Medical English 170X240
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ZDRAVSTVENO VELEUČILIŠTE, ZAGREB
Petar Režić Srebrenka Žurić Havelka
Izdavač ZDRAVSTVENO VELEUČILIŠTE Mlinarska cesta 38, 10000 Zagreb http://www.zvu.hr Za izdavača Prof. dr. sc. Mladen Havelka Biblioteka "Udžbenici i priručnici Zdravstvenog veleučilišta” Svezak 42. Urednik biblioteke Prof. dr. sc. Predrag Keros Lektor Nitor usluge d.o.o. Recenzenti Prof. dr. sc. Miljenko Marotti Prof. dr. sc. Marija Frković
Copyright © 2013. Sva prava pridržana. Nijedan dio ove knjige ne smije se reproducirati ni prenositi ni u kakvom obliku niti ikakvim sredstvima, elektroničkim ili mehaničkim, fotokopiranjem, snimanjem ili umnažanjem u bilo kojem informatičkom sustavu za pohranjivanje i korištenje bez prethodne suglasnosti vlasnika prava. CIP zapis dostupan u računalnom katalogu Nacionalne i sveučilišne knjižnice u Zagrebu pod brojem 832567. ISBN 978-953-6239-34-4 Grafičko oblikovanje i tisak "Offset NP GTO tisak d.o.o.", 2013.
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Petar Režić Srebrenka Žurić Havelka
Introduction to Basic Medical Terminology for Health Professions A textbook for students of health studies
ZDRAVSTVENO VELEUČILIŠTE Zagreb, 2013
Contents PREDGOVOR.................................................................................................. VII INTRODUCTION - Hypocratic Oath����������������������������������������������������������������� 1 About the English Language..................................................................... 3 01. Basic elements of a medical word Grammar revision – the passive voice..................................................................................... 6 02. The Most Common Suffixes and Prefixes................................................ 12 03. Body as a Whole For further practice: translate into English (the cell)............................. 22 04. Integumentary System............................................................................. 35 05. Musculoskeletal System.......................................................................... 49 06. Gastrointestinal System........................................................................... 70 07. Respiratory System.................................................................................. 87 08. Cardiovascular System............................................................................ 98 09. Urinary System...................................................................................... 111 10. Nervous System..................................................................................... 121 11. Blood and Lymphatic System................................................................. 138 12. Endocrine System.................................................................................. 158 13. Female Reproductive System................................................................ 176 14. Male Reproductive System.................................................................... 191 15. Sense Organs......................................................................................... 204 SUPPLEMENT 16. Oncology – Cancer Medicine.................................................................. 219 17. General Care of the Patient .................................................................. 227
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18. British Medical Training and Registration ............................................ 233 19. Smoking – Hazardous Adaptation......................................................... 237 20. AIDS........................................................................................................ 253 21. Stress Management .............................................................................. 261 22. Radiology and Nuclear Medicine .......................................................... 275 23. Pharmacology ....................................................................................... 281 24. Psychiatry............................................................................................... 285 GLOSSARY.................................................................................................... 296 REFERENCES.............................................................................................. 398
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Predgovor Ovaj je udžbenik - priručnik namijenjen studentima preddiplomskih i specijalističkih diplomskih studija stručnih zdravstvenih studijskih programa – medicinskim sestrama, fizioterapeutima, radnim terapeutima, radiološkim inženjerima, medicinsko-laboratorijskim inženjerima, sanitarnim inženjerima, primaljama i drugim zdravstvenim strukama, npr. liječnicima. Udžbenik obuhvaća tematske nastavne jedinice utvrđene nastavnim programom za predmet Engleski jezik na zdravstvenim studijima, a temelji se na tjelesnim sustavima. Većina poglavlja uključuje leksičko-gramatičke skupine zadataka vezane uz određeni tjelesni sustav te skraćene popularne i stručne tekstove koje studenti trebaju prevesti s engleskog na hrvatski ili s hrvatskog na engleski jezik. Sastavni dio udžbenika su sadržaji vezani uz tvorbu (morfologiju) medicinskog nazivlja pomoću prefiksa i sufiksa latinskog odnosno grčkog podrijetla te njihovi ekvivalenti u engleskom strukovnom i kolokvijalnom nazivlju. Glavni izvor za engleske tekstove poslužio je udžbenik “The Language of Medicine”, autorice D. A. Chabner, 5. i 7. izdanje, kao i “Medical English”, treće izdanje iz 1982. godine (autorice: V. Momčinović, V. Tanay i S. Žurić Havelka). Dodatak ovom udžbeniku (Supplement) su tekstovi koji bi studentima mogli biti zanimljivi kao dopunske teme u slučaju njihova posebnog interesa. Nadamo se da će priručni Glosar biti od pomoći našim studentima i svima zainteresiranima za sadržaje iz ovog priručnika. Autori
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Introduction HIPPOCRATIC OATH “Life is short, and the Art long; the occasion fleeting; experience fallacious, and judgment difficult. The physician must not only be prepared to do what is right himself, but must also make the patient, the attendants, and externals cooperate.” (Hippocrates: Aphorisms)
HIPPOCRATES (late 5th century B.C.), generally regarded as the “Father of Medicine”, son of a priest-physician, was born on the island of Cos. By stressing that there is a natural cause for disease he did much to dissociate the care of the sick from the influence of magic and superstition. His carefully kept records of treatment and solicitous observation of the ill provided a foundation for clinical medicine in the case report; and by reporting also unsuccessful methods of treatment he anticipated the modern scientific attitude. The way for the professional nurse was prepared by his emphasis on the importance of skilled bedside care, and his bedside care example demonstrated the value of clinical instruction. Many of the writings of Hippocrates and his school have survived - it is the so-called Corpus Hippocraticum, although it is not certain which parts were written by Hippocrates himself. These writings are usually characterized by the stress laid on treatment and prognosis. A moral code for medicine has been established by his ideal of ethical conduct and practice as embodied in the Oath, generally taken by students receiving a medical degree. The Oath sets forth an ethical code for medical profession. 1
Hippocratic Oath “I swear by Appolo1, the physician, and by Asklepios2, Hygeia3, and Panacea4, and all the gods and goddesses, and call them to witness that I will keep this oath and contract to the best of my ability and judgment; to regard him who teaches me this art as equal to my own parents; to share my living with him, and provide for him in need; to treat his children as my own brothers, and teach them this art if they wish to learn it, without payment or contract; to give guidance, lectures, and every other kind of instruction to my own sons and those of my teacher, and to students bound by contract and oath to medical law, but to nobody else. I will prescribe treatment at the best of my ability and judgment for the good of the sick, and never for a harmful or illicit purpose. I will give no poisonous drug, even if asked to, nor make any such suggestions; and likewise, I will give no woman a pessary5 to cause abortion. I will both live and work in purity and godliness. I will not operate, not even on patients with stone, but will give way to specialists in this work. I will go into the houses that I visit in order to help the sick, and refrain from all deliberate harm or corruption, especially from sexual relations with women or men, free or slave. Anything I see or hear about people, whether in the course of my practice or outside it, that should not be made public, I will keep to myself and treat as an inviolable secret. If I abide by this oath, and never break it, let all men honour me for all time on account of my life and work; but if I transgress and break my oath, let me suffer the reverse.”
Appolo - Greek god of the arts, prophecy, medicine and light, protector of herds and flocks, son of Zeus and Leto, brother of Artemis. His principal sanctuary and oracle were at Delphi. In art he is presented as the ideal of young male beauty. 2 Asklepios, also spelt Asclepius, hero and Greek god of healing; he corresponds to Aesculapius, Roman god of medicine 3 Hyg(i)ea - in Greek mythology, the goddess of health; daughter of Asklepios. 4 Panacea – in Greek mythology, the goddess of healing; sister of Hygea; the word literally means a cure for all ills, a universal remedy or medicine for all diseases. In English it is also called an All-heal. 5 pessary (Lat. pessarium) – an instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 1
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For further reading: ABOUT THE ENGLISH LANGUAGE English is not the language that has always been spoken in the British Isles, nor indeed is it the only language that is spoken there today. English was originally a foreign language, imported by foreign invaders. These invaders were two Germanic tribes living in what is now Northern Germany, along the North Sea coast. They were called the Angles and the Saxons, and they spoke different dialects of the same language. It is from these dialects that modern English has descended. Anglo-Saxon, or Old English, as historians of the language prefer to call it, remained the language of England from about A.D. 450 to about A.D. 1150. The reason why it is not still the language of England is that there were two more foreign invasions of the island by people speaking different tongues – first the Northmen or Vikings from Denmark, and then the Normans from Normandy in France. The result of these further invasions, particularly the second by the Frenchspeaking Normans in A.D. 1066 (William the Conqueror), was to modify Old English very considerably, and turn it, in the course of the next three centuries, into a compound language which we know as Middle English. Middle English is recognizably the ancestor of the English we speak today (which Old English is not), and it was the common tongue of the inhabitants of England from about A.D. 1150 to about A.D. 1500. As there were no more foreign conquests of the island the language was thenceforward able to develop – as it were – under its own impetus. There were no more radical changes and so Middle English merged imperceptibly into the Early Modern English of Shakespeare’s age and then into the language we speak now. The reference has so far been made only to England and not to Britain. The distinction is important because England is only a part of Britain - the biggest part, it is true, but still only a part – whereas Britain includes also Wales and Scotland. The Anglo-Saxons after conquering England never succeeded in penetrating to these remote parts of Britain, so that the English language was never implanted there. The inhabitants, known as Celts, who were independent of the English for many years, kept their own language, Celtic, various dialects of which are still spoken today in these parts of Britain and in Ireland. Welsh is spoken in Wales, Gaelic in Scotland, and Erse in Ireland. A fourth Celtic dialect, Cornish, used to be spoken in the south-west corner of England, the Cornwall, but it became extinct about 200 years ago.
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Anglo-Saxon is now, of course, a dead language, but a good deal of its vocabulary has survived, in one form or another, to the present day. Most of the very common words in modern English are Anglo-Saxon in origin: nouns like father, mother, food, drink, bed, most of the prepositions and conjunctions, and nearly all of the strong verbs. When it was mixed with Norman French there were three main results: the grammar was simplified, the pronunciation and spelling became (and still are) much more complicated, and the vocabulary was enormously extended. French is a Latin language, so the part of our vocabulary is now Latin in origin. That is also one reason why we have so many synonyms. In pair of words like “wed” and “marry”, “fat” and “corpulent”, “lively” and “vivacious”, the first word is derived from Anglo-Saxon, the second from Latin. A language never stands still. It is always changing and developing. These changes are rapid in primitive societies, but slow in advanced ones, because the invention of printing and the spread of education have fixed a traditional usage. The only important change that English has undergone since the sixteenth century is a very large increase in its vocabulary. It is interesting to trace the different ways in which new words are adopted or invented. Let us take just four English words and see how they were made; admiral, yacht, sandwich, and television. Admiral was introduced into England from France in the fifteenth century. It was then spelt “amiral” and was derived by the French from a compound Arabic word “amir-al-bahr” meaning “Prince of the Sea”. Some time later certain misguided English scholars, looking at this word, assumed that it was a corruption of Latin word “admirare”, meaning “to wonder at”, and proceeded to replace- as they thought- the “d” in first syllable. So out of this confusion, involving three languages, we have the present word admiral. Yacht is a Dutch word, which accounts for its unusual spelling. The first yacht was given by the Dutch to King Charles II as a wedding present in 1662. The name is derived from the Dutch word for hunting (Germ. Jagd), and yachts were so named for their speed. As a matter of fact many nautical words come from Dutch, just as many words connected with music and painting come from Italian. Sandwich, which is now no longer a purely English word, but almost international, comes from the fourth Earl of Sandwich (died 1792), who invented this particular form of quick meal so that he could go on gambling all through the nights without stopping for dinner. Many names of things are, in fact, taken from the names of their first inventors, e.g. the electrical terms watt and volt.
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Television is typical of many new scientific words which are deliberately invented from Old Greek and Latin words. In this case the prefix “tele” is Greek and means “far” (cf. telephone, telegram), while the root “vision” is derived from the Latin verb meaning “to see”. Answer these questions: 1. When was Anglo-Saxon spoken in England? 2. Why is Anglo-Saxont not like modern English? 3. What happened to the language as a result of Norman Conquest? 4. Which countries form part of the British Isles? 5. Which other languages are spoken in Britain today? 6. Why is English not spoken as a first language in parts of Wales and Scotland? 7. Why does language tend to change more rapidly in a primitive society than in an advanced one? 8. What kind of words in modern English are derived from Anglo-Saxon? 9. Why does English have such a large vocabulary? 10. What is the origin of the word yacht? From: D.H. Spencer & A.S. Hornby: An Intermediate English Course for Adult Learners. Oxford University Press.
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CHAPTER 1
BASIC ELEMENTS OF A MEDICAL WORD: WORD ROOTS, COMBINING FORMS, SUFFIXES, PREFIXES There are several important reasons for studying word elements related to medical terminology: 1. To be able to analyze all elements of a specific word and understand more complex terminology and expressions used in medicine and other allied health professions. 2. Define and provide several examples of word roots, combining forms, suffixes, and prefixes. 3. Divide the words into their component parts. 4. Describe and explain how medical and other words are formed. To analyze words mostly used in medical and allied health professions, the four elements that may be used to form a word need to be identified. 1. WORD ROOTS The main part or stem of a word is called a word root (WR). A WR is usually derived from the Greek or Latin language and frequently indicates a body part. The words can be composed of one, two, or more roots. When a term is composed of more than one word root it is referred to as a combined or a compound word. Examples of Word Roots Greek Word kardia (heart) gaster (stomach) hepat (liver) nephros (kidney) osteon (bone)
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Word Root cardi gastr hepat nephr oste
Meaning heart stomach liver kidney bone
2. COMBINING FORMS The combining form (CF) is a WR plus a combining vowel, usually an “o”. Examples of Combining Forms Word Root + Combining Vowel cardi o gastr o arthr o derm o cyt o cephal o cerebr o
= Combining Form cardi/o gastr/o arthr/o derm/o cyt/o cephal/o cerebr/o
Meaning heart stomach joint skin cell head brain
3. SUFFIXES A suffix is a word ending. In the words tonsill/itis and tonsill/ectomy, The suffixes are –itis (inflammation) and –ectomy (excision, removal). Changing a suffix gives the word a new meaning. In medical terminology a suffix usually indicates a procedure, condition, disease, or part of speech. Many suffixes are derived from Greek and Latin words. Examples of Suffixes Combining Form + Suffix = arthr/o -centesis (joint) (puncture)
Medical Word arthrocentesis
Meaning puncture of a joint
thorac/o (chest)
-tomy (incision)
thoracotomy
incision of the chest
gastr/o (stomach)
-megaly gastromegaly (enlargement)
enlargement of the stomach
erythr/o (red)
-cyte (cell)
erythrocyte
red blood cell
cyt/o (cell)
-logy (study)
cytology
study of a cell
4. PREFIXES A prefix is a word element located at the beginning of a word. When a medical word contains a prefix, the meaning of the word is changed. The prefix usually indicates a number, time, position, direction, colour, or negation.
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Examples of Prefixes Prefix + Word Root + Suffix = hyper therm -ia (excessive) (heat) (condition)
Medical Word hyperthermia
Meaning condition of excessive heat
intra (in, within)
muscul (muscle)
-ar intramuscular (relating to)
within the muscles
macro (large)
gloss (tongue)
-ia (condition)
macroglossia
condition of a large tongue
micro (small)
card (heart)
-ia (condition)
microcardia
condition of a small heart
Defining Medical and Other Words The word is usually defined by first identifying its suffix, or ending, then the prefix, or word beginning, and finally the middle part, i.e. the word root. For Example: gastr/o stomach (2)
enter/ intestine (3)
itis inflammation (1)
Read as follows: 1. Inflammation of (suffix) 2. Stomach and (first part of the word) 3. Intestine (middle) GRAMMAR REVISION: THE PASSIVE VOICE Elementary Note: appropriate tense of verb “to be” with the past participle of the main verb. Example: Someone has stolen my books – My books have been stolen. No agents with “by” are required in the following sentences. Turn the following sentences into the passive voice: 1. People always admire this picture. 2. He hurt his leg in an accident. 3. No one has opened that box for the last hundred years. 4. People formerly used the Tower of London as a prison. 5. Someone has broken two of my dinner plates. 6. They fought a big battle here two hundred years ago. 7. People will forget this play in a few years’ time. 8
8. No one has ever beaten my brother at tennis. 9. People speak English all over the world. 10. Did anyone ask any questions about me? 11. People mustn’t take these books away 12. They punished me for something I didn’t do. 13. Someone wants you to help lay the table. 14. Somebody left the dog in the garden. 15. We shall discuss the matter tomorrow. 16. Nobody heard a sound. 17. What have people done about this? 18. Has anybody answered your question? 19. They made this gun in Birmingham. 20. They make a book of paper. Elementary and intermediate Note: When the verb in the active voice has two objects, it is more usual in English to have the personal object as the subject of the passive voice. Example: Someone gave me a book. --- I was given the book. Put the following sentences into the passive voice with a personal subject: 1. They gave my little sister a ticket, too. 2. People will show the visitors the new buildings. 3. Someone has already paid the electrician for his work. 4. They promise us higher wages. 5. They will allow each boy a second plate of ice-cream. 6. They will ask us all several questions. 7. Someone will read you another chapter next time. 8. They have made my uncle a captain. 9. The others told the new students where to sit. 10. They still deny women the right to vote in some countries. 11. Somebody will tell you what time the train leaves. 12. Somebody has recommended me another doctor. 13. Someone taught him French and gave him a dictionary. 14. They asked the rest of us to be there at eight o’clock. Note: The use of “by” with an agent should always be avoided, except when it is necessary to complete the sense of the sentence. For example: This poem was written by Shakespeare. Note: Prepositions or adverb particles must not be left out with verbs requiring them. For example: They will look after you well --- You will be well looked after 9
Intermediate and advanced Turn the following sentences into the passive voice as appropriate: 1. Someone has asked the student a very difficult question. 2. We must look into this matter. 3. People speak well of my friend Peter. 4. Someone reads to the old lady every evening. 5. You must work for success. 6. They gave me two shillings change at the shop. 7. She promised him a book. 8. It is time they brought the cows in. 9. Nobody has slept in that room for years. 10. The teacher promised Mary a prize if she worked well. 11. A friend told me the news this morning. 12. Unkind remarks easily upset my friend Maisie. 13. What ought we to do about this? 14. What questions did the examiner set? 15. Nobody has made any mistakes. 16. Beethoven composed this piece. 17. A guide pointed out the Pyramids to me. 18. Somebody must do something for these poor men. 19. Nobody has answered my question properly. 20. They didn’t tell me the truth about the situation. 21. People ought not to speak about such things in public. 22. An unseen hand opened the window. 23. They had eaten all the dinner before they finished the conversation. 24. Somebody left the light on all night. 25. We shall lock the house up for the summer and the old gardener will look after it. 26. Has someone mended that chair yet? 27. Nobody has ever spoken to me like that before. 28. Didn’t they tell you to be here by six o’clock? 29. I’d like someone to read to me. 30. No one has drunk out of this glass. 31. The fire destroyed many valuable paintings. 32. I hate people looking at me. 33. Do you intend us to take your remark seriously? 34. This is a good idea, but one cannot carry it out in practice. 35. People shan’t speak to me as if I were a child. 36. Somebody has locked the box and I cannot open it.
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37. Somebody must have taken it while I was out. 38. Did the noise frighten you? 39. Don’t let the others see you. 40. Did anybody ever teach you how to behave? 41. They did nothing until he came. 42. I can assure you I will arrange everything in time. 43. A sudden increase in water pressure would break the dam. 44. One cannot eat an orange if nobody has peeled it. 45. Her beauty struck me deeply. 46. People generally assume that money brings happiness. 47. You must account for every penny. 48. People say tortoises live longer than elephants. 49. I should love to be taken out to dinner. 50. Naturally one expects you to interest yourself in the job they have offered you. 51. It must have disappointed him terribly that people told him they didn’t want him. 52. They must have given you the paper (that) they meant for the advanced candidates. 53. Someone had already promised me a watch for my birthday when they presented me with one as a prize. 54. It surprised me to hear someone had robbed you. 55. People say that figs are better for us than bananas. 56. We haven’t moved anything since they sent you away to cure you. 57. Nobody would have stared at him if they had told him beforehand what clothes one had to wear in such a place. 58. People will laugh at you if you wear that silly hat. 59. People ought to tell us how much they expect of us. 60. When I was a child, people used to read to me out of a book of fairy tales someone had given me for my birthday.
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CHAPTER 2
THE MOST COMMON SUFFIXES AND PREFIXES 1. SURGICAL PROCEDURE SUFFIXES a) Incision • -ectomy – surgical removal, excision; example: appendectomy, hemorrhoidectomy • -centesis – surgical puncture; example: amniocentesis, arthrocentesis • -stomy – forming an opening; example: bronchostomy • -tome – instrument used for cutting; example: osteotome • -tomy – cutting; example: gastrotomy b) Plastic operation, reconstruction, loosening, refracturing • -clasis – breaking, refracturing; example: osteoclasis • -desis – bindig, stabilization; example: arthrodesis • -lysis – loosen, free from adhesions, destruction; example: enterolysis, thrombolysis • -pexy – fixation, suspension; example: nephropexy • -plasty– plastic repair; example: rhinoplasty • -rrhaphy – suture; example: splenorrhaphy • -tripsy – to crush; example: neurotripsy, lithotripsy 2. DIAGNOSTIC, SYMPTOMATIC AND OTHER COMMON SUFFIXES • • • • • •
-algia – pain; example: myalgia, dorsalgia, gastralgia -cele – hernia, swelling; example: nephrocele, cystocele, rectocele -dyna – pain; example: splenodynia, otodynia -ectasis – dilatation, expansion; example: bronchiectasis -emia – blood condition; example: leukemia -gen – beginning, origin; example: pathogen- any disease–producing microorganism • -gram – a writing, record; example: cardiogram (written record of the heart rate) 12
• -graph – to write, record; example: cardiograph (an instrument for the measurement of heart rate) • -iasis – condition, formation of, presence of; example: nephrolithiasis (kidney stones) • -sis – state of, condition; example: prognosis (foreknowledge) • -itis – inflammation; example: nephritis • -logy – study of; example: biology • -malacia – softening; example: osteomalacia • -megaly – enlargement; example: acromegaly (enlargement of the extremities) • -oid – resemble; example: rheumatoid • -oma – tumour; example: hepatoma • -osis – abnormal condition; example: neurosis • -pathy – disease; example: adenopathy • -penia – decrease, deficiency; example: erythropenia • -phagia – eating; example: polyphagia • -plegia – paralysis, stroke; example: paraplegia • -phobia – morbid fear; example: claustrophobia • -rrhea – discharge, flow; example: diarrhea • -sclerosis – hardening; example: arteriosclerosis • -scope – instrument to visually examine; example: gastroscope • -scopy – examination, view; example: gastroscopy 3. ADJECTIVE ENDINGS The most common adjective endings (meaning related to or pertaining to) are the following: • • • • • • •
-ac – cardiac -al – carpal -ary – hereditary -ical – physiological -ous – serous -tic – mycotic -ic – splenic
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4. PLURAL ENDINGS RULE Singular Plural Retain a and add e • -ae Drop x and add ces • -ax Drop en and add ina • -en Drop ex and add ices • -ex Drop is and add es • -is Drop ix and add ices • -ix Retain ma and add ta • -ma Drop on and add a • -on Drop um and add a • -um Drop us and add i • -us Drop y and add ies • -y
EXAMPLE Singular Plural pleura pleurae thorax thoraces lumen lumina apex apices diagnosis diagnoses appendix appendices carcinoma carcinomata ganglion ganglia bacterium bacteria bronchus bronchi deformity deformities
5. PREFIXES A prefix is a word element located at the beginning of a word. Most prefixes in medical and other terminology are of Greek or Latin origin. A prefix cannot stand alone and is used in conjunction with combining form or a combining form and a suffix. Here follows a list of the most common prefixes used not only in medical terminology, but also in the formation of words frequently used in other allied health professions. a) Prefixes of position and direction • • • • • • • • • • • • • •
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ab- (away from) ad- (toward, near) ambi- (both) ante- (in front of, before) antero- (the front, toward the front side) circum- (around) dextro- (right, to the right side) dia- (through) dorso- (back) ec-, ecto- (out, outside) endo- (in, within) epi- (above) ex-, exo-, extra- (out, outside, outward) hyper- (above)
• • • • • • • • • • • • • • • •
hypo-, infra-, sub- (deficient, under, below) inter- (between) intra- (inside) latero- (side) meso-, medio- (middle) meta (change, beyond) para- (near, beside) per- (through) peri- (around) post-, postero- (after, behind) pre- (before) retro- (behind, backward) sinistro- (left) super-, supra- (upper, above) trans- (across) ultra- (beyond, excess)
b) Prefixes of colour • • • • • • •
albino-, albumino-, leuko- (white) chloro- (green) cirrho-, jaundo-, xantho- (yellow) cyano- (blue) erythro-, roseo- rubeo- (red) glauco-, polio- (grey) melano- (black)
c) Prefixes of number and measurement • • • • • • • • •
primi- (first) uni-, mono- (one) bi-, di- (two) hemi-, semi- (half) macro- (large) micro- (small, minute) multi-, pan-, poly- (many, all, much) tri- (three) quadri- (four)
d) Prefixes of negation • a-, an-, ar- (without, not) • im-, in- (no, not)
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e) Miscellaneous prefixes • • • • • • • • • • • •
anti-, contra- (against) brady- (slow) dys- (painful, difficult) eu- (good) hetero- (different) hydro- (water) homeo-, homo- (same) neo- (new) mal- (bad, insufficient) pseudo- (false) sym-, syn- (together) tachy- (rapid)
EXERCISES -suffixes 1. Find the suffixes in the following words and give the meaning of the entire term: 1.1. leukemia............................................................................................................................................ 1.2. gastrectomy..................................................................................................................................... 1.3. hematoma......................................................................................................................................... 1.4. nephritis............................................................................................................................................. 1.5. gastroscope...................................................................................................................................... 1.6. dermatosis........................................................................................................................................ 1.7. psychogenic..................................................................................................................................... 1.8. neuralgia............................................................................................................................................ 2. Define the suffixes for the following terms and give example of a medical term: 2.1. inflammation................................................................................................................................... 2.2. resection or surgical removal............................................................................................... 2.3. section................................................................................................................................................. 2.4. condition (usually abnormal)................................................................................................. 2.5. process of study............................................................................................................................. 2.6. instrument to examine visually............................................................................................ 2.7. instrument to cut.......................................................................................................................... 2.8. one who specializes in............................................................................................................... 16
2.9. pertaining to..................................................................................................................................... 2.10. blood condition............................................................................................................................ 2.11. tumour.............................................................................................................................................. 2.12. pain..................................................................................................................................................... 2.13. record ............................................................................................................................................... 2.14. cell...................................................................................................................................................... 2.15. process of viewing .................................................................................................................... 3. Test your knowledge by giving the meaning of the following suffixes: 3.1. -gram...........................................................
3.11. -coccus.....................................................
3.2. -plasty..........................................................
3.12. -trophy......................................................
3.3. -osis..............................................................
3.13. -tomy.........................................................
3.4. -itis................................................................
3.14. -ectomy ...................................................
3.5. -genic...........................................................
3.15. -stomy.......................................................
3.6. -graphy........................................................
3.16. -megaly....................................................
3.7.-oma..............................................................
3.17.-malacia....................................................
3.8. -tome...........................................................
3.18. -dynia........................................................
3.9. -graph..........................................................
3.19. -poiesis.....................................................
3.10. -emia.........................................................
3.20. -centesis..................................................
4. Construct medical words: 4.1. earache............................................................................................................................................... 4.2. enlargement of the liver........................................................................................................... 4.3. incision of the chest.................................................................................................................... 4.4. deficiency of white blood cells ............................................................................................. 4.5. softening of the brain................................................................................................................. 4.6. one who specializes in the study of the eye.................................................................. 4.7. new opening of the kidney....................................................................................................... 4.8. fear of light.......................................................................................................................................
17
4.9. formation of red blood cells (RBCs).................................................................................. 4.10. prolapse of the kidney............................................................................................................. 4.11. fixation of the internal organs (viscera)........................................................................ 4.12. formation of bone....................................................................................................................... 4.13. condition of hardening of arteries.................................................................................... 4.14. removal of tonsils...................................................................................................................... 4.15. resembling a stone................................................................................................................... 4.16. small vein....................................................................................................................................... 4.17. small artery................................................................................................................................... 4.18. small bronchus........................................................................................................................... 4.19. tumour of the liver..................................................................................................................... 4.20. surgical repair of nerves........................................................................................................ EXERCISES - prefixes 1. Define the prefix and give the meaning of the entire term: 1.1. inter/dental between.................................................................................................................. 1.2. hypodermic....................................................................................................................................... 1.3. sinistrocardia................................................................................................................................... 1.4. epigastrium...................................................................................................................................... 1.5. dorsalgia............................................................................................................................................ 1.6. retrocervical..................................................................................................................................... 1.7. subnasal............................................................................................................................................. 1.8. cyanoderma..................................................................................................................................... 1.9. albuminosis...................................................................................................................................... 1.10. melanocarcinoma...................................................................................................................... 1.11. quadriplegia.................................................................................................................................. 1.12. hyperliposis................................................................................................................................... 1.13. primipara........................................................................................................................................ 1.14. ultraviolet........................................................................................................................................ 1.15. polydipsia........................................................................................................................................ 18
1.16. suprasternal.................................................................................................................................. 1.17. perirenal.......................................................................................................................................... 1.18. anacidity.......................................................................................................................................... 1.19. macrocephaly............................................................................................................................... 1.20. cirrhotic........................................................................................................................................... 2. Fill in the correct medical word that matches the definitions below: 2.1. ........................................................... morbid fear of water. 2.2. ........................................................... abnormally slow breathing. 2.3. ........................................................... rapid breathing. 2.4. ........................................................... difficult or bad breathing. 2.5. ........................................................... condition of hardening. 2.6. ........................................................... poor or bad nutrition. 2.7. ........................................................... good, easy breathing. 2.8. ........................................................... condition of sweating. 2.9. ........................................................... false encephalitis. 2.10. ......................................................... abnormal fear of everything. 3. Fill in the correct medical term for the definitions below: 3.1. ........................................................... left-footed. 3.2. ........................................................... vision in which objects appear blue. 3.3. ............................................................ located behind and at the inner side of a part. 3.4. ........................................................... destroying (poisoning). 3.5. ........................................................... back of the colon. 3.6. ........................................................... abnormal redness of skin. 3.7. ........................................................... pertaining to both sides. 3.8. ........................................................... before birth. 3.9. ........................................................... below the axilla. 3.10. ......................................................... pain in the back. 3.11. ......................................................... black tumour.
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3.12. ......................................................... between the ribs. 3.13...................................................... near the middle. 3.14...................................................... in the middle of the sternum. 3.15. ......................................................... pertaining to the region above the stomach. 4. Give the meaning of the following prefixes: 4.1. anti- .............................................................
4.11. hypo- ........................................................
4.2. pro- ..............................................................
4.12. peri- ..........................................................
4.3. sub-...............................................................
4.13. im- .............................................................
4.4. ab- ................................................................
4.14. dia- ............................................................
4.5. para- ............................................................
4.15. endo- ........................................................
4.6. retro- ...........................................................
4.16. ecto- ..........................................................
4.7. contra- .......................................................
4.17. brady- ......................................................
4.8. amphi- ........................................................
4.18. syn- ...........................................................
4.9. semi- ...........................................................
4.19. homo- ......................................................
4.10. poly- ..........................................................
4.20. primi-........................................................
FURTHER PRACTICE 1. Give the meaning of the following combining forms: 1.1. aden/o ........................................................
1.12. physi/o .....................................................
1.2. leuk/o ..........................................................
1.13. path/o .......................................................
1.3. cephal/o ....................................................
1.14. rhin/o ........................................................
1.4. arthr/o ........................................................
1.15. nephr/o ...................................................
1.5. cerebr/o .....................................................
1.16. carcin/o ...................................................
1.6. cyt/o .............................................................
1.17. gnos/o ......................................................
1.7. oste/o ..........................................................
1.18. onc/o .........................................................
1.8. dermat/o ...................................................
1.19. tom/o ........................................................
1.9. erythr/o ......................................................
1.20. gynec/o ....................................................
1.10. encephal/o ............................................
1.21. hepat/o ....................................................
1.11. bi/o .............................................................
1.22. cyst/o ........................................................
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2. Build medical terms for the following: 2.1. blood mass (tumour) ................................................................................................................. 2.2. inflammation of a gland .......................................................................................................... 2.3. record of the electricity of the heart ................................................................................ 2.4. abnormal condition of clotting cells (slight increase in numbers) ................................................................................................. 2.5. pertaining to across the stomach ...................................................................................... 2.6. study of the skin (and its diseases) ................................................................................... 2.7. head pain .......................................................................................................................................... 2.8. instrument to cut bone ............................................................................................................. 2.9. removal of the stomach ........................................................................................................... 2.10. instrument to visually examine the eye ....................................................................... 2.11. to view life (removal of living tissue for microscopic examination) ............................................................................................ 2.12. inflammation of bones and joints .................................................................................... 2.13. one who specializes in the study of tumours ........................................................... 2.14. pertaining to producing disease ...................................................................................... 2.15. incision of the stomach ......................................................................................................... 2.16. process of viewing the urinary bladder ....................................................................... 3. Give the meaning for the following terms: 3.1. autopsy ......................................................
3. 8. cystitis......................................................
3.2. nephrotomy..............................................
3.9. hepatoma.................................................
3.3. erythremia................................................
3.10. anemia....................................................
3.4. oncogenic..................................................
3.11. leukemia................................................
3.5. cephalic......................................................
3.12. carcinoma.............................................
3.6. gastric incision.......................................
3.13. thrombosis...........................................
3.7. gastric excision......................................
3.14. sarcoma ................................................
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CHAPTER 3
BODY AS A WHOLE 1. Structural Organization Cell The cell is the fundamental structural and functional unit of every living being. The study of cells is called cytology. Cells are everywhere - every organ is made up of these individual units. They are responsible for all activities associated with life, for instance: utilizing food, eliminating waste, reproducing. All cells are similar in that they contain a gelatinous substance called the protoplasm. It is composed of water, protein, sugar, acids, fats, and various minerals. However, cells are different, or specialized, throughout the body in order to carry out their individual functions. The following are among the major parts of the cell. 1. Cell membrane. This structure surrounds and protects the internal environment of the cell, determining what passes in and out of the cell. 2. Nucleus. The nucleus is the controlling structure of the cell. It controls the way in which a cell reproduces and contains genetic material that determines the functioning and structure of the cell. All the material within the nucleus is called nucleoplasm or karyoplasm (kary/o = nucleus, pl. nuclei). 3. Chromosomes. These are 23 pairs of thin strands of genetic material (DNA) located within the nucleus of each cell in a human body, except in sperm and egg cells, which contain only half of the genetic material each. Chromosomes contain regions known as genes which determine our hereditary makeup. The DNA within chromosomes regulates the activities of each cell by guiding the formation of another substance called RNA, which can leave the cell nucleus, enter the cytoplasm, and direct the activities of the cell. In the human there are about 31 000 genes that determine unique human characteristics. Chromosomes can be studied and classified as to size, arrangement, and number. This classification is called a karyotype. Karyotyping of chro-
22
mosomes is useful in determining whether chromosomes are normal in number and structure. 4. Cytoplasm. Cytoplasm is all the protoplasmic material outside the nucleus. It carries on the work of the cell and contains various structures called organelles (in a muscle cell, it does the contracting; in a nerve cell, it transmits impulses). Nucleus is the largest cell organelle. Some other organelles are: a) Mitochondria (sg. mitochondrion) - small bodies which carry on the production of energy in the cell by burning food in the presence of oxygen. This process is called catabolism. During catabolism complex food materials are broken down into simpler substances and energy is released. b) Endoplasmic reticulum - a series of canals within the cell. Some canals contain small bodies called ribosomes which help make substances (proteins) for the cell. This synthesizing (building-up) process is called anabolism. c) Golgi apparatus (complex, or body) – among other functions serves as a site of formation of primary lysosomes, which are responsible for the breakdown of particles entering the cell. d) Centrioles – participate in cell division. Together the processes of catabolism and anabolism constitute the total metabolism of the cell. Metabolism means the sum of the building-up processes (anabolism) and breaking-down processes (catabolism) in a cell. Figure 3.1. The Cell
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Tissue A tissue is a group of similar cells working together to do a specific job. The study of tissues is called histology. A histologist is one who specializes in the study of tissues. More than 200 cell types compose four major tissues of the body: Epithelial Tissue. Epithelial tissue is located all over the body as lining for internal organs, cavities and canals, as secreting portions of exocrine and endocrine glands, at the outer surfaces of the skin covering the body. It is composed of cells arranged in sheets consisting of one or more layers. Muscle Tissue. Voluntary, or skeletal, muscles are groups of muscles attached to bones and they are responsible for the movement of the body in its external environment. Involuntary, or visceral muscles are those muscles responsible for the movement of internal organs and their functioning is said to be involuntary, i.e. not under conscious control. Basic function of muscle tissue is to provide for the contraction and relaxation of all muscle groups. Connective Tissue. This is the tissue that supports and connects other tissues and organs. It is composed of different cell types, e.g. fibroblasts, fat cells, bone and cartilage cells, blood cells. Nerve Tissue. Nerve tissue conducts electrical impulses as it relays information throughout the entire body. Organ These structures can be made of several types of tissue. For example, an organ like the stomach is composed of muscle tissue, nerve tissue, and glandular epithelial tissue. The medical term for internal organs is viscera (singular: viscus). Examples of abdominal viscera (organs located in the abdomen) are the liver, stomach, intestines, pancreas, spleen, and gallbladder. System These can be briefly defined as groups of organs working together to perform complex functions. For example, the mouth, esophagus, stomach, and small and large intestines are organs of the digestive system. Here follows the list of body systems and their major organs: 1. Gastrointestinal, or digestive system - mouth, pharynx, esophagus, stomach, intestines (small and large), liver, gallblader, pancreas. 2. Urinary, or excretory - kidneys, ureters, urinary bladder, urethra. 3. Respiratory – nose, pharynx, larynx, trachea, bronchi, left and right lung lobes, alveoli. 4. Musculoskeletal – muscles, bones, joints, tendons, ligaments. 5. Integumentary – skin, sebaceous and sweat glands, hair, nails. 24
6. Cardiovascular – heart, blood vessels (arteries, veins capillaries), lymphatic vessels and nodes, spleen. 7. Endocrine – endocrine glands (hypophysis, thyroid g., parathyroid g., adrenal, gonads, pancreas – islets of Langerhans, thymus, pineal g.). 8. Nervous – neurons and neuroglial cells (brain, spinal cord, nerves, collections of nerves) 9. Reproductive a) Female: ovaries, fallopian tubes, uterus, vagina, mammary g. b) Male: testes and associated tubes, urethra, penis, prostate g. 10. Special senses – the eye and the ear. Organism Organism is defined as the highest level of organization i.e. as a complete living entity capable of independent existence. All complex organisms, including humans, are made up of several body systems that work together to sustain life. 2. Body cavities A body cavity is a space within the body which contains internal organs (viscera). The names of the body cavities and important organs contained within them are listed below. Cavity 1. Cranial 2. Thoracic
3. Abdominal
Organs Brain Lungs, heart, esophagus, trachea, thymus gland, aorta The thoracic cavity can be divided into two smaller cavities: a) The pleural cavity - the areas surrounding the lungs. Each pleural cavity is lined with a double-folded membrane called pleura; visceral pleura is closest to the lungs and parietal pleura is closest to the outer wall of the cavity. b) The mediastinum- the area between the lungs. It contains the heart, aorta, trachea, esophagus, and thymus gland. Stomach, small and large intestines, spleen, liver, gallbladder, pancreas. The peritoneum is the double-folded membrane surrounding the abdominal cavity. The kidneys are two bean-shaped organs situated at the back (retroperitoneal area) of the abdominal cavity on either side of the backbone.
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4. Pelvic 5. Spinal
Urinary bladder, urethra, ureters; uterus and vagina in the female. Spinal cord and spinal nerve roots.
The cranial and spinal cavities are considered dorsal body cavities because of their location on the back portion of the body. The thoracic, abdominal, and pelvic cavities are considered ventral body cavities because they are on the front, or belly side, of the body. The thoracic and abdominal cavities are separated by a muscular partition called the diaphragm. The abdominal and pelvic cavities are not separated by a partition and together they are usually referred to as the abdominopelvic cavity. 3. Anatomical divisions of the abdomen – 9 regions and 4 quadrants These divisions are used in anatomy texts to describe the regions in which organs and structures are found. The following are 9 abdominal regions 1. Hypochondriac regions (two upper lateral regions beneath the ribs) 2. Epigastric region (region of the stomach) 3. Lumbar regions (two middle lateral regions) 4. Umbilical region (region of the navel or umbilicus) 5. Inguinal (iliac) regions (two lower lateral regions) 6. Hypogastric region (lower middle region, below the umbilicus) Figure 3.2. Anatomical divisions of the abdomen – 9 regions & 4 quadrants
Right upper quadrant
Left upper quadrant
Right lover quadrant
Left lover quadrant
Right hypochondriac region
Epigastric region
Left hypochondriac region
Right lumbar region
Umbilical region
Left lumbar region
Right inguinal Hypogastric Left inguinal (iliac) region region (iliac) region
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4. Anatomical division of the back (spinal column) The back is divided into segments that correspond to regions of the spinal, or vertebral,column. The spine is composed of a series of bones extending from the neck to the tail bone (coccyx). Each bone is called a vertebra (plural: vertebrae). Division of the back 1. Cervical
Abbreviation C
2. Thoracic
T or D (D = dorsal)
3. Lumbar
L
4. Sacral
S
5. Coccygeal
Cg
Location Neck region. There are 7 cervical vertebrae (Cl-C7). Chest region. There are 12 thoracic vertebrae (T1-T12). Each bone is joined to a rib. Loin or flank region (between the ribs and the hip bone). There are 5 lumbar vertebrae (L1-L5). Five bones (s1-S5) are fused to form one bone – the sacrum. The coccyx (tailbone) is a small bone composed of 4 fused pieces.
An important distinction should be made between the spinal column (the vertebrae) and the spinal cord (nerves running through the column). The former is bone tissue, while the latter is composed of nerve tissue. The spaces between the vertebrae (intervertebral spaces) are identified according to the two vertebrae between which they lie; e. g. LS-Sl lies between the 5th lumbar and the 1st sacral vertebrae. An intervertebral cartilaginous (made of cartilage) disk (or disc) lies between each vertebra and acts as a pad to absorb shock and make movement easier.
Figure 3.3. Anatomical divisions of the back (spinal column) 27
5. Positional and directional terms afferent
Conducting toward a structure. Example: veins are called afferent vessels since they take blood toward the heart.
efferent
Conducting away from a structure. Example: arteries are efferent blood vessels since they take blood away from the heart.
anterior (ventral)
Front of the body. Example: the abdomen is located anterior to the spinal cord. Ventral and anterior mean the same position in the human.
posterior (dorsal)
Back of the body. Example: the posterior lobes of the brain are in the back of the head and are called the occipital lobes. Dorsal means the same position as posterior.
central
Pertaining to the centre. Example: the heart is located in the central portion of the thoracic cavity – between the lungs and the mediastinum.
deep
Away from the surface. Example: the lesion penetrated deep into the abdomen, away from the surface of the body.
superficial
Near the surface. Example: the wound was a superficial one, just penetrating the skin.
distal
Away from the beginning of a structure; away from the centre. Example: at its distal end, the thigh bone (femur) joins with the knee cap (patella).
proximal
Pertaining to the beginning of a structure. Example: the proximal proximal end of the femur joins with the pelvic (hip) bone.
inferior (caudal)
Away from the head; situated below another structure. Example: the feet are the caudal parts of the human body.
superior (cephalic)
Pertaining to the head; situated above another structure. Example: in a cephalic presentation of the fetus, the head comes through the birth canal first.
lateral
Pertaining to the side. Example: the little toes are lateral to the big toes.
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medial
Pertaining to the middle or nearer the median plane of the body. Example: in the anatomical position the palms of the hands are facing outward and the fifth finger lies medial to the other fingers.
supine
Lying on the back – facing upward.
prone
Lying on the belly (abdomen) – facing downward.
6. Planes of body A plane is an imaginary flat surface that anatomists use to identify different sections of the body. The following are the most commonly used body planes and their anatomical divisions. 1. frontal – coronal – vertical plane dividing the body or structure into anterior and posterior portions 2. midsagittal – median – lengthwise vertical plane dividing the body or structure into right and left portions or into right and left halves. 3. transverse - horizontal - Plane running across the body parallel to the ground (horizontal). It divides the body or structure into upper and lower portions. Figure 3.4 Planes of the Body
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7. Medical word elements Combining form acr/o adip/o chondr/o cyt/o eti/o hist/o idi/o kary/o morph/o
Meaning extremity fat cartilage cell cause tissue unknown nucleus shape, form
nucle/o path/o somat/o son/o
nucleus disease body sound
viscer/o
int. organ
Terminology acromegaly = enlargement of extremities adipose = pertaining to fat (tissue) chondritis = inflammation of cartilage cytology = the study of cells etiology = study of the cause of diseases histology = the study of tissues idiopathic = of unknown cause karyolysis = destruction of the nucleus morphology = the study of shape, form, or structure nuclear = pertaining to the nucleus pathology = the study of diseases somatic = pertaining to the body sonography = the process of recording sound visceral = pertaining to internal organs
8. Diagnostic and Therapeutic Procedures and Related Terms Terms adhesion dehiscence febrile homeostasis inflammation morbid sepsis suppurative Procedures anastomosis biopsy cauterize endoscopy resection 30
Definition fibrous band holding together tissues that are normally separated bursting open of a wound pertaining to a fever; feverish relative balance of internal environment of the body body defence against injury, infection etc. pertaining to a diseases (morbus = lat. disease) the presence of pathological microorganisms or their toxins in the bloodstream associated with the production of pus (purulent)
surgical joining of two ducts, vessels, bowel segments, etc. removal of living tissue for microscopic examination destroy tissue by electricity, freezing, corrosive chemicals or heat visual examination of a hollow organ or body cavity with a specialized instrument called an endoscope partial excision of a bone, organ or other structure
EXERCISES 1. Answer the following questions: 1.1. Where is the mediastinum? ..........................................................................................................................................................................
What organs are contained within the mediastinum? ..........................................................................................................................................................................
1.2. What does sacroiliac mean? ................................................................................................. 1.3. Where are the inguinal regions of the abdomen? .................................................... 1.4. What is adipose tissue? ........................................................................................................... 1.5. What is epithelial tissue? ........................................................................................................ 1.6. What is the endoplasmic reticulum? ............................................................................... 1.7. What are ribosomes? ................................................................................................................ 1.8. Describe the location and function of chromosomes. ..........................................................................................................................................................................
2. Give the opposites of the following terms: 2.1. deep..............................................................
2.5. posterior.....................................................
2.2. afferent.......................................................
2.6. caudal..........................................................
2.3. proximal.....................................................
2.7. supine..........................................................
2.4. ventral......................................................... 3. Identify the following planes: 3.1. Which plane divides the body into anterior and posterior portions? ..........................................................................................................................................................................
3.2. Which plane divides the body into upper and lower portions? ..........................................................................................................................................................................
3.3. Which plane divides the body into left and right halves? ..........................................................................................................................................................................
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4. Complete the following sentences using medical terms expressing position or direction: 4.1. The left lung lies ........................................................... to the heart. 4.2. The upper arm (humerus) joins at its ................................. end with the elbow. 4.3. The humerus joins at its............................................... end with the shoulder. 4.4. The pelvic cavity is ................................................................ to the abdominal cavity. 4.5. The head is .................................................................... to the feet. 4.6. The chest is bordered on the ..................................................... region by vertebral column and associated muscles. 4.7. The fingers are found at the ............................................................. end of the hand. 4.8. A tube within the liver is called the ..................................................... hepatic duet. 4.9. In the abdominal position the thumb is on the ................................................ side of the hand. 4.10. The fluid between cells is called ...................................................... cellular fluid. 4.11. The stomach is situated ........................................................................... to the heart. 5. From the following list of terms, pick the one, which fits the definition best: ribosomes mediastinum mitochondria diaphragm
pleural cavity endoplasmic reticulum chromosomes catabolism
anabolism metabolism
Structures in the cytoplasm of the cell which produce energy by chemically burning food in the presence of oxygen. ..........................................................................................................................................................................
Contains the hereditary material (DNA) of the cell. ..........................................................................................................................................................................
Building-up, or synthesizing, process in the cell. ..........................................................................................................................................................................
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Contains the heart and other structures between the lungs in the thoracic cavity. ..........................................................................................................................................................................
Process in the cell whereby food is burned to release energy. ..........................................................................................................................................................................
Structures in cytoplasm of cell which are the site of protein synthesis. ..........................................................................................................................................................................
Surrounds the lungs in the thoracic cavity. ..........................................................................................................................................................................
Network of canals in the cytoplasm of a cell. ..........................................................................................................................................................................
Total of building-up and breaking-down processes in the cell. ..........................................................................................................................................................................
Muscular wall dividing the abdominal and thoracic cavities. ..........................................................................................................................................................................
6. Translate the following text into English: the Cell Proučavanje bolesnih stanja živih orrganizama temelji se na istraživanju promjene oblika pojedinih njihovih sastavnih dijelova. Razvoj različitih bioloških znanosti međusobno je usko povezan, pa je tako otkriće mikroskopa (17. stoljeće) omogućilo spoznaju da su svi živi organizmi građeni od mikroskopski vidljivih sastavnih dijelova, koji su nazvani stanicama (R. Hooke, 1635-1703). U drugoj polovici 19. stoljeća, uz daljnji razvoj fizike i kemije, proučavanje stanica postaje predmet medicinskog istraživanja i tako nastaje znanost koja se naziva citologija (gr. xutos /kitos/ = šupljina; grč. logos = govor, raspravljanje, izučavanje). R. Virchow (1821-1902), njemački liječnik i istraživač, osnivač je tzv. celularne patologije (lat. cellula = stanica), koja smatra da patološke promjene stanica dovode do pojave bolesti tkiva i organa, odnosno da su patološka stanja 33
organizma posljedica patoloških promjena na stanicama. Proučavanje izgleda stanice može, prema tome, poslužiti u svrhu postavljanja dijagnoze; radi toga se citodijagnostika primjenjuje u različitim medicinskim područjima. Za promatranje stanica najčešće služi običan svjetlosni mikroskop. Osim njega upotrebljava se i mikroskop s faznim kontrastom te fluorescentni i elektronički mikroskop. Napredak kemije doveo je do razvitka posebne grane citologije, citokemije, koja omogućuje prikazivanje pojedinih kemijskih elemenata. Ova grana citologije omogućuje prikazivanje pojedinih kemijskih elemenata ili reakcija unutar stanica. Za promatranje stanica može poslužiti materijal izlučen iz pojedinih dijelova tijela, u kojem se nalaze stanice odljuštene s površine različitih organa – to je tzv. citodijagnostika. .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 4
SKIN - INTEGUMENTARY SYSTEM Skin is the outer covering of the body. Skin and its accessory organs comprising hair, nails and glands, are known as the integumentary system of the body. The word “integument” stems from the Latin word which means a covering. Skin is the largest organ of the body and it performs a number of vital functions. It is a complex system of specialized tissues. It contains glands which secrete several types of fluids, nerves which carry impulses, and blood vessels which aid in the regulation of body temperature. The main functions of the skin are as follows: −− it serves as a protective barrier against microorganisms due to the acidity of its secretions; −− it helps shield the delicate, sensitive tissues underneath from mechanical and other injuries; −− it acts as an insulator against heat and cold, and helps eliminate body wastes in the form of perspiration; −− it guards against excessive exposure to the ultraviolet rays of the sun by producing a protective pigmentation, and it helps produce the body’ s supply of vitamin D; −− its sense receptors enable the body to feel pain, cold, heat, touch and pressure. Structure of the Skin The skin consists of two main layers and a subcutaneous fat layer: (1) Epidermis - the outermost layer of the skin which is a thin cellular membrane made up of several layers of different kinds of cells, is composed of squamous epithelium. The cells of squamous epithelium are flat and scalelike and are arranged in several layers (strata), therefore called stratified squamous epithelium. The deepest layer is called basal layer. The cells in this layer are constantly growing and multiplying and give rise to all other cells in the epidermis. As the basal layer cells divide they are pushed upward toward 35
the most superficial layer of the epidermis, called the stratum corneum. On this way they become flatten, lose their nuclei and die, becoming filled with a protein called keratin. Then these cells are called horny cells, because of the hard protein material they are composed of. Finally, within 3 to 4 weeks after beginning as a basal cell in the bottom part of the epidermis, the horny, keratinized cell is sloughed off or shedded from the surface of the skin. In this way the epidermis is constantly renewing itself, cells dying at the same rate at which new cells are born. The cells of the protective, horny layer are nonliving and require no supply of blood for nourishment. As long as the horny outer layer remains intact, microorganisms cannot enter. The basal layer of the epidermis contains special cells called melanocytes which form and contain a black pigment melanin. The amount of melanin accounts for the colour differences among the races. Also, the presence of melanin in the epidermis is vital for the protection against the harmful effects of ultraviolet radiation which can manifest themselves as skin cancer. (2) Corium, or dermis, is the thicker part of the skin underneath the epidermis and is made up of connective tissue that contains blood vessels and nerves. The corium projects into the epidermis in ridges called papillae of the corium. Lymph vessels and the accessory organs of the skin, which are hair follicles, sebaceous glands and sweat glands are also located in the dermis. There are several types of connective tissue cells in the dermis; fibroblastscells that are active in repair of injury, histiocytes (macrophages) - phagocytic cells that protect the body by devouring foreign substances, and mast cells specialized cells containing histamine and heparin. Collagen, a fibrous protein material, found also in bone, cartilage, tendons and ligaments, is another important structural component of the dermis. It is tough and resistant, yet flexible. Collagen fibres support and protect the blood and nerve networks that pass through the corium. (3) Subcutaneous Layer - beneath the corium is a layer of subcutaneous tissue, which is another connective tissue layer specialized for the formation of fat. Lipocytes (fat cells) prevail in the subcutaneous layer and they manufacture and store large amounts of fat. This tissue helps insulate the body against heat and cold and cushions it against shock.
36
Figure 4.1. The three layers of the skin and their structure Touch receptor Hair shaft
Sweat gland pore
Stratum corneum
Epidermis
Basal layer
Sebaceous (oli) gland
Dermis
Hair follicle Subcutaneous tissue
Adipose tissue
Papilla
Arteriole Venule
Nerve
Sudoriferous (sweat) gland
Accessory Organs of the Skin Hair Hair is distributed over the entire body, except the bottom of the feet (soles) and palms of the hands. The roots of the hair lie in follicles, or pockets of epidermal cells situated in the corium. At the bottom of the follicle is a loop of capillaries enclosed in a covering called the papilla. The cluster of epithelial cells lying over the papilla reproduces and is responsible for the eventual formation of the hair shaft – a visible part of the hair. As long as these cells remain alive, hair will regenerate even though it is cut or plucked or otherwise removed. Hair is kept soft and flexible by sebaceous glands which secrete varying amounts of oily sebum into the upper part of hair follicle located near the surface of the skin. The growth of hair is similar to the growth of the epidermal layer of the skin: deep-lying cells in the hair root produce horny cells which move upward through the hair follicles which hold the hair fibres. Melanocytes are located at the root of the hair follicle, and they support the melanin pigment for the horny cells of the hair fibre. Hair turns gray when the melanocytes stop producing melanin.
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Nails Nails are hard keratin plates covering the dorsal surface of the most distal phalanges of each finger and toe. They are composed of horny cells that are cemented together tightly and can extend (grow) indefinitely unless cut or broken. The nails grow in much the same way as the hair. The nail bed, like the hair root, is situated in the corium. The pink colour of the nails is due to their translucent quality which allows the underlying vascular tissue to show through. The semilunar (half-moon) white region at the base of the nails is called lunula. It has a whitish appearance because the vascular tissue underneath does not show through. The narrow band of epidermis that extends from nail wall on to the surface is called the cuticle or eponychium (onych means nail). The average growth rate for fingernails is around l mm per week and it is somewhat slower for toenails. The major function of the nails is to protect the tips of the fingers and toes from bruises and other kinds of injuries. Glands 1. Sebaceous Glands The sebaceous glands produce on oily secretion called the sebum and are located in the corium layer of the skin. These glands are filled with cells, the centres of which are saturated with fatty droplets. As these cells disintegrate they yield the sebum. They are closely associated with hair follicles and their ducts open into the hair follicle through which the sebum is released. The acidic nature of sebum helps destroy harmful organisms on the surface of the skin and, thus, prevents infection. Sebum also lubricates the skin and minimizes water loss. Sebaceous glands are present over the entire body except the soles of the feet and palms of the hands. They are influenced by sex hormones, which cause them to hypertrophy at puberty and atrophy in old age. 2. Sweat Glands Sweat glands are also called sudoriferous glands (sudor - sweat). They are located deep in the corium and are found on almost all body surfaces. They collect fluid containing water, salt and waste products from the blood and carry it away in canals that end in pores on the skin surface, where it is deposited as sweat. The milk producing mammary gland is another type of modified sweat gland; it secretes milk only after the birth of a child.
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Sweat, or perspiration, helps regulate body temperature as well, because cooling of the skin occurs when sweat evaporates. The odour produced when sweat accumulates on the skin is due to the action of bacteria on sweat. Key Terms • • • • • • • • • • • • • • • • • • • • •
albino – a person with deficient pigment in skin, hair and eyes. basal layer – the deepest layer of the epidermis. collagen – structural protein found in the skin and connective tissue. corium – the middle layer of the skin. cuticle – band of epidermis at the base and side of the nail plate. dermis – the corium. epidermis – the outermost layer of the skin. epithelium – the layer of skin cells forming the outer and inner surfaces of the body. hair follicle – the sac or tube within which each hair grows. horny cell – a keratin-filled cell in the epidermis. keratin – hard protein material found in the epidermis, hair, and nails; commonly found in the horns of animals. lesion – pathological alteration of tissue. lipocyte – a fact cell. lunula – the half-moon-shaped white area at the base of the nail (crescent). melanin – black pigment formed by melanocytes in the epidermis. sebum – an oily substance produced by sebaceous glands. squamous epithelium – flat, scale-like cells composing the epidermis. stratum (pl: strata); stratified – a layer of cells; arranged in layers. stratum corneum – horny layer; outermost layer of the epidermis. subcutaneous tissue – innermost layer of the skin, containing fat tissue. sudor – sweat, a product of sweat (sudoriferous) glands.
Combining Forms adip/o lip/o steat/o
Meaning fat
Terminology adiposis lipocele steatoma
cutane/ dermat/o derm/o
skin
subcutaneous dermatology hypodermic
hidr/o sudor/o
sweat
hidroadenitis sudoresis (diaphoresis)
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Combining Forms ichthy/o xer/o
Meaning
kerat/o
horny tissue
keratosis
melan/o
black
melanoma
myc/o
fungus
dermatomycosis
onych/o ungu/o
nail
onychomycosis subungual
phyt/o
plant
dermatophytosis
pil/o trich/o
hair
pilonidal trichopathy
scler/o
hardening
scleroderma
seb/o
sebum
seborrhea
squam/o
scale
squamous
xanth/o
yellow
xanthemia
xen/o
foreign
xenograft
dry, scaly
Terminology ichthyosis xeroderma
Disorders of the Skin 1. Cutaneous Lesions A lesion is a pathological or traumatic alteration of tissue. The following terms describe the most common skin lesions; macule papule wheal
vesicle
pustule
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nonpalpable, discoloured (especially reddened) flat spots or patches (examples: measles, rash, flat moles, freckles.) small, solid, circumscribed raised areas of skin (examples: warts, pimples) vascular eruption of the skin often characterized by smooth, slightly elevated, edematous area that is redder or paler than the surrounding skin usually accompanied by itching (examples: allergic reactions to insect bites, hives) circumscribed collection containing serous fluid (blisters) (examples: burns, dermatitis, scabies, smallpox) bullae (singular: bulla) are large blisters. circumscribed collection of pus (abscess of the skin); (examples: vesicles that contain pus; the term vesicopustular is common).
polyp
ulcer
cyst fissure
a mushroom-like growth extending on a stalk from the surface of a mucous membrane; polyps are most frequently found in the uterus, nose, mouth, urinary bladder, and tubes of the digestive tract. an open sore or erosion of the skin or mucous membrane; ulcers usually involve loss of tissue substance and formation of pus (abscess). a closed sac or pouch containing fluid or semisolid material. (examples: pilonidal cyst, follicular cyst). a groove or cracklike sore resembling ulcer-like sores can occur in the anal region (naturally occurring fissures are found in the brain, the spinal cord and liver). Figure 4.2. Lesions of the Skin
2. Symptoms and Pathological Skin Conditions acne
a chronic inflammatory disease of the sebaceous glands and hair follicles of the skin characterized by papular and pustular eruptions of the skin.
acne vulgaris (ordinary)
a common variety of acne. It is characterized by the formation of blackheads (comedones, singular: comedo); papules, nodules and pustules usually appear on the face, neck and upper part of the trunk.
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albinism
absence of pigment in the skin, hair and eyes.
alopecia
natural or abnormal baldness or deficiency of hair, partial or complete, localized or generalized.
athlete ‘s foot
fungal infection of the foot; also called tinea pedis.
basal cell carcinoma malignant tumour of the basal cell layer of the epidermis. This is the most frequent type of skin cancer. It is a slow- growing tumour of the basal layer of the epidermis and usually occurs on the upper half of the face, near the nose, and is nonmetastasizing. Bowen disease
intraepidermal carcinoma (squamous cell) characterized by red-brown scaly or crusted lesions that resemble a patch of psoriasis or dermatitis (precancerous dermatosis).
burns
thermal injuries to the outer surfaces of the body. They are usually classified into three types: first degree burns (no blisters; superficial lesions mainly in the epidermis; hyperesthesia and erythema); second degree burns (damage to the epidermis and corium, blisters, erythema, hyperesthesia); and third degree burns (both the epidermis and corium are destroyed and subcutaneous layer is damaged; scar formation results; if more than two thirds of the skin is destroyed death is the most probable outcome).
cellulitis
a spreading infection, especially of the subcutaneous tissue.
chloasma
pigmentary skin discolorations, usually those occurring in yellowish-brown patches or spots.
cicatrix
scar left by a healed wound; keloids are abnormally raised, thickened scars that form in the skin after trauma or surgical incision.
comedo
typical small skin lesion of acne vulgaris caused by accumulation of keratin, bacteria, and dried sebum plugging an excretory duct of the skin. (pl. comedones)
decubitus ulcer (bedsore)
decubitus means “lying down”; ulcers occur over bony areas that have been subjected to pressure against a hard external object such as a bed.
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dermatitis
inflammation of the skin.
discoid lupus
benign dermatitis confined to the skin, marked by a scaly rash, usually in a butterfly pattern over the nose and cheeks, sometimes extending to the scalp and causing baldness.
ecchymosis
a bruise or purple spot on the skin caused by escape of blood from injured vessels.
eczema
a chronic moist dermatitis caused by a number of external and internal factors acting singly or in combination; these areas may be dry or have a watery discharge; it is a common allergic reaction in children, but can also occur in adults; often, it is accompanied by pruritus.
eschar
damaged tissue following a severe burn.
exanthematous viral eruption (exanthema) of the skin due to a viral disease infection; examples are: rubeola-measles; rubella German measles; and varicella-chickenpox. gangrene
death of tissue associated with loss of blood supply. In this condition, ischemia resulting from injury, inflammation, frostbite, diseases such as diabetes, or arteriosclerosis can lead to necrosis of tissue, followed by bacterial invasion and putrefaction.
hemangioma
an area in which the blood vessels form an abnormally excessive network in the skin. They usually occur as birthmarks and some disappear with age; others can be treated surgically, with medications or with irradiation.
hirsutism
condition characterized by the excessive growth of hair in unusual places, especially in women.
impetigo
bacterial inflammatory skin disease marked by isolated vesicles, pustules and crusted-over lesions.
keratosis
thickened areas of the epidermis; some keratoses are pigmented and due to excessive exposure to sunlight (actinic keratosis); seborrheic keratoses are called senile warts and occur in older patients.
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lentigo
leukoplakia
pediculosis systemic lupus erythematosus (SLE)
small brown macules (esp. on the face and arms) caused by sun exposure; it is a benign lesion requiring no treatment. white, thickened patches on mucous membrane tissue of the tongue or cheek; this may be a precancerous lesion; it is common in smokers, and may be caused by chronic inflammation. infestation with lice, transmitted by personal contact or common use of brushes, combs, or headgear. a chronic inflammatory disease of the joints and collagen of the skin and other organs of the body; it is commonly marked by erythematous rash on the face and other areas exposed to sunlight; it involves the vascular and connective tissues of many organs, resulting in a multiplicity of local and systemic manifestations; etiology is unknown, but incidence is highest in females between puberty and menopause; it is an autoimmune condition and often fatal.
melanoderma
abnormal brown or black pigmentation of the skin.
melanoma, malignant
cancerous tumour composed of melanocytes; the tumours often metastasize to the lungs, liver, and brain after arising in areas of the body where pigmented cells occur.
nevus; nevi
congenital proliferation of blood vessels or pigmented cells on the skin surface (moles and hemangiomas are examples).
onychia
inflammation of the nail bed, frequently with loss of the nail.
pemphigus
blistering (bullous) eruptions affecting the skin and mucous membranes of unknown etiology; the disease may be acute or chronic and affects adults; the lesions appear asymptomatically and leave pigmented spots.
petechiae
small, purplish, hemorrhagic spots on the skin; smaller versions of ecchymoses.
pruritus
itching, associated with most forms of dermatitis and other conditions as well.
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psoriasis
a discrete pink or dull red lesion surmounted by characteristic silvery scaling; the condition may begin at any age as flat-topped papules covered with thin, greyish- white scales; under the dry scales are red bleeding points; its etiology is not yet fully explained.
purpura
merging ecchymoses and petechiae over any part of the body.
rash
an outbreak of lesions on the skin.
scabies
a contagious parasitic infection of the skin with intense pruritus caused by scabies mite (itch mite).
scleroderma
a chronic disease of the skin caused by infiltration of fibrous or scar tissue into the skin; scleroderma leads to hardening, pigmentation, and atrophy of the skin and internal organs, such as the kidneys, lungs, and esophagus.
squamous cell carcinoma
malignant tumour of the squamous epithelial cells of the epidermis; the tumour may grow in places other than the skin and can metastasize to lymph nodes.
tinea
any fungal skin disease, especially ringworm, occurring in various parts of the body.
urticaria
hives; this condition is basically a localized edema (swelling) in association with itching; etiology may be allergy to foods or drugs or psychological stimuli.
vitiligo
loss of pigment in areas of the skin (milk -white patches). The condition is often found in the tropics and the etiology is unknown.
wart (verruca)
epidermal growth caused by a virus.
EXERCISES 1. a) The functions of the integumentary system are: .................................................... b) The accessory organs of the skin are: ........................................................................... 2. Complete the following sentences: 2.1. A fat cell is known as a .............................................................................................................
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2.2. The half-moon-shaped white area at the basis of a nail is called the ..........................................................................................................................................................................
2.3. The sebaceous glands are located in the....................................................................... 2.4. Sweat, or ............................................................... helps regulate body temperature. 2.5. Hair is distributed over .......................................... except ................................................. and ............................................................................................... 3. Give the opposite of each term: 3.1. animate ......................................................
3.6. life .................................................................
3.2. material .....................................................
3.7. thin ...............................................................
3.3. organic .......................................................
3.8. upward .......................................................
3.4. visible ..........................................................
3.9. rational ......................................................
3.5. sensitive ....................................................
3.10. hard ...........................................................
4. Match the following terms with their meanings: 4.1. alopecia .....................................................
a) inflammation of the nail bed
4.2. impetigo ....................................................
b) eponychium
4.3. onychia .......................................................
c) baldness
4.4. scabies .......................................................
d) skin infection marked by pustular vesicles
4.5. cuticle .........................................................
e) contagious skin disease transmitted by the itch mite
5. Give the meaning of the following terms: 5.1. acne ..................................................................................................................................................... 5.2. albinism ............................................................................................................................................ 5.3. eczema ............................................................................................................................................... 5.4. epidermis ......................................................................................................................................... 5.5. basal layer ....................................................................................................................................... 5.6. horny cells ....................................................................................................................................... 5.7. mast cells .........................................................................................................................................
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5.8. melanocytes ................................................................................................................................... 5.9. macule ............................................................................................................................................... 5.10. ulcer .................................................................................................................................................. 6. Provide the plural form for the following nouns: 6.1.keratosis ....................................................
6.6. epithelium ................................................
6.2. bacillus ......................................................
6.7. stratum ......................................................
6.3. louse ............................................................
6.8. fungus ........................................................
6.4. nevus ...........................................................
6.9. squama ......................................................
6.5. petechia .....................................................
6.10. papilla ......................................................
7. Provide the noun form for the following adjectives: 7.1. allergic .......................................................
7.6. effective .....................................................
7.2. epithelial ...................................................
7.7. present .......................................................
7.3. bullous .......................................................
7.8. dermal ........................................................
7.4. scaly .............................................................
7.9. distant ........................................................
7.5. ulcerative ..................................................
7.10. superficial .............................................
8. Give appropriate medical word for the following skin conditions: 8.1. bullous eruptions on the skin .............................................................................................. 8.2. bedsore .............................................................................................................................................. 8.3. necrosis of skin tissue resulting from ischemia ....................................................... 8.4. cancerous tumour composed of melanocytes ........................................................... 8.5. fungal skin infection .................................................................................................................. 8.6. abnormal brown or black pigmentation of the skin ............................................... 8.7. absence of pigment in the skin ........................................................................................... 8.8. fungus infection of the foot .................................................................................................... 8.9. excessive growth of hair .......................................................................................................... 8.10. severe itching of the skin .....................................................................................................
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9. Translate into Croatian: Disease Descriptions 1. Candidiasis (Candida is a yeastlike fungus): This fungus is normally found on mucous membranes, skin, and vaginal mucosa. Under certain circumstances (excessive warmth, administration of birth control pills, antibiotics and corticosteroids, debilitated states, infancy) it can change to a pathogen and cause localized or generalized mucocutaneous disease. Examples are paronychial lesions, lesions in areas of the body where rubbing opposed surfaces is common (groin, perianal, axillary, inframammary, and interdigital), and vulvovaginitis. 2. Cellulitis: This is a common nonsuppurative infection of connective tissue with severe inflammation of the dermal and subcutaneous layers of the skin. Cellulitis appears on an extremity as a reddish brown area of edematous skin. A surgical wound, puncture, skin ulcer, or patch of dermatitis is the usual means of entry for bacteria (most cases are caused by streptococci). Therapy entails rest, elevation, hot wet packs, and penicillin. Any cellulitis on the face should be given special attention because the infection may extend directly to the brain. (From: D. E. Chabner: The Language of Medicine) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 5
MUSCULOSKELETAL SYSTEM 1. Introduction The musculoskeletal system includes the bones, muscles and joints. Each has several important functions in the body. Bones, by providing the framework around which the body is constructed, protect and support our internal organs. Also, by serving as a point of attachment for muscles, bones assist in body movements. The inner core of bones is composed of hematopoietic tissue (red bone marrow manufactures blood cells), while other parts are storage areas for minerals necessary for growth, such as calcium and phosphorus. Joints are the places where bones come together. Several different types of joints are found within the body. The type of joint found in any specific location is determined by the need for greater or lesser flexibility of movement. Muscles, whether attached to bones or to internal organs and blood vessels, are responsible for movement. Internal movement involves the contraction and relaxation of muscles that are a part of viscera, and external movement is accomplished by the contraction and relaxation of muscles that are attached to the bones. 2. Formation and structure of bones Bones are organs chiefly composed of connective tissue called osseous (bony) tissue plus a rich supply of blood vessels and nerves. Osseous tissue is a dense connective tissue that consists of osteocytes (bone cells) surrounded by a hard, intercellular substance filled with calcium salts. During fetal development, the bones of the fetus are composed of cartilage tissue, which resembles osseous tissue but is more flexible and less dense because of a lack of calcium salts in its intercellular spaces. As the embryo develops, the process of depositing calcium salts in the soft, cartilaginous bones occurs, and continues throughout the life of the individual after birth. 49
The gradual replacement of cartilage and its intercellular substance by immature bone cells and calcium deposits is called ossification (bone formation). Figure 5.1. Skeletal System
ACROMION
CLAVICLE SCAPULA STERNUM RIBS
XIPHOID PROCESS COSTAL CARTILAGE
HUMERUS
ILIUM
ULNA
ISCHIUM PUBIS
SACRUM RADIUS CARPALS METACARPLAS PHALANGES FEMUR
PATELLA TIBIA
FIBULA TARSALS METATARSALS PHALANGES
Osteoblasts are the immature osteocytes that produce the bony tissue that replaces cartilage during ossification. Osteoclasts (-clast means to break) are large cells that function to reabsorb, or digest, bony tissue. Osteoclasts (also called bone phagocytes) digest dead bone tissue from the inner sides of bones and thus enlarge the inner bone cavity so that the bone does not become overly thick and heavy. When a bone breaks, osteoblasts lay down the mineral bone matter (calcium salts) and osteoclasts remove excess bone debris (smooth out the bone). The formation of bone is dependent to a great extent on a proper supply of calcium and phosphorus to the bone tissue. These minerals must be taken into the body along with a sufficient amount of vitamin D. Vitamin 50
D helps the passage of calcium through the lining of the small intestine and into the bloodstream. Once calcium and phosphorus are in the bones, osteoblastic activity produces an enzyme that causes the formation of a calciumphosphate compound giving bone its characteristic hard quality. Not only are calcium and phosphorus part of the hard structure of bone tissue, but calcium is also stored in bones and small quantities are present in the blood. If the proper amount of calcium is lacking in the blood, nerve fibers are unable to transmit impulses effectively to muscles; heart muscle becomes weak and muscles attached to bones undergo spasms. The necessary level of calcium in the blood is maintained by the parathyroid gland, which secretes a hormone to release calcium from bone storage. Excess of the hormone (caused by tumour or other pathological process) will raise blood calcium at the expense of the bones, which become weakened by the loss of calcium. 3. Types of bones −− −− −− −−
Bones all over the body are of several different types. Long bones are found in the thigh, lower leg, and upper and lower arm. These bones are very strong, are broad at the ends where they join with other bones, and have large surface areas for muscle attachment. Short bones are found in the wrist and ankle and have small, irregular shapes. Flat bones are found covering soft body parts. These are the shoulder bone, ribs, and pelvic bones. Sesamoid bones are small, rounded bones resembling a grain of sesame in shape. They are found near joints; the knee cap is the largest example of this type of bone.
The shaft, or middle region, of a long bone is called the diaphysis. Each end of a long bone is called an epiphysis. The epiphyseal line or plate represents an area of cartilage tissue which is constantly being replaced by new bony tissue as the bone grows. Cartilage cells at the edges of the epiphyseal plate form new bone and this is responsible for the lengthening of bones during childhood and adolescence. The plate calcifies and disappears when the bone has achieved its full growth. The periosteum is a strong, fibrous, vascular, membrane that covers the surface of a long bone, except at the ends of the epiphyses. Bones other than long bones are completely covered by the periosteum. Beneath the periosteum is the layer of osteoblasts which deposit calcium-phosphorus compounds in the bony tissue. The ends of long bones are covered by a thin layer of cartilage called articular cartilage. It cushions the bones at the place they meet with other bones (joints). 51
Figure 5.2. Structure of a long bone EPIPHYSIS
SHAFT DIAPHYSIS (CORPUS)
EPIPHYSIS
Compact (cortical) bone is a layer of hard, dense tissue that lies under the periosteum in all bones and chiefly around the diaphysis of long bones. Within the compact bone is a system of small canals containing blood vessels that bring oxygen and nutrients to the bone and remove waste products such as carbon dioxide. These channels are called haversian canals. Compact bone is tunnelled out in the shaft of the long bones by a central medullary cavity which contains yellow bone marrow. Yellow bone marrow is chiefly composed of fat cells. Cancellous bone, sometimes called spongy bone, is much more porous and less dense than compact bone. The mineral matter in it is laid down in a series of separated bony fibres called a spongy latticework or trabeculae. It is found largely in the epiphyses of long bones and in the middle portion of most other bones of the body as well. Spaces in cancellous bone contain red bone marrow. This marrow, as opposed to a yellow marrow which is fatty tissue, is richly supplied with blood and consists of immature and mature blood cells in various stages of development. In an adult, the ribs, pelvic bone, sternum (breastbone) and vertebrae, as well as the epiphyses of long bones, contain red bone marrow within cancellous tissue. The red marrow in the long bones is plentiful in young children, but decreases through the years and is replaced by yellow marrow.
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4. Processes and Depressions in Bones Bone processes are enlarged tissues which normally extend out from bones to serve as attachments for muscles and tendons. The shapes of some of the common bony processes are: 1. bone head - rounded end of a bone separated from the body of the bone by a neck. 2. tubercle - small, rounded process for attachment of tendons or muscles. 3. trochanter - large process on the femur for attachment of muscles. 4. tuberosity - large, rounded process for attachment of muscles or tendons. 5. condyle - rounded, knuckle-like process at the joint. Bone depressions are the openings or hollow regions in a bone which help to join one bone to another and serve as passageways for blood vessels and nerves. The names of some common depressions in bone are: 1. fossa (pl. fossae) - depression or cavity in or on a bone. 2. foramen (pl. foramina) - opening for blood vessels and nerves. 3. fissure - a narrow, deep, slitlike opening. 4. sulcus (pl. sulci) - a groove or furrow. 5. sinus - cavity within a bone. 5. Cranial Bones The bones of the skull, or cranium, protect the brain and its related structures, such as the sense organs. Muscles for controlling head movements and chewing motions are attached to the cranial bones. The cranial bones of a newborn child are not completely joined. There are gaps of unossified tissue in the skull at birth. These are called soft spots, or fontanelles (little fountains). The pulse of blood vessels can be felt under the skin in those areas. Here is a list of major cranial bones: 1. frontal bone - forms the forehead and bony sockets that contain the eyes. 2. parietal bone - there are two parietal bones which form the roof and upper part of the sides of the cranium. 3. temporal bone - two temporal bones form the lower sides and base of the cranium. Each bone encloses an ear and contains a fossa for joining with the mandible (lower jaw bone). The mastoid process is a round process of the temporal bone behind the ear. 4. occipital bone - forms the back and base of the skull and joins the parietal and temporal bones, forming a suture (juncture line of cranial bones). The inferior portion of the occipital bones has an opening called the foramen magnum through which the spinal cord passes. 53
5. sphenoid bone - this bat-shaped bone extends behind the eyes and forms part of the base of the skull. Because it joins with the frontal, occipital, and ethmoid bone, it serves as an anchor to hold those skull bones together (sphen/o means wedge.) 6. ethmoid bone - this thin, delicate bone is composed primarily of spongy, cancellous bone. It supports the nasal cavity and forms part of the orbits of the eyes (ethm/o means sieve). 6. Facial Bones All of the facial bones, except one, are joined together by sutures so that they are immovable. The mandible (lower jaw bone) is the only facial bone capable of movement. This ability is necessary for activities such as mastication (chewing) and speaking. The facial bones are: 1. nasal bones - two slender nasal (nas/o = nose) bones support the bridge of the nose. They join with the frontal bone superiorly and form part of the nasal septum. 2. lacrimal bones - two paired lacrimal (lacrim/o = tear) bones are located one at the corner of each eye. These thin, small bones contain fossae for the lacrimal gland (tear gland) and canals for the passage of the lacrimal duct. 3. maxillary bones - two large bones compose the massive upper jaw bones (maxillae). They are joined by a suture in the median plane. If they are not joined together normally before birth, the condition known as cleft palate results. 4. mandibular bone (mandible) - this is the lower jaw bone. Both the maxilla and mandible contain the sockets called alveoli in which the teeth are embedded. The mandible joins the skull at the region of the temporal bone, forming the temporomandibular joint (TMJ) on either side of the skull. 5. zygomatic bones - two bones, one on each side of the face, form the high portion of the cheek. 6. vomer- this thin, single flat bone forms the lower portion of the nasal septum. Sinuses, or air cavities, are located in specific places within the cranial and facial bones to lighten the skull and warm and moisten air as it passes through. 7. Vertebral column and structure of vertebrae The vertebral, or spinal, column is composed of 26 bone segments, called vertebrae, which are arranged in five divisions from the base of the skull to the tail bone (coccyx). 54
The first seven bones of the vertebral column, forming the neck bone, are the cervical (Cl-C7) vertebrae. These vertebrae do not articulate (join) with the ribs. The second set of 12 vertebrae are known as the thoracic (Tl-T12 or Dl-Dl2), or dorsal vertebrae. These vertebrae articulate within the 12 pairs of ribs. The third set of five vertebral bones are the lumbar (Ll-LS) vertebrae. They are the strongest and largest of the backbones. The sacrum is a slightly curved, triangularly shaped bone. At birth it is composed of five separate segments (sacral bones); these gradually become fused in the young child. The coccyx is the tailbone, and it, too, is a fused bone, having been formed from four small coccygeal bones. Although the individual vertebrae in the separate regions of the spinal column are all slightly different in structure, they do have several parts in common. A vertebra is composed of an inner, thick, disk-shaped portion called the vertebral body. Between the body of one vertebra and the bodies of vertebrae lying beneath and above are cartilaginous disks which help to provide flexibility and cushion most shocks to the vertebral column. The vertebral arch is the posterior part of the vertebra, and consists of a spinous process, transverse processes, and laminae. The neural canal is the space between the vertebral body and the vertebral arch through which the spinal cord passes. 8. Bones of the thorax, pelvis, and extremities Bones of the thorax: 1. clavicle:- collar bone; a slender bone, one on each side of the body, connecting the breastbone to each shoulder bone. 2. scapula - shoulder bone; two flat, triangular bones, one on each dorsal side of the thorax. The extension of the scapula which joins both the clavicle to form the joint of the shoulder is called the acromion (acr/o means extremity; om/o means shoulder). 3. sternum - breastbone; a flat bone extending down the midline of the chest. The uppermost part of the stern um articulates on the sides with the clavicle and ribs, while the lower, narrow, portion is attached to the diaphragm and abdominal muscles. The lower portion of the sternum is called the xiphoid process (xiph/o means sword). 4. ribs - there are 12 pairs of ribs. The first seven pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages. Ribs 1-7 are called true ribs. They join with the sternum anteriorly and with the vertebral column in the back. Ribs 8-10 are called false ribs. They join with the vertebral column in the back but join the 7th rib anteriorly, instead of attaching to the sternum. Ribs 11 and 12 are the floating ribs because they are completely free at their anterior extremity. 55
Bones of the arm and hand 1. humerus – upper arm bone; the large head of the humerus is rounded and joins with the scapula and clavicle. 2. ulna – medial lower arm bone; the proximal bony process of the ulna at the elbow is called the olecranon (elbow bone). 3. radius – lateral lower arm bone. 4. carpals – wrist bones; there are two rows of four bones each in the wrist. 5. metacarpals – these are five radiating bones to the fingers. 6. phalanges (singular: phalanx) - finger bones, each finger (except the thumb) has three phalanges; a proximal, middle and distal phalanx. The thumb has only two phalanges. Bones of the pelvis The pelvic girdle, or hip bone, supports the trunk of the body and articulates with the thigh bone and sacrum. The adult pelvic bone is composed of three pairs of fused bones: the ilium, ischium, and pubis. 1. ilium is the uppermost and largest portion. Dorsally, the two parts of the ilium do not meet. Rather, they join the sacrum on either side. The connection between the iliac bones and the sacrum is so firm that they are commonly spoken of as one bone: the sacroiliac. The superior part of the ilium is known as the iliac crest. It is filled with red bone marrow, and serves as an attachment for abdominal wall muscles. 2. ischium is the posterior part of the pelvis. The ischium and the muscles attached to it are what you sit on (Lat. gluteus = buttocks). 3. pubis is the anterior part and contains suture marks where the two pubes join by way of a cartilaginous disk. This area of fusion is called the pubic symphysis. The region within the ring of bone formed by the pelvic girdle is called the pelvic cavity. The rectum, sigmoid colon, bladder, and female reproductive organs lie within the pelvic cavity. Bones of the leg and foot 1. femur- thigh bone; this is the longest bone in the body. At its proximal end it has a rounded head which fits into a depression, or socket, in the hip bone. This socket is called the acetabulum. The acetabulum was named because of its resemblance to a rounded cup the Romans used for vinegar (acetum). 2. patella - kneecap; this is a small, flat bone which lies in front of the articulation between the femur and one of the lower leg bones called the tibia. It is surrounded by protective tendons and held in place by muscle attachments. 56
3. tibia -largest of two lower bones of the leg; the tibia (meaning “flute”) runs under the skin in the front part of the leg. It joins with the femur at the patella, and at its distal end (ankle) forms a swelling which is the bony prominence (medial malleolus) at the inside of the ankle. The tibia is commonly called the shin bone. 4. fibula - smaller of two lower leg bones; this thin bone, well hidden under the leg muscles, joins at its proximal end with the tibia laterally, and joins at its distal end with the tibia and ankle bones to form the bony prominence (lateral malleolus) on the outside of the ankle. 5. tarsals - ankle bones; these are seven short bones which resemble the carpal bones of the wrist but are larger. The calcaneus is the largest of these bones and is also called the heel bone. 6. metatarsals - there are five metatarsal bones- each leads to the phalanges of the toes. 7. phalanges of the toes - there are two phalanges in the big toe and three in each of the other four toes. 9. Joints 1.Types of Joints A joint (articulation) is a place in the body where two or more bones come together. Some joints are immovable, such as the suture joints between the skull bones. Other joints, such as those between the vertebrae, are partially movable. Most joints, however, allow considerable movement. These freely movable joints are called synovial joints. Examples of synovial joints are the ball and socket type (hip joint; the head of the femur fits into the acetabular fossa of the ilium) and hinge type (elbow, knee, and ankle joints). The bones in a synovial joint are separated by a joint capsule composed of fibrous cartilage tissue. Ligaments (fibrous bands, or sheets, of connective tissue) often anchor the bones together around the joint capsule to strengthen it. The surface of the bones at the joint is covered with a smooth cartilage called the articular cartilage. The synovial membrane lies under the joint capsule and lines the synovial cavity between the bones. The synovial fluid contains water and nutrients which nourish and lubricate the joints so that friction on the articular cartilage is minimal. 2. Bursae Bursae are closed sacs of synovial fluid lined with a synovial membrane. They are formed in the spaces between tendons (connective binding bones to bones), and bones. Bursae lubricate these areas where friction would normally 57
develop close to the joint capsule. Some common bursae locations are at the elbow joint (olecranon bursa), knee joint (patellar bursa), and shoulder joint (subacromial bursa). Figure 5.3. a synovial joint
10. Muscles There are three types of muscles in the body. Striated muscles, also called voluntary or skeletal muscles, are the muscle fibres that move all bones, as well as the face and eyes. We have conscious control over the activity of this type of muscle. Striated muscle fibres (cells) have a pattern of dark and light bands, or fibrils, in their cytoplasm. A delicate membrane called a sarcolemma surrounds each skeletal muscle fibre. Fibrous tissue that envelops muscles is called fascia. Smooth muscles, also called involuntary or visceral muscles, are those muscle fibres which move our internal organs such as digestive tract, blood vessels, and secretory ducts leading from glands. We have no conscious control over these muscles. They are called “smooth” because they have no dark and light fibrils in their cytoplasm. While skeletal muscle fibres are arranged in bundles, smooth muscle forms sheets of fibres as it wraps around tubes and vessels. 58
Cardiac muscle is striated in appearance but like smooth muscle in its action. Its movement cannot be consciously controlled. The fibres of cardiac muscle are branching fibres and are found in the heart. Figure 5.4. selected muscles of the body
ORBICULARIS OCULI MASSETER STERNOCLEIDOMASTOID
PectoraLIS MAJOR Triceps brachii Biceps brachii
rectus abdominus
11. Actions of Skeletal Muscles Skeletal (striated) muscles are the muscles that move the bones of our body. When a muscle contracts, one of the bones to which it is joined remains virtually stationary as a result of other muscles that hold it in place. The point of attachment of the muscle to the stationary bone is called the origin (beginning) of that muscle. However, when the muscle contracts, another bone to which it is attached does move. The point of junction of the muscle to the bone that moves is called the insertion of the muscle. 59
There can be more than one origin for a muscle, as is the case with the upper arm muscle (biceps brachii) where one origin is at the upper end of the humerus near the shoulder joint and a second origin is above the scapula. The insertion of the biceps brachii is at the upper end of the radius near the elbow. Near the point of insertion, a muscle narrows and is connected to the bone by way of a tendon. One type of tendon that helps attach muscles to larger bone areas is called an aponeurosis. Muscles can perform a variety of actions. Some of the terms used to describe them are listed below: abduction adduction dorsiflexion extension plantar flexion pronation rotation supination torsion
- movement away from the midline of the body - movement toward the midline of the body - bending foot backward, decrease the angle of the ankle joint - straightening out a limb, increase the angle between two bones - extending the foot downward, as when pointing the toes - facing downward - circular movement around an axis - facing upward - a rotary movement of the trunk; twisting.
Key Terms • • • • • • • • • • • • •
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appendage – any body part attached to a main structure articulation – place of union between two or more bones; a joint bursa – a fluid filled sac near a joint calcium – one of the mineral constituents of bones cancellous – spongy or porous structure cartilage – flexible connective tissue found on joint surfaces and embryonic skeleton cranium – a skull diaphysis – shaft, corpus, or midportion of a long bone disk (disc) – flat, plate-like structure of fibrocartilagenous substance between the vertebrae epiphysis – the end of a long bone fascia – fibrous membrane separating and enveloping muscles hematopoiesis – production and development of blood cells, usually in the bone marrow fissure – narrow, slit-like opening between bones
• fontanelle – soft spot (incomplete bone formation) between the skull bones of an infant • foramen – opening or passage in bones where blood vessel and nerves enter and exit an organ • fossa – shallow cavity in a bone • ligament – connective tissue bands binding bones to other bones, supporting and strengthening the joint • medullary cavity – central hollowed-out area in the shaft of a long bone • ossification – the process of bone formation • osteoblast – bone cell that helps form bone tissue • osteoclast – bone cell that absorbs and removes excess bone tissue • periosteum – membrane surrounding bone • red bone marrow – site of hemopoiesis in cancellous bone • sequestrum – a fragment of necrosed bone • sinus – cavity within a bone • sternum – breastbone • sulcus – groove-like depression • synovial fluid – viscous fluid within the synovial cavity produced by synovial membrane and contained in joint cavities, bursae and tendon sheath • tendon – connective tissue that binds muscles to bones • vertebra – back bone • yellow bone marrow – fatty tissue found in the diaphyses of long bones Combining Forms Meaning
Terminology
ankyl/o
stiff, bent
ankylosis = abnormal condition of stiffness
articul/o arthr/o
joint
articular = pertaining to a joint arthritis = inflammation of a joint
burs/o
bursa
bursitis = inflammation of a bursa
calc/o calci/o
calcium
hypercalcemia = excess calcium (in bloodstream) decalcification = loss of calcium
chondr/o
cartilage
chondroma = tumour of a cartilage
cost/o
rib
costal= pertaining to a rib
dactyl/o
finger, toe
dactylitis = inflammation of fingers or toes
fasci/o
band
fascioplasty = surgical repair of fascia
kyph/o
humpback
kyphosis = a humpback posture (posterior curvature in the thoracic region)
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Combining Forms Meaning
Terminology
leiomy/o
smooth muscle
leiomyoma = tumour of a smooth muscle
lord/o
swayback
lordosis = a swayback posture (anterior curvature in the lumbar region)
muscul/o my/o myos/o
muscle
muscular = pertaining to a muscle myoma = tumour of a muscle myositis = inflammation of a muscle
myel/o
bone marrow, spinal cord
myelopoiesis = formation of bone marrow
orth/o
straight
orthopaedics = specialty for bone diseases
osse/o oste/o
bone
osseous = pertaining to bone osteitis = inflammation of bone
rachi/o
spine
rachitis = inflammation of the spine
rhabd/o
striated
rhabdomyoma = tumour of a striated muscle
scoli/o
crooked, bent
scoliosis = lateral bent of the spine
spondyl/o
vertebra
spondylosis = degeneration of intervertebral disks
syndesm/o
ligament
syndesmoplasty = surgical repair of a ligament
ten/o, tend/o tendin/o
tendon
ten(din)oplasty = surgical repair of a tendon tendinitis = inflammation of a tendon
Disorders of the Musculoskeletal System Pathological Conditions of the Skeletal System and Fractures ankylosing spondylitis chronic, progressive arthritis with stiffening of joints, primarily of the spine arthritis
inflammation of joints
bunion
abnormal prominence with bursal swelling at the metatarsophalangeal joint near the base of the big toe
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bursitis
inflammation of bursae
crepitation
crackling sensation felt and heard when the ends of a broken bone move together
Ewing sarcoma
malignant bone tumour involving the shaft of a long bone
exostoses
bony growths (benign tumours) arising from the surface of the bone
fracture
sudden breaking of a bone. Some terms describing fractures and related injuries are: a) closed f.: a bone is broken but there is no open wound in the skin (simple fracture) b) open f.: a broken bone with an open wound in the skin (compound fracture) c) complicated f.: a broken bone has injured an internal organ d) comminuted f.: a bone has broken, splintered, into pieces e) impacted f.: one end of a broken bone is wedged into the interior of another bone f) incomplete f.: fracture line does not transverse the entire bone g) g reenstick f.: a bone is partially broken and partially bent h) Colles f.: a break at the lower end of the radius (typical radial f.) Treatment of fractures involves reduction, which is the restoration of the fracture to its normal position. A closed reduction is manipulative reduction without an incision; in an open reduction an incision is made into the fracture site. A cast (solid mould of the body part) is applied to fractures to immobilize the injured area.
dislocation
displacement of a bone from its joint
gouty arthritis (gout)
inflammation of joints caused by excessive uric acid in the body. An inherited defect in metabolism causes too much uric acid to accumulate in blood (hyperuricemia), joints, and soft tissues near joints. The uric acid crystals destroy the articular cartilage and damage the synovial membrane. A joint 63
chiefly affected is the big toe; hence the condition is often known as podagra (pod = foot -agra = excessive pain). Treatment consists of drugs to lower uric acid production and prevent inflammation, and a diet avoiding foods rich in uric acid (red meat). osteitis fibrosa cystica inflammation of bone with fibrous changes in the bone tissue When the parathyroid gland produces an excess of parathyroid hormone (hyperparathyroidism), calcium is removed from the bones and appears in the blood. The bones become porous (osteoporosis) and decalcified, leading to curvature and cyst formation as well as fractures. Blood calcium accumulation may lead to renal and cystic calculi (stones). osteoarthritis
chronic inflammation of bones and joints due to degenerative changes in cartilage
osteoporosis
decrease in bone density; thinning and weakening of bone due to loss of calcium salts
osteogenic sarcoma
malignant tumour arising from bone. Osteoblasts multiply without control and form large tumours, especially at the ends of long bones.
osteomyelitis
inflammation of the bone and bone marrow due to a pyogenic infection
sprain
trauma to a joint, with pain, swelling, and injury to ligaments; sprains may also involve damage to blood vessels, muscles, tendons and nerves
strain
less serious injury with overstretching of muscles
protrusion of an intervertebral disc
abnormal extension of cartilaginous intervertebral pad into the neural canal (slipped disc)
rickets (rachitis)
inflammation of the spinal column characterized by osteomalacia (softening of bone tissue) due to improper absorption of calcium and phosphorus.
Disorders of the spine and muscles Because of various conditions, the normal curvature of the s pine may become abnormally bent or slope away. These cases are referred to as curvatures of the spine. When a lateral curvature (usually consisting of two curves) 64
of the spine takes place, the disorder is identified as scoliosis (bent). Scoliosis may be congenital, or it may develop in the early teens. Poor posture over a long period of time is a contributing factor, and it may be accompanied by lack of muscle tone and general physical inactivity. Surgery, braces, casts and corrective exercises may eliminate this condition. Abnormally increased convexity in the curvature of the thoracic spine as viewed from the side is referred to as kyphosis (hunchback or humpback). This condition may be caused by rheumatoid arthritis, rickets, chronic respiratory diseases or a congenital disorder. It never develops from poor posture. There are no specific symptoms of kyphosis besides back pain and increasing immobility of the spine. Symptoms vary with the cause, and any back pain or injury should be investigated. Lordosis (swayback) is a forward curvature of the lumbar spine. I may be caused by increased weight of the abdominal contents. This could be due to obesity or excessive weight gain during pregnancy. Amyotrophic lateral sclerosis is a specific type of movement disorder (muscles atrophy) with degeneration of nerves in the spinal cord and lower region of the brain (brain stem). Early symptoms include difficulty in swallowing and talking, and weakness in the arms and legs. As the disease progresses there is increased spasticity and atrophy of muscles. Etiology and effective treatment are unknown. Muscular dystrophy includes a group of inherited diseases characterized by progressive weakness and degeneration of muscle fibres without involvement of the nervous system. Pseudohypertrophic (Duchenne) muscular dystrophy is the most common form. Muscles enlarge as fat replaces functional muscle cells that have atrophied. Myasthenia gravis is briefly defined as the lack of muscle strength marked by paralysis. This condition is characterized by extreme weakness of the muscles of the face, jaw, and eyelids and difficulty in swallowing. The etiology is unknown, but it is thought that there is some defect at the myoneural junction where the nerve enters the muscle fibre to stimulate muscle contraction. There is either a lack of acetylcholine to help transmit the impulse across the myoneural junction or an increase in cholinesterase, which is an enzyme released at the junction to destroy whatever acetylcholine remains after the impulse has passed. Treatment consists of giving a drug to interfere with cholinesterase production. Some cases are associated with benign tumours of the thymus (thymoma), and thymectomy is found to be beneficial.
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Polymyalgia rheumatica is characterized by muscle pain, primarily of the shoulder and pelvis, with absence of arthritis and signs of muscle distress. Treatment with low doses of corticosteroids may relieve symptoms. Other related terms Claudication = lameness, limping Contracture = fibrosis of connective tissue in the skin, fascia, muscles or joint capsule Exacerbation = increase in severity of a disease or symptoms (aggravation) Ganglion cyst = tumour of tendon sheath of joint capsule (commonly in the wrist) Hemarthrosis = effusion of blood into a joint cavity Hypotonia = loss or diminishing of muscle tone Multiple myeloma = primary malignant tumour that infiltrates the bone and red bone marrow Osteophyte = bony outgrowth, also called bony spur Phantom limb = perceived sensation, following amputation of a limb, that it still exists Prosthesis = r eplacement of a missing part by an artificial substitute Subluxation = p artial or incomplete dislocation EXERCISES 1. List some functions of the skeletal system: ...................................................................................................................................................................................
2. Fill in the correct term: 2.1. The inner core of bones is composed of ........................................................ tissue. 2.2. Spongy or ................................................. bone is less dense than compact bone. 2.3. Freely movable joints are called ........................................................................... joints. 2.4. A delicate membrane surrounding each skeletal muscle is referred to as a........................................................................................................................................................ 2.5. The point of attachment of the muscle to the stationary bone is the ..........................................................................................................................................................................
3. Give the opposite of each term: 3.1. abduction ..................................................
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3.6. anterior ......................................................
3.2. pronation ..................................................
3.7. backward ..................................................
3.3. distal ............................................................
3.8. superior .....................................................
3.4. depression ...............................................
3.9. normal ........................................................
3.5. movable .....................................................
3.10. malignant ..............................................
4. Match the following terms with their meanings: 4.1. costal ..........................................................
a) a type of tendon that helps attach muscles to bones
4.2. fossa ............................................................
b) inflammation of joints
4.3. fracture ......................................................
c) pertaining to the ribs
4.4. arthritis ......................................................
d) a broken bone
4.5. aponeurosis ............................................
e) a depression in a bone surface
5. Give the meanings of the following terms: 5.1. ossification ....................................................................................................................................... 5.2. osteoblasts ...................................................................................................................................... 5.3. insertion ............................................................................................................................................ 5.4. diaphysis ........................................................................................................................................... 5.5. exostoses .......................................................................................................................................... 5.6. bursitis ............................................................................................................................................... 5.7. haversian canals .......................................................................................................................... 5.8. sprain .................................................................................................................................................. 5.9. kyphosis ............................................................................................................................................. 5.10. acetabulum ................................................................................................................................... 6. Provide the plural form of the following nouns: 6.1. vertebra .....................................................
6.6. diaphysis ...................................................
6.2. pelvis ...........................................................
6.7. toe .................................................................
6.3. foramen .....................................................
6.8. radius...........................................................
6.4. phalanx ......................................................
6.9. fossa.............................................................
6.5. process ......................................................
6.10. femur......................................................... 67
7. Provide the adjective form for the following nouns: 7.1. muscle .......................................................
7.6. fibre ..............................................................
7.2. joint ..............................................................
7.7. ilium ............................................................
7.3. bone .............................................................
7.8. patella ........................................................
7.4. skeleton .....................................................
7.9. humerus ...................................................
7.5. pubis ............................................................
7.10. cranium ..................................................
8. Give appropriate term for the following: 8.1. decrease in bone density ........................................................................................................ 8.2. the shaft of the long bone ....................................................................................................... 8.3. t he extension of the scapula which joins with the clavicle to form the joint of the shoulder.................................................................................................................... 8.4. the second cervical vertebra ................................................................................................ 8.5. the posterior bone of the pelvis............................................................................................ 8.6. large process on the femur for attachment of muscle ......................................... ..........................................................................................................................................................................
8.7. fibrous tissue that envelops muscles .............................................................................. 8.8. a fibrous attachment spanning over a large area of bone .................................. ..........................................................................................................................................................................
8.9. malignant bone tumour involving the entire shaft of a long bone ......................................................................................................................................................................... .
8.10. lack of muscle strength marked by paralysis........................................................... ......................................................................................................................................................................... .
9. Translate into Croatian: Backache is one of the most common physical complaints, experienced by millions of people every day. Many victims of lower back pain - spasmodic pain near the inward curve of the back above the base of the spine - are stricken while simply reaching to pick something up. The pain may disappear as spontaneously as it came, or last for days, and commonly it will reappear periodically. Almost anything can cause pain in the back, from sudden stop in a car, to athletic overexertions, to a reflex action like sneezing. The lower portion of 68
the spine is the site of most back pain which may simply develop from overworked or underexercised muscles. Strains are especially common when tired or weak back muscles are called upon to do more than they are capable of doing. The muscles will then suddenly go into spasm - an involuntary contraction - and become a knotty mass while the body sends out a signal of sharp pain. Other muscles nearby will also go into spasm in an effort to protect the strained muscles and prevent further damage. (From: Ellis, J. W. Medical Symptoms and Treatments)
.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 6
GASTROINTESTINAL SYSTEM Functions The gastrointestinal system is also called the digestive or alimentary system. It begins with the mouth or the oral or buccal cavity where food enters the body, and terminates at the anus where solid waste materials leave the body. The functions of the digestive system are threefold: ingestion of food, absorption of nutrients, elimination of solid metabolic waste material. When food is ingested it is in a form that cannot reach the cells because of its inability to pass through the intestinal mucosa into the bloodstream. Therefore, the consumed food must be prepared for absorption. Digestive enzymes are substances that speed up chemical reactions and help in the breakdown (digestion) of complex nutrients. Complex proteins are digested to simpler amino acids, complicated sugars are reduced to simple sugars, such as glucose; and large fat molecules are broken down to fatty acids and triglycerides. Thus, digestion can be defined as a complete process of changing the chemical and physical composition of food in order to facilitate assimilation of the nourishing ingredients of food by the cells of the body. Anatomy of the Digestive System The gastrointestinal (GI) tract begins at the oral cavity or mouth. The structures within the oral cavity are the cheeks or bucca and the tongue and its muscles, which extend across the floor of the mouth. The main functions of the tongue are manipulation of food during the chewing process, speech, deglutition or swallowing, speech production, and determination of taste. The surface of the tongue has rough elevations; these elevations are taste buds. These sense organs are called papillae and are capable of perceiving a variety of flavours found in our foods, such as bitterness, sweetness, saltiness, and sourness.
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The teeth are also found in the oral cavity and play an important role in the initial stages of digestion. The teeth that are located in front of the oral cavity, the incisors and cuspids, cut and tear the food into small pieces. The teeth located in the rear of the mouth are called molars. They further crush and grind the food into finer particles. Teeth are covered by hard enamel, which gives them a white and smooth appearance. The enamel is the hardest substance in the body. Beneath the enamel is the main structure of the tooth, the dentin. It is yellowish and is composed of bony tissue which is softer than enamel. Dentin is surrounded by a thin layer of modified bone called cementum. In the innermost part of the tooth is the pulp, a soft, delicate layer, which stores the nerves and blood vessels of the tooth. The teeth are embedded in pink fleshy tissue known as gums, or gingiva. Figure 6.1. Anatomy of a tooth
Some of the other structures located within the mouth are the hard and soft palates. The hard palate lies in the anterior portion of the roof of the mouth, while the soft palate lies in its posterior portion. The soft palate forms a partition between the mouth and nasopharynx and is continuous with the hard palate. Rugae are the irregular ridges in the mucous membrane covering the anterior portion of the hard palate. The entire buccal cavity, like the rest of the digestive tract, is lined with mucous membrane.
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After the food is chewed, it is formed into a round, sticky mass called a bolus. The bolus is pushed by the tongue from the mouth into the pharynx. Its downward movement is guided into the pharynx or throat by the soft, fleshy V-shaped tissue called the uvula. The uvula hangs from the soft palate and also functions to aid in producing sounds and speech. The pharynx is a muscular tube which serves as a common passageway for air from the nasal cavity to the larynx (voice box), as well as for food going from the mouth to the esophagus. The pharynx is divided into three major sections: 1. The nasopharynx or epipharynx (the throat behind the nose) 2. The oropharynx or mesopharynx (the throat behind the mouth) 3. The laryngopharynx or hypopharynx (the throat above the larynx) The laryngopharynx is further divided into two tubes; one which leads to the lungs, called the trachea (wind pipe), and one which leads to the stomach, called the esophagus (gullet). A small flap of tissue, the epiglottis, covers the trachea. The main function of the epiglottis is to prevent food from entering the trachea, thus allowing all food to be channelled to the stomach through the esophagus. Stomach The stomach is a saclike structure located in the abdominal cavity directly below the diaphragm. It is continuous with the esophagus. Thus, food continues its descent down the esophagus in peristaltic, or wavelike, movements until it reaches the stomach. The stomach mixes the undigested food with gastric juices to further break it down for digestion. Within the stomach there are a considerable number of folds called rugae. The rugae appear only when the stomach is empty. As the stomach fills, the interior walls become smooth. The interior lining of the stomach is composed of mucous membranes and contains the glands that secrete hydrochloric acid (HCl) and gastric juices. Once the food or bolus is mixed with gastric juices and HCl, it forms a semicreamy fluid called chyme. There are two valves in the stomach. The first valve is called the cardiac valve, or cardiac sphincter, and is located at the top or fundus of the stomach. It connects the esophagus to the stomach. The second valve is called the pyloric valve, or pyloric sphincter, and is located at the base or antrum of the stomach. It connects the stomach to the small intestine. Both valves are composed of a round band of muscles called sphincters which contract and expand to allow food to enter and leave the stomach.
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Figure 6.2. Organs of the digestive system Tongue Mouth (oral cavity)
Parotid gland Submandibular gland Sublingual gland
Salivary gland
Pharynx Esophagus Food bolus
Liver Gallbladder Duodenum Hepatic flexure Pancreas Jejunum
Stomach Spleen Splenic flexure Transverse colon Descending colon
Ascending colon Ileum Cecum Appendix
Sigmoid colon Rectum Anus
Small Intestine (Small Bowel) The small intestine is approximately one inch in diameter and is a continuation of the gastrointestinal tube. It extends from the pyloric sphincter to the first part of the large intestine. The small intestine is 20 feet long and has three parts: 1. The duodenum, the uppermost division which is about ten inches long. 2. The jejunum, which is approximately eight feet long. 3. The ileum, which is about twelve feet long. Most of the absorption of food takes place in the ileum by tiny fingerlike projections called villi. Inside the villi one finds a network of fine capillaries, veins, and arteries. There are also many other digestive glands located in the mucous membrane lining of the small intestine. These microscopic glands secrete additional digestive juices. The pancreas and liver produce digestive secretions, and these secretions are added to the chyme at the beginning of the small intestine. With the exception of some forms of fat, water, and waste products, all food ingested into the body is absorbed through the walls of the small intestine. 73
Large Intestine (Large Bowel) The large intestine extends from the end of the ileum to the anus. It is divided into four parts: cecum, colon, sigmoid colon, and rectum. The large intestine is a continuation of the gastrointestinal tube and is attached to the ileum by ileocecal valve. This valve is composed of sphincter muscles that serve to close the ileum at the point at which the small intestine is connected to the colon. The large intestine has an average diameter of two-and-half inches and is approximately five feet long. The cecum is the first two or three inches of the large intestine. It is a pouch on the right side. Attached to the cecum is a wormlike (vermiform) projection - the appendix, which performs no function in the digestive tract and only causes problems when infected. The colon consists of the following parts: 1. The ascending colon, which extends from the cecum to the lower border of the liver - hepatic flexure 2. The transverse colon, which passes horizontally across the abdomen to the left toward the spleen - splenic flexure 3. The descending colon, which continues down to form the sigmoid colon (shaped like an S - sigma). 4. The rectum, which serves as a storage area for the waste products of digestion, and is approximately five inches long. The terminal inch of the rectum is referred to as the anal canal. The canal is kept closed by internal and external sphincters except during the process of defecation (elimination of feces). Three important additional organs of the digestive system are the liver, pancreas, and gallbladder. Although food does not pass through these organs, each plays a crucial role on the pro per digestion and absorption of nutrients. Liver The liver is the largest glandular organ in the body and weighs approximately three to four pounds. It is located beneath the diaphragm in the right upper quadrant (RUQ) of the abdominal cavity. The liver produces so many vital functions that the human organism cannot survive without it. The following are some of its more important functions: 1. Produces bile, which is used in the small intestine to emulsify and absorb fats. Bile is a thick, yellowish brown, sometimes greenish, fluid. It contains cholesterol (a fatty substance), bile acids, and several bile pigments. One of these pigments is called bilirubin. Bilirubin is a waste product of hemoglobin destruction (which occurs in the liver as red blood cells are destroyed). 2. Removes glucose (sugar) from blood, which it synthesizes and stores as glycogen (starch) in liver cells. This is called glycogenesis. 74
3. Stores vitamins, such as B12, A, D, E, and K. 4. Breaks down or transforms some toxic products into less harmful compounds. 5. Maintains normal level of glucose in the blood. 6. Destroys old erythrocytes and ingests bacteria and foreign particles from the blood by phagocytes. 7. Produces various blood proteins, such as prothrombin and fibrinogen, which aid in the clotting of blood (coagulation). Pancreas The pancreas secretes and produces pancreatic juices that help break down all types of food during the digestive process. These juices empty into the pancreatic duct and eventually are absorbed by the small intestine. Insulin is another hormone that is secreted by the pancreas and exerts major control over carbohydrate metabolism or the utilization of sugar in the body. Insulin is produced by the cells located within the tissue of the pancreas. These cells are called the islands of Langerhans. The pancreas is both an exocrine and endocrine organ. It is also discussed in chapter 13 - The Endocrine System. Gallbladder The gallbladder serves as the storage area for bile. It is a pear-shaped sac under the liver. During the process of digestion, when there is a need for some bile, gallbladder releases it into the duodenum through the common bile duct. Bile is also drained from the liver through the hepatic ducts. The hepatic ducts connect with the cystic duct from gallbladder and form the common bile duct (choledochus). Figure 6.3. liver, pancreas and gallbladder
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Key Terms • absorption – passage of materials through the intestinal walls into the bloodstream • alimentary canal – the digestive tract • amino acids – building blocks of proteins, produced when proteins are digested • amylase – pancreatic enzyme for digestion of starch • bile – digestive juice produced by the liver and stored in the gallbladder • bilirubin – pigment resulting from destruction of hemoglobin, released by the liver • bolus – mass of masticated food ready to be swallowed • bowel – intestine • canine teeth – pointed dog-like teeth • cecum (blind) – first part of the large intestine • colon – large intestine • deglutition – swallowing • dentin – basic tissue composing the tooth • digestion – breakdown of complex foods into smaller forms • emulsification – breakdown of large fat globules into smaller ones • enamel – hard outer covering of a tooth • enzyme – a chemical that speeds up digestion • esophagus – gullet • fatty acids – substances produced when fats are digested • feces – solid wastes; stools • gingiva – gums • glucose – simple sugar; blood sugar • glycogen – animal starch; glucose is stored in the form of glycogen in liver cells • hydrochloric acid – a substance produced by the gastric mucosa necessary for digestion of food • incisors – front teeth in the dental arch (cutters) • insulin – pancreatic hormone important for carbohydrate metabolism • lipase – pancreatic enzyme needed in the digestion of fats • mastication – chewing • palate – roof of the mouth • papilla(e) – small elevations on the surface of the tongue; any nipple-like elevation • parotid gland – salivary gland near the ear • peristalsis – rhythmic contractions of digestive tubes and other tubular structures
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• • • • • • •
pharynx – throat pulp – soft inner part of a tooth containing blood vessels and nerves ruga(e) – folds on the hard palate and gastric walls saliva – digestive juice produced by the salivary glands sphincter – circular muscles inside a tube triglycerides – large fat molecules villi (sg. villus) – microscopic projections in the walls of the small intestine (blood vessels) through which nutrients are absorbed into the bloodstream
Combining Forms Meaning
Terminology
an/o
anus
perianal = around the anus
append/o
appendix
appendectomy = removal of the appendix
bucc/o
cheek
buccal = pertaining to the cheek
celi/o lapar/o
abdomen
celiac = pertaining to the abodmen laparoscopy = endoscopic examination of parts of the abdominal cavity
cheil/o labi/o
lip
cheiloplasty = surgical repair of lips labial = pertaining to the lips
cholecyst/o
gallbladder cholecystectomy = removal of the gallbladder
choledoch/o
bile duct
choledochotomy = incision into the bile duct
col/o colon/o
large intestine
colonic = pertaining to the large intestine colonoscopy = visual examination of the colon
dent/o odont/o
tooth
dental = pertaining to teeth orthodontist = dental specialist for correction and prevention of dental abnormalities
enter/o
small intestine
enteropathy = disease of the small intestine
faci/o
face
facial = pertaining to the face
gastr/o
stomach
gastralgia = pain in the stomach (stomach-ache)
gingiv/o
gums
gingivitis = inflammation of the gingiva
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Combining Forms Meaning
Terminology
gloss/o lingu/o
tongue
hypoglossal = under the tongue sublingual = “
hepat/o
liver
hepatomegaly = enlargement of the liver
mandibul/o
lower jaw (mandible)
submandibular = under the lower jaw
or/o stomat/o
mouth
oral = pertaining to the mouth stomatitis = inflammation of oral mucosa
proct/o
anus, rectum
proctologist = specialist in the diseases of the anorectal region
sial/o
saliva, sali- sialolith = calculus formed in a salivary vary gland duct or gland
Disorders of the Gastrointestinal System Hemorrhoids The enlargement of the veins of the anal canal causes hemorrhoids or piles. The two kinds of hemorrhoids involving the anal canal are internal and external hemorrhoids. These are the enlarged veins in the mucous membrane, either inside or just outside the rectal area. Hemorrhoids are usually caused by straining to evacuate hard, dry stools. They sometimes occur in pregnancy because of pressure on the veins caused by the enlarged uterus. They may also result from pressure on the veins caused by a disorder of the liver or the heart or may be symptomatic of a tumour that may exert pressure against the veins. Temporary relief from hemorrhoids can usually be obtained by cold compresses, sitz baths, fecal softeners, or analgesic ointment. Treatment of an advanced hemorrhoidal condition is by surgical removal (hemorrhoidectomy). Hernias A hernia is an abnormal protrusion or projection of an organ or tissue through the structures that normally contain them. They may be abdominal, inguinal, or umbilical. Even though hernias occur most commonly in the abdominal region, they may develop in the diaphragm (diaphragmatic) or in the form of a hiatus. When this condition occurs, the lower end of the esophagus and the adjacent part of the stomach herniate into the thorax (gastroesophageal). The strangulated hernia cuts off circulation and the herniated blood vessel is likely to become gangrenous. This is also known as an incar78
cerated hernia, as it result in complete bowel obstruction. The inguinal hernia occurs in the groin where the abdominal folds of flesh meet the thighs. Inguinal hernias account for about 80 percent of all hernias. In the initial stages such a hernia may be hardly noticeable and appears as a soft lump under the skin, no larger than a marble. There may be little pain. As time passes, the pressure of the contents of the abdomen against the weak abdominal wall may increase the size of the opening and accordingly, the size of the hernia lump. The protrusion of part of the intestine at the navel (umbilical hernia) is more frequent in women than men and is treated surgically. Hernias may also be found in newborns (congenital) or can be acquired at an early age. Ulcers An open sore or the lesion of the skin or mucous membrane, producing loss of substance, and sometimes accompanied by formation of pus, is characteristic of ulcers. The peptic ulcers occur in the digestive tube that is exposed to the action of the acidic gastric juice. It is noted that peptic ulcers occur most commonly in the first portion of the duodenum, next most frequently in the stomach, and rarely in the lower portion of the esophagus. They may be of long duration (chronic) or arise suddenly (acute). It is also observed that chronic ulcers are more common in the duodenum, while acute ulcers are usually found in the stomach. Inflammation of the colon, with formation of ulcers in the lining of the intestine (ulcerative colitis), can occur at any age but is most common in young adults. The chief symptom is severe diarrhea, which is often accompanied by blood and mucus in the stool. The patient may feel very weak, lose weight, and sometimes experience anemia. He may also suffer from pains in the joints (arthralgia). Other terms related to pathology of the digestive system: achlorhydria
lack of hydrochloric acid in the stomach. This condition may be produced by chronic gastritis or carcinoma of the stomach.
anal fistula
abnormal tubelike passageway near the anus which may communicate with the rectum
anorexia
lack or loss of appetite
ascites
abnormal accumulation of fluid in the peritoneal cavity
borborygmus
the rumbling and gurgling sound made by the movement of gas in the intestine
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cachexia
general ill health, wasting of tissues, malnutrition, profound and marked state of constitutional disorder
cholelithiasis
presence and formation of gallstones in the gallbladder
cirrhosis
chronic disease of the liver with degeneration of liver cells
cleft palate
congenital split in the roof of the mouth; lip may also be affected
colic
spasm in any hollow or tubular soft organ
colonic polyposis
polyps (small growths) protrude from the mucous membrane of the colon
constipation
difficult and delayed defecation (opstipation)
Crohn disease
Inflammation of the intestinal tract, commonly of the terminal (end)portion of the ileum. Crohn disease is a chronic relapsing inflammation with diarrhea, abdominal cramping, and fever. It is similar to ulcerative colitis and both are considered types of inflammatory bowel diseases (IBD). Crohn disease, believed to be caused by virus or autoimmunity (antibodies attack the body’s own cells), is treated with drugs (anti- inflammatory steroids) to promote healing of lesions. Surgical removal of the diseased portion, with anastomosis of the remaining intestinal parts, may be needed.
dental caries
tooth decay
diverticula (sg.diverticulum)
abnormal side pockets in a hollow structure such as the intestine common sites are the sigmoid colon and duodenum.
dysentery
severe bacterial (shigellae) infection of the large intestine
dyspepsia
difficult digestion, indigestion
dysphagia
difficulty or inability in swallowing
eructation
belching or raising from the stomach
esophageal varices
swollen, twisted veins around the distal end of the esophagus
flatus
gas expelled through the anus
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gallstones
hard collections of bile that form in the gallbladder and bile ducts
gastroesophabackflow of gastric contents into the esophagus due to geal reflux disease a malfunction of the sphincter muscle at the inferior (GERD) portion of the esophagus halitosis
offensive, or “bad,” breath
heartburn (pyrosis)
a burning sensation caused by reflux (backflow) of acid from the stomach into the esophagus
hematemesis
vomiting blood
hepatitis
inflammation of the liver caused by virus or damage to the liver from toxic substances. There are 3 most common types of viral hepatitis: Hepatitis A (caused by type A virus and formerly called infectious hepatitis) is spread through water and food, and the virus is excreted in feces. Hepatitis B (caused by type B virus and formerly called serum hepatitis) is acquired from transfusions and via body fluids such as tears, saliva, and semen. Hepatitis C is transmitted by blood or blood products and close personal contact.
icterus
jaundice
ileus
intestinal obstruction
intussusception
telescoping of the intestines
irritable bowel syndrome
a group of symptoms associated with stress and tension; spastic colon
jaundice (icterus)
yellow-orange discoloration of skin or other tissues; it results from excessive accumulation of bilirubin in the bloodstream and can occur in three major ways: 1. obstruction of bile passageways prevents bilirubin from leaving the body in bile (i.e. cholelithiasis); 2. malfunction of liver cells, as in cirrhosis, hepatitis, or hepatic carcinoma, impairs the liver’s ability to combine bilirubin with bile; bilirubin thus remains in the bloodstream; 3. excessive destruction of erythrocytes, as in erythroblastosis fetalis and other anemias, creates abnormally high levels of bilirubin in the blood.
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laxative
a medication promoting defecation
melena
black stools; feces containing blood
nausea
unpleasant sensation from the stomach with a tendency to vomit
oral leukoplakia
white plaques on the oral mucosa; a precancerous lesion
pancreatitis
inflammation of the pancreas
regurgitation
return of solids and fluids to the mouth from the stomach (vomiting)
steatorrhea
excessive amount of fat in the feces, often seen in pancreatic disease
volvulus
twisting of the intestine upon itself; an operation can be performed to untwist the loop of the bowel.
EXERCISES 1. What are the three functions of the digestive system? 1.1. ................................................................................................................................................................. 1.2. ................................................................................................................................................................. 1.3................................................................................................................................................................... 2. Fill in the correct term: 2.1. One of the main functions of the tongue is swallowing or ................................. . ............................................
speech production and ..................................................... of taste.
2.2. The incisors and ......................................... cut and ......................................... the food into small pieces. 2.3. The teeth are embedded in pink fleshy tissue known as gums or ..........................................................................................................................................................................
2.4. Within the stomach there are many folds called ...................................................... 2.5. Bile is also .............................. from the liver through the ............................................ 3. Give the opposite of each term: 3.1. hard palate ..............................................
3.6. rough ...........................................................
3.2. floor of the mouth ...............................
3.7. bitter ............................................................
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3.3. upper ...........................................................
3.8. empty ..........................................................
3.4. descending ..............................................
3.9. harmful ......................................................
3.5. innermost .................................................
3.10. sufficient ................................................
4. Match the following terms with their meanings: 4.1. chyme .........................................................
a) the inner part of the tooth
4.2. bolus ............................................................
b) a semi-creamy fluid formed in the stomach when food is mixed with gastric juices and HCl
4.3. taste buds .................................................
c) a round, sticky mass formed after the food is chewed
4.4. peristalsis ................................................
d) rough elevations on the surface of the tongue
4.5. pulp ..............................................................
e) wavelike movement of digestive tubes
5. Give the meanings of the following terms: 5.1. colitis ..........................................................
5.6. anorexia .....................................................
5.2. hernia .........................................................
5.7. ascites ........................................................
5.3. umbilical ...................................................
5.8. hypoglycemia .........................................
5.4. hemorrhoidectomy .............................
5.9. constipation ............................................
5.5. melena .......................................................
5.10. ileus ..........................................................
6. Provide the adjective form for each of the following: 6.1. abdomen ...................................................
6.6. stomach .....................................................
6.2. ulcer ............................................................
6.7. saliva ...........................................................
6.3. liver ..............................................................
6.8. bucca ...........................................................
6.4. intestine ....................................................
6.9. face ...............................................................
6.5. tongue ........................................................
6.10. pain ............................................................
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7. Give the plural of the following nouns: 7.1. trachea .......................................................
7.6. bucca ...........................................................
7.2. ruga .............................................................
7.7. cavity ...........................................................
7.3. villus ............................................................
7.8. appendix ....................................................
7.4. tooth ............................................................
7.9. speech ........................................................
7.5. calculus .....................................................
7.10. mass .........................................................
8. Give appropriate medical terms for the following: 8.1. complete process of changing the chemical and physical composition of food................................................................................................................................................................. 8.2. enlargement of the spleen ..................................................................................................... 8.3. process of visually examining the stomach ................................................................. 8.4. enzyme to digest fats ................................................................................................................ 8.5. congenital split in the roof of the mouth ....................................................................... 8.6. the musculomembranous partition separating the abdominal and thoracic cavities ..................................................................................................................................... 8.7. abnormal frequency and liquidity of fecal discharges............................................ 8.8. the major fuel-regulating hormone in humans ........................................................ 8.9. a practitioner who specializes in diseases of the digestive tract ..........................................................................................................................................................................
8.10. pertaining to the stomach and the heart .................................................................... 9. Translate into Croatian: Appendicitis is an inflammation of the appendix resulting from a bacterial infection. Located at the juncture of the small and large intestines, the appendix is a small, worm-like piece of intestinal tissue with no known function in humans. It is called a vestigial organ because, although it may have previously served some function, it has no function now. The appendix can be the source of a serious or, at times, even fatal illness. When it becomes swollen and filled with pus from bacteria, it may form an abscess or may break, allowing the infection to spread to the surrounding organs. Rupture may lead to peritonitis, an inflammation of the lining of the abdominal cavity
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(peritoneum). The infection can spread so quickly that gangrene and rupture may occur within a matter of hours from the first symptoms. (From: Ellis, J. W. Medical Symptoms and Treatments) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
10. Translate into English Bol u trbuhu: je li riječ o bolesti? Boli u trbuhu mogu nastati naglo (akutno) ili traju dugo, mjesecima pa čak i godinama. Važno je također znati opetuje li se bol u pravilnim ili nepravilnim vremenskim razmacima, te postoje li uz bol još i druge tegobe, primjerice mučnina, povraćanje, proljev, začep, ili vrućica. Nagla bol u trbuhu može biti uzrokovana različitim bolestima trbušnih organa. Takva bol često je uzrokovana bolešću koja zahtijeva hitnu liječničku pomoć jer može biti ugrožen bolesnikov život. Akutna upala crvuljka (akutni apendicitis) bolest je na koju uvijek valja pomisliti pri boli u trbuhu, napose u mlađih ljudi. Napadaj boli zbog upale crvuljka najčešće započne u gornjem dijelu trbuha ili oko pupka. Bol može biti grčevita (kolike) i u naletima se pojačava i slabi. Nakon nekoliko sati bol se spušta u donji desni dio trbuha, gdje je i smješten crvuljak. Bolesnici često
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povraćaju zbog podražaja potrbušnice, a često postoji i malo povišena tjelesna temperatura. Neki bolesnici i stariji ljudi mogu imati manje izražene znakove upale crvuljka, što može stvoriti teškoće u pravodobnu prepoznavanju bolesti. (From: Željko Reiner, Praktična medicina) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 7
RESPIRATORY SYSTEM Respiration is usually thought of as being a mechanical process of breathing, that is the repetitive and, for the most part, unconscious exchange of air between the lungs and the external environment. Respiratory activity consists of two separate, simultaneous operations that involve the exchange of oxygen (O2) and carbon dioxide (CO2). The first operation, external respiration, refers to the exchange of O2 and CO2 between the organism and the external environment. In this operation oxygen-rich air from the environment is brought into the lungs during inspiration (inhaling) and CO2 is removed from the body during expiration (exhaling). Air inhaled contains about 21 percent oxygen. Oxygen is inhaled into the air spaces (sacs) of the lungs and immediately passes into tiny capillary blood vessels surrounding the air spaces. Simultaneously, carbon dioxide, a gas produced when oxygen and food combine in cells, passes from the capillary blood vessels into the air spaces of the lungs to be exhaled (exhaled air contains about 16 % of oxygen). More familiarly, external respiration is called lung breathing. The second operation, internal respiration (also called cellular respiration), refers to the exchange of O2 and CO2 at the tissue or cellular level. This exchange is also called tissue breathing. Just as the organism as a whole requires the exchange of gases to maintain life, each individual cell of the organism must likewise receive oxygen for the metabolic process and expel waste gases that have accumulated in the cell. During internal respiration the red blood cells transport O2 from the lungs to body tissues. They deposit O2 with the tissue as they remove CO2. The red blood cells return to the lungs where they finally expel CO2 during external respiration. For example, red blood cells transport O2 to liver cells and, in turn, receive CO2 from the liver cells. The CO2 is then expelled from the lungs during external respiration.
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Anatomy and Physiology of Respiration Figure 7.1. Respiratory tract
Adenoids
Nasal cavity
Nasopharynx
Nose
Oropharynx
Palatine tonsils
Laryngopharynx
Epiglottis
Larynx Glottis and vocal cords
Thyroid cartilage
Trachea
Apex of lung
Bronchi
Bronchiole
Mediastinum Right lung
Left lung
Visceral pleura Pleural cavity
Diaphragm
Base of lung
Parietal pleura
During the breathing process, air from the environment is drawn in through the nose and passes through the nasal cavity to the pharynx (throat). The nasal cavity is lined with a mucous membrane and fine hairs (cilia) to help filter out foreign bodies, as well as to warm and moisten the air. Paranasal sinuses are hollow, air-containing spaces within the skull that communicate with the nasal cavity. They also have a mucous membrane lining and function to provide the lubricating fluid mucus, to lighten the bones of the skull and help produce sound. The pharynx is a muscular tube and consists of three major divisions: 1. the nasopharynx, or epipharynx, posterior to the nose and the nearest to the nasal cavity; 2. the oropharynx or mesopharynx, posterior to the mouth; 3. the laryngopharynx (also called hypopharynx), posterior to the larynx. Within the nasopharynx there is a collection of lymphatic tissue known as adenoids or pharyngeal tonsils. They are more prominent in children, and if 88
enlarged can obstruct air passageways. Another collection of lymphatic tissue called palatine tonsils, or more commonly tonsils are located in the oropharynx. It is in the hypopharyngeal region that the pharynx, serving as a common passageway for food from the mouth and air from the nose, divides into two branches, the larynx (voice box) and the esophagus. The larynx is responsible for sound production or phonation. It contains vocal cords and is surrounded by pieces of cartilage for support. Sounds are produced as air is expelled past the vocal cords and the cords vibrate. The tension of the vocal cords determines the high or low pitch of the voice. A leaf-shaped structure in the larynx, the epiglottis, seals off the air passage to the lungs during swallowing. This structure insures that food or liquids do not obstruct the flow of air and thus cause the individual to choke. The epiglottis is attached to the root of the tongue and acts like a lid over the larynx. On its way to the lungs, air passes from the larynx to the trachea (wind pipe), a vertical tube about 4.12 inches long and an inch in diameter. The trachea is kept open by 16 to 20 C-shaped cartilage rings separated by fibrous connective tissue which stiffen the front and sides of the tube. In the region of the mediastinum the trachea divides into two branches called bronchi. One bronchus leads to the right lung and the other to the left lung. Like the trachea, the bronchi contain C-shaped cartilage rings. These rings provide the necessary rigidity to keep air passage open at all times. Without them the trachea or bronchi may possibly collapse and endanger life. Each bronchus divides into smaller and finer tubes, somewhat like the branches of a tree, called bronchioles (little bronchi). At the end of them are clusters of air sacs called alveoli. An alveolus resembles a small balloon because it expands and contracts with inflow and outflow of air. Capillary beds of the circulatory system lie adjacent to the thin tissue membranes of the alveoli. Carbon dioxide passes from the red blood cells of the pulmonary capillaries into the alveolar spaces, while O2 from the alveoli passes into the blood. After the blood becomes oxygenated, it returns to the heart. The heart pumps blood to all body tissues. At the tissue level O2 from the blood is exchanged for tissue CO2. This exchange of gases is called internal respiration. The lungs are divided into lobes: three lobes in the right lung and two lobes in the left lung. It is possible for one lobe of the lung to be removed without damage to the rest, which can continue to function normally. The uppermost part of the lung is called the apex, and the lower area is the base. The haulm of the lung is the midline region where blood vessels, nerves, and bronchial tubes enter and exit the organ. The space between the right and left lung is the mediastinum. It contains the heart, aorta, esophagus (gullet) and the bronchi.
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A double fold of serous membrane, the pleura, surrounds the lungs. The innermost layer is the visceral pleura; the outermost, the parietal pleura. The small space between these membranes is the pleural cavity, which contains a small amount of lubricating fluid permitting the visceral pleura to glide smoothly over the parietal pleura during respiration. The ability of the lungs to fill with air and to expel it depends upon a pressure differential between the atmosphere and the chest cavity. A large muscular partition, the diaphragm, lies between the chest cavity and abdominal cavity. By contracting and relaxing, the diaphragm produces the needed pressure differential for respiration. When the diaphragm contracts, it partially descends into the abdominal cavity, decreasing the pressure within the chest. This allows the air to enter the lungs. When the diaphragm begins to relax, it slowly re-enters the thoracic cavity. This increases the pressure within, and air slowly passes from the lungs. The intercostal muscles assist the diaphragm in changing the volume of the thoracic cavity. As the diaphragm contracts, the intercostal muscles elevate the rib cage (chest). Both of these activities result in enlarging the thoracic cavity. Consequently, the air from the environment passes into the lungs. The reverse activity causes air to pass from the lungs into the environment. Key Terms • adenoids – collections of lymphatic tissue in the nasopharynx; pharyngeal tonsils • alveolus (pl. alveoli) – air sac in the lung • apex of the lung – the uppermost portion of the lung • bronchioles – smallest branches of the bronchi • bronchus (pl. bronchi) – branch of the trachea that acts as a passageway into the air spaces of the lung; bronchial tube • cilia (sg. cilium) – thin hairs in the mucous epithelium lining the respiratory tract • epiglottis – a lid-like piece of cartilage covering the larynx • exhalation – breathing out (expiration) • glottis – the opening to the larynx • inhalation – breathing in (inspiration) • larynx – voice box • pharynx – throat • pleura – double-folded membrane surrounding each lung • pulmonary parenchyma – cells of the lung performing its main function • trachea – windpipe
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Combining Forms Meaning
Terminology
adenoid/o
adenoids
adenoidectomy = surgical removal of adenoids
alveol/o
alveolus
alveolar = pertaining to the alveoli
bronch/o bronchi/o
bronchial tube bronchospasm = spasm of the bronchi bronchiectasis = dilation of the bronchi
capno/o
carbon dioxide hypercapnia = excessive amount of CO2 in the blood
coni/o
dust
lob/o
lobe of the lung lobectomy = removal of a lung lobe
nas/o rhin/o
nose
nasal = pertaining to the nose rhinoplasty = repair of the nose
pector/o steth/o thorac/o
chest
pectoral = pertaining to the chest stethoscope = instrument for examining the chest thoracodynia = pain in the chest
phon/o
voice (sound)
dysphonia = voice impairment
phren/o
diaphragm; mind
phrenic = pertaining to the diaphragm or the mind
pneum/o pneumon/o
air, lung
pneumothorax = air in the chest cavity pneumonitis = inflammation of the lung; pneumonia
pulmon/o spir/o
coniosis = lodging of dust particles in the lungs
pulmonary = pertaining to the lungs breathing
spirometer = instrument for the measurement of breathing, or lung, capacity
Disorders of the Respiratory System Atelectasis is a condition in which the lung is collapsed, or more simply, in an airless state. The prefix atel- means incomplete - hence the definition of imperfect expansion of the air sacs, functionless, airless lung or portion of a lung. The bronchioles and alveoli (pulmonary parenchyma) resemble a collapsed balloon. Common causes of atelectasis include blockage of a bronchus or smaller bronchial tube after general anesthesia for surgery and a chest wound that permits air to leak into the pleural cavity. Acute atelectasis requires removal of the underlying cause (tumour, foreign body, excessive secretions) and therapy to open airways. Chronic atelectasis may neces91
sitate lobectomy and antibiotics to combat infection of the lung. Atelectasis may occur at birth (congenital) when the lungs fail to inflate properly in the newborn infant (neonate). Chronic Obstructive Lung Disease (COLD) Chronic obstructive lung disease or chronic obstructive pulmonary disease (COPD) includes respiratory diseases characterized by obstructions in the bronchi or bronchioles that inhibit the flow of air into and out of the alveoli. These diseases include bronchial asthma, chronic bronchitis, pulmonary emphysema, and bronchiectasis. Chronic obstructive lung disease cause difficulty in breathing (dyspnea) and is associated with and overdevelopment of tissue (hyperplasia) within the lungs and bronchi. Bronchial asthma often results as a response to an allergen. Etiology may involve infection, or be related to nervous tension and emotional problems. With this condition there is a narrowing or constriction of the bronchi, accompanied by a sudden or violent attack (paroxysm) of dyspnea, wheezing, gasps, and cough. Treatment includes the use of agents that loosen and break down mucus (mucolytics) in order to facilitate the obstructed air passages. Oxygen therapy may be also needed. Chronic bronchitis is an infection of the bronchi. A thickening of the bronchial walls occurs, decreasing the inner diameter (lumen) of the bronchi. Associated with chronic bronchitis is a heavy and productive cough which facilitates the expelling of mucus from the lungs (expectoration of sputum). Pulmonary emphysema is a disease in which the alveoli lose elasticity. The air sacs expand (dilate) but are unable to contract to their initial form. Air is trapped in the alveoli, and many bronchioles are obstructed by mucorrhea. Consequently, the patient must actively engage in exhaling (expiration) in order to force the air from the lungs. Frequently, the patient experiences discomfort in breathing in any but the erect, sitting or standing positions (orthopnea). As a result of dyspnea and hypoxemia, the heart must work harder to pump blood and this leads to right-sided heart failure (cor pulmonale). In bronchiectasis there is a dilation of the bronchus or bronchi that results in the production of large amounts of sputum mixed with pus (purulent sputum). Treatment of this condition includes the use of agents that relax the smooth muscles of the bronchi (bronchodilators) and loosen sputum in the chest (expectorants).
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Pleural effusion is a disorder in which fluids or air escape into the pleural cavity. Two techniques used in the diagnosis of the pleural effusion include listening to the sounds of the chest cavity with or without a stethoscope (auscultation) or gently tapping the chest cavity with the fingers to determine the position, size, or consistency of the underlying structures (percussion). Pleural effusion may include the escape of pus (pyothorax, empyema), serum (hydrothorax), blood (hemothorax), air (pneumothorax), or mixture of pus and air (pyopneumothorax), into the pleural cavity of the chest. Pneumoconiosis is a condition in which small particles of dust lodge in the lung. Various forms of pneumoconioses are named according to the type of dust particle inhaled: • silicosis - silica dust or glass (grinder’s disease) • anthracosis - coal dust (black-lung disease in coal miners) • asbestosis - asbestos particles (in shipbuilding and construction industry) • byssinosis - cotton, flax, and hemp (brown-lung disease) • chalicosis - lime stone • siderosis - iron • volcanoconiosis -volcanic ash Pneumonia is an inflammatory disease of the lungs and infection of the alveoli. It may be caused by a variety of agents including bacteria, viruses, chemicals, or other substances. Infection damages alveolar membranes so that fluid, blood cells, and debris consolidate in the alveoli. Chest pain (thoracodynia), purulent sputum, and coughing up of blood (hemoptysis) are frequent symptoms of pneumonia. Lobar pneumonia involves one or more lobes of a lung associated with consolidation. Bronchopneumonia begins in the terminal bronchioles. Bed rest and antibiotics are important in therapy. Other Pathological and Related Terms anosmia
absence or lack of the sense of smell
apnea
temporary loss of breathing
asphyxia
insufficient supply of oxygen
atelectasis
airless state of lungs
auscultation
listening to sounds in the chest cavity
bronchogenic carcinoma
cancerous tumour arising from a bronchus; lung cancer 93
compliance
ease with which lung tissue can be stretched
coryza
head cold; upper respiratory infection (URI)
crackle
abnormal respiratory sound; rale
croup
acute respiratory syndrome in children and infants; characterized by obstruction of the larynx, barking cough, and stridor
cystic fibrosis
hereditary disorder of exocrine glands causing the secretion of thick mucus that clogs ducts of respiratory and digestive tracts
diphtheria
acute bacterial infection of the throat and upper respiratory tract
epistaxis
nasal hemorrhage; nosebleed
hypoxemia
oxygen deficiency in the blood
hypoxia
oxygen deficiency in tissues – sign of respiratory insufficiency
pertussis
whooping cough – a contagious bacterial infection of the upper respiratory tract
pleurisy
inflammation of the pleural membrane
pulmonary abscess
localized area of pus in the lungs
pulmonary edema
swelling and fluid in the air sacs and bronchioles
pulmonary embolism
floating clot (embolus) or other material blocking the blood vessels of the lung
sputum
material expelled from the chest by coughing or clearing the throat
stridor
a strained, high-pitched noisy breathing associated with obstruction of the larynx and bronchus
sudden infant death
unexpected and unexplained death of an apparently normal, healthy infant usually less than 12 months of age; crib death
syndrome (SIDS) tuberculosis
an infectious disease due to Mycobacterium tuberculosis
wheeze
whistling or sighing sound heard on auscultation resulting from narrowing of the lumen of respiratory passageways
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EXERCISES 1.1. The main organs in the respiratory system are: ....................................................... 1.2. The respiratory system provides the following functions: ..........................................................................................................................................................................
2. Fill in the correct term: 2.1. Within the nasopharynx there is a collection of lymphatic tissue known as adenoids or ........................................................................................................................................ 2.2. A leaf-shaped structure in the larynx the......................................... seals off the air passage to the lungs during ................................................................................................... 2.3. A double-fold serous membrane that surrounds the lungs is called ..........................................................................................................................................................................
2.4. A large muscular partition, the ...................................... lies between the chest cavity and abdominal cavity. 2.5. Pulmonary emphysema is a ................................................... in which alveoli lose ..........................................................................................................................................................................
3. Give the opposite of each term: 3.1. external .....................................................
3.6. single ..........................................................
3.2. receive ........................................................
3.7. inhibit ..........................................................
3.3. posterior ...................................................
3.8. palpable .....................................................
3.4. rigidity ........................................................
3.9. frequent .....................................................
3.5. expand ........................................................
3.10. always ......................................................
4. Match the following terms with their meanings: 4.1. dyspnea .....................................................
a) lodging of small particles of dust in the lungs
4.2. bronchodilator .......................................
b) coughing up of blood
4.3. empyema (pyothorax) .......................
c) accumulation of pus in the thoracic cavity
4.4. hemoptysis ..............................................
d) an agent that causes relaxation of the smoothmuscles of the bronchi 95
4.5. pneumoconiosis ...................................
e) difficulty in breathing
5. Give the meanings of the following terms: 5.1. orthopnea .................................................
5.6. pleurisy ......................................................
5.2. pertussis ...................................................
5.7. embolism .................................................
5.3. epistaxis ....................................................
5.8. pneumoconiosis ...................................
5.4. pleura .........................................................
5.9. mediastinum ..........................................
5.5. alveolus .....................................................
5.10. larynx .......................................................
6. Provide the singular form of the following nouns 6.1. lumina ........................................................
6.6. feet ...............................................................
6.2. sputa ...........................................................
6.7. allergies ....................................................
6.3. thoraces ....................................................
6.8. pharynges ................................................
6.4. alveoli .........................................................
6.9. chalicoses ................................................
6.5. bronchi .......................................................
6.10. pleurae ....................................................
7. Provide the noun form for the following adjectives: 7.1. hyperplastic ............................................
7.6. removed ....................................................
7.2. orthopnic ..................................................
7.7. oxygenated ..............................................
7.3. pulmonary ................................................
7.8. pharyngeal ...............................................
7.4. purulent .....................................................
7.9. cartilagenous .........................................
7.5. environmental .......................................
7.10. costal ........................................................
8. Give appropriate medical term for the following: 8.1. breathing is only possible in an upright position ...................................................... 8. 2. coughing up of blood ................................................................................................................ 8. 3. condition of pus in a pleural cavity .................................................................................. 8. 4. high pitched, harsh sound heard during inspiration ............................................. 8. 5. listening to sounds with a stethoscope .........................................................................
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8. 6. incision of a bronchus ............................................................................................................. 8. 7. surgical repair of the nose .................................................................................................... 8. 8. absence of the sense of smell ............................................................................................ 8. 9. normal (good) breathing ........................................................................................................ 8.10. surgical puncture of the chest .......................................................................................... 9. Translate into Croatian: Pleurisy is a general term for any inflammation of the pleura, the membrane that covers the outside of the lungs and lines the chest cavity. The more common simple inflammation of the pleura is called dry pleurisy. When the inflamed pleura also has fluid oozing from it, the condition is called wet pleurisy. The fluid produced in wet pleurisy often compresses the lungs. Pleurisy may be a complication of other diseases such as an upper respiratory tract infection, pneumonia, tuberculosis, or a tumour. Dry pleurisy can be caused by any type of infection of the lungs; however, it most often follows viral or bacterial pneumonia. It may also accompany acute bronchitis, or be a complication of tuberculosis or tumour. Wet pleurisy can also be caused by infection, tuberculosis, or tumour, as well as by injury or liver disease. Certain liver diseases may inflame the diaphragm and thus inflame the part of the pleura that covers the diaphragm. (From: Ellis, J.W. Medical Symptoms and Treatments) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 8
CARDIOVASCULAR SYSTEM The cardiovascular system is composed of the heart, blood vessels and blood. The principal function of the system is to provide all body tissues and cells with adequate amounts of oxygenated blood and to return blood laden with cellular metabolic wastes to proper excretory organs. The pumping action of the heart muscle is of utmost importance in performing these functions. The Vascular System Three types of vessels carry blood throughout the body. Each differs in structure depending on its function. These vessels include the arteries, capillaries and veins. Arteries Arteries carry blood from the heart to body tissues and organs. The blood is propelled by the pumping action of the heart. Consequently, arterial walls are thick and muscular and capable of expanding to accommodate the surge of blood that results when the heart contracts. The expansion of the arterial walls at each heartbeat is referred to as a pulse. Because of the pressure against the arterial walls associated with the pumping action of the heart, a cut or severed artery is a serious condition. Blood in all arteries contains a high concentration of oxygen (02), except for the blood in the pulmonary artery. Blood that is rich in 02 is referred to as oxygenated blood. Arteries branch to form smaller vessels called arterioles (little arteries). Eventually, the arterioles branch to form the smallest vessels of the circulatory system, the capillaries. Capillaries Capillaries are microscopic vessels that join the arterial system with the venous system. Although seemingly the most insignificant of the three types
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because of size, they are functionally the most important. The walls of the capillaries are composed of a single layer of endothelial cells. The thinness of these walls makes it possible for the substances to pass quite readily into and out of the vessels. Consequently, the primary function of the vascular system - providing cells with vital products - is accomplished by the capillaries. It is important to note that the vast number of capillaries makes their combined diameter so great that blood tends to flow through them very slowly. This allows sufficient time for the exchange of materials to occur between blood and body cells. The pathway for this exchange is as follows: Vital Products – Blood to Body Cells – Waste Products – Blood to Excretory Organs Veins All veins carry blood back to the heart from body organs and tissues. Veins are formed from smaller vessels called venules (little veins). Capillaries connect arterioles to venules. This connection provides a gateway for the return of blood back to the heart. The extensive network of capillaries throughout the body absorbs the propelling pressure exerted by the heart. Blood in veins now must rely on other methods of propulsion in order to return to the heart. These methods include muscular contraction (especially in the legs), gravity (in the upper areas of the body), respiratory activity (in the thoracic area), and valves. Valves are small structures within the vessels that prevent the backflow of blood. Valves are especially important in the legs where blood, in order to reach the heart, must travel long distances against the force of gravity. The blood carried in veins contains high concentrations of CO2 (except for the blood in the pulmonary vein). The CO2 is a waste product of cell metabolism and is carried back to the heart. From the heart it is transported to the lungs where it is expelled. The Heart The heart is a hollow, muscular organ that pumps blood through the blood vessels. It is enclosed in a fibroserous sac called the pericardium. The heart has three distinctive layers of tissue: 1. the endocardium, a serous, innermost membrane which lines the four chambers of the heart and valves and is continuous with the arteries and veins; 2. the myocardium, the muscular, middle layer of the heart; 3. the epicardium, the outermost (external) layer of the heart. The heart is divided into four chambers. These chambers are the right atrium, right ventricle, left atrium and left ventricle. The two upper chambers, 99
the atria, collect blood. The two lower chambers, the ventricles, pump blood from the heart. The right side of the heart provides for oxygenation of blood (pulmonary circulation), and the left side is responsible for transportation of blood to and from body cells (systemic circulation). The muscular wall dividing the right side of the heart from the left is called the septum. Body cells produce waste substances during metabolism. These waste products include carbon dioxide (CO2), a gas that must be removed from the cells or tissue death will occur. Red blood cells accept the CO2 from body cells and transport it to the heart by way of two large veins: the superior vena cava, a vein which collects and carries blood from the top portion of the body, and the inferior vena cava, a vein that collects and carries blood from the lower portion of the body. The presence of CO2 gives the blood in veins a purple-red colour. Blood is collected in the top right chamber of the heart, the right atrium. From the right atrium blood passes through the tricuspid valve to the right ventricle. The tricuspid valve prevents blood from returning to the right atrium during contraction of the ventricles. When the heart contracts, blood leaves the right ventricle by way of the pulmonary artery. This artery branches into millions of capillaries within the lungs. At this point, CO2 in the red blood cells is replaced by O2 that has been drawn into the lungs during inspiration. The oxygenated blood takes on a bright red appearance. The pulmonary capillaries unite to form the pulmonary veins which carry blood back to the heart. The right and left pulmonary veins enter the left atrium of the heart carrying oxygenated blood. This blood passes from the left atrium through the bicuspid valve (also called the mitral valve) to the left ventricle. Upon contraction of the heart, the oxygenated blood leaves the left ventricle through the largest artery of the body, the aorta. Within the aorta is a valve called the semilunar valve or aortic valve. This valve permits blood to flow in only one direction - from the left ventricle to the aorta. The aorta branches into many smaller arteries that carry blood to all parts of the body. Some arteries derive their name from the organs or areas of the body they vascularize. For example, the coronary arteries vascularize the heart muscle, the renal arteries vascularize the kidneys, and so on. It is important to note that the O2 present in the blood passing through the chambers of the heart cannot be used by the myocardium. Consequently, an arterial system called the coronary arteries, which branch from the aorta, provides the heart with its own blood supply. If, for any reason, the flow of blood in the coronary arteries is diminished, myocardial damage may result. If severe damage occurs, death results.
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Figure 8.1. The heart and its components.
Blood Pressure (BP) Each heartbeat is composed of two phases, the contraction, phase, or systole, when the blood is forced out of the heart, and the relaxation phase, or diastole. A blood pressure measures the force exerted by the blood against the artery walls during these two phases. Systole indicates the maximum force exerted by the blood against the artery walls; diastole, the weakest. These are recorded as two figures separated by a slant (/); the systolic pressure is given first, followed by the diastolic pressure. For example, a blood pressure may be recorded as 120/80; 120 is the systolic pressure, and 80 is the diastolic pressure. Blood pressure is measured by a device called a sphygmomanometer. Several factors influence the blood pressure, including the resistance of blood flow in the blood vessels, the pumping action of the heart, the viscosity or thickness of blood, the elasticity of the arteries, and the quantity of blood, in the vascular system. An elevated pressure is called hypertension; a decreased pressure is called hypotension. The Conductive System of the Heart Within the heart there is a specialized cardiac tissue known as conductive tissue. Its sole function is the initiation and propagation of contraction impulses. The conductive tissue consists of four masses of highly specialized cells: 1. sinoatrial node (S-A node) 2. atrioventricular node (A-V node) 101
3. bundle of His 4. Purkinje fibers The S-A node, located in the upper portion of the right atrium, possesses its own intrinsic rhythm. Without any stimulation by external nerves, it has the ability to initiate and propagate each heartbeat, thereby setting the basic pace for the cardiac rate. For this reason, it is commonly known as the pacemaker. This rate may be altered, however, by impulses from the autonomic nervous system. Such an arrangement allows outside influences to accelerate or decelerate the rate of the heartbeat. For example, during a period of physical exertion, the heart beats faster, and during a restful interval the rate becomes slower. Each electrical impulse discharged by the S-A node is transmitted to the A-V node causing the atria to contract. The A-V node is located at the base of the right atrium. From this point a tract of conducting fibres called the bundle of His, composed of a right and left branch, relays the impulse to both the right and left ventricles, causing them to contract. The blood is now forced out of the heart through the pulmonary artery and the aorta. In summary, the sequence of involvement of the four structures in the heart that are responsible for the conduction of a contraction impulse is as follows: S-A node - A-V node - Bundle of His - Purkinje fibres Impulse transmission through the conduction system generates weak electrical currents which can be detected on the surface of the body. These electrical impulses can be recorded on an instrument called electrocardiograph Figure 8.2. The Conductive System of the Heart
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(ECG). The record used to detect these electrical changes in heart muscle as the heart beats is called an electrocardiogram (ECG) or EKG. The deflection of the needle of the electrocardiograph produces waves or peaks designated by the letters P, Q, R, S and T, each of which is associated with a specific electrical event (impulse). The P wave is the depolarization of the atria, and the QRS complex is the depolarization of the ventricles. The T wave, which appears a short time later, is the repolarization of the ventricles. Key Terms • • • • • • • • • • • • • • • • • • • • • • • • • •
aorta – largest artery in the body arteriole – small artery atrium (pl. atria) – upper chamber of the heart capillary – smallest blood vessel coarctation – narrowing (of the aorta) cor – the heart coronary arteries – blood vessels that carry oxigen-rich air to the heart diastole – relaxation phase of the heartbeat endocardium – inner lining of the heart endothelium – innermost lining of blood vessels infarction – area of dead tissue mitral valve – a valve between the left atrium and the left ventricle of the heart murmur – abnormal heart sound myocardium – muscle layer of the heart occlusion – closure of a blood vessel pacemaker – special tissue in the right atrium that begins the heartbeat (SA node) palpitation – uncomfortable sensation in the chest related to cardiac arrhythmia patent - open pericardium – sac-like membrane surrounding the heart pulmonary circulation – the flow of blood from the heart to the lungs and back to the heart pulse – heartbeat systemic circulation – the flow of blood from body cells to the heart and back, i.e. from the heart to the body cells systole – contraction phase of the heartbeat valve – a structure in the heart and in veins that temporarily closes an opening so that blood flows in one direction only ventricle – lower and larger chamber of the heart venule – small vein 103
Combining Forms Meaning
Terminology
angi/o
vessel (artery) angioplasty = repair of a severed blood vessel
aort/o
aorta
aortostenosis = narrowing of the aorta
arter/o arteri/o
artery
arteriosclerosis = hardening of an artery
atrio/o
atrium
atrial = pertaining to the atrium
brachi/o
arm
brachial artery = artery in the upper arm
cardi/o
heart
cardiomegaly = abnormally large heart
coron/o
coronary artery arteries supplying the heart muscle with blood
hemangi/o
blood vessel
hemangiona = tumour of a blood vessel
phleb/o ven/o
vein
phlebitis = inflammation of a vein venous = pertaining to a vein
scler/o
hardening
arteriosclerosis = hardening of an artery
sphygm/o
pulse
sphygmomanometer = instrument for the measurement of blood pressure
sten/o
narrowing
aortostenosis = narrowing or stricture of the aorta
steth/o
chest
stethoscope = instrument for the listening of sounds in the chest cavity
thromb/o
clot
thrombolysis = destruction of a blood clot
valvul/o valv/o
valve
valvuloplasty = repair of a valve valvotomy = incision into a valve
vas/o vascul/o
vessel
vasodilation = expanding of blood vessel vascular = pertaining to blood vessel
ven/o
vein
venous = pertaining to a vein
ventricul/o
chamber of the ventricular = pertaining to the chamber heart or brain of the heart or brain (also: stomach)
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Pathological Conditions of the Cardiovascular System Coronary Artery Disease (CAD) Coronary artery disease is a condition in which the coronary arteries fail to deliver the amount of blood that is required by the heart muscle. As a result, localized areas of the heart experience a decrease in blood supply (ischemia). Usually, coronary artery disease is a result of a thickening and hardening of the inner wall of the coronary arteries (arteriosclerosis). Myocardial ischemia causes the patient to experience a suffocating chest pain (angina pectoris or angina) and difficulty in breathing (dyspnea). An attack of angina is generally associated with physical exertion or emotional stress. It generally lasts about five minutes and is relieved upon resting. The use of nitroglycerine, a medication that dilates the blood vessels (vasodilator), also brings relief. If pain cannot be controlled with medication, a surgery designed to circumvent the obstruction (by-pass surgery) may be required. Coronary artery disease may ultimately produce an acute myocardial infarction (AMI). In this life-threatening condition, blood supply in the coronary artery is totally suppressed, causing tissue death (necrosis or infarction) in a portion of the myocardium. Valvular Heart Disease The valves of the heart are generally thin, smooth structures that permit the flow of blood through the chambers of the heart. Birth defects or certain infections, especially those caused by scarlet fever or rheumatic fever, may produce scarring of the valves. When this occurs, there may be a narrowing of the valves (stenosis) or an inability of the valves to close properly, which is referred to as valvular insufficiency. Varicose Veins Varicose veins develop when damage occurs to the valves of the veins. A backflow of blood, especially in the legs, causes the veins to enlarge. Stagnation of the blood in varicose veins may cause the formation of a blood clot (thrombus). A more serious condition may subsequently develop when the thrombus breaks loose from the vein wall and begins to travel in the vascular system (embolism). Death may result if the embolus lodges in a vital organ. In extreme cases, the affected vein is tied off (ligated) and removed (stripped). Occasionally, varicose veins lead to a condition called phlebitis. If the infection occurs in a deep vein and involves the inner layer of vein tissue, clots may form resulting in a condition known as thrombophlebitis.
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Other Related Terms aneurysm – localized abnormal dilation of an arterial blood vessel angina pectoris – chest pain arrest – loss of effective cardiac function; cessation of blood circulation arrhythmia – abnormal heart rhythm; some examples are: 1. heart block (atrioventricular block) 2. flutter (up to 260 beats per minute) 3. fibrillation (350 and more beats per minute) bruit – heart murmur cardiomyopathy – any disease or weakening of heart muscle that diminishes its function congenital heart disease – abnormalities in the heart at birth; some examples are: 1. coarctation of the aorta (narrowing of the aorta) 2. patent ductus arteriosus (small duct between the aorta and pulmonary artery remains open after birth) 3. septal defects (small holes in the septa between the atria or the ventricles) congestive heart failure – failure of the heart to supply adequate amount of blood to tissues and organs heart murmur – an extra heart sound heard between normal sounds of the heart hemostasis – arrest of bleeding or blood circulation hyperlipidemia – excessive amounts of lipids in the blood hypertension – elevated blood pressure; essential and secondary hypertensive heart disease – heart disorder caused by prolonged hypertension infarct (infarction) – area of tissue that undergoes necrosis as a result of cessation of blood supply ischemia – local and temporary deficiency of blood supply resulting from circulatory obstruction perfusion – circulation of blood or fluids through vessels of tissues and organs Raynaud phenomenon - short episodes of pallor and numbness in the fingers and toes due to temporary constriction of arterioles in the skin.
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rheumatic heart disease – heart disease caused by rheumatic fever stent – slender device used to support, or hold open tubular structures or arteries tetralogy of Fallot – a congenital malformation of the heart involving four distinct defects (1. pulmonary artery stenosis; 2. ventricular septal defect; 3. shift of the aorta to the right; 4. hypertrophy of the right ventricle) vegetations – collections of platelets, clotting proteins, microorganisms, and red blood cells that attach to the endoradium in conditions such as bacterial endocarditis and rheumatic heart disease. EXERCISES 1. The cardiovascular system is composed of: ............................................................................ 2. What are the arteries, capillaries and veins responsible for? ...................................... ...................................................................................................................................................................................
3. Fill in the correct term: 3.1. Blood that is rich in O2 is referred to as ............................................................. blood. 3.2. The vas t number of capillaries makes their combined ................................... so great that blood tend to flow through them very ................................................................... 3.3. The extensive network of capillaries throughout the body absorbs the ..........................................................................................................
pressure exerted by the heart.
3.4. Within the aorta is a valve called the ..................................................................... valve. 3.5. An elevated blood pressure is called .................................................................................... 4. Match the following terms with their meanings: 4.1. pericardium .............................................
a) inflammation of a vein
4.2. S-A node ...................................................
b) slow heart action
4.3. bradycardia ..............................................
c) a fibroserous sac enclosing the heart
4.4. diaphoresis ..............................................
d) profuse sweating
4.5. phlebitis .....................................................
e) pacemaker
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5. Give the meanings of the following terms: 5.1. systole ................................................................................................................................................ 5.2. ischemia ............................................................................................................................................ 5.3. angina pectoris ............................................................................................................................. 5.4. fibrillation.......................................................................................................................................... 5.5. arteriosclerosis ............................................................................................................................ 5.6. arrhythmia ....................................................................................................................................... 5.7. sphygmomanometer ................................................................................................................. 5.8. heart murmur ................................................................................................................................ 5.9. bacterial endocarditis ............................................................................................................... 5.10. aneurysm ....................................................................................................................................... 6. Provide the plural form of the following nouns: 6.1. atrium .........................................................
6.6. vena cava ..................................................
6.2. aorta ............................................................
6.7. thrombus ..................................................
6.3. stenosis .....................................................
6.8. artery ..........................................................
6.4. embolus ....................................................
6.9. ventricle ....................................................
6.5. capillary .....................................................
6.10. emphysema ..........................................
7. Provide the adjective form for the following nouns: 7.1. vein ...............................................................
7.6. breathing ..................................................
7.2. insufficiency ............................................
7.7. inflation .....................................................
7.3. artery ..........................................................
7.8. heart ............................................................
7.4. dilation .......................................................
7.9. inflammation ..........................................
7.5. lungs ...........................................................
7.10. constriction ...........................................
8. Give appropriate medical term for the following: 8.1. short episodes of pallor and numbness in the fingers and toes ..................... ..........................................................................................................................................................................
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8.2. the varicose vein which is tied off ...................................................................................... ..........................................................................................................................................................................
8.3. a medication that dilates the blood vessels ................................................................ ..........................................................................................................................................................................
8.4. an electrical device used to restore normal heart rhythm.................................. ..........................................................................................................................................................................
8.5. failure of proper conduction of impulses through the A-V node to the bundle of His ............................................................................................................................................ 8. 6. drugs promoting loss of fluid .............................................................................................. 8. 7. surgical removal of an aneurysm ..................................................................................... 8. 8. tissue death ................................................................................................................................... 8. 9. the external layer of the heart ............................................................................................ 8.10. the valve which prevents blood from returning to the right atrium during contraction of the ventricles ......................................................................................... ..........................................................................................................................................................................
9. Translate into Croatian: “The metal-and-plastic heart whirred and clicked in an eerie, mechanical rhythm as Dr. William DeVries, 40, removed the tracheal tube from his patient’s throat. For the first time since his artificial heart has been implanted about 36 hours earlier, William Schroeder, 52, could breathe on his own and speak.” Can I get you something to drink?” the doctor asked. Replied Schroeder: ‘’I’d like a beer.” It was, De Vries admitted afterward, one of the high points of the tension-filled hours following his second successful attempt to implant an artificial heart. By week’s end the world’s second recipient of an artificial heart was getting out of bed and sitting in a chair, eating solid foods and sipping that longed-for beer. On Friday Schroeder tested a new portable power system for the artificial heart. For 22 minutes in the afternoon, and an hour later that evening, he was free of the 323-1 b. air-driven unit that normally runs the heart, and was hooked up to small, 11-lb. device encased in a leather shoulder bag. The portable system worked flawlessly though there were two breathless 3-sec. intervals when the heart stopped beating, as technicians switched from one system to the other. Afterward, Schroeder thanked the inventor of the device, Engineer Peter Heimes of Aachen, West Germany, and shook his hand. From the beginning, Schroeder’s treatment seemed to go more smoothly
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than that of his predecessor, Seattle Dentist Barney Clark, the world’s first recipient of a permanent artificial heart. Clark’ s surgery and his 112 days of life with the man-made pump were fraught with life-and-death crises. “I felt certain that he would die on the operating table”, reflected Dr. Robert Jarvik, 38, designer of the Jarvik-7 heart used in both patients. “This time”, he said, “I felt the opposite.” (TIME, No. 50, December 10, 1984) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 9
URINARY SYSTEM In both males and females the urinary system consists of four major structures a pair of kidneys, two ureters, a bladder, and a urethra. The urinary system acts as the regulator of extracellular products of the body. Protein foods that we eat contain carbon, hydrogen, and oxygen plus nitrogen and other elements. The waste that is produced when proteins combine with oxygen is called nitrogenous waste, and it is more difficult to excrete it (to separate out) from the body than are gases like carbon dioxide and water vapour. The body cannot efficiently put the nitrogenous waste into a gaseous form and exhale it, so it excretes it in a form of a soluble (dissolved in water) waste substance called urea. Urea is an undesirable substance produced when body cells metabolize protein. Urea and other waste materials are collected from body tissues by the blood and are conveyed to the kidneys. The kidneys, in turn, filter these products from the blood as they form a complex solution called urine. Urine is eventually expelled from the body. Failure to eliminate urea may actually result in death. The major function of the urinary system is to remove urea from the bloodstream so that it does not accumulate in the body and become toxic. Urea is formed in the liver from ammonia, which in turn is derived from the breakdown of simple proteins (amino acids) in the body cells. The urea is carried in the bloodstream to the kidneys, where it passes with water, salts, and acids out of the bloodstream and into the kidney tubules as urine. Besides removing urea from the blood, another important function of the kidneys is to maintain proper balance of water, salts, and acids in the body fluids. Salts (sodium and potassium) and some acids are known as electrolytes (molecules which can conduct an electrical charge). Electrolytes are necessary for the proper functioning of muscles and nerve cells. The kidneys adjust the amounts of water and electrolytes by secreting some substances into urine and holding back others in the bloodstream for use in the body.
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In addition to forming urine and eliminating it from the body, the kidneys also act as endocrine organs, secreting into the bloodstream substances that act at some distant site in the body. Examples of the kidneys’ endocrine function include the secretion of the renin, a substance important in the control of the blood pressure, and erythropoietin, a material that regulates the production of red blood cells. The kidneys also secrete an active form of vitamin D, necessary for the absorption of calcium from the intestine. In addition, hormones such as insulin and parathyroid hormone are degraded and extracted from the bloodstream by the kidney. Figure 9.1. Anatomy of the major organs of the urinary system
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Kidneys and Associated Tubes (the macroscopic structures of the urinary system) Two kidneys, each about the size of a fist, are located in the retroperitoneal area of the abdominal cavity on either side of the vertebral column in the lumbar region of the spine. A concave medial borders gives the kidney its beanlike shape. The kidneys are embedded in a cushion of adipose tissue and surrounded by fibrous connective tissue for protection. They weigh about half a pound each. Near the medial border is a slitlike aperture, the hilus or hilum. It serves as an opening for a renal vein and a renal artery to enter the kidney. The renal artery carries the blood that is laden with waste products to the microscopic filtering tubules located within the kidney for purification. After the blood is cleansed, it leaves the kidney by way of the renal vein. The waste material now in the form of urine, is carried to a hollow chamber, the renal pelvis, that is located at the hilus. The chamber is an enlarged funnelshaped extension of the ureter at the entrance to the kidney. The kidneys consist of an outer cortex region (cortex means outer portion or bark, as in bark of a tree) and an inner medulla region (medulla means marrow or inner portion). Each ureter is a slender tube about ten to twelve inches in length and conveys urine, in peristaltic waves, to the bladder. Urinary bladder is an expandable (distensible) hollow, muscular sac in the pelvic cavity. It serves as a temporary reservoir for urine. The trigone is a triangular space at the base of the bladder where the ureters and the urethra lead out. Urethra is membranous tube through which urine is discharged from the urinary bladder. The process of expelling (voiding) urine through the urethra is called micturition. The external opening of the urethra is called the urethral or urinary meatus. The urethra is approximately one and one-half inches in the female and about seven inches in the male. Nephrons (the microscopic structures of the urinary system) Microscopic examination of the kidney reveals the presence of approximately one million tiny funnel-shaped structures called nephrons. Nephrons are responsible for maintaining homeostasis or a stable optimal internal environment by continually adjusting the conditions that are necessary for survival. When the level of various products in the blood elevates beyond a normal range, nephrons selectively remove them from the blood and re-establish a level that can sustain life. The substances that are removed by nephrons are the end products of metabolism - urea, uric acid, and creatinine.
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Nephrons also extract any excess sodium, chloride, and potassium ions which are referred to as electrolytes. Some pathological states may cause the appearance in the blood of certain undesirable substances which may also be removed by the nephrons. For example, when the blood sugar level becomes elevated, as in diabetes mellitus, the excess sugar is filtered from the blood and is removed from the body in the urine. Figure 9.2. Glomerulus and Bowman’s Capsule
Each nephron includes a renal corpuscle and a renal tubule. The renal corpuscle is composed of a tuft of capillaries, the glomerulus, and a modified, funnel-shaped end of the renal tubule, Bowman’s capsule. This capsule encases the glomerulus. An afferent vessel (arteriola glomerularis afferens) conveys blood to the glomerulus and a smaller efferent vessel (arteriola glomerularis efferens) carries blood away from the glomerulus. As the efferent vessel passes behind the renal corpuscle, it forms the peritubular capillaries. Each renal tubule consists of four sections: the proximal tubule, followed by the narrow loop of Henle; then, a larger portion, the distal tubule, and finally the collecting tubule. Removal of waste products from the blood by the nephron is accomplished by three physiological activities: filtration, absorption, and secretion. All of these activities are performed by different sections of the nephron. The first phase of urine production, filtration, occurs in the renal corpuscle. Here, water, electrolytes, sugar, amino acids, and other compounds pass from the blood plasma in the glomerulus into Bowman’s capsule. The fluid that is formed is called filtrate. The next phase of urine production starts with passing
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of filtrate through the four sections of the tubule. As it travels the long and twisted pathways, most of the water and some of the electrolytes and amino acids are absorbed by the peritubular capillaries, and thus re-enter the circulating blood. The final stage of urine production occurs when specialized cells of the collecting tubules secrete ammonia, uric acid, and other substances directly into the lumen of the tubule. Now the formation of urine is completed, and it passes from the collecting tubules to the renal pelvis, or basin of the kidney. Key Terms • ammonia – a pungent colourless gaseous alkaline compound of nitrogen and hydrogen easily soluble in water (NH3) • calix (calyx), pl. calices – a cup-shaped collecting region of the renal pelvis • catheter – a tube for injecting or removing fluids • cortex, pl. cortices – outer region of an organ (like a bark of a tree) • creatinine – nitrogenous metabolic waste excreted in urine • erythropoietin – a hormone secreted by the kidney that stimulates red blood cell production • filtration – a process by which some substances pass through a filter • glomerulus, pl. glomeruli – tiny ball of microscopic blood vessels in kidney cortex • hilum, or hilus – a concave borderline or depression in an organ where blood vessels and nerves enter and exit the organ • meatus – opening or canal • medulla – the inner region of a structure or organ • micturition – urination, passing urine • nitrogenous wastes – substances containing nitrogen (wastes produced in muscle metabolism • renal pelvis – central collecting region in the kidney • renal tubules – microscopic tubes in the kidney where urine is formed as water, sugar, and salts are secreted back into the bloodstream • rennin – a hormone synthesized, stored and secreted by the kidney • trigone – triangular area in the bladder where the ureters enter and the urethra exits • urea – major nitrogenous waste product excreted in urine • ureter – one of two tubes leading from the kidney to the bladder • urethra – a tube leading from the bladder to the outside of the body • uric acid – nitrogenous waste excreted in the urine • voiding – expelling urine (micturition)
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Combining Forms Meaning
Terminology
cali/o calic/o
calyx
caliectasis (dilation of the kidney calices) caliceal (pertaining to the kidney calyx)
cyst/o vesic/o
urinary bladder
cystitis (inflammation of urinary bladder) perivesical (around the urinary bladder)
lith/o
stone, calculus
lithotripsy (crushing of a stone)
nephr/o ren/o
kidney
nephritis (inflammation of the kidney) renal (pertaining to the kidney)
pyel/o
renal pelvis
pyelolithotomy (removal of calculus that blocks the flow of urine)
ur/o
urine, urinary
urolith (stone formation in the urinary tract)
Disorders of the Urinary System and Other Pathology Related Terms anuria
absence of urine production or urinary output
azotemia (uremia)
retention of excessive amounts of nitrogenous compounds in the blood
bacteriuria
presence of bacteria in the urine
bladder neck obstruction (BNO)
occurs when there is a blockage of the bladder outlet; the obstruction may be the result of an enlarged prostate gland (prostatic hypertrophy), or the presence of any obstructive masses (calculi, blood clots, tumour)
dysuria
difficult or painful urination
enuresis (incontinence) involuntary discharge of urine essential hypertension high blood pressure without an apparent cause leading to the narrowing and thickening of arterial walls in the kidney frequency
voiding urine at frequent intervals
glomerulonephritis
inflammation of the kidney glomerulus (Bright disease)
hematuria
presence of blood in the urine
hesitancy
involuntary delay in initiating urination
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hydronephrosis
enlarged and distended kidney resulting from the obstruction of urine flow (water in the kidney)
interstitial nephritis
inflammation of connective tissue between the renal tubules (renal interstitium)
nephrolithiasis (renal calculi)
kidney stones, usually composed of uric acid or calcium salts
nephritic syndrome (nephrosis)
a group of symptoms caused by excessive protein loss in the urine
nocturia
excessive or frequent urination after going to bed
oliguria
diminished urine production
polycystic kidney
multiple fluid-filled sacs (cysts) within and upon the kidney
pyelonephritis
inflammation of the renal pelvis
renal failure
failure of the kidney to excrete urine
renal hypertension
high blood pressure resulting from kidney disease; the most common type of secondary hypertension
urgency
feeling of the need to void immediately
urinary retention
blockage in the passage of urine from the bladder
EXERCISES 1.1. List some functions of the urinary system: .......................................................................... ...................................................................................................................................................................................
1.2. What are the macroscopic structures of this system? .......................................... ..........................................................................................................................................................................
2. Fill in the correct term: 2.1 After the blood is ................................................ , it leaves the kidneys by way of the renal vein. 2.2. The renal pelvis is located at the......................................................................................... 2.3. When .......................................... or a desire to urinate is experienced, the urine is expelled from the .............................................................................. through the urethra. 2.4. Nephrons are responsible for maintaining ..................................................................
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2.5. Glomerulonephritis is an .......................................................................... of the kidney 3. Give the opposite of each term: 3.1. soluble .......................................................
3.6. sufficiency ................................................
3.2. eventually .................................................
3.7. common ....................................................
3.3. failure .........................................................
3.8. loss ...............................................................
3.4. destruction ..............................................
3.9. widening ....................................................
3.5. outside .......................................................
3.10. accelerate ..............................................
4. Match the following terms with their meanings: 4.1. hematuria .................................................
a) a slitlike aperture
4.2. glycosuria .................................................
b) protein in the urine
4.3. pyuria ..........................................................
c) blood in the urine
4.4. proteinuria ...............................................
d) sugar in the urine
4.5. hilus .............................................................
e) pus in the urine
5. Give the meanings for the following terms: 5.1. nephrorraphy .........................................
5.6. essential hypertension .....................
5.2. pyeloplasty ...............................................
5.7. hematuria .................................................
5.3. nephrectomy ..........................................
5.8. polydipsia .................................................
5.4. albuminuria ............................................
5.9. micturition ...............................................
5.5. uremia ........................................................
5.10. urethra ....................................................
6. Provide the adjective form for each of the following: 6.1. meatus .......................................................
6.6. glomerulus ..............................................
6.2. tube ..............................................................
6.7. night ............................................................
6.3. nephrosis ..................................................
6.8. excess .........................................................
6.4. urine ............................................................
6.9. blockage ....................................................
6.5. ischemia ....................................................
6.10. acid ............................................................
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7. Provide the plural form of the following nouns: 7.1. calyx/calix .................................................
7.6. nephrosclerosis ....................................
7.2. proteinuria ...............................................
7.7. abscess ......................................................
7.3. glomerulus ..............................................
7.8. nephroma .................................................
7.4. kidney .........................................................
7.9. biopsy ..........................................................
7.5. nephropexy ..............................................
7.10. meatus ....................................................
8. Give appropriate medical term for the following: 8.1. inflammation of the walls of the glomeruli ................................................................. 8.2. kidney stones ................................................................................................................................. 8.3. surgical removal of renal calculi ........................................................................................ 8.4. inflammation of the renal interstitium ........................................................................... 8.5. thickening of the arteriole walls of the kidney ........................................................... 8.6. cup-shaped capsule surrounding each glomerulus ............................................... 8.7. a small molecule that carries an electrical charge ................................................ 8.8. opening or canal............................................................................................................................ 8.9. central collecting region in the kidney ............................................................................ 8.10. sac which holds urine ............................................................................................................ 9. Translate into Croatian: Urination is a complex process controlled by several sets of muscles, including the internal and external sphincters, which are circular muscles surrounding the urethra; they have the power to contract and prevent flow through it. The internal sphincter is at the outlet of the bladder and works automatically. The external sphincter, situated along the urethra below the prostate in males and at an equivalent position in females, is controlled voluntarily. As the bladder fills, the bladder muscles tend to contract automatically. The urge to urinate enters consciousness, but voiding may be controlled consciously to some extent. When the person decides to urinate, the bladder muscle contracts and both sphincters relax. (From: Miller & Keane: Encyclopedia and Dictionary of Medicine, Nursing and Allied Health) 119
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CHAPTER 10
NERVOUS SYSTEM The nervous system is one of the most complicated systems in both structure and function. Along with the endocrine system it controls many bodily activities that maintain a stable and suitable environment for all of the body cells - a situation known as homeostasis. The nervous system senses changes in both the internal and external environment, interprets these changes, and then coordinates responses that maintain homeostasis. The central nervous system (CNS) is composed of the brain and spinal cord. These structures receive, coordinate and transmit nervous impulses. The peripheral nervous system (PNS) is composed of all other nervous tissue found outside of the CNS. It includes 12 pairs of cranial nerves, which emerge from the base of the skull, and 31 pairs of spinal nerves, which emerge from the spinal cord. These nerves may be sensory or motor, or a mixture of both sensory and motor fibres. Figure 10.1. The divisions of the nervous system
Sensory nerves receive impulses from the sense organs, such as the eyes, ears, nose, tongue, and skin and transmit them to the CNS. These sensory nerves are also known as afferent nerves, because they conduct impulses toward a specific site, the central nervous system. 121
Figure 10.2 Transmission of an impulse to the CNS and from the CNS
Motor nerves conduct impulses away from the CNS, thus they are known as efferent nerves. These impulses travel to muscles and other body organs causing them to respond in some manner. If the response is under the control of the individual, such as walking or talking, the impulse is relayed by voluntary or somatic nerves. If the response is involuntary or nonthinking, such as digesting food or secreting hormones, the impulse is relayed by autonomic nerves.
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Nerves composed of both sensory and motor fibres are called mixed nerves. For example, when the facial nerve supplies the facial muscles with motor impulses, such as for smiling or frowning, it is functioning as a motor nerve. But when the tongue transmits a taste impulse to the brain, the facial nerve is functioning as a sensory nerve. The autonomic nervous system is responsible for the control of the internal environment: heart rate, peristaltic movement of the stomach and intestines, constriction of the iris, and other involuntary activities. This system is composed of a sympathetic and parasympathetic division. The two divisions are largely antagonistic to each other, although in certain instances they exhibit independent activity. Generally, sympathetic nerves initiate or accelerate an autonomic function, and parasympathetic nerves decelerate or stop the initiated activity. For example, in situations of fear or fright, sympathetic nerve fibres produce vasoconstriction and an increased heart rate and depress gastrointestinal activity. When the danger is passed, the parasympathetic system conveys impulses to bring about vasodilation, a slower heart rate, and a return to normal gastrointestinal activity. Nervous Tissue In spite of its complexity, the nervous system is composed of only two principal types of nerve cells, neurons and neuroglia. Neurons, the functional cells of the nervous system, are responsible for impulse conduction. All neural circuits are composed of neuron chains. In contrast to neurons, neuroglia does not transmit impulses. It is specialized nervous tissue that functions as connective tissue that supports and binds neurons. During infection, neuroglia is capable of performing certain phagocytic activities. Neurons Neurons consist of three major sections: the dendrites, which receive impulses and transmit them to the cell body; the cell body, which contains the cell nucleus; and the axon, a long single projection, which transmits the impulse from the cell body. Many axons in both the PNS and CNS are covered with a white, lipoid sheath called myelin. This wrapping accelerates the impulses that travel down the axon. The presence of myelin on axons in the brain and spinal cord gives a white appearance to these structures and makes up what is called the white matter of the CNS. Unmyelinated fibres, dendrites, and nerve cell bodies make up the gray matter. On peripheral nerves, a thin cellular membrane called neurolemma, or neurolemmal (Schwann) sheath, wraps around the myelin sheath. The neurolemmal sheath may allow a damaged axon to regenerate. Since no neurolemma can be found in the CNS, 123
injured nerves in the system cannot regenerate. Their nerve function is permanently lost. Neurons are not continuous with one another. Instead, a small space known as a synapse is found between the axon of one neuron and the dendrite or cell body of another. In order for the impulse to travel along a nerve path, the impulse must be transmitted at the synapse. This transmission is facilitated by certain chemical substances called neurotransmitters. Figure 10.3. A neuron, neuroglial cells
Neuroglia The term neuroglia literally means nerve glue. It was once believed that neuroglia served only a supporting role for neurons. But it is now known that different shaped neuroglia cells, perform many other functions. Astrocytes, as their name suggests, are star-shaped neuroglia and are believed to be involved in the transfer of substances from the blood to the brain. 124
Oligodendroglia are cells with only a few processes. They are believed to help in the development of myelin on neurons of the CNS. Microglia, the smallest of the ncuroglia, possess phagocytic properties and may become very active during times of infection.
The Brain In addition to being one of the largest organs of the body, the brain is also the most complex in structure and function. It integrates almost every physical and mental activity of the body. This organ is also the centre for memory, emotion, thought, judgment, reasoning and consciousness. The brain is composed of four major sections: the cerebrum, cerebellum, diencephalon (interbrain), and brain stem. Figure 10.4. Sections of the brain
The cerebrum is the largest and uppermost portion of the brain. It consists of two hemispheres divided by a deep longitudinal fissure or groove. The fissure does not completely separate the hemispheres. A structure called the corpus callosum joins them medially on their inferior surfaces. Each hemisphere is further divided into five lobes. Four of these lobes are named after the bones 125
that lie directly above them. A fifth lobe of the cerebrum is hidden from view and can only be seen upon dissection. Numerous folds, or convolutions, called gyri (singular: gyrus) are found in the cerebral surface. These are separated by furrows called fissures or sulci (singular: sulcus). A thin layer of gray matter called the cerebral cortex, composed of millions of cell bodies covers the entire cerebrum and is responsible for its gray colour. The remainder of the cerebrum is composed of white matter (myelinated axons). Major functions of the cerebrum include sensory perception and interpretation, muscular movement, and the emotional aspects of behaviour and memory. The second largest part of the brain, the cerebellum, occupies the back portion of the brain. lt is attached to the brain stem. When the cerebrum initiates muscular movement, the cerebellum coordinates and refines the movement. The cerebellum also maintains the equilibrium, or balance of the body. The diencephalon, or interbrain, is composed of many smaller structures, two of which are the thalamus and the hypothalamus. All sensory stimuli, except olfactory, are received by the thalamus. Here they are processed and transmitted to the proper area of the cerebral cortex. In addition, impulses from the cerebrum are received by the thalamus and relayed to efferent nerves. Beneath the thalamus is a small structure, the hypothalamus. Its chief function is the integration of autonomic nerve impulses and the regulation of certain endocrine functions. The brain stem completes the last major section of the brain. It is composed of three structures: the medulla oblongata, the pons, and the midbrain (mesencephalon). In general, the brain stem serves as a pathway for impulse conduction between the brain and the spinal cord. The brain stem also serves as the origin for 10 of the 12 pairs of cranial nerves. Spinal Cord The spinal cord conveys to the brain sensory impulses from different parts of the body and also transmits motor impulses from the brain to all muscles and organs. The sensory nerve tracts are also called ascending tracts, since the direction of the impulse is upward. Conversely, motor nerve tracts that relay motor impulses to muscles and organs are called descending tracts, since they carry impulses in a downward direction. A cross-section of the spinal cord reveals an inner gray area composed of cell bodies and dendrites, with an outer area composed of the myelinated tissue of the ascending and descending tracts.
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The entire spinal cord is located within the spinal cavity of the vertebral column. Thirty-one pairs of spinal nerves exit from between the intervertebral spaces almost throughout the entire length of the spinal column. Unlike the cranial nerves, which have specific names, the spinal nerves are known by the region of the vertebral column from which they exit. Meninges Both the brain and the spinal cord are protected against injury by bones. The brain is enclosed within the skull and the spinal cord is enclosed within the vertebral column. In addition, both the brain and spinal cord receive limited protection from a set of three coverings called meninges (singular: meninx). The outermost coat, the dura mater, is tough and fibrous. Immediately beneath the dura mater is a cavity called the subdural space. It is filled with serous fluid. The next layer of the meninges is the arachnoid. As its name suggests, the arachnoid has a spider-web appearance. A subarachoid space, filled with cerebrospinal fluid, provides additional protection for the brain and spinal cord by acting as a shock absorber. Finally, the innermost layer, the pia mater, contains numerous blood vessels and lymphatics, which provide nourishment for the underlying tissues. Cerebrospinal fluid circulates around the spin al cord and the brain and through spaces called ventricles. These ventricles are located within the inner portion of the brain. Key Terms • acetylcholine – neurotransmitter chemical released at the ends of some nerve cells • afferent nerves – nerves that carry impulses toward the brain and spinal cord; sensory nerves • blood-brain barrier – blood vessels that selectively let certain substances enter the brain tissue and keep other substances out • cauda equina – horse’s tail; a collection of spinal nerves below the end of the spinal cord at the level of the second lumbar vertebra • cell body – part of the nerve cell that contains the nucleus • cerebral cortex – outer region of the cerebrum; the gray matter of the brain • cerebrospinal fluid (CSF) – liquid that circulates throughout the brain and the spinal cord • convolution – elevated portion of the cerebral cortex; gyrus • efferent nerves – nerves that carry impulses away from the brain and spinal cord to the muscles, glands, and organs; motor nerves 127
• ependyma – a membrane lining the fluid-filled cavities of the brain ventricles and central canal of the spinal cord • gait – a manner of walking • microglial cell – one type of neurglial cell • neurotransmitter – a chemical substance (chemical messenger) released at the end of a nerve cell, that stimulates or inhibits another cell • palliative – relieving symptoms but not curing • plexus – a large interlacing network of nerves • receptor – an organ that receives a nervous stimulation and passes it on to nerves within the body • stimulus (pl. stimuli) – a change in the internal or external environment that can evoke a response • ventricles of the brain – canals (reservoirs) in the interior of the brain that are filled with cerebrospinal fluid Combining Forms Meaning
Terminology
alges/o
pain
analgesia = no sensitivity to pain
cerebr/o
cerebrum
cerebrotomy = incision of the cerebrum
crani/o
skull (cranium)
craniomalacia = softening of skull bones
dendr/o
tree
dendroid = resembling a branching tree
esthesi/o
nervous sensation
anesthesia = no nervous sensation (no feeling)
feeling encephal/o
brain
encephalitis = inflammation of the brain
gli/o
glu; neuroglia
glioma = tumour of neuroglial tissue
kinesi/o
movement
bradykinesia = condition of slow movement
lept/o
thin, slender leptomeningitis = inflammation of the pia and the arachnoid membranes
lex/o
word, phrase
mening/o
membranes meningocele = herniation of the covering meninges brain and spinal cord
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dyslexia = difficulty or inability in using words when reading or writing
myel/o
spinal cord
myelocele = herniation of the spinal cord
narc/o
stupor; numbness; sleep
narcotic = pertaining to or producing narcosis
neur/o
nerve
neurology = the study of nerves
radicul/o
nerve root
radiculopathy = disease of the nerve root(s)
sthen/o
strength
asthenia = lack of strength
tax/o
order, ataxia = persistent unsteadiness on the coordination feet
vag/o
vagus nerve vagotomy = incision of the vagus nerve (10th cranial nerve)
narcolepsy = uncontrollable compulsion to sleep
Disorders and Pathological Conditions of the Nervous System agnosia
inability to comprehend auditory, visual, spatial, or other sensation
Alzheimer disease
brain disorder marked by deterioration of mental capacity beginning at middle age; the disorder develops gradually, and early signs are loss of memory for recent events followed by impairment of judgment, comprehension, and intellect.
amyotrophic lateral
progressive disorder characterized by degeneration of motor neurons in the spinal cord and brain stem (Lou Gehrig Disease).
sclerosis (ALS) ataxia
failure of muscular coordination; irregularity of muscular action.
aura
premonitory awareness of an approaching physical or mental disorders; particularly sensation preceding seizures.
autism
developmental disorder characterized by extreme withdrawal and an abnormal absorption of fantasy; inability to communicate even on a basic level.
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Bell palsy
facial paralysis due to a functional disorder of the seventh cranial nerve; it produces weakness (asthenia) and numbness (anesthesia) of the face, corneal infection (keratitis), speech difficulties (dysphasia), pain behind the ear or in the face, overflow of tears down the cheek (epiphora) due to keratitis; often there appears grotesque facial disfigurement and facial spasms; it may result in unilateral paralysis (plegia) of facial muscles and distortion of taste perception.
cerebral palsy
partial paralysis and lack of muscular coordination due to damage to the cerebrum during gestation or in the perinatal period
cerebrovascular accident (CVA)
damage to the brain caused by a disorder within the blood vessels of the cerebrum, also known as a stroke or apoplexy; it is the result of a localized area of ischemia,in the brain; it may be caused by: 1. thrombosis - blood clot (thrombus) in the arteries leading to the brain, resulting in occlusion (blocking) of the vessel. This is the most common type of stroke, and may lead to paralysis. 2. embolism - a piece of clot (embolus) breaks off from its place or origin and occludes a cerebral artery. This type of stroke occurs very suddenly.
cerebral contusion
bruising of brain tissue as a result of direct trauma to the head; neurological deficits persist longer than 24 hours; a contusion is usually associated with a fracture of the skull.
coma
a state of unconsciousness from which the patient cannot be aroused; irreversible coma is one in which there is complete unresponsitivity to stimuli, no spontaneous breathing or movement – brain death.
concussion of the brain
temporary brain dysfunction after injury, usually clearing within 24 hours; there is no evidence of structural damage to the brain tissue; severe concussions may lead to coma.
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convulsion
any sudden and violent contraction of one or more muscles.
dementia
a broad term referring to cognitive deficit, including memory impairment.
dyslexia
inability to learn and process written language.
epilepsy
sudden transient brain dysfunction due to disturbances in discharging electrical brain impulses; two main types are: 1. grand-mal seizures, or tonic-clonic seizures that are manifested by severe convulsions and unconsciousness; and 2. petit-mal seizures, or absence seizures, characterized by momentary lapse of consciousness.
glioma
malignant tumour of the brain arising from glial cells.
Guillain-Barré syndrome
autoimmune condition that causes acute inflammation of peripheral nerves in which myelin sheaths are destroyed, resulting in decreased nerve impulses, loss of reflex response and sudden muscle weakness.
hemorrhage (bleeding)
bursting forth of blood from a cerebral artery.
herpes zoster (shingles)
viral disease affecting peripheral nerves.
Huntington chorea
hereditary nervous disorder involving bizarre, abrupt, involuntary movement.
hydrocephalus
abnormal accumulation of fluid in ventricles of the brain.
lethargy
abnormal inactivity or lack of response to normal stimuli.
meningioma
benign tumours of the brain.
meningitis
inflammation of brain meninges caused by viruses or bacteria.
multiple sclerosis (MS)
destruction of myelin sheath (demyelination) and replacement by neurological scar tissue that prevents the conduction of nerve impulses.
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myasthenia gravis
neuromuscular disorder characterized by relapsing weakness of skeletal muscles; it is a chronic autoimmune disorder in which the ability of acetylcholine (a neurotransmitter) is blocked
neuroblastoma
malignant tumour arising from immature nerve cells.
neurosis
non-psychotic mental illness that triggers feelings of distress and anxiety and impairs normal behaviour.
paralysis
loss or impairment of motor, or also sensory, function due to lesion of neural or muscular mechanism.
paraplegia
paralysis of the lower limbs or lower trunk.
paresis
slight or incomplete paralysis.
Parkinson disease
degeneration of nerves in the brain, occurring in later life, leading to tremors, weakness of muscles, and slowness of movement.
poliomyelitis
viral inflammation of the gray matter of the spinal cord.
Reye syndrome
acute encephalopathy and fatty infiltration of the brain, liver and lymph nodes (at times pancreas heart, kidney and spleen are involved).
sciatica
severe pain in the leg along the course of the sciatic nerve felt at the base of the spine, down the thigh, and radiating down the leg due to a compressed nerve.
seizure
sudden attack or recurrence of a disease.
spina bifida
congenital defect of the spinal column due to imperfect union of the vertebral parts; the most common types are: spina biffida occulta - vertebral lesion covered with skin and evident only on x-ray spina bifida with meningocele – meninges protrude through the vertebral defect spina bifica with meningomyelocele – the spinal cord and meninges herniated through the vertebral lesion
syncope
fainting; sudden loss of consciousness.
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Tourette syndrome
neurological disorder marked by involuntary, spasmodic, twitching movements; uncontrollable vocal sounds and inappropriate words.
transient ischemic attack
temporary interference with blood supply to the brain lasting (TIA) from a few minutes to a few hours.
EXERCISES 1.1. The functions of the nervous system are:...................................................................... ..........................................................................................................................................................................
1.2. The nervous system is divided as follows: ................................................................... ..........................................................................................................................................................................
2. Complete the following sentences: 2.1. Sensory nerves ......................................................................... from the sense organs. 2.2. Motor nerves ......................................................................................away from the CNS. 2.3. The autonomic nervous system is responsible for .................................................. 2.4. The two principal types of nerve cells are .................................................................... 2.5. The brain is composed of ........................................................................................................ 3. Give the opposite of each term: 3.1. peripheral ................................................
3.6. convergence ............................................
3.2. voluntary ...................................................
3.7. attraction ..................................................
3.3. afferent ......................................................
3.8. ancestry .....................................................
3.4. ascending .................................................
3.9. elastic .........................................................
3.5. progress ....................................................
3.10. proceed ...................................................
4. Match the following terms with their meanings: 4.1. thalamotomy ..........................................
a) neurotoxin
4.2. asthenia .....................................................
b) trembling
4.3. tremor ........................................................
c) incision into the thalamus
4.4. clonic spasm ..........................................
d) weakness
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4.5. nerve poison ...........................................
e) excessive loss of muscle tone
5. Give the meanings of the following terms: 5.1. anesthesia ....................................................................................................................................... 5.2. apoplexy ............................................................................................................................................ 5.3. encephalocele ................................................................................................................................ 5.4. neuralgia .......................................................................................................................................... 5.5. craniomalacia ................................................................................................................................ 5.6. neurotripsy ...................................................................................................................................... 5.7. gangliectomy .................................................................................................................................. 5.8. dysrhythmias .................................................................................................................................. 5.9. ataxia .................................................................................................................................................. 5.10. hemiplegia .................................................................................................................................... 6. Provide the plural forms of the following nouns: 6.1. meningococcus .....................................
6.6. sulcus .........................................................
6.2. cranium .....................................................
6.7. gyrus ...........................................................
6.3. cerebellum ..............................................
6.8. cortex ..........................................................
6.4. cerebrum ..................................................
6.9. equilibrium ..............................................
6.5. nucleus ......................................................
6.10. epilepsy ...................................................
7. Provide the noun form for the following adjectives: 7.1. neural .........................................................
7.6. sensory ......................................................
7.2. cerebral .....................................................
7.7. neuroglial .................................................
7.3. spinal ..........................................................
7.8. fibrous ........................................................
7.4. autonomic ................................................
7.9. emotional .................................................
7.5. central ........................................................
7.10. cranial ......................................................
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8. Give appropriate medical word for the following terms: 8.1. inflammation of the meninges ............................................................................................ 8.2. abnormal accumulation of fluid in the brain .............................................................. 8.3. muscle weakness marked by progressive paralysis .............................................. 8.4. inability to speak .......................................................................................................................... 8.5. slowness of movement ............................................................................................................ 8.6. inflammation of nerves ............................................................................................................ 8.7. measurement of the skull ...................................................................................................... 8.8. hardening of the spinal cord ................................................................................................. 8.9. x-ray picture of the brain ......................... : ............................................................................. 8.10. softening of nerve tissue ...................................................................................................... 9. Translate into Croatian: Case Report The patient was admitted on January 14 with a history of progressive right hemiparesis for the previous l to 2 months, fluctuating numbness of the right arm, thorax and buttocks, jerking of the right leg, periods of speech arrest, diminished comprehension in reading, and recent development of a spastic hemiplegic gait (partial hemiplegia with spasmodic contractions of muscles when walking). He is suspected of having a left parietal tumour. Examinations done prior to hospitalization included skull films, EEG, brain scan and CSF analysis, which were all normal. Following admission the brain scan was abnormal in the left parietal region, as was the EEG. Left percutaneous common carotid angiographywas attempted, but the patient became progressively more restless and agitated after receiving the sedation, so that it was impossible to do the procedure. During the recovery phase from the sedation the patient was alternatively somnolent and violent, but it was later apparent that he had developed almost a complete aphasia and right hemiplegia. In the next few days he became more alert although he remained dysarthric and hemiplegic. Bilateral carotid angiograms under general anesthesia on January 19 showed complete occlusion of the left internal carotid artery with cross-filling of the left anterior and middle cerebral arteries from the right internal carotid circulation.
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Final diagnosis: Left cerebral infarction due to left internal carotid artery occlusion. .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
Autopsy Report: Brain and Meninges Meninges were clear and adherent to underlying brain. The brain was grossly without evidence of metastases. There was questionable evidence of herniation bilaterally over the sphenoid ridge and herniation of the cerebellum. The brain was edematous. On the lateral surface of the pons there is small (less than l cm), brownish-red lesion located below the arachnoid thought to be hemorrhage vs. metastasis. Microscopically, the cerebral cortex over the sphenoid ridge did not demonstrate evidence of herniation; however, grossly nonpigmented area of necrosis in the cerebellum revealed metastatic melanoma. On the right lateral surface of the pons, the grossly pigmented lesion was on microscopic examination metastatic melanoma. Diagnosis: 1. Brain, edema. 2. Metastatic melanoma, pons, cerebellum. (From: Chabner D. E.: The Language of Medicine) 136
.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 11
BLOOD AND LYMPHATIC SYSTEMS Blood and lymph are specialized liquid tissues of the body. They circulate through the whole body and thus represent the chief means of transport within the body. Each is composed of cells that are suspended in a liquid medium. The blood and lymphatic systems have many functions. Blood transports oxygen from the lungs to the body tissues, and carbon dioxide from the tissues to the lungs. It carries nutrients and hormones to the tissues, removes waste products to the kidneys and carries fluid to and from the tissues, helping to maintain the fluid balance of the body. Lymph transports needed proteins that have leaked out of the blood capillaries back to the bloodstream via the veins. Both blood and lymph protect the body by carrying disease-fighting cells (phagocytes) and protein substances called antibodies that combat infection. Also, plasma proteins and blood clotting cells (platelets) contribute in the important coagulation (clotting) function of the blood. 1. Blood System Blood is composed of a liquid medium called plasma and a solid portion that consists of three major blood cells: red blood cells (erythrocytes), white blood cells (leukocytes) and platelets (thrombocytes). Blood cells account for about 45 percent and plasma accounts for about 55 percent of the total blood volume. All blood cells originate from unspecialized, immature cells called stem cells or hemocytoblasts (hemoblast or formative cell). They mature in the red bone marrow of adults (ribs, stern um, skull, vertebrae, pelvic bone and the ends of the long bones of the limbs) and the liver and spleen of the fetus. From the initial undifferentiated form blood cells change into specialized or differentiated cells which involves alterations in their size and shape. They change from large (immature cells) to small or mature forms; the size of the cell nucleus decreases (in red cells, the nucleus practically disappears).
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Blood plasma consists mainly of water in which are dissolved the substances carried by the blood to and from the tissues. Erythrocytes (Red Blood Cells) The great majority of the cells in the blood are red blood cells. There are about 5 million red blood cells in a s peck of blood the size of a pin-head, and about 35 trillion of them in the average adult. Although microscopic in size, these cells have a total surface area almost the size of a football field. This vast surface area is important in the blood’s task of carrying oxygen from the lungs to the tissues, because the exchange of oxygen in both places takes place across the cell surface and must be accomplished quickly as the blood flows by. Figure 11.1. The maturation of blood cells-hematopoiesis Stem cell
Bone marrow
Erythroblast
Myeloblast
Myelocyte Normoblast Metamyelocytes
Mature cells
Reticulocyte Circulating bloodstream
Monoblast
Megakaryoblast Lymphoblast
Erythrocyte
Megakaryocyte Prolymphocyte Promonocyte
Band cells Segmented
Basophilic Eosinophilic granulocyte granulocyte Neutrophilic granulocyte
Monocyte
Lymphocyte
Platelets
Agranulocytes
The erythrocytes owe their oxygen-carrying ability to the nonprotein heme, which contains iron and gives the blood its red colour. Heme combines with another protein, globin, and forms hemoglobin, a major part of the red blood cell. Hemoglobin has the special ability of attracting and forming a loose connection with free oxygen, and its presence enables blood to absorb about 60 times the amount of oxygen that the plasma by itself absorbs.
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Red blood cells are stored in the spleen, which acts as a reservoir for the blood system and discharges the cells into the blood as required. The spleen also discharges extra red blood cells into the blood during emergencies such as hemorrhage or shock. Red blood cells mature from undifferentiated reticuloendothelial cells and they live on the average about 110 to 120 days. Then red blood cells disintegrate and are removed in the spleen and the liver. About 180 million red blood cells are destroyed every minute. Since the number of cells in the blood remains more or less constant, this means that about 180 million red blood cells are manufactured every minute. The hemoglobin of destroyed cells is decomposed and carried to the liver. There the iron is stored and the rest of the chemicals are passed on to be excreted from the body in the bile, the feces and the urine. Leukocytes (White Blood Cells) The leukocytes are the body’s primary defence against infections. They have no hemoglobin and thus are colourless and, unlike red blood cells, they can move about under their own power. White blood cells are larger than red blood cells and fewer in number. Normally the blood has about 8000 white blood cells per cubic millimeter. Leukocytes also play a role in tissue repair but this activity is not yet fully understood. Leukocytes are classified into granulocytes (those with granules in the cytoplasm) and agranulocytes (those without granules). Granulocytes are further subdivided into neutrophils, eosinophils and basophils. These names are derived from the dye which stains their cytoplasmic granules. Agranulocytes include both monocytes and lymphocytes. Of the several types of leukocytes, the neutrophils are the most numerous, forming about 70 percent of the total number; lymphocytes make up about 20 percent of the total. The neutrophils, the lymphocytes and most other white blood cells are phagocytic that is, they have the ability to engulf and destroy bacteria. Leukocytes multiply rapidly when the body is invaded by infective microorganisms. The cells migrate rapidly to the site of the infection, surround the infective agent and overwhelm it. Under a microscope, as many as 15 or 20 bacteria can be seen within a single white blood cell. The exact function of basophils is unknown, but their numbers are increased in leukemia. Eosinophils are increased in allergic conditions and parasitic infections and phagocytize antigen-antibody combinations. Monocytes also fight against disease by phagocytosis. They dispose of dead and dying cells and other debris by engulfing and swallowing the cells.
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Platelets (thrombocytes) Platelets are small, clear, disk-shaped bodies about one-third the size of red blood cells or even smaller, which initiate blood clotting and are concerned in contraction of a clot. When they encounter a leak in a blood vessel, they disintegrate and adhere to the edges of the injured tissue. There are about 25.000 platelets per cubic millimeter of blood. Plasma Plasma is the liquid part of the blood which consists of about 90 percent of water, 7 percent proteins and less than l percent inorganic salts, organic substances other than proteins, dissolved gases, hormones, antibodies and enzymes. Plasma from which the fibrinogen and prothrombin have been removed is called serum. Dissolved in the plasma are many important proteins such as serum albumin, gamma globulin and fibrinogen. Serum albumin is important in the nutrition of the body. It probably originates in the liver, as does fibrinogen. Fibrinogen is essential in the clotting process. Gamma globulin, which is formed in the lymphoid tissues and reticuloendothelial system, contains almost all of the antibodies important in establishing immunity. Blood Groups (Blood Types) Blood group means the phenotype of erythrocytes defined by one or more antigenic determinants. Under the usual system of blood typing there are four main blood types or blood groups: A, B, O and AB. Each of the blood groups has a specific combination of factors (antigens and antibodies) which are inherited. These antigen (also called agglutinogen) and antibody (also called agglutinin) factors of the various blood types are: • • • •
Type A, containing A antigen and anti-B antibody Type B, containing B antigen and anti-A antibody Type AB, containing A and B antigens and no anti-A or anti-B antibodies Type O, containing no A or B antigens and both anti-A and anti-B antibodies.
The ABO blood typing system was first introduced in 1900 by Karl Landsteiner and is still generally used today as the basis for transfusing whole blood. It is now known, however, that many different antigens exist in the red blood cells, and that as many as 11 or more different antigenic systems of grouping blood can be recognized. Correct typing and cross-matching of blood are extremely important clinically in the prevention of transfusion reaction. The adverse reaction is called agglutination, or clumping, of the recipient’s blood. 141
Damage to the erythrocytes also occurs, so that hemoglobin leaks out of the cell (hemolysis). The agglutination is fatal to the recipient because it stops the flow of blood. Similar problems can occur in other transfusions if the donor’s antigens are incompatible with the recipient’s antibodies. People with type O blood are known as universal donors because their blood contains neither A nor B antigens. Those with type AB blood are known as universal recipients because their blood contains neither anti-A nor anti-B antibodies. Another important factor, called the Rh factor (named so because it was first found in the blood of a rhesus monkey) must also be considered in blood typing. This is a very complex system: eight principal variants of the Rh factor are known, and there are others not yet identified and grouped. For practical purposes there are two main groups of Rh types. Persons with the Rh factor present in the blood are referred to as Rh positive those without are Rh negative. This particular factor may be involved in hemolytic diseases of the newborn because of an incompatibility existing between the maternal blood and the fetal blood. Figure 11.2. Composition of blood
Blood clotting Blood clotting or coagulation, is a complicated process involving many different substances and chemical reactions. The end result of the process is the formation of a fibrin clot from the plasma protein fibrinogen. Platelets are important in initiating the process, which, stated more simply, involves the following steps: 1. When a blood vessel is damaged or breaks, a prothrombin activator is released into the blood in response to special factors from platelets and tissues. One of these factors is the protein that is missing in patients suffering from hemophilia. 2. The prothrombin activator, along with calcium and other plasma factors, helps to convert prothrombin (a plasma protein) into an enzyme called thrombin. 142
3. Thrombin then couverts fibrinogen, a soluble blood protein, into fibrin threads (insoluble protein) which trap red blood cells, platelets, and plasma to form the clot. Normally clots (thrombi) do not form in blood cells unless the vessel is damaged or the flow ofblood is impeded. Anticoagulant substances in the bloodstream inhibit blood clotting so thrombi or emboli (floating dots) do not form. Heparin, produced by specialized tissue cells, is an example of an anticoagulant. Figure 11.3. General sequence of events in blood clotting
2. Lymphatic System Lymphatic system is composed of lymph fluid, lymph capillaries, lymphatic vessels, lymphatic ducts and lymph nodes. The main function of this system is to transport fluid from the tissues back to the bloodstream. It also aids in the control of infection caused by microorganism and in conveyance of lipids or fats away from the digestive organs. Lymph originates from blood plasma. It is clear and colourless and contains less protein than blood plasma. Other noncellular constituents of lymph are water, salts, sugar and metabolic wastes, such as urea and creatinine. The cells of the lymph include lymphocytes, monocytes and a few platelets and erythrocytes.
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The fluid filling the spaces between the tissue cells is called the interstitial fluid. It cleanses the body tissues through which it circulates and collects cellular debris, bacteria, and particulate matter. Eventually the interestitial fluid enters into open-ended vessels called lymph capillaries. This fluid is now called lymph. Lymph passes from the capillaries to larger vessels and finally to lymph nodes which serve as depositaries for cellular debris. Lymph vessels from the right chest and arm join the right lymphatic duct. This duct drains into the right subclavian vein a major vessel in the cardiovascular system. Lymph from all other parts of the body joins the thoracic duet, which drains lymph into another large blood vessel, the left subclavian vein. In this way lymph is redeposited into the circulating blood in order to begin the cycle again. Three organs are associated with the lymphatic system: the spleen, thymus gland, and tonsils. Spleen The spleen acts as a filter for blood. Phagocytic cells within the lining of the spleen remove cellular debris, bacteria, parasites, and other infectious agents thereby cleansing the lymph. Although the spleen is not essential to life it is important for its hemolytic activity, filtration of microorganisms, production of antibodies and immunity, chiefly by leukocytes, for production of lymphocytes and monocytes and as a storage of blood, especially red blood cells. Also, the spleen seems to have a stimulatory effect on the production of blood from the bone marrow. Thymus Gland and Immunity The thymus gland is located in the mediastinum, posterior to the breastbone and between the lungs. It plays an important role in the body’s immunologic system, especially in fetal life and the early years of growth. It is known that thymectomy performed in animals during the first few weeks of life im pairs the ability of the animal to make antibodies to fight against foreign antigens. The immunological activity of an organism involves the production of two types of lymphocytes, B-cells and T-cells, and is basically divided into two categories: humoral immunity and cell-mediated immunity. Humoral immunity is provided by B-lymphocytes. B-cells are produced in bone marrow. Humoral immunity involves the production of a substance called an antibody which seeks out and renders harmless the invading substance called an antigen. As a general rule, the antigen-antibody reaction is a specific
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reaction; that is, the antibody reacts only with the antigen that induced its formation. For example, if the body has developed antipolio antibodies in response to the presence of polio antigens (a situation that occurs after the administration of polio vaccination), these polio antibodies provide no protection against any other antigen except polio. In order to produce antibodies, the B-cells are activated in the p resen ce of an antigen to become plasma cells. Plasma cells synthesize and export antibodies. Some activated B-cells do not develop into plasma cells but remain as “memory cells”. These cells stay in the lymphoid tissue. In the event of a future encounter by the same antigen, the memory cells immediately produce the plasma cells that are capable of manufacturing a specific antibody. The antibodies that are made by plasma cells are called immunoglobulins. Cell-mediated immunity is dependent on T-cell lymphocytes and is seen in the fight against chronic bacterial infectious (such as tuberculosis), viral and fungal diseases, malignant cell growth, and cells of transplanted organs. T-cells mature in the thymus gland and are active in destruction of foreign materials, such as bacteria, viruses, and foreign tissues such as skin grafts. When they encounter an antigen, T –cells become sensitized and change into “killer cells”. They produce a lymphotoxin or cytotoxin (lymphokines) that damages or ruptures the cell membranes of the antigen and that helps the macrophages (large phagocytes found in lymph nodes and other body tissues) do their job. T-cells also aid in the production of interferon, a protein released from cells that have been invaded by a virus or other antigen. Interferon induces non-infected cells to form an antiviral protein that inhibits viral multiplication within the cell. Tonsils There are three different kinds of tonsils: palatine tonsils are oval-shaped structures partially embedded in the mu co us membrane, one on each side of the back of the throat; below them, at the base of the tongue, are the lingual tonsils; and on the upper rear wall of the mouth cavity are the pharyngeal tonsils, or adenoids, which are of fair size in childhood but which usually shrink after puberty. These tissues are part of the lymphatic system and help to filter the circulating lymph of bacteria and any other foreign material that may enter the body, especially through the mouth and nose. In the process of fighting infection the palatine tonsils and the adenoids sometimes become enlarged and inflamed (tonsillitis).
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Key Terms • acquired immunity – formation of antibodies and lymphocytes after exposure to an antigen • agglutination – clumping of recipient’s blood cells when incompatible bloods are mixed • albumin – protein found in blood; also called serum albumin • antibody – a protein substance developed by lymphocytes in the presence of antigen • antigen – foreign material causing the production of an antibody • cell-mediated immunity – an immune response involving T cell lymphocytes • coagulation – the process of blood clotting • corpuscle – little body (refers to a blood cell) • cytotoxic cells – T cells that directly kill foreign cells (killer cells); also called T8 cells • fibrin – protein threads that form the basis of a blood clot • fibrinogen – plasma protein that is converted to fibrin in the clotting process • globin – the protein part of haemoglobin • globulin – plasma protein (alpha, beta, gamma) • helper cells – T cells that aid B cells in recognizing antigens and stimulating antibody production; also called T4 cells • heme – iron-containing non-protein portion of the haemoglobin molecule • haemoglobin – blood protein enabling the red blood cell to carry oxygen • heparin – an anticoagulant produced by liver cells and found in blood and tissues • humoral immunity – immune response in which B cells transform into plasma cells and secrete antibodies • immune reaction – reaction between an antigen and an antibody • immune response or immunity – the body’s capacity to resist all types of organisms and toxins that can damage tissue and organ • immunoglobulin – a protein (globulin) with antibody activity • interferons – antiviral proteins secreted by T cells • interleukins – proteins that stimulate the growth of T cell lymphocytes • macrophages – large phagocytes that destroy old red blood cells • megakaryocyte – platelet precursor (forerunner) formed in the bone marrow • myeloid – derived from bone marrow cells • natural immunity – one’s own genetic ability to fight off disease • plasma – liquid portion of blood
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• • • • • • • •
platelet – smallest formed element in the blood; a thrombocyte reticulocyte – developing red blood cell serum – plasma minus clotting proteins in cells stem cell – a cell in bone marrow that gives rise to different types of blood cells suppressor cells – T cell lymphocytes that inhibit the activity of B cell lymphocytes T cells – lymphocytes formed in the thymus gland thrombin – an enzyme that helps convert fibrinogen to fibrin during coagulation thromboplastin – a clotting factor that promotes the formation of a fibrin clot.
Combining Forms Meaning
Terminology
chrom/o
colour
hypochromia = reduction in haemoglobin in red blood cells
coagul/o
clotting
coagulation = blood clotting
hem/o hemat/o sanguin/o
blood
hemolysis = destruction of red blood cells hematology = the study of blood sanguinous = pertaining to blood (haemic)
immun/o
protection
immunology = the study of immune system
lymphaden/o
lymph node lymphadenitis = inflammation of a lymph lymph gland gland
lymphangi/o
lymph vessel lymphangiogram = radiography of lymph vessels
phag/o
eat, swallow phagocyte = a cell capable of ingesting particulate matter
poikil/o
varied, irregular
poikilocytosis = irregularity in the shape of red blood cells
sider/o
iron
sideropenia = iron deficiency (anemia)
spher/o
globe, round spherocytosis = a round shape of erythrocytes
splen/o
spleen
thym/o
thymus gland thymoma = tumour of the thymus gland
tox/o
poison
splenectomy = removal of the spleen toxic = poisonous
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Disorders of the Blood and Lymphatic Systems AIDS (acquired immunodeficiency syndrome) anemia
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a disease marked by a decrease in the immune response (for more detailed description see the Chapter on AIDS in the Supplement)
deficiency in erythrocytes or haemoglobin; it implies reduction in red blood cells; the most common type is iron deficiency, or sideropenic, anemia caused by a lack of iron; some other types include: • aplastic anemia – results from bone marrow failure; pancytopenia occurs as stem cells fail to produce leukocytes, platelets and erythrocytes; it is treated with blood transfusions and bone marrow transplants (usually conducted with marrow from an identical twin); • haemolytic anemia – reduction in red cells due to excessive destruction; hemolysis may be due to exposure to chemicals and toxic substances, or it may be congenital; jaundice may be a symptom in addition to usual symptoms of anemia; treatment includes blood transfusions and sometimes splenectomy; • pernicious anemia (macrocytic) – a deficiency in the absorption of vitamin B12 or folic acid; vitamin B12 is a common constituent of food but it cannot be absorbed into the bloodstream without the aid of a special substance called intrinsic factor, which is normally found in gastric juice. Individuals with pernicious anemia lack this factor in their gastric juice, and the result is unsuccessful maturation of red cells, with an excess of large, immature, nucleated, and poorly functioning red cells (megaloblasts) in the circulation; the treatment consists in the administration of vitamin B12 for life; • sickle-cell anemia - a genetically determined defect of hemoglobin synthesis associated with poor physical development and skeletal anomalies, occurring usually in Negroes; • thalassemia – an inherited defect in the ability to produce hemoglobin, usually seen in persons of Mediterranean background; this condition, consisting of various forms and degrees of severity (the most severe form is called Cooley anemia), usually leads to hypochromic anemia (diminished hemoglobin content in red cells).
graft rejection
Destruction of transplanted organ or tissue by the recipient’s immune system.
graft-versus-host disease (GVHD)
Condition that occurs following bone marrow transplant or blood transfusion; in this condition the immune cells in the transplanted marrow produce antibodies against the host’s tissues; the condition may be acute or chronic.
granulocytosis
abnormal increase in granulocytes in the blood as a response to infection or inflammation.
haemophilia
Excessive bleeding caused by a congenital lack of substance necessary for blood clotting. The disease is sex-linked and is most often found in males. The female is the carrier of the trait and generally does not have symptoms of the disease; while the platelet count of a hemophiliac is normal, there is a marked deficiency in a plasma clotting factor (factor VIII) which results in a very prolonged coagulation time; in addition to excessive bleeding, joints and muscles may likewise be affected; if blood collects in the joints (hemarthrosis), permanent crippling may result.
Hodgkin disease
Malignant tumour arising in lymphatic tissue such as lymph nodes and spleen. This disease of unknown origin produces lymph node enlargement, and weight loss. A malignant cell, called a Reed-Stenberg cell, is characteristically found in the lymph nodes. There may be metastases to other organs in the more advanced stages of the disease. Radiation and chemotherapy are effective methods of treatment.
leukemia
Leukemias are malignant disease of the bloodforming organs (spleen, lymphatic system, and bone marrow). Numerous malignant leukocytes spread and proliferate throughout the bone marrow. The cells are immature (blastic) and unable to function in a normal manner. Since
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the leukemic process drastically reduces the ability of the body to produce normal blood cells, it results in anemia and increased susceptibility to infections. There are many clinical manifestations in leukemia. The major treatment for leukemia is chemotherapy. Four major types of leukemia are: •a cute myelogenous (myelocytic) leukemia (AML) – immature granulocytes predominate; platelets and erythrocytes are diminished; •a cute lymphocytic leukemia (ALL) – immature lymphocytes predominate this form is seen most often in children and adolescents; the onset is sudden; • c hronic myelogenous leukemia (CML) - mature and immature granulocytes are present in the marrow and bloodstream; this is a slowly progressive illness; • c hronic lymphocytic leukemia (CLL) – abnormal numbers of relatively mature lymphocytes predominate in the marrow, lymph nodes and spleen; it occurs later in life and follows a slowly progressive course. lymphadenitis
inflammation of lymph nodes, usually due to infection.
lymphocytosis
increased number of lymphocytes in the blood and bone marrow.
lymphosarcoma (lymphoma)
Malignant tumour of lymph nodes which closely resembles Hodgkin’s disease. It affects the lymph nodes, spleen, bone marrow and other organs. There are several types of lymphoma (lymphocytic, histiocytic, etc.). Chemotherapy and radiation are used in treatment.
mononucleosis
Acute infectious disease with enlarged lymph nodes and spleen and increased numbers of lymphocytes and monocytes in bloodstream. The disease is caused by virus. Lymphadenopathy is present, with sore throat and enlarged, tender nodes in the cervical and sometimes axillary and inguinal regions, splenomegaly, hepatomegaly, and marked asthenia (weakness) are also present.
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multiple myeloma
A primary malignant tumour of bone marrow. This is a progressive malignancy of antibodyproducing cells. The condition often leads to osteolytic lesions, anemia, hypercalcemia, renal damage, and increased susceptibility to infection. Treatment is with analgesics, radiotherapy, chemotherapy, and special orthopedic supports.
polycythemia (primary or vera)
purpura
Abnormal increase in the erythrocyte count or in hemoglobin concentration. The cause of the disease is not fully understood. There is hyperplasia of the cell-forming tissues of the bone marrow, with resultant elevation of the erythrocyte count and hemoglobin level, and platelets. The condition has been compared to leukemia and regarded as a malignant neoplastic disease. Treatment is aimed at reducing the red cell count and decreasing the blood volume. It includes both the modern techniques of radiation therapy and the ancient practice of bloodletting. A hemorrhagic disease characterized by extravasation of blood into the tissues, under the skin and through the mucous membranes, and producing spontaneous ecchymoses (bruises) and petechiae (small red patches) on the skin. The disorder is accompanied by a marked decrease in circulating platelets and hence is sometimes called thrombocytopenic purpura. Primary or idiopathic purpura is of unknown cause while the secondary or symptomatic purpura may be associated with exposure to drugs or other chemical agents, systemic diseases such as anemia and leukemia, diseases affecting the bone marrow or spleen and infectious diseases such as rubeolla. Treatment is aimed at the cause of disease. Splenectomy and drug therapy are used.
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sarcoidosis
Inflammatory disease of unknown etiology in which small nodules, or tubercles, form in lymph nodes and other organs. Besides spleen and lymph nodes, lesions also develop in lungs and liver.
septicemia
Serious life-threatening bloodstream infection that may arise from other infections in the body; also called sepsis, blood infection, blood poisoning.
EXERCISES 1.1. The main functions of the blood are: ............................................................................... 1.2. The function and the accessory organs of the lymphatic system are as follows: ........................................................................................................................................................ 2. Fill in the correct term: 2.1. Blood is composed of ............................. called .......................................................... and ....................................................
that consists of .................................................................................
2.2. The erythrocytes owe their ...................................................... ability to the protein .............................................................
which contains .........................................................................
2.3. Leukocytes also play a role in ...................................................... but this activity is 2.4. Lymph .................................................................................................... from blood plasma. 2.5. The fluid between the tissue cells is called.................................................................. 3. Give the opposite of each term: 3.1. early .............................................................
3.6. continuance .............................................
3.2. past ..............................................................
3.7. conversion ................................................
3.3. permanence ............................................
3.8. strong .........................................................
3.4. sharp ...........................................................
3.9. fertile ..........................................................
3.5. cause ...........................................................
3.10. dry ..............................................................
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4. Match the following terms with their meanings: 4.1. albumin .....................................................
a) red blood cell
4.2. thrombocyte ............................................
b) iron-containing non-protein portion of the hemoglobin molecule
4.3. heme ...........................................................
c) antiviral protein secreted by T-cells and other cells
4.4. interferon ..................................................
d) platelet
4.5. erythrocyte ..............................................
e) protein found in blood
5. Give the meanings of the following terms: 5.1. antigen ............................................................................................................................................... 5. 2. antibodies ....................................................................................................................................... 5. 3. cell-mediated immunity.......................................................................................................... 5. 4. interstitial fluid ............................................................................................................................ 5. 5. globin ................................................................................................................................................. 5. 6. bilirubin ............................................................................................................................................ 5. 7. coagulation .................................................................................................................................... 5. 8. fibrinogen ........................................................................................................................................ 5. 9. globulin ............................................................................................................................................ 5.10. immune reaction ....................................................................................................................... 6. Provide the plural forms of the following nouns: 6.1. thymus .......................................................
6.6. hematoma ................................................
6.2. nucleus ......................................................
6.7. antigen .......................................................
6.3. edema .........................................................
6.8. lymphadenoma .....................................
6.4. serum .........................................................
6.9. anemia .......................................................
6.5. hemolysis .................................................
6.10. albumin ...................................................
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7. Provide the adjective form of the following nouns: 7.1. spleen .........................................................
7.6. thymus .......................................................
7.2. blood ............................................................
7.7. albumin .....................................................
7.3. hemostasis ..............................................
7.8. fibre ..............................................................
7.4. lymph ..........................................................
7.9. cell ................................................................
7.5. nucleus ......................................................
7.10. genesis ....................................................
8. Give appropriate medical term for the following: 8.1. stringy substance in clots ....................................................................................................... 8.2. liquid part of blood without fibrinogen ........................................................................... 8.3. provide cell-mediated immunity ........................................................................................ 8.4. inflammation of lymph nodes .............................................................................................. 8.5. increased numbers of lymphocytes in the blood and bone marrow ..........................................................................................................................................................................
8.6. removal of the thymus .............................................................................................................. 8.7. inflammation of the thymus .................................................................................................. 8.8. deficiency in erythrocytes or hemoglobin ..................................................................... 8.9. disease-fighting cells ............................................................................................................... 8.10. deficiency in the absorption of vitamin B12 .............................................................. 9. Translate into Croatian: Allergy Allergy is usually defined as abnormal and individual hypersensitivity to substances that are ordinarily harmless. Basically it develops like immunity to disease, which is one of the natural defence mechanisms of the human body resulting in antigen-antibody reaction, but to an exaggerated degree. An allergy cannot occur on the first contact with a potential allergen, i.e. a substance capable of inducing hypersensitivity, because antibodies have not yet been produced by the body. It may occur on the second contact, when antibodies have been produced and are in reserve in the body tissues, but it does not necessarily do so. In some cases it may not occur until late in life when, after repeated contact with the allergen, a person suddenly develops a sensi-
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tivity. Although anyone can develop an allergy after repeated exposure to some offending allergen, it is believed that some individuals inherit the tendency or predisposition. In addition to microorganisms, dust, dog dander, pollens, grasses, mol d spores, and practically any substances in the environment - collectively termed allergens - may function as antigens and stimulate the production of antibodies within the host. Allergens can enter the body by being inhaled, swallowed, touched or injected. The allergen is not directly responsible for the allergic reaction, but sets off the chain of events that brings it about. A variety of allergic reactions can take place almost anywhere in the body; the cell affected may be destroyed or injured, and they release powerful defensive chemicals such as heparin, leukotaxine and especially histamine that cause systemic symptoms which may range from sneezing, slight local edema and numerous other discomforting signs and symptoms to fatal anaphylactic shock (dyspnea, cyanosis, rapid drop of blood pressure, weakening of pulse, convulsions and loss of consciousness). Emotional factors such as anxiety, fear, anger and strong excitement are also known to have a role in allergy, not exactly as causes but mostly in view of evidence that emotional upset may set off an allergic attack. Common allergic diseases include hay fever, asthma, allergic dermatitis (eczema), allergic contact dermatitis, urticaria (hives), food allergies, drug allergies, and allergies to insect bites. In most cases allergy is dealt with by identifying the responsible allergen and then avoiding it. An allergy that is resistant to cure may be controlled with medication (antihistamines, epinephrine, ephedrine, aminophylline and varieties of steroids of the cortisone and ACTH type). In many instances the patient can be cured of the allergy by a series of desensitization treatments, in which the patient is exposed to gradually increasing amounts of the allergen until his resistance is built up to immunity. .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
Common Allergens inhaled substances: pollens from weeds, grasses, treed, and plants; dusts, mold spores, animal skin/hair, feathers, hair lotions, kapok, tobacco. foods:
lobster, crab, shellfish and fish; meats, fowl, chocolate, nuts, spices, eggs, milk and grains.
skin contact substances:
plastics, certain metals, rubber, fabrics, dyes, cosmetics, resins, drugs, and plant foliage.
injected drugs:
antibiotics, certain serums, hormones, liver extract, and insulin.
drugs given by mouth:
aspirin, laxatives, sedatives, sleeping pills, tranquilizers, and antibiotics.
(From: Charles Carroll and Dean Miller: Health, the Science of Human Adaptation; and Miller-Keane: Encyclopedia and Dictionary of Medicine and Nursing.)
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CHAPTER 12
ENDOCRINE SYSTEM The endocrine and nervous systems comprise the two major systems of the body. The first one functions by means of chemical reactions and the second one by means of electrical impulses. Once the nervous system receives either an internal or external stimulus, the stimulus produces a series of electrical impulses, which are then transmitted to the brain via neurons. The endocrine system works differently. It affects bodily activities by releasing chemical messengers, or hormones, into the bloodstream. These chemical substances can regulate the many and varied functions of an organism. The word hormone is of Greek origin and means “urging on”. The hormones, produced by various glands, stimulate or inhibit activities of the body. For example, one hormone stimulates the growth of bones, another causes the maturation of sex organs and reproductive cells, and another controls the metabolic rate (metabolism) within all individual cells of the body. Hormones produce their effects by binding to receptors, which are recognition sites in the various target tissues upon which the hormones act. The receptors initiate specific biological effects when the hormones bind to them. Each hormone has its own receptor, and binding of receptor by hormone is much like the interaction of a key and a lock. It is important to distinguish the two different types of glands within our body. The exocrine glands, which are not part of the endocrine system, secrete their products directly into ducts, which carry them to specific places within the body. Examples of exocrine glands are sweat, mammary, mucous, salivary, digestive, and lacrimal (tear) glands. Endocrine glands are ductless glands, and their products are hormones, which are released directly into the bloodstream. The ductless, internally secreting endocrine glands are the following: 1. Thyroid gland 2. Parathyroid glands (four glands) 3. Adrenal glands (one pair)
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4. Pancreas (islands of Langerhans) 5. Pituitary gland (hypophysis) 6. Thymus and pineal gland 7. Ovaries in female (one pair) 8. Testes in male (one pair) The last two glands are called sex glands or gonads. The pineal and thymus gland, are included as endocrine glands because they are ductless, although little is known about their endocrine function in the human body. Thyroid Gland The largest gland of the endocrine system is the thyroid gland. It is located in the neck just below the larynx. This gland is composed of two fairly large lobes - a right and left lobe that are separated by a strip of tissue called an isthmus. The thyroid gland is located on either side of the trachea, below a large piece of cartilage called the thyroid cartilage. This cartilage covers the larynx and produces the prominence on the neck known as the Adam’s apple. The main function of the thyroid gland is to produce the hormones thyroxine and triiodothyronine. These hormones are synthesized in the thyroid gland from iodine, which is picked up from the blood circulating through the gland, and from an amino acid called tyrosine. Thyroxine is vital in maintaining normal growth and metabolism. It is responsible for a person’s energy level. This gland also influences skeletal growth and sexual development. A more recently discovered hormone produced by the thyroid gland is called calcitonon (thyrocalcitonin). Calcitonin is secreted when calcium levels in the blood are high. It stimulates the passage of calcium into bones from the blood. Parathyroid Glands The parathyroid glands are four small oval bodies located on the dorsal aspect of the thyroid gland or are embedded within it. They occur in a variable number of pairs, commonly two. Parathyroid glands secret e a parathyroid hormone (PTH), which regulates calcium and phosphorus metabolism fur blood, bones, and teeth. Normally, calcium in the food we eat is absorbed from the intestine and carried, by the blood, to the bones, where it is stored. The adjustment of the level of calcium in the blood is a good example of the way hormones in general control the homeostasis (equilibrium or constancy in the internal environment) of the body. If there is a decrease in blood calcium (as in pregnancy or rickets, a vitamin D deficiency disease), parathyroid hormone is secreted in larger amounts to cause calcium to leave the bones and enter the bloodstream. Thus, blood calcium levels are brought back to normal.
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Conversely, any situation of increase in calcium in the bloodstream, such as excess quantity of calcium or vitamin D in the diet, will lead to decreased parathyroid hormone secretion, decreasing blood calcium so that homeostasis is again achieved. Adrenal Glands The adrenal glands, also called the suprarenal glands, are two small glands situated one on top of each kidney. Each gland consists of two parts, an outer portion called the adrenal cortex and an inner portion called the adrenal medulla. The cortex and medulla are two glands in one, each secreting its own different endocrine hormones. The cortex secretes hormones called steroids (complex chemicals derived from cholesterol), and the medulla secretes hormones called catecholamines (chemicals derived from an amino acid). The adrenal cortex secretes three types of steroid hormones: 1. Mineralocorticoids - these hormones are essential to life because they regulate the amounts of mineral salts (also called electrolytes) that are retained in the body. A proper balance of water and salts in the blood and tissues is essential to the normal functioning of the body. The most important mineralocorticoid is called aldosterone. The secretion of aldosterone by the adrenal cortex increases the reabsorption of sodium (a mineral electrolyte commonly found in salts) by the kidney tubules. At the same time, aldosterone stimulates the excretion of another electrolyte called potassium. The secretion of aldosterone increases manyfold in the face of a severe sodium restricted diet, thereby enabling the body to hold needed salt in the bloodstream. 2. Glucocorticoids - these hormones have an important influence on the metabolism of sugars, fats, and proteins within all body cells. Cortisol (also called hydrocortisone ) is the most important glucocorticoid hormone. Cortisol increases the ability of cells to make new sugars out of fats and proteins (gluconeogenesis) and regulates the quantity of sugars, fats, and proteins in the blood and cells. Cortisone is a hormone very similar to cortisol and can be prepared synthetically. Cortisone is useful in treating inflammatory ailments such as rheumatoid arthritis. 3. Androgens, Estrogens, and Progestins - these are male and female hormones that maintain the secondary sex characteristics, such as beard and breast development, and are necessary for reproduction. Most of these hormones are also produced in the ovaries and testes. Excess adrenal androgen secre160
tion in females leads to virilism (development of male characteristics), and excess adrenal estrogen and progestin secretion in males produces abnormal feminine characteristics (feminism). The adrenal medulla secretes two types of catecholamine hormones: 1. Epinephrine (adrenaline) - this hormone increases cardiac activity, dilates bronchial tubes, and stimulates the production of glucose from a storage substance called glycogen when glucose is needed by the body. Epinephrine is often referred to as the fight or flight hormone, because of its effect during stress. Epinephrine causes the involuntary muscles to contract and produces an increase in blood pressure. It converts glycogen into blood sugar for use by the voluntary muscles to perform extra work. 2. Norepinephrine (noradrenaline) - this hormone constricts vessels and raises blood pressure. Both epinephrine and norepinephrine are called sympathomimetic agents because they mimic, copy, the actions of the sympathetic nervous system. During times of stress, these hormones are secreted by the adrenal medulla in response to nervous stimulation. They help the body respond to crisis situation by raising blood pressure, increasing heartbeat and respiration, and bringing sugar out of storage in the cells. Pancreas (Islands of Langerhans) The pancreas, located behind the stomach in the region of the 1st and 2nd lumbar vertebrae, produces both external and internal secretions. The external secretion, called pancreatic juice, is produced by the cells of the acini. Pancreatic juice passes through the pancreatic ducts into the duodenum where it plays an important role in the digestion of various foods. The specialized cells in the pancreas that produce hormones are called the islets of Langerhans. They produce two hormones called insulin and glucagon. Both of these hormones play a role in the proper metabolism of sugars and starches in the body. Insulin is necessary in the bloodstream so that sugars can pass from the blood into the cells of the body where they are burned to release energy. When blood sugar (glucose) is above normal, insulin is released by the island cells of the pancreas. The insulin causes sugar to enter body cells to be burned and stimulates the conversion of glucose (a starch-storage form of sugar) in the liver. Thus, sugar can leave the blood to be stored (as glycogen) or used to release energy. Glucagon, the opposite “twin” of insulin, is released into the blood when sugar levels are below normal. It causes the breakdown of liver glycogen to sugar (glucose), so that there is a rise in the sugar content of blood leaving the liver. 161
The islands of Langerhans include two major types, containing granules that stain differently. The alpha cells (10 to 30 percent of the cells) stain red and produce glucagon. The beta cells (60 to 90 percent of the cells) stain blue and produce insulin. While the islands of Langerhans carry on the endocrine functions of the pancreas, other cells within the organ carry on its exocrine functions. These cells secrete digestive enzymes and juices into the gastrointestinal tract. Pituitary Gland (Hypophysis) All the endocrine glands interact with one another to some extent, but only the pituitary gland has the special function of stimulating other endocrine glands to produce their own particular hormones. Because of this, the pituitary gland (also called hypophysis) is known as the master gland. It is small, no larger than a pea, and is attached to the base of the brain in a small pocket-like depression of the skull called the sella turcica. The pituitary gland is connected to the hypothalamus by the hypophyseal stalk. Even though the pituitary gland looks like a single gland, it actually consists of two separate glands the adenohypophysis, or anterior lo be; and the neurohypophysis or posterior lobe. These two glands are formed from different embryonic structures and secrete different hormones. Signals transmitted from the hypothalamus control almost all secretions by the pituitary gland. Secretion from the neurohypophysis is controlled by nerve fibers originating in the hypothalamus and ending in the neurohypophysis. Secretion by the adenohypophysis is controlled by special hormones called releasing and inhibiting factors. These hormones are secreted by the hypothalamus and pass to the adenohypophysis by way of special capillaries. The adenohypophysis produces several hormones: 1. Growth hormone (GH or HGH in humans, also called somatotropin) - this hormone acts on bone tissue to accelerate its growth in the body. 2. Thyroid-stimulating hormone (TSH, also called thyrotropin) - this hormone stimulates the growth of the thyroid gland and its secretion of thyroxine. 3. Adrenocorticotropic hormone (ACTH) - this hormone stimulates the growth of the adrenal cortex and increases its secretion of steroid hormones (primarily cortisol). 4. Gonadotropic hormones - there are several gonadotropic hormones that influence the growth and hormone secretion of the ovaries in females and testes in males. In the female, follicle-stimulating hormone (FSH) stimulates the growth of eggs in the ovaries, and luteinizing hormone (LH) induces the secretion of progesterone (pregnancy-sustaining hormone) from the 162
ovaries. In the male, gonadotropins (FSH and LH) from the adenohypophysis influence the development of spermatozoa and testes. 5. Prolactin (PRL) - this hormone promotes the growth of breast tissue and stimulates and sustains milk production after birth. 6. Melanocyte-stimulating hormone (MSH) - this hormone influences the formation of melanin and causes increased pigmentation of the skin. This effect is observed only when hypersecretion of the hormone occurs. The neurophypophysis secretes two important hormones. They are formed in the hypothalamus but secrete through the posterior pituitary gland: 1. Antidiuretic hormone (ADH) - this hormone, also known as vasopressin, stimulates the reabsorption of water by the kidney tubules. In addition, ADH can also increase blood pressure by constricting arterioles. 2. Oxytocin - stimulates the uterus to contract during childbirth and maintains labour during childbirth. Oxytocin is also secreted during suckling, and causes the production of milk from the mammary glands. Thymus and Pineal Gland (Cerebral Epiphysis) Both the thymus and pineal glands are regarded as endocrine glands, because they are ductless. However, little is known about their endocrine function in the human organism. The thymus gland is an unpaired organ located in the upper mediastinal cavity, anterior to and above the heart. It consists of two flattened symmetrical lobes, each enclosed in a capsule. The thymus gland is prominent in the child but tends to a trophy in the adult. Since the function of the thymus is concerned with immunity, its major contribution is stimulation of the lymphoid organs to produce T-lymphocytes for immunological activity. The pineal gland is shaped like a pine con e and is attached to the posterior part of the third ventricle of the brain. Although the exact functions of this gland have not been established, there is evidence that it secretes the melatonin hormone. It is believed that melatonin may inhibit the activities of the ovaries. When melatonin production is high, ovulation is b locked, and there may be a delay in puberty development. The pineal gland starts to degenerate at about 7 years of age and in the adult it consists mostly of fibrous tissue. Sex Glands (Gonads) The ovaries are the female sex organs. They produce estrogen, which aids in the development of secondary sex characteristics. Ovaries also produce progesterone, which assists in the normal development of pregnancy.
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The male sex glands, or testes, produce testosterone. This hormone aids in the development of secondary sex characteristics in the male. For quick reference please refer to the table below: Comparison Between the Endocrine and Nervous Systems Endocrine System Secretes hormones that are carried in body fluids
Nervous System Transmits nerve impulses via nerve fibres
Causes changes in the metabolic activities of target tissues
Causes muscles to contract or glands to secrete
Effects exerted relatively slowly
Effects exerted relatively rapidly
Effects generally prolonged
Effects generally brief
Key Terms • antagonistic – acting in opposition; mutually opposing g • catecholamines – hormones derived from an amino acid and secreted by the adrenal medulla (e.g. epinephrine) • corticosteroids – hormones produced by the adrenal cortex (e.g. glucocorticoids) • homeostasis – a constant internal environment • hormone – a substance produced by an endocrine gland and carried through the blood to a target organ • sella turcica (Turkish saddle) – a cavity in the skull where the pituitary gland is located • steroid – a complex chemical related to fats (oil) and derived from a sterol (e.g. cholesterol) • sympathomimetic – an agent that mimics or copies the effect of the sympathetic nervous system (e.g. adrenaline) • target – a structure, organ or tissue to which something is directed.
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Combining Forms Meaning
Terminology
aden/o
gland
adenectomy = removal of a gland
adren/o adrenal/o
adrenal gland
adrenal = pertaining the adrenal gland adrenalectomy = removal of the adrenal gland
andr/o
male
androgen = male sex hormone
cortic/o
cortex, outer cortical = pertaining to the outer region region
crin/o
secrete
endocrine = internally secreting (gland)
dips/o
thirst
polydipsia = excessive thirst (e.g. in diabetes mellitus)
estr/o
female
estrogen = female sex hormone
gluc/o glyc/o Glycos/o
sugar, sweetness
glucogenesis = producing sugar hypoglicemia = lower than normal blood sugar glycosuria = abnormal amount of glucose in the urine
kal/i
potassium (an electrolyte)
hypokalema = decrease in blood potassium level
lact/o
milk
prolactin = a hormone that promotes lactation
myx/o
mucus
myxedema = decreased thyroid function
natr/o
sodium (an electrolyte)
hyponatremia = decreased sodium content in the blood
phys/o physi/o
growth, natural process
hypophysis = growing from the undersurface of the brain physiology = the study of natural processes
somat/o
body
somatotropin = growth hormone
toc/o
childbirth dystocia = difficult childbirth.
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Disorders of the Endocrine System Disorders of the endocrine system are based on underproduction (hyposecretion) or overproduction (hypersecretion) of hormones. Most deficiencies result from genetic disorders, surgical removal of the gland, or production of poor-quality hormones. Thyroid Gland Thyrotoxicosis (exophthalmic goitre) is a condition marked by protrusion of the eyeballs, increased heart action, enlargement of the thyroid gland, weight loss, and nervousness. This condition is due to hypersecretion of thyroxine, a thyroid hormone. One of the early symptoms of this disorder is an enlarged thyroid (goitre) and edema behind the eye, which causes the protrusion of the eyes, (exophthalmos). Exophthalmic goitre is also known as Graves disease. Thyrotoxicosis is usually treated by administering drugs that suppress thyroxine synthesis or by surgically removing part of the gland (thyroidectomy). Thyroid deficiency during adulthood (myxedema) results in physical changes such as puffiness of the skin, swollen lips, thickened nose, and loss of hair. Hyposecretion of the thyroxine, especially during infancy, results in cretinism. With this disorder, every aspect of the child’s development is affected. The child exhibits dwarfism and mental retardation. Both cretinism and myxedema can also occur when the thyroid gland atrophies or when it is surgically removed. Thyroid gland enlargement may be a symptom of many different conditions. Examples of two types of goitre are: Endemic goitre - This condition, prevalent in certain regions and peoples and marked by accumulation of colloid (gluelike or gelatinous) material in the thyroid gland, causes hypertrophy of the thyroid. The etiology is deficiency of iodine in the diet, which causes the thyroid to work harder to make hormone and thus enlarge as compensation for the scarcity of iodine. Treatment is to increase the supply of iodine in the diet. Nodular or adenomatous goitre - This form of goitre is marked not only by enlargement (hyperplasia) of the thyroid, but by the formation of nodules or adenomas. Some patients develop hyperthyroidism with the symptoms such as rapid pulse, tremors, nervousness, and excessive sweating. Treatment consists of use of thyroid hormone to suppress the normal thyroid gland functioning. Thyroid carcinoma - cancer of the thyroid gland. Some tumours are very slow in growing and others may metastasize widely. Adenomas (noncancerous growths) are distinguished from carcinomas in radioactive tracer studies. Hot tumour areas (those collecting more radioactivity than surrounding tissues) 166
usually indicate benign growths; cold nodules can be either benign or malignant. Parathyroids Hypoparathyroidism or hyposecretion of the parathyroids results in neuromuscular hyperexcitability manifested by convulsions, muscle twitches and spasms (tetany). Blood calcium decreases and blood phosphorus rises. The decrease of calcium in the bones results in increased bone fragility. Other symptoms include cataract, teeth defects, bone lesions, maldevelopment of hair and nails and skin disturbances. Hyperparathyroidism causes demineralization of bones (osteitis fibrosa cystic, or von Recklinghausen disease of bone). The parathyroid hormone draws calcium from bones marking them highly susceptible to fracture and deformity. This condition can be the result of a benign tumour of the parathyroid gland (adenoma) and is treated by surgical removal. Adrenals Adrenal cortex Addison disease results from a deficiency in the secretion of adrenocortical hormones (adrenal cortical hypofunction). Although it is known to be due to a failure of the adrenal glands, the cause of this failure is not always certain. Tuberculosis of the adrenals accounts for less than half the cases and idiopathic atrophy of the glands for the remainder. If untreated, the disease will continue a chronic course with progressive but relatively slow deterioration. In some patients the deterioration may be repaid. Patients treated early, usually with adrenocortical hormones, have an excellent prognosis. Cushing syndrome is caused by hypersecretion of the adrenal cortex and results in excessive production of glucocorticoids. This overactivity is commonly due to an abnormal growth of the adrenal cortices. It may also be caused by a benign or malignant tumour of one of the adrenal glands. Symptoms include fatigue, weakness, edema, excessive hair growth in unusual places (hirsutism) in females, high blood pressure, and purplish markings (striae) of the skin. Treatment of the disorder is partial removal of the adrenal gland (adrenalectomy) or removal of the tumour, if that is the source of the problem. Adrenal Medulla Pheochromocytoma is a tumour occurring in the adrenal medulla. The tumour cells (which stain dark) produce excess secretion of the epinephrine and norepinephrine. The excess catecholamines produce hypertension, palpi167
tations, severe headaches, sweating, flushing of face, and muscle spasms. Surgery to remove the tumour and administration of antihypertensive drugs are possible courses of treatment. Pituitary Gland (Hypophysis) Adenohypophysis The anterior the adenohypophysis, produces a number of hormones that directly control the activities of other endocrinc glands. However, human growth hormone (HGH) is produced in the anterior lobe and does not control the activities of other glands. Instead, HGH is the hormone that builds bone tissue during the growth years. If there is hypersccretion of HGH before the closure of epiphyseal plates a generalized increase in body size takes place, particularly in the long bones of children (gigantism). This condition is also known as hyperpituitarism. It can be correctcd by early diagnosis in childhood. On the other hand, excessive HGH secretion after the epiphyseal closure will cause a chronic disease characterized enlargements of bones and soft tissues of the extremities (acromegaly). If HGH is normal childhood hut low in adult life (hypopituitarism ), the individual will not receive enough hormone needed to stimulate the protein building activities of the body. This results in wasting away of tissues (atrophy), which may lead to a rare condition called Simmond disease, or pituitary cachexia. Neurohypophisis The principal abnormality associated with the dysfunction of the posterior lobe, the neurohypophysis, is diabetes insipidus. Damage of the hypothalamus can result in hyposecretion of ADH - antidiuretic hormone, or vasopressin. Deficient antidiuretic hormone causes the tubules to fail in reabsorbing the needed water and salts. Clinical symptoms include excretion of large amounts of urine (polyuria) and subsequent excessive thirst Treatment includes administration of synthetic preparations of ADH into the nose several times a day. This disease should not be confused with diabetes a disorder of the pancreas which involves sugar metabolism. Inappropriate ADH (IADH,) or excessive secretion of antidiuretic hormone produces excess water retention in the body. Treatment consists of dietary water restriction. Tumour, drug reactions, and head injury are some of the possible factors.
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Pancreas Diabetes mellitus is a disorder of carbohydrate metabolism, characterized by increased blood sugar (hyperglycemia) and the presence of glucose in the urine (glycosuria). In most cases diabetes mellitus is the result of a genetic disorder. The basic cause is still unknown but the direct cause is failure of the pancreas to secrete an adequate amount of insulin (hypoinsulinism). Another cause of diabetes may be an inadequate utilization of insulin. Besides hyperglycemia and glycosuria other symptoms include excessive urine production (polyuria), increase in food intake (polyphagia), and excessive thirst (polydipsia). When severe diabetes is allowed to progress without proper treatment, a sweet breath odour may be noted along with other progressive symptoms of intoxication and delirium. All of these are followed by a deep coma and finally death. There are two major types of diabetes mellitus: Type I diabetes, “insulin dependent” (IDDM or juvenile-onset diabetes), seen mostly in children and adolescents, involves destruction of the beta cells of the islets of Langerhans with complete deficiency of insulin in the body. Patients are usually thin and require frequent injections of insulin to maintain a normal level of glucose in the blood. Type II diabetes, “non-insulin dependent” (NIDDM or adult- onset diabetes), is a separate disease from Type I, with a different inheritance pattern. Patients are usually older, and obesity is very common. The islets of Langerhans are not destroyed, and there is a relative deficiency of insulin secretion with resistance of target tissue to the action of insulin. Treatment is with diet, body weight reduction, and, when necessary, administration of insulin or oral hypoglycemic agents that can stimulate the release of insulin from the pancreas and improve the body’s sensitivity to insulin. Diabetes is associated \with both primary and secondary complications: Primary complications include ketoacidosis (fats are improperly burned leading to accumulation of ketons in the body) and hyperosmolar coma, a condition when blood sugar concentration (osmolarity) gets too high or the patient receives insufficient amounts of insulin. Hypoglycemia can occur when too much insulin is taken by the patient. Secondary (long-term) complications occur many years after the patient develops diabetes. These include destruction of the blood vessels of the retina 169
of the eyes (diabetic retinopathy), causing visual loss and blindness; destruction of the kidneys (diabetic nephropathy), causing renal insufficiency and often requiring haemodialysis or renal transplantation; destruction of blood vessels, with atherosclerosis; and destruction of nerves (diabetic neuropathy) involving pain or loss of sensation, most commonly in the extremities. Hyperinsulinism is an excess of insulin. This condition may be caused by a tumour of the pancreas (benign adenoma or carcinoma) or overdose of insulin. Excess insulin draws sugar out of the bloodstream, resulting in hypoglycemia. Fainting spells, convulsions, and loss of consciousness are common because a minimum level of blood sugar is necessary for proper mental functioning. Reactive hypoglycemia occurs after ingestion of glucose or a meal. This is due to an abnormality in the timing of insulin secretion in response to a meal, and is distinct from the type of hypoglycemia seen with hyperinsulinism. Other Related Terms diuresis
increased formation and secretion of urine
hirsutism
abnormal hairiness, especially in women
hypervolemia
abnormal increase in the volume of circulating fluid in the blood
insulinoma
tumour of the islets of Langerhans of the pancreas
obesity
excessive accumulation of fat above the body’s physical standards
thyroid storm
crisis of uncontrolled hyperthyroidism; thyrotoxic crisis
virilism
masculinisation in a woman; development of male secondary sex characteristics in a woman.
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For brief reference to abnormal conditions of the endocrine glands, refer to the table below.
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EXERCISES 1.1. The endocrine system is made up of the following glands: ............................... ..........................................................................................................................................................................
1.2. Make a comparison between the endocrine and nervous systems: ..........................................................................................................................................................................
2. Fill in the correct term: 2.1. Some examples of exocrine glands are sweat, digestive, and ......................... ........................................................................................................................................................
glands.
2.2. The ............................................................ gland is referred to as the master gland. 2.3. Ovaries produce .......................................... while the testes secrete .......................... 2.4. The thymus gland is an ................................................ organ located in the upper mediastinal ............................................................................................................................................... 3. Give the opposite of each term: 3.1. hypersecretion ......................................
3.6. infancy ........................................................
3.2. endocrine .................................................
3.7. deterioration ...........................................
3.3. prolonged .................................................
3.8. to lose .........................................................
3.4. goitre ...........................................................
3.9. complicated ............................................
3.5. inhibit ..........................................................
3.10. minimum ................................................
4. Match the following terms with their meanings: 4.1. hypoparathyroidism ...........................
a) protrusion of the eyes
4.2. hirsutism ..................................................
b) removal of the adrenal gland
4.3. adrenalectomy .......................................
c) hyposecretion of the parathyroids
4.4. exophthalmos ........................................
d) excessive hair growth
4.5. pheochromocytoma ...........................
e) tumour occurring in the adrenal medulla
5. Give the meanings for the following terms: 5.1. hirsutism .......................................................................................................................................... 5. 2. cretinism ......................................................................................................................................... 172
5. 3. myxedema ...................................................................................................................................... 5. 4. Cushing disease .......................................................................................................................... 5. 5. diabetes mellitus ........................................................................................................................ 5. 6. progesterone ................................................................................................................................. 5. 7. vasopressin .................................................................................................................................... 5. 8. acromegaly .................................................................................................................................... 5. 9. thymitis ............................................................................................................................................. 5.10. exacerbation ................................................................................................................................ 6. Provide the adjective form for each of the following: 6.1. hormone ...................................................
6.6. exophthalmos ........................................
6.2. metabolism .............................................
6.7. cretinism ...................................................
6.3. responsibility ..........................................
6.8. fatigue ........................................................
6.4. resorption .................................................
6.9. kidney .........................................................
6.5. pancreas ...................................................
6.10. diabetes ..................................................
7. Provide the singular form of the following nouns: 7.1. hormones .................................................
7.6. striae ...........................................................
7.2. ovaries ........................................................
7.7. adenomata ...............................................
7.3. medullae ...................................................
7.8. leaves ..........................................................
7.4. cortices ......................................................
7.9. negroes ......................................................
7.5. thyroidectomies ....................................
7.10. hypophyses ...........................................
8. Give appropriate medical term of the following: 8.1. inflammation of the adrenal glands ................................................................................. 8.2. any disease of the adrenal glands ..................................................................................... 8.3. pertaining to the formation of glycogen ......................................................................... 8.4. excessive presence of hair in unusual places ............................................................ 8.5. an excessive amount of insulin in the blood ................................................................
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8.6. surgical fixation of an enlarged thymus in a new position .................................. 8.7. increase in food intake ............................................................................................................. 8.8. excessive urine production .................................................................................................... 8.9. a test measuring the glucose levels in a blood sample from a fasting patient .......................................................................................................................................................... 8.10. pictures obtained from ultrasound waves ................................................................. 9. Translate into Croatian: Hypoglycemia is an abnormally low level of sugar (glucose) in the blood. Anyone who has not eaten for quite a while may experience the symptoms o flow blood sugar. True chronic hypoglycemia, however, is not very common. There are two types of hypoglycemia. The most common form is reactive hypoglycemia. In this condition, the blood sugar level drops sharply several hours after a large portion of sugar or starches has been consumed. When sugar is eaten, the pancreas is normally stimulated to produce the hormone insulin which enables the body to use the sugar. However, in reactive hypoglycemia the pancreas continues to produce insulin long after the need has passed. The result is abnormally low blood sugar levels. The other type of hypoglycemia, fasting hypoglycemia, may occur during pregnancy, strenuous exercise, and infectious accompanied by fever. All of these situations increase the body’s need for sugar; if sugar intake is not increased, temporary hypoglycemia may result. Disorders of the liver may also lead to fasting hypoglycemia. This is especially common in heavy drinkers, since alcohol upsets the sugar release response in the liver. Consequently, alcoholics are at a greater risk of developing fasting hypoglycemia. (From: Ellis, J. W. Medical Symptoms and Treatments) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 13
FEMALE REPRODUCTIVE SYSTEM 1. Reproduction Reproduction means the process by which a living entity or organism produces a new individual of the same kind. The gonads, or sex glands - the ovaries in the female and the testes in the male - produce the germ cells (gametes) that unite and grow into a new individual. Reproduction begins when the germ cells unite, which is a process called fertilization. The germ cells are the male spermatozoon and the female ovum, or egg. These are specialized cells differing primarily from normal body cells in one important way. Each sex cell contains exactly half the number of chromosomes that a normal body cell contains. When the ovum and spermatozoon unite, the cell produced receives half of its genetic material from its female parent, and half from its male parent; thus it contains a full, normal complement of hereditary material. Maturation of an ovum is a process controlled by hormones secreted by the female’s endocrine glands. An ovum, after leaving the ovary, travels down a duct (uterine or fallopian tube) leading to the uterus (womb). If coitus (copulation, sexual intercourse) has occurred and sperm cells are present in the uterine tube, union of the ovum and spermatozoon may take place. Ordinarily only one ovum matures alternatively from each ovary during one menstrual cycle. However, if by chance two eggs have been released and are fertilized by two sperm, fraternal twins are formed. Identical twins are reproduced by a single fertilized egg that divides into two eggs early in its development. Fertilization can occur only on the average of 4 days of every menstrual cycle. The mature ovum lives only l or 2 days after ovulation, and the sperm have about the same amount of time before they perish in the female reproductive tract. The fertilized egg, which is now called the embryo (and fetus after the second month) then begins a 9-month period of development (gestation, pregnancy) within the uterus. 176
The female reproductive system consists of organs that produce ova and provide a place for the growth of the embryo. In addition, the female reproductive organs supply important hormones that contribute to the development of secondary sex characteristics (body hair, breast development, structural changes in bones and fat). Ova are produced by the ovary from the onset of puberty (beginning of the fertile period when secondary sex characteristics develop) to menopause (cessation of fertility and diminishing of hormone production). If fertilization occurs at any time during the years between puberty and menopause, the fertilized egg may grow and develop within the uterus. Various hormones are secreted from the ovary and from a blood-vessel-filled organ, placenta, that grows in the wall of the uterus during pregnancy. If fertilization does not occur, hormone changes result in the shedding of the uterine lining, and bleeding, or menstruation, occurs. Ovarian hormones that play important role in the process of menstruation and pregnancy, and in the development of secondary sex characteristics, are estrogen and progesterone. Other hormones that arc responsible for the functions of the ovaries, breasts and uterus, are secreted by the pituitary gland. Gynecology is the study of the female reproductive system (organs, hormones, and diseases); obstetrics is a specialty concerned with pregnancy and delivery of the baby; and neonatology is the study and treatment of the newborn child. 2. Major Organs of the Female Reproductive System The female reproductive system consists of internal and external organs of reproduction. The internal or essential organs for reproduction are the ovaries, fallopian tubes, uterus, and vagina or birth canal. The external genitalia include the labia majora, labia minora, clitoris, vestibule of the vagina, and the greater vestibular glands or Bartholin glands. The combined structures of the external genitalia are known as the vulva. Both the cervix of the uterus and vagina are lubricated by the mucous secretions of Bartholin glands. A fold of membrane, the hymen, is sometimes found partially covering the orifice of the virginal vagina. A hymen may be ruptured at the first sexual intercourse, even though there have been cases in which pregnancies have occurred without any ruptures. Ovaries The reproductive system is linked to the body’s system of endocrine glands by the ovaries. Besides producing the ova, the ovaries secrete the female sex
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hormones estrogen and progesterone. These hormones influence the body’s development and general functioning as well as the sexual function. The two ovaries, each about the size of a small plum, lie on each side of the pear-shaped uterus at its wider upper part. Within each ovary are thousands of small sacs called graafian follicles. Each graafian follicle contains an ovum. When an ovum is mature, the graafian follicle ruptures to the surface of the ovary, breaks through its own outer covering, and is released. Release of an egg cell, called ovulation, occurs about once in 28 days. The ruptured follicle fills first with blood, and then with a yellow fatlike material. It is then called the corpus luteum (yellow body). Figure 13.1. Female reproductive organs
Fallopian tubes Fallopian tubes, oviducts, salpinges (sg. salpinx), or uterine tubes, extend laterally from superior angles of the uterus. They transport the ovum from the ovary to the uterus by rhythmic contractions of the tube walls and by the cilia of the mucous membrane lining. The opening of the tubes near the ovaries o pens directly into the uterus. Each oviduct is a muscular tube and consists of the same three layers found in the uterus: mucosa, serosa and a layer of smooth muscle. In addition to conveying the ovum, an oviduct provides a passageway through which sperm travel from the uterus toward the ovary. It is within the uterine tube that fertilization takes place while the ovum is moving through 178
the tube. It usually takes the ovum about 5 days to pass through the uterine tube. If coitus takes place near the time of ovulation and no contraception is used, there is a likelihood that sperm cells will be in the uterine tube when the egg cell is passing through. If fertilization has not occurred, the ovum remains unfertilized and, after a day or two, disintegrates. Uterine tubes and ovaries are called the adnexa (accessory structures) of the uterus. Uterus and Vagina Uterus is a hollow muscular pear-shaped organ, with muscular walls and mucous membrane lining filled with a rich supply of blood vessels. This organ is capable of stretching to contain a fertilized ovum as it grows through the 9 months of pregnancy. The uterus is located in the pelvic area between the bladder and rectum. The rounded upper portion of the uterus is called the fundus, while the larger central section is the corpus (body of the organ). The specialized epithelial mucosa of the uterus is called the endometrium; the middle, muscular layer is the myometrium; and the outer membraneous tissue layer is the perimetrium. The uterus is also adapted to hold the unborn infant securely and to nourish it. When the ovum arrives, the hormones estrogen and progesterone produced in the ovary have previously stimulated the uterus to prepare its lining with extra blood. If the egg has not been fertilized it loses its vitality, the hormone supply ceases, and the extra blood and tissues are discharged from the body through the vagina in the menstrual flow. The lower end of the uterus forms an opening called the cervix, or neck, which protrudes into the birth canal or vagina. Vagina is a muscular tube about seven and one-half cm long, and its lining consists of a mucous membrane fold that gives the organ its elastic quality. It extends from the cervix to the exterior of the body. Besides serving as the organ of sexual intercourse, and receptor of semen, the vagina discharges the menstrual flow. Like the uterus, the vagina undergoes changes during pregnancy that enable it to stretch to many times its usual size, allowing the infant to pass through it in childbirth (parturition). 3. Breasts - Accessory Organ of Reproduction The breasts or mammary glands are located in the upper anterior aspect of the chest. During puberty the glands begin to develop as they are exposed to periodic stimulation of two ovarian hormones, estrogen and progesterone. Estrogen is responsible for the fatty growth and increased size of the mammary glands as they reach full maturity. The size of the breast is basically determined by the amount of fat around the glandular tissue and is not indicative 179
of its functional ability. The other ovarian hormone progesterone forms the lobules that are present in the breast. Each mammary gland has approximately 20 lobes of glandular tissue. These lobes raise nipple. Circling the nipple, there is a border of slightly darker skin referred to as the areola. Full development of the breasts is achieved by the time female reaches the age of sixteen. The main purpose of the mammary glands is secretion of milk for nourishment of the newborn infant. During pregnancy, the hormones from the ovaries and the placenta stimulate glandular tissue in the breasts to their full development. After parturition (childbirth) hormones from the pituitary gland stimulate the production of milk (lactation). Figure 13.2. View of sagittal cut through breast
4. Menstrual Cycle and Menopause The menstrual cycle consists of a series of events that are associated with the maturation of the ovum. Approximately every 28 days the endometrium, the lining of the uterus, is prepared to receive a fertilized egg. If no fertilization, or conception occurs, the endometrium along with the unfertilized ovum is released from the body. The periodic discharge from the vagina of blood and tissues from a nonpregnant uterus is called menstruation. Menstruation occurs monthly, actually every 28 days or so from puberty to menopause. If the mature egg is fertilized, menstruation will not take place and the ferti180
lized ovum implants itself upon the uterine wall and continues to develop within the uterus. Menopause is the span of time during which the menstrual cycle diminishes and gradually stops. It is also called climacteric. During this period the ovaries stop functioning and therefore menstruation and childbearing cease. It is a natural physiologic process that results from the normal aging of the ovaries and occurs when the ovaries can no longer perform the function of ovulation and estrogen production. It usually begins between 40 and 50 years of age and its duration varies from 6 months to 3 years. 5. Pregnancy and Labour If fertilization does occur in the uterine tube, the fertilized egg begins to change immediately after. Soon the egg is dividing into a cluster of two, then four, then more cells, as it makes its way down the uterine tube toward the uterus for implantation. By the time the egg reaches the uterus, in 3 to 5 days, the cells are formed in the shape of a minute ball, hollow on the inside with an internal bump at one side where the embryo will form. This aggregation of cells, called a blastocyst, quickly buries itself in the lining of the uterus, which is the process known as implantation. As soon as the blastocyst is implanted, its wall begins to change into a structure that eventually develops into the placenta. Through the placenta the fetus secures nourishment from the mother and rids itself of waste products. Essentially the placenta is a filtering mechanism by which mother’s blood is brought close to the fetal blood without the actual mixing of blood cells. The outermost membrane which surrounds the developing embryo is called the chorion and the innermost is the amnion. The amnion contains the fetus surrounded by the amniotic fluid. The amnion and fluid are sometimes known as the “bag of water” which breaks to signal the onset of labour. The placenta, also known as the “afterbirth” because it becomes detached from the uterus after delivery, produces its own hormone as it develops in the uterus. This hormone is called human chorionic gonadotropin – HCG, or pregnancy hormone, and it stimulates the corpus luteum to continue producing hormones until about the third month of pregnancy, when the placenta itself takes over the endocrine function and releases estrogen and progesterone. During the early stages of pregnancy, the future child grows at an extremely rapid rate. The mother’s body must undergo profound changes to support this organism. The muscles of the uterus grow, the blood volume expands, the work of the heart increases, the breasts prepare for lactation and other adjustments are made throughout the mother’s body.
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The average duration of pregnancy or the gestation period is about 280 days, or 9 calendar months, although it may vary considerably from that average. The events of menstruation and pregnancy are dependent not only upon hormones from the ovary (estrogen and progesterone) but also on hormones from the pituitary gland. These pituitary gland hormones are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones stimulate the development of the ovum and ovulation. After ovulation, LH in particular influences the maintenance of the corpus luteum and its production of estrogen and progesterone. Labour, or childbirth, is the physiologic process by which the fetus is expelled from the uterus. It occurs in three stages: (l) opening or dilation of the cervix is the time from the onset of labour to complete dilation of the cervix (about 10 cm); (2) the second stage is called the expulsion stage during which the baby must be pushed through and out of the vagina; (3) the third stage is the stage of separation and expulsion of the placenta; in this final stage the placenta detaches itself from the uterine wall and is expelled. Key Terms • adnexa – accessory parts of the uterus: the fallopian tubes and the ovaries • amnion – the innermost membrane around the developing embryo • areola – dark-pigmented area around the breast nipple • chorion – outermost layer of the two membranes surrounding the embryo; it is part of the placenta • cyesis - pregnancy • embryo – stage in development from fertilization of the ovum through the 2nd month of pregnancy • endometrium – the inner mucous membrane lining the uterus • estrogen – ovarian hormone responsible for secondary sex characteristics • fallopian tubes – ducts through which the egg travels after its release from the ovary (oviducts, uterine tubes, salpinges) • fertilization – union of the sperm and the ovum (fusion of two nuclei occurs) • fetus – the embryo from the 3rd month (after 8 weeks) to birth • fimbriae (pl. fimbria) – finger-like ends of the fallopian tubes) • gamete – sex cell; the sperm and the ovum • gestation – pregnancy • gonads – organs in the male and female that produce gametes; ovaries and testes 182
• graafian follicle – developing sac enclosing each ovum within the ovary; only about 400 of these sacs will mature in a woman’s lifetime • lactiferous ducts – tubes that carry milk within a breast • menarche – the beginning of the first menstrual period during puberty • myometrium – the muscle layer lining the uterus • ovaries – female gonads • ovulation – release of the ovum from the ovary • ovum (pl. ova) – egg cell; female gamete • parturition – the act of giving birth • perimetrium – the membrane surrounding the uterus • perineum – in females, the area between the anus and the vagina • placenta – vascular organ that develops during pregnancy in the uterine wall and serves as a communication between the maternal and the fetal bloodstream • progesterone – hormone produced by the corpus luteum in the ovary and the placenta of pregnant women • puberty – beginning of the fertile period when gametes are produced and secondary sex characteristics appear • tocia - childbirth • uterus – womb; muscular organ in which the embryo develops • vagina – birth canal; a tube extending from the uterus to the exterior of the body Combining Forms Meaning
Terminology
amni/o
amnion
amniocentesis = surgical puncture of amniotic sac
colp/o vagin/o
vagina
colposcopy = visual examination of birth canal vaginocele = vaginal hernia
galact/o lact/o
milk
galactorrhea = persistent discharge of milk lactogen = forming or producing milk
gynec/o
woman, female
gynecology = specialisation in female reproductive system
hyster/o metr/o metri/o uter/o
womb, uterus
hysterectomy = removal of the uterus metrorrhagia = excessive uterine bleeding uterine = pertaining to the uterus
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mamm/o mast/o
breast
mammogram = radiograph of the breast mastitis = inflammation of breast tissue
men/o
menstruation menorrhagia = escessive menstrual flow
myom/o
muscle tumour
myomectomy = removal of fibroids from uterus
nat/o
birth
prenatal = before birth
obstetr/o
midwife
obstetric = pertaining to midwifery
o/o ov/o ovul/o
egg
oogenesis = formation of an egg cell ovum = egg ovulation = release of the egg
oophor/o ovari/o
ovary
oophorectomy = removal of the ovary ovarian = pertaining to the ovary
salping/o
uterine tubes salpingoplasty = surgical repair of a fallooviducts pian tube fallopian tubes
Disorders of the Female Reproductive System 1. Breast and Gynecological Conditions amenorrhea
absence of menstrual flow
breast cancer
malignant tumour of the breast; the most common type of canceramong women
cervical cancer
malignant tumour of the uterine cervix; one of the most common malignancies affecting women
cervicitis
inflammation of the cervix
chronic cystic mastitis inflammation of the breast tissue; fibrocystic breast disease dysmenorrhea
painful menstruation
endometrial carcinoma malignant tumour of the inner lining of the uterus endometriosis
endometrial tissue found in abnormal locations (e.g. ovaries, cul-de-sac, pelvic peritoneum, small intestine)
fibroids
benign tumours of the uterus; leiomyomas
menorrhagia
excessive bleeding during regular menstrual flow
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metrorrhagia
significant uterine bleeding between menstrual periods
ovarian carcinoma
malignant tumour of the ovary
ovarian cysts
collections of fluid within a sac (cyst) in the ovary
pelvic inflammatory disease (PID)
inflammation of the pelvic region; salpingitis
2. Pregnancy and Childbirth abortion
termination of pregnancy before the embryo or fetus is capable o of surviving outside the uterus
abruption placentae
premature separation of a normally situated placenta
breech presentation
abnormality of delivery in which the fetal buttocks or feet present first rather than the head
caesarean section
removal of the fetus by abdominal incision into the uterus
Down syndrome trisomy 21
congenital condition characterized by physical malformations and certain degree of mental retardation (three rather than two copies of chromosome 21)
dystocia
difficult labour
eclampsia
serious form of toxaemia during pregnancy
ectopic pregnancy
implantation of the fertilized egg in any site other than the normal uterine lining
fetal erythroblastosis
haemolytic disease of the newborn due to Rh incompatibility
gravida
pregnant woman
hydrocephalus
accumulation of fluid in brain ventricles (chambers)
kernicterus
high levels of bilirubin in the bloodstream of neonates
placenta praevia
placental implantation over the cervical opening or the lower region of the uterine wall
premature birth
when a live infant is born between 20th and 35th week of pregnancy
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puerperium
the period of 42 days following childbirth and expulsion of the placenta and membranes
pyloric stenosis
narrowing of the pyloric sphincter
3. Other Related Terms atresia dyspareunia infertility oligomenorrhea parturition, partus pyosalpinx sterility
congenital absence or closure of a normal body opening painful sexual intercourse inability or diminished capacity to produce offspring scanty or infrequent menstrual flow childbirth, the process of giving birth; delivery pus in the fallopian tube inability of the female to become pregnant or the male to impregnate the female
EXERCISES 1.1. The main functions of the female reproductive system are: ..........................................................................................................................................................................
1.2. The function of the breasts is ............................................................................................... 2. Complete the following sentences: 2.1. Fertilization can occur only on the average of 4 days of every ......................... ..........................................................................................................................................................................
2.2. The germ cells are the male ....................... and the.......................................... female 2.3. Beside producing the ova, the ovaries secrete .......................................................... 2.4. The study of female reproductive system is called ................................................. 2.5. Julius Cesar is said to have been born by .................................................................... 3. Give the opposite of each term: 3.1. similar ........................................................
3.6. give ...............................................................
3.2. resemble ...................................................
3.7. complete ...................................................
3.3. young ..........................................................
3.8. careful ........................................................
3.4. male .............................................................
3.9. complicated ............................................
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3.5. health ..........................................................
3.10. wealth ......................................................
4. Match the following terms with their meanings: 4.1. mastitis ......................................................
a) muscular layer of the uterus
4.2. myometrium ...........................................
b) release of egg from ovary
4.3. menorrhagia ...........................................
c) union of egg and sperm cells
4.4. fertilization ..............................................
d) inflammation of the breast
4.5. ovulation ...................................................
e) excessive bleeding during menstruation
5. Give the meaning of the following terms: 5. 1. ectopic pregnancy ...................................................................................................................... 5. 2. placenta ........................................................................................................................................... 5. 3. breech presentation ................................................................................................................. 5. 4. C-section ......................................................................................................................................... 5. 5. areola ................................................................................................................................................ 5. 6. menopause .................................................................................................................................... 5. 7. dystocia.............................................................................................................................................. 5. 8. amnion .............................................................................................................................................. 5. 9. salpingitis ....................................................................................................................................... 5.10. perineum ....................................................................................................................................... 6. Provide the plural form of the following nouns: 6.1. ovum ............................................................
6.6. placenta .....................................................
6.2. uterus .........................................................
6.7. corpus ........................................................
6.3. salpinx ........................................................
6.8. endometrium .........................................
6.4. fetus .............................................................
6.9. body .............................................................
6.5. cervix ...........................................................
6.10. amnion ....................................................
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7. Provide the adjective forms of the following nouns: 7.1. uterus .........................................................
7.6. amnion .......................................................
7.2. ovum ............................................................
7.7. ovary ............................................................
7.3. menstruation .........................................
7.8. cervix ...........................................................
7.4. breast ..........................................................
7.9. cortex ..........................................................
7.5. gamete .......................................................
7.10. labium ......................................................
8. Give appropriate medical word for the following: 8.1. pregnancy sustaining hormone .......................................................................................... 8.2. finger-like processes surrounding the abdominal opening of each uterine tube .............................................................................................................................................. 8.3. removal of an ovary .................................................................................................................... 8.4. yellow body ...................................................................................................................................... 8.5. mongolism ....................................................................................................................................... 8.6. inflammation of an ovary ........................................................................................................ 8.7. innermost embryonic membrane ...................................................................................... 8.8. accessory parts of the uterus .............................................................................................. 8.9. cessation of a woman’s reproductive function ........................................................... 8.10. the embryo from the beginning of the third month............................................... 9. Translate into Croatian: Drugs in Pregnancy Since the tragic crippling of thousands of unborn children in the late 1950s by the tranquilizer “thalidomide”, the use of drugs during pregnancy has become a highly controversial issue. Thalidomide was prescribed as a mild sedative for pregnant women until its disastrous side effects became obvious. The history of this drug has shown why it is impossible to rely solely on animal tests in studying the effects of drugs in pregnant women. Humans were found to be over 700 times more sensitive to thalidomide than hamsters, for example. Even enormous doses of the drug given to several species of animals failed to produce the severe crippling, disfigurement, and limb deletion that the drug causes in humans.
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The effects of drugs in the fetus depend upon the particular drug (or combination of drugs), the dosage, and most importantly, the stage of fetal development. Embryonic cells multiply and grow rapidly while food exchange and waste elimination occur through simple diffusion. Therefore, drugs capable of rapid cellular diffusion introduced during this period may cause significant embryonic alterations. Between the fifth and eighth weeks, drug action can cause abnormal tissue and/or organ differentiation. Timing is vital, with the most severe effects occurring in the nervous system between days fifteen to twenty-five; in the heart between days twenty to forty; in the legs between days twenty-four to thirty-six; and in the eyes between days twenty-four to forty. The major parts of the body have usually been differentiated by the eight week of pregnancy, and the danger of drugs diminishes. Some effects, like smoking, are cumulative, however. Most authorities now recommend that the ingestion of all drugs and medications, including over-the-counter and prescription drugs, be kept to a minimum or totally eliminated during all stages of pregnancy, unless such medications are considered necessary by the physician. Pharmacogenetics, the study of the interrelationship of hereditary constitution and drug responses, has become an important specialty as a result of these concerns. (From: Carrol Ch. and Miller D.: Health, the Science of Human Adaptation.) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 14
MALE REPRODUCTIVE SYSTEM Introduction The male reproductive organs consist of the external genitalia: a pair of testes, scrotum and penis; accessory glands that secrete special fluids: the prostate, two seminal vesicles, a pair of bulbourethral glands known also as Cowper’s glands, and the ducts through which these organs and glands are connected to each other and through which the spermatozoa are ejaculated during coitus, seminiferous tubules, epididymis, vasa deferentia and urethra. Apart from providing structures necessary to transport and maintain sperm viable, the male reproductive system produces the male sex cells, spermatozoa or sperm, which contain one half of the genetic material necessary to produce a living being. The male sex cell, the spermatozoon (pl. spermatozoa = sperm cells) is a microscopic, relatively uncomplicated cell, composed of a head region, which contains nuclear hereditary material (chromosomes), and a tail region, consisting o a flagellum, or a long whiplike tail used for locomotion. The s perm cell contains relatively little food and cytoplasm, for it needs to live only enough to travel from its point of release from the male to where the egg cell lies within the female (uterine tube). Only one spermatozoon of about 200 to 500 million s perm cells which may be released during a single ejaculation (ejection of sperm and fluid from the male urethra) can penetrate a single ovum and produce fertilization of the ovum. If more than one egg is passing down the uterine tube when sperm are present, multiple fertilizations are possible, and twins, triplets, quadruplets, and so forth may occur. Twins resulting from the fertilization of separate ova by separate sperm cells are called fraternal twins. Fraternal twins, developing “in utero” with separate placentas, have individual patterns of inheritance and resemble each other no more than ordinary brothers and sisters.
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Identical twins are formed from the fertilization of a single egg cell by a single sperm. As the fertilized egg cell divides and forms many cells, it somehow comes a part and each part continues separately to undergo further division, each producing an embryo. Both embryos share the same placenta. Identical twins are always of the same sex and very similar in form and feature (physique). All body organs contain parenchyma (parenchymal cells or tissue) which perform the essential functions of the organ. Organs also contain supportive, connective, and framework tissue, such as blood vessels, connective tissues, and sometimes muscles as well. This supportive tissue is called stroma (stromal tissue). Anatomy of the Male Reproductive System The male gonads consist of a pair of testes, also called testicles, which develop in the kidney region of the body before descending during fetal development into the scrotum, a sac enclosing the testes on the outside of the body. The testes produce the sperm cells and the male hormone testosterone, which gives a sexually mature male his distinctively masculine characteristics and his sexual energy and drive (libido). The interior of a testis is composed of a large mass of narrow, coiled tubules called the seminiferous tubules. These tubules contain cells which manufacture spermatozoa. The seminiferous tubules are the parenchymal tissue of the testis, which means that they perform the essential work of the organ. Other cells in the testis, called interstitial cells, manufacture the male hormone testosterone. As soon as they are formed, sperm cells move through the seminiferous tubules and are collected in ducts which lead to a large tube at the upper part of each testis. This is the epididymis. The spermatozoa become motile in the epididymis and are temporarily stored there. The epididymis runs down the length of the testicle and then turns upward again and becomes a narrow, straight tube called the vas deferens (seminal duct or ductus deferens). The vas deferens carries the sperm up into the pelvic region, around the urinary bladder, and then into a duct leading toward the urethra. It is the vas deferens that is cut or tied off when a sterilization procedure called a vasectomy is performed. The seminal vesicles are glands which are located at the base of the bladder and they open into the vas deferens as it joins the urethra. The seminal vesicles secrete a thick, yellowish substance that nourishes the s perm cells and forms much of the volume of ejaculated semen. Semen is a combination of fluid and spermatozoa which is ejected from the body through the urethra.
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In the male, as opposed to the female, the genital orifice combines with the urinary opening (meatus). Figure14.1. The Male Reproductive System
Each epididymis is connected to a vas deferens, a part of the spermatic cord that conducts the spermatozoa to the duet lying close to the bladder. The vasa deferentia join with ducts leading from the seminal vesicles just before the urethra. The combined duet is called the ejaculatory duct. This duct passes through the prostate and joins with the urethra. The urethra then conducts the semen through the penis. The prostate gland secretes a thick fluid which, as part of semen, aids the motility of the sperm. This gland is also supplied with muscular tissue which aids in the expulsion of sperm during ejaculation. Cowper glands, or bulboure193
thral glands, are located just below the prostate and they secrete an alkaline fluid into the urethra that is necessary for the viability of the sperm. The urethra expels both semen and urine from the body, but during ejaculation, the sphincter at the base of the bladder is closed. This not only stops the urine from being expelled with the semen, but also prevents the s perm from entering the bladder. The penis is the organ through which semen is transferred into the female during coitus. The tissues that form the mass of the penis are called erectile tissue. This tissue is spongy in nature and filled with innumerable hollow spaces. There is also a network of arteries and veins within the penis. Its tip expands and forms a soft, sensitive region called the glans penis. Circumcision is the process whereby the foreskin is removed, leaving the glans penis visible at all times. Figure 14.2. The passage of sperm from the seminiferous tubules in the testes to the outside of the body
Key Terms • flagellum (pl. flagella) – hair-like process on a sperm cell enabling its motility • parenchyma – tissue composed of essential cells of an organ
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• perineum – area between the anus and the scrotum in the male (vulva in the female) • semen – spermatozoa and fluid • seminiferous – sperm-producing • sterilization – any procedure rendering an individual incapable of reproduction • stroma – supportive, connective tissue of an organ. Combining Forms Meaning
Terminology
cry/o
cold; ice
cryogenic surgery = surgical method employing freezing
crypt/o
hidden
cryptorchism = undescended testicles
gon/o
seed
gonorrhoea = sexually transmitted bacterial infection
gonad/o
sex glands
gonadopathy = disease of the sex glands
olig/o
scanty
oligospermia = decreased production of sperm cells
orch/o orchi/o orchid/o test/o
testis (pl. testes)
orchitis = inflammation of testes orchialgia = pain in the testes orchidoptosis = prolapsed of the testes testectomy = surgical removal of a testis
prostat/o
prostate gland
prostatomegaly = enlargement of the prostate gland
py/o
pus
pyorrhoea = flow or discharge of pus
sperm/o spermat/o
spermatozoa, spermic = pertaining to sperm cell semen spermatocele = swelling containing spermatozoa
terat/o
monster
teratoma = a tumour composed of different types of tissue (e.g. bone, hair, cartilage, skin)
varic/o
dilated vein
varicocele = collection of varicose veins above the testes
vas/o
vessel, duct
vasectomy = removal of vas deferens
zo/o
animal life
azoospermia = absence of sperm cells in the semen
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Disorders and Pathological Conditions of the Male Reproductive System and Sexually Transmitted Diseases adenocarcinoma of the prostate
malignant tumour of the prostate; this is the most common cause of cancer in men over 50 years of age; radical prostatectomy and radiotherapy are common methods of treatment
anorchidism (anorchia)
congenital absence of one or more testes
balanitis
inflammation of the skin covering the glans penis
benign prostatic hyperplasia (hypertrophy)
overgrowth of glandular tissue of the prostate, often associated with the aging process; as urethral lumen is decreased causing a number of urinary problems (cystitis, nephritis, etc.); surgical methods of removal of the prostate gland include: 1. perineal prostatectomy (removal through the perineum) 2. transurethral resection (TUR – excision through the urethra) 3. suprapubic prostatectomy (removal through the opening in the upper bladder)
cryptorchism, cryptorchidism
undescended testicles; the testes descend into the scrotal sac normally about 2 months before birth; if not, the condition is referred to as chriptorchism; if they do not descend on their ownby the end of a child’s first year of life, correction involves surgical suspension (orchyopexy) of the testes in the scrotum; the condition may be unilateral or bilateral
epispadia
congenital opening of the urethra on the upper surface of the penis
hydrocele
sac (hernia) of clear fluid in the scrotum or in the tubes leading from the testes
hypospadia
congenital opening of the urethra on the undersurface of the penis
phimosis
narrowing or stenosis of the opening of the foreskin over the glans penis; the condition may interfere with urination; treatment is by circumcision
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testicular carcinoma malignant tumour of the testes and ovaries; these tumours are classified according to the type of tissue that is involved in the disease; examples of testicular carcinomas are seminoma, embryonal carcinoma, choriocarcinoma, and teratocarcinoma (malignant teratoma); the last one is composed of embryonic tissue such as bone, hair, cartilage, and skin cells and has an unpleasant or monster-like appearance; the tumours are treated by surgery, radiotherapy and chemotherapy varicocele
swollen, enlarged, herniated veins near the testicles; the condition is often associated with oligospermia and infertility; oligospermic men with varicoceles and scrotal pain should have a varicocelectomy; in this procedure, the internal spermatic vein is ligated (piece is cut out and ends are tied off), leading to a marked increase in fertility.
Sexually Transmitted Diseases (STD, Venereal Diseases) The following conditions, occurring in both men and women, are the most communicable diseases in the world and are transmitted by sexual intercourse: chlamydial infection
bacterial infection of the urethra of men and the vagina and cervix in women; men may experience dysuria and a white or clear discharge from the penis; women may develop a yellowish endocervical discharge, but often the disease is asymptomatic
genital herpes
infection of the skin and mucosa of the genitals caused by herpes virus (HSV) type II and sometimes type I; after primary infection, numerous recurrent episodes of the disease often follow; in more severe cases lesions may occur within the vagina and cervix, with ulceration or necrosis of tissue; in such cases there is higher incidence of cervical cancer; the disease is self-limiting and there is no drug known to be effective as cure.
gonorrhoea
inflammation of the genital tract mucous membranes caused by infection with gonococcus; other areas of the body such as eye, oral mucosa, rectum, and joints may
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also be affected; symptoms include dysuria and yellow mucopurulent discharge in men; some women carry the disease asymptomatically, while others have pain, vaginal and urethral discharge and salpingitis. syphilis (lues)
chronic infectious disease affecting any organ of the bodycaused by a spirochete Treponema pallidum (spiral-shaped bacterium); it enters the body through a break in the skin or mucous membrane; at the initial stage the disease is referred to as primary syphilis; about three weeks after exposure there is a development of a chancre, or a firm, hard, ulcerlike lesion; in women the chancre usually appears on the labia or within the vagina; secondary syphilis occurs about four months after the disappearance of a chancre, which may also appear on the lip, tongue, eyelid, or anus; the secondary stage is characterized by a blotchy red rash over the body; thin white sores appear on the mucosa of the mouth, throat, and genital area; contagiousness at this time is extremely high; tertiary syphilis, also called late syphilis, may develop after the symptoms of secondary syphilis disappear or it may lie dormant for many years. Later stages include damage to the brain, spinal cord, and heart. Syphilis (named after a shepherd in an Italian poem) can be congenital in the fetus if transmitted from the mother during pregnancy.
trichomoniasis
infection of the genitourinary tract of either sex, caused by Trichomonas vaginalis, a one-celled organism. This condition is more commonly found in women and causes vaginitis, urethritis, and cystitis. In men, it causes prostatitis, cystitis, and urethritis, but most infected males are asymptomatic carriers who are infectious to their partners. Several medications are available for the treatment of Trichomonas.
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EXERCISES 1.1. The organs of the male reproductive system are:..................................................... ..........................................................................................................................................................................
1.2. The main functions of the male reproductive system are:................................... ..........................................................................................................................................................................
2. Complete the following sentences: 2.1. Identical twins are formed from the fertilization of................................................. .......................................................................................................................................................... sperm.
2.2. If more than one egg is passing down the uterine tube when s perm are present.............................................................................................................................are possible. 2.3. Seminiferous tubules contain cells which produce ................................................ 2.4. In the male the genital orifice combines with the .................................................... 2.5. The ejaculatory duet passes through the ...................................................................... and joins with the .................................................................................................................................. 3. Give the opposite of each term: 3.1. remember ................................................
3.6. humble .......................................................
3.2. start .............................................................
3.7. attach ..........................................................
3.3. guilt ..............................................................
3.8. true ...............................................................
3.4. accept .........................................................
3.9. identical .....................................................
3.5. implicit .......................................................
3.10. possible ...................................................
4. Match the following terms with their meanings: 4.1. testosterone ............................................
a) removal of the prepuce
4.2. circumcision ...........................................
b) prepuce
4.3. phimosis ...................................................
c) scanty sperm
4.4. oligospermia ..........................................
d) a hormone produced by interstitial cells in testes
4.5. foreskin ......................................................
e) a narrowing or stenos is of theprepuce
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5. Give the meaning of the following terms: 5.1. stroma ................................................................................................................................................ 5.2. the prostate gland ....................................................................................................................... 5.3. sperm cell ........................................................................................................................................ 5.4. scrotum ............................................................................................................................................. 5.5. Cowper glands .............................................................................................................................. 5.6. hypospadias .................................................................................................................................... 5.7. seminiferous tubules................................................................................................................. 5.8. teratocarcinoma of the testes .............................................................................................. 5.9. cryptorchism.................................................................................................................................... 5.10. varicocele........................................................................................................................................ 6. Provide the plural forms of the following nouns: 6.1. scrotum .....................................................
6.6. testis ............................................................
6.2. placenta .....................................................
6.7. vas deferens ...........................................
6.3. hernia .........................................................
6.8. teratoma ...................................................
6.4. epididymis ................................................
6.9. flagellum ..................................................
6.5. spermatozoon ........................................
6.10. semen ......................................................
7. Provide the adjective form of the following nouns: 7.1. embryo .......................................................
7.6. testis ............................................................
7.2. maturation ...............................................
7.7. prostate .....................................................
7.3. hernia .........................................................
7.8. syphilis .......................................................
7.4. ejaculation ...............................................
7.9. semen .........................................................
7.5. perineum ..................................................
7.10. urethra ....................................................
8. Give appropriate medical word for the following: 8.1. nuclear hereditary material .................................................................................................. 8.2. twins resulting from the fertilization of separate ova by separate sperm cells................................................................................................................................................................
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8.3. the area between the anus and the scrotum at the floor of the pelvic cavity.............................................................................................................................................................. 8.4. the tubules containing cells which manufacture spermatozoa ..........................................................................................................................................................................
8.5. large tube at the upper part of each testis ................................................................... 8.6. a combination of fluid and spermatozoa which is ejected from the body through the urethra ............................................................................................................................. 8.7. congenital opening of the male urethra on the upper surface of the penis ............................................................................................................................................................. 8.8. a sac of fluid in the tubes leading from the testes .................................................. 8.9. chronic infectious disease caused by Treponema pallidum .............................. ..........................................................................................................................................................................
8.10. infection of the genitourinary tract caused by Trichomonas .......................... ..........................................................................................................................................................................
9. Translate into Croatian: The Controversy of Sexually Transmitted Disease (STD) Few diseases raise as much controversy as do the sexually transmitted ones. In the mind of the general public, STD has become confused with the method of its transmission. Indeed, “we have so consistently identified this disease with illegimate sex that anybody who gets it feels as though he were a criminal, no matter how he got it.” Some people claim there is never an “innocent party” to STD. But how else could we classify the husbands and wives who contract STD from a “cheating spouse”? Some infected persons develop so much guilt that they do not seek medical care. Others fear the public or private censure sometimes dispensed by health professionals so they avoid treatment. The tragedy of STD is two-fold: while many of the STDs are both curable and preventable, they are not being cured in millions of cases, and they are not being adequately prevented! Many people are convinced that the epidemic of STD throughout the world is evidence of widespread immorality and the decline of civilization. Some are more concerned that hundreds of thousands of untreated individuals are harbouring dangerous and damaging pathogens that possibly will be transmitted to unsuspected victims. Other view the increasing numbers of STD
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cases reported to public officials as evidence of increased personal and social responsibility. It is hoped that infected people seek help because they want to be cured and do not wish to give the disease to someone else. Still others look upon the alarming statistics of incidence and attribute the current epidemic to better case- finding and reporting techniques. Perhaps all viewpoints have some merit. One thing is certain: most people are not going to stop having sexual relations. If they do get STD and are not treated early, they are likely to suffer severe physical damage, perhaps even death. STD Warning Signals for Females −− discharge: abnormal yellow or white vaginal discharge that causes irritation or itching −− burning upon urination: painful and frequent urination −− sores: painless as well as painful sores or blisters in or around the vagina, external sex organs, mouth, and rectum −− bumps and lumps: painless vaginal warts, sometimes irritated by a heavy discharge from the vagina −− itching: intense itching in the genital area that may result in the appearance of bumps and lumps −− lower abdominal pain: with or without fever, this condition may indicate serious pelvic inflammatory disease (PID) STD Warning Signals for Males −− - discharge: white, clear, or often thick yellowish discharge of pus from the penis or from the rectum following anal intercourse −− - burning upon urination: painful and frequent urination −− - sores: painless as well as painful sores or blisters on the penis, around the genital area, mouth, and rectum −− - bumps and lumps: bumpy, painless warts; body rash; pimplelike bumps on the penis, swelling of lymph nodes in the groin −− - itching: intense itching particularly in the genital area. (American Medical Association) (From: Carrol Ch. and Miller D.: Health, the Science of Human Adaptation) .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 15
SENSE ORGANS – THE EYE AND THE EAR Both the eye and the ear are highly specialized sense organs. They provide information regarding the external environment. The eye is the receptor for light stimulation and is responsible for vision. The ear is the receptor of sound stimulation and is responsible for hearing. The Eye The eye functions in a manner similar to that of a camera. Light rays pass through a small opening and are focused by a lens upon photoreceptive surface. In a camera this surface is photographic film. In the eye, it is the retina. The eye is a globe-shaped organ that is composed of three distinct layers. Its outermost layer is the sclera. As the name suggests, it is a tough fibrous tissue and serves as a protective shield for the more sensitive structures beneath. The sclera is also known as the white of the eye. A highly vascular middle layer, the choroid, provides a blood supply for the entire eye. The retina is the innermost layer. It is chiefly composed of nerve endings that are responsible for the reception and transmission of light impulses. A specialized portion of the sclera, the cornea, passes in front of the lens. Rather than being opaque, it is transparent in order to permit entrance of light into the interior of the eye. One of the two major humours, or fluids of the eye is the aqueous humour. The iris divides the aqueous humour into two small chambers, the anterior chamber and the posterior chamber. A coloured, contractile membrane, the iris, functions as a sphincter. Its perforated centre is the pupil. The amount of light entering the eye is regulated by the size of the pupil. As the environmental light increases, the pupil constricts; as the light decreases, the pupil dilates. Located behind the posterior chamber is the lens. This crystalline structure is suspended between the ciliary muscles. As the muscles relax or contract, they alter the shape of the lens making it thicker or thinner, respectively, thus
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enabling the light rays to focus upon the retina. This process is called accommodation. The second major humour of the eye is the vitreous humour. This clear jellylike fluid occupies the entire orbit of the eye behind the lens. The vitreous humour, the lens and the aqueous humour are the refractive structures of the eye. They are responsible for the bending of light rays so that the rays focus sharply upon the retina. If any of these structures do not function properly, vision is impaired. Figure 15.1. Components of the eye
OPTIC NERVE
RETINA
OPTIC DISC
CHOROID SCLERA IRIS CORNEA PUPIL PATH OF LIGHT
MACULA
LENS
FOVEA RETINAL ARTERIES AND VEINS
VITREOUS CHAMBER
INSET
EYELID SCLERA
PUPIL IRIS
The retina is an extremely delicate eye membrane. It is continuous with the optic nerve and has two types of light receptors upon its surface, rods and cones. Rods function in dim light and provide black and white vision. Cones function in bright light and provide colour vision. Rods and cones contain chemicals called photo pigments. As light strikes the pigments, a chemical change occurs that produces a nervous impulse. These impulses are then transmitted to the brain through the optic nerve. The brain interprets them as vision. Both the optic nerve and the blood vessels of the eye enter the eyeball at the optic disc. Its centre is referred to as the blind spot, because the area has neither rods nor cones. 205
Six muscles control the movement of the eye: the superior, inferior, lateral and medial rectus muscles, and the superior and inferior oblique muscles. These muscles are coordinated to move both eyes in a synchronized manner. The front of the eye is protected by two movable folds of skin, the eyelids. Their edges are lined with two or three rows of eye lashes, which protect the surface of the eye. A thin mucous membrane called conjunctiva lines the inner surface of the eyelids and passes over the cornea. Lying superior and to the outer edges of each eye are the lacrimal glands. They produce tears to bathe and lubricate the eyes. The tears collect at the inner edges of the eyes, the canthi (singular: canthus), and pass through pinpoint openings, the lacrimal canaliculi, of the nose. The Ear The ear is the sense organ of hearing. It consists of three major sections: the external or outer ear; the middle ear or tympanic cavity; and the inner ear or labyrinth. Although each of these sections transmits sound waves, each accomplishes the task in a different way. The external ear conducts sound waves through air; the middle ear, through bone; and the inner ear through fluid. As will be subsequently explained, this series of transmissions play an integral part in hearing. The external ear is designed to channel sound waves from the environment to the middle and inner ears. An auricle or pinna is the external structure designed to collect waves travelling through air. The auricle channels the waves through the ear canal, or slender tube that leads to the middle ear. The canal is lined with glands that produce a waxy secretion called cerumen. Cerumen prevents foreign particles from entering the ear. A flat membranous structure, the tympanum (tympanic membrane or eardrum), is drawn over the end of the canal. Sound waves that enter ear canal strike against the tympanum. In the middle ear, vibrations of the tympanum are picked up by three tiny bones called ossicles. They are responsible for transmission of sound waves through the middle ear. The three articulating bones are the malleus (hammer), the incus (anvil), and the stapes (stirrups). These bones form a chain that stretches from the inner surface of the tympanum to an inner ear structure called the cochlea. A tube, called the Eustachian tube, connects the nose and the throat with the cavity of the middle ear. Its purpose is to equalize pressure on the outer and inner surfaces of the eardrum. In situations in which sudden pressure changes occur, equalization of pressure is achieved by deliberate swallowing. 206
INCUS
AURICLE
MALLEUS
Figure: Structures of the external, middle, and inner ear
SEMICIRCULAR CANALS VESTIBULOCOCHLEAR NERVE SEMICIRCULAR CANALS VESTIBULE EXTERNAL AUDITORY CANAL
EUSTACHIAN TUBE
STAPES OVAL WINDOW
TYMPANIC MEMBRANE
COCHLEA
The inner ear, sometimes referred to as the labyrinth because of its complicated mazelike design, is composed of three structures: a snail-shaped cochlea, the semicircular canals, and the vestibule, a chamber that joins the cochlea and the semicircular canals. The cochlea is a triple-looped tube that is filled with fluid. Lining its inner surface are tiny nerve endings called the hairs of Corti. There is a membrane-covered opening on the external surface of the cochlea called the oval window. That is precisely where the stapes is attached to the cochlea. Transmission of sound along the ossicles in the middle ear causes the stapes to exert a gentle pumping action against the oval window. The pumping action forces the cochlea fluid to move. Disturbances of the fluid stimulates the hairs of Corti, causing them to generate a series of nervous impulses. The impulses are transmitted to the brain by way of the auditory nerve, where they are interpreted as sound. Key Terms – the Eye • accommodation – adjustment of the eye for seeing objects at various distances • acuity – clearness or sharpness of a sensory function • adnexa – adjacent structures, e.g. extra ocular muscles, eyelids, conjunctiva, orbits, lacrimal apparatus 207
• aqueous humour – fluid in the anterior and posterior chambers of the eye • biconvex – having two rounded sides, like part of a sphere, e.g. the lens of the eye • chiasm – crossing • choroid – the middle vascular layer of the eye; a dark brown membrane • cones – photosensitive receptors; responsible for colour and central vision • fovea – tiny depression; in the eye it is the region of clearest vision • humour – any fluid or semi fluid of the body • lacrimal – tear producing; pertaining to tears • lens – a transparent biconvex body behind the pupil of the eye; it bends light rays • optic – pertaining to the eye • opaque – substance that does not allow the passage of light; not transparent • photo pigment – light-sensitive pigment in the retinal cones and rods; visual pigment • pupil – the dark opening of the eye surrounded by the iris • refraction – bending of light rays by the cornea, lens, and fluids of the eye to bring the rays into focus on the retina • rods – photosensitive receptors responsible for peripheral vision and vision in dim light • sclera – tough, white, outer coat of the eyeball • tunic(a) – layer of coat or tissue; a membrane layer • visual field – area within which objects may be seen when the eye is in a fixed position • vitreous humour – soft, jelly-like material behind the lens Combining Forms Meaning
Terminology
ambly/o
dull, dim
amblyopia = partial loss of vision
aque/o
water
aqueous = pertaining to water
blephar/o palpebr/o
eyelid
blepharitis = inflammation of the eyelid palpebral = pertaining to the eyelid
core/o pupill/o
pupil
coreometer = instrument for measuring the pupil pupillography = recording eye movement
corne/o kerat/o
cornea
corneal = pertaining to the cornea keratotomy = incision of the cornea
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cycl/o
ciliary body or cycloplegia = paralysis of the ciliary body muscle of the eye
dacry/o lacrim/o
tear; lacrimal dacryoma = tumourlike edema of lacriapparatus mal duct lacrimotomy = incision of the lacrimal duct
goni/o
angle
goniometry = examination of the angle
ir/o irid/o
iris
iritis = inflammation of the iris iridoplegia = paralysis of the iris
mydr/o
widen, enlarge
mydriasis = enlargement of pupils
ocul/o ophthalm/o
eye
oculomycosis = fungal infection of the eye ophthalmologist = eye specialist
opt/o optic/o
eye, vision
optometry = measuring vision optical = pertaining to the eye or vision
phac/o phak/o
lens
phacocele = herniation (protrusion) of the lens aphakia = absence of lens
phot/o
light
photophobia = fear of light
presby/o
old age
presbyopia = poor vision due to old age
retin/o
retina
retinosis = abnormal condition of the retina
scler/o
white of the eye (sclera)
scleromalacia = softening of the sclera
scot/o
darkness
scotoma = area of diminished vision; blind spot
uve/o
uvea; uveitis = inflammation of part or all of vascular the uvea layer of the eye (choroid; retina)
vitr/o
glassy
vitrectomy = removal of the vitreous chamber (its contents)
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Key Terms – the Ear • • • • • • • • • • • • • • • • • • •
auditory – pertaining to hearing auricle – the flap of the ear; also called pinna cerumen – a waxy substance secreted by the external ear; ear wax cochlea – a shell-shaped tube in the inner ear endolymph – fluid within the labyrinth of the inner ear Eustachian tube – auditory tube incus – the second ossicle of the middle ear; the anvil labyrinth – a series of intricate communicating passages malleus – the first ossicle of the middle ear; the hammer organ of Corti – sensitive auditory receptor in the cochlea of the inner ear ossicle – small bone oval window – a membrane between the middle and the inner ears perilymph – fluid contained in the labyrinth of the inner ear pinna – auricle saccule – little bag; organ in the inner ear associated with maintaining equilibrium semicircular canals – passages in the inner ear associated with maintaining equilibrium stapes (pl. stampedes) – the third ossicle of the middle ear; stirrup tympanic membrane – a membrane between the outer and the middle ear; the eardrum utricle – a tiny sac-like structure in the inner ear; associated with maintaining equilibrium
Combining Forms Meaning
Terminology
acous/o audi/o audit/o
hearing
acoustic = pertaining to hearing audiometer = instrument to measure hearing auditory = pertaining to hearing
aur/o auricul/o ot/o
ear
aural = pertaining to the ear auricular = pertaining to an auricle or the ear otalgia = earache
myring/o tympan/o
eardrum
myringitis = inflammation of the eardrum tympanotomy = incision in the tympanic membrane
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salping/o
auditory tube salpingoscopy = examination of the Eustachian tube
staped/o
stapes
stapedectomy = excision of the stapes
Pathological Conditions of the Sense Organs The Eye Errors of Refraction An error of refraction (ametropia) is caused when light rays are not brought into proper focus upon the retina. This may be due to a defect in the lens or cornea or a defect in the shape of the eyeball. If the eyeball is too long, the image falls in front of the retina. This condition is called nearsightedness (myopia). Correction is made by employing a concave lens. Farsightedness (hyperopia, hypermetropia) is the opposite of myopia. In farsightedness the eyeball is too short and causes the image to fall behind the retina. Correction involves the use of a convex lens. Another form of ametropia is a condition in which the cornea or lens has a defective curvature. This causes the light rays to diffuse over a large area of the retina, rather than being sharply focused on a given point. This gives rise to a condition known as astigmatism. Lenses that compensate for the imperfect curvature of the cornea or lens are used to correct astigmatism. Cataracts Cataracts are opacities that form on the lens or the capsule that encloses the lens. These opacities are produced by a build-up of protein, layer by layer, until there is a loss of vision. The only effective treatment is removal of the lens or capsule. Several techniques may be employed for cataract removal. In one method, a super-cooled metal probe (cryoprobe) is placed upon the cataract. The cataract bonds to the cold probe and the cataract and lens are gently lifted from the eye (cryoextraction). Another method of treatment is the removal of the entire Jens and its capsule (intracapsular cataract extraction). This is usually the method of choice when the cataract develops as a result of old age (senescent or senile cataract). Glaucoma Glaucoma is an eye disease characterized by increased pressure within the eyeball (intraocular pressure). This pressure leads to degeneration (atrophy) of the optic nerve. Glaucoma may result in blindness if not successfully treated. 211
The increased intraocular pressure is due to the failure of the aqueous humour to drain from the eye through a tiny duct called the canal of Schlemm. Treatment for glaucoma involves the use of medications that cause the pupils to constrict (myotics). This permits the escape of aqueous humour. If this treatment proves ineffective, surgery may be necessary. Three possible kinds of surgery for glaucoma include puncturing of the cornea (paracentesis of the cornea); the excision of a small portion of the iris (partial iridectomy); or separating the iris from its attachment (iridodialysis, coredialysis). Glaucoma is diagnosed by the use of an instrument that measures internal pressure of the eye (tonometer). This procedure is a simple, painless technique and should be performed on all patients after the age of 35 during routine eye examinations. Strabismus Strabismus is a condition in which the eyes turn from the normal position so that they are not aimed in the same direction. If the eyes deviate outward (exotropia), causing a divergent squint, the individual is said to be wall-eyed. If the eyes turn toward each other (esotropia), causing a convergent squint, the individual is said to be cross-eyed. Strabismus may be due to poor vision (decreased visual acuity), un equal ocular muscle tone, or an oculomotor nerve lesion. Eye testing (refraction) and prescribing of corrective lenses, eye exercise (orthoptic training) and surgery (strabotomy) in which the ocular tendons are cut, are the usual methods of treatment. Presbyopia Impairment of vision due to old age. With increasing age, loss of elasticity of the ciliary body impairs its ability to adjust the lens for accommodation to near vision. The lens of the eye cannot become fat to bend the rays coming from near objects (less than 20 feet). The light rays focus behind the retina, as in hyperopia. Therefore, a convex lens is needed to refract the rays coming from objects closer than 20 feet. Other Conditions and Related Terms achromatopsia
severe congenital deficiency in colour perception; colour blindness
chalaizon
small, hard, cystic mass on the eyelid as a result of chronic inflammation of a sebaceous gland
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conjunctivitis
inflammation of the conjunctiva producing a red or pink eye
diabetic retinopathy
disorder occurring with the diabetes and characterized by small haemorrhages, edema and neovascularisation near the optic disc, leading to scarring and eventual loss of vision
epiphora
abnormal overflow of tears
exophthalmos
protrusion of one or both eyeballs
hemianopia
loss of one half of the visual field, usually due to a stroke or damage to a portion of the optic nerve or its fibres
hordeolum (stye)
localized, circumscribed, purulent, inflammatory bacterial infection of a sebaceous gland in the eyelid
macular degeneration
deterioration of the macula lute of the retina; the condition may be inherited, drug induced, or age related and leads to severe loss of central vision; peripheral vision is retained
metamorphopsia
visual distortion of objects
nyctalopia
impaired vision in dim light; night blindness
nystagmus
involuntary, rapid, rhythmic movement of the eyeball
retinal detachment two layers of the retina separate from each other as a result of trauma to the eyeball, head injuries, bleeding, scarring from infection, shrinkage of the vitreous humour retinitis pigmentosa
progressive retinal sclerosis, pigmentation and atrophy, characterized by the deposition of pigmented scar on the retina
scotoma
area of depressed vision surrounded by an area of normal vision caused by damage to the retina or optic nerve
trachoma
chronic, contagious form of conjunctivitis usually leading to blindness
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The Ear Otitis Media Otitis media is an infection of the middle ear, found most commonly in infants and young children. It is frequently associated with an upper respiratory infection (URI). Symptoms may include earache (otodynia, otalgia), draining of pus from the ear (otopyorrhea), or rupturing of the eardrum (tympanorrhexis or myringorrhexis). Treatment consists of bed rest, medications to relieve pain (analgesics) and antibiotics. Occasionally, an incision of the eardrum (myringotomy, tympanotomy) may be necessary to relieve pressure and promote draining of pus from the middle ear. If left untreated, otitis media may lead to infection of the mastoid process (mastoiditis) or inflammation of the brain tissue near the middle ear (otoencephalitis). Otosclerosis Otosclerosis is a condition characterized by the hardening of spongy bone around the oval window. This decreases the ability of the stapes to move the oval window (ankylosis). Consequently, there is a hearing loss. Occasionally the individual perceives a ringing sound (tinnitus) within the ear. Surgical correction involves the removal of the stapes (stapedectomy) and reconstruction of the oval window. Sometimes insertion of an artificial stapes is necessary in order to restore hearing. Other Conditions and Related Terms acoustic neuroma
benign tumour arising from the acoustic nerve in the bran; it causes tinnitus, vertigo and decreased hearing
anacusia (anacusis) complete deafness; it may be unilateral or bilateral cholesteatoma
collection of skin cells and cholesterol in a sac within the middle ear
Meniere disease
disorder of the labyrinth in the inner ear due to elevated endolymph pressure within the cochlea leading to progressive loss of hearing; symptoms include tinnitus, headache, hyper-sensitivity to loud sounds nausea and vertigo
noise induced loss of hearing due to excessive exposure to sounds hearing loss (NIHL) that are too long, too loud and too close
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otitis media (serous, non-infectious inflammation of the middle or suppurative) ear characterized by accumulation of serum; inflammation of the middle ear caused by bacterial infection and with pus formation (suppurative) otosclerosis
hardening of the bony tissue of the labyrinth of the ear
presbycusis
hearing loss occurring with old age; it is the most common form of nerve deafness resulting from the physiological process of aging; hearing loss is irreversible; sudden deafness may occur as a result of in infectious illness, e.g. mumps or measles
tinnitus noise
(ringing, buzzing, roaring) sound in the ears
vertigo, dizziness
sensation of irregular or whirling motion either of oneself or of external objects; it is often associated with nausea and is due to a severe disturbance of equilibrium organs in the labyrinth
EXERCISES 1. Explain how the eye functions: ................................................................................................... 2. The ear consists of the following three major sections: ................................................ ..........................................................................................................................................................................
3. Fill in the correct term: 3.1. A highly vascular middle layer of the eye, the ..................................... provides a blood .............................................................................................................................. for entire eye. 3.2. One of the two major fluids of the eye is the ............................................ humour. 3.3. The ................................................................. tube connects the nose and the throat with the cavity of the middle ear. 3.4. Lining the inner surface of the cochlea are tiny nerve endings called the ..........................................................................................................................................................................
3.5. A pinna or an .................................................is the external structure designed to ..........................................................................................
sound waves travelling through air.
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4. Match the following terms with their meanings: 4.1. myopia ........................................................
a) the third ossicle of the middle ear
4.2. stapes .........................................................
b) nearsightedness
4.3. esotropia ...................................................
c) hearing loss occurring with old age
4.4. myringotomy ..........................................
d) an incision of the eardrum
4.5. presbycusis .............................................
e) a convergent squint (cross-eyed)
5. Define the following terms: 5.1. otodynia ............................................................................................................................................. 5.2. intraocular pressure .................................................................................................................. 5.3. paracentesis of the cornea .................................................................................................... 5.4. cerumen ............................................................................................................................................ 5.5. oval window ..................................................................................................................................... 5.6. cochlea ............................................................................................................................................... 5.7. blind spot .......................................................................................................................................... 5.8. lacrimal canaliculi ...................................................................................................................... 5.9. chalazion .......................................................................................................................................... 5.10. microtia ........................................................................................................................................... 6. Provide the plural form of the following nouns: 6.1. disc ...............................................................
6.6. iris .................................................................
6.2. auricle ........................................................
6.7. tympanum ................................................
6.3. sclera ..........................................................
6.8. pinna ...........................................................
6.4. canthus ......................................................
6.9. lens ..............................................................
6.5. Conjunctiva ..............................................
6.10. focus .........................................................
7. Provide the adjective form for the following nouns: 7.1. vision ...........................................................
7.6. correction .................................................
7.2. receptor .....................................................
7.7. divergence ...............................................
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7.3. cerumen ....................................................
7.8. capsule .......................................................
7.4. refraction ..................................................
7.9. impairment ..............................................
7.5. ophthalmology ......................................
7.10. crystal ......................................................
8. Translate into Croatian: Conjunctivitis Conjunctivitis is an infection or an inflammation of the conjunctiva, the delicate membrane that lines the eyelids and continues over the exposed surface of the eye. Although conjunctivitis will generally run its course in about two weeks and not cause permanent damage, some untreated cases of conjunctivitis may lead to more serious eye problems. Such complications may include ulcers on the cornea, the transparent covering across the front of the eye. A corneal ulcer is an eroded area of the cornea, which, if untreated, may leave a scar that interferes with vision. Most cases of conjunctivitis are caused by bacteria, viruses, or fungi. Allergies, chemicals, dust smoke, or foreign objects may also irritate the conjunctiva and lead to conjunctivitis. Measles, a childhood illness, is often accompanied by conjunctivitis. In addition, both children and adults who swim a great deal may contract conjunctivitis - either from chlorine in the pool or from contaminated water. Symptoms The symptoms of conjunctivitis include redness (pinkeye), burning, itching, tearing, discharge (sometimes containing pus ), pain and sensitivity to light. Sometimes the symptoms last a few days; at other times a severe case may linger for two weeks. Treatment Treatment can range from symptom-relieving measures (symptomatic therapy) to medication. Rest and shielding the eyes from bright light are often helpful. If the conjunctivitis is caused by environmental irritants, eliminating such factors may be sufficient. Antibiotic drops (or antiseptic, germ-killing) may be prescribed. (Ellis, J. W. Medical Symptoms and Treatments) .......................................................................................................................................................................... ..........................................................................................................................................................................
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SUPPLEMENT CHAPTER 16
ONCOLOGY – CANCER MEDICINE Oncology is the study of tumours. It includes both malignant and nonmalignant growths, or neoplasms. Cancer is a disease generally characterized by uncontrolled and excessive growth of body cells. It may develop in any body tissue and at any age, although more frequently in older people and rarely in the young ones. As cancerous cell grow they eventually destroy their surrounding normal tissue and they have also the ability to spread throughout the body, either by bloodstream or by lymphatic system, and forms distant sites of malignant growths, which often causes death. Lung, breast and colorectal cancers rank highest in the percentage of deaths for women, while lung, colorectal and prostate cancers are highest in percentage of deaths for men. Neoplasms In healthy individuals cell division is an orderly process in which body cells are produced for growth of the individual or for replacement of cells that are destroyed or worn out. In some instances, however, cell division is without purpose. The newly formed cells increase at an uncontrolled rate, producing a lump or swelling known as a tumour or neoplasm. Neoplasms may be either benign or malignant. Benign neoplasms Benign neoplasms are growths that occur in body tissues. They are composed of the same cells as the tissue in which they are growing. For example, a benign tumour of a gland is composed of the glandular tissue from which it is developing. Benign neoplasms are contained within a capsule and do not invade the surrounding tissue. They harm the individual only insofar as they place pressure on surrounding structures. If the benign neoplasm
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remains small and places no pressure on adjacent structures, it is not often removed. If it becomes enlarged or places pressure on other organs or structures, it must be removed. Benign brain tumours are always very serious, since the cranial cavity is enclosed and pressure on other parts of the brain inevitably results. As a general rule, however, benign tumours are not life-threatening. Once they are removed, they do not regrow. Malignant neoplasms The cells that compose a malignant neoplasm often do not resemble the tissue in which they are growing. In such cases the tumour is said to be undifferentiated. The tumour cells lack specialization in both structure and function. More significantly, however, the cells of the malignant neoplasm are not encapsulated and are able to spread to normal tissues. This invasive growth occurs by direct extension or metastasis. In direct extension, the tumour grows directly into normal tissue. This is called proliferation. With metastasis the malignant cells from the primary tumour site find their way into lymph channels or blood vessels and are carried to remote body structures in which secondary malignant neoplasms develop. Nomenclature of Tumours Tumour nomenclature is based, in part, upon the tissue from which the tumour originates. This is referred to as histogenesis. For purpose of tumour nomenclature, four types of tissue are identified: epithelial, connective (including muscle), hematopoietic (blood and lymph), and nervous tissue. To indicate a benign tumour that arises from epithelial or connective tissue add the suffix -oma to the word root. An exception to this rule is melanoma, which is a malignant tumour of epithelial origin. There are certain characteristics of a tumour that help in diagnosing whether it is benign (noncancerous) or malignant (cancerous). A benign tumour is usually enclosed within a capsule, grows slowly, and does not invade surrounding tissue (metastasize). A malignant tumour is not encapsulated, grows rapidly, and metastasizes. Staging Staging is an attempt to define the extent of cancer by classifying it into three categories: T, N and M. T represents the primary tumour site or place of origin; N represents local or regional node involvement; and M tells whether or not there is metastasis. When the primary site contains classifications of Tl, T2, T3, or T4, the higher numbers would indicate progressive increase in tumour size and involvement. Similarly, NO, Nl, N2, or N3 represents progres220
sively advancing nodular involvement. Finally, MO or M+ defines absence or presence of metastasis, respectively. Grading Grading of a malignant tumour is an evaluation of the histological makeup of the neoplasm. Generally, four grades are employed, Grade l to Grade 4. Neoplasms that are composed of cells that closely resemble the tissue from which they arise are given a Grade l rating. The tissue demonstrates a minimum amount of anaplasia. At the other extreme is Grade 4 in which there is a great deal of anaplasia within the tumour. Such tumours are more serious and prognosis is very poor. Grades 2 and 3 are intermediate grades between these two extremes. HISTOGENESIS OF BENIGN AND MALIGNANT NEOPLASMS HISTOGENESIS TISSUE OF ORIGIN
BEHAVIOUR BENIGN
MALIGNANT
1. Epithelial Tissue Tumours: surface epithelium glandular papilloma epithelium adenoma
carcinoma adenocarcinoma
2. Connective Tissue Tumours: fibrous tissue fibroma cartilage chondroma bone osteoma fat lipoma blood vessels hemangioma lymph vessels lymphangioma smooth muscle leiomyoma striated muscle rhabdomyoma
fibrosarcoma chondrosarcoma osteosarcoma liposarcoma hemangiosarcoma lymphangiosarcoma leiomyosarcoma rhabdomyosarcoma
3. Hematopoietic Tissue Tumours: lymphoid tissue granulocytic tissue erythrocytic tissue plasma cells
myelocytic leukemia erythroleukemia multiple myeloma plasmocytoma
4. Nerve Tissue Tumours: glial tissue meninges
glioma meningeal sarcoma
meningioma
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nerve cells
neuroma, ganglioneuroma nevus (nevocytoma) neurilemoma
neuroectoderm nerve sheaths retina adrenal medulla
5. Tumours Consisting of More than One Tissue: breast fibroadenoma embryonic kidney multipotent cells teratoma uterus
neuroblastoma, melanoma neurolymphoma neurilemmic sarcoma retinoblastoma pheochromocytoma cystosarcoma nephroblastoma choriocarcinoma mixed mesodermal
6. Tumours that do not Fit into One of the Above Groups: melanoblasts pigmented nevus melanoma placenta hydatidiform mole choriocarcinoma ovary cystosarcoma cell tumours testis teratoma thymus thymoma The terms that are listed below describe the appearance of a malignant tumour either on gross (visual) or on microscopic examination Gross Descriptions cystic
forming large open spaces filled with fluid; mucinous tumours are filled with mucus, while serous tumours are filled with watery fluid resembling serum; the most common site is in ovaries
fungating
a mushroom-like pattern of growth during which tumour cells pile one on top of the other; usually found in colon
inflammatory
- having the features of inflammation: redness, swelling, heat; usually occur in the breast
medullar
large soft fleshy tumours; usually occurring in the thyroid and the breast
necrotic
containing dead tissue; any type of tumour can outgrow its blood supply and undergo necrosis
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polypoid
projections extending outward from a base, like extending from a stem or stalk
ulcerating
characterized by an open, i.e. exposed surface resulting from death of the overlying tissue; often found in the stomach breast, colon, skin
verrucous
resembling a wart-like growth; tumours of the gingival are usually of the verrucous type.
Microscopic Descriptions alveolar
tumour cells look like microscopic sacs; commonly found in tumours of the muscle, bone, fat and cartilage
carcinoma in situ – localized tumour that has not invaded the adjacent structures diffuse
spreading evenly throughout the affected tissue; e.g. malignant lymphomas areknown to have such spread
dysplastic
pertaining to abnormal cell formation, not clearly cancerous; examples are dysplastic nevi
epidermoid
resembling squamous epithelial cells, often occurring in the respiratory tract
follicular
forming small microscopic, gland-type sacs; e.g. the thyroid cancer
nodular
forming multiple areas of tightly placked clusters of cells (nodules); e.g. malignant lymphomas
papillary
small finger-like or nipple-like projections of cells; e.g. bladder cancer
pleomorphic
composed of a variety of types of cells; e.g. mixed-cell tumours
scirrhous
densely packed, hard tumours, overgrown with fibrous tissue; e.g. breast or stomach cancers
undifferentiated
– lacking microscopic structures typical of normal mature cells.
Treatment Malignant tumours – cancers, are usually treated by three standard methods either singly or in combination. These are: surgery, radiation and chemotherapy. Besides these, new methods of treatment are being extensively tested and gradually introduced. These include biological agents, e.g. mono223
clonal antibodies, and differentiating agents, e.g. those that cause tumour cells to differentiate stop growing and die. EXERCISES 1.1. What is oncology? ........................................................................................................................ 1.2. Name four tissues from which the tumour originates........................................... ..........................................................................................................................................................................
2.1. In healthy ................................. cell division is an ............................................ process. 2.2. Benign neoplasms are ................................... within a ...................................................... 2.3. Benign brain tumours are always very ..................................... : ................................... 2.4. Staging is an ................................................. to define the ............................ of cancer. 2.5. N represents ................................................. or ................................ node involvement. 3. Match the following terms with their meanings: 3.1. proliferation ............................................
a) a new growth of tissue
3.2. staging .......................................................
b) spread of malignant cells into the surrounding tissue
3.3. sarcoma ....................................................
c) a method of classifying malignant spread
3.4. neoplasm ..................................................
d) malignancy of connective tissue origin
4. Give the meaning of the following term: 4.1. lethal ...........................................................
4.6. lipoma ........................................................
4.2. oncologist .................................................
4.7. meninges ..................................................
4.3. multicentric ............................................
4.8. hemangioma ..........................................
4.4. dormant .....................................................
4.9. melanoma ................................................
4.5. fibroma ......................................................
4.10. necrotic ...................................................
5. Give appropriate medical word for the following: 5. 1. the newly formed cells............................................................................................................. 5. 2. an undifferentiated tumour .................................................................................................. 224
5. 3. an attempt to define the extent of cancer .................................................................... 5. 4. an evaluation of the histological makeup of the neoplasm ............................... 5. 5. epithelial tissue having velvety appearance ............................................................... 5.6. penetrating the spaces within tissues ............................................................................ 5. 7. a cancerous tumour composed of cells of epithelial tissue ............................. ..........................................................................................................................................................................
5. 8. tumour of a smooth muscle ................................................................................................ 5. 9. pertaining to the marrow ....................................................................................................... 5.10. tumour of the skeletal muscle .......................................................................................... 6. Provide the adjective forms of the following nouns: 6.1. cancer .........................................................
6.6. multiplication .........................................
6.2. lymph ..........................................................
6.7. genesis .......................................................
6.3. glioma ........................................................
6.8. ability ..........................................................
6.4. structure ...................................................
6.9. neoplasm ..................................................
6.5. predomination .......................................
6.10. granulocyte ...........................................
7. Provide the plural form of the following nouns: 7.1. melanoma ................................................
7.6. tremor ........................................................
7.2. nevus ...........................................................
7.7. loss ...............................................................
7.3. axilla ............................................................
7.8. neurosurgeon ........................................
7.4. radiotherapy ...........................................
7.9. disk ...............................................................
7.5. area ..............................................................
7.10. month .......................................................
8. Translate into Croatian: A 37-year-old male underwent abdominal resection for a malignant melanoma arising in a nevus. One year later, he underwent bilateral axillary node dissection, which indicated 2 of 23 left axillary nodes positive for tumour. Two months later, his bone scan was positive at the right proximal humerus, and a biopsy revealed metastatic melanoma. The patient began having symptoms
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of involvement of the fourth lumbar nerve roots and received radiotherapy to the L-4 spine and the humerus with good response. However, several weeks later, he noted progressive right leg weakness and left leg sensory loss. Myelogram demonstrated two metastatic lesions at 7 -12/L-1 and L-4 that were not thought to be accessible surgically. The patient received further radiotherapy to the affected vertebral areas. The patient received one course of BCNU (a chemotherapeutic drug) from another physician who noted some optic disk edema. The patient was placed on dexamethasone (Decadron) therapy for 2 weeks, after which his course deteriorated progressively with numbness in his upper extremities bilaterally, left leg hyperesthesia, and tremors. Decadron was continued and a neurosurgeon felt that little could be done surgically to reverse the deficits. (From “The Language of Medicine” Davi-Ellen Chabner) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 17
GENERAL CARE OF THE PATIENT The patient admitted to hospital enters a strange world and is apprehensive in case he or she has cancer or is to undergo an operation, and worries about his family at home. The nurse should introduce herself and deal with the patient calmly, tactfully, pleasantly and reassuringly. The patient should be made comfortable. His/her name, age, address and the name, address and telephone number of next-of-kin should be recorded. Rest in bed helps to combat disease but predisposes, especially in the elderly, to stiff joints, weak muscles, bedsores, constipation and venous thrombosis, which must all be prevented. Noise disturbs rest and should be avoided. Cupboards, doors, bedpans and trolleys should not be allowed to bang, and nurses’ shoes should have rubber soles and heels. Daily Routine Each morning the patient should be bathed and the bed made. The hands are washed in the middle of the day, after defecation and at night, and the hair is brushed. The mouth, skin and bowels are cared for. The patient is assessed for the intensity of treatment required on the grounds of age, general condition, degree of arterial disease and the disease causing admission. Thus an elderly, poorly nourished patient with paralysis will need frequent turning and care to pressure areas, whereas a young person with appendicitis will need less intensive nursing. Feeding The patient should be positioned comfortably and be allowed to wash his/ her hands. The nurse washes her hands before handling crockery or cutlery or serving food. Everything should be within easy reach of the patient. Helpings should be small; more being given later if required. Only one course should be served at a time. Plates, glasses and cups should not be too full.
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For recumbent patients a serviette is placed under the chin and the head is raised by placing the hand beneath the pillow, not under the neck. The patient is fed at his own pace. Liquids may be taken through a straw. The diet should be adequate in joules, fat, protein, vitamins and minerals. Moving the Patient The patient who is weak or unable to move should be lifted, not dragged, into position in bed. Dragging causes friction between the skin and the sheet and predisposes to bedsores. Before lifting, the pillows should be tidied and the bedclothes loosened. The nurse should not attempt to lift a heavy patient without assistance, either from the patient, if permitted, or from a second nurse. There are several ways of lifting. In the Australian lift each nurse places her shoulder under the patient’s axilla and the arm below the thigh, grasping the other nurse’s wrist. The nurse should keep her back straight, bending from the hips so as to prevent injury to her back. To turn a patient the nurse stands at the side to which the patient is to be turned; places his arm across his chest and crosses his legs, reaches over him, and with one hand around the pelvis and the other below the shoulder, turns him towards her. To move a patient from a trolley to a bed, the two are placed at right angles to each other, the head of one near the foot of the other. Three persons stand on the same side of the patient and lift together. Bathing in Bed (“Blanket Bath”) Procedure: Explain the procedure to the patient. Screen the bed. Ask the patient if he wishes to use a bedpan or urinal. Place clean nightwear on a nearby radiator to warm. Turn the bedclothes back, leaving the patient covered with his top sheet. A large bath towel is placed beneath him to prevent the bedding from getting wet. Remove the patient’s nightwear, drape a blanket over him if he is likely to feel cold, and wash him with soap and hot water, starting with the face and neck, using the face flannel and towel, allowing the patient to wash and dry his own face, if able. A second flannel is used for the remainder of the body, only exposing those parts of the patient which are being washed. When the arms, chest and abdomen have been washed and dried, the water in the bowl is changed and the lower limbs, genitals and buttocks are washed. The patient should wash and dry his own pubic area, if able. The feet should be placed in the bowl of water, if possible. During bathing the patient is unobtrusively examined, and any skin rashes, bruises, sacral edema or other abnormality reported. The pressure areas are massaged during the bed bath, the patient dressed in the warmed nightwear, the nails trimmed if necessary,
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and the hair brushed or combed. The teeth or dentures are cleaned (the patient may do this), and a mouthwash is given. The bed is made with clean linen and the patient repositioned and asked if he is comfortable. Female patients may be helped with their cosmetics. Care of the Skin (Pressure Areas) Bedsores are gangrenous ulcers due to ischemic death of the skin. Causes: exclusion of blood from the skin by prolonged pressure caused by immobility (paralysis, stiff joints, sedation), lying or sitting on creases of linen, crumbs, or hard pads, or a moist skin, e. g. incontinence of urine or feces, local sweating (sitting on plastic). Rough handling easily damages skin which is inelastic (elderly patients), has a poor circulation (atheroma), or is poorly nourished. Edema and congestion prevent the exchange of metabolites between the blood and the tissues. The areas to be treated are the elbows, shoulder blades, tips of the shoulders, occiput, vertebrae, iliac crest, buttocks, knees, ankles and heels. Reassure the patient and explain the reason for the procedure. Close the windows and screen the patient. Turn back the bedclothes, leaving a sheet covering the patient. Clean the area with a damp wipe, especially the buttocks if the patient is incontinent. Wash with soap and water, dry the area thoroughly but gently. Sparingly apply fine talcum powder or cream. Remake the bed. Creams or sprays do not prevent bedsores, but if they are used the area must be thoroughly washed and dried before they are applied or reapplied. Pressure areas are treated two-hourly if the patient is confined to bed or is incontinent. The patient is encouraged to move in bed and his position should be regularly altered by turning. The sheet must be free from creases and crumbs. Decubitus pads are aids to the prevention of pressure sores, but the above procedure must also be used. Any indication of a pressure sore commencing must be reported immediately to the sister in charge. The first sign is a reddening of the skin, a burning feeling or irritation. Care of the Nails and Hair Fingernails should be trimmed with scissors to the shape of the fingertips. Toenails should be cut straight across (if cut short and curved, the free margin of the nail may dig into the tissues as it grows, producing an “ingrowing nail”). Nails are cut more easily after soaking in warm water. The hair should be brushed or combed daily and washed weekly, observing for parasites and
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nits. If a man is too ill to shave himself, he may be shaved by a visiting barber, convalescent patient, or the nurse. (Harrison, R. Textbook of Medicine with Relevant Physiology and Anatomy) EXERCISES 1. Fill in the correct term: 1.1. The nurse should ............................................................................................ the patient’s name, age and address upon admission to the hospital. 1.2. Bed rest ................................................. the elderly to .............................................. joints. 1.3. Each morning the patient should be .............................................................. and the bed ................................................................................................................................................................. 1.4. An elderly, poorly ................................................................................... patient will need frequent ...................................................................................................................................................... 1.5. Only one course should be ................................................................................ at a time. 1.6. The patient is fed at his own ................................................................................................. 1.7. Dragging causes ................................................................................and predisposes to 1.8. The nurse should not attempt to .................................................................................... a heavy patient without ......................................................................................................................... 1.9. During bathing the patient is ......................................................................... examined. 1.10. Decubitus .........................................................................are aids to the prevention of ................................................................................................................. sores.
2. Define the following terms: 2.1. hospitalization ............................................................................................................................... 2.2. next-of-kin ....................................................................................................................................... 2.3. appendicitis ..................................................................................................................................... 2.4. intensive nursing ......................................................................................................................... 2. 5. helping(s) ........................................................................................................................................ 2. 6. recumbent patient ..................................................................................................................... 2. 7. joule ....................................................................................................................................................
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2. 8. screening ........................................................................................................................................ 2. 9. (o)edema .......................................................................................................................................... 2.10. metabolite ..................................................................................................................................... 3. Provide the plural form of the following nouns: 3.1. tissue .................................................................................................................................................. 3.2. extremity ........................................................................................................................................... 3.3. vertebra ............................................................................................................................................. 3.4. ankle .................................................................................................................................................... 3.5. toenail ................................................................................................................................................. 3.6. spray .................................................................................................................................................... 3.7. occiput................................................................................................................................................. 3.8. pelvis.................................................................................................................................................... 3.9. trolley .................................................................................................................................................. 3.10. glass ................................................................................................................................................. 4. Provide the adjective form for the following nouns: 4.1. muscle ............................................................................................................................................... 4.2. artery .................................................................................................................................................. 4.3. constipation .................................................................................................................................... 4.4. lifting ................................................................................................................................................... 4.5. abdomen ........................................................................................................................................... 4.6. joint ...................................................................................................................................................... 4.7. gangrene ........................................................................................................................................... 4. 8. ulcer ................................................................................................................................................... 4. 9. congestion ...................................................................................................................................... 4.10. incontinence ................................................................................................................................. 5. Give appropriate medical term for the following: 5.1. a mass of plaque of degenerated, thickened arterial intima occurring in atherosclerosis........................................................................................................................................ 231
5.2. an ulceration caused by prolonged pressure in a patient lying still in bed for a long period of time ................................................................................................................... 5.3. a vessel for urine ......................................................................................................................... 5.4. stools .................................................................................................................................................. 5.5. sweating ............................................................................................................................................ 5.6. pain in a joint/joints .................................................................................................................... 5.7.lack of muscle strength ............................................................................................................ 5.8. deficiency of blood in a body part....................................................................................... 5.9. reddening of the skin ................................................................................................................ 5.10. any joint disease......................................................................................................................... 6. Circle the correct spelling: 6.1. tromboses ............................... thrombosis .......................... thrombozis ........................ 6.2. peristalsis ............................... perastalsis ........................... parastalsis ......................... 6.3. seedation ................................. cedation ................................ sedation............................... 6.4. convalescent .......................... convalesent ......................... konvalescent ................... 6.5. iritation ..................................... irritation ................................ eerritation ......................... 6.6. symdrone ................................. sindrome .............................. syndrome ........................... 6.7. periferal .................................... peripheral ............................ peripherel ......................... 6.8. appendix ................................... apendix .................................. appendiks .......................... 6.9. paralisis .................................... paralysis ............................... parelysis ............................. 6.10. sweat ....................................... swet ......................................... swat ..................................... .
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CHAPTER 18
BRITISH MEDICAL TRAINING AND REGISTRATION 1. Undergraduate Training There are not enough places at British medical schools for all those who wish to study medicine. Consequently competition for places is very great and it is almost impossible for a student from another country to get a place. The study period normally lasts about six years. For the first three years of preclinical studies, the student is taught the scientific basis of his profession. He is trained in such subjects as human anatomy, physiology, biology, biochemistry, bacteriology, elementary psychology and so on. Then follow three years of clinical training during which time the student not only attends lectures and classes but also progresses through a whole series of practical clinical clerkships. In these clinical clerkships, he helps in hospital wards and outpatient clinics under the guidance of hospital doctors. He learns and practices the careful examination of patients, writes up their case histories and under supervision - learns the technique of a wide variety of diagnostic and therapeutic procedures. He also has to attend the teaching ward rounds of the consultant in charge of the department, help the surgeon in the operating theatre and be present, and help, at a required number of confinements (births). At the end of his clinical years, he takes examinations which include written, practical and oral examinations, known as the Finals. If successful, he may acquire a University degree or one of the other, but lesser, basic registrable qualifications or licenses. He is then granted Provisional British Medical Registration as a doctor. This newly qualified U. K. Doctor must then complete satisfactorily two scheduled House Officer appointments as a resident hospital doctor in medicine and surgery (or obstetrics and gynaecology) lasting six months each before he can get Full British Medical Registration. Only after he is fully registered may he enter any other form of medical employment, become a trainee in general practice or start working towards any specialist diploma.
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In Britain the University Diploma of M. D. (Doctor of Medicine) is not a basic medical qualification but is a higher specialist degree in Internal Medicine which is gained several years after getting a basic University medical degree. The candidate must pass a difficult examination and/or write an acceptable thesis. Normally an M. D. degree can only be gained at the same university where the doctor gained his basic degree. 2. Medical Registration for Overseas Doctors An overseas-qualified doctor must apply to the general Medical Council for registration before engaging in any professional employment in the United Kingdom. Registration gives a doctor the legal status necessary for carrying out his professional duties. There are three types of registration - full, provisional and limited. Full registration may be granted by the General Medical Council if the doctor holds qualifications recognized by the G.M.C. for the purpose. A doctor with such qualifications may be granted provisional registration if, in the view of the G.M.C., he lacks the necessary professional experience for full registration. However, the number of posts in the U.K. suitable for doctors with provisional registration is so limited that doctors from overseas are urged to gain the required experience before coming to this country. Limited registration may be granted to a doctor who holds a qualification, obtained overseas, which is accepted by the G.M.C. for this purpose. Such registration may be held only in respect of supervised appointments in approved hospitals or institutions and may be granted in relation to one particular employment or specified range of employment. Limited registration for new entrants is subject to a time limit of five years. The majority of overseas doctors who wish to apply for limited registration for the first time will be required to take and pass the PLAB test (Professional and Linguistic Assessments Board) which comprises both medical and linguistic components. Limited registration is now granted, in the main, only for employment in hospital posts or departments which have been approved for educational and training purposes by one of the Royal Colleges or faculties. 3. Postgraduate Training in the UK Overseas doctors should be fully medically qualified and registered in their own country and must speak and write English fluently. They should not come to Britain until they have completed at least two years of post qualification resident hospital appointments in their own country. Many British higher diplomas prescribe definite periods of resident hospital appointments in recognized
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hospitals which must be served before the examination can be attempted. Very few overseas hospitals are recognized. The amount of postgraduate medical training in Britain consisting of fulltime teaching courses is limited. Places on such courses are usually awarded by selection to graduates who are fluent in English and who also have considerable recent clinical experience in major hospitals. Doctors accepted for British Medical Registration who work in the British hospital service receive postgraduate guidance and training and by using the postgraduate training facilities available at the nearest Postgraduate Medical Centre, they can gain considerable further training in the common specialties, internal medicine, general surgery and so on. Over 260 large General Hospitals are graded as District General Hospitals and have good libraries and Postgraduate Centres where regular programmes of lectures, case-demonstrations and so on are held. At many District General Hospitals, regular one-day-a-week courses, known as day-release courses, are also held in preparation for a number of postgraduate diplomas. To work in a small hospital, therefore, does not mean that the graduate will be cut off from postgraduate training opportunities. (Joy Parkinson: A Manual of English for the Overseas Doctor) 4. Nurse education programmes – conditions required for UK registration • Duration of at least 3 years of full-time nursing studies and which included at least 4600 hours of nursing education. This means that unrelated subjects, such as foreign languages, sport or philosophy, do not count towards the nursing education hours but applied subjects such as healthcare ethics would be relevant. • The nursing programme does not have to be delivered at a degree level, but it should be undertrained after completion of full secondary education and after reaching the age of 17. • The nursing programme needs to be equally divided between theory and practice and the programme must cover five main areas i.e. medical, surgical. Women and children, mental health and community. • Upon completion of the nursing education programme, nursing students should be considered to be fully qualified registerable first-level nurses and fully capable of obtaining the nursing diploma and right to practise. This implies that the nursing education programme is considered to be complete in itself and without additional practice periods and/or supervision, and that until nursing students obtain the nursing diploma they are not considered to be fully qualified first-level nurses.
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Apart from these requirements, the NMC (Nursing and Midwifery Council) requests that nurses complete at least 6 months of nursing work in their home country to consolidate their education experience. Nurses trying to obtain UK registration without 6 months’ experience in their home country might experience problems getting onto the register. (Joy Parkinson & Chris Brooker: Everyday English for International Nurses - a guide to working in the UK. Churchill Livingstone, 2004)
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CHAPTER 19
SMOKING - HAZARDOUS ADAPTATION Since the beginning of time, human beings have searched for substances that would not only sustain and protect them but also would act on their nervous systems to produce pleasurable sensations. Among the things that have been found to have a psychoactive effect - a temporary change in mood, though t, feeling, or behaviour – are ethyl alcohol, hemp and cactus plants, mushrooms, poppies, and tobacco, a herb that has been smoked and sniffed for more than 400 years. People have been attracted to these psychoactive substances because they have been useful in helping individuals adapt to an ever-changing environment. Indeed, smoking, drinking, and drug taking have lightened the load of life; reduced tensions, anxieties, and frustrations; counteracted boredom as well as fatigue; enhanced the pleasures of the moments; and in some instances, provided an escape from the harsh realities of existence. Chemical mood and behaviour modifiers have also been employed to enhance self-image, build confidence, gain approval or acceptance, and heal psychological hurts. Use of substances for such personal gratification and temporary adaptation often carries a high price tag, such as various forms of drug dependency, personal and social disorganization, and predisposition to serious and sometimes fatal diseases. These undesirable and health-threatening consequences of adaptive and adjustive behaviour are referred to as maladaptations, which usually occur as the remote consequences of behaviour that has an immediate beneficial effect. Such is the case with cigarette smoking, now characterized as one of the most serious and yet preventable health problems, a major international threat, and “suicide in slow motion”. The dimensions of this adaptive, yet disease-producing, activity are more easily recognized when one examines the reasons for the inability to stop smoking. Two areas have often been cited in which remedial action is more difficult to initiate.
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1. The individual smoker who becomes “hooked” after taking 60.000 or more puffs a year on a cigarette. The minor vice of smoking- that silly little ha bit- has been well learned through repetitive practice. Habits well learned are hard to break! 2. Our society at large which finds itself “hooked” - burdened with a king-sized tobacco industry, mammoth agricultural enterprise, a considerable source of governmental revenues, and a significant customer of the communications media. Thus, we identify sociocultural and economic factors, in addition to personal gratification, in the perpetuation of a learned, adaptive behaviour that is also a primary health risk. Prevalence of smoking From its introduction into Western civilization by explorers returning from the New World, smoking, until recently, was viewed almost exclusively as a masculine activity. Before World War I, a woman who smoked usually demeaned her femininity. During the past sixty years, however, women have gradually cast aside the moral and social stigmas surrounding cigarette use, and since World War II they have been smoking more and more like men- and dying like men! Statistics for the United States show that for the generation born between 1951 and 1960, the percentages of men and women smokers are almost equal. Women are not only starting to smoke at younger age but are also becoming heavier smokers. While many smokers eventually give up the practice, once a woman takes up smoking, she is less likely to quit than a man. According to the US government surveys, the number of men smokers dropped from 53 percent in 1964 to 37 percent currently, but women smokers declined from 32 percent in 1964 to only 28 percent at present. It appears that attitudes toward smoking are becoming increasingly negative, even among smokers themselves. More than 70 percent of smokers currently agree that smoking is harmful to their health and could lead to disease and death. In addition, an estimated nine out of ten smokers would like to quit, and a large percentage of smokers think that there should be some regulations against smoking. At the same time, non-smokers are becoming more and more forceful in their demands for pollution-free public environments. Evidently both smokers and non-smokers are becoming somewhat less tolerant of smoking. Surveys of teenage smokers reveal that nearly 12 percent of young persons between twelve and eighteen years of age are current, regular smokers, i.e., they smoke at least weekly. This figure represents an actual decline over a recent five-year period. But for the first time, more female than male teen238
agers are smoking, perhaps as an early sign of female social emancipation. Surveys also indicate that nearly a million teenagers in the United States take up smoking each year. The influence of peers who smoke and the role model of smoking parents continue to attract new smokers despite the real health hazards. In fact, most teenagers who smoke regularly are from families where one or both parents smoke. Personal Use vs. the Non-smoker Until the invention of the cigarette manufacturing machine after the Civil War, tobacco was principally consumed in pipes and cigars and in chewing and sniffing. Once mass production of cigarettes was a reality and production cost decreased, cigarettes became readily available Their pre-eminence as a tobacco form has been traced to World War I where they found the favour of the doughboys (soldiers). Cigarettes have enjoyed an immense popularity because they provide the user with certain personal gratifications unobtainable in other tobacco forms. They can be smoked easily and quickly; they can be in haled; they are readily available and relatively inexpensive; and they have been socially accepted or at least tolerated. Smoking has long been considered an individual right. However, little thought or consideration has been given to what right the non-smoker has to live and work in areas free from air polluted by smoke. It would seem as though the non-smoker has a right to travel in an airplane, bus, or train; to listen to a lecture or attend a concert in an auditorium; to work; or to eat at a restaurant, without being exposed to air filled with the smoke from cigarettes, pipes or cigars. This calls for major changes as separate areas for the smoker and the non-smoker arc increasingly demanded. Recently the silent majority of non-smokers have become assertive in its demands for plain, unpolluted air. Tired of being assaulted by tobacco smoke, the vocal and visible non-smokers now proclaim that the smoker’s liberty ends where their noses begin. Considerable number of organized groups of nonsmokers together with professional medical and dental associations, have been successful in restricting smoking in public areas and in establishing the legal right of non-smokers to be free of others’ cigarette smoke. The non-smokers’ liberation movement has been successful in banning cigarette commercials on television, limiting smoking in certain hospitals, lobbying for laws and regulations that require health warnings on cigarette packages and separate smoking and non-smoking sections on commercial airlines and buses, and prohibiting smoking in trams, elevators, indoor theatres, libraries, art galleries, museums, and dining cars of passenger trains. 239
Not to be overlooked as a factor in cigarette consumption are the persistent promotional activities of tobacco companies and their advertising agencies. Agencies long ago discovered through motivational research that sales could be increased if products were linked with basic human desires and drives. Not content with assertions of mildness and good taste, advertisements soon depicted smokers as models of sophistication, eternal youth, handsome ruggedness, enduring beauty, alluring sexuality, and determined individualism, and with athletic prowess sufficient to walk at least a mile for a favourite cigarette. Smoking: An Adaptive Behaviour These phenomena alone do not explain why people begin and continue to smoke, especially when they frankly admit awareness of possible health hazards. Many smokers express a desire to quit, but they just cannot manage to do so. A consideration of smoking as “adaptive behaviour” may illuminate the reasons and motivations involved in the use of cigarettes. A Learned Behaviour Smoking is a learned behaviour. No one is born a smoker, although the new baby may interact with smokers and with smoke early in infancy - often on the way home from the hospital after delivery. Curiosity and the desire to imitate adults, especially smoking parents, probably encourage many children to experiment. The initial reaction, however, is likely to be unpleasant, and usually there is no social approval forthcoming. It is not until adolescence that smoking becomes a live option for most young persons. More time is now spent away from home with peers; there is increased freedom from authority figures who often discourage or forbid smoking; needs for security and acceptance through group conformity grow; and the demand or need for immediate gratification flourishes. The psychological stage for smoking has been set and is fertile enough to generate millions of new young smokers each year. Psychological Rewards The search for adulthood or maturity through the act of smoking appears to be a primary factor in the initiation of cigarette use. Following the example set by many adults and parents, adolescents partake of adulthood by smoking - they feel older, more mature, and more important. Smoking may also help them to overcome feelings of uncertainty and embarrassment in situations that they find awkward. Thus, security is enhanced. There are other psychological rewards for the new smoker. Smoking may be the passport to acceptance among one’s peers; it may represent freedom or independence from restric240
tive home life or revolt against parental authority; it may be the result of an unconscious desire to imitate esteemed smokers; it may be nothing more than a soothing and pleasurable way to contract boredom. Because of the handto-mouth motions associated with lighting up, the cigarette may amount to a convenient “psychological recycling centre” that provides a socially approved and refreshing activity between environmental challenges. Some people like the taste and smell of cigarettes, and a few get a kick out of watching the smoke. In essence, the cigarette provides a smoker with a readily available way to deal with a host of personal problems and needs. Factors in Smoking Behaviour 1. Stimulation- If you score high or fairly high on this factor, it means that you are one of those smokers who gets a lift from smoking - you feel that it helps wake you up, organize your energies, and keep you going. The perkingup effect is due to nicotine’s temporary stimulation, which briefly relieves fatigue. If you try to give up smoking, you may want a safe substitute: a brisk walk or moderate exercise whenever you feel the urge to smoke. 2. Handling - Oral Gratification - Having something to handle, manipulate, or fondle can be very satisfying. Additionally, having something in your mouth to chew on, such as a toothpick, straw, or pencil, can fulfil certain emotional needs. From a Freudian perspective, cigarette smoking may be seen as a satisfaction of infantile needs to suck or chew - a fixation or libidinal energy at the oral or mouth level. Why not try with a pen or pencil? Try doodling or play with a coin, a piece of jewellery, or some other harmless object. If you must put something in your mouth, use candy cigarettes or even a real cigarette if you can trust yourself not to light it. 3. Pleasurable Relaxation -About two-thirds of smokers score rather high on the accentuation of pleasure. You smoke for positive feelings of contentment, achievement, victory, and satisfaction - such as upon completion of a job well done or after a delicious, mouth-watering meal. Those who do get real pleasure out of smoking often find that an honest consideration of the harmful effect of their habit is enough to help them quit. They substitute eating, drinking, social activities, and physical activities - within reasonable bounds - and find they do not seriously miss their cigarettes. 4. Crutch-Tension Reduction - Many smokers use the cigarette to manage negative effects, such as stressful situations and feelings of anger, fear, and anxiety. Sometimes the cigarette is used as a tranquilizer or as an escape vehicle from cares and worries. Thus, smoking represents a tension- reducing activity. When the going gets rough, cigarettes can be a crutch, a comfort, and a consolation. When it comes to quitting, this kind of smoker may find it easy 241
to stop when everything is going well but may be tempted to start again in a time of crisis. Again, physical exertion, eating, drinking, or social activity - in moderation - may serve as useful substitutes in times of tension. 5. Craving- Psychological and Physical Addiction- Quitting smoking is difficult for the person who scores high on the factor of craving. For such an individual, the overpowering desire for the next cigarette begins to build up the moment the old one is put out. A dependent or addicted smoker must have a cigarette after a short period of time or otherwise experiences mild withdrawal symptoms - a “nicotine fit” with its uneasiness, restlessness, nervousness, anxiety, headache, digestive disturbances, and impairment of concentration, judgment, and psychomotor performance. Peculiarly, the dependent smoker craves a cigarette, as in chain-smoking, first to increase positive feelings and then to decrease negative feelings of withdrawal. In essence, the smoker satisfies a need to smoke - a physical need for more nicotine. Contrary to popular belief, research now suggests that smoking does not reduce anxiety or calm nerves. Under stress, smokers consume cigarettes heavily because stress depletes the body’s nicotine. Thus, nicotine-deficient smokers smoke more under stress to maintain their usual nicotine level. Tapering off is not likely to work for dependent smokers. They must go “cold turkey”. It may be helpful for them to smoke more than usual for a day or two, so that the taste of cigarettes is spoiled, and then isolate themselves completely from cigarettes until the craving is gone. Giving up cigarettes may cause so much discomfort that once these persons quit, they will find it easy to resist a return to smoking. Otherwise, they know that some day they will have to go through the same agony again. 6. Habit-A behavioural pattern has been established almost involuntarily by the habit smoker. This individual responds automatically to some cue - a cup of coffee, getting into a car, or nearing the vicinity of an ashtray. Once regarded as psychologically significant, smoking loses its former functions of fulfilling status, relaxation, security, or other needs. Such a smoker no longer gets much satisfaction from cigarettes. Smoking: Agent of Maladaptation and Disease From health point of view, personal gratification is acceptable for most persons as long as it does not injure the individual or cause harm to other persons. Unfortunately, smoking is now seen as a health threat to both. Smokers, non-smokers, and even unborn children are caught up in this multifaceted problem leading to self indicated morbidity and premature mortality,
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increased health and welfare cost, added irritating effects of cigarette-induced air pollution, and the mounting threat of home, commercial, and forest fires caused by discarded cigarettes. Figure 19.1. Diseases and conditions associated with smoking
tobacco amblyopia bronchitis emphysema coronary heart disease cirrhosis of the liver decreased birth weight
lip, tongue, gum cancer larynx cancer lung cancer peptic ulcer bladder cancer
accidents Buerger's disease peripheral vascular disease
Many diseases and conditions are associated with smoking. Not all are causally related, but they should not be overlooked. For instance, accident rates are higher for smokers than non-smokers. This includes fires in the home caused by the smoker who dozes off with a lighted cigarette in hand. The blood level of carbon monoxide is higher in smokers during the time they are smoking. Increasing attention is being given to the question of whether this carbon monoxide in the blood may be dulling the alertness of drivers to the point where this is a contributory factor in auto accidents.
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Components of Cigarette Smoke The starches, proteins, sugars, and hydrocarbons of the tobacco leaf, when burned, are converted into a complex aerosol mixture of gases, uncondensed organic vapours, and particulate matter. The temperature of the smoke at the burning zone is nearly 900ºC, although that which reaches the smoker’s mouth is in a temperature range from 30-50ºC. While scientists estimate the number of cigarette smoke components to be several thousands, only 1,200 have been identified to date. These components of smoke are sufficient to produce an extremely dense “respiratory environment”, more concentrated than the air pollution of major urban centres. The smoke from an average, nonfiltered cigarette is composed of several types of chemicals. Gaseous Elements and Compounds - These elements and compounds, notably nitrogen and its oxides, carbon dioxide, oxygen, and carbon monoxide, combine with the hemoglobin in red blood cells and thereby reduce the oxygencarrying capacity of the blood. Also isolated in the fraction of smoke from cigarettes arc small amounts of toxic chemicals, particularly acetaldehyde, acetone, and hydrogen cyanide. Particulate Matter - Particulate matter, containing tiny particles of tobacco smoke, is a respiratory tract irritant. Investigations have shown that more than 90 percent of these particles remain in the lungs of the smoker who inhales. When condensed, the particles- regarded as lung-damaging in size - form a yellowish brown sticky mass known as tobacco tar, The tar contains several carcinogenic (cancer producing) hydrocarbons, especially benzopyrene and chrysene; nitrosamines; nickel compounds; fatty acids; phenols, which have tumour-promoting activity in addition to being toxic to the cilia; and nicotine, a colourless, oily compound in commercial insecticides. Nicotine - Identified as the addictive or dependency- producing component in tobacco smoke, nicotine is responsible for the temporary stimulation following smoking. Nicotine initiates a series of nervous and endocrine functions that result in a release of glycogen from the liver. This causes the brief “kick” and reduction of fatigue often reported by smokers. Once absorbed into the bloodstream, nicotine is also responsible for raising blood pressure and heart rate, causing the heart to work harder, and for vasoconstriction (blood vessel narrowing) that in turn lowers skin temperature. The list of serious health risks should be sufficient to discourage smokers from continuing their life-threatening form of adaptive behaviour and to deter new smokers. But the mere presentation of facts has little effect upon all but a few smokers – those who are highly motivated to reduce their exposure
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to smoking or to quit smoking entirely. Persistence in smoking might seem contradictory in this enlightened, scientific area, but it is due in part to the effectiveness of early learning reinforced thousands of times, puff after puff. As a result of so many rewarding interactions with cigarettes, smoke, and other smokers, the individual’s personal values and basic attitudes about life become so ingrained and inflexible that they cannot be cast aside, even when the person recognizes and openly admits the errors of prior learning. Other considerations play a role in maintaining the conflict between smoking behaviour and possible health hazards. One, of course, is the fact that not everyone who smokes becomes ill, incapacitated, or dies. Indeed, certain of the cigarette-related diseases may require some genetic, biological, chemical, or physical factor to be operable before smoking takes its toll. Then, too, rationalization is commonly employed to justify the smoker’s action. We often hear these replies to probing inquiries: “Just one cigarette never hurts anybody”. “It won’t happen to me because I’m lucky’.” “Why should I quit since I don’t feel sick?” Many of these excuses are based on the remoteness, the delayed action of the possible harmful effects of smoking. If one cigarette caused serious, immediate illness or instant death, smoking would rapidly decline or become extinct. Risk taking, a necessary component of daily living, compounds the smoking problem. Certainly, people should avoid certain risks, but sometimes risks are taken if they seem negligible or remote in anticipation of the possible, immediate rewards. Not to be overlooked as a further explanation for perpetuating a disease and death-inducing adaptive behaviour is the very real reluctance of individuals to acknowledge that their actions are stupid, irrational, or injurious to themselves. There are many authors nowadays who have raised another dimension of cigarette problem suggesting that some smokers really do not care if their life expectancy is reduced. Such dangerous indifference may reflect an insensitivity to the “fragility and preciousness of life” and may correlate with the spread of violence and our life-style of abundance. In essence, the real danger beyond smoking may be a crisis in basic human values. Cardiovascular Diseases and Smoking Cigarette smoking is now recognized as a significant risk factor contributing to the development of specific cardiovascular diseases, namely, coronary heart disease, atherosclerosis, and peripheral blood vessel disease. It is an established fact that nicotine is responsible for the near-instantaneous increase in heart rate, blood pressure, cardiac output, heart contractions, and consumption of
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oxygen by heart muscle. Because of its blood vessel narrowing effect, nicotine can also decrease peripheral blood flow, thus placing added stress on the smoker’s heart. In its adaptive response to smoking the heart requires more oxygen for its function. But carbon monoxide from cigarette smoke tends to displace oxygen from hemoglobin, thus interfering with the transportation of oxygen and depriving the heart muscle of its needed oxygen supply. Recent evidence suggests that absorbed nicotine and carbon monoxide contribute to the development of atherosclerosis (clogging of the arteries with fatlike substances). Cigarette smoking may also be a factor in increased platelet adhesiveness, which predisposes to blood clot formation. Smoking and Chronic Obstructive Lung Diseases (COLD) Pulmonary emphysema and chronic bronchitis, two diseases that until recently were infrequently reported in the population, today are reaching epidemic proportions. They are jointly referred to as COLD and are an adaptive response to inhaled irritants and a maladaptation to smoking. Cigarette smoking has been identified as the most important cause of COLD and increases greatly the risk of dying from pulmonary emphysema and chronic bronchitis. While other factors, including hereditary predisposition, may contribute to COLD, cigarette smoking is now recognized as the major factor in the promotion of ‘’pulmonary patients”. Chemicals in inhaled cigarette smoke irritate the bronchial tubes and alveolar sacs over and over again with each puff. In time, the tissues lining the bronchi thicken, the mucous glands enlarge, and the normal cleansing system of the lungs, especially ciliary function, is impaired. The smoker is now more predisposed to respiratory infectious and aggravation of existing ones than is the non-smoker. Smoking and Lung Cancer Most lung cancers originate in the lining or epithelium of the bronchi. Normal epithelium cleanses the lungs of foreign matter such as dust or smoke particles. Mucus secreted onto the surface of the epithelium, traps foreign substances. Cilia, extending from the columnar cells, continually move the mucus from the bronchi, through the trachea, and into the mouth, where it is either swallowed or expectorated. Tobacco smoke contains, in addition to tumour initiators and promoters, substances that affect the cleansing action of the bronchial cells, and thus indirectly influence the induction of lung cancer. These agents may impair
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and destroy cilia and may affect the mucus layer so that smoke particles are retained in the bronchi. In lung cancer victims, cures are rare, and 95 out of 100 persons who develop lung cancer will be dead within five years. In fact, the survival rate for the first year after diagnosis of lung cancer is only 25 percent. Studies of the frequency, distribution, causes, and control of cigaretterelated diseases have led an overwhelming number of scientists to conclude that smoking is the major cause of lung cancer in men. It is also a cause of lung cancer in women, but for a variety of possible reasons - genetic, hormonal, and differences in dose and frequency of exposure - it accounts for a smaller proportion of cases in women than in men. However, the percentage of women is steadily increasing and it is expected that lung cancer will soon surpass breast cancer as the leading cancer peril to women. It is estimated that the risk of death from this disease is nearly ten times greater for smokers than for those who do not use cigarettes. This uncontrolled growth or malignant neoplasm in the lungs is termed bronchogenic carcinoma because it arises in the lining of the bronchial tubes through which air passes inwardly to various parts of the lungs. The chances of sustaining lung cancer are enhanced with increased numbers of cigarettes smoked per day, with the duration or length of smoking, and with earlier initiation of use. The risks are reduced when smoking ceases. Apparently, cigarette smoking triggers a disease process (via the tobacco tars) in which continual repair and recovery are possible up to some “critical point”. Beyond this point, the process is not reversible. EXERCISES 1. Review Questions: 1.1. How has smoking helped humans adapt to their environment? ..........................................................................................................................................................................
1.2. Explain what is meant by “smoking is suicide in slow motion”. ..........................................................................................................................................................................
1.3. According to health statistics, how do men and women differ in smoking habits? ......................................................................................................................................................... 1.4. How do cigarettes provide the smoker with personal gratifications that are not found in other tobacco forms? ..................................................................................... ..........................................................................................................................................................................
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1.5. How has motivational research increased the sale of cigarettes? ..........................................................................................................................................................................
1.6. Explain some of the psychological rewards obtained by smoking. ..........................................................................................................................................................................
1.7. What physiological effects does nicotine have on the body? ..........................................................................................................................................................................
1.8. How does cigarette smoking account for the higher incidence of cardiovascular disease?..................................................................................................................... ..........................................................................................................................................................................
1.9. What is pulmonary emphysema? How does it affect airflow within the lungs?........................................................................................................................................................... ..........................................................................................................................................................................
1.10. What are the effects of chronic bronchitis? Is this more serious than emphysema?............................................................................................................................................ 1.11. How does cigarette smoking promote the development of cancer in various parts of the body? ............................................................................................................... ..........................................................................................................................................................................
1.12. Do you think that risk-taking behaviour is a valid excuse for smoking? ..........................................................................................................................................................................
1.13. Discuss the advantages of smoking vs. non-smoking. ..........................................................................................................................................................................
1.14. Although there is no safe way to smoke, discuss the recommendations made to make cigarette use less hazardous? ..........................................................................................................................................................................
1.15. Discuss the many possible alternatives to smoking. ..........................................................................................................................................................................
2. Fill in the missing word(s): 2.1. Indeed, smoking, ................................. and ........................................... have lightened the .............................................................. life.
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2.2. Two areas have often been ............................ in which remedial ............................. is more difficult to .......................................................... 2.3. Women are not only starting to smoke ................................................................... but are also becoming ...................................................... smokers. 2.4. It appears that ............................................ toward ................................. are becoming increasingly ................................................................................... 2.5. Many smokers ........................................... a desire to .................................................. but they just cannot .................................................. to do so. 2.6. It is not until ................................................................... that smoking becomes a live .........................................................................................
for most young persons.
2.7. Thus, smoking ......................................... a tension-reducing ......................................... 2.8. In essence, a smoker .................................................................... a need to smoke- a physical need for more ...................................................................................................................... 2.9. Such a smoker no ....................................... gets much .......................................... from cigarettes. 2.10. The smoke of an average ................................................... cigarette is composed of ..................................................................................... 3. Define the meaning of the following terms: 3.1. gratification .............................................
3.9. tar .................................................................
3.2. maladaptation .......................................
3.10. alertness ................................................
3.3. prevalence ................................................
3.11. aerosol ....................................................
3.4. sociocultural ..........................................
3.12. irritant .....................................................
3.5. perpetuation ...........................................
3.13. nicotine ...................................................
3.6. craving .......................................................
3.14. vasoconstriction ................................
3.7. hazard .........................................................
3.15. cardiac output .....................................
3.8. carbon monoxide .................................
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4. Explain the following phrases.· 4.1. psychoactive effect .............................
4.9. psychological recycling centre ..................................................................................
4.2. load of life ................................................
4.10. the perking-up effect ......................
4.3. to become “hooked” ..........................
4.11. psychological and physical addiction .............................................................
4.4. adaptive behaviour ..............................
4.12. escape vehicle .....................................
4.5. to call for ...................................................
4.13. a live option ..........................................
4.6. to lobby for ...............................................
4.14. handsome ruggedness ..................
..................................................................................
..................................................................................
4.7. when the going gets rough ............
4.15. cold turkey ............................................
..................................................................................
4.8. to get a kick out of something ..... ..................................................................................
5. Find verbs and adjectives of the following nouns: 5.1. preference ........................................................................................................................................ 5.2. initiation ............................................................................................................................................ 5.3. risk ....................................................................................................................................................... 5.4. estimate ............................................................................................................................................ 5.5. deprivation ....................................................................................................................................... 5.6. abundance ....................................................................................................................................... 5.7. value .................................................................................................................................................... 5.8. interference .................................................................................................................................... 5.9. addiction ........................................................................................................................................... 5.10. affection .......................................................................................................................................... 6. Provide the nouns of the following adjectives: 6.1. morbid ........................................................
6.6. alveolar ......................................................
6.2. libidinal ......................................................
6.7. ciliary ..........................................................
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6.3. bronchial ...................................................
6.8. adaptive .....................................................
6.4. pulmonary ................................................
6.9. perilous .....................................................
6.5. foreign ........................................................
6.10. genetic .....................................................
7. Translate into Croatian: If you smoke and you still don’t believe that there’s a definite link between smoking and bronchial troubles, heart disease and Jung cancer, then you arc certainly deceiving yourself. No one will accuse you of hypocrisy. Let us just say that you are suffering from a bad case of wishful thinking. This needn’t make you too uncomfortable because you are in good company. Whenever the subject of smoking and health is raised, the governments of most countries hear no evil, see no evil and smell no evil. Admittedly, a few governments have taken timid measures. In Britain, for instance, cigarette advertising has been banned on television. The conscience of the nation is appeased, while the population continues to puff its way to smoky, cancerous death. You don’t have to look very far to find out why the official reactions to medical findings have been so lukewarm. The answer is simply money. Tobacco is a wonderful commodity to tax. It’s almost like a tax on our daily bread. In tax revenue alone, the government of Britain collects enough from smokers to pay for its entire educational facilities. So while the authorities point out ever so discreetly that smoking may, conceivably, be harmful, it doesn’t do to shout too loudly about it. This is surely the most short-sighted policy you could imagine. While money is eagerly collected in vas t sums with one hand, it is paid out in increasingly vaster sums with the other. Enormous amounts are spent on cancer research and on efforts to cure people suffering from the disease. Countless valuable lives are lost. In the long run, there is no doubt that everybody would be much better off if smoking were banned altogether. .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................
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CHAPTER 20
AIDS Acquired immune deficiency syndrome, or AIDS, is a recently recognized disease entity. It is caused by infection with the human immunodeficiency virus (HIV), which attacks selected cells in the immune system and produces defects in its function. These defects may not be apparent for years. They lead in a relentless fashion, however, to a severe suppression of the immune system’s ability to resist harmful organisms. This leaves the body open to an invasion by various infections, which are therefore called opportunistic diseases, and to the development of unusual cancers. The virus also tends to reach certain brain cells. This leads to the so-called neuropsychiatric abnormalities, or psychological disturbances caused by physical damage to nerve cells. Since the first AIDS cases were reported in 1981, through mid-1992, more than 190,000 AIDS cases and more than 152,000 deaths had been reported in the United States alone. This is only the top of the iceberg of HIV infection, however. It is estimated that between 1 million and 1.5 million Americans had been infected with the virus by the early 1990s but had not yet developed clinical symptoms. In addition, although the vast majority of documented cases have occurred in the United States, AIDS cases have been reported in about 162 countries worldwide. Sub-Saharan Africa in particular appears to suffer a heavy burden of this illness. No cure or vaccine now exists for AIDS. Many of those infected with HIV may not even be aware that they carry and can spread the virus. It is evident that HIV infection represents an epidemic of serious proportions. Combating it is a major challenge to biomedical scientists and health-care providers. HIV infection and AIDS represent one of the most pressing public policy and public health problems worldwide.
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Definition of AIDS The U. S. CENTER FOR DISEASE CONTROL has established criteria for defining cases of AIDS that are based on laboratory evidence, the presence of certain opportunistic diseases, and a range of other conditions. The opportunistic diseases are generally the most prominent and life-threatening clinical manifestations of AIDS. It is now recognized, however, that neuropsychiatric manifestations of HIV infection of the brain are also common. Other complications of HIV infection include fever, diarrhea, severe weight loss, and swollen lymph nodes. When HIV-infected persons experience some of the above symptoms but do not meet full criteria for AIDS, they are given the diagnosis of AIDS-related complex, or ARC. The growing feeling is that asymptomatic HIV infection and ARC should not be viewed as distinct entities but, rather, as stages of an irreversible progression toward AIDS. Historical Background In the late 1970s, certain rare types of cancer and a variety of serious infections were recognized to be occurring in increasing numbers of previously healthy persons. Strikingly, these were disorders that would hardly ever threaten persons with normally functioning immune systems. First formally described in 1981, the syndrome was observed predominantly to be affecting homosexual and bisexual men. Soon thereafter, intravenous drug users, hemophiliacs, and recipients of blood transfusions were recognized as being at increased risk for disease as well. It was also noted that sexual partners of persons displaying the syndrome could contract the disease. Further study of AIDS patients revealed marked depletion of certain white blood cells, called T4 lymphocytes. These cells play a crucial role in orchestrating the body’s immune defences against invading organisms. It was presumed that this defect in AIDS patients was acquired in a common manner. Then, in 1983, a T-cell lymph tropic virus was separately discovered by Robert Gallo at the U. S. National Institutes of Health and Luc Montaigne at France’s Pasteur Institute. The virus was at first given various names: human lymphotropic virus (HTLV) III, lymphadenopathy-associated virus (LAV), and AIDS -associated retrovirus (ARV). It is now officially called human immunodeficiency virus (HIV), and considerable evidence demonstrates that it is indeed the causative agent for AIDS. A second strain that has been identified, HIV-2, is thus far relatively rare outside of Africa. Little is known about the biological and geographical origins of HIV. Apparently, however, this is the first time in modern history that the virus has spread
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widely among human beings. Related viruses have been observed in animal populations, such as certain African monkeys, but these do not produce disease in humans. The Nature of the Virus HIV is an RNA RETROVIRUS. Viewed in an electron microscope, it has a dense cylindrical core that encases two molecules of viral RNA genetic material. A spherical outer envelope surrounds the core. Like all retroviruses, HIV possesses a special enzyme, called reverse transcriptase, which is able to make a DNA copy of the viral DNA. This enables the virus to reverse the normal flow of genetic information and to incorporate its viral genes into the genetic material of its host. The virus may then remain in a latent form for a variable and often lengthy period of time until it is reactivated. Further knowledge of the mechanisms and triggers of the activation process is important to the efforts being made to control HIV infection. A critical step in HIV infection is the binding of the virus to a host-cell receptor, enabling it to gain entrance into the cell. Studies have demonstrated that a molecule called CD4, expressed predominantly on the surface of the T4 cell, serves as this receptor. Although the T4 cell is a major HIV target, virtually any other cell also expressing the CD4 surface molecule is able to become infected with HIV. Thus cells of the monocyte and macrophage type are very important additional targets. Modes of Transmission Researchers have isolated HIV from a number of body fluids, including blood, semen, saliva, tears, urine, cerebrospinal fluid, breast milk, and certain cervical and vaginal secretions. Strong evidence indicates, however, that HIV is transmitted only through three primary routes: sexual intercourse, whether vaginal or anal, with an infected individual; nondigestive exposure to infected blood or blood products; and from an infected mother to her child before or during birth. At least 97 percent of U.S. AIDS cases have been transmitted through one of these routes, with transmission between homosexual men accounting for about 60 percent of the cases. Heterosexual transmission in the United States accounts for only about 5 percent of cases but is a significant mode of transmission in Africa and Asia. About 21 percent of AIDS cases occur in intravenous drug abusers exposed to HIV-infected blood through shared needles. Current practices of screening blood donors and testing all donated blood and plasma for HIV antibodies have reduced the number of cumulative cases due to transfusion to about 1 percent. 255
The number of new cases of AIDS in women of reproductive age is increasing at an alarming rate. AIDS has become the leading cause of death for women between the ages of 20 and 40 in the major cities of North and South America, Western Europe, and sub-Saharan Africa. In the United States, AIDS has hit hardest among black and Hispanic women. These women represent 17 percent of the female population but make up 73 percent of women with AIDS. AIDS is also having a devastating impact on infant mortality, since over 80 percent of HIV-infected children under the age of 13 acquired HIV from their infected mothers. Between 24 and 33 percent of children born to infected women will develop the disease. No scientific evidence supports transmission of AIDS through ordinary nonsexual conduct. Careful studies demonstrate that despite prolonged household contact with infected individuals, family members have not become infected--except through the routes described above. Health-care workers have been infected with HIV from exposure to contaminated blood or by accidentally sticking themselves with contaminated needles. Clinical Signs Following infection with HIV, an individual may show no symptoms at all, or may develop an acute but transient mononucleosis-like illness. The period between initial infection and the development of AIDS can vary greatly, apparently from about 6 months to 11 years. Various estimates indicate that somewhere between 26 to 46 percent of infected individuals will go on to develop full-blown AIDS within a little more than 7 years following infection. Once AIDS sets in, the clinical course generally follows a rapid decline; and most people with AIDS die within 3 years. Opportunistic Infections and Cancers Because the T4 cell is involved in almost all immune responses, its depletion renders the body highly susceptible to opportunistic infections and timorous growths. The most predominant and threatening is Pneumocystic carinii PNEUMONIA, which is frequently the first infection to occur and is the most common cause of death. Other infections include the parasites Toxoplasma gondii (TOXOPLASMOSIS) and Cryptosporidiosis; fungi such as Candida (CANDIDIASIS) and Cryptococcus (FUNGUS DISEASES); mycobacteria such as Mycobacterium avium, intracellulare, and tuberculosis (TUBERCULOSIS); and viruses such as cytomegalovirus and herpes simplex and zoster. Increased susceptibility to bacterial infection is noted particularly among children with AIDS.
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Many AIDS patients develop cancers, including Kaposi sarcoma (KS), nonHodgkin lymphoma, and Hodgkin disease. KS occurs in patients who manifest hardly any evidence of immunological impairment, indicating that other factors may also be at work in the development of such cancers. Among the non-Hodgkin lymphomas are immunoblastic and Burkitt-type lymphomas as well as primary brain lymphomas. These tumours tend to be unusually aggressive and poorly responsive to chemotherapy, particularly in AIDS patients who have already experienced opportunistic infections. Other HIV-Related Disorders and Co-Factors Neuropsychiatric manifestations occur in about 60 percent of HIV-infected persons. It is now well established that HIV can exist and proliferate within the brain, spinal cord, and peripheral nerves. This results in a broad range of symptoms, including meningoencephalitis and dementia. Evidence thus far indicates that circulating HIV-infected monocytes may be responsible for the initiation of infection in the brain, with little evidence to support direct infection of neuron tissue by HIV. Blood-cell abnormalities of HIV patients include anemia, reduced white blood-cell counts, and platelet deficiencies. Researchers have also been able to show direct infection of bone-marrow cells--the precursors of circulating blood cells-- and the proliferation of the virus within these cells. Thus bone marrow may represent an important reservoir of HIV in an infected person and provide a potential mechanism for dissemination of the virus through the body. Other HIV-related syndromes include nephritis, arthritis, and lung inflammation (pneumonitis). Certain co-factors appear to play an important role in HIV infection and AIDS by increasing susceptibility to infection and by enhancing viral-disease activity. Other sexually transmitted diseases appear to be of particular significance. Damage to genital skin and mucous membranes may facilitate transmission of the virus. In addition, laboratory studies show that certain microbes frequently found in AIDS patients, such as mycoplasmas, also probably act as co-factors. Treatment of HIV Two major avenues are being pursued by biomedical scientists in the fight against HIV infection and AIDS One strategy is to develop a vaccine that can induce neutralizing antibodies against HIV and protect uninfected individuals if exposed to the virus itself. The second approach involves the discovery and development of therapeutic agents against HIV infection and AIDS.
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At present no vaccine exists to protect against infection, although recent advances have led some experts to predict that a vaccine should be available within the next 10 years. Obstacles still remain, however, primarily due to the variability of the virus itself. Many different strains of HIV exist, and even within a given individual’s body the virus can undergo mutations rapidly and easily. A number of candidate vaccines were in the early phases of testing in human volunteers by the early 1990s around the world. Dramatic strides are also being made in the treatment of HIV infection and its complications. Efforts are being focused on two major areas: antiviral drugs with a direct effect against the causative agent, and immunomodulators that act to reconstitute or enhance immune-system function. Efforts to develop and improve treatments of specific opportunistic infections and neoplasms are also being made. Because of the complex life cycle of HIV, however, the successful development of antiviral and immune-enhancement therapies represents an enormous scientific challenge. Unlike most known pathogens, HIV infects the very cells that are intended to orchestrate and lead the immune system’s attack against invaders. This makes it technically very hard to kill the virus without destroying the already threatened immune system. Furthermore, there may be several important reservoirs in the body for HIV that will be difficult to deal with while not causing fundamental damage to the host cells involved. For example, macrophage cells can support HIV replication while harbouring the virus from the body’s immune surveillance. Circulating macrophages appear to play an important role in the propagation of HIV throughout the body, including the brain. In seeking effective therapies, other important considerations are involved. Thus, since the brain is an important target of HIV infection, an effective antiHIV agent should be able to cross the blood-brain barrier. It would also be desirable if therapies could be taken orally, since it is likely that AIDS drugs would have to be taken for a long period and perhaps a lifetime. Dozens of agents have been tested in humans, but only two have been licensed by the U.S. Food and Drug Administration (FDA): azidothymidine (AZT) and dideoxyinosine (DDI). AZT interferes with virus replication and has been found to prolong life significantly in some patients and delay the onset of full-blown AIDS in persons with no symptoms, but its potentially toxic side effects may preclude uses in many cases. DDI acts similarly but is recommended for those who cannot tolerate AZT. Other promising drugs are in clinical trials. Some drugs are available to fight major opportunistic illnesses. Eye infections can be treated with ganciclovir or foscarnet, which also helps patients live longer, while aerosolized pentamidine fights Pneumocystis carinii pneumonia and protects the patient from AIDS dementia. 258
The slow process of FDA approval of new AIDS drugs has developed into a political issue. AIDS activists are demanding that the government speed up authorization by postponing certain tests comparing efficacy and ability to prolong life until after the drug is on the market. While a faster approval rate may expose patients to unforeseen side effects, activists argue that patients with life-threatening diseases who have no alternative therapy should still be entitled to choose these drugs. Efforts at Prevention In the absence of an effective vaccine or therapy, education and risk reduction remain the most powerful tools in the fight against AIDS. Because of the limited number of transmission routes, the further spread of AIDS could virtually be stopped by avoiding behaviours that place persons at risk. Education can help to achieve this, through development and dissemination of materials by local community groups, statewide organizations, and national governments. In 1988, for example, the U.S. Public Health Service produced a simple, straightforward brochure containing information about HIV infection and AIDS. The brochure was mailed to every household in the U.S.A. A test to screen blood directly for antibodies to HIV was developed and made available. The presence of antibodies, which generally takes weeks or months to develop, means only that an individual has been exposed to the virus. It does not indicate whether that individual has or will develop AIDS, although this is almost certain. All blood intended for use in transfusion or manufacture of blood products is now tested for the antibody. The standardized procedure involves the use of the ELISA (enzyme-linked immunosorbent assay) screening test, with confirmation of positive results with a more specific test known as the Western Blot. Blood that tests positive on any of these is absolutely eliminated from the blood-donation pool. Tissue and organ banks use a similar process. Blood donations themselves pose no risk of HIV infection at all, because sterile equipment is always used. Conclusion The AIDS epidemic is having a profound impact on many aspects of medicine and health care. The U.S. Public Health Service estimates that the annual cumulative lifetime cost of treating all persons with AIDS in the United States in 1991 is $5.3 billion; this is expected to reach $7.8 billion by 1993. The Public Health Service budget for AIDS research was $849 million in 1991. Persons exposed to HIV are having difficulties in obtaining adequate health insurance coverage. Year AZT expenses, for example, can average approximately $6,000, 259
although in 1989 the drug’s maker did offer to distribute AZT freely to HIVinfected children. The yearly expense for DDI is somewhat less at $2,000. The effects of the epidemic on society at large are increasingly evident. AIDS tests are now required in the military services. Various proposals have been made for mandatory screening of other groups such as health-care workers, especially since a Florida dentist who died of AIDS in 1990 is believed to have infected five patients. A number of nations, including the United States, have instituted stringent rules for testing long-term foreign visitors or potential immigrants for AIDS, as well as testing returning foreign nationals. In the United States one frequent phenomenon is the effort to keep school-age children with AIDS isolated from their classmates, if not out of school altogether. Governmental and civil rights organizations have countered restrictive moves with a great deal of success. There is little doubt that the ultimate physical toll of the AIDS epidemic will be high, as will be its economic costs, however the social issues are resolved. Concerted efforts are under way to address the problem at many levels, and they offer hope for successful strategies to combat HIV-induced disease. Margaret A. Hamburg, M.D.
(Copyright - 1993 Grolier Electronic Publishing, Inc.)
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CHAPTER 21
STRESS MANAGEMENT FOR PATIENT AND PHYSICIAN By David B. Posen, MD The Canadian Journal of Continuing Medical Education, April 1995 One of the most important things we can do for patients is teach them about stress management. Even better, we can learn these lessons ourselves and then model them for our patients. Although there are many approaches to stress management, this article lists 10 ways for reducing stress that are practical, beneficial and which even busy physicians can start implementing in their patients’ and their own lives. Main Article Stress is the most common cause of ill health in our society, probably underlying as many as 70% of all visits to family doctors. It is also the one problem that every doctor shares with every patient. This presents physicians with two advantages: • It is an issue we can relate to experientially so we can use ourselves as a reference point • In studying and better understanding stress, we can derive personal as well as professional benefits. The manifestations of stress are legion. Early in the 20th century, medical students were taught that “if you know syphilis (the great masquerader), you know medicine.” One could say the same about stress. It can contribute to or mimic just about any symptom you can think of. However, the main presentations can be summarized under four headings: physical, mental, emotional and behavioural. The causes of stress are multiple and varied but they can be classified in two general groups: external and internal. External stressors can include relatives getting sick or dying, jobs being lost or people criticizing or becoming angry.
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However, most of the stress that most of us have is self-generated (internal). We create the majority of our upsets, indicating that because we cause most of our own stress, we can do something about it. This gives us a measure of choice and control that we do not always have when outside forces act on us. This also leads to my basic premise about stress reduction: to master stress, you must change. You have to figure out what you are doing that is contributing to your problem and change it. These changes fall into four categories: change your behaviour, change your thinking, change your lifestyle choices and/or change the situations you are in. By getting to the root causes of your stress, you can not only relieve current problems and symptoms but you can also prevent recurrences. For example, if you keep becoming frustrated over arguments with your children, you might discover that the cause of your upset is not their behaviour but your unrealistic expectations. By modifying your standards, you might find the children’s actions no longer bother you. There are many ways to relieve stress, from going for a walk to quitting your job. Here follows a list of 10 practical and down-to-earth strategies which I have found helpful over the years for both myself and my patients. Some are simple and can be implemented quickly; others are a bit more involved. All are feasible and beneficial. 1. Decrease or Discontinue Caffeine In terms of “bang for the buck,” it is hard to beat this simple intervention. Most patients do not realize that caffeine (coffee, tea, chocolate and cola) is a drug, a strong stimulant that actually generates a stress reaction in the body. I tell patients that the best way to observe the effect of caffeine is to get it out of the system long enough to see if there is a difference in how they feel. Three weeks is adequate for this purpose and all my patients accept this suggestion, especially when I frame it as an experiment. (“If you don’t notice a difference, you can go back to it; but if you feel better without it, you will probably want to stay off it.”) I would guess that 75% to 80% of my patients notice a benefit. They feel more relaxed, less jittery or nervous, sleep better, have more energy (a paradox, since you are removing a stimulant), less heartburn and fewer muscle aches. Many patients feel dramatically better and cannot believe the difference. One warning, however. Patients must wean themselves gradually or they will get migraine-type withdrawal headaches. I suggest decreasing by one drink per day until they are down to zero, then they should abstain for three weeks. When they feel better, they will thank you. In fact, you will be a hero because it is such an easy thing to do and delivers a big payoff Incidentally,
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I do not believe caffeine is a highly addictive substance. I have never met a patient in 10 years who could not give it up within one week. 2. Regular Exercise As a way of draining off stress energy, nothing beats aerobic exercise. To understand why, we need to review what stress is. People often think of stress as pressure at work, a demanding boss, a sick child or rush-hour traffic. All these may be triggers but stress is actually the body’s reaction to factors such as these. Stress is the fight-or-flight response in the body, mediated by adrenaline and other stress hormones, and comprised of such physiologic changes as increased heart rate and blood pressure, faster breathing, muscle tension, dilated pupils, dry mouth and increased blood sugar. In other words, stress is the state of increased arousal necessary for an organism to defend itself at a time of danger. The stress reaction is in us, not “out there.” It provides us with the strength and energy to either fight or run away from danger and is therefore selfprotective. There is only one problem: unlike a caveman being attacked by a wild animal or warring tribesman, fighting and running away are rarely appropriate responses to stressful situations in the modern world. The result is that our bodies go into a state of high energy but there is usually no place for that energy to go; therefore, our bodies can stay in a state of arousal for hours at a time. Exercise is the most logical way to dissipate this excess energy. It is what our bodies are trying to do when we pace around or tap our legs and fingers. It is much better to channel it into a more complete form of exercise like a brisk walk, a run, a bike ride or a game of squash. During times of high stress, we could benefit from an immediate physical outlet - but this often is not possible. However, regular exercise can drain off ongoing stress and keep things under control. I recommend physical activity every day or two. At the very least, it is important to exercise three times per week for a minimum of 30 minutes each time. Aerobic activities like walking, jogging, swimming, bicycling, racquet sports, skiing, aerobics classes and dancing are suitable. Choose things you like or they will feel like a chore and you will begin to avoid them. It is also beneficial to have a variety of exercise outlets. I have never met a patient who did not feel better with some form of regular exercise- and I know I could not exist without it. For chronic or acute stress, exercise is an essential ingredient in any stress reduction program.
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3. Relaxation/Meditation Another way to reduce stress in the body is through certain disciplines which fall under the heading of relaxation techniques. Just as we are all capable of mounting and sustaining a stress reaction, we have also inherited the ability to put our bodies into a state of deep relaxation which Dr. Herbert Benson of Harvard University has named “the relaxation response.” In this state, all the physiologic events in the stress reaction are reversed: pulse slows, blood pressure falls, breathing slows and muscles relax. Where the stress reaction is automatic, however, the relaxation response needs to be brought forth by intention. Fortunately, there are many ways of doing this. Sitting quietly by a lake or fireplace, gently petting the family cat, lying on a hammock and other restful activities can generate this state. There also are specific skills that can be learned which are efficient and beneficial. A state of deep relaxation achieved through meditation or self-hypnosis is actually more physiologically restful than sleep. These techniques are best learned through formal training courses which are taught in a variety of places. Books and relaxation tapes can be used when courses are not available or are beyond the patient’s budget. I can attest to the benefits of regular meditation from personal experience. And on days when exercise is not possible, relaxation techniques are an excellent way to bring down the body’s stress level. Whereas exercise dissipates stress energy, relaxation techniques neutralize it, producing a calming effect. As little as 20 minutes once or twice per day confers significant benefit. 4. Sleep As mundane as it sounds, sleep is an important way of reducing stress. Chronically stressed patients almost all suffer from fatigue (in some cases resulting from stress-induced insomnia), and people who are tired do not cope well with stressful situations. These dynamics can create a vicious cycle. When distressed patients get more sleep, they feel better and are more resilient and adaptable in dealing with day-to-day events. I always ask patients how much sleep they are getting, whether they wake up rested or tired, and how much sleep they generally need to function well. Most people know what their usual sleep requirement is (the range is five to 10 hours per night; the average being seven to eight), but a surprisingly large percentage of the population is chronically sleep deprived. I urge patients to go to bed 30 to 60 minutes earlier and to monitor the results after a few days or a week. If they are still tired, I suggest a bedtime 30 minutes earlier than this. Eventually, they find what works for them. The three criteria of success are waking refreshed, good daytime energy and waking naturally before the alarm goes off in the morning. 264
Sleeping-in is fine but if you sleep too long, it throws off your body rhythms during the following day. It is better to go to bed earlier. Daytime naps are an interesting phenomenon. They can be valuable if they are short and timed properly (i.e., not in the evening). The “power nap” or catnap is a short sleep (five to 20 minutes) that can be rejuvenating. A nap lasting more than 30 minutes can make you feel groggy. Patients with insomnia should be discouraged from daytime naps. Beyond these cautionary notes, sleep can be key in reducing stress and helping patients cope and function better. 5. Time-outs and Leisure No one would expect a hockey player to play an entire game without taking breaks. Surprisingly though, many otherwise rational people think nothing of working from dawn to dusk without taking intermissions, and then wonder why they become distressed. The two major issues are pacing and work/ leisure balance. Pacing has two components: monitoring your stress and energy level, and then pacing yourself accordingly. It is about awareness and vigilance; knowing when to extend yourself and when to ease up. It is also about acting on the information your body gives you. A diagram designed by Dr. Peter Nixon, a British cardiologist, illustrates some important points: • Increased stress produces increased performance, initially. • Once you pass a certain point (the hump), any more stress results in decreased performance. Trying harder at this point is unproductive or even counterproductive. The only sensible move is to take a break. • We need a certain amount of stress to function well (healthy tension) this is called eustress (good stress). However, stress becomes harmful (distress) when there is too much, when it lasts too long or when it occurs too often. • One of the first symptoms of distress is fatigue, which we tend to ignore. Dr. Nixon advocates a healthy respect for fatigue and doing something about it before it becomes exhaustion. An important key to pacing is taking periodic time-outs. Too many people go far too long without breaks. Dr. Ernest L. Rossi wrote The 20-Minute Break, an excellent book extolling the virtues of a short recess every couple of hours throughout the day. Just as we all have cycles of deep sleep and dream sleep throughout the night (at roughly 90- to 120-minute intervals), we also have cycles through the day: peaks of energy and concentration interspersed with troughs of low energy and inefficiency. These cycles are called “ultradian rhythms” because they happen many times per day (as opposed to the 24-hour circadian rhythm with which we are all familiar). The main point of the book 265
is that we need to watch for these troughs and take 20 minute “ultradian healing breaks” when they occur, as opposed to working through them and building up stress. It is not always convenient for people to take time-outs when nature tells us to but we can all become better at this. A mid morning break, lunch, a mid afternoon break and supper divide the day into roughly two-hour segments. These time-outs can include power naps, meditation, daydreaming, a social interlude, a short walk, a refreshment break, a change to low-concentration tasks or listening to music. Since I (and some of my patients) have started to work with this biologic pattern (instead of resisting it), the results have been pleasing. Like the catnap, it is simply a good investment of time that pays itself back quickly in increased productivity and reduced stress. Work-leisure balance. Despite all our labour-saving devices, leisure is still an elusive commodity for most people. Statistics show that the average American (and probably Canadian) is working an extra three hours per week compared with 20 years ago. That translates into an extra month of work each year. Add to that the phenomenon of the two career family (which makes family and leisure time even more scarce) and you start to get a picture of society on an accelerating treadmill. Leisure time and levels of distress are inversely proportional - the less leisure, the more stress. I ask patients to fill in a chart so we can both see what their work/leisure ratio looks like. I ask them to think of their lives (excluding sleep time) in four compartments (work, family, community and self) and then to assess what percentage of their time and energy in an average week goes into each part. There is no normal range but I become concerned when work is over 60% and/or when self is less than 10%. We all require time to meet our own needs (self-care, self-nurturing, etc.) and when that is neglected, trouble usually follows. Self directed activities can include exercise or recreation, relaxation, socializing, entertainment and hobbies. The word leisure is derived from the Latin word licere which means “permission.” The main reason so many people do not have enough leisure is that they are not giving themselves permission to make the time to enjoy it. Leisure is one of the most pleasant stress relievers ever invented. It is strange that people resist it so much (e.g., feeling selfish, guilty). I am not preaching hedonism - just a healthy amount of necessary respite from the day’s pressures. We as doctors can give patients permission if they will not give it to themselves. Once they experience a payoff, the benefits will reinforce the behaviour. After that, they are usually able to give themselves permission.
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6. Realistic Expectations A common source of stress is unrealistic expectations. People often become upset about something, not because it is innately stressful, but because it does not concur with what they expected. Take, for example, the experience of driving in slow-moving traffic. If it happens at rush hour, you may not like it but it will not surprise or upset you. However, if it occurs on a Sunday afternoon, especially if it makes you late for something, you are more likely to be stressed by it. When expectations are realistic, life feels more predictable and therefore more manageable. There is an increased feeling of control because you can plan and prepare yourself (physically and psychologically). For example, if you know in advance when you have to work overtime or stay late, you will take it more in stride than when it is dropped on you at the last minute. There is much we can do to help patients by letting them know when their expectations (of themselves and others) are unrealistic. I remember a patient berating himself and feeling guilty because he did not love his stepdaughter as much as his own biologic children. Blended families are common and I suspect many people struggle with this issue of love and loyalty. I asked this man where he got the idea that he would love his second wife’s children as if they were his own. He did not know. I suggested to him that his expectation was probably unrealistic, especially early in the new marriage. He felt relieved by this idea and stopped putting pressure on himself to feel something he did not feel. As for expectations of others, another patient said: “Expect less from people who cannot give you what you want. It makes it easier - not great, just less upsetting.” 7. Reframing This is one of the most powerful and creative stress reducers of which I know. Reframing is a technique used to change the way you look at things in order to feel better about them. We all do this inadvertently at times. For example, many people viewed the baseball, or football strikes as a personal disaster whereas others immediately realized they were going to save a lot of time and money by not hotfooting it down to the ballpark whenever their favourite teams were in town. The key to reframing is to recognize that there are many ways to interpret the same situation. It is like the age-old question: Is the glass half empty or half full? The answer of course is that it is both or either, depending on your point of view. As Dr. Joel Goodman put it at The Power of Laughter and Play
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Conference, Toronto, 1986: “There is more than one meaning to the same reality.” However, if you see the glass as half full, it will feel different than seeing it as half empty because the way we feel almost always results from the way we think. The message of reframing, then, is that there are many ways of seeing the same thing - so you might as well pick the one you like. One of the things we can do with patients is help them reframe stressful situations. This most often involves helping them see positives in a negative situation and assisting them in understanding the behaviour of other people. It is best to get the patient to provide the input first (to which you can add later) by asking certain questions. The information is more meaningful when it comes from them. For example, I had a patient who lost her job because of a chronic, though not life-threatening illness. I asked if anything positive had come out of this experience and she came up with several things, including “It will make me a stronger person,” “I never liked the work I was doing before. This gives me the chance to do what I really want to do,” “It has made my marriage stronger,” “It has brought me closer to my family,” and “I have learned to watch my money and spend more carefully, which I never had to do before.” I then asked her to focus on what is there (what she can still do) rather than what is missing (due to the restrictions of her illness). She replied, “Most things - my hobbies, watch television, go to the cottage, socialize, go out; although some things are still (physically) uncomfortable.” By asking her to think about her illness from a different perspective, she was encouraged to reframe the situation and she felt better emotionally as a result. In terms of reframing the behaviour of other people, ask patients why they think someone did what they did. For example, a woman’s boss was acting critical and domineering towards her. I said, “Assuming your boss is not just evil or malicious, why do you think she might be acting like this?” Answers included, “She is probably insecure,” “She is under a lot of pressure2“, and “She is having personal problems.” Performing this exercise helped the patient step outside herself and look at other possible interpretations of her boss’s behaviour. After that, her upset was considerably decreased. In fact, after such a discussion some patients feel more compassion than anger for the person who is bothering them. Notice that reframing does not change the external reality but simply helps people view things differently (and less stressfully). It should be done with a bit of preamble to explain the premise (e.g., using the glass half empty as an illustration) and only after you have acknowledged the validity of the patient’s initial (stressful) interpretation. You are not trying to disrespect their point of view but only to suggest there are other, less stressful ways of looking at the same thing. 268
8. Belief Systems A lot of stress results from our beliefs. We have literally thousands of premises and assumptions about all kinds of things that we hold to be the truth - everything from, “You can’t fight City Hall” and “The customer is always right,” to “Men shouldn’t show their emotions” and “Children should make their beds.” We have beliefs about how things are, how people should behave and about ourselves (“I can never remember people’s names”). Most of our beliefs are held unconsciously so we are unaware of them. This gives them more power over us and allows them to run our lives. Beliefs cause stress in two ways. The first is the behaviour that results from them. For example, if you believe that work should come before pleasure, you are likely to work harder and have less leisure time than you would otherwise. If you believe that people should meet the needs of others before they meet their own, you are likely to neglect yourself to some extent. Several patients tell me, “If you want something done right, you have to do it yourself” They do not delegate well and tend to get overloaded. In the above three cases, the beliefs are expressions of people’s philosophy or value system, but all lead to increased effort and decreased relaxation - a formula for stress. There is no objective truth to begin with. These are really just opinions but they lead to stressful behaviour. Helping patients uncover the unconscious assumptions behind their actions can be helpful in getting them to change. The second way beliefs cause stress is when they are in conflict with those of other people. One of my patients had a fight with his son because the child wore the same clothes several days in a row. I asked why it bothered him and he replied, “Because you should change your clothes every day.” I asked him where this idea originated: “Well, my mother taught me that. Everyone knows you should change your clothes every day.” I told him that this was not “the truth,” but merely his opinion based on the way he was raised. I said I had lived in cultures where people did not change clothes often and nothing bad happened to them. I helped him see that this was a premise he held but one which was not shared by his son. The argument was not over the clothes themselves but merely about a difference of opinion. Once he recognized his belief was not “true,” his anger diminished. We can do much for patients by getting them to articulate their beliefs and then to label them as such. Next, we need to help them acknowledge that their assumptions are not truth but rather opinions and, therefore, they can be challenged. Lastly, we can help patients revise their beliefs or at least admit that the beliefs held by the other person may be just as valid as their
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own. This is a mind-opening exercise and usually diminishes the upset the patient was experiencing. 9. Ventilation/Support System We have all had patients who come into the office upset, talking incessantly about a problem, and feeling better when they are finished. They have told their story, cried or made some admission, and the act of doing so in the presence of a trusted and empathic listener has been therapeutic. We often do not have to say much. We just have to be there, listen attentively and show our concern and caring. On other occasions we might offer validation, encouragement or advice. But the combination of the patient being able to ventilate and our support can be profoundly beneficial. There is an old saying that “a problem shared is a problem halved.” People who keep things to themselves carry a considerable and unnecessary burden. We can do much for patients by allowing them to ventilate or encouraging them to do so. We can also help by urging them to develop a support system (a few trusted relatives, co-workers or friends to talk to when they are upset or worried). Another form of ventilation that many patients find helpful is writing, for example in a private journal at home. Former tennis star Guillermo Vilas once said: “When my life is going well, I live it. When it’s not going well, I write it.” When patients are angry, I often suggest they write a letter to the person at whom they are vexed. These letters are not for sending; they should be destroyed once they are written- unread. The value is in expressing the feelings and getting them out. Rereading the letter just reinforces the upset and fans the flames of anger all over again. 10. Humour Humour is a wonderful stress reducer, an antidote to upsets. Laughter relieves tension. In fact, we often laugh hardest when we have been feeling most tense. One of my patients was lamenting the 15 pounds she gained over the winter and the fact that she could not get into her bathing suit. She had always been sensitive about her weight. While talking about her upset she suddenly stopped, her face softened and a smile came to her lips. “You know what? I’ve just decided,” she said. “I’ll swim in the dark this year.” Another case involved a man who worked in a busy company dealt with customers at the counter, customers on the phone and staff members who needed his help. He felt besieged often from several directions at once. He told me he started
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using a phrase which helped him cope and gave him a laugh; “I love it when they fight over me.” In both cases, patients generated their own humour and reduced their upset. Humour is an individual thing- what is funny to one individual may be hurtful to another. It is wonderful when patients can poke fun at themselves. We can also do this with patients, but we have to be careful and respectful in what we say. If you think of something funny that may help the patient, say it if you feel it will ease their tension and not be offensive. I will often throw in a quip or joke when I think it is appropriate. When it is done sensitively, laughter is a great gift to people you care about. Conclusion One of the most important things we can do for patients is teach them about stress management. Even better, we can learn these lessons ourselves and then model them for our patients. Although there are many approaches to stress management, this article has listed 10 ways for reducing stress that are practical, beneficial and which even busy physicians can start implementing immediately - for their patients and for themselves. Reference 1. Schor, JB: The Overworked American. Basic Books, New York, 1991, p. 11. Suggested Reading 1. Watzlawick, P, Weakland, J, Fisch, R: Change. Norton, New York, 1974. 2. Selye, H: Stress Without Distress. Signet, Scarborough, 1975. 3. Benson, H: The Relaxation Response. Avon, New York, 1975. 4. Freudenberger, HJ: Bum-Out. Bantam, NewYork,1980. 5. Eliot, RS: Is it Worth Dying For? Bantam, New York, 1984. 6. Borysenko, J: Minding the Body, Mending the Mind. Addison-Wesley, 1987. 7. Schor, JB: The Overworked American. Basic Books, New York, 1991. 8. Dominguez, J, Robin, V: Your Money or Your Life. Viking, New York, 1992. 9. Prochaska, J, Norcross, J, DiClemente, C: Changing For Good. Morrow, New York, 1994. 10. Rainham, DC: Winning Your Battle With Stress. Optimum Health Resources, 900 King Street, W., Kitchener, Ontario, N2G 1G5,I994. 11. Posen, DB: Always Change a Losing Game. Key Porter, Toronto, 1994. 12. Presented at Tri-University Winter Medical Symposium St. Petersburg, Florida March 11, 1995. 13. Dr. Posen practiced family medicine in Oakville, Ontario until 1985, when he gave up his family practice to devote his time exclusively to stress manage271
ment, lifestyle counselling and psychotherapy. He has given seminars for IBM, Motorola, Bell Canada, Peat Marwick and the 14. Royal Bank of Canada. His first book, Always Change a Losing Game, was published in 1994 by Key Porter Books, and became a Canadian best seller. He also presents seminars about stress management for McMaster University medical school and has given presentations for the Ontario Medical Association and the Ontario College of Family Physicians. He received his medical degree from University of Toronto in 1967. INFORMATION FOR PATIENTS - STRESS MANAGEMENT WHAT IS STRESS? Dr. Hans Selye, the father of stress theory, defined stress as “the nonspecific response of the body to any demand made upon it.” The “demand” can be a threat, a challenge or any kind of change which requires the body to adapt. The response is automatic, immediate. Stress can be good (called “eustress”) when it helps us perform better, or it can be bad (“distress”) when it causes upset or makes us sick. What Does the Stress Reaction Consist of? The stress reaction results from an outpouring of adrenaline, a stimulant hormone, into the bloodstream. This, with other stress hormones, produces a number of changes in the body which are intended to be protective. The result often is called “the fight-or-flight response” because it provides the strength and energy to either fight or run away from danger. The changes include an increase in heart rate and blood pressure (to get more blood to the muscles, brain and heart), faster breathing (to take in more oxygen), tensing of muscles (preparation for action), increased mental alertness and sensitivity of sense organs (to assess the situation and act quickly), increased blood flow to the brain, heart and muscles (the organs that are most important in dealing with danger) and less blood to the skin, digestive tract, kidneys and liver (where it is least needed in times of crisis). In addition, there is an increase in blood sugar, fats and cholesterol (for extra energy) and a rise in platelets and blood clotting factors (to prevent hemorrhage in case of injury). What Are Common Symptoms of Stress? Manifestations of stress are numerous and varied but they generally fall into four categories (this is only a partial list of most common symptoms): Physical: fatigue, headache, insomnia, muscle aches/stiffness (especially neck, shoulders and low back), heart palpitations, chest pains, abdominal
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cramps, nausea, trembling, cold extremities, flushing or sweating and frequent colds. Mental: decrease in concentration and memory, indecisiveness, mind racing or going blank, confusion, loss of sense of humour. Emotional: anxiety, nervousness, depression, anger, frustration, worry, fear, irritability, impatience, short temper. Behavioural: pacing, fidgeting, nervous habits (nail-biting, foot-tapping), increased eating, smoking, drinking, crying, yelling, swearing, blaming and even throwing things or hitting. What Are the Causes of Stress? Dr. Selye called the causes of stress “stressors” or “triggers.” There are two kinds of stressors: external and internal. External stressors include: • Physical environment: noise, bright lights, heat, confined spaces. • Social (interaction with people): rudeness, bossiness or aggressiveness on the part of someone else. • Organizational: rules, regulations, “red tape,” deadlines. • Major life events: death of a relative, lost job, promotion, new baby. • Daily hassles: commuting, misplacing keys, mechanical breakdowns. Internal stressors include: • Lifestyle choices: caffeine, not enough sleep, overloaded schedule. • Negative self-talk: pessimistic thinking, self-criticism, over-analyzing. • Mind traps: unrealistic expectations, taking things personally, all-ornothing thinking, exaggerating, rigid thinking. • Stressful personality traits: Type A, perfectionist, workaholic, pleaser. It is important to note that most of the stress that most of us have is actually self-generated. This is a paradox because so many people think of external stressors when they are upset (it is the weather, the boss, the children, the spouse, the stock market). Recognizing that we create most of our own upsets, however, is an important first step to dealing with them. What Are Some Ways to Master Stress? The following are some categories that can be helpful in mastering stress:
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Change lifestyle habits • • • • • • • •
Decrease caffeine (coffee, tea, cola, chocolate). Well-balanced diet. Decrease consumption of junk food. Eat slowly. Regular exercise (at least 30 minutes, three times per week). Adequate sleep (figure out what you need, then get it). Leisure time (do something for yourself everyday). Relaxation exercises (e.g., meditation, self-hypnosis). Change stressful situations
• • • •
Time and money management. Assertiveness. Problem-solving. Possibly leaving a job or a relationship. Change your thinking
• • • •
Look at things more positively. See problems as opportunities. Refute negative thoughts. Keep a sense of humour.
Diversion and distraction. Take a time-out (anything from a short walk to a vacation) to get away from the things that are bothering you. This will not resolve the problem, but it gives you a break and a chance for your stress levels to decrease. Then, you can return to deal with issues feeling more rested and in a better frame of mind. Prepared by Dr. David B. Posen Lifestyle Counsellor and Psychotherapist, and Author of “Always Change a Losing Game” Oakville, Ontario May be copied and distributed to patients Internet Mental Health (www.mentalhealth.com) copyright© 1995-1996 by Phillip W. Long, M.D.
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CHAPTER 22
RADIOLOGY AND NUCLEAR MEDICINE Introduction Radiology (also called roentgenology after its discoverer, Wilhelm Conrad Roentgen) is the medical specialty concerned with the study of x-rays. X-rays are invisible waves of energy that are produced by an energy source (x-ray machine) and are useful in diagnosis and treatment of disease. Nuclear medicine is the medical specialty that studies the characteristics and uses of radioactive substances in the diagnosis of disease. Radioactive substances are materials that emit high-speed particles and energycontaining rays from the interior of their matter. The emitted particles and rays are called radioactivity and can be of three types: alpha particles, beta particles, and gamma rays. Gamma rays are similar to x-rays in that they have no mass and are used effectively as a diagnostic label to trace the path and uptake of chemical substances in the body. A radiologist is a physician who specialises in the practice of diagnostic, therapeutic, and interventional radiology. A nuclear physician is physician who specializes in the practice of administering diagnostic nuclear medicine procedures. Allied health care professionals who work with physicians in the field of radiology and nuclear medicine are radiologic technologists. Types of radiologic technologists are: radiographers (aid physicians in administering diagnostic x-ray procedures) and nuclear medicine technologists, (attend to patients undergoing nuclear medicine procedures and operate devices under the direction of a nuclear physician). 1. Radiology Several characteristics of x-rays are useful to physicians in the diagnosis and treatment of disease.
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1. Ability to cause exposure of a photographic plate. If a photographic plate is placed in front of a beam of x-rays, the x-rays, travelling unimpeded through the air, will expose the silver coating of the plate and cause it to blacken 2. Ability to penetrate different substances to varying degrees. If the x-rays are absorbed (stopped) by the denser body substance (e.g. calcium in the bones ), they do not reach the photographic plate held behind the patient, and white areas are left in the x-ray film. 3. A substance is said to be radiolucent if it permits passage of most of the x-rays. Radiopaque substances (bones) are those that absorb most of the x-rays they are exposed to. 4. Invisibility. X-rays cannot be detected by sight, sound, or touch. Workers exposed to x-rays must wear a film badge to detect and record the amount of radiation to which they have been exposed. 5. Travel in straight lines. This property allows the formation of precise shadow images on the x-ray plate and also permits x-ray beams to be directed accurately at a tissue site during radiotherapy. 6. Scattering of radiation. Scattering occurs when x-rays come in contact with any material. Greater scatter occurs with dense objects. Scatter can blur images so a grid is placed in front of the film to absorb scattered radiation before it strikes the x-ray film. 7. Ionization. X-rays have the ability to ionize substances through which they pass. Ionization is a chemical process in which the energy of an x-ray beam causes rearrangement and disruption within a substance. In x-ray therapy, the ionizing effect of x-rays can help kill cancerous cells and stop tumour growth. Ionizing x-rays can also affect normal body cells, leading to tissue damage and malignant changes. Thus, persons exposed to high doses of x-rays are at risks of developing leukemia, thyroid tumours, breast cancer, or other malignancies. Diagnostic Techniques X-rays X-rays are used in a variety of ways to detect pathological conditions. The most common use of the diagnostic x-ray is dental, to locate cavities in teeth. Other areas examined include the digestive, nervous, reproductive, and endocrine systems and the chest and bones. Some special diagnostic x-ray techniques are the following: Computed Tomography or Computerized Axial Tomography(CT, CAT). Machines called CT scanners beam x-rays at multiple angles through a section of a patient’s body. A computer creates a cross-sectional picture of the body 276
section examined. The CT scanners are highly sensitive in detecting diseases in bony structures and can provide images of internal organs that are impossible to visualize with ordinary x-ray technique. Contrast Studies. In x-ray film, the natural differences in the density of body tissues (e.g. air in lung) produce contrasting shadow images on the x-ray film; however, when x-rays pass through two adjacent body parts composed of substances of the same density, their images cannot be distinguished on the film or on the screen. It is necessary, then, to inject a contrast medium into the structure or fluid so that a specific part, organ, tube, or liquid can be visualized. The following are artificial materials used in diagnostic radiological studies. Barium Sulphate. Barium sulphate is a metallic powder that is mixed in water and used for examination of the upper and lower gastrointestinal tract. An upper GI series involves oral ingestion of barium sulphate so that the esophagus, stomach, and duodenum can be visualized. A small bowel followthrough traces the passage of barium in a sequential manner as it passes through the small intestine. A barium enema (lower GI series) opacifies the lumen of the large intestine. A double-contrast study uses both a radiopaque and a radiolucent contrast medium. For example, the walls of the stomach or intestine are coated with barium and the lumen is filled with air. Iodine Compounds. Radiopaque fluids containing up to 50 percent iodine are used in the following tests: Angiography An x-ray image of blood vessels and heart chambers. Arthrography Contrast or air, or both, is injected into a joint, and x-rays are taken of the joint. Pyelography X-ray images are made of the renal pelvis. Fluoroscopy. This x-ray procedure uses a fluorescent screen instead of a photographic plate to derive a visual image from the x-rays that pass through the patient. The fact that ionizing radiation can produce fluorescence is the basis for fluoroscopy. A major advantage of fluoroscopy over normal radiography is that internal organs, such as the heart and digestive tract organs, can be observed in motion. Interventional Radiology. Interventional radiologists perform invasive procedures (therapeutic or diagnostic) under fluoroscopic, CT, and more recently MR (magnetic resonance) guidance. Procedures include placement of drainage catheters, drainage of abscesses, occlusion of bleeding vessels, and installation of antibiotics or chemotherapy through catheters. In addition, interventional radiologists perform thermal(heating or freezing) radiofrequency, and ultrasound ablation(destruction) of benign and malignant lesions. 277
Ultrasound This technique employs high-frequency, inaudible sound waves that bounce off the body tissues and are then recorded to give information about the anatomy of an internal organ. An instrument called a transducer or probe is placed near or on the skin, which is covered with a thin coating of gel to assure good transmission of sound waves. Ultrasound is used as a diagnostic tool not only by radiologists but also by neurosurgeons and ophthalmologists to detect intracranial and ophthalmic lesions, by cardiologists to detect heart valve and blood vessel disorders as well as gastroenterologists, obstetricians and gynecologists. It is important to know that sound waves are nonionizing and noninjurious to tissues. Two ultrasound techniques, Doppler ultrasound and colour-flow imaging, make it possible to record blood velocity, and to image major blood vessels in patients at risk for stroke. Magnetic Imaging or Magnetic Resonance Imaging This is a type of diagnostic radiography that uses electromagnetic energy rather than x-rays. The technique produces sagittal, coronal (frontal), and axial(cross-sectional) images. MR examinations are performed with and without contrast. The contrast agent most commonly used for MRI is gadolinium(Gd)..MRI is used for providing soft- tissue images, detecting edema in the brain, projecting a direct image of the spinal cord, detecting tumours in the chest and the abdomen, and visualizing the cardiovascular system. X-Ray Positioning In order to take the best view of the part of the body being radiographed, the patient, film, and x-ray tube must be positioned in the most favourable alignment possible. There are special terms used by radiologists to refer to the direction of travel of x-ray through the patient. 1. Posteroanterior (PA) view. In this most commonly requested chest x-ray view, x-rays travel from a posteriorly placed source to an anteriorly placed detector. 2. Anteroposterior (AP) view. X-rays travel from an anteriorly placed source to a posteriorly placed detector 3. Lateral view. In a left lateral view, x-rays travel from a source located to the right of the patient to a detector placed to the left of the patient 4. Oblique view. X-rays travel in a slanting direction at an angle from the perpendicular plane. Oblique views show regions ordinarily hidden and superimposed in routine PA and AP views.
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2. Nuclear Medicine Radioactivity and radionuclides The emission of energy in the form of particles or rays coming from the interior of a substance is called radioactivity. A radionuclide or radioisotope is a substance that gives off high-energy particles or rays as it disintegrates. Half-life is the time required for a radio-substance to lose half of its radioactivity by disintegration. The half-life must be long enough to allow for diagnostic imaging but as short as possible to minimize patient’s exposure to radiation. Radionuclides emit three types of radioactivity: alpha particles, beta particles, and gamma rays. Gamma rays, which have greater penetrating ability than alpha and beta particles, and more ionizing power, are especially useful in both the diagnosis and the treatment of disease. Technetium-99m is a pure gamma emitter with a half-life of 6 hours. Its properties make it the most frequently used radionuclide in diagnostic imaging. Nuclear medicine physicians use two types of tests in the diagnosis of disease: in vitro (in the test tube) and in vivo (in the body). In vitro procedures involve analysis of blood and urine specimens using radioactive chemicals. RIA (radioimmunoassay) is an in vitro procedure to detect hormones and drugs in a patient’s blood. In vivo tests trace the amounts of radioactive substance within the body. Examples of diagnostic procedures that utilize radionuclides. 1. Bone scan. 99mTc(technetium) is used to label phosphate substances and is injected intravenously. The scan is useful in demonstrating malignant metastasis to the skeleton. 2. Gallium scan. The radioisotope gallium-67 is injected intravenously and has an affinity for tumours and non-neoplastic lesions such as abscesses. 3. Liver and spleen scan. To visualize the liver and spleen, a radiopharmaceutical (99mTc and sulphur colloid) is injected intravenously, and images are taken with a scintiscanner (gamma camera). 4. Positron emission tomography (PET scan). Radioactive substances are given intravenously and then emit positrons which create a cross-sectional image of the metabolism of the body. PET scanning has determined that schizophrenics do not metabolize glucose equally in all parts of the brain and that drug treatment can bring improvement to these organs. 5. Single-photon emission computed tomography (SPECT). Clinical application includes detecting liver tumours, detecting cardiac ischemia, and evaluating bone diseases of the spine.
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6. 99mTechnetium sestamibi scan. It is injected intravenously to study the motion of the heart wall muscle and the ventricle’s ability to eject blood (ejection fraction). 7. Thallium scan (TL). It is injected intravenously to allow for myocardial perfusion. Infarcted or scarred myocardium does not extract any Tl, showing up as cold spots. 8. Thyroid scan. Hyper functioning thyroid nodules (adenomas) accumulate higher amounts of 131I radioactivity and are termed “hot”. Thyroid carcinoma does not concentrate radioiodine well and is seen as a “cold” spot on the scan. Abbreviations Angio - angiography
AP - anteroposterior
Ba - barium
CAT- computerized axial tomography
CT - computerized tomography
CXR – chest x-ray
Decub - lying down, decubitus
DI - diagnostic imaging
FDG - fluorodeoxyglucose (radiopharmaceutical) 67Ga - radioactive gallium
131 I radioactive iodine
IVP - intravenous pyelogram
KUB – kidneys, ureters, bladder
LAT - lateral
MR or MRI – magnetic resonance
MRA - magnetic resonance angiography
PA - posteroanterior
PET – positron emission tomography computed
SPECT – single photon emission
201Tl - radioisotope (thallium)
UGI - upper gastrointestinal (series)
Tomography.
US, U/S – ultrasound VQ scan – ventilation perfusion scan of the lungs
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CHAPTER 23
PHARMACOLOGY Introduction Drugs (medicines) are substances used to prevent or treat a condition or disease. Drugs are obtained from parts of plants, such as the roots, leaves, and fruit. An example of a plant-derived drug is a cardiac medicine, digitalis (from the foxglove plant). Other drugs (antibiotics such as penicillin) are obtained from yeast, moulds, and fungi. Drugs are also obtained from animals; for example, hormones are secretions from the glands of animals. Some drugs are synthesized in a laboratory. Anticancer drugs, such as methotrexate and prednisone, are laboratory synthesized drugs. Vitamins are drugs that are isolated from plant or animal sources and are contained in foods. A pharmacist prepares and dispenses drugs through a pharmacy (drugstore) on written orders from a physician. Currently, most schools/colleges of pharmacy offer a Pharm. D. (Doctor of Pharmacy) degree after six or seven years of study. As a health care professional, a pharmacist cooperates with, and sometimes advices licensed practitioners concerning drugs. In addition, the pharmacist answers patient’s questions concerning their prescription needs. Pharmacology is the study of the preparation, properties, uses, and action of drugs. A pharmacologist is either an M.D.(Medical Doctor) or a Ph.D.(Doctor of philosophy) who specializes in pharmacology. Pharmacology contains many subdivisions of study: medicinal chemistry, pharmacodynamics, pharmacokinetics, molecular pharmacology, chemotherapy, and toxicology. Medicinal chemistry is the study of new drug synthesis and the relationship between chemical structure and biological effect. Pharmacodynamics involves the study of drug effects in the body. The mathematical description of drug disposition (appearance and disappearance) in the body over time is pharmacokinetics. Molecular pharmacology involves the interaction of drugs and subcellular entities, such as DNA, RNA, and enzymes. 281
Chemotherapy is the study of drugs that destroy microorganisms, parasites, or malignant cells within the body. Toxicology is the study of the harmful effects of drugs and chemicals on the body. A toxicologist is also interested in finding proper antidotes to any harmful effects of drugs. A drug can have three different names. The chemical name is the chemical formula for the drug; the generic name (shorter and less complicated) identifies the drug legally and scientifically; the brand name or trademark is the private property of the individual drug manufacturer Chemical Name Generic Name Brand Name Derivative of 6-aminopenicillanic acid ampicillin Omnipen Polycillin Principen Totacillin Administration of Drugs How a drug is introduced into the body: Oral administration. Drugs given by mouth are slowly absorbed into the bloodstream through the stomach or intestinal wall. This method although convenient for the patient, has several disadvantages: it can be destroyed in the digestive tract or cannot pass through the intestinal mucosa. It is also not good in case when time is an important factor in therapy. Sublingual administration. Drugs placed under the tongue dissolve in the saliva. Nitro-glycerine is administered in this way. Rectal administration. Suppositories and aqueous solutions are inserted into the rectum. Drugs are given by rectum when oral administration presents difficulties, as when the patient is nauseated and vomiting. Parenteral administration. Injection of drug from a syringe through a hollow needle placed under the skin, into a muscle, vein, or body cavity. There are several types of parenteral injections: 1. Intracavitary injection. This injection is made into a body cavity, such as the peritoneal or pleural cavity. 2. Intradermal injections. This shallow injection is made into the upper layers of the skin and is used chiefly in skin testing for allergic reactions. 3. Intramuscular injection (IM). The buttock or upper arm is usually the site for this injection.
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4. Intrathecal injection. This injection is made into the space under the membranes (meninges) surrounding the spinal cord and brain. Methotrexate is injected intrathecally for treatment of leukemia. 5. Intravenous injection. This injection is made directly into a vein. It is used when an immediate effect from the drug is desired. 6. Subcutaneous injection. Introduction of a hypodermic needle under the skin, usually on the upper arm, thigh, or abdomen. Inhalation. Vapours, or gases, taken into the nose or mouth are absorbed into the bloodstream through the thin walls of air sacs in the lungs. Topical Application. Drugs are locally applied on the skin or mucous membranes of the body. Antiseptics (against infection) and antipruritics (against itching) are commonly used as ointments, creams, and lotions. Terminology of Drug Action When a drug enters the body, the target substance with which the drug interacts to produce its effects is called a receptor. The following terms describe the action and interaction of drugs in the body after they have been absorbed into the bloodstream: Additive Action. If the combination of two similar drugs is equal to the sum of the effects of each, then the drugs are called additive. If two drugs give less than an additive effect, they are called antagonistic. If they produce greater than additive effect, they are called synergistic. Synergism. A combination of two drugs can sometimes cause an effect that is greater than the sum of the individual effects of each drug given alone. For example penicillin and streptomycin produce a synergistic effect. Tolerance. Tolerance is a feature of addiction to drugs such as morphine. Addiction is the physical and psychological dependence on and craving for a drug. Drug Toxicity Drug toxicity is the poisonous and potentially dangerous effect of some drugs. Idiosyncrasy is an example of an unpredictable type of drug toxicity. This is an unexpected effect that appears in the patient following administration of a drag. In some patients penicillin causes an idiosyncratic reaction, such as anaphylaxis (acute hypersensitivity with asthma and shock). Iatrogenic (produced by treatment) disorders can occur, however, as a result of mistakes in drug use or in individual sensitivity to a given agent. Side effects are toxic effects that routinely result from the use of a drug. For
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example, nausea, vomiting, and alopecia are common side effects of chemotherapeutic drugs used to treat cancer. Contraindications are factors in a patient’s condition that make the use of a drug dangerous and ill advised.
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CHAPTER 24
PSYCHIATRY Psychiatry (psych/o means mind, iatr/o means treatment) is the branch of medicine that deals with the diagnosis, treatment, and prevention of mental illnesses. Psychiatrists complete the same medical training as other physicians and receive an M.D. degree. Then they spend a varying number of years training in the methods and practice of psychotherapy and drug therapy. Psychiatrists can also take additional years of training to specialize in various aspects of psychiatry. Child psychiatrists specialize in the treatment of children; forensic psychiatrists specialize in the legal aspects of psychiatry, such as the determination of mental competence in criminal cases. Psychoanalysts complete 3 to 5 years of training in a special psychotherapeutic technique called psychoanalysis in which the patient freely relates her or his thoughts to the analyst, who does not interfere in the flow of thoughts. A psychologist is a non medical person who is trained in methods of psychotherapy, analysis, and research. A clinical psychologist, like a psychiatrist, can use various methods of psychotherapy to treat patients, but, unlike the psychiatrists, cannot prescribe drugs or electroconvulsive therapy. Other nonphysicians trained in the treatment of mental illness are licensed clinical social workers and psychiatric nurses. Clinical psychologists are trained in the use of tests to evaluate various aspects of a patient’s mental health and intelligence. Psychiatric Clinical Symptoms These terms describe abnormalities in behaviour that are evident to an examining mental health professional. amnesia
Loss of memory.
anxiety Varying degrees of uneasiness, apprehension, or dread often accompanied by palpitations, tightness in the chest, breathlessness, and choking sensations. 285
apathy Absence of emotions ; lack of interest or emotional involvement. autism Severe lack of responsiveness to others, preoccupation with inner thoughts; withdrawal and retarded language development. compulsion Uncontrollable urge to perform an act repeatedly. conversion Anxiety becomes a bodily symptom, such as blindness, deafness, or paralysis, that does not have an organic basis. delusion A fixed, false belief that cannot be changed by logical reasoning or evidence. dissociation Uncomfortable feelings are separated from their real object. In order to avoid mental distress, the feelings are redirected toward a second object or behaviour pattern. dysphoria Sadness, hopelessness; depressive mood. euphoria Exaggerated feeling of well-being (high). hallucination False or unreal sensory perception as, for example, hearing voices none are present. labile Unstable; undergoing rapid emotional change. mania State of excessive excitability; hyperactivity and agitation. mutism Nonreactive state; stupor. obsession An involuntary, persistent idea or emotion. paranoia Delusions persecution or grandeur or combination of the two. Psychiatric Disorders Anxiety Disorders These disorders are characterized by anxiety-the experience of unpleasant tension, distress, troubled feelings, and avoidance behaviour. A panic attack, marked by intense fear or discomfort and symptoms such as palpitations, sweating, trembling, and dizziness, can occur on its own with no symbolic meaning for the patient(i.e., it occurs “out of the blue”), or it can occur in the context of the following anxiety disorders: phobic disorders, obsessivecompulsive disorder, and post-traumatic stress disorders.
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Phobic disorders are characterized by irrational or debilitating fears associated with a specific object or situation. The patient with a phobic disorder goes to extreme lengths to avoid the object of her or his fear. Panic attacks can occur in anticipation of the phobic situation. Agoraphobia is the fear of being alone or in open, crowded, public places from which escape would be difficult or in which help might not be available. They may feel comfortable only by remaining at home or in the company of a friend or relative. A social phobia (social anxiety disorder) is the fear of situations in which the individual is open to public scrutiny which could result in possible embarrassment and humiliation. Fear of speaking in public, using public lavatories, or eating in public are examples of social phobias. Other specific phobias are claustrophobia (fear of closed-in places); acrophobia (fear of heights); zoophobia (fear of animals). O b s e s s i v e co m p u l s i v e d i s o rd e r ( O C D ) i n v o lv e s re c u r re n t thoughts(obsessions) and repetitive acts (compulsions) that dominate the patient’s behaviour. The patient experiences anxiety if he or she is prevented from performing special rituals, which are used to shield against overwhelming anxiety or fear. Often the OCD consumes time and significantly interferes with the individual’s social or occupational functioning. Post-traumatic stress disorder is the development of symptoms (intense fear, helplessness, insomnia, nightmares etc.) following exposure to a traumatic event. Many survivors of the September 11 attack experienced posttraumatic stress disorder. Delirium and Dementia Delirium and dementia are both disorders of abnormal cognition (mental processes of thinking, perception, reasoning, judgement). Delirium is acute, temporary disturbance of consciousness and mental confusion. It is characterized by rambling, irrelevant, or incoherent speech, sensory misperceptions, and disorientation as to time, place, or person and by memory impairment. Delirium is caused by a variety of conditions, including drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycemia, electrolyte imbalances, or hepatic or renal failure. Delirium tremens is brought on by withdrawal after prolonged periods of heavy alcohol ingestion. Dementia is a general more gradual loss of intellectual abilities that involves impairment of judgement, memory, and abstract thinking as well as changes in personality. Dementia may be caused by conditions, some revers287
ible and some progressive, involving damage to the brain. The most common cause is Alzheimer disease, but others are cerebrovascular disease (stroke), central nervous system infection, brain trauma, tumours, and Parkinson and Huntington disease. Dissociative Disorders Dissociative disorders are chronic or sudden disturbances of memory, identity, consciousness, or perception of the environment that are not caused by the direct effects of brain damage or drug abuse. Symptoms hide the pain and anxiety of unconscious conflicts. Examples of dissociative disorders are dissociative identity disorder, which is the existence within the individual of two or more distinct personalities that take hold of the individual’s behaviour (illustrated in literature by Dr. Jekyll and Mr. Hyde); dissociative amnesia (inability to remember important personal information that is too extensive to be explained by ordinary forgetfulness); and dissociative fugue (sudden, unexpected travel away from home or customary work locale). The fugue (flight) disorder includes the assumption of a new identity and inability to recall one’s previous identity. Eating Disorders Eating disorders are severe disturbances in eating behaviour. Examples are anorexia nervosa and bulimia nervosa. Anorexia nervosa is a refusal to maintain a minimally normal body weight. An individual is intensely afraid of gaining weight and has a disturbance in the perception of the shape or size of her or his body. The condition predominantly affects adolescent females, and its principal symptom is a conscious, relentless attempt to diet along with excessive, compulsive overactivity, such as exercise, running, or gymnastics. Most postmenarchal females with this disorder are amenorrheic. Bulimia nervosa (bulimia means abnormal increase in hunger) is characterized by binge eating (uncontrolled indulgence in food) followed by purging(eliminating food from the body). Bulimic individuals maintain normal or nearly normal weight because after binging they engage in inappropriate purging. Examples are self-induced vomiting and the misuse of laxatives or enemas. Mood Disorders A mood disorder is prolonged emotion such as depression or mania (elation) that dominates a patient’s entire mental life. Examples of mood disorders are bipolar disorders and depressive disorders. Bipolar disorders (bi - two; pol/o –extreme) are characterized by one or more manic episodes alternating with
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depressive episodes. A manic episode is a period during which the predominant mood is excessively elevated (euphoria), expansive, or irritable. Associated symptoms include inflated self-esteem, or grandiosity, decreased need for sleep, nearly continuous flow of rapid speech with quick changes of topic, distractibility, an increase in goal-directed activity, and excessive involvement in pleasurable activities that have a high potential for painful consequences. Often there is increased sociability and participation in multiple activities marked by intrusive, domineering, and demanding behaviour. Hypomania describes a mood resembling mania, but of lesser intensity. Bipolar I is one or more manic episodes, often alternating with major depressive episodes. Bipolar II is recurrent major depressive episodes alternating with hypomanic episodes. Cyclothymic disorders (cycl/o –cycle; thym/o – mind) is a mild form of bipolar disorder characterized by at least two years of hypomania and numerous depressive episodes that do not meet the criteria that define a major depressive episode. Depressive disorders are marked by one or more major depressive episodes without a history of mania or hypomania. Major depression involves episodes of severe dysphoria (sadness, helplessness, worry, discouragement). Other symptoms are appetite disturbances and changes in weight, sleep disorders such as insomnia or hypersomnia, fatigue or low energy, feelings of worthlessness, hopelessness, or excessive or inappropriate guilt, difficulty thinking or concentrating, and recurrent thought of death or suicide. Dysthymia is a depressive disorder involving depressed mood that persists over a 2-year period but is not as severe as major depression. Also there are no psychotic features (delusion, hallucinations, incoherent thinking) as are sometimes found in major depression. Dysthymic disorder can be very impairing but commonly responds well to medications. Physicians have noted a relationship between the onset of an episode of depressive disorder and a particular 60-day period of the year. A regular appearance of depression may occur between the beginning of October and the end of November every year. This is referred to as a seasonal affective (mood) disorder (SAD). A change from depression to mania or hypomania also may occur within a 60-day period from mid-February to mid-April. Personality Disorders Personality traits are established patterns of thinking and ways of relating to and perceiving the environment and one’s self; however, when these traits become inflexible and rigid, causing impairment of functioning, distress, and
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conflict with others, they constitute personality disorders. Examples of personality disorders are as follows: antisocial No loyalty to or concern for others, and without moral standards; acts only in response to desires and impulses; cannot tolerate frustration and blames others when he or she is at false. borderline Instability in interpersonal relationships and sense of self; characterized by alternating involvement with and rejection of people. Frantic efforts are made to avoid real or imagined abandonment. histrionic Emotional, attention-seeking, immature, and dependent; irrational outbursts and tantrums; flamboyant and theatrical; having general dissatisfaction with one’s self and angry feelings about the world narcissistic Grandiose sense of self-importance or uniqueness and preoccupation with fantasies of success and power. Narcissism is a pervasive interest in one’s self with a lack of empathy for others. paranoid Continually suspicious and mistrustful of other people but not to a psychotic or delusional degree; jealous and overly concerned with hidden motives of others; quick to take offense. schizoid Emotionally cold and aloof; indifferent to praise or criticism or to the feelings of others; few friendships and rarely appears to experience strong emotions, such as anger or joy. IV. Therapeutic Terminology Psychotherapy This is the treatment of emotional problems by using psychological techniques. The following are psychological techniques used by psychiatrists, psychologists, and other mental health professionals. Cognitive Behaviour Therapy (CBT). Conditioning (changing behaviour patterns and responses by training and repetition) is used to relieve anxiety and treat phobias and other disorders. Family Therapy. Treatment of an entire family to resolve and understand their conflicts and problems.
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Group Therapy. A group of patients with similar problems gains insight into their own personalities through discussions and interaction with each other. In psychodrama, patients express their feelings by acting out roles along with other patients-actors on a stage. After a scene has been presented, the audience (composed of other patients)is asked to make comments and offer interpretations about what they have observed. Hypnosis. A trance (state of altered consciousness) is created to increase the speed of psychotherapy or to help recovery of deeply repressed memories. Insight-Oriented Psychotherapy. Face-to-face discussion of life problems and associated feelings. Play Therapy. Therapy in which a child, through play, uses toys to express conflicts and feelings that he or she is unable to communicate in a direct manner. Psychoanalysis. Developed by Sigmund Freud, this long-term and intense form of psychotherapy seeks to influence behaviour and resolve internal conflicts by allowing patients to bring their unconscious emotions to the surface. Sex Therapy. This form of therapy helps individuals overcome sexual dysfunctions such as frigidity, impotence and premature ejaculation. Supportive Psychotherapy. Offering encouragement, support, and hope to patients facing difficult life transitions and events. Electroconvulsive Therapy A treatment in which an electric current is applied to the brain while the patient is anesthetized, paralyzed, and being ventilated. This produces convulsions (involuntary muscular contractions) which, with modern techniques, are usually observable only in the form of a twitching of the toe. It is chiefly used for serious depression and depressive phase of bipolar (manic-depressive) disorder. Drug Therapy The following are categories of drugs used to treat psychiatric disorders. Antianxiety and antipanic agents. These drugs lessen anxiety, tension, and agitation, especially when they are associated with panic attacks. Example – benzodiazepines(BZDs). Antidepressants. These drugs gradually reverse depressive symptoms and produce feelings of well-being. The basis of depression is thought to be an imbalance in the levels of neurotransmitters in the brain.
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Anti-obsessive-compulsive disorder agents.(OCD). These drugs are prescribed to relieve the symptoms of obsessive-compulsive disorder. Antipsychotics (neuroleptics). These drugs modify psychotic symptoms and behaviour. Examples are phenothiazines, which are tranquilizers that reduce the anxiety, tension, agitation, and aggressiveness associated with psychoses and modify psychotic symptoms such as delusions and hallucinations. Hypnotics. These drugs are used to produce sleep and relieve insomnia. Examples are sedatives and benzodiazepines. Mood stabilizers. These drugs treat the manic episodes of bipolar illness. Lithium is commonly used to reduce the levels of manic symptoms, such as rapid speech, hyperactive movements, grandiose ideas, poor judgement, aggressiveness, and hostility. Lithium is a simple salt that is thought to stabilize nerve membranes. Stimulants. These drugs(amphetamines) are prescribed for attentiondeficit hyperactivity disorder in children. Common symptoms of ADHD are having a short attention span and being easily distracted, emotionally unstable, impulsive, and moderately to severely hyperactive. Some Common Combining Forms, Suffixes, Prefixes, and Terminology 1.Combining forms: anxi/o
uneasy, anxious, distressed anxiolytic .....................................................
hallucin/o hallucination
hallucinogen .............................................
hypn/o
sleep
hypnosis ......................................................
iatr/o
treatment psychiatrist ................................................
ment/o
mind mental ..........................................................
phil/o
attraction to, love
phren/o
mind schizophrenia ...........................................
psych/o
mind
psychosis ....................................................
schiz/o
split
schizoid ........................................................
somat/o
body psychosomatic ........................................
paraphilia ...................................................
somatoform disorder ..........................
2. Suffixes -genic
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produced by
psychogenic ..............................................
-leptic
to seize hold of
neuroleptic drugs ..................................
-mania
obsessive preoccupation
kleptomania ..............................................
-phobia fear (irrational and disabling)
agoraphobia ..............................................
-phoria feeling, bearing
euphoria ......................................................
-thymia mind
cyclothymia ...............................................
dysthymia ...................................................
3. Prefixes a-, an- no,not
apathy ...........................................................
cata-
catatonic stupor ......................................
down
hypo- deficient, less than, below
hypomania .................................................
hypochondriasis .....................................
para-
abnormal paranoia ......................................................
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Glossary A abdomen
trbuh, trbušna šupljina
abdominal
trbušni
abduction
odmicanje
ability
sposobnost, vještina, umijeće
abnormal
nenormalan, neprirodan
abnormality
nenormalnost, neprirodnost
abortion
pobačaj, abortus
abrupt
nagao, žestok, iznenađen
abruptio placentae
abrupcija (odvajanje) posteljice
abscess
apsces
absorb
apsorbirati
absorption
apsorpcija
accelerate
ubrzati, povećati brzinu
acceleration
ubrzanje
accessory
dodatan, dopunski, pomoćni
accommodation
akomodacija, prilagodba oka za gledanje na daljinu
accumulate
nakupiti, skupiti
accumulation
nakupljanje, skupljanje
acetabulum, pl. acetabula
acetabulum, čašica zdjelične kosti
acetylcholine
acetikolin
achlorhydria
aklorhidija (nestvaranje želučane kiseline)
294
acid
kiselina
acidic
kiseo
acidity
kiselost, aciditet
acidosis
acidoza
acinus, pl. acini
acinus, bobica; plućna jedinica
acne vulgaris
acne vulgaris
acoustic neuroma
neurom (tumor) slušnog živca
acquired
stečen
acromegaly
akromegalija
acromion
akromion lopatice
act
djelovati, funkcionirati; čin djelo
action
djelovanje, rad, utjecaj
acuity
oštrina (vida), zaoštrenost
acute
akutan
adenomatous goitre/goiter
adenomska gušavost (struma)
Adam’s apple
Adamova jabučica
Addison disease
Addisonova bolest
aduction
primicanje
adenocarcinoma
adenokarcinom (zloćudni žljezdani tumor)
adenohypophysis
adenohipofiza
adenoids
polipi (u nosu), adenoidi
adenopathy
adenopatija (bolest žlijezda)
adhere
prijanjati, držati se (čega)
adhesion
prianjanje, adhezija
adipose tissue
masno (adipozno) tkivo
adjacent
susjedan, obližnji
administration of drugs.
davanje lijekova
adnexa
privjesci maternice, adneksa (jajovodi i jajnici)
adolescence
mladost, adolescencija
adolescent
mladić, djevojka, adolescent
adrenal gland
nadbubrežna žlijezda
295
adrenalectomy
adrenalektomija (kirurško uklanjanje nadbubrežne žlijezde)
adrenaline
adrenalin
adrenocorticotropic hormone (acth)
adrenokortikotropni hormon, kortikotropin
adult
albuminurija
adulthood
odrasla životna dob
advancing age
poodmakla životna dob
adverse
suprotan, oprecan; štetan
affect
utjecati, štetno djelovati, zahvatiti
afferent
dovodan, aferentan
afterbirth
babinje, puerperij
agent
uzrocnik, lijek; agens
agglutination (clumping)
aglutinacija; nakupljanje
agglutinin (antibody)
aglutinin; protutijelo
agglutinogen
aglutinogen; tvar koja potiče stvaranje protutijela
aging
starenje
aid
pomoći, omogućiti, olakšati
aids – acquired imunodeficiency syndrome
sindrom stečene imunodeficijencije
ailment
bolest, tegoba
albinism
albinizam
albino
albino
albuminuria
albuminurija
alcohol abuse
prekomjerno uživanje alkohola
alcoholism
alkoholizam
aldosterone
aldosteron
alimentary
probavni
alkaline
lužina, baza, lužnat
allergen
alergen
allergic
alergičan
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allergologist
alergolog
allergology
alergologija
allergy
alergija
allopurinol
alopurinol; sredstvo za snižavnje razine mokraćne kiseline(kod gihta i sl.)
alopecia
ćelavost
alpha cell
alfa stanica
alter
promijeniti, izmijeniti
alteration
promjena, izmjena
alveolus, pl. alveoli
plućni mjehurić; zubna šupljina
Alzheimer disease / presenile dementia
Alzheimerova bolest; predsenilna demencija
am(o)eba, pl. am(o)ebae, am(o)ebas
ameba
am(o)ebic
amebni
amenorrh(o)ea
amenoreja, izostanak mjesečnice
ametropia
ametropija, poremećaj u lomu svjetlosnih zraka
amino acid
aminokiselina
ammonia
amonijak
amniocentesis
amniocenteza, perkutana punkcija uterus radi uzimanja plodne vode
amnion, pl. amnia, amnions
vodenjak, plodni mjehur
amount
količina, iznos
amyotrophic
amiotrofni, koji se odnosi na atrofiju mišićnog tkiva
an(a)esthesia
anestezija
anabolism
anabolizam, gradbeni, ili pretvorbeni, metabolički proces
anal
čmarni, analni
anal canal
čmarni kanal
anal fistula
čmarna fistula
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analgesic
analgetik, sredstvo protiv boli
anastomosis
anastomoza, premosnica
anatomy
anatomija
anchor, n.
sidro, kotva, držac
anchor, vb.
usidriti se
aneurysm/aneurism
aneurizma, proširenje (arterije)
aneurysmectomy
aneurizmektomija; kirurško uklanjanje aneurizme
angina pectoris
angina pectoris; bol u prsištu
angiorrhexis
angioreksija; prsnuće krvne žile
angle
kut (geometrijski)
angulation
nagib
ankle
nožni zglob, gležanj
ankylosing spondylitis
ankilozni spondilitis; ukočenost kralješnice
anomaly
anomalija, nenormalnost
anorexia
anoreksija, manjak apetita
anosmia
anosmija, odsustvo osjeta mirisa (njuha)
antagonistic
suprotan, antagonistički
anterior
prednji
anthracosis
antrakoza (bolest crnih pluća)
anti-inflammatory
protuupalan
antibiotic
antibiotic, protubakterijski lijek
antibody
protutijelo
anticoagulant
antikoagulant, sredstvo protiv zgrušavanja krvi
antidiuretic hormone
antidiuretski harmon
antigen
antigen, bilo koja tvar koja potiče obrambenu reakciju
antitoxin
protuotrov
antrum of the stomach
baza želuca
anus
čmar, anus
anvil
nakovanj; lat. incus
298
anxiety
tjeskoba, anksioznost
aorta, pl. aortae.
aorta
aortic
aortni
aortic valve
aortni zalistak
apex, pl. apices
vrh, apeks
aphasia
afazija, nemogućnost govora ili razumijevanja govora
aphonia
afonija, gubitak glasa
aplastic an(a)emia
aplasticna anemija
apn(o)ea
apneja, zastoj disanja
aponeurosis
aponeuroza, široka plosnata tetiva
apoplexy (stroke)
moždani udar, apopleksija, kap
appendectomy
apendektomija, uklanjanje crvuljka
appendicitis
upala crvuljka, apendicitis
appendix, pl. appendices
crvuljak
application
primjena
aqueous humo(u)r
očna vodica
arachnoid
paučinasta ovojnica, arahnoidea
arch
luk
area
područje, regija
areola, pl. areolae, areolas
areola (dojke)
arise
nastati, proistjecati, potjecati
armpit
pazuh, aksila
arrhythmia
aritmija, poremećaj ritma (srčanog)
arteriole
Arteriola, mala arterija
arteriosclerosis
arterioskleroza
artery
arterija
arthritis
artritis, upala zglobova
arthrodesis
artrodeza, fiksiranje nestabilnog zgloba
arthrotomy
artrotomija, punkcija zglobne tekućine
articular
zglobni
articulation
zglob
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artifical
umjetan
asbestosis
azbestoza, nakupljanje azbestne prašine u plućima
ascending
uzlazan
ascites
ascites, nakupljanje tekućine u trbušnoj šupljini
assimilation
asimilacija, upijanje
associated
povezan, pripadajući, pridružen
asthenia
astenija, tjelesna slabost
asthma
astma
astigmatism
astigmatizam
astrocyte
astrocit, jedan tip neuroglijalnih stanica
astrocytoma
Astrocitom, primarni moždani tumor koji se sastoji od astrocita
B bacillary
bacilni
bacillus, pl. bacilli
bacil
backbone
kralješnica, hrptenica
backflow
vraćanje, refluks (krvi, mokraće, itd.)
bacterium, bl. bacteria
bakterija
bacteriuria
bakteriurija; bakterije u mokraći
balance
ravnoteža
ball and socket joint
kuglasti zglob
balloon, vb.
napuhati
band
mišićna tetiva, trak, vrpca, zavoj za rane
barium swallow/meal
barijeva kasa
bark
kora, npr. drveta; pseći lavež
barking cough
kašalj poput psećeg laveža
barrier
zapreka, prepreka
Bartholin glands
Bartholinove velike žlijezde predvorja rodnice
basal cell carcinoma
bazaliom, rak bazalnih stanica
300
basin
zdjelica, pelvis
basophil
bazofil, zrnati (granularni) leukocit
basophilia
bazofilija, znatan porast broja bazofila u krvi
bat-shaped
nalik krilima šišmiša
bath
kupka, kupelj
bean-shaped
graholik, nalik zrnu graha
bed rest
mirovanje u postelji
belching
podrigavanje
Bell palsy/paralysis
Bellova kljenut (paraliza)
belly out
izbočiti se, napuhati se
bend
svijati (se), flektirati, pognuti
bending
svijanje, fleksija
bending of light rays
lom (refrakcija) svjetlosnih zraka
benign
dobroćudan, benigni
bent adj.
svijen, flektiran
bent n.
skolioza, lateralna svijenost (kralješnice)
benzene
benzol, bezbojna hlapljiva tekućina
beta blocker
beta blokator, regulator srčanog ritma
beta cell
beta stanica Langerhansovih otočića u gušterači (izlučuje inzulin)
biceps brachii
dvoglavi mišić nadlaktice
bicuspid valve
bikuspidni (mitralni) zalistak
bile
žuč
bilirubin
žučni pigment
bile pigment
bilirubin
bind
vezivati, spajati
biopsy
biopsija
birth canal
porođajni kanal, rodnica
birthmark
znamenka od rođenja, hemangiom
bite
ubod (kukca); ugriz (npr. psa)
bizarre
čudan, neobičan
blackhead
sujedica, komedon
301
bladder
mjehur
bladder outlet
otvor mokraćnog mjehura
blastocyst
blastocista, rani stadij (postmorularni) razvitka oplođene stanice u sisavaca
blastoma, pl. blastomata
blastom, tumor koji je građen od zametnih stanica
bleed
krvariti
bleeding, haemorrhage
krvarenje
blepharoptosis
blefaroptoza, spuštene vjeđe
blind spot
slijepa pjega
blindness
sljepoća
blink reflex
refleks treptanja (vjeđom)
blister
plik, mjehurić, žulj
bloating
napuhnutost (želuca)
blockage
zastoj, zaustavljanje, blokada
blood
krv
blood clot
krvni ugrušak
blood clotting
zgrušavanje krvi, koagulacija
blood count
krvna slika
blood group/type
krvna grupa
blood plasma
krvna plazma
blood pressure
krvni tlak
blood serum
krvni serum
blood sugar
šećer (glukoza) u krvi
blood transfusion
transfuzija krvi
blood vessel
krvna žila
blood volume
volumen krvi
bloodletting
puštanje krvi
bloodstream
optok krvi
blotchy
mrljast
bolus
bolus, homogeni zalogaj stvoren žvakanjem hrane
bond
prianjati, vezati se
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bone
kost
bone cell
koštana stanica, osteocit
bone head
glava kosti
bone process
koštani nastavak
bone projection
izbočenje na kostima
bony tissue
koštano tkivo
borborygmus, pl. borborygmi
kruljenje (crijeva)
border
rub, granica
bowel
crijevo
braces
proteza
bradycardia
bradikardija,usporen rad srca
bradypn(o)ea
bradipneja, usporeno disanje
brain
mozak
brain stem
moždano deblo
branch
ogranak, grana
branch, vb.
granati se, razgranati se, proširiti se
break off
osloboditi se, odvojiti se
break, n
lom (kostiju); ranica
break, vb
slomiti, prelomiti, razbiti, raskinuti
breakdown
razgradnja, propadanje
breast
dojka
breast plate
prsna kost
sternum, breastbone
prsna kost
breath
dah
breath odo(u)r
zadah
breathing
disanje, respiracija
breech birth
porođaj (novorođenčeta) na zadak
bridge of the nose
hrbat nosa
bright light
jaka svjetlost
Bright disease
Brightova bolest
bring about
prouzročiti
303
bronchiectasis
bronhiektazija, proširenost bronha
bronchiole
bronhiola
bronchodilator
bronhodilatator, sredstvo za širenje bronha
bronhopneumonija
upala bronha i pluća
bronchostomy
bronhostomija
bronchus,bl.bronchi
dušnica,bronh
bruise
modrica, krvni podljev
bruising
nagnječenje, oštećenje
bucca, pl.buccae
obraz
buccal
obrazni, bukalni, koji se odnosi na usnu šupljinu
bulbourethral bulla, pl. bullae bump
bulbouretralan mjehurić, bula oteklina (od udarca), kvrga, čvoruga, ispupčenje
bundle of His
Hisov snop
bunion
izraslina na palcu ili stopalu
bunionectomy
bunionektomija
burden
teret, opterećenje
Burkitt lymphoma
Burkittov limfom
burn, n.
opeklina
burn, vb.
sagorijevati, peći, žariti
burning
pečenje, žarenje, žgaravica
bursa, pl. bursae
bursa, vrećica ili mjehurić ispunjen želatinoznom tekućinom
bursitis
bursitis, upala burse
burst forth
izbiti, izaći, probiti
bursting
rasprsnuce, probijanje
buttocks
stražnjica
bypass
premosnica (npr. začepljene arterije)
byssinosis
bisinoza, bolest dišnih organa izazvana prašinom od vune i pamuka
304
C c(a)ecum, pl. c(a)eca
slijepo crijevo
c(a)esarean section
carski rez
cachexia
kaheksija, opća slabost i atrofija
calcaneus, pl. calcanei
petna kost
calcification
ovapnjenje, kalcifikacija
calcify
ovapniti, kalcificirati
calcitonin
kalcitonin, tirokalcitonin; hormon štitnjače
calcium
kalcij
calculus, pl. calculi
kamenac
calyx/calix, pl. calyces/ calices
vrč, čašica (bubrežna)
canal
kanal
canal of Schlemm canaliculus, pl. canaliculi
schlemmov kanal kanalić
cancellous
spužvast, spongiozan, porozan
cancer
rak, karcinom
cancerous
kancerozan
canthus, pl. canthi
ugao
capillary
kapilara
capsule
čahura
carbon
ugljik
carbon dioxide
ugljični dioksid
carbonic
ugljikov
carcinoma
rak, karcinom
carcinoma in situ
lokaliziran rak (karcinom)
cardiac
srčani
cardiac valve
srčani zalistak
cardiocairograph
kardiokairograf, tehnika rendgenskog snimanja srca u svakoj fazi otkucaja
cardiologist
kardiolog
cardiology
kardiologija 305
cardioversion
kardioverzija, vraćanje srčanog ritma u normalu
caries
karijes, kvarenje
carpal
karpalan, koji se odnosi na zapešće
carpopedal spasm
karpopedalni spazam (zahvaća zapešće i stopalo)
carrier of the trait
nositelj znakova ili svojstava
cartilage
hrskavica
cartilage ring
hrskavični prsten
cartilaginous
hrskavičan
cast
gipsani zavoj
catabolism
katabolizam, razgradbeni metabolički proces
cataract
mrena, katarakta
catecholamine
katekolamin (dopamin, noradrenalin, adrenalin); simpatomimetici
cathartic
katartik, sredstvo za pražnjenje crijeva
catheter
kateter
caudal
kaudalan, repni
cavity
šupljina
cell
stanica
cell body
stanično tijelo
cell membrane
stanična opna (membrana)
cell-mediated immunity
stanična imunost
cellular
stanični
cellulitis
celulitis
cementum
zubni cement
cephalic
cefaličan, kranijalan, koji se odnosi na glavu
cerebellum, pl. cerebella, cerebellums
mali mozak
cerebral
moždan, cerebralan
cerebral contusion
nagnječenje (kontuzija) mozga
306
cerebral palsy
cerebralna kljenut (paraliza)
cerebrospinal fluid
moždanokralješnička (cerebrospinalna) tekućina, likvor
cerebrovascular accident
moždani udar, cerebrovaskularni inzult, apopleksija
cerebrum,pl. cerebra
veliki mozak
cerumen
ušna mast
cervical
vratni
cervix, pl. cervices
grlo (npr. maternice), vrat
cessation
prestanak, prekid
chain
lanac
chalazion, pl. chalazia
kalazion, ječmenac
chalicosis
kalikoza, kamena prašina u plućima
chamber
komora, klijetka
chancre
čir, čankir
channel
kanal
cheek
obraz
chemonucleolysis
kemonukleoliza, vraćanje iskliznutog međukralješničnog diska u normalan položaj
chemotherapy
kemoterapija
chest
prsni koš, toraks
chew
žvakati
chewing, mastication
žvakanje, mastikacija
childbirth, partus, parturition, delivery
porođaj,rađanje, partus
chill
zimica, tresavica
chloasma
kloazma, smeđe pigmentne pjege po licu (u trudnoći i kaheksiji)
chloramphenicol
kloramfenikol
chloremia
kloremija, kloroza
307
cholecystectomy
kolecistektomija, odstranjenje žučnog mjehura
choledocholithotomy
koledokolitotomija, incizija glavnog žučovoda (radi odstranjenja žučnog kamenca)
cholelithiasis
kolelitijaza, stvaranje kamenca u žučnom mjehuru
cholesteatoma
kolesteatom, cistična tvorba ilia benigni tumor koji se razvija iz keratiniziranih epidermalnih stanica
cholesterol
kolesterol
cholinesterase
kolinesteraza, enzim prisutan u jetri, krvnom serumu i gušterači
chorea
korea, diskinezija, nekontrolirani pokreti
choriocarcinoma
koriokarcinom, zloćudna tvorba koja nastaje iz placentalnog epitela
chorion
korion, vanjska ovojnica (omotač) zametka
choroid
žilnica (oka)
chromosome
kromozom
chronic
kroničan
chyme
kaša (probavljene hrane u želucu), kimus
cicatrix, pl. cicatrices
ožiljak, brazgotina
ciliary muscle
cilijarni mišić
cilium, pl. cilia
trepetljika, bič, cilija, trepavica
circle
kružnica, krug, ciklus
circuit
krug (npr. strujni)
circular
kružan
circulate
kolati, cirkulirati
circulation
optjecaj (krvi), cirkulacija
circumcision
obrezivanje
circumscribed
zaokružen
cirrhosis
ciroza, bolest jetre
claustrophobia
klaustrofobija, strah od zatvorenog prostora
308
clavicle
ključna kost, klavikula
clavicular
ključni, klavikularni
cleanse
pročistiti, očistiti
cleansing
pročišćavanje, čisćenje
cleft palate
rascijepljeno nepce
climacteric
klimakterij,menopauza
clitoris
dražica
closure
zatvaranje
clot, n.
ugrušak krvi
clot, vb.
zgrušavati se, koagulirati
clotting
zgrušavanje, koagulacija
clubfoot
zgrčeno stopalo (prirođena deformacija), talipes
clumping
aglutinacija, nakupljanje
cluster
nakupina, grozd
coagulate
zgrušavati se, koagulirati
coagulation
zgrušavanje, koagulacija
coat
ovojnica, omotač
coccus, pl. cocci
kok
coccygeal
trtični
coccyx, pl. coccyges
trtična kost, trtica
cochlea
pužnica
coitus
odnošaj
colchicine
kolhicin, biljni preparat za liječenje gihta
colitis
kolitis, upala debelog crijeva
collagen
Kolagen, izvanstanični protein – glavni sastojak vezivnog tkiva
collapse
kolaps, urušavanje, opći pad
collar bone
ključna kost, klavikula
collect
skupljati, sabirati
collecting tubule
sabirni kanalić (tubul)
collection
skupljanje, nakupljanje
309
colon
debelo crijevo, kolon
colonic polyposis
polipoza kolona
colpoplasty
kolpoplastika, plastična operacija rodnice
coma
koma, nepovratni gubitak svijesti
comatose
komatozan
combat
boriti se, suzbijati
comedo, pl.comedones
sujedica, komedon
comminuated
kominutivan (lom kosti)
common bile duct
glavni žučovod
compact
čvrst, kompaktan
compensation
nadoknada, kompenzacija
complement
potpuni broj (količina), potpunost
composition
sastav, sastavljanje, uređenje
compound
spoj (kemijski)
compound fracture
složen (kompliciran) lom
compress, n.
oblog, kompresa
compress, vb.
stisnuti, komprimirati
compression
pritisak, kompresija
concave
udubljen, konkavan
conception
začeče, zanošenje
concussion of the brain
potres mozga
condition
stanje, bolest
conduct
provoditi, voditi
conduction
provođenje, vođenje
conductive
provodan
condyle
čvor, kondil
cone
stožac, čunj
congenital
prirodan, kongenitalan
congestive heart failure
srčana dekompenzacija
conization
konizacija
conjunctiva
spojnica oka
connection
veza, spoj
310
connective
vezivan
conscious
svjestan, pri svijesti
consciousness
svijest, svjesnost
constipation
zatvor (stolice), opstipacija
constitutent
(bitan) sastavni dio, element
constrict
stezati
constriction
stezanje, suženje, konstrikcija
contagious
zarazan, infektivan
contagiousness
zaraznost, infektivnost
contraceptive
kontracepcijsko sredstvo
contract
stegnuti se, kontrahirati; navući na se bolest, oboljeti
contraction
stezanje, kontrakcija
contusion
nagnječenje, kontuzija
conversely
obratno, protivno, suprotno
conversion
pretvorba
convert
pretvoriti
convex
izbočen, ispupčen, konveksan
convey
prenositi, odašiljati
conveyance
prijenos, odašiljanje
convolution
vijuga
convulsion
grčenje, grč, konvulzija
Cooley an(a)emia
Cooleyeva slabokrvnost
coordinate
uskladiti
coordination
usklađivanje
copulation
snošaj, kopulacija
cor pulmonale
plućno srce
core
jezgra
coredialysis
iridodijaliza
corium
usmina, korij, derma, koža
cornea
rožnica
coronary artery
vjenčasta (koronama) arterija
311
corpus callosum, pl. corpora callosa
žuljevito tijelo
corpus luteum, pl. corpora lutea
žuto tijelo
corpus, pl. corpora
tijelo, trup, korpus
corpuscle
tjelešce
cortex, pl. cortices
kora, korteks
cortical
čvrst kompaktan (kost)
corticosteroid
kortikosteroid, hormon kore nadbubrežne žlijezde (adrenalni korteks)
cortisol
kortizol, hidrokortizon
cortisone
kortizon
cough, n. (bf)
kašalj
cough, vb. (bf)
kašljati
coughing
kašljanje
covering
ovojnica, omotač
Cowper glands
bulbouretralne (Cowperove) žlijezde
crackling
pucketanje (kostiju)
cramp
grč
cramping
grčenje
cranial
lubanjski, kranijalni
cranium, pl. crania
lubanja
creatinine
kreatinin
crepitation
pucketanje, krepitacija (kostiju)
crest
greben, krista
cretinism
kretenizam, kronično stanje koje je posljedica prirođenog teškog hipotiroidizma
cripple
onesposobiti, osakatiti
crippling
invalidnost, onesposobljavanje
Crohn disease
Crohnova bolest, regionalni enteritis ili ileitis
cross-section
presjek
crossmatching
unakrsna reakcija
312
croup
krup, akutna djelomična opstrukcija gornjih dišnih putova
crushed
zgnječen, zdrobljen, smrvljen
crust
krasta
cryocauterization
kriokauterizacija
cryoextraction
krioekstrakcija
cryoprobe
kriosonda
cryptorchism/cryptorchidism kriptorhizam, nespušteni testisi crystalline
kristalan, poput kristala
cul-de-sac
bilo koji oblik slijepog crijeva (cecum) ili vrećice; tobolac
curative
ljekovit, kurativan, izlječiv
cure
liječenje, ozdravljenje, lijek
curettage
kiretaža, struganje
current
struja
curvature
zakrivljenost
curve
krivulja, zavoj
Cushing syndrome
Cushingov sindrom
cushion, n.
jastučić
cushion, vb.
štititi, zaštititi, ublažiti (udarac)
cuspid
očnjak
cutaneous
kožni, kutani
cuticle
pokožica, eponihij
cyanoderma
cijanoderma
cyanopia
cijanopija
cycle
ciklus, krug, razdoblje
cyclic
kružan, ciklican
cyst
cista, mjehur
cystadenocarcinoma
cistadenokarcinom
cystadenoma
cistadenom
313
cystic
cističan
cystic duct
cistički vod
cystoscopy
cistoskopija, endoskopski pregled mjehura
cytologist
citolog
cytoplasm
citoplazma
cytotoxin
citotoksin
D damage, n.
oštećenje, šteta
damage, vb.
oštetiti, naškoditi
damaged
oštećen
deaf
gluh
deafness
gluhoća
debris
otpad, otpadni proizvod
decay
raspadanje, truljenje
decelerate
usporiti
decline
opadanje, propadanje, pad
decompose
razgraditi, raspasti se
decomposition
razgradnja, propadanje
decrease, n.
smanjenje, sniženje, opadanje
decrease, vb.
smanjiti, sniziti, opasti
decubitus
dekubitus, rane od ležanja
def(a)ecation
pražnjenje stolice, defekacija
defibrillation
defibrilacija
defibrillator
defibrilator
deficiency
pomanjkanje, manjak
deficient
manjkav
deflection
otklon, pomak
deformation
izobličenje, deformacija
deformity
nakaznost, izobličenost
degenerated
degeneriran
degeneration
degeneracija
314
degenerative
degenerativan
deglutition
gutanje, degluticija
degrade
umanjiti, opasti, sniziti se, razgraditi
deliberate
hotimičan, namjeran
delirium
delirij
demineralization
demineralizacija
demyelination
demijelinizacija
dendrite
dendrit
dense
gust, čvrst
density
gustoća, čvrstoća
dentin
dentin
denture
umjetno zubalo
deoxyribonucleic acid
deoksiribonukleinska kiselina (dnk)
depletion
iscrpljenje, ispražnjenje
depolarization
depolarizacija, neutralizacija polariteta
deposit
pohraniti, odložiti, uskladištiti
depositing
pohranjivanje, odlaganje, uskladištenje
depository
spremište, skladište
depress
usporiti, smanjiti
depression
udubljenje, uleknuće
dermatitis
dermatitis, upala kože
dermis
usmina, derma, korij, koža
descending
silazan
destruction
uništenje, razaranje
detach
odvojiti se, odijeliti se, otkinuti
detachment
odvajanje, otkidanje
detect
otkriti
detection
otkrivanje, detekcija
deteriorate
pogoršati se, pokvariti se
deteriorated
pogoršan
deterioration
pogoršanje
development
razvoj
315
device
naprava, sprava, uređaj, sredstvo
devour
progutati, proždrijeti
diabetes insipidus
diabetes insipidus
diabetes mellitus
sećerna bolest
diabetic nephropathy
dijabetička nefropatija
diabetic neuropathy
dijabetička neuropatija
diabetic retinopathy
dijabetička retinopatija
diagnosis, pl. diagnoses
dijagnoza
diagnostic
dijagnostički
diagnostics
dijagnostika
dialysis, pl. dialyses
dijaliza
diameter
promjer, dijametar
diaphoresis
dijaforeza, pojačano znojenje
diaphragm
ošit, pregrada, dijafragma
diaphysis, pl. diaphyses
srednji dio, tijelo, duge kosti, dijafiza
diarrh(o)ea
proljev
diastole
dijastola, opuštanje srčanog mišića
diencephalon
međumozak
diet
prehrana, dijeta
digestion
probava, probavljanje
digestive
probavan, digestivan
digitalis
digitalis, sredstvo za jačanje srčanog mišića
dilated
proširen, dilatiran
dilation
širenje, dilatacija
dim light
prigušeno svjetlo
diminished
smanjen, snižen
diphtheria
difterija
disc/disk
kolut, disk
discharge
iscjedak; otpust bolesnika
discolo
promjena boje
discomfort
nelagoda, tegoba
discontinue
prekinuti, prestati
316
disease
bolest
disintegrate
razgraditi se, raspasti se
disintegration
razgradnja, raspadanje
dislocation
iščašenje, dislokacija
dislodged
izbačen, istisnut, istjeran
disorder
poremećaj
dispose
ukloniti, odložiti, odbaciti
disproportion
nerazmjer, nesklad
disrupt
prekinuti
dissection
seciranje, sekcija
dissolution
rastvaranje, otapanje, otopina
distal
distalan, udaljen
distensible
rastezljiv
distention
širenje, rastezanje, napuhanost
distortion
uganuće, distorzija
distress
tegoba, klonulost, bol
disturbance
poremećaj, smetnja
diuretic
sredstvo za izmokrivanje, diuretik
diverticulectomy
divertikulektomija, kirurško uklanjanje divertikula
diverticulitis
divertikulitis, upala divertikula
diverticulum, pl. diverticula
divertikul
division
dioba, podjela, dio
dizziness
vrtoglavica
dizzy
koji osjeća vrtoglavicu
donour
davatelj (krvi, organa)
dormant
pritajen, latentan
dorsal
leđni, dorzalan
dorsiflexion
dorzifleksija
dosage
doziranje, dozaža
dose, n.
doza (lijeka)
dose, vb.
dozirati, davati u dozama
317
Down syndrome
Downov sindrom, trisomija 21
drag
vući, povlačiti, potezati
dragging
povlačenje, potezanje
drain
odvoditi, istjecati, prazniti se, drenirati
draining
odvodenje, praznjenje, dreniranje
drop
kap, kaplja
droplet
kapljica
dropsy
otok, edem; ascites
drug
lijek, droga (narkotik, opijat)
drug abuser/drug addict
ovisnik o narkoticima/lijekovima (narkoman)
drug-induced
prouzročen (izazvan) lijekovima
Duchenne disease
Duchenneova bolest
duct
vod
duodenal
duodenalni
duodenum, pl. duodena
dvanaesnik
dura mater
tvrda (moždana) ovojnica
dwarf
patuljak
dwarfism
patuljast stas, nanosomija
dye
boja (sredstvo za bojenje)
dysentery
dizenterija
dysgerminoma
disgerminom, maligna neoplazma jajnika
dysmenorrhea
dismenoreja, bolna mjesečnica
dyspareunia
dispareunija, bol pri snošaju
dysphagia
disfagija, otezano gutanje
dysphasia
disfazija, poremećaj govora
dysplasia
displazija, nenormalan razvoj (u veličini, obliku i organizaciji tjelesnih stanica)
dyspn(o)ea
zaduha, dispneja, otežano disanje
dysrhythmia
disritmija
dystocia
distocija, otežan porođaj
dystrophy
distrofija
dysuria
dizurija, bolno ili otežano mokrenje
318
E ear
uho
ear canal
zvukovod
earache
uhobolja
eardrum, tympanum
bubnjić
ecchymosis, pl. ecchymoses ehimoza, krvni podljev u koži eclampsia
eklampsija
ectopic pregnancy
ektopijska (izvanmaterična) trudnoća
eczema
ekcem
edema
oteklina, edem
efferent
odvodan, eferentan
effusion of blood
izljev krvi
egg, ovum
jajašce, ovum
ejaculation
ejakulacija
ejaculatory duct
ejakulatorni vod
ejection
izbacivanje
electric pacemaker
električni stimulator srčanog ritma
electrical charge
električni naboj
electrocardiogram
elektrokardiogram
electrocardiograph
elektrokardiograf
electrolyte
elektrolit, element s električnim nabojem
elephantiasis
elefantijaza (tropska parazitarna bolest)
elevated
povećan, povišen, podignut
elevation
povećanje, povišenje, podizanje
elimination
otklanjanje, odstranjivanje, izbacivanje
embedded
usađen, uložen, ugrađen
embolism
embolija
embolus, pl. emboli
embolus
embryo
zametak, embrij
emerge
izlaziti, izranjati
emergency
hitan slučaj
empyema, pl. empyemata
empijem, nakupina gnoja u tjelesnoj šupljini 319
emulsify
emulgirati, razgraditi
emulsion
emulzija
enamel
caklina
encapsulation
učahurenje, inkapsulacija
encase
omatati, obavijati
encephalitis
encefalitis, upala mozga
end product
krajnji (finalni) proizvod
endanger
ugroziti
endemic goitre/goiter
endemska guša(vost), struma
endocarditis
endokarditis, upala endokarda
endocardium
usrčnica, endokard, unutarnja srčana ovojnica
endocervicitis
endocervicitis, upala sluznice grlića maternice
endocrine
endokrini, s unutarnjim izlučivanjem
endometriosis
endometrioza
endometritis
endometritis
endometrium
endometrij, sluznica maternice
endoscope
endoskop, instrument za vizualni pregled unutrašnjosti bilo kojeg šupljeg organa
engorgement
začepljenje, opstrukcija
engulf
progutati
enlarged
povećan, proširen
enlargement
povećanje, proširenje
enterolysis
enteroliza, oslobađanje od crijevnih priraslica
entity
biće; suština
envelop
omatati, obavljati
environment
okoliš, sredina
enzyme
enzim
eosinophil
eozinofil
eosinophilia
eozinofilija
320
ependymoma, pl. ependymomata, ependymomas
ependimom
epidermis
pokožica, epiderma
epididymis
pasjemenik, epididimis
epiglottis
poklopac (grkljana)
epilepsy
padavica, epilepsija
epinephrine
adrenalin
epiphora
suzenje (očiju)
epiphyseal line/plate
epifizna crta (ploča)
epiphysis, pl. epiphyses
okrajina (kosti), epifiza
epispadia, pl. epispadias
epispadija, uretralni otvor na gornjoj strani penisa
epistaxis
krvarenje iz nosa, epistaksa
epithelium
epitel
eponychium
epitelna pokožica, eponihij
equalization
izjednačenje, izjednačavanje
equalize
izjednačiti
equilibrium, pl. equilibria
ravnoteža, ekvilibrij
erect
uspravan, ravan, uzdignut
erectile tissue
erektilno tkivo
erection
podizanje, ukručenje, erekcija
erode
nagrizati, izjedati, razarati, erodirati
erosion
nagrizanje, izjedanje, erozija (kože, sluznice)
error of refraction
pogreška refrakcije, ametropija
eructation
podrigivanje
erupt
izbiti, nicati, probiti
eruption
izbijanje, nicanje (zubi), provala, osipanje, osip
erythema
crvenilo kože, eritem
erythroblast
eritroblast, nukleizirana crvena krvna stanica
321
erythroblastosis
eritroblastoza, povećan broj nukleiziranih eritrocita
erythrocyte
crvena krvna stanica, eritrocit
erythropoietin
eritropoetin, hormon koji stimulira stvaranje krvnih stanica
escape, n.
istjecanje (tekućine)
escape, vb.
istjecati, izlaziti
esophageal varices
proširenost (varikozitet) vena jednjaka
esophagus/oesophagus, pl. esophagi; gullet
jednjak
essential hypertension
esencijalna hipertenzija (povišen krvni tlak)
estrogen/oestrogen
estrogen, ženski spolni hormon
ethmoid bone
rešetnica, etmoidna (sitasta) kost
etiology/aetiology
etiologija
eupnea
normalno disanje, eupneja
Eustachian tube
slušna (Eustahijeva) cijev
evacuate
isprazniti
evacuation
pražnjenje, ispražnjavanje
evidence
dokaz
Ewing sarcoma
Ewingov sarkom
exacerbation
pogoršanje (bolesti)
exanthem
egzantem
excess
višak, prekomjernost
exchange
izmjena, razmjena
excitation
razdraženost, uzbuđenje, podraživanje
excrete
izlučiti, izbaciti
excretion
izlučivanje, izbacivanje
excretory
koji izlučuje, ekskretoran
exert
obavljati, naprezati se
exertion
naprezanje, napor, obavljanje
exhalation
izdisaj, izdisanje
exhale
izdahnuti, izdisati
322
exit, n.
izlaz; smrt
exit, vb.
izaći
exocrine
egzokrini, s vanjskim izlučivanjem
exophthalmic goitre/goiter
tirotoksikoza, guša, struma
exophthalmos
buljookost, egzoftalmus
exostosis
koštana izraslina, egzostoza
expandable
rastezljiv
expectorant
sredstvo za iskašljavanje
expectoration
iskašljavanje
expel
izbaciti, istjerati
expiration
izdisaj, izdisanje
expire
izdahnuti, izdisati, umrijeti, ugasiti se
exposure
izlaganje, otkrivanje
expulsion of placenta
istiskivanje (ekspulzija) posteljice
extension
rastezanje, sirenje, ispružanje; nastavak
external
vanjski
extract
izvući, izvaditi, ekstrahirati, izlučiti
extraction
vađenje (zubi), izlučivanje, ekstrakcija
extradural
izvan tvrde moždane ovojnice (dure mater)
extremity
ud, ekstremitet; kraj, vrh
exudate
izljev, eksudat
eye
oko
eye orbit/socket
očna šupljina
eyeball
očna jabučica
eyebrow
obrva
eyelash
trepavica
eyelid
očna vjeđa, kapak
eyesight
vid
F f(a)eces
stolica, fekalije
f(o)etus
čedo, fetus
323
facilitate
olakšati, omogućiti
facilitation
olakšavanje, olakšanje
failure
zatajenje, poremećaj, izostanak, propust, neuspjeh
faint
onesvijestiti se, klonuti
fainting
nesvjestica
fallacious
varljiv, lažan, koji obmanjuje
fallopian tube
fallopijeva cijev, jajovod
farsightedness
dalekovidnost
fascia
vezivna ovojnica, fascija
fat
mast, masnoća, lipid
fat cell, lipocyte
masna stanica, lipocit
fatal
smrtonosan, letalan
fatigue
umor, klonulost
fatty
mastan
fatty acid
masna kiselina
febrile
koji ima groznicu, febrilan
female, adj.
ženski
female, n.
žena
femur
bedrena kost
fertile
plodan, fertilan
fertilization
oplodnja
fertilize
oploditi
fever
groznica, vrućica
fibre/fiber
vlakno, nit
fibril
vlakance
fibrillation
treperenje, fibrilacija
fibrin
fibrin, netopiv protein - osnovica za stvaranje krvnog ugruška
fibrinogen
fibrinogen, faktor zgrušavanja
fibroadenoma
fibroadenom
fibroblast
fibroblast, stanica vezivnog tkiva
324
fibroid
fibroid, koji ima strukturu vezivnog trkiva
fibrosarcoma
fibrosarkom, zloćudni tumor sastavljen od stanica vezivnog tkiva
fibrosis
fibroza, stvaranje vezivnog tkiva
fibrous
vlaknast, fibrozan
fibula, pl. fibulae
lisna kost
filtrate
filtrat
fimbria, pl. fimbriae
trepetljika, resa
firing of nerve impulses
okidanje živčanih impulsa
fissure
pukotina, rascjep, fisura
fist-sized
veličine pesnice
flagellum, pl.flagella, flagellums
bić:, rep (spermatozoida)
flank
slabina
flatus
crijevni vjetar, plin
flavour
okus, vrsta okusa, miris, začin
flax
lan
flexibility
savitljivost, elastičnost, fleksibilnost
flexion
svijanje, pregibanje, fleksija
flexure
pregib, fleksura
floor of the mouth
dno usne šupljine
flow of air
struja zraka
flushing
rumenilo, crvenjenje (lica), crvenilo
flutter
treperenje, vibriranje; undulacija (pretklijetke ili klijetke)
focal
žarišni
focus, pl. foci, focuses
žarište
focus, vb.
skupiti u žarištu, fokusirati
fold
nabor
folic acid
folna kiselina
follicle
mjehurić, folikul
follow-up
praćenje (bolesnika)
325
fontanelle
fontanela
foot, pl. feet
stopalo; stopa (30,48 cm)
foramen, pl. foramina
otvor
force
sila
forehead
čelo
foreskin
prepucij, kožna navlaka penisa
fossa, pl. fossae
jama
fracture
lom, prijelom (kosti)
fragile
lomljiv, krhak
fragility
lomljivost, krhost
framework
okosnica, okvir
fraternal twins
dvojajni blizanci
freckle
pjega, mrlja (na koži)
friction
trenje
fringe
resica, fimbrija
front
čelo; prednja strana
frontal
čeoni, frontalan, prednji
frontal bone
čeona kost
frostbite
ozeblina
fulguration
paljenje (električnom strujom), fulguracija
fullness
ispunjenost, punoća, sitost
fundus
dno, pod
fundus of the stomach
svod želuca
fungal
gljivični
fungus, pl. fungi, funguses
gljivica, gljiva
funnel
ljevak
funnel-shaped
ljevkast
furrow
brazda
fused
srašten (kost)
fusion
srastanje (cijeljenje) kostiju, spajanje, fuzija
326
G gait
hod, način hoda
gall
žuč
gallbladder
žučni mjehur
gallstones
žučni kamenci
gamete
gameta, zametna stanica
gangrene
gangrena
gas
plin
gaseous
plinovit
gasp
dahtanje, soptanje, dahtaj, soptaj
gastric juice
želučani sok
gastritis
gastritis, upala želučane sluznice
gastroscope
gastroskop
gastroscopy
gastroskopija, endoskopski pregled želuca
gelatinous
želatinozan
gene
gen
genesis
geneza
genetic
genetski, genetički
genetics
genetika
genital
genitalni, spolni; spolni organ
genitalia
spolni organi, genitalije
germ cell
zametna stanica, gameta
German measles
crvenka, rubeola
gestation
trudnoća, gestacija
gigantism
divovski stas, makrosomija
gingiva
desni, zubno meso
girdle
obruč, pojas
gland
žlijezda
glandular
žljezdast
glaucoma
zelena mrena, glaukom
glia
glija, potporno živčano tkivo
glial tissue
glijalno tkivo 327
glioblastoma multiforme
multiformni glioblastom
glioma, pl. gliomata, gliomas gliom, tumor sastavljen od glijalnih stanica globin
globin, proteinski sastojak hemoglobina
globulin
globulin, svaki tip iz skupine porteina netopivih u vodi
glomerulonephritis
glomerulonefritis, nefritis s upalom kapilarnih petlji bubrežnih glomerula
glomerulus, pl. glomeruli
glomerul, skupina kapilarnih krvnih žila (npr. bubrežni glomerul)
glucagon
glukagon, hormon alfa stanica Langerhansovih otočića
glucocorticoid
glukokortikoid, steroidni hormon
glucose
glukoza, krvni šećer
glue
ljepilo
gluelike
ljepljiv, poput ljepila
glycogen
glikogen, ugljikohidratna rezerva pohranjena u jetri
glycogenesis
glikogeneza, stvaranje glikogena
glycosuria
glikozurija, šećer u mokraći
goitre/goiter
guša, gušavost, struma
gonad
spolna žlijezda, gonada
gonadotropic hormone
gonadotropni hormon
gonadotropin
Gonadotropin, hormon koji stimulira rad spolnih žlijezda
gonococcus, pl. gonococci
gonokok
gonorrh(o)ea
kapavac, triper, gonoreja
gout
ulozi, podagra, giht
graafian follicle
graafov (ovarijalni) folikul
grading
stupnjevanje, gradiranje
graft
kalem, presadak, transplantat
grafting
presađivanje, transplantacija
grain
zrno
grand mal seizure
toničko-klonički epileptički napadaj
328
granule
zrnce, granula
granulocyte
granulocit, stanica koja sadrži zrnca (npr. granularni leukocit)
granulocytosis
granulocitoza, nenormalno velik broj granulocita u krvi
Graves disease
Gravesova bolest, bazedov, tirotoksikoza
gravity
sila teža, gravitacija
gray matter
siva tvar
greenstick fracture
lom mlade (rahitične) kosti
grind
mrviti, mljeti, smrviti
groin
prepona
groove
brazda, žlijeb
gross appearance
opći izgled (npr. tumora)
grow
rasti, razvijati se
growth
rast
growth hormone
hormon rasta, somatotropin
growth rate
brzina rasta
guaiac
smola trospkog stabla – reagens za testiranje krvi u stolici
guanethidine sulphate/ sulfate
gvanetidinski sulfat – lijek protiv visokog krvnog tlaka
guard
štititi, čuvati
gullet
jednjak
gums
desni, zubno meso
gyn(a)ecologist
ginekolog
gyn(a)ecology
ginekologija
gynandroblastoma
ginandroblastom
gyrus, pl. gyri
vijuga (kore velikog mozga)
H h(a)emangioma
hemangiom, benigna tvorba mreže krvnih žila
h(a)emarthrosis
hemartroza, krvarenje u zglobu
329
h(a)ematocrit
hematokrit
h(a)ematopoiesis
hematopoeza, tvorba krvnih stanica
h(a)ematosalpinx
hematosalpinks, krv u jajovodu
h(a)ematuria
hematurija, krv u mokraći
h(a)emianopia/h(a ) emianopsia
hemianopsija, ispad polovice vidnog polja
h(a)emodialysis
hemodijaliza
h(a)emoglobin
hemoglobin
h(a)emolysis
hemoliza, razgradnja crvenih krvnih stanica
h(a )emolytic an(a)emia
hemolitička anemija
h(a)emophilia
hemofilija, bolest zgrušavanja krvi
h(a)emoptysis
hemoptiza, iskašljavanje krvi
h(a)emorrhoidectomy
odstranjenje hemoroida (šuljeva), hemoroidektomija
h(a)emorrhoids
šuljevi, hemoroidi
h(a)emothorax
hemotoraks, krv u pleuralnoj šupljini
hair
kosa, vlas, dlaka
hair shaft
vlas (vidljivi dio vlasi)
hairs of Corti
Cortijeve dlačice
hammer
čekić, malleus
hard palate
tvrdo nepce
hardening
otvrdnuće, skleroza
haversian canals
haversovi kanali
hazard
opasnost, pogibelj, rizik
hazardous
opasan, pogibeljan, riskantan
headache
glavobolja
heal
zacijeliti, izliječiti
healing
cijeljenje, zacjeljenje
hearing
sluh
heart
srce
heart action
rad srca
heart block
srčani blok, atrioventrikularni blok
330
heart failure
zastoj (arest) srca
heart murmur
srčani šum
heart rate
brzina otkucaja srca
heart valve
srčani zalistak
heartburn
žgaravica
heel
peta
heel bone
petna kost, calcaneus
helping
porcija obroka
hemisphere
polutka (mozga)
hemp
konoplja
heparin
heparin, sredstvo protiv zgrušavanja krvi
hepatitis
hepatitis, upala jetre
hepatocyte
hepatocit, jetrena stanica
hepatomegaly
hepatomegalija, povećanje jetre
hereditary
nasljedan, hereditaran
heredity
nasljednost, nasljeđe
hernia, pl. herniae hernias
kila, hernija
herpes
herpes, (virus)
herpes zoster
herpes zoster
hiatal hernia
hijatalna kila (hernija)
hiatus
otvor (nepravilnog oblika)
hidrosis
hidroza, prekomjerno znojenje
hilar cell tumour
hilusni tumor
hilum/hilus
vratnica; udubljenje u dijelu organa gdje ulaze krvne žile i živci
hinge
šarka, šarnir
hinge joint
kutni (valjkasti) zglob
hip
kuk
hip bone
zdjelična kost
hirsutism
hirzutizam, povećana dlakavost (npr. u žena)
histamine
histamin, produkt histidina (esencijalna amino kiselina)
331
histogenesis
histogeneza, nastank ili razvitak tkiva
histological makeup
histološki sastav (građa)
histology
histologija
hives
koprivnjača, urtikarija
Hodgkin disease
Hodgkinova bolest
hollow
šupalj
homeostasis
homeostaza, stabilnost tjelesnih funkcija
hordeolum, stye
ječmenac, stafilokokna infekcija vjeđe
hormone
hormon
horn
rog, roževina
horny cells
rožnate stanice
humerus
nadlaktična kost
humo(u)r
tekućina, vodica
humoral immunity
humoralna imunost
humpback
grbavost, kifoza
hunchback
grbavost, kifoza
Huntington chorea
Huntingtonova koreja
hyaline
hijalin, prozirna, staklasta opna
hydroc(o)ele
hidrokela, vodena kila
hydrocephalus
vodena glava, zastoj cerebrospinalne tekućine u moždanim komorama
hydrochloric acid
solna (klorovodična) kiselina
hydrocortisone
hidrokortizon
hydrogen
vodik
hydronephrosis
hidronefroza, širanje bubrežnihn čašica i zdjelice zbog zadržavanja mokraće uslijed opstrukcije u mokraćovodu
hydrophobia
hidrofobija, strah od vode
hydrothorax
hidrotoraks, nakupljanje sukrvice u pleuralnoj šupljini
hymen
djevičnjak, himen
hyper(a)esthesia
hiperestezija, preosjetljivost na podražaj
332
hypercalc(a )emia
hiperkalcemija, povišena razina kalcija u krvi
hyperexcitability
prekomjerna razdražljivost (podražljivost)
hyperfunction
prekomjerna (povećana) funkcija, hiperfunkcija
hyperglyc(a)emia
hiperglikemija, povećan sadržaj šećera u krvi
hyperinsulinism
hiperinzulinizam
hypernephroma
hipernefrom, karcinom bubržnih stanica
hyperopia;hypermetropia
dalekovidnost, hipermetropija
hyperosmia
prekomjerna osjetljivost na mirise
hyperparathyroidism
hiperparatiroidizam
hyperpituitarism
hiperpituitarizam, prekomjerno izlučivanje hiofiznih hormona
hyperplasia
hiperplazija, povećanje broja tkivnih stanica ili organa
hypersecretion
prekomjerno izlučivanje, hipersekrecija
hypertension
hipertenzija, povećan arterijski krvni tlak
hyperthyroidism
hipertiroidizam, prekomjerno izlučivanje hormona štitnjače
hypertrophy
hipertrofija, nenormalno povećanje ili rast tkiva odnosno organa
hyperuric(a)emia
hiperurikemija, prekomjerno povećanje mokraćne kiseline u krvi
hypoalbumin(a)emia
hipoalbuminemija
hypochromic an(a)emia
hipokromna anemija
hypofunction
smanjena funkcija, hipofunkcija
hypoglyc(a)emia
hipoglikemija, smanjen sadržaj šećera u krvi
hypoinsulinism
hipoinzulinizam
hypoparathyroidism
hipoparatiroidizam
hypophyseal stalk
ljevkasti držak, infundibulum (hipofize)
hypophysis
hipofiza, moždani privjesak
hypopituitarism
hipopituitarizam 333
hyposecretion
smanjeno izlučivanje, hiposekrecija
hypospadia
hipospadija, urođena anomalija mokraćne cijevi – mokraćni otvor na donjoj površini penisa
hypotension
hipotenzija, smanjen arterijski krvni tlak
hypothalamus
hipotalamus
hypothyroidism
hipotiroidizam
hypox(a)emia
hipoksemija, smanjena oksigenacija krvi
hysterectomy
histerektomija, kirurško uklanjanje maternice
I iatrogenic
jatrogeni, koji je posljedica (nuspojava) liječenja
icterus
žutica, ikterus
identical twins
jednojajni (identični) blizanci
idiopathic
spontan, primaran, etiološki nepoznat, idiopatski
ileoc(a)ecal
Ileocekalan, koji se odnosi na tanko i prvi dio debelog crijeva (cekuma)
ileum, pl. ilea
tanko (vito) crijevo, ileum
ileus
zapletaj crijeva, ileus
iliac
koji se odnosi na bočnu kost, ilijakalni
iliac crest
ilijačna krijesta (crista iliaca)
ilium, pl. ilia
bočna kost, greben bočne kosti
ill
bolestan; loš; pokvaren
illegitimate
nezakonit
illicit
nedopušten
illness
bolest
illuminate
osvijetliti; razjasniti
image imaging technique
predodžba, slika, lik tehnika snimanja
imbalance
neravnoteža
334
imitation
oponašanje
immature
nezreo; preuranjen
immediate
neposredan, izravan
immense
beskrajan, neizmjeran
imminent
prijeteći, neizbježan
immobile
nepokretan, ukočen
immobilize
učiniti nepokretnim, imobilizirati
immovable
nepomičan, nepokretan
immune
otporan, zaštićen, imun
immune response
reakcija protutijela na antigen
immunity
otpornost na bolest, imunost
immunodeficiency
manjak imunosti, imunodeficijencija
immunodiffusion
imunodifuzija
immunoglobulin
imunoglobulin
immunologist
imunolog
immunology
imunologija
impacted fracture
ukliješten lom kosti
impair
oštetiti; pogoršati; naškoditi
impairment
oštećenje; slabljenje; pogoršanje
impalpable
neopipljiv, sitan
impermeable
nepropustan
impetigo
impetigo, zarazna gnojna bakterijska infecija kože
implant
usađen dio; usaditi
implantation
usađivanje, implantacija
impulse
podražaj, impuls, poticaj
in situ
na svom mjestu; in situ
inability
nesposobnost, nemoćnost
inacidity
manjak kiseline, osobito želučane (hcl)
inaction
nepokretnost, mirovanje
inactivate
učiniti nedjelotvornim, inaktivirati
inactivation
inaktivacija
335
inanimate
neživ
incapacitated
onesposobljen
incarcerated
ukliješten, inkarceriran
inch
inč, palac (2,54 cm)
incidence
pojavnost, rasprostranjenost
incision
rez, rezanje, incizija
incisor
sjekutić, inciziv
inclination
sklonost; nagnutost
incompatibility
nespojivost, nepristajanje
incompatible
nespojiv; koji ne pristaje
inconclusive
neuvjerljiv, bez dokazane snage
incontinence
nesposobnost zadržavanja mokraće ili stolice, inkontinencija
incudal incus, pl. incudes
koji se odnosi na nakovanj, inkudalni nakovanj
indeks finger
kažiprst
indeks, pl. indices
kazalo, pokazatelj
indicate
pokazati, oznaćiti, navesti
indication
znak; simptom; ukazivanje
indict
optužiti
individual
pojedinac; pojedinačni
induce
izazvati; potaknuti
induction
uvod; navodenje; indukcija
inevitably
neizbježno
infancy
novorođenačka dob
infant
malo dijete; dojenče
infarct
kljenut, infarkt; nekrotizirano tkivo
infarction
proces nastajanja infarkta; infarkt
infect
zaraziti, inficirati
infection
zaraza, infekcija
infectious
zarazan (npr. bolest)
infective
zarazan (npr. mikroorganizam)
336
inferior
niži, donji, inferioran
infertility
neplodnost
infestation
napad, napadnutost (gamad i sl.), zagađenost
infiltrating
infiltrirajući; prodirući
infiltration
prodiranje; infiltracija
inflame
upaliti
inflammmable
upaljiv, zapaljiv
inflammation
upala, upalni proces
inflammatory
upalni
inflation
napuhavanje
inflexible
neelastičan
influence
utjecaj
influenza
gripa, influenza
inframammary
ispod dojke
infusion
ulijevanje; infuzija
ingest
uzimati (gutati) hranu
ingestion
uzimanje hrane (na usta ili umjetno)
ingrained
ukorijenjen
ingredient
sastojak
inguinal
preponski, ingvinalni
inhalation
udisanje, inhalacija
inhale
udisati, inhalirati
inherit
naslijediti
inheritance
baština, nasljeđe
inhibit
spriječiti, zaustaviti
inhibition
sprječavanje, kočenje
initial
početni, inicijalni
injection
uštrcavanje, injekcija
injurious
štetan, poguban
injury
ozljeda, trauma
innate
urođen, prirođen
337
innocent
nedužan, nevin; dobroćudan
innominate bone
zdjelična kost, bezimena kost
inoculation
cijepljenje, inokulacija
inorganic
anorganski, beživotan
insect
kukac
insecticide
insekticid
insemination
osjemenjivanje
insertion
hvatište (mišića); umetak
insidious
podmukao, koji vreba
insipid
bez okusa, bljutav
insolation
izlaganje suncu; sunčanje
insoluble
netopiv
insomnia
nesanica
inspection
nadziranje; razgledanje
inspiration
udisanje; nadahnuće
inspire
udahnuti; nadahnuti
instant
trenutak, čas
instantaneous
trenutan; istovremen
instinct
nagon; instinkt
instrument
sredstvo; instrument
insufficiency
manjkavost, slabost, nepravilan rad organa, nedostatnost
insulate
odvojiti, izolirati
insulation
odvajanje, izoliranje
insulator
izolator, loš vodič
insulin
inzulin
insusceptibility
neosjetljivost
intake
unos, uzimanje, konzumacija (npr. hrane)
integument
opna, koža, prirodni ovoj, pokrov
integumentary
ovojni, pokrovni
intensive care
intenzivna njega
inter-
među, između
338
interact
međusobno djelovati
interaction
međusobno djelovanje, interakcija
interbrain
međumozak, diencefalon
intercellular
međustanični
intercostal
međurebreni
intercourse
snošaj
interdigital
između prstiju
interferon
interferon
interior
unutrašnjost
intermediate
koji se nalazi između; srednji; prijelazni
internal
unutrašnji, interni
internal medicine
interna medicina
interpretation
tumačenje, objašnjenje
interseptal
međupregradni, interseptalni
interstitial fluid
intersticijska tekućina
interstitial nephritis
nespecifična upala bubrega, pijelonefritis
interstitium
međustanično vezivno tkivo
intestinal
crijevni, utrobni
intestine
crijevo
intima
unutarnja ovojnica krvne žile
intoxication
trovanje, intoksikacija
intra-
unutar, unutra
intracellular
unutarstanični
intracranial
unutar lubanje, intrakranijalni
intracutaneous
unutar kože, intrakutani
intraocular pressure
tlak u očima
intrauterine
unutar maternice, intrauterini
intravenous
unutar vene, intravenski
intrinsic factor
unutarnji, esencijalni čimbenik, intrinzični faktor
introduce
uvesti, uvoditi
intussusception
invaginacija, intususcepcija
339
invade
napadati; zahvaćati (bolest)
invasive
nasilan, koji napada, invazivan
involuntary
nehotičan, koji nije pod kontrolom volje
involvement
uključenost, zahvaćenost
iodine
jod
ion
ion, čestica s električnim nabojem
iridectomy
izrezivanje dijela šarenice, iridektomija
iridodialysis
odvajanje baze šarenice od hvatišta, iridodijaliza
iris, pl. irides
šarenica
iron
željezo
irradiation
obasjavanje, ozračivanje
irrational
neracionalan
irritant
koji izaziva upalu, koji draži, nadražuje
irritate
iritirati, nadraživati
irritation
nadraženost; upala
isch(a)emia
nedostatna opskrbljenost krvlju, ishemija
isch(a)emic
bez krvi, ishemičan
ischiatic, ischial·
koji se odnosi na kuk
ischium, pl. ischia
kost kuka, sjedna kost
isolate
izolirati, odvojiti
isolation
izolacija; karantena
isomer
izomer
isomerism
odnos između dva izomera
isoniazid
tuberkulostatski lijek, izonijazid
isotope
izotop
issue
izlaženje, emitiranje; predmet (npr. rasprave)
isthmic
koji se odnosi na prevlaku, suženje
isthmus
prevlaka, suženje, tjesnac
itch mite
grinja svraba, svrabac
340
itch n., vb.
svrbež (npr. od svraba); svrbjeti
itching
svrbjeti, svrbež, pruritus
J jaundice
žutica, ikterus
jaw
čeljust
jawbone
donja čeljust, mandibula
jejunum
tašto crijevo, jejunum
jelly
žele, gel, želatina
jerk
trzaj; trzanje
joint capsule
zglobna čahura
joint n., adj.
zglob; združen, udružen
judge
ocjena; mišljenje; sud
jugular
vratni, jugularni
juice
sok
junction
spoj; šav; veza
juncture line
šavni spoj; spojna crta
juvenile
mlad, mladenački, malodoban
K kapok
tropsko stablo iz porodice bambusa
Kaposi sarcoma
Kaposijev sarkom, idiopatski hemoragični sarkom
karyoplasm
karioplazma, nukleoplazma
karyotype
kariotip
keloid
keloid, fibrozna hiperplazija, zadebljano ožiljno tkivo
keratin
keratin, rožnato tkivo
keratinized
keratiniziran
keratitis
upala rožnice
keratosis
keratoza
341
kernicterus
kernikterus, hiperbilirubinemija, žutica moždanih jezgri
ketoacidosis
ketoacidoza, nakupljanje velikog broja ketonskih tijela
ketosis
ketoza, prevelika količina ketona u tijelu
kick
udarac; snaga; pokušaj
kidney
bubreg
killer cells
stanice ubojice
kin
srodan, blizak
kinesi(o)therapy
kineziterapija
kinesiology
kineziologija
kinetic
koji se odnosi na pokret, kinetički
knee
koljeno
knee cap
iver, patela
knock
otkucaj (npr. srca); udarac
knot
čvor; vezanje čvora; uzao
knuckle
zglob prsta, članak
kophemia
gluhoća, kofemija
kyphosis, pl. kyphoses
grbavost, kifoza
L labium majus, pl. labia majora
velika usna
labium minus, pl. labia minora
mala usna
labo(u)r
trudovi (porođajni)
labo(u)r pains
porođajne boli
labyrinth
labirint (npr. uha)
lacrimal
suzni
lactation
dojenje, laktacija
lactiferous duct
mliječni vod
laden
opterećen, pun
lamina, pl. -ae
tanka ploča ili sloj
342
laminectomy
laminektomija
langerhans, the islands of, the islets of
langerhansovi otoci, otočići
laparoscope
laparoskop, enoskopski instrument za prelged unutrašnosti trbušne šupljine
laryngitis
upala grkljana (grla) laringitis
laryngopharynx
grkljan i ždrijelo
laryngoscopy
pregled unutarnjeg dijela grkljana, laringoskopija
larynx, pl. larynges
larinks, grkljan
lateral
bočni, lateralni
laxative
sredstvo za pospješivanje stolice, laksativ
layer
sloj
lead
olovo
leak out
istjecati, propuštati, curiti
leaky
koji curi, propušta, istjeće
leg
noga
leiomyoma
leiomiom, vrsta benignog tumora
lens
leća
lesion
ozljeda, oštećenje, lezija
lethal
smrtan, smrtonosan
leuk(a)emia
leukemija
leuk(c)ocyte
bijela krvna stanica, leukocit
leuk(c)ocytic
leukocitni
leuk(c)ocytosis
leukocitoza, broj leukocita iznad normalne granice
leuk(c)openia
broj leukocita ispod normalne granice, leukopenija
leuk(c)oplakia
leukoplakija
leuk(c)orhea
leukoreja
leuk(c)otaxis
svojstvo leukocita da se nakupljaju na mjesta ozljede ili upale
libidinal
koji se odnosi na libido
343
libido
libido, spolna želja
lid
poklopac, zatvarač
life-threatening
opasan po život, ugrožavajući
ligament
veza, spona, ligament
ligation
vezanje, podvezivanje
light rays
svjetlosne zrake
limb
ud, ekstremitet
lime stone
kamen vapnenac
line
obavijati, obložiti, presvući
linger
oklijevati, zaostajati
lingual tonsil
jezični krajnik
lining
ovojnica, prevlaka
lipid
mast, lipid
lipocyte
masna stanica, lipocit
lipoid
lipoidan
lipoma, pl. -s, -ata
lipom
liposarcoma
liposarkom
lithoid
poput kamena
lithotomy
kirurško odstranjenje kamenca, litotomija
live
živ
liver
jetra
load of life
teret (teskoće) života
lobby
potajno se zalagati
lobe
režanj, resa
lobotomy
uklanjanje moždanog tkiva, lobotomija
lobster
jastog
locomotion
pokretnost, micanje, kretanje
loin
slabine, kriza
loop of henle
henleova petlja
loose
slobodan, pušten, oslobođen, labav
loosening
oslobađanje; omekšavanje, olabavljenje
lordosis
lordoza
344
louse, pl. lice
uš
lubricate
mazati, podmazivati
lubricating fluid
tekućina za podmazivanje
lues
lues, sifilis
lumbar
slabinski, lumbalni
lumen, pl. lumina
šupljina, lumen
lump
kvržica, gruda, izbočina, lokalno oticanje ili tumor
lumpectomy
uklanjanje kvržice
lung
pluća
lung cancer
rak pluća
lunula, pl. -ae
mali mjesec, lunula (nokta)
lupus
niz kroničnih degenerativnih kožnih lezija
luteinizing hormone, lh
luteinizirajući harmon, lh
lymph
limfa
lymph(o)edema
začepljenje limfne žile, limfedem
lymphadenitis
limfadenitis, upala limfnog čvora
lymphatic, adj., n.
limfni, limfatički; limfna žila
lymphocyte
limfocit
lymphocytosis
limfocitoza, povećan broj limfocita
lymphoid cancer
limfni ili limfoidni karcinom
lymphokine
limfokin
lymphoma
limfom, maligni tumor limfnog tkiva
lymphotoxin
limfotoksin
lyse
razgradivati, otapati, osloboditi (npr. od priraslica)
lysin
lizin
lysis, pl. -es
razgradnja; otapanje stanice, liza
lytic
koji se odnosi na lizu, lizni
M macrocytic an(a)emia
makrocitna anemija
345
macrophage
makrofag, velika fagocitna stanica
macrotia
abnormalno veliko vanjsko uho, makrotija
macula lutea
žuta pjega
macule
mrlja, pjega, makula
major
veći; punoljetan; glavni
maladaptation
loša, slaba prilagodba
malaise
slabost, mlitavost
maldevelopment
nedostatan iii nepravilan rast iii razvoj
male, adj., n.
muško, muškarac
malformation
nakaznost, malformacija
malfunction
nepravilan rad
malignant
zloćudni, maligni
malleolus, pl. malleoli
gležanj; dio kosti koji ima oblik glave čekića
malleus, pl. mallei
čekić (srednjeg uha)
mamma, pl -ae
dojka
mammary gland
mliječna zlijezda
mammectomy
amputacija dojke, mamektomija
mammillary
koji se odnosi na bradavicu dojke
mammography
radiografsko snimanje dojke, mamografija
mammoth
mamut
mandible
donja čeljust
margin
rub, kraj, margina
marrow
koštana srž, moždina
masculine
muški
mass
mnoštvo, masa
massive
sveobuhvatni, veliki, masivni
mast cell
mastocit
mastectomy
amputacija dojke, mastektomija
mastication
žvakanje
mastitis
upala dojke, mastitis
mastoid process
mastoidni nastavak
mastoiditis
upala mastoidnog procesa
346
matter
tvar, materija
mattress
strunjača, madrac
maturation
dozrijevanje, sazrijevanje
maturity
zrelost
maxilla, pl. -ae
gornja čeljust
maxillary
maksilaran
measles
ospice, morbilli
meatus
otvor, prolaz, hodnik
meconium
mekonij, stolica novorođenčeta (zelenkaste boje)
medial
srednji, medijalni
median
srednja crta (tijela, šake, stopala)
mediastinum, pl. mediastina sredoprsje medical
liječnički, medicinski, medikameotozni
medication
lijek; liječenje
medicine
liječništvo, medicina; lijek; čarolija
medium, pl. media
sredstvo; oruđe; medij, hranilište
medulla oblongata, pl. -ai
produžena moždina
medulla, pl. -ae
moždina, srž
medullary
medularan
medulloblastoma
meduloblastom, zloćudni tumor malog mozga
melanin
melanin
melanocyte
melanocit
melanoderma
melanoderma
melanoma
melanom
melatonin hormone
harmon melatonin
melena
crna stolica, melena
membrane
opna, membrana
membraneous
opneni, membranski
memory cells
stanice memorije (u imunosnim reakcijama)
menarche
prva menstruacija, menarha
347
Meniere syndrome
Menierov sindrom (bolest slušnog aparata)
meningeal sarcoma
meningealni sarkom
meninges, sg. meninx
opne, ovojnice (moždane)
meningioma
lokalni tumor szs-a, meningiom
meningitis
upala opni, meningitis
meningoc(o)ele
meningokela, hernija opni kroz koštano oštećenje
meningococcus
meningokok (neisseria meningitidis)
meningomyeloc(o)ele
meningomijelokela, hernija opni i kralješnične moždine
menopause
meonopauza, klimakterij
menorrh(o)ea
mjesečnica, menstruacija
menorrhagia
preobilna mjesečnica, menoragija
menstrual
menstruacijski, menstrualni
menstruation
mjesečnica, menstruacija
mental
umni, duševni
mesencephalon
srednji mozak
mesenchyme
mezenhim, embrijsko vezivno tkivo
mesentery
trbušna opna, mezenterij
mesoderm
mezoderma, srednji zametni listić
metabolism
mijena tvari, metabolizam
metabolite
metabolit
metacarpal
koji se odnosi na kosti zapešća, metakarpalni
metastasis, pl. -ses
metastaza – prijenos bolesti s jednog organa na drugi (osobito svojstvo zloćudnih stanica)
metastasize
metastazirati
metastatic
metastatski
metatarsal
koji se odnosi na kosti donožja, metatarzalni
metronidazol
metronidazol (vrsta antibiotika za liječenje infekcija anaerobnim mikroorganizmima)
metroptosis
prolaps maternice, metroptoza
metrorrhagia
krvarenje iz maternice, metroragija
348
microbe
mikrob, mikroskopski mali (osobito patogeni) orgnaizam
microbiology
mikrobiologija
microglia
mikroglija, fagocitne stanice glijalnog tkiva živčanog sustava
microorganism
mikroorganizam
microscope
mikroskop
microstaging method
metoda određivanja mikrostadija
microtia
neprirodno mala vanjska uska, mikrotija
micturition
mokrenje
midbrain
srednji mozak, mezencefalon
middle ear
srednje uho
midline
središnja crta (tijela)
midstagittal plane
središnja (medijalna) sagitalna ravnina tijela
midwife
primalja, babica
mildness
blagost
milk teeth
mliječni zubi
mind
um, svijest
mineral
ruda, mineral
mineralocorticoid
steroidni harmon kore nadbubrežne žlijezde
minor, adj., n.
manji, niži, donji; malodobnik, maloljetnik
minute
malen, sićušan
miscarriage
pobačaj (spontani)
mite
grinja; svrabac
mitochondrion, pl. -a
mitohondrij
mitral
mitralan, dvokuspidni (npr. zalistak)
mo(u)ld
kalup, odljev; plijesan
mo(u)ld spore
spora (gljivice) plijesni
modifier
modifikator, izmjenjivač
moist
vlažan, mokar
molar
kutnjak (zub)
mole
madež; zakržljali zametak; krtica
349
molecule
molekula
mongolism (obsolete)
Downov sindrom, trisomija 21
monitoring
praćenje
monocyte
monocit
mononucleosis, infective
mononukleoza, infektivna (uzročnik – Epstein-Barr virus)
monoxide
monoksid; popularni naziv za ugljični monoksid
mood
raspoloženje
moral, n., adj.
moral; moralan, ćudoredan
morbid
izopaćen, bolestan, morbidan
morbidity
pobol, morbiditet
morbilli
ospice, morbilli
mortality
smrtnost
morula
morula, kupinasta nakupina blastomera u početnoj diobi zigote
motile
gibljiv, pokretan
motility
gibljivost, pokretnost
motivation
motivacija
motivational
motivacijski
motor
motorički, koji pokreće
mounting
koji povećava, raste
mouth
usta
mucolytic
mukolitik, koji razgrađuje sluz (u dišnim organima)
mucorrh(o)ea
mukoreja, prekomjerno stvaranje sluzi
mucosa
sluznica
mucous, adj.
sluzav, mukozan
mucus, n.
sluz
multicentric
koji ima mnoga središta, multicentričan
multifaceted
koji ima mnogo ravnih površina (npr. neki žućni kamenci)
multiform
raznolik, s mnogo oblika, polimorfan
350
multiple sclerosis
multipla skleroza
multiple, adj., n.
višestruk; višekratnik
multipotent
koji ima višestruku moć, djelovanje, učinak
mumps
zaušnjaci
murine
mišji
murmur
šum (srčani)
muscle
mišić
muscular
mišićni, mišićav
musculoskeletal
mišićnokoštani
mushroom
gljiva
myalgia
bol u mišiću, mialgija
myasthenia gravis
mijastenija gravis
myasthenic
koji boluje od mišićne slabosti, mijasteničan
mycosis myelin
bolest izazvana gljivičnom infekcijom mijelin
myelocytic leukemia
granulocitna leukemija
myeloma, multiple
mnogostruki mijelom, zloćudni plazmacitom
myocardial
koji se odnosi na srčani mišić
myocarditis
upala srčanog mišića, miokarditis
myocardium
srčani mišić, miokard
myomectomy
kirurško odstranjenje mioma, miomektomija
myometrium
mišićni sloj maternice, miometrij
myoneural
koji pripada mišiću i živcu (odnosi se na živčane završetke u mišićnom tkivu)
myoneural junction
mioneuralni spoj
myopia
kratkovidnost, miopija
myringotomy
rez na bubnjiću, miringotomija
myx(o)edema
hipofunkcija štitne žlijezde, miksedem
N nail
nokat
narcotic
opojno sredstvo, narkotik
351
narcotism
narkotiično stanje, odavanje narkoticima
naris, pl. nares narrowing
nosnica suženje, konstrikcija
nasal
nosni
nasopharynx
nosni dio ždrijela
natural defense mechanism prirodni obrambeni mehanizam nausea
mučnina
navel, col. belly button
pupak
nearsightedness
kratkovidnost, miopija
neck
vrat, šija, grlić (npr. maternice)
necrosis, pl. -ses
odumiranje tkiva, nekroza
necrotic
koji odumire, nekrotičan
need
potreba
negligible
beznačajan, nevažan, zanemariv
neonatal
novorođenački, neonatalan
neonate
novorođenče
neonatology
neonatologija (izutavanje stanja djece do 2 mjeseca starosti)
neoplasm
tumor, neoplazma
neoplastic
neoplastičan, tumorski
neostigmine
neostigmin, vrsta neuroprijenosnika
nephritis, pl. nephritides
upala bubrega, nefritis
nephrolithiasis
bubrežni kamenac, nefrolitijaza
nephrologist
nefrolog, specijalist za bubrežne bolesti
nephrology
nefrologija
nephron
nefron, osnovna funkcionalna i anatomska bubrežna jedinica
nephropathy
bubrežna bolest, nefropatija
nephrosclerosis
nefroskleroza
nephrosis
degenerativna bolest bubrega, nefroza
nephrotic syndrome
nefrotički (nefropatski) sindrom
nephrotomy
nefrotomija
352
nerve
živac
nervous
živčani, koji se odnosi na živce, nervozan
nest, n., vb.
gnijezdo; ugnijezditi se
neural
neuralan, koji se odnosi na živce
neuralgija
neuralgija, jaka bol u području inervacije nekog živca
neurilemma, neurolemma
neurolema, Schwannova ovojnica
neurilemmoma
neurilemom, tumor Schwannove ovojnice
neuritis neuroblastoma
upala živca neuroblastom
neurocytoma
neurocitom
neuroectoderm
neuroektoderma
neuroglia
neuroglija, vezivno žičano tkivo
neurohypophysis
neurohipofiza
neurologist
neurolog
neurology
neurologija
neuroma
neurom, tumor građen od živčanih stanica i živčanih vlakana (neurogangliom)
neuron
živčana stanica, neuron
neurosis
neuroza
neurosurgeon
neurokirurg
neurotoxin
živčani otrov, neurotoksin
neurotransmitter
neuroprijenosnik
neurotripsy
drobljenje živaca, neurotripsija
neutrophil
neutrofil
nevus, pl. nevi
madež, znamenka, nevus
nickel
nikal (kem. el. ni)
nicotine
nikotin
nipple
bradavica, mamilla
nit
jajašca ili larva (uši), gnjida
nitrogen
dušik
nitrogenous
dušični, koji sadrži dušik
353
nitroglycerine
nitroglicerin
node
čvor
nodular goitre/goiter
adenomska gušavost (struma)
nodule
čvorić
nonmalignant
koji nije zloćudan
nonsmoker
nepušač
nonsuppurative
koji se ne gnoji; kirurški čist
noradrenaline
noradrenalin
norepinephrine
nos
nourish
hraniti, prehranjivati, jacati, uzgajati
nourishment
hrana, prehrana, hranjivi sastojak
nuclear
koji se odnosi na jezgru
nucleoplasm
nukleoplazma, karioplazma
nucleus, pl. nuclei
jezgra
numbness
ukočenost, omamljenost, obamrlost, tupost
nurse
medicinska sestra
nursemaid
dadilja, njegovateljica
nursery
dječja soba; dječji vrtić
nursing
njega (bolesnika); dojenje
nutrient, n., adj.
hranjiva tvar, hrana; hranjiv
nutrition
prehrana; hranjenje
nyctalopia
noćno sljepilo
nystagmus
nistagmus, nehoticne titrajuće kretnje očiju u jednom smjeru i natrag
O oat cell carcinoma
oblik karcinoma (pluća) kojeg su stanice nalik zrnu zobi
oath
zakletva, prisega
obese
gojazan, debeo, pretio
obesity
gojaznost, debljina, pretilnost
objective, n., adj.
cilj, predmet; objektivan
354
oblique muscles
kosi mišići
obstetrician
porodničar, opstetričar
obstetrics
porodništvo, opstetricija
obtrusive
nametljiv
occipital
zatiljni, koji pripada zatiljku
occiput
zatiljak
occlusion
zatvorenost, začepljenost, okluzija
occur
javiti se, nastati, dogoditi se
ocular tendon
očna tetiva
odo(u)r
miris, zadah
offending agent
štetna tvar, sredstvo
oil glands
žlijezde lojnice
ointment
mast (za mazanje)
olecranon
vrh lakta
olfactory
koji se tiče osjetila mirisa, njušni, olfaktorni
oligodendroglia
Oligodendroglija, vrsta neuroglijalnih stanica
oligodendroglioma
oligodendrogliom
oligospermia
manjak spermija, oligospermija
oncogenic
koji se odnosi na stvaranje tumora, onkogeni
oncologist
onkolog, spicijalist za tumore
oncology
onkologija
onset
početak, izbijanje (simptoma)
onychia
upala ležišta nokta, onihija
oophoritis
upala jajnika
opacity
neprozirnost, zamućenje
opaque
neproziran, zamućen
operable
koji se može operirati, operabilan
operating theatre/room
operacijska dvorana (sala)
ophthalmologic
očni, oftalmološki
ophthalmologist
specijalist za očne bolesti, oftalmolog
ophthalmology
oftalmologija
355
ophthalmoscopy
oftalmoskopija
optic disc/disk
vidna ploča (disk)
optic nerve
vidni živac
option
slobodan izbor, pravo izbora
oral
usni, usmen, oralan
oral cavity
usna šupljina
orbit
očna šupljina, orbita
orchi(d)opexy
Orhidopeksija, kirurško fiksiranje nespuštenih testisa u skrotum
orchitis
upala sjemenika (testisa)
ordinary
redovit, pravilan; uobičajen
organ
organ
organic
organski
organism
organizam
orifice
otvor, ušće
origin
podrijetlo, ishodište
originate
uzrokovati, nastati, vući podrijetlo
oropharynx
usni dio ždrijela
orthop(a)edic orthop(a)edics
ortopedski ortopedija
orthopnea
ortopneja, otežano disanje osim u sjedećem ili stojećem položaju
orthoptic training orthosis, brace, splint
ortoptičke vježbe (očnog mišića) ortopedsko omagalo ili aparat
osmolarity
osmolarnost, propusnost (npr. opne)
osseous
koštan; košćat
ossicle
mala kost, košćica
ossification
okoštavanje, osifikacija
osteitis
upala kosti, osteitis
osteitis fibrosa cystica
fibrozna cistična upala kosti (von Recklinghausenova bolest)
osteoarthritis
osteoartritis, upala kosti i zglobova
356
osteoblast
osteoblast, početna (nezrela) koštana stanica
osteochondroma
osteokondrom, benigna koštano-hrskavične izraslina
osteoclasis
osteoklazija, kirurški prijelom kosti
osteoclast
osteoklast, koštani fagocit
osteolytic
koji se odnosi na degeneraciju kosti, osteolitičan
osteoma
osteom, benigni sporo rastući koštani tumor
osteomalacia
osteomalacija, rahitis odraslih
osteomyelitis
osteomijelitis, upala kosti i koštane srži
osteoporosis
osteoporoza, smanjenje koštane gustoće
osteosarcoma
osteosarkom, zloćudni primarni tumor kosti
otalgia, otodynia
uhobolja
otitis media
upala srednjeg uha
otoencephalitis
otoencefalitis
Otopyorrh(o)ea
gnojni iscjedak iz uha, otopioreja
otosclerosis
otoskleroza
outbreak
početak, nastup (bolesti)
oval window
ovalni otvor (prozor), fenestra vestibuli
ovarian
koji se odnosi na jajnike
ovary
jajnik
overcome
prevladati, nadjačati
overgrowth
prekomjeran rast
overpowering
pretežan, kojemu se ne može oduprijeti; tegoban
overwhelming
silan, nadmoćan, neodoljiv
oviduct
jajovod
ovulation
ovulacija, sazrijevanje jajašca
ovum, pl. -ova
jaje, jajašce
oxide
oksid
oxidization
oksidacija; izgaranje
oxidize
oksidirati 357
oxigenate
obogatiti (spojiti sa) kisikom, oksigenirati
oxygen
kisik
oxygenation
obogaćivanje (spajanje sa) kisikom, oksigenacija
oxytocin
oksitocin
oyster
oštriga (kamenica)
ozone
ozon
P p(a)ediatric
pedijatrijski
p(a)ediatrician
pedijatar
p(a)ediatrics
pedijatrija
pace
korak; hod; brzina hoda; tempo
pacemaker, SA node
predvodnik; električni stimulator srca; SA čvor
pad
jastučić (koji umanjuje trenje)
pain
bol
palate
nepce
palatine
nepčani
pale
blijed
paleness
bljedilo, bljedoća
palliative
palijativan, koji ublažuje, olakšava
pallor
bljedilo, bljedoća, blijedost
palm
dlan
palpation
pipanje, pregled pipanjem, palpacija
palpitation
pojačano, prekomjerno udaranje bila, treperenje, lupanje (srca)
palsy
kljenut, uzetost, paraliza
panacea
lijek protiv svih bolesti, panaceja
pancreas
gušteraća
pancreatitis
upala gušteraće, pankreatitis
papanicolau test, pap.test
citološki postupak (za otkrivanje raka grlića maternice; papa-test)
358
papilla, pl. -ae
sitna izraslina, bradavica
papillary dermis
papilarni dermis
papilloma, pl. -s, -ata
Papilom, benigni epitelni tumor
papule
čvorić (na koži)
paracentesis of the cornea
paracenteza (punkcija) rožnice
paralysis
kljenut, uzetost, paraliza
paranasal
paranazalni
paraplegia
kljenut (uzetost) donjih udova
parasite
nametnik, parazit
parasitic
nametnički
parasympathetic
parasimpatički
parathyroid gland
paratiroidna (nusštitna) žlijezda
parenchymal
parenhimni
parenchyme
funkcionalni elementi tkiva, parenhim
parietal
zidni, parijetalni
parietal bone
tjemena kost
parietal pleura
porebrica, parijetalna pleura
Parkinson disease
Parkinsonova bolest
paronychial
koji se odnosi na rub nokta
parotid
zaušna (parotidna) žlijezda
parotitis
upala zaušne žlijezde, mumps
paroxysm
nenadano pojačanje boli, nastup grča i sl., paroksizam
particle
čestica
particulate matter
tvar u obliku čestice
partition
dijeljenje, pregrada
parturition
porođaj, rađanje
partus
porođaj
partus agrippinus
porođaj djeteta zatkom
atch patella, knee cap
komadić; zakrpa; mrlja iver, patela
pathogen
sve ono što izaziva bolest, patogen
359
pathologic
bolestan, patološki
pathologist
patolog
patient
bolesnik
pattern
uzorak; model; način; obrazac
peak
vrh, gornja granica (npr. krivulje)
pectoral
prsni
peculiar
svojstven, osobit, osebujan
peer
ravan nekomu po časti, položaju, podrijetlu, i sl.
pellucid
proziran, bistar, kristalan
pelvis, pl. pelvises, pelves
zdjelica
pemphigus
čir, pemfigus
penicillin
penicilin
penis
muško udo, penis
peptic ulcer
peptički vrijed, ulkusna bolest
perceive
opažati, shvatiti, percipirati
perception
opažanje, percepcija
percussion
pregled kucanjem, perkusija, perkutiranje
percutaneous
koji se obavlja preko kože, perkutani
perianal
koji se nalazi ili nastaje u predjelu anusa, perianalni
pericarditis
upala osrčja, perikarditis
pericardium
osrčje, perikard
peril
opasnost, pogibelj
perimetrium
serozni sloj maternice, perimetrij
perimisium
vanjska mišićna ovojnica, perimizij
perinatal
perinatalni
perineal
koji pripada međici, perinealni
perineum, pl. -a
međica
periosteum, pl. -a
pokosnica
perish
nestati, išćeznuti, slabiti, propasti
peristalsis
peristaltika
360
peristaltic
peristaltički
peritoneum
potrbušnica
peritonitis
upala potrbušnice, peritonitis
peritubular
peritubularni
perk up
dizati nos, razmetati se; razveseliti se, živnuti
pernicious an(a)emia
perniciozna anemija; nepostojanje intrinzičnog faktora za resorpciju vitamina B12
perpetuation
neprekidno trajanje, produživanje
persistent
ustrajan, tvrdokoran
perspiration
znoj, znojenje
pertussis
hripavac
pessary
pesar; podupirajući prsten
petechia, pl. -ae
petehija
petit mal
napadaj gubitka svijesti, napadaj padavice
phagocyte
stanica žderač, fagocit
phagocytic
fagocitni
phagocytosis
fagocitoza
phalanx, pl. phalanges
članak (prsta)
pharyngeal tonsils
ždrijelni krajnici
pharynx, pl. pharynges
ždrijelo
phenol
fenol, otrovan bezbojni kristalinični spoj
phenomenon, pl. -a
pojava, fenomen
phenotype
fenotip
phenylketonuria
prisustvo fenilketona u mokraći
pheochromocytoma
tumor srži nadbubrežne žlijezde
phimosis
suženost udne navlake, fimoza
phlebitis
upala vene, flebitis
phlebotomy
otvaranje vene, flebotomija, venesekcija
phlegm
gusti sekret iz dišnih putova
phobia
bolesni strah, fobija
361
phonation
stvaranje glasa, fonacija
phosphorus
fosfor
physical
tjelesni, fizički; fizikalni
physician
liječnik
physiologic/al
fiziološki
physiology
fiziologija
pia mater
meka moždana ovojnica, mozgovnica
pigmentation
pigmentacija
pigmented
pigmentiran
piles
šuljevi, hemoroidi
pillow
jastuk; podloga, ležaj
pilonidal cyst
pilonidna cista
pimple
bubuljica
pineal gland
cerebralna epifiza
pinkeye
akutni zarazni konjunktivitis; upala očiju
pinna, pl. pinnea
ušna školjka, uška
pituitary cachexia
hipopituitarizam, pituitarna kaheksija
pituitary gland
žlijezda hipofiza
placenta
posteljica
placenta praevia
placenta previja
placental
koji se odnosi na posteljicu, placentaran
plant
biljka; postrojenje
plantar flexion
plantarna fleksija, fleksija tabana
plaque
ploča; naslaga
plasma
plazma (krvna)
platelet
krvna pločica, trombocit
pleasurable
koji pruža zadovoljstvo, ugodu
plegia
uzetost, kljenut, paraliza
pleomorphic
pleomorfan, koji se javlja u mnogo različitih oblika
pleura, pl. pleurae
plućna maramica, porebrica, pleura
pleural effusion
pleuralni izljev (eksudat)
362
pleurisy, pleuritis
upala porebrice
pneumoconiosis
pneumokonioza, taloženje raznih vrsta prašine u plućnom tkivu
pneumonia
upala pluća, pneumonija
pneumothorax
zrak u prsištu, pneumotoraks
podagra
ulozi, podagra (bol u nozi), giht
poison
otrov
polio
dječja paraliza, poliomijelitis
pollen
pelud, cvjetni prah
polycentric
policentričan, koji ima vise središta ili jezgara
polycythemia
povećan broj eritrocita, policitemija
polydipsia
prekomjerna žeđ
polyp
peteljkasta izraslina, polip
polyphagia
prekomjerna glad, polifagija
polyuria
prekomjerno mokrenje, poliurija
pons, pl. pontes
most
poppy
mak; opijum koji se dobiva iz maka
pore
pora
portal vein
vena vratarnica
positioning
namještanje
posterior
stražnji
posture
položaj, držanje (tijela)
potassium
kalij
potential
mogućnost, potencijal, latentna sila
pouch
vrećica
pound
funta, oko 1/2 kg
practice
obavljanje posla, praksa
predisposition
sklonost, predispozicija
preeminence
nadmoć, superiornost, isticanje
pregnancy
trudnoća
premature birth
prijevremeni porođaj
363
prepuce
udna navlaka, prepucij
presby(a)cusis
staračka nagluhost, smanjenje sluha, prezbiakuzija
presbyopia
staračka dalekovidnost, smanjenje vida, prezbiopija
prescribe
propisati
prescription
recept (liječnički); propis
primary health care
primarna zdravstvena zaštita
primipara
žena koja prvi puta rađa, prvorotkinja
probe, cryoprobe
štapić za širenje kanala, sonda; pipaljka; sonda koja se primjenjuje u liječenju ledom
probing
pretraživati sondom
process
nastavak, izdanak
productive cough
produktivni kašalj
profuse
obilan
progesterone
progesteron; glavni gestacijski hormon
prognosis
predviđanje, prognoza
progressive
koji napreduje, širi se, dalje se razvija (npr. bolest)
prolapse
spuštanje, pad (npr. organa)
proliferate
rasti, množiti se
proliferation
nagli rast, bujanje
prominence
isticanje, izbočina
pronation
ležanje ničice, potrbuške
prone
licem prema zemlji, potrbuške; sklon, naklonjen
propel
potiskivati, tjerati naprijed
propelling pressure
potisni (propulzivni) tlak
prophylactic
zaštitan, profilaktičan
propulsion
potisak, propulzija, pogon
prostate gland
predstojna žlijezda, prostata
prostatectomy
prostatektomija, kirurško uklanjanje prostate
364
prostatic hypertrophy
hipertrofija prostate
protect
zaštititi
protection
zaštita
protein
bjelančevina
proteinuria
bjelančevine u mokraći
prothrombin
protrombin, faktor zgrušavanja, faktor II
protoplasm
protoplazma
protrusion
izbočenje, stršenje
prowess
odvažnost, junaštvo, smjelost
proximal
bliži, proksimalan
pruritus
svrbež
psoriasis
psorijaza
psyche
duša, psiha
psychiatrist
psihijatar
psychiatry
psihijatrija
psychologist
psiholog
psychology
psihologija
psychosis
psihoza
ptosis
spuštanje, ptoza, prolaps
puberty
doraslost, pubertet
pubic
koji se odnosi na stidnu (preponsku) kost
pubis, pl. pubes
stidna (preponska) kost
puerperal
babinji, puerperalni
puerperium
babinje, puerperij
pulmonary
plućni
pulmonary emphysema
plućni emfizem
pulp
srž, pulpa (zuba)
pulse
bilo, puls
puncture
punkcija, ubod
pupil
zjenica
365
purification
pročišćavanje, čišćenje
purity
čistoća, jasnoća
purpura
purpura, sitna potkožna periferna krvarenja
purulent
gnojan
pus
gnoj
pustular
gnojan
pustule
gnojni mjehurić, pustula, prištić
putrefaction
truljenje, gnjiljenje
pyelonephritis
pijelonefritis
pyeloplasty
pijeloplastika, plastična operacija bubrežne zdjelice
pyloric valve
pilorički zalistak, pilorus, vratarnik
pylorospasm
pilorospazam
pylorus
vratarnik, pilorus
pyogenic
gnojan, piogen
pyothorax
empijem, piotoraks, gnoj u grudnom košu
pyrosis, heartburn
žgaravica
pyuria
pijurija (bakterijska infekcija), gnoj u mokraći
Q quadrant
kvadrant
quadruplets
četvorke
quality
kakvoća, kvaliteta
quantity
količina, kvantitet
quarter
četvrtina, kvartal; cca 1l
questionable
koji je pod znakom pitanja; sumnjiv
quinsy
gnojna upala krajnika; peritonzilarni apsces
quit
napustiti; prestati; ostaviti
quotient
količnik, kvocijent
R race
366
rasa, rod, vrsta
rachitis, rickets
rahitis
radial
zrakast, radijalan
radiate
zračiti, sjajiti se, širiti se (zrakasto)
radiation
zračenje, isijavanje
radical
temeljit, korjenit, radikalan, koji se odnosi na korijen
radiologist
radiolog
radiology
radiologija
radiotherapy
radioterapija
radius, pl. radii
palčana kost; polumjer
raised
izbočen, uzdignut, ispupčen
rale
hroptanje
random
slučajan
range
kretati se, varirati, javljati se; raspon
rarely
rijetko, neobično
rash
osip
rate
odnos, omjer, stupanj, brzina
rather
zapravo, stoviše, prije (nego), radije
raw
ranjav, otvoren, bolan, upaljen, sirov
Raynaud’s phenomenon
Raynaudova pojava, fenomen
re-establish
opet uspostaviti, opet utvrditi
reach
doprijeti, dosezati, prodrijeti
rear
stražnji dio, straznja strana, pozadina
receive
primati, prihvatiti, dobiti
recent
nedavni, skorašnji, recentan
receptor
prihvatač, receptor
recipient
primatelj
Recklinghausen disease
von Recklinghausenova bolest (osteitis fibrosa cystica)
recognition
prepoznavanje, raspoznavanje, identifikacija
record, n.
bilješka, zapis, evidencija
record, vb.
bilježiti, zapisivati
367
recourse
rješenje, izlaz
recovery
oporavak, rekonvalescencija
rectal
rektalan
rectum, pl. recta
ravno crijevo
rectus
ravan mišić
recumbent
ležeći, počivajući, naslonjen
recurrent
povratan, recidivan
reduce
smanjiti; kir. reducirati, uzglobiti, učašiti
reduction
smanjenje, redukcija, uzglobljenje, ulaganje
refer to
odnositi se, ticati se (čega), upućivati (na)
refine
usavršiti, poboljsati, dotjerati
reflux
tok unatrag, vraćanje, povrat
refractive
refrakcijski
refracturing
kirurško lomljenje kosti
regard
smatrati, gledati, paziti, motriti
regarding
s obzirom na, u vezi sa
regenerate
obnavljati, regenerirati
region
područje, mjesto, dio, regija
regress
vraćati se, povratiti se (bolest, ponašanje)
regression
vraćanje, povratak, regresija
regurgitation
povraćanje, vraćanje hrane iz želuca u usta, bljuvanje
rehabilitation
oporavak, osposobljavanje za rad, rehabilitacija
reinforce
pojačati
relapse
vratiti se, opetovati se, recidivirati
relapsing
koji vraća, opetuje, recidivan
relax
opustiti se, omlohaviti se, odmoriti se
relay
prenositi (impulse)
release
osloboditi, ispustiti, pustiti
relevance
značajnost, važnost
relief
olakšanje, smirenje
368
relieve
olakšati, smiriti, ublažiti
reluctance
protivljenje, opiranje, nesklonost, odvratnost
remain
preostati, ostati
remainder
ostatak, preostali dio
remarkable
znatan, značajan, jedinstven, zamjetan
remedy
lijek
remission
stadij mirovanja bolesti, privremeno jenjavanje bolesti, remisija
remote
udaljen, dalek
removal
uklanjanje, odstranjenje
remove
ukloniti, odstraniti
renal
bubrežni, renalan
renal calculus, pl. calculi
bubrežni kamenac
renal pelvis
bubrežna zdjelica
renal vein
bubrežna vena
renew
obnavljati se
renewed
izliječen, nanovo oživljen, obnovljen
renin
renin
repair
obnavljanje, regeneracija
repetitive
koji se opetuje, ponavlja
replacement
nadomjestak, nadopuna, zamjena
repolarization
repolarizacija
reproduction
umnažanje, razmnažanje, rasplodnja, reprodukcija
reproductive
rasplodni, reprodukcijski
require
tražiti, zahtijevati, iziskivati, trebati, biti potreban
resection
isijecanje, resekcija, kirurško uklanjanje
resemblance
sličnost
resemble
sličiti, biti sličan, naličiti
reserpine
lijek protiv hipertenzije, reserpin
reservoir
spremište, spremnik
369
residual
preostali
residue
ostatak
resilient
savitljiv, podatan, otporan
resin
smola
resistance
otpornost, čvrstoća, otpor
resolve
otopiti, rastvarati (se), riješiti (problem)
respectively
odnosno, dotično
respiration
disanje
respiratory
dišni
respond
odgovoriti, reagirati
response
odgovor, reakcija
responsible
odgovoran
restful
miran, spokojan, tih
restoration
obnavljanje, vraćanje u prijašnje stanje
restore
obnoviti (se), uspostaviti, vratiti u prijašnje stanje
restrictive
ograničen, koji ograničuje
retain
zadržavati
retardation
zaostajanje, retardacija
retention
zadržavanje, retencija (mokraće)
reticuloendothelial
retikuloendotelni
reticulum, pl. reticula
retikulum, mrežica
retina, pl. retinae
mrežnica
retinitis
upala mrežnice
retinitis pigmentosa
upala mrežnice s pigmentacijom na očnoj pozadini
retinoblastoma
retinoblastom, maligni tumor embrionalnih stanica mrežnice
retraction
uvlačenje, povlačenje, prevlačenje
retrograde
koji se povlači, koji se pogoršava, koji nazaduje
reveal
otkriti, pokazati
revenue
prihod, dohodak
370
reverse adj.
obratan, protivan, naopak, suprotan
reverse, vb.
okrenuti, promijeniti
rhabdomyoma
rabdomiom, tumor poprečnoprugastog mišića
rhabdomyosarcoma
rabdosarkom
rhesus factor
rezus (rh) čimbenik
rheumatic fever
reumatska groznica
rheumatoid arthritis
reumatoidni artritis
rhinitis
hunjavica, upala nosne sluznice
rhinology
rinologija
rib
rebro
rib cage
prsni koš
ribonucleic acid
ribonukleinska kiselina
ribosome
ribosom
rickets
rahitis
ridge
greben, hrbat, krijesta
rigidity
krutost, ukočenost, rigidnost
ring
prsten, kolut, obruč
ringworm
lišaj (kožna bolest)
ripening
sazrijevanje
risk
pogibelj, opasnost, rizik
rod
štapić
rod-shaped
štapičast
rodent ulcer
nagrizajući čir, ulkus rodens
roentgen
rendgen
roentgenology
rendgenologija
role
funkcija, uloga
roof of the mouth
svod usne šupljine
root
korijen, žila, srž
root canal work
liječenje kanala zubnog korijena
rosacea
rozaceja (kožni osip)
rotation
obrtanje, okretanje, vrtnja
371
rough
hrapav, grub, neravan, promukao (glas), trpak
rubella
crvenka, rubeola
rubeola
trodnevne ospice
ruga, pl. rugae
nabor, bora
ruggedness
hrapavost
rumbling
kruljenje
rupture
prsnuće, ruptura
S sac
vreća
saclike
vrećast
sacral
križni, koji pripada križima (križnim kralješcima)
sacroiliac
sakroilijakalni
sacrum, pl. sacra
križna kost
safe
siguran, bezopasan, neškodljiv
sagittal
usporedan s uzdužnom središnjom ravninom, sagitalan
saliva
slina
salivary glands
žlijezde slinovnice
salpingectomy
salpingektomija, kirurško uklanjanje jajovoda
salpingitis
upala jajovoda
salpinx
jajovod, tuba uterina
salt
sol
sample
uzorak
sane
razuman, pametan, normalan
saphenous vein
površinska vena (safena)nogu
sarcolemma
ovojnica mišićnog vlakna, sarkolema
sarcoma,pl. sarcomas,sarcomata
sarkom
saturated
zasićen, ispunjen
372
scab
krasta
scabies
svrab
scale
ljuska, ljuskica
scalelike
ljuskav
scaling
ljuska, ljuskica, stvaranje ljuskica
scalp
vlasište, kosom poikrivena koža lubanje
scan, vb.
podrobno ispitati, pregledati, radarski pretražiti
scapula, pl. scapulae
lopatica; lopatična kost
scar
ožiljak
scar tissue
ožiljno tkivo
scarcity
oskudnost, nestašica, rijetkost
scarlatina, scarlet fever
šarlah, skarlatina
scarring
stvaranje ožiljaka odn. ožiljka
scheme
shema, nacrt, plan
Schwann sheath
Schwannova ovojnica, neurilema
sciatica
išijas, bol duž živca ischiadicusa
sclera, pl. sclerae
bjeloočnica
scleroderma
sklerodermija
sclerosis, pl. scleroses
skleroza
scoliosis, pl. scolioses
skolioza, postranično (lateralno) iskrivljenje kralješnice
scotoma
točkasti ispadi u vidnom polju, skotom
scrape
strugati, ostrugati
scraping away
abrazija
screen
zakloniti, zaštititi; proučavati
scrotum, pt. scrota
mošnje
seal off
začepiti, zatvoriti (hermetički)
search
tražiti, istraživati
sebacious glands
žlijezde lojnice
sebum
loj (ljudski)
secrete
izlučivati
373
secretion
izlučivanje
section
rez, presjek, dio, odsjek, sekcija
securely
sigurno, čvrsto
sedation
liječenje sedativima, stanje prouzrokovano liječenjem sedativima
seek
tražiti, potražiti
seemingly
prividno
seep out
iscuriti, cijediti se
seizure
napadaj bolesti
self-limiting disease
bolest ograničenog trajanja
sella turcica
tursko sedlo
semen, pl. semina
sjeme
semicircular
polukružan
semilunar valve
polumjesečasti zalistak
seminal
sjemenski
seminal vesicle
sjemenski mjehurić
seminiferous tubules
sjemenski kanalćci (tubuli)
seminoma
seminom, maligna neoplazma testisa
senescent
starački
senile
starački, senilan
sensation
osjet, osjećaj
sense organ
osjetilo, osjetni organ
sensitivity
osjetljivost, nježnost
sensitized
osjetljiv, senzibiliziran
sensory
osjetni, osjetilni
separate
zaseban, odijeljen, razdvojen
separation
odjeljivanje, rastavljanje, separacija
septum, pl. septa
pregrada, pregradna stijenka
sequence of involvement
redoslijed uključivanja
sequestrum, pl. sequestra
mrtav dio tkiva ili organa, sekvestar
serosa
serozna opna, seroza
serosal
koji se odnosi na serozu
374
serous
sukrvičast, koji proizvodi ili sadrži serum, serumski
serous fluid
serumska tekućina
serum, pl. sera
krvni serum
serve
poslužiti, pomagati, koristiti, služiti
serviette
ubrus
sesame
sezam
sesamoid bone
sezamska kost
set off
istaknuti, dati se (na posao)
several
nekoliko, nekolicina
sever
presjeći, prekinuti, odrezati
severity
žestina, težina, ozbiljnost (bolesti)
sew
šivati, sašiti
sex cord
spolni snop u ranom fetal nom razvoju
sex glands
spolne žlijezde, gonade
sex linked
spolno vezan
sexual climax
spolni vrhunac, orgazam
sexual intercourse
odnošaj
shaft
trup (kosti), dijafiza
shallow
plitak
shape
oblik
sharp
oštar
sheath
ovojnica, omotac
shedding
ljuštenje (kože)
sheet
plahta, ploha
shell-fish
školjka, rak, ljuskar
shepherd
pastir, ovčar
shield, n.
štitnik, zastita
shield, vb.
štititi, braniti
shigella, pl. shigellae
šigela
shin bone
cjevasta kost
shingles
herpes zoster
375
shock
šok, udarac
shortsightedness
kratkovidnost, miopija
shoulder
rame
shoulder blade
lopatica, skapula
shoulder bone
lopatica, skapula
shrink
skvrčiti se, smanjiti se, skupiti se
shrinkage
skupljanje, smanjenje, stezanje
shuffling gate
teturav hod
shunt
spoj, skretaljka, premosnica
sickle-cell an(a)emia
anemija srpastih stanica
siderosis, pl. sideroses
pneumokonioza prouzročena udisanjem željezne prašine, sideroza
sieve
sito, rešeto
sigmoid colon
sigmoidno debelo crijevo
sign
znak
significant
značajan, važan, istaknut
signify
značiti, označiti, naznačiti
silica
silicijski dioksid
silicon
silicij
silicon dioxide
silicijski dioksid
silicosis, pl. silicoses
pneumokonioza prouzrocena udisanjem pješćane prašine koja sadrzi silicijski dioksid, silikoza
silvery
srebrnast, srebrene boje
similarity
sličnost, istovrsnost
Simmonds disease
pituitarna kaheksija, Simmondsova bolest
simple fracture
jednostavan lom kosti (fraktura)
simultaneous
istodoban
single
jednostruk, pojedinacan
sinister
lijevi; zlokoban
sinistral
lijevi, usmjeren na lijevo
sinotrial node
sinuatrijski (SA) čvor
376
sinus
zaton, sinus
sinusitis
upala sinusa
sip, n.
gutljaj, srkanje
sip, vb.
gucnuti, srknuti
sister in charge
dežurna medicinska sestra
site
sijelo, lokalizacija (tumora)
size
veličina
skeletal
kosturni, skeletni
skeleton
kostur, skelet
skin
oštećenje kože
skin rash
osip na koži
skull
lubanja
slant
kosa crta
slender
tanak, slab, nježan, malen
slipped disk
iskliznuće diska
slit
pukotina, prorez, rascjep, usjeklina
slitlike
poput pukotine (usjekline), uzak
slope-away
nagnuti se, ukoso se spuštati, biti nagnut, kos
slough
ljuštiti se
slow-motion
usporen, usporeno snimljen
small intestine
tanko crijevo
smallpox, variola
crne kozice, velike boginje, variola
smell
osjet mirisa, njuh, miris
smooth muscle
glatki mišić
snail -shaped
u obliku puževe kućice
snare
uhvatiti u omču (npr. polip)
soak
namakati (se), promočiti, upijati, prožeti (tekućinom)
socket
udubljenje, supljina (zglobna, očna)
sodium
natrij
soft palate
meko nepce
377
softening
omekšavanje, smekšavanje, ublažavanje
sole
potplat, đon
sole of the foot
taban
solely
samo, jedino, isključivo
solid
krut, čvrst
solidify
skrutnuti, ukrutiti, zgusnuti se
soluble
topiv
solution
otopina; rješenje
somatic
tjelesan, somatičan
somatotropin
somatotropin
somewhat
nešto
somnolent
pospan, sanjiv, snen
sore
rana, bolno mjesto, ranjeno mjesto
sore throat
upala grla i krajnika, angina
sound
zvuk, šum, glas
sound production
stvaranje glasova, fonacija
sound wave
zvučni val
source
izvor, podrijetlo, početak
space
prostor, svemir
span, n.
vremenski razmak, raspon, trajanje, opseg
span, vb.
premostiti
sparingly
umjereno, štedljivo
spark
iskra, varnica
spasm
grč, napad kašlja, spazam
spastic
grčevit, spastički
spastic colon
spastički kolon
spasticity
zgrčenost, spastičnost
specialized
poseban, specijaliziran
speck
mrlja, točkica
spell
razdoblje, kratko vrijeme
spelling
sricanje, pravopis
sperm
sjeme, sperma
378
sperm viability
životna sposobnost, životnost spermija
spermatic cord
sjemeni snop
spermatozoon, pl. spermatozoa
muška sjemenska stanica, spermij
sphenoid bone
klinasta (sfenoidna) kost
sphincter
kružni mišić, sfinkter
sphygmomanometer
tlakomjer, sfigmomanometar
spider-web
paučinast, tanak; paukova mreža
spina bifida
rascjep kralješnice, spina bifida
spinal
kralješnični
spinal cord
kralješnična moždina
spine
kralješnica
spinous process
šiljasti, trnasti nastavak
spirochete
spiroheta
spit
ispljunuti, pljuvati
spleen
slezena
splenectomy
kirursko odstranjenje slezene, splenektomija
splenodynia
bolovi u slezeni
splenomegaly
povećanje slezene, splenomegalija
splenopexy
splenopeksija
splenorrhaphy
splenorafija
splint
longeta, imobilizacija
splinter
smrskati, razmrviti
split
rascjep (usne)
spongy
spužvast, spongiozan
spontaneous
samonikao, sam od sebe, spontan
spot
mrlja, točka, pjega
sprain
iščašenje, uganuće, distorzija
spread
rasprostirati se, širiti se, protezati se
sputum
ispljuvak
squama, pl. squamae
ljuska
379
squamous
ljuskav, plosnat
squamous cell carcinoma
rak pločastih stanica, planocelularni karcinom
squint
razrokost, škiljavost, strabizam
stabilization
učvršćenje, stabilizacija
stable
čvrst, stalan, stabilan
stage
stupanj, faza, stadij, razdoblje razvoja
stain
obojiti, bojati
stalk
držak, stalak, stabljika
stapedectomy
stapedektomija, kirurško uklanjanje (ekscizija) stremena
stapes, pl. stapedes, stirrups stremen staphyloccocus, pt. staphylococci
stafilokok
star-shaped
zvjezdolik
starch
škrob
steatorrh(o)ea
velika količina masti u stolici
stem
stablo, stabljika, peteljka, korijen (riječi)
stem cell
hematoblast, osnovna (početna) stanica
stenosis, pl. stenoses
suženje, stenoza
step
korak
sterilization
sterilizacija
sternum, pl. sterna
prsna kost
steroid
steroid
stethoscope
stetoskop
stiffen
ukrutiti se, ukočiti se, postati ukrućen
stiffening
kočenje, ukočenost, ukrućenost
stiffness
ukočenost
stimulus, pl. stimuli
podražaj
stirrup
stremen
stomach
želudac
stones
kamenci
380
stool
stolica, feces
store
pohraniti, spremiti, uskladištiti
strabismus
razrokost, škiljavost, strabizam
strabotomy
strabotomija, presjecanje tetive očnog mišića
straighten out
izravnati
strain
napor, naprezanje; soj (bakterija); istegnuće (mišića)
strand
vlakno, pramen
strangulated
ukliješten, udavljen
stratum, pl. strata stratum corneum
sloj rožnati sloj
straw
slama, slamčica
strengthen
pojačati, učvrstiti
streptococcal
streptokokni
streptococcus, pl. streptococci
streptokok(i)
stress
udarac, potres, stres
stretch
rastezati, protezati, istezati
stretching
rastezanje, istezanje
stria, pl. striae
pruga, strija
striated muscle
poprečno prugasti (kosturni) mišić
stricture
suzenje
stridor
disanje poput šištanja (zviždanje), stridor
strike
udariti, pogoditi
stringy
žilav, vlaknast, ljepljiv, viskozan
strip
uska vrpca, pojas, pruga
stroke
moždani udar, kap, apopleksija
stroma, pl. stromata
potporno tkivo, stroma; tkivna matrica
structure
anatomska tvorba, građa, struktura
stupor
tupost, stupor
stye
ječmenac, halazion
381
subarchnoid
ispod paučinaste ovojnice (mozga), subarahnoidan
subclavian vein
potključna vena
subcutaneous
potkožan, supkutan
subsequent
sljedeći, kasniji, naredni
subside
jenjavati, povući se (bolest)
substance
tvar
suckling
dojenče
sudor
znoj
sudoriferous glands
žlijezde znojnice
suffer from
trpjeti, bolovati, patiti (od čega)
suffice
dostajati, zadovoljavati
sufficient
dostatan, dovoljan
suffocating
gušeći, koji guši, zagušljiv
suitable
prikladan, pogodan, zgodan
sulcus, pl. sulci
brazda, žlijeb
superficial
površinski
superior vena cava
gornja šuplja vena
supination
usporedan položaj kostiju podlaktice,supinacija
supine
ležeci licem prema gore, supinacijski
supply
snabdijevati, opskrbiti
support
potporanj, oslonac, podupirač, podloga
suppository
siljast čepić, supozitorij
suppurative
gnojan
suprapubic
suprapubičan
suprarenal gland
nadbubrežna žlijezda
supress
suzbiti, spriječiti, potisnuti, zatomiti
surface
površina
surge of blood
navala krvi
surgeon
kirurg
surgery
kirurški zahvat, kirurgija
382
surgical
kirurški
surrounded
okružen, opasan, obavijen
surroundings
okolina, okoliš
survival
preživljavanje, opstanak
survival rate
stopa preživljenja
susceptibility
osjetljivost, prijemljivost, podložnost
susceptible
osjetljiv, prijemljiv, podložan (bolesti)
suspect, v.
sumnjati, posumnjati, nagađati
suspended
lebdeci, suspendiran
suspension
učvršćenje, fiksacija, suspenzija
sustain
pretrpjeti (ozljedu); održati (život)
suture, n.
šav rane; kirurški konac; šavni spoj kostiju; sutura
suture, v.
spojiti šavom, sašiti ranu, vezati
swallow
gutati
swallowing
gutanje
sweat glands
žlijezde znojnice
sweat, s.
znoj
sweat, vb.
znojiti se
sweating
znojenje
swelling
oticanje, otok, edem
swollen
otečen
sympathetic
koji pripada simpatikusu, simpatički
sympodia
sraštenost donjih ekstremiteta, simpodija
synapse
sinapsa, spojište živčanih stanica
synarthrosis
nepomičan zglob, sinartroza
syncope
nesvjestica, sinkopa
synovial
koji pripada sinoviji
synovial capsule
zglobna čahura
synovial fluid
sinovijalna tekućina
synovial membrane
sinovijalna opna (membrana)
synthesis, pl. syntheses
spajanje, sastavljanje, sinteza
383
synthesize
sintetizirati; proizvesti
syphilis
sifilis, lues
syphilitic
sifilitičan
syringe
štrcaljka
system
sustav
systemic circulation
veliki krvotok
systole/sistole
stezanje (srčanog mišića), sistola
systolic
sistolički
T tachycardia
ubrzano bilo, ubrzani rad srca, tahikardija
tachypn(o)ea
ubrzano disanje, tahipneja
tag
navika, privjesak, pramen, prirepak, etiketa
tail
rep, kauda
tailbone
trtična kost
take over
preuzeti (funkciju)
take place
dogoditi se
talipes
urođeno zgrčeno (krivo) stopalo
tap
lupkati, perkutirati
tapper off
nestajati, prestajati, stanjivati (se)
tar
katran, smola
target tissue
ciljno tkivo
tarsal
kost korijena stopala (tarzusa)
task
zadatak, zadaća
taste
okus
taste buds
okusni pupoljci
tax
državni porez, dažbina, pristojba, taksa
tear gland
suzna žlijezda
tear, n.
suza
tear, vb.
kidati, cijepati
technique
postupak, tehnika, način obavljanja
telescope
teleskopirati
384
telescoping
teleskopiranje
temporal
sljepoočni
temporal bone
sljepoočna kost
temporary
privremen, prolazan
temporomandibular joint
čeljusni zglob
tendency
sklonost, naklonost, naginjanje, težnja
tender
osjetljiv, mekan, bolan
tenderness
osjetljivost, mekoća
tendon
tetiva
tension
napetost, napregnutost, tenzija
teratocarcinoma
teratokarcinom
teratoma, pl. teratomata, teratomas
urođena nakaznost, nakazna izraslina, teratom
tertiary
treći po redu, tercijaran
test tube
epruveta
testicle
sjemenik, mudo, testis
testicular
koji se odnosi na testis
testicular carcinoma
rak sjemenika
testis, pl. testes
sjemenik, mudo
testosterone
testosteron, muški spolni hormon
tetanus
tetanus
tetany
tetanija
thalamotomy
talamotomija
thalamus
vidni humak, ložnica, talamus
thalassemia
nasljedna hemolitička anemija, talasemija, hemoglobinopatija
thick
gust (tekućina); debeo
thickened
zgušnjavanje (tekućine); zadebljanje
thickness
debljina; gustoća (tekućine)
thigh
bedro
thin
rijedak, proziran (tekućina); tanak
thin sore
plitka ranica
385
thinness
rijetkoća (tekućine), tankoća
thinning
prorjedivanje, razrjedivanje, smanjenje, opadanje (dlaka, kose)
thirst
žeđ
thoracic
koji se odnosi na prsni koš, torakalni
thorax, pl. thoraces
prsni koš
thought
misao, mišljenje, razmišljanje
thread
vlakno, nit, konac
threat
prijetnja, opasnost, ugroženost
thrive
rasti, razvijati se
throat
grlo, grkljan
thrombm:yte
krvna pločica, trombocit
thrombophlebitis
upala vena s trombozom, tromboflebitis
thrombosis, pl. thromboses
začepljenje krvne žile ugruškom krvi, tromboza
thrombus, pl. thrombi
krvni ugrušak, tromb
thrush
upala usne sluznice
thumb
palac na ruci
thymectomy
kirurško uklanjanje prsne žlijezde, timektomija
thymitis
upala prsne žlijezde, timitis
thymoma
timom, dobroćudni i zloćudni tumor timusa
thymus
prsna žlijezda, timus
thyroid gland
štitnjača, štitna (tiroidna) žlijezda
thyroidectomy
kirurško odstranjenje štitne žlijezde, tiroidektomija
thyrotoxicosis
tireotoksikoza, hipertireoza
thyroxine
hormon štitne žlijezde, tiroksin
tibia, pl. tibiae
goljenična kost, tibija
tick
krpelj
tied off
podvezan
timing
vremensko usklađivanje
tinea pedis
gljivična bolest stopala, športsko stopalo
386
tinge
preljev, (nijansa) boje
tinnitus
šum u uhu
tiny
malen, sitan, sićušan
tip
vrh, kraj, apeks
tiredness
sustalost, malaksalost, umor
tissue
tkivo
titre/er
titar
tobacco
duhan
toe
prst stopala
toenail
nokat na prstu stopala
toll
porez, carina, taksa, namet, danak
tongue
jezik
tonometar
mjerač tlaka (krvnog), tonometar
tonsil
krajnik, žabica, mandula
tonsillectomy
tonsilektomija, kirurško odstranjenje krajnika
tonsillitis
upala krajnika, tonsilitis
tooth removal
vađenje zuba
tooth, pl. teeth
zub
toothpick
čačkalica
tough
žilav, čvrst, krut
tox(a)emia
otrovanje krvi, toksemija
toxic
otrovan, toksičan
toxin
otrov
trabecula, pl. trabeculae
gredica, tračak, trabekula
trachea
dušnik
tract
vod, sustav, trakt
trait
značajka, osobina, karakteristika
tranquillizer
sredstvo za umirenje, trankvilizator
transaminase
transaminaza
transient
prolazan, kratkotrajan
translucent
proziran, providan
387
transmit
prenositi, prenijeti, širiti podražaje
transparent
proziran, providan
transplant, n.
kalem, transplantat
transplant, vb.
presaditi, transplantirati
transurethral resection
transuretralna resekcija
transverse colon
poprečno (transverzalno) debelo crijevo
transverse process
poprečni nastavak, (kralješka)
trap
uhvatiti, uloviti
trauma, pl. traumata, traumas
ozljeda, trauma
travel
putovati, kretati se
treatment
liječenje, postupak, tretman
treponema pallidum
blijeda treponema (uzročnik sifilisa)
triangular
trokutni, trouglast, trobridan
trichomonas vaginalis
trihomonas vaginalis
trichomoniasis
trihomonijaza
tricuspid valve
trolisni (trikuspidalni) zalistak
trigger
izazvati, prouzrociti
triglyceride
triglicerid
trigone
trokutasto područje, trigon
triiodothyronine
trijodtironin, tironin (hormon štitnjače)
triple-looped
trostruko zavijen
triplets
trojke
trochanter
kvrga
true ribs
prava rebra
trunk
trup, stablo
tube
cijev
tubercle
kvržica, tuberkulum
tuberculosis
sušica, tuberkuloza
tuberosity
hrapavost
tubes
jajovodi
tubular
cjevast
388
tubule
cjevčica, kanalić, tubul
tuft of capillaries
mreza kapilara
tumo(u)r
novotvorevina, izraslina, tumor
turkey
puran, purica
twin
blizanac, dvojnik
twist
zavijati
twisted
uvojit, zavojit, spiralan
twitches
grčevito trzanje (miića)
twitching
stezanje, kontrakcija, trzanje (udova)
tympanic cavity
bubnjište
tympanorrhexis
prsnuće (razdor) bubnjića, timpanoreksija
tyrosine
tirozin
U ulcer
vrijed, čir, ulkus
ulcerate
gnojiti se, prouzročiti čireve
ulceration
gnojenje, stvaranje vrijeda, ulceracija
ulcerative
gnojan, ulcerozan
ulcerative colitis
ulcerozna upala debelog crijeva
ulcerlike
poput čira
ulcerous
zahvaćen ulceracijom
ulna, pl. ulnae
lakatna kost
ultrasound
ultrazvuk
ultraviolet
ultraljubičast
ultraviolet radiation
ultraljubičasto zračenje
umbilical
pupčan
umbilical cord
pupkovina, pupčana vrpca
umbilical hernia
pupčana kila (hernija)
umbilicus
pupak
unable
nesposoban
unblinking
koji ne trepće
uncertainty
nesigurnost, neizvjesnost, nepouzdanost
389
uncondensed
nekondenziran
unconscious
nesvjestan, onesviješten
unconsciousness
nesvjestica
undergo
pretrpjeti, prepatiti, podvrći se (pregledu, pretragama)
underlying
koji se nalazi ispod
underneath
dolje, ispod
undescending
koji se ne spušta
undesirable
nepoželjan, neugodan
undifferentiated
nediferenciran
unequal
nejednak, nerazmjeran
unfortunately
nažalost
unicellular
jednostaničan
unilateral
jednostran
union
veza, spoj
unit
jedinica, uređaj
unobtainable
koji se ne može dobiti, nedokučiv, nedostižan, nedohvatljiv
unobtrusively
nenametljivo, čedno
unossified
neokoštan
unpaired
neparan, nesparen, jedan
unpleasant
neugodan, odvratan
unpolluted
čist, nezagađen
unresponsitivity
odsutnost reagiranja, reakcije
unspecialized
nespecijaliziran, koji nije pojedinacno naveden
untwist
otplesti, rasplesti, razmrsiti
unusual
neobičan, izvanredan
upper
viši, gornji
upper back
gornji dio leđa
upper respiratory infection
infekcija gornjih dišnih putova
uppermost
najvisši, gornji
390
urban
gradski
urea
mokraćevina, urea
uremia
otrovanje mokraćnim sastojcima u krvi, uremija
ureter
mokraćovod, ureter
urethra
mokraćna cijev, mokraćnica
urethritis
upala sluznice mokraćne cijevi
urge
pospješivati, požurivati, natjerati
uric acid
mokraćna kiselina
urinary
mokraćni
urinary bladder
mokraćni mjehur
urinary meatus
mokraćni prolaz
urinary passages
mokraćni putovi
urinary retention
zastoj mokraće, zadržavanje, zaustavljanje
urination
mokrenje, mikcija
urine
mokraća, urin
urinogenital
mokraćno-spolni, urogenitalni
urogenital
urogenitalni
urologist
urolog
urology
urologija
urticaria
koprivnjača, urtikarija
use, n.
primjena, namjena, upotreba
use, vb.
upotrebljavati, služiti, primijeniti
usual
običan, uobičajen, redovan
usually
obično, pravilno, redovito, u pravilu
uterine
koji pripada maternici
uterus, pl. uteri
maternica
utilization
korištenje, potrošnja, uporaba
uvula, pl. uvulae
resica, uvula
V vaccinate
cijepiti, vakcinirati
391
vaccination
cijepljenje, vakcinacija
vaccine, n.
cjepivo, vakcina
vagina, pl. vaginae
rodnica
vaginal
koji se odnosi na rodnicu, vaginalan
vaginismus
bolan grč rodnice, vaginizam
vaginitis
upala rodnice
valve
zalistak
valvula, pl. valvulae
malen zalistak
valvular
koji ima zaliske, koji se odnosi na zalistak
vapour
para, isparina, maglica
variable
promjenljiv, nestalan, kolebljiv, varijabilan
varicella
vodene kozice, varićele
varices
čvorasta proširena vena, varikozitet
varicoc(o)ele
oteklina od proširenih sjemenskih vena, varikokela
varicose vein
proširena vena (varikozna vena)
varix, pl. varices
variks, proširena i iskrivljena vena, arterija ili limfna žila
vary
mijenjati se, promijeniti se, razlikovati se
vas deferens, pl. vasa deferentia
sjemenovod, vas deferens
vascular
koji se odnosi na krvne žile, vaskularni
vascularity
prokrvljenost
vascularize
snabdjeti krvlju
vasectomy
presijecanje sjemenovoda, vazektomija
vasoconstriction
vazokonstrikcija, suženje krvnih žila
vasodilator
sredstvo za širenje krvnih žila, vazodilatator
vasopressin
vazopresin, antidiuretski hormon (oslobađa ga neurohipofiza)
vast
vrlo velik, golem, ogroman
vein
vena
vena cava
šuplja vena
392
veneral disease; STD = sexually tranmitted disease
spolna ili splno prenosiva (venerična) bolest
venous
venozan
ventral
trbušni
ventricle
srčana klijetka; moždana komora
venule
mala vena, venula
verruca
bradavica, bradavičasta izraslina
vertebra, pl. vertebrae
kralježak
vertebral
koji se odnosi na kralješnicu
vertebral arch
luk kralješka
vertebral body
tijelo kralješka
vertebral column
kralješnica
vertigo
vrtoglavica
vesicle
mjehurić, vezikula
vesicular
mjehurast, mjehuricast
vessel
(krvna) žila
vestibule
predvorje, vestibulum
vestige
rudiment, zakržljalo udo ili organ
vestigial
rudimentaran, zakržljao
viability
životnost, životna sposobnost
viable
životan, koji ima životnu sposobnost
vibrate
titrati, odzvanjati, vibrirati
vice
porok, mana, zla navika, pogreška, zabuna
vicinity
blizina, susjedstvo, bliži okoliš
victim
žrtva, stradalnik
victory
pobjeda
view
pregledati, ispitati, gledati, istražiti
vigorous
snažan, jak, energičan, žestok
villus, pl. villi
crijevna resica
vinegar
ocat, kvasina
violent
žestok, nagao, nasilan
viral
virusni
393
virgin
djevica
virginal
djevičanski, čist
virginity
djevičanstvo
virilism
muževnost, muškost, virilizam
virtue
krijepost, vrlina
virus
virus
viscera, sg. viscus
utroba, unutarnji organi
visceral pleura
poplućnica, visceralna pleura
visceropexy
visceropeksija – fiksiranje spuštenog unutarnjeg organa (npr. spuštenog bubrega i dr.)
viscosity
viskoznost
visible
vidljiv, vidan, očevidan, jasan
vision
vid
visual
vidni, očni
vital
životni, vitalan
vitality
životna snaga, vitalnost
vitamin
vitamin
vitiligo
bjelkaste mrlje na koži, bolest depigmentacije kože, vitiligo
vitreous
staklast, staklen
vitreous humour
tekućina staklastog tijela, humor vitreus, stakličevina
vocal
glasovni, usmen, govorni, vokalni, pjevni
vocal cords
glasnice
voice box
grkljan, larinks
void
isprazniti, izbaciti, izlučiti
voiding
pražnjenje (mjehura), mokrenje
volcanoconiosis
vulkanokonioza, pneumokonioza izazvana vulkanskom prašinom
voluntary
voljan, namjeran
voluntary muscle
prugasti mišić
volvulus
zapletaj crijeva
394
vomer
ralo, lemeš
vomit
povraćati
vomiting
povraćanje
voracious
lakom, pohlepan, proždrljiv
vowel
samoglasnik, vokal
vulva, pl. vulvae
stidnica
vulvovaginitis
upala stidnice i rodnice, vulvovaginitis
W wall
stijenka, zid
wall-eyed
škiljav, razrok
wane
slabiti, popuštati, smanjivati se, nestajati, iščeznuti
ward
bolnički odjel
ward off
upozoriti, izbjeći opasnost
warm, adj.
topao, zagrijan
warm, vb.
utopliti, grijati, zagrijati
wart
bradavica
waste-product
otpadni proizvod
watch for
pripaziti (na)
wave
val
wavelike
valovit
wax
vosak
weakened
oslabljen, neotporan, opušten
weakness
slabost, boležljivost, slabunjavost
wealth
izobilje, bogatstvo, imućnost
wedge
klin, predmet klinasta oblika
wedged
ukliješten
weed
korov, trava, biljka, duhan, cigara, marihuana
weigh
težiti
395
weight
težina
weight gain
povćanje tjelesne težine, debljanje
weight loss
mršavljenje, smanjenje tjelesne težine
welfare
dobra, dobrobit, sreća; socijalna skrb
wet
mokar, vlažan
wheal
urtika
wheeze
soptati, dahtati, teško disati
wheezing
sipljiv, koji sopće, dahće
whiplike
u obliku biča
whir
zujanje, cvrčanje
whirl
vrtnja, okretanje
white matter
bijela tvar
whitish
bjelkast
whooping cough, pertussis
veliki kašalj, hripavac, pertusis
wide
širok
Wilms tumour
Wilmsov tumor
windpipe
dušnik, traheja
wipe
obrisati, izbrisati, osušiti
wishful
pun želja, željan, požudan, koji čezne
withdraw
povući natrag, dići, povući se
within
u, unutra, u opsegu
womb
maternica, utroba
word root
korijen riječi
wormlike
crvolik
worn-out
istrošen, iscrpljen, iznošen, izmožden
wound
rana, ozljeda
wrapping
ovojnica, omotač
wrist
ručni zglob, zglavak
wrong
pogrešan, kriv, neprikladan
X x-ray, v.
396
rentgenski snimiti
x-rays, n.
rentgenske zrake, x-zrake
xanthemia
prisustvo žutog pigmenta (bilirubina) u krvi, ksantemija
xenograft, heterofgraft xiphoid
tkivni presadak od ruge životinjske vrste u obliku mača, ksifoidan, mačolik
xiphoid appendage
ksifoidni nastavak prsne kosti
Y yawning yaws
zijevanje frambezija (endemska tropska kožna bolest), malinaste tropske boginje
yeast
kvas, kvasac, pjenica
yellow body
žuto tijelo, corpus luteum
yellow fever
žuta groznica; akutna virusna infekcija koju penose komarci
yellow marrow
žuta koštana moždina (srž)
yield
proizvesti, ostvariti
yolk
žumanjak, žumanjce
yolk sac
žumanjčana vreća
Z zone
pojas, područje, predio, zona
zoster, herpes zoster
pojas, pojasni zoster
zygoma, pl. zygomata/ zygomas
sponična kost
zygomatic zygote
sponični, zigomatični oplođeno jajašce; stanica koja je rezultat spajanja muške i ženske spolne stanice
397
References 1. blakiston’s Gould Medical Dictionary, 4th ed., McGraw-Hill Book Company, New York 1979 2. Bujas Ž: Veliki hrvatsko-engleski i englesko hrvatski rječnik, 2. Izdanje, Zagreb Globus 2001 3. Caroll, Ch. i Miller, D. Health, the Science of Human Adaptation, WBC, New York, 1983 4. Chabner, D.E. The Language of Medicine, 5th and 7th eds., Saunders, Philadelphia 2001, 2004 5. Dorland’s Illustrated Medical Dictionary, 30th ed., Saunders, Philadelphia 2003 6. Ellis, J.W. Medical Symptoms and Treatments, Beekman House, New York 1986 7. Gylys, B.A. & Wedding, M.W. Medical Terminology: A Systems Approach, 6th ed., F.A. Davis, Philadelphia 2009 8. Keros, P., Bagi, Č. i Pećina, M. Temelji anatomije čovjeka, Medicinski fakultet Sveučilišta u Zagrebu, Zagreb 1987 9. Loknar, V. Teme iz medicinskog nazivlja, Jumena, Zagreb, 1988. 10. Medicinski leksikon, Leksikografski zavod “Miroslav Krleža”, Zagreb 11. Merriam-Webster’s Collegiate Dictionary 12. Miller, B.F. & Keane, C.B. Encyclopedia and Dictionary of Medicine, Nursing and Allied Health, W.B. Saunders Company 13. Mosby’s Dictionary of Medicine, Nursing & Health Professions, Mosby – Elsevier, 2009 14. Parkinson, J. A Manual of English for the Overseas Doctor, 3rd ed., Churchill Livingstone, Edinburgh, 1985 15. Parkinson J. & Brooker C: Everyday English for International Nurses – A guide to working in the UK. Churchill Livingstone 2004. 16. Webster’s Medical Desk Dictionary, Merriam-Webster, Inc., Springfield, Mass.
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