRO- small microphage MIC/ro/phage MONO- single, one mononuclear MON/o/nucflear MUCO mucous membrane mucinoid mu/cm/OlD MYELO spinal cord, bone my/el/o/BLAST marrow MYO muscle myoblastoma my/Ofblast/O/ma NARCO sleep narcolepsy nar/CO/lep/sy NASO nose nasopharyngeal nas/o/PHA/ryn/geal NECRO death necrosis NEC!ros/is NEO- new neoplastic NE/o/plas/tic NEPHRO kidney nephrosis ne/PHRO/sis NEURO nerve neurology neu/ROL/o/gy NON no, not nonantigenic non/AN/ti/gen/ic HYPER- over, above, hyperthyroid hy/per/THY/roid increased, excessive HYPO- under, beneath, hypothyroid hy/po/THY/roid decreased HYSTER uterus hysterotomy hys/ter/OT/o/my -IASIS condition of nephrolithiasis neph/RO/lith/I/a/sis ICTERO jaundice icterus index IC/ter/us in/DEX ILEO ileum (part of small ileostomy il/e/OS/tom/y intestine) ILIO ilium (bone) iliococcygeal i/i/o/COCC/y/gea INTER- between interstitial inter/STIT/ial INTRA- within intravenous in/trafVEN/ous -1TIS inflammation of gastritis gastfRi/tis LAPARO abdomen laparoscopy la/par/O/scop/y -LEPSY seizure, convulse epilepsy EP/illep/sy 62 Medical Terminology Course

Word element Refers to or means Example LEUKO white leukoplakia leu/k0IPLAK/ia LIPO fat liposarcoma /O/sarlcolma LITH stone, calculus ureterolithiasis ur/E/ter/o/lith/i/a/sis -LYSIS loosen, dissolve hemolysis hem/OL/y/sis MACRO- large, long MAC/ro/phage MAL- bad,poor, disor- malodorous mal/O/dor/ous dered OCULO eye oculomotor 0/cu/lo/mo/tor -OLOGY study of gerontology GER/ont/OL/o/gy -OMA tumour myoma my/O/ma OOPHOR ovary oophoritis oo/phor/I/tis OPHTHALMO eye ophthalmologist oph/THAL/mol/o/gist -OPIA vision myopia my/O/pi/a ORCHI testicle orchidectomy ORCH/i/dec/tom/y -ORRAPHY to repair a defect colporrhaphy colp/OR/raph/y ORTHO- straight orthodontist orth/o/DONT/ist -OSCOPY look into, see panendoscopy pan/en/DOS/co/py -OSIS condition of cirrhosis cirrh/O/sis OSTEO bone osteotomy os/te/O/to/my -OSTOMY surgical opening cecostomy cec/ost/o/my OTO ear otolaryngology OT/o/lar/nyg/O/log/y -OTOMY incision, surgical cystotomy cyst/OTto/my cutting PARA- alongside of pararenal par/a/RENtal PATH disease pathogenic pa/THO/gen/ic PED (Latin) foot pedalgia PED/al/gia PED (Greek) child pediatrician pe/di/AT/ric/ian -PENIA too few thrombocytopenia thromfbo/cyt/o/PEN/ i/a PERT around, covering periosteum pe/ri/OS/te/um -PEXY to sew up in posi- orchidopexy OR/chid/O/pex/y tion PHARYNGO throat pharyngitis pha/RYN/gi/tis PHLEBO vein phlebotomy phie/BO/to/my -PHOBIA fear, dead claustrophobia claus/tro/PHOfbi/a -PLASTY operative revision mammoplasty MA1vIM/o/plas/ty PLEGIA paralysis hemiplegia hem/i/PLE/gi/a OR hem/i/PLA/gia Medical Terminology Course 63

Word element Refers to or means Example -PNEA breathing dyspnoea dys/p/NE/a (p silent) PNEUMO air, lungs pneumothorax pneu/MO/thor/ax POLY- much, many polycythaemia po/ly/cy/THE/mia POST- after postoperative post/OP/er/a/tive PROCTO rectum proctoscope proc/TO/scope PRE- before prevention pre/VEN/tion - falling nephroptosis nephIROP/to/sis -PYELO pelvis of kidney pyelonephrosis py/el/o/neph/RO/sis PYO pus pyodermia py/o/DERM/ia PYRO heat, temperature antipyretic an/ti/PY/ret/ic RENAL kidney adrenal ad/REN/al RETRO behind, backward retroperitoneal ret/ro/PER/i/tonleal -RHAGE haemorrhage, flow haemorrhagic HEM/or/rhag/ic -RHoEA flow dysmenorrhoea dysIMEN/orrh/ea RHINO nose rhiINO/plas/ty SALPINGO oviduct salpmgogram sal/pin/GO/gram SEMI- half semilunate sem/i/LUN/ate SEPTIC poison, infection antiseptic an/ti/SEP/tic STOMATO mouth enterostomal en/terfO/STO/mal SUB- under subnormal subfNOR/ mal SUPER above supraclavicular su/pra/CLAV/ic/ul/ar -THERAPY treatment radiotherapy RA/dio/THER/a/py -THERMY heat thermometer then MO/meter THORACO chest thoracentesis thor/a/CENT/e/sis THROMBO clot throinbophiebitis throm/BO/phleb/i/tis THYRO thyroid gland thyrotoxicosis thyfRO/tox/i/cos/is TRANS- across Iransabdominal trans/ab/DOM/in/al URO urine UR/o/lo/gy -URIA, -URIC condition of, pres- albuminuria ALtbum/in/ur/ia ence in urine UNI one unilateral 1 u/ni/LATter/al VASO blood vessel vasodilator vasJo/DI/lat/or 64 Medical Terminology Course

19 ASSIGNMENTS FOR MEDICAL TERMINOLOGY COURSE

Using your glossary or a medical dictionary, break the following words down into prefixes, roots and suffixes, and write the meaning of the word:

Prefix Root Suffix Meaning 1. antenatal antepartum antipyretic ante mortem antibiotic antihistimine antidote anticoagulant 2. adenectomy adenocarcinoma adrenaline adermia anaerobe amenorhoea anaemia analgesia anaesthesia angioma anoxia anovesical asepsis 3. cytology cytodde cytolysis cystocele cystoplasty cystitis 4. diacidic diataxia diathermy diuretic Medical Terminology Course 65

Prefix Root Suffix Meaning 5. dysmenorrhoea dysarthria dyspnoea disarticulate disinfect dislocate 6. endocrariial endoderm enterolith enteropathy encapsulate engorgement environment enthermic 7. haemoglobin haemolith haematuria haematemesis hemiopia haemialgia 8. hypertension hyperventilate hyperthermia hypotension hypoventilate hypothermia hypodermic 9. lIeus ileitis ileostomy ilium ioinguinal iliac crest 99 Medical Terminology Course

Prefix Root Suffix Meaning 10. intervaginal interrenal intertubular intraabdominal intracranial intrathoracic 11. macrodactyly macropodia macroglossia macrycyte microdactyly microcyte microlith microscope 12. myelocele myeloma myelocyte myoma myocele myocarditis 13. necropsy necrotomy nephrotis nephrolith neuritis neuroma 14. otitis otolith otogenous osteitis osteoma osteopathy 15. perfusion perception pericardium Medical Terminology Course 67

Prefix Root Suffix Meaning perirenal periangitis peridontal precordial precancerous 16. pyonephrosis pyoderma pyomethtis pyrotoxin pyrometer

Integumentary system assignment Root Meaning Medical term Meaning of term Skin Subcutaneous Derma Skin Epidermis Diaphoreo Perspiration Diaphoretic Onychia Nail Paionychia Papilla Papillary Pilus Hair Depilation Trichos Hair Trichophobia

Skeletal system assignment On Diagram 19 label the following: Joints: Ball and socket joint, hinge joint, .

Bones: Parietal Clavicle Occipital Humerus Frontal Radius Temporal Ulna Mandible Carpus Cervical vertebrae Metacarpus Thoracic vertebrae Patella Lumbar vertebrae Tibia Sacrum Fibula Ilium Calcaneus Scapula

Because all physicans rely heavily on accuracy and baseline data, a sound knowledge of radiolog- ical terminology is essential. The dictionary homework relative to the skeletal system is therefore lengthy, however, time spent in becoming familiar with the words will be well worth the effort 68 Medical Terminology Course

Diagram 19: The skeleton Medical Terminology Course RE

Dictionary homework Crista Gaul - - Words to note: Pertaining to appendicular Hyoid - skeleton Hypophysis - Infundibulum - Acromion - Lambdoid - Appendicular - Opisthion - Astragalus - Palpebral - Capitate - Petrous - Cephalad - Pterion - Condyle - Pterygoid - Coracoid - Ramus - Coronoid - Stephanion - Cuneiform - Styloid - Ensiform - Vomer - Gladiolus - Zygomatic - Hamate - Lunate - Words to note: pertaining to vertebral col- Manubriurn - umn and thoracic cage - Navicular - Bifid - Nucleus pulposus - Cornu - Obturator - Epistropheus - Olecranon - Homologous - Pisiform - Imbricate - Plantai - Lamina - Popliteal - Odontoid - Scaphoid - Piriforrnis- Sesamoid - Scalene - Styloid - Sulcus - Talus— Trapezium - Triquetrum - Trochanter - Tuberosity - Unciform - Volai - Xiphoid -

Words to note: pertaining to skull

Acoustic - Ala (Alea) - Apophysis - Asterion - Basalis - Bregma - Canthus - Carotid - Choana - Clinoid - Cornu - Coronal - Cribriform - 70 Medical Terminology Course

Musculoskeletal system assigment (Dictionary Assignment)

Word Medical Term Definition oint Synarthrodial Bursa (small sac between moving Bursectomy parts) Wrist Metacarpal Head Encephalitis Hand Chiroplasty Cartilage Chondrolysis Coccyx Coccygectomy Rib Intercostal Hip Coxodynia Finger Dactylomegaly Ligament Desmorrhexis Diaphragm Diaphragmatic hernia Movement Kinetosis Skull Cranioplasty Muscle Intramuscular Marrow Myelogenous Muscle Myoblastoma Mucus Myxadenoma Shoulder Omohysid Bone Osteosarcorna Fibula Peroneus Foot Talipes Foot Pediatrist Vertebrae Spondylopathy Tendon Tenosynovitis Medical Terminology Course 71

NERVOUS SYSTEM ASSIGNMENT

Word Notes convolution cerebrum cortex neurone ganglion thalamus commissure corpus striatum medulla cerebellum myelin neurilernmna dura-mater pia-mater arachnoid axon cisterna magna cistema pontis saggital autonomic cauda equina neurologist aphasia chordotomy astrocytoma epilepsy cerebral palsy cerebral sclerosis Niemann-Picks disease Ataxia telangiectasia meningitis hemi-paresis glioma medulloblastoma ependymoma oligodendroglioma memngioma neurofibroma neurosurgeon 72 Medical Terminology Course

Special sense organs assignment Dictionary homework

Word Derivation Meaning acoustic uveal tract gustatory tarsus olfactory sciera cochlea retina eustachian limbus labyrinth lens mastoid lacrimal tympanic iris aqueous cornea canthus conj onctiva choroid vitreous

Cardiovascular system assignment

Root Meaning Example Definition Angelon Vessel Angiogenesis Aorte Aorta Aortectasia Arteria Artery Arteriorraphy Cardia Heart Endocardium Phlebo Vein Phlebothrombosis Vena Vein Venesection Sphygmos Puise Sphygmomanometer Aden Gland Adenocarcinoma Haema Blood Haemoglobin Splen Spleen Spienomegaly Medical Terminology Course 73

-- Blood and blood forming organs assignment

Word Root Meaning afferent agglutination agglutinogen agglutinin aplastic efferent erythroblast erytbiopoiesis haemolysis haematopoiesis incompatible lymph lymphocyte myeloblast myeloid normoblast normochromic precursor reticuloendothelial trabeculae megaloblast myeloma intrinsic factor hyperplasia polymorphonudear polycythaemia pleomorphic vera myelogenous hepatomegaly splenomegaly metastases myelophthisic thrombocytopenia lymphoma lymphosarcoma dysproteinaemia 74 Medical Terminology Course

Respiratory system assignment Root Meaning Example Definition Bronch Bronchus Bronchoscopy Pectus Chest Phren Diaphragm Phrenicectomy Pneumon Lung Pneumonitis Rhin Nose Rhinostenosis Thorax Chest Thoracotomy Trachea Windpipe Tracheoplasty

Dictionary homework

Word Meaning alveolus aphonia arytenoid bronchus caseous catarrh concha corniculate coryza cricoid cuneiform dyspnoea epiglottis epistaxis glottis haemoptysis hilus larynx lung meatus mediastinal nares nasolacrimal olfactory osmosis pharynx pleura septum sinus trachea turbinates Medical Terminology Course 75

- Digestive system assignment

Root Meaning Example Definition Amygdale Tonsil Amygdaioid fossa Cheios Lip Cheilostomatoplasty Choie Bile Cholelithasis Chylos Chyle Colon Colon Colostomy Copros Excrement Copremesis Dipsa Thirst Dipsomania Emesis Vomiting Haematemesis Enteron Gut Enterostatis Gaster Stomach GasUectomy Glossa Tongue Glossitis Glottis Glottis (a part of Epiglottis voice box) Hepato Liver Hepatomegaly Ileos Ileum Ileocaecal Larynx Larynx Mesoenteron Mesentery Mesenteritis Odont Tooth Odontologist Oesophagos Gullet Osophagitis () Orexis Appetite Anorexia Phagein Swallowing Dysphagia Pharynx Pharynx Pharyngeal Proktos Anus or Rectum Proctodynia Pyloros Pylorus Pylorostenosis Stoma Mouth Stomatitis Tonsila Tonsil Tonsillitis 76 Medical Terminology Course

Medical terminology assignment: Digestive system Dictionary homework

Word R Meani- ng Absorb Alimentary Ampulla Annular Antrum Anus Appendix Assimilate Biirubm Buccal Cecum Chyle Colon Common bile duct Crypts of Lieberkühn Cystic duct Duct Duodenum Dysphagia Emesis Epiploic Excretion Fauces Faeces Freriulum Fundus Fungating Gastroenterologist Gastroenterology Glossopalatine Glucagon I-iaematemnesis Haemorroids Hiatus Hyperglycemic Hyperkeratosis lleocaecal Ileum Ingest Insulin Islets of Langerhans jejunum Lacteal Mastication Meckels diverticulum Medical Terminology Course 77

Word 22 Meaning Mesentery Mucin Omentum Palate Pancreas Parietal Parotid Peristalsis Pharyngopalatine Plica Polypoid Porta hepatis Ptyalin Pylorus Rugae Salivary Salivation Scirrhous Secrete Sphincter of Oddi Stercobilin Sublingual Submandibular Succus entericus Urobilin Urobilinogen Uvula Vermiform 78 Medical Terminology Course

Urinary system assignment

Root Meaning Example - Definition Cystitis Bladder Cystotomy Nephros Kidney Nephrectomy Pyelos Kidney/Pelvis Pyelogram Ren Kidney Adrenal Urina Urine 1 Polyuria Vesicula Vesicle I Intravesicular

Urinary system medical terminology Dictionary Homework

Word Meaning Afferent Arcuate Azotaemia Bowman capsule Calculus Calyces Convoluted Cortex Creatinine Cystitis Cystocele Cystometrogram Dysuna Efferent Filtration Glomerulus Haematuna Henles loop Hydronephrosis Incontinent Intravesicular Nephron Nephroptosis Oliguria Parenchymatous Pelvis Penile Perinephric Polyuria Postpartum Renal fascia Retention Medical Terminology Course 79

Word Meaning Retrograde Retroperitoneal Suppression Synthesis Transitional Trigone Urea Uraemia Ureter Urethra Venereal Vesical Void

Reproductive system assignment

Root Meaning Example Definition Colpos Vagina Colpomyomotomy Didyrnoi Epididymis (small Epididymitis body lying above tes- tes) Genos Genesis Hymen Hymen Hymenectomy Hystera Womb/Uterus Hysteromyoma. Kleitoris Clitoris Clitoriditis Metra Womb/Uterus Metrorrhagia Oophoreiri Ovary Oophorectomy Orchis Testicle Orchidectomy Salpinx Fallopian tube Salpingectomy Sperma Semen Spermicide Uterus Uterus Uteropexy I 80 Medical Terminology Course

Reproductive system medical terminology

Dictionary homework

Word Meaning abortion amenorrhoea amitosis areola atrophicus bulbouretral cavernous cervix uteri clitoris corpora cavernosa corpus luteum dysmenorrhoea ectopic pregnancy endometrium epididymis fertilization fimbria foreskin gamete gonad Graafian follicle hymen hyperplastic inguinal labia menorrhagia menopause menstruation metrorrhagia mons pubis myometrium nulliparous ostium abdominale ovary oviduct ovulation ovum parainetrium penis perineum prepuce prostate Medical Terminology Course 81

Word Meaning puberty scrotum semen seminal vesical spermatozoa testis tunica vaginalis uterus vagina vas deferens vestibule vulva zygote

Endocrine system assignment

Root Meaning Example Definition Carotis Carotid Carotid gland Gone Gonad Gonadotrophic Pinea Pineal Pmealopathy Pituita Pituitory Pituitrin Thymos Thymus Thyreos Thyroid Thyroadenitis Galact Milk Galactemia Mamma Breast Mastos Breast Mastitis Thel Nipple Thelalgia

Endocrine system medical terminology Dictionary Homework Word .9221L s Meaning cachexia cell rests chromaffin cortex diabetes endocrinology estrogen exophthahnos gastrin 82 Medical Terminology Course

Word Root(s Meaning glucosuria gonad glycosuria hormone hypophyseal hypotension iatrogenic insular intracranial libido medulla morbid myxoedematous placenta polydipsia polyphagia prostration secretion somatotrophic tetarly thyroxin vascular

Pathology assignment Dictionary homework

Signs and symptomsMeaning Cephalalgia Diplopia Tmnitus Epistaxis Rhinorrhoea Dyspnoea Haemoptysis Palpitation Oedema Syncope Dysphagia Aerophagia Borborygmus Nausea Haematemesis Jaundice Medical Terminology Course 83

Signs and symptoms Meaning Diarrhoea Pruritis Frequency Tenesmus Incontinence Polyuria Dysuria Haematuria Impotence Amenorrhoea Dysmenorrhoea Metrorrhagia Paraesthesia Skin eruptions maculai papular desquamating Pigmentation Petechiae Telangiectasia Atheroma Cicatrix Verrucae (Verruca) Naevi (Naevus) Hirsute Alopecia Cerumen Auricular tophi Ptyalism Pyorrhoea Parulis Stridor Aphonia Bruit Gynaecomastia Tachypnoea Bradypnoea Dyspnoea Orthopoea Apnoea Ascultation Raies Bradycardia Tachycardia Aneurysm 84 Medical Terminology Course

Signs and symptoms Meaning Pulse - dorsalis pedis - posterior tibial Condylomata Introitus Retroversion Retroflexion Ankylosis Flaccid Spastic Romberg test Crernasteric Euphoria Necropsy Oncology Forensic medicine Idiopathic etiology Degeneration Infiltration Amyloidosis Metastatic calcification Calcinosis Ochronosis Melanomata Porphyrins Hyperaemia Pyknosis Karyorrhexis Karyolysis Caseation Rubor Calor Dolor Intermitotic Postmitotic Aplasia Hypoplasia Atrophy Metaplasia Dyplasia Hyperplasia Hypertrophy Neoplasia Carcinogen Papilloma Anaplasia Medical Terminology Course 85

REVIEW MEDICAL TERMINOLOGY ASSIGNMENT Prefixes which indicate location, direction and tendency

Prefix Meaning Example Meaning of example 1. Ab ) Abduction Apo )From, away Apoplexy from De ) Detract 2. Ad To, near, Adrenal toward 3. Arnbi Both Ambidextrous 4. Amphi ) Arnpitheatre ) On both sides Ampho ) Ainphogenic 5. Ana Up, apart, Anabolism across 6. Ante ) Antenatal Pre )Before Precancerous Pro ) Prognosis 7. Anti ) Antispasmodic Contra )Against Contraindication Counter ) Counterbalance 8. Cata )Down Catabolism 9. Circum ) Circumference )Around Peri Pericardium 10. Co ) Co-ordination Corn ) Compound Con )With, Congenital together Sym ) Symbiosis Syn ) 11. Dia ) Diaphoresis Per )Through Percutaneous Trans ) Transhepatic 12. Di ) Diarthrosis Apart from Dis ) Disarticulation 13. E ) Enucleate Ec )Out from Eczema Ex ) Exhale 14. Ect ) Ectopic Exo )Outside Exogenous Extra ) Extravasation 15. Em ) Empyema En ) Encapsulated In 1m ) Impacted In ) Inspiration 86 Medical Terminology Course

Prefix Meaning Example Meaning of example 16. End ) Endocardium Ento ) Within Entopic Intra. ) Intravenous 17. Epi Upon Epicondyle 18. Infra ) Inframamary Hypo ) Under Hypodermic Sub ) Subelavian 19. inter Between Intercostal 20. Intro into Introduction 21. Meta Change Metaplasia 22. Para Beside Paranasal 23. Post After Postoperative 24. Re Again Recurrence 25. Retro ) Retroflexion Backward Re ) Relapse 26. Super ) Superimpose Above Supra ) Suprapubic 27. Ultra Excessive Ultrasonic Negative prefixes 1. A ) Apnoea Without An ) Anaesthetic 2. 1m ) Immature Not In ) Incurable Pseudoprefixes denoting number and measurement 1. Uni ) Unilateral One Mono ) Monocyte 2. Bi ) Bifocal Bin ) Two Binocular Di ) Dichromatic 3. Ter ) Tertiary Three Tri ) Trigone

4. Quadra ) Quadriceps )Four Tetra Tetragenous 5. Quinque ) Quintuplet Five Pent(a) Pentose 6. Sex ) Sextipara )Six _____ Hex(a) ) Hexadactylism Medical Terminology Course 87

Prefix Meaning Example Meaning of example 7. Sept ) Septan Seven Hept(a) ) Heptose 8. Octa Eight Octogenarian 9. Nonagen ) Nonan Nine Novem ) Novemiobate 10. Dec ) Decigram Ten Dec(a) 11. Cent ) Centimetre Hundred Hect(o) ) Hectogram 12. Milli ) Millimetre Thousand Kilo ) Kilogram 13. Demi ) Demilune Semi ) Half Semicircular Hemi ) Hemiplegia 14. Multi ) Multinodular Many Poly ) Polycythaemia 15 Super ) Supernumerary Per ) Pertussis More Hyper ) Hyperaemia Extra ) Extrasystole 16. Sub ) Subnormal Less Hypo ) Hypocrinism Prefixes denoting colour 1. Albumin ) Albuminuria Alb ) Luc ) White Leuc ) Leucitis Leuk ) Leukaemia 2. Aure Golden Auriginous 3. Cmer ) Cinerea Grey Polio ) Poliomyelitis 4. Chlor ) Chlorophyll Glauc ) Green Glaucoma Verdin ) Verdohaemoglobin S. Cirr I ) Cirrhosis Lutein ) Yellow Corpus luteum Xanth ) Xanthopsis 88 Medical Terminology Course

6. Rube ) Rubella Red Erythr ) Erythrocyte 7. Cyan Cyanosis Blue Indigo ) Indigouria 8. Purpur Purpura Purple ______Porphyr ) Porphyrin 9. Melan Black Menanoma

Miscellaneous pseudo-prefixes

Prefix Meaning Example Meaning of example Aniso Unequal Anisocytosis Ate! Imperfect Atelectasis Blast Germobe Blastomycosis Brachy Short Brachygnathia Brady Slow Bradyeardia Cry Cold Cryosurgery Crypt(o) Hidden Cryptorchidism Cyt Cell Cytology Fibr Ropelike Fibroma Gyn Woman Gynaecology Hetero Different Heterogeneous Hydr Water Hydronephrosis Leio Smooth Leiomyoma Lith Stone Cholelithiasis Micr Small Microscope Morph Form Myc Fungus Mycoplasm Neo New Neoplasm 011g Few Oliguiia Onc Tumour Oncology Pachy Thick Pachyderm Pan All Pan hysterectomy Pseudo False . Pseudocyesis Py Pus Pyorrhoea Sciirh Hard Scirrhous Scoho Crooked Scoliosis Medical Terminology Course 89

Prefix Meaning Example Meaning of example Sten Contracted Stenosis Tachy Fast Tachycardia Toxi Poison Toxicology Troph Thyrotropic Vas VesselNourishmen4Vasospasm Suffixes

Suffix Meaning Example Meaning of Example orna New growth Carcinoma algia Pain Neuralgia atresia Without Proctatresia opening blast Germ Myeloblast cele Swelling Hydrocele dde Killer Germicide cleisis Closure Enterocleisis clysis Injection Hypodermoclysis cyst Sac of fluid Dacrocyst cyte Cell Leukocyte dynia Pain Pleurodynia ectasis Expansion Atelectasis emesis Vomiting Haematernesis

Suffix Meaning Example Meaning of example aemia Blood Anaemia iris Inflammation Iritis lith Stone Fecolith ogy Study of Biology malacia Softening Osteomalacia orexia Appetite Anorexia pathy Disease Adenopathy penia Poor Thrombopenia plasia Formation Aplasia pnoea Breathing Dyspnoea ptosis A falling Nephroptosis orrhagia Bursting forth Metrorrhagia rrhoea Flow Diarrhoea spasm Contraction Pylorospasm stasis Position Metastasis uria In the urine I Haematuria