Medical English 170X240

June 24, 2016 | Author: Lucia | Category: N/A
Share Embed Donate


Short Description

Download Medical English 170X240...

Description

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.

II

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

V

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

VI

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

VII

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

2

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.

3

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.

4

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.

5

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)

6

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.

7

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.

10

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.

--------------------------------------------

11

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

13

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 • • • • • • • • • • • • • •

14

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)

15

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.

19

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 ........................................................

20

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 ................................................

21

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

23

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.

25

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

26

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.

28

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

29

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? ..........................................................................................................................................................................

31

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. ..........................................................................................................................................................................

32

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. .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

34

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.

37

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.

38

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)

39

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

40

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.

41

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.

42

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.

43

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.

44

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 .............................................................................................................

45

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 .........................................................................................................................................

46

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 .....................................................................................................

47

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) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

48

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.

52

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 • • • • • • • • • • • • •

60

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)

61

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

62

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.

65

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 ..................................................

66

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)

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

69

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.

70

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.

71

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.

72

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

75

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

76

• • • • • • •

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

77

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

79

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

80

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.

81

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 ............................................................

82

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 ............................................................

83

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

84

(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

85

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) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

86

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.

87

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.

89

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

90

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).

92

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

94

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 .........................................................................

96

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) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

97

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

98

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.

100

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

102

(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)

104

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.

105

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.

106

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

107

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 ..................... ..........................................................................................................................................................................

108

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

109

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) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

110

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.

111

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

112

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.

113

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

114

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)

115

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

116

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 ..................................................................

117

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 ............................................................

118

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

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

120

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.

122

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.

126

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

128

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.

129

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.

130

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.

131

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.

132

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

133

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 ......................................................

134

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.

135

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

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

137

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).

138

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.

139

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.

140

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.

143

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

144

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).

145

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

146

• • • • • • • •

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

147

Disorders of the Blood and Lymphatic Systems AIDS (acquired immunodeficiency syndrome) anemia

148

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

149

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.

150

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.

151

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 ..............................................................

152

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 ...................................................

153

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-

154

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. .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

155

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

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.)

156

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

157

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)

158

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.

159

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.

163

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.

164

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.

165

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.

168

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.

170

For brief reference to abnormal conditions of the endocrine glands, refer to the table below.

171

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 ................................................................

173

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) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

174

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

175

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

177

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.

181

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

183

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

184

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

185

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 ............................................

186

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 ....................................................

187

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.

188

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.) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

189

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

190

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.

191

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.

192

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

194

• 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

195

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

196

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

197

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.

198

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

199

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................................................................................................................................................................

200

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

201

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) .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

202

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

203

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

204

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

208

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)

209

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

210

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

212

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

213

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

214

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.

215

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 ...............................................

216

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) .......................................................................................................................................................................... ..........................................................................................................................................................................

217

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

218

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

219

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

221

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

222

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

225

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) .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

226

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.

227

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,

228

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

229

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 ....................................................................................................................................................

230

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 ..................................... .

232

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.

233

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

234

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.

235

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)

236

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.

237

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,

242

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.

243

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

244

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

245

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

246

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? ..................................................................................... ..........................................................................................................................................................................

247

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.

248

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 .................................

249

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 ..........................................................

250

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. .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

251

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

252

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.

253

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

254

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.

256

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.

257

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.)

260

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.

261

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,

262

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.

263

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.

266

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

267

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

269

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

270

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

272

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:

273

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.

274

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.

275

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.

278

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.

279

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

280

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.

282

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

283

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.

284

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.

286

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

288

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

289

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.

290

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.

291

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

292

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 ......................................................

--------------------------------------------

293

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

296

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

297

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

299

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

302

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



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.

398

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

399

.......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... ..........................................................................................................................................................................

400

View more...

Comments

Copyright ©2017 KUPDF Inc.
SUPPORT KUPDF