Anatomy and Disease The human body is remarkably well designed.

. Most of its organs have a great deal of extra capacity or reserve: They can still function adequately even when damaged. For example, more than two thirds of the liver must be destroyed before serious consequences occur, and a person can usually live with only one lung or kidney. Other organs can tolerate little damage before they malfunction and symptoms occur. For example, if an artery in the brain becomes blocked or ruptures (stroke) and even a small amount of tissue in a vital part of the brain is destroyed, a person may be unable to speak, move a limb, or maintain balance. If a heart attack destroys a small amount of tissue in the part of the heart that creates or carries the signals to beat, the heart rate may become dangerously slow and the person may even die.

Disease often affects anatomy, and changes in anatomy can cause disease. If the blood supply to a tissue is blocked or cut off, the tissue dies (infarction), as in a heart attack (myocardial infarction) or stroke (cerebral infarction). An abnormal heart valve can cause heart malfunction. Trauma to the skin may damage its ability to act as a barrier, which may lead to infection. Abnormal growths, such as cancer, can directly destroy normal tissue or produce pressure that ultimately destroys it.

Because of the relationship between disease and anatomy, methods of seeing into the body have become

a mainstay in the diagnosis and treatment of disease. The first breakthrough came with x-rays, which enabled doctors to see into the body and examine internal structures without surgery. Another major advance was computed tomography (CT), in which x-rays are linked with computers. A CT scan produces detailed crosssectional (two-dimensional) images of the body's interior.

Other methods of producing images of internal structures include ultrasound scanning, which uses sound waves; magnetic resonance imaging (MRI), which uses the movement of atoms in a magnetic field; and radionuclide imaging, which uses radioactive chemicals injected into the body. These are noninvasive ways to see into the body, in contrast to surgery, which is an invasive procedure.

Common Medical Tests A large number of tests are widely available Many tests are specialized for a particular disease or group of related diseases Generally, specialized tests are described with the appropriate diseases. However, other tests are used commonly for a wide range of diseases Tests are performed for a variety of reasons, including screening, diagnosing a disease,

evaluating the severity of a disease so that treatment can be planned, and monitoring the response to treatment Sometimes, a test may be used for more than one purpose. A blood test may reveal that a person has too few red blood cells (anemia), and then the same test may be repeated after treatment to check that the number of red blood cells has returned to normal In some instances, a condition can be treated at the same time a screening or diagnostic test is performed. For example, when colonoscopy, a test in which a flexible viewing tube is used to examine the inside of the large intestine, reveals growths (polyps), they can be removed before colonoscopy is completed Types of Tests Medical tests generally fall into one of six categories: analysis of body fluids, imaging tests, endoscopy, measurement of body functions, biopsy, and analysis of genetic material in cells analysis of body fluids

 In many instances, the lines that separate the categories become blurred. For example, endoscopy of the stomach enables the examiner to view the inside of the stomach as well as obtain tissue samples for examination in a laboratory. Analysis of body fluids: most often consists of tests of the blood, urine, and fluid that surrounds the spinal cord and brain (cerebrospinal fluid). Less often, fluids such as sweat and saliva and fluid from the digestive tract (for example, gastric juices) are analyzed. Sometimes, the fluids analyzed are present only if a disease is present, such as when fluid collects in the abdomen (ascites) or in the space between the two membranes covering the lungs (pleural effusion). Imaging: consists of tests that provide a picture of the inside of the body, either in its entirety or only of certain parts. Ordinary x-rays are the most common imaging tests, but others include ultrasound, radioisotope (nuclear) scans, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans. Endoscopy: is the use of a viewing tube to directly observe the inside of body organs or spaces (cavities). Most often, the endoscope is flexible, although a few types are rigid. The tip of the endoscope is usually equipped with a light and a camera, so images can be seen on a television monitor while the examiner is observing through the endoscope. Tools are often passed through a channel in the endoscope. One type of tool is used to cut and remove tissue samples. Endoscopy usually consists of passing the viewing tube through an existing body opening. For example, esophagogastroduodenoscopy

(EGD) is accomplished by passing a viewing tube through the mouth. Colonoscopy involves passing a viewing tube through the anus. However, sometimes an opening in the body must be created. This can be done by making a small cut (incision) through the skin and through layers of tissue beneath the skin, so that the endoscope can be passed into a body cavity. For example, in arthroscopy, an endoscope is passed through an incision to view a joint, such as the knee or shoulder. Measurement of body functions: often involves recording and analyzing the activity of various body organs. For example, electrical activity of the heart is measured with electrocardiography (ECG), and electrical activity of the brain is measured with electroencephalography (EEG). Biopsy: involves removing tissue samples and examining them, usually with a microscope. The examination often focuses on finding abnormal cells that might provide evidence of inflammation or of a disease, such as cancer. Tissues that are commonly examined include skin, breast, lung, liver, kidney, and bone. Analysis of genetic material: usually involves testing cells from skin, blood, or bone marrow. Genetic testing consists of an examination for abnormalities of chromosomes, genes, or both. Examination of genes includes analysis of DNA. Fetuses may undergo genetic testing to determine whether they have a genetic disorder. Children and young adults often undergo genetic testing to determine whether they themselves have a disease or are at risk of a disease. Adults sometimes undergo genetic testing to help determine the likelihood that their relatives, such as children or grandchildren, will develop certain diseases.

Risks and Results Every test has some risk The risk may be only the need for further testing if the result is abnormal, or it may be the possibility of injury during the test Doctors weigh the risk of a test against the usefulness of the information it will provide Normal test result values are expressed as a range, which is based on the average values in a healthy population; 95% of healthy people have values within this range, but average values are slightly different for women and men and also may vary by age. These values also vary somewhat among laboratories. Blood Tests Test Reference Range/Threshold (Conventional Units) Acidity (pH) 7.35-7.45 Alcohol (ethanol) 0 mg/dL (more than 0.1 mg/dL usually indicates intoxication) Ammonia 15-50 units/L Amylase 53-123 units/L Antinuclear antibodies (ANA; 0 (negative result) other antibodies can also be identified) Ascorbic acid 0.4-1.5 mg/dL Bicarbonate (carbon dioxide 18-23 mEq/L content) Bilirubin Direct: up to 0.4 mg/dL Total: up to 1.0 mg/dL Blood volume 8.5-9.1% of body weight

Calcium Carbon dioxide pressure (expressed as a comparison with how high the level of mercury [Hg] rises in a tube due to air pressure at sea level) Carboxyhemoglobin (carbon monoxide in hemoglobin) CD4 cell count Ceruloplasmin Chloride Complete blood cell count (CBC)

8.5-10.5 mg/dL (slightly higher in children) 35-45 mm Hg

Copper Creatine kinase (CK or CPK) Creatine kinase isoenzymes Creatinine Electrolytes

Erythrocyte sedimentation rate (ESR) Glucose Hematocrit

Less than 5% of total hemoglobin 500-1500 cells/L 15-60 mg/dL 98-106 mEq/L See individual tests: Hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular volume, platelet count, white blood cell count 70-150 g/dL Male: 38-174 units/L Female: 96-140 units/L 5% MB or less 0.6-1.2 mg/dL See individual tests: Electrolytes routinely tested include calcium, chloride, magnesium, potassium, and sodium Male: -13 mm/hr Female: 1-20 mm/hr Fasting: 70-110 mg/dL Male: 45-52%

Hemoglobin Iron Iron-binding capacity Lactate (lactic acid) Lactic dehydrogenase Lead Lipase Lipids: Cholesterol High-density lipoprotein (HDL) Low-density lipoprotein (LDL) Triglycerides Triglycerides Liver function tests

Female: 37-48% Male: 13-18 gm/dL Female: 12-16 gm/dL 60-160 g/dL (higher in males) 250-460 g/dL Venous: 4.5-19.8 mg/dL Arterial: 4.5-14.4 mg/dL 50-150 units/L 20 g/dL or less (much lower in children) 10-150 units/L Less than 225 mg/dL (for age 40-49 yr; increases with age) 30-70 mg/dL 60 mg/dL

40-200 mg/dL (higher in males) 40-200 mg/dL (higher in males) Include bilirubin (total), phosphatase (alkaline), protein (total and albumin), transaminases (alanine and aspartate), prothrombin Magnesium 1.5-2.0 mg/dL Mean corpuscular hemoglobin 27-32 pg/cell (MCH) Mean corpuscular hemoglobin 32-36% hemoglobin/cell concentration (MCHC) Mean corpuscular volume 76-100 cu m (MCV) Osmolality 280-296 mOsm/kg plasma

Oxygen pressure (expressed as 83-100 mm Hg a comparison with how high the level of mercury [Hg] rises in a tube due to air pressure at sea level) Oxygen saturation (arterial) 96-100% Phosphatase (alkaline) 50-160 units/L (higher in infants and adolescents, lower in females) Phosphorus 3.0-4.5 mg/dL Platelet count 150,000-350,000/mL Potassium 3.5-5.0 mEq/L Prostate-specific antigen 0-4 ng/mL (increases with age) (PSA) Protein: Total 6.0-8.4 gm/dL Albumin 3.5-5.0 gm/dL Globulin 2.3-3.5 gm/dL Prothrombin time (PT) 10-13 seconds Red blood cell (RBC) count 4.2-5.9 million/mL Sodium 135-145 mEq/L Thyroid-stimulating hormone 0.5-5.0 m units/L (TSH) Transaminase: Alanine (ALT) 1-21 units/L Aspartate (AST) 7-27 units/L Troponin: I Less than 1.6 ng/mL T Less than 0.1 ng/mL Urea nitrogen (BUN) 7-18 mg/dL Uric acid 3.0-7.0 mg/dL Vitamin A (other vitamins can 30-65 g/dL also be measured)

White blood cell (WBC) count 4,300-10,800 /mL * Blood can be tested for many other substances as well.

Units are explained in Appendix I. Conventional units can be converted to international units by using a conversion factor. International units (IU), a different system, is sometimes used by laboratories.

Diagnostic Procedures Procedure Amniocentesis Body Area or Sample Tested Fluid from the sac surrounding the fetus Any artery in the body; commonly in the brain, heart, kidneys, aorta, or legs Ears Description Analysis of fluid to detect an abnormality in the fetus X-ray study in which radiopaque dye is used to detect and outline or highlight a blockage or defect of an artery Assessment of the ability to hear and distinguish sounds at specific pitches and volumes Listening with a stethoscope for

Arteriography (angiography)

Audiometry

Auscultation

Heart

Barium x-ray studies

Biopsy

Esophagus, stomach, intestine, rectum Any tissue in the body

Blood pressure measurement Blood tests

Usually an arm Usually a blood sample from an arm

Bone marrow aspiration

Hipbone or breastbone

Bronchoscopy Cardiac catheterization Chorionic villus sampling

Airways of the lungs Heart Placenta

abnormal heart sounds X-ray study to detect ulcers, tumors, or other abnormalities Removal and examination of tissue sample under a microscope for cancer or another abnormality Test for high or low blood pressure Measurement of substances in the blood to evaluate organ function and to help diagnose and monitor various disorders Examination of marrow under a microscope for abnormalities of blood cells Direct examination for a tumor or other abnormality Study of heart function and structure Examination of a sample under a

Chromosomal analysis

Blood

Colonoscopy Computed tomography (CT)

Large intestine Any part of the body

Cone biopsy

Cervix

Culture

Dilation and curettage (D and C)

Sample from any area of the body (usually a fluid such as blood or urine) Cervix and uterus

microscope for an abnormality in the fetus Examination under a microscope to detect a genetic disease or to determine a fetus's sex Direct examination for a tumor or other abnormality Computerenhanced x-ray study to detect structural abnormalities Removal and examination of a cone-shaped piece of tissue Examination of microorganisms grown from a sample to identify infection with bacteria or fungi Examination of a sample under a microscope for an abnormality of the uterine lining Study of thickness

Dual X-ray absorptiometry Skeleton,

(DEXA)

Echocardiography

focusing on specific regions, usually hip, spine, and wrist Heart

of bones using a type of x-ray

Electrocardiography (ECG) Electroencephalography (EEG) Electromyography Electrophysiologic testing

Heart Brain Muscles Heart

Endoscopic retrograde cholangiopancreatography (ERCP)

Biliary tract

Endoscopy

Digestive tract

Study of heart structure and function using sound waves Study of the heart's electrical activity Study of brain's electrical function Recording of a muscle's electrical activity Test to evaluate rhythm or electrical conduction abnormalities X-ray study of the biliary tract after injection of a radiopaque dye using a flexible viewing tube to reach the biliary tract Direct examination of internal structures using a flexible viewing tube

Enzyme-linked immunosorbent assay (ELISA)

Fluoroscopy

Hysteroscopy

Intravenous urography

Joint aspiration

Laparoscopy

Usually blood The sample is mixed with a sample of allergens or microorganisms to test for the presence of specific antibodies Digestive A continuous x-ray tract, heart, study that allows a lungs doctor to see the inside of an organ as it functions Uterus Direct examination of the inside of the uterus with a flexible viewing tube Kidneys, X-ray study of the urinary tract kidneys and urinary tract after intravenous injection of a radiopaque dye Joints Examination of between fluid from the space bones, within joints for especially blood cells, crystals shoulder, formed from elbow, minerals, and fingers, hips, knees, organisms knees, ankles, toes Abdomen Direct examination for diagnosis and

Magnetic resonance imaging (MRI) Mammography Mediastinoscopy

Any part of the body Breasts Chest

Myelography

Spinal column

Nerve conduction study Occult blood test Ophthalmoscopy

Nerves Large intestine Eyes

Papanicolaou (Pap) test

Cervix

Paracentesis

Abdomen

treatment of abnormalities in the abdomen Magnetic imaging test for any structural abnormality X-ray study for breast cancer Direct examination of the area of the chest between the lungs Simple or computer-enhanced x-ray of the spinal column after injection of a radiopaque dye Test to determine how fast an impulse travels Test to detect blood in the stool Direct examination to detect abnormalities inside the eye Examination under a microscope of cells scraped from the cervix to detect cancer Insertion of a

Percutaneous transhepatic cholangiography

Liver, biliary tract

Positron emission tomography (PET) Pulmonary function tests

Brain and heart Lungs

Radionuclide imaging

Many organs

Reflex tests Retrograde urography

Tendons Bladder, ureters Rectum and

Sigmoidoscopy

needle into the abdominal cavity to remove fluid for examination X-ray study of the liver and biliary tract after injection of a radiopaque dye into the liver Radioactive imaging to detect abnormality of function Tests to measure the lungs' capacity to hold air, to move air in and out of the body, and to exchange oxygen and carbon dioxide Radioactive imaging to detect abnormalities of blood flow, structure, or function Tests to detect abnormalities of nerve function X-ray study of the bladder and ureters after infusion of a radiopaque dye Direct examination

Skin allergy tests Spinal tap (lumbar puncture) Spirometry

last portion of the large intestine Usually an arm or the back Spinal canal

to detect tumors or other abnormalities Tests for allergies

Stress test (exercise tolerance) Thoracentesis

Thoracoscopy

Tympanometry

Test for abnormalities of spinal fluid Lungs Test of lung function that involves blowing into a measuring device Heart Test of heart function with exertion The space that Removal of fluid surrounds the from the chest with lungs (pleural a needle to detect space) abnormalities Lungs Examination of the pleura and the pleural space through a viewing tube Ears Measurement of the impedance (resistance to pressure) of the middle ear, which helps in determining the cause of hearing

Ultrasonography (ultrasound scanning) Urinalysis

Any part of the body Kidneys and urinary tract

Venography

Veins

loss Ultrasound imaging to detect structural or functional abnormalities Chemical analysis of urine sample to detect protein, sugar, ketones, and blood cells X-ray study to detect blockage of a vein