Biology

Study Unit
Excretory,
Reproductive, and
Immune Systems
The body has one goalsurvival. Like all other body systems,
the systems that youll study in this unit help the body
achieve that goal. In this unit, well examine the excretory,
reproductive, and immune systems. The urinary and excre-
tory systems allow for proper elimination of wastes from the
body; without regular removal, wastes would build up to
toxic levels within the body. Although the male and female
reproductive systems may differ greatly in structure, they
both function to allow for survival of a species. Mating and
bearing offspring are possible because of the reproductive
system. The immune system defends the body against
viruses, parasites, bacteria, and fungi, while the lymphatic
system filters bacteria, transports fluid, and regulates blood
cells. The circulatory network of this system allows it to per-
form numerous tasks essential to our survival.
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When you complete this study unit, youll be
able to
Explain the anatomy and function of the excretory,
reproductive, immune, and lymphatic systems
List diseases of the excretory, reproductive, and
lymphatic systems
Identify tests and procedures to diagnose and treat
diseases of the excretory, reproductive, and lymphatic
systems
Use combining forms to build and analyze terms related
to the excretory, reproductive, and lymphatic systems
URINARY/EXCRETORY SYSTEM 1
The Anatomy and Physiology of Excretion 3
Pathology of the Urinary System 15
Tests and Procedures of the Urinary System 24
MALE AND FEMALE REPRODUCTIVE SYSTEMS 35
Anatomy and Physiology of the Male
Reproductive System 36
Anatomy and Physiology of the Female
Reproductive System 43
Pathology of the Reproductive System 56
Tests and Procedures of the Reproductive System 69
IMMUNE AND LYMPHATIC SYSTEMS 79
Anatomy and Physiology of the Lymphatic System 79
Pathology of the Lymphatic System 97
Tests and Procedures of the Lymphatic System 98
SELF-CHECK ANSWERS 101
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URINARY/EXCRETORY SYSTEM
The organs of the excretory (urinary) system are two kidneys,
two ureters (y-rtrz), the urinary bladder, and the urethra
(y-rthr). Because the male urinary tract shares some
common anatomy with the genital tract, the urinary and
reproductive systems are sometimes studied together as the
urogenital or genitourinary (GU) system. The branch of medi-
cine concerned with the male genital tract and the urinary
tracts of both genders is urology (yu-rol o-je ).
You may have heard the phrase what goes in must come
out. This applies to the human body. Everything we eat or
drink must either be used or eliminated. Waste elimination
occurs as a natural process of our daily lives. Most of us take
it for granted, but without proper excretion, waste products
would build up to toxic levels within our bodies. Youll recall
that the urinary system, lungs, skin, and intestines all have
roles in getting rid of the waste in our bodies. The process of
excretion (eks-kre shun) is very different from elimination (e-
lm -na shun), which is what we call the discharge of
digestive wastes from the GI tract.
Whether you drink a gallon or a glass of water a day, whether
you salt every bite of food you eat or leave the shaker alone,
your body has to keep its fluid and salt content at a steady
level to function properly. Your very survival depends on a
stable internal environment of body fluids, temperature,
blood pressure, and countless other factors. The term body
fluid refers not just to the water that makes up 60 percent of
the human bodys weight; it also includes the substances dis-
Excretory, Reproductive,
and Immune Systems
Excretory, Reproductive, and Immune Systems
2
solved in the water, most importantly the electrolytes (e-
lek tro-lts), chemicals that conduct electrical impulses. Youll
recall that fluid both fills and surrounds each cell. About
two-thirds of all body fluid is within cells, in the intracellular
compartment; the remaining fluid is outside of cells, in the
extracellular compartment. The body must keep a correct elec-
trolyte balance in these fluids for the proper function of
muscle and nerve cells.
The urinary system functions as the bodys main waste dis-
posal, flushing away the garbage that results from the
metabolic processes in every cell of the body. It also helps to
maintain the proper pH (acid-base) balance of the blood.
Failure of the urinary system to do its job is fatal to the body.
If the nitrogenous ( n-troj-ns) (nitrogen-containing) wastes
of protein metabolism build up in the bloodstream, a toxic
condition called uremia (u-reme-ah) will result (UR/O means
urine; -EMIA means blood).
The kidneys, the most important organs of the urinary sys-
tem, also have an endocrine function because they secrete
substances that influence the function of other body parts.
For example, they secrete the enzyme renin (re nn), which
plays an important role in regulating blood pressure; the
hormone erythropoietin (e-rth ro-poi e-tn), which stimulates
the maturation of red blood cells in the bone marrow; and
vitamin D, which makes it possible for the intestines and the
bones to absorb calcium.
The processes of the urinary system can be broken down
as follows:
1. Filtration (fl-tra shun)removing toxic wastes and excess
substances from the blood
2. Formation of urineconverting wastes and excess sub-
stances into urine
3. Micturition (mk chu-rsh un) (also called urination [yu r-
na shun] or voiding)excreting urine from the body
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The Anatomy and
Physiology of Excretion
The combining form MACR/O means large, and MICR/O
means small. The suffix -SCOPIC means pertaining to
visual examination. Thus the term macroscopic (mak ro -
skop k) is used to refer to objects visible to the unaided eye,
and microscopic (m kro-skop k) refers to objects too small to
be seen without magnification. The instrument used to mag-
nify microscopic objects is a microscope (mkro-sko p).
Macroscopic anatomy (-nat o-me ), also called gross (gro s)
anatomy, is the study of body structures we can see without
a microscope. Microscopic anatomy, or histology (hs-tol o-je ),
is the study of minute structures. Because of the unique
structure of the urinary system, its important to understand
both its macroscopic and its microscopic anatomy.
Macroscopic Structures
Your kidneys look like a pair of reddish-brown kidney beans
(which is how those beans get their names!), each about the
size of a computer mouse. The kidneys lie in the posterior
aspect of the upper abdomen. If you stand up, put your
hands on your hips, and touch your thumbs together over
your backbone, your kidneys will be just above each thumb,
with the left kidney a little higher than the right one. The
right kidney is just below the liver, and the left kidney is just
below the spleen. Theyre located beneath a layer of muscles
and a cushion of fat just under your ribs, not in the peri-
toneum. Along with the aorta and inferior vena cava, the
kidneys are located behind the peritoneal cavity in the
retroperitoneum (rtr-pr--t-nm). Thus, the kidneys are
said to be retroperitoneal (rtr-pr--t-nl).
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The kidneys are complex organs made up of several macro-
scopic parts. Youll notice the word renal a lot because the
combining form REN/O means kidney, as does NEPHR/O.
Refer to Figure 1 as you learn about the macroscopic struc-
tures of a kidney:
The renal cortex (re nal kor teks) is the outer layer. In
Latin, cortex means bark, as in the kind that covers
trees. In the body, a cortex is the outer portion of a
structure.
The renal medulla (me-du l ah) is the inner portion.
Medulla means marrow, and in reference to the body,
its the deep, inner part of a structure.
The renal pyramids (pe r ah-mdz) are the cone-shaped
masses that make up the renal medulla. They contain
the tubules and the apparatus for secretion. The cavity
in which they lie is called the renal sinus.
The renal papilla (pah-pl ah) (plural, papillae [pah-pl a ])
is the narrow, inner tip of any of the pyramids along the
sinus wall, through which urine passes out.
Renal columns are bands of granular tissue separating
adjacent renal pyramids. The renal columns contain ves-
sels and urinary tubes that run to the cortex.
The calix (ka lks) (also spelled calyx; plural, calices [ka l-
sez]) is the cuplike recess of the renal pelvis, enclosing
the pyramid and receiving urine from the papilla. Two or
three minor calices will join to form a major calix.
The renal pelvis (pel vs) is the funnel-shaped upper end
of the ureter that the calices open into. It accepts the
urine and channels it through the hilum (h lum) and into
the ureter.
The hilum (h lum) or hilus (h lus) is the medial indenta-
tion of the kidney. Hilus refers to any depression or pit
through which the vessels and nerves enter an organ.
The renal pelvis, renal vein, and renal artery are located
at the renal hilus.
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Take a look again at Figure 1, which shows the structure of
the right kidney through a coronal plane. (The coronal plane
divides the body vertically, into anterior and posterior por-
tions.) See how large the renal blood vessels are in diameter?
Thats not an artists mistake! The arteries really are large to
let lots of blood into the kidneys so they can do an efficient
cleaning job. A high rate of blood flow through the kidneys
the heart pumps over 20 percent of its blood flow straight to
the kidneysis essential for the formation of urine. This high
flow rate exerts high pressure on the narrow renal capillaries,
forcing the blood through the kidneys microscopic filters,
the thin blood-vessel walls of its nephrons (nef ronz).
Now that you know the gross anatomy of the kidney, you can
better understand the physiology of the urinary tract. Waste-
laden blood is carried into the kidney via the renal artery,
and the blood is purified by those microscopic filters called
nephrons. Clean blood leaves the kidney via the renal vein.
Meanwhile, the waste material thats now urine is funneled
through the renal pelvis into the ureter (yu-re ter), a 10- to
12-inch duct that uses peristalsis (muscle contractions) to
move urine along to the bladder.
The urinary bladder is a reservoir made of muscular walls
lined with a loose mucous membrane that wrinkles into folds
called rugae (rga ) when its empty. Sounds a lot like the
Minor Calix
Major Calix
Renal Cortex
Renal Artery
Renal Vein
Renal Pelvis
Ureter
Renal Column
Medulla
Pyramid
Papilla
FIGURE 1Coronal Section
through the Right Kidney
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stomach, doesnt it? The bladder lining has a smooth, close-
to-the-muscle section called the vesical trigone (ves -kal
tr gon). The term trigone means triangular area, and the
three corners of the vesical trigone are where the two ureters
enter and the urethra exits.
As a storage reservoir, the bladder has its
limitsabout 1
1
/
2
pints. When the blad-
der expands enough to stimulate the
nerves that initiate the emptying reflex,
the internal urethral sphincter (yu-re thral
sfngk ter) is automatically released.
Urine then passes into the urethra (yu-
re thrah), the tube leading from the
bladder to the surface, and the person
has a strong desire to empty the bladder.
The adult males urethra is approximately
7 inches long; it passes through the
penis, and also conveys semen. The
females urethra is 1
1
/
2
inches long and
surfaces between the clitoris and the
vagina.
The external urethral sphincter, at the end
of the urethra, is the last valve holding
the urine back. This sphincter is under
voluntary control after the age of two or
three. The opening through which urine
leaves the body is the urinary meatus
(yur-nere me-a tus)a meatus is an
opening or a passage. Figure 2 shows all
the macroscopic structures of the urinary
system.
Kidneys
Ureters
Bladder
Urethra
Internal
Urinary
Sphincter
External
Urinary
Sphincter
FIGURE 2The Macroscopic Structures of the
Urinary System
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Microscopic Structures
You may be wondering how, exactly, does the kidney clean
the blood. How does it know which substances to remove
and which ones to return to the bloodstream?
If you put a section of kidney tissue under a microscope,
youll find a bunch of unique little structures that look like
funnels with squiggly edges: these are the nephrons (Figure
3). There are over a million nephrons in each kidney. Each
nephron is like a mini-factory that filters blood, removes
wastes, and reabsorbs essential electrolytes and compounds.
They may be microscopic, but theyre complex in structure
and have a very big job. Homeostasisand thus human life
cant be maintained without the nephrons (or an artificial
kidney to do their work).
There are actually two different kinds of nephrons. Cortical
nephrons have their corpuscles (kor puslz) (cellular bodies)
in the cortex and take care of excretion and regulatory func-
tions. These account for about 85% of the nephrons in our
bodies. The juxtamedullary nephrons (jkst-mdy-lr
nfrnz) have their corpuscles near the medulla, and their
job is to concentrate and dilute urine.
Efferent Arteriole
Afferent Arteriole
Glomerulus
Bowmans Capsule
Artery
Vein Proximal
Tubule
Capillaries
Loop of Henle
Collecting Tubule
Distal
Tubule
FIGURE 3A Nephron
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Each nephron has two main sections: the renal corpuscle is
the part that provides the initial filtering; and the renal tubule
(t byul) is a winding passage that takes care of reabsortion
and secretion.
Renal corpuscle. There are two parts to this filtering sec-
tion of the nephron. The sac-like Bowmans capsule cups
around the glomerulus (glo-meryu-lus), a network of blood
capillaries that accept blood into the nephron for filtration.
Remember that the renal artery is what brings the blood into
the kidney for filtering, and the renal vein is what takes the
clean blood back to the heart. The renal artery branches off
into smaller and smaller vessels within the kidney until it
reaches the nephron. Arterioles are the smallest vessels
before the capillaries that make up the glomerulus. (Do you
remember from the circulatory system that capillaries are so
small that they allow blood cells through only in single file?)
The vessel that leads to the glomerulus is called an afferent
arteriole (af er-rent ar-te re-ol), while the vessel conveying
blood away from the glomerulus is called an efferent arteriole
(efer-ent). You can remember the difference by remembering
that blood arrives by an afferent arteriole and exits by an
efferent arteriole.
If you look at Figure 3, youll see that the afferent arteriole
carrying dirty blood feeds into the capillary mass of the
glomerulus through the hole at the top of the Bowmans cap-
sule. As in capillaries in other parts of the body, the fluid,
electrolytes, and other particles pass through glomerular
wallsthe first stage of the filtering action by the kidney.
This filtered material (filtrate) is absorbed by the Bowmans
capsule, and the remaining blood is carried away by the
efferent arteriole and out to the renal vein. The filtrate then
enters the proximal tubule of the nephron.
A large amount of water and other substances are filtered
through the glomerulus each day. The rate of filtration is the
glomerular filtration rate (GFR), an important measure of kid-
ney function. Note that not all the filtered fluid is excreted as
urine. If so, you might urinate as much as 180 liters a day!
The average rate of urine production is approximately one to
one and a half liters per day. What happens to the rest of the
filtrate? Ninety-nine percent of the remaining filtrate is reab-
sorbed into the bloodstream from the tubules.
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Renal tubule. Renal pyramids (Figure 4) are cone-shaped
tissues of the kidney that are formed by straight parallel seg-
ments of nephrons.
FIGURE 4Portion of a
Renal Pyramid Glomerulus Distal Tubule
Cortex
Bowmans
Capsule
Proximal Tubule
Loop of Henle
Papilla of Pyramid
Calix of
Renal Pelvis
Major Calix
Renal Pelvis
Papilla
Pyramid
Medulla
Renal
Column
Ureter
Renal Vein
Renal Artery
Renal Cortex
Collecting Tubule
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There are four parts to this section of the nephron. First is
the proximal convoluted (prok s-mal kon-vo-lu-ted) tubule,
called convoluted because of its many twists and turns.
This tube has an extension called the loop of Henle (hen le ),
which looks like a stretched-out hairpin. Next comes the
distal (ds tal) convoluted tubule, and finally the collecting
tubule, a straight section thats really the joining of the distal
tubules of several nephrons. The filtrate passes sequentially
through these parts, while substances are added or removed
from the filtrate during the process. The filtrate ultimately
drains into the renal pelvis. All the nephrons empty their fil-
trate here. Then the filtrate leaves the kidney by way of the
single ureter.
The proximal tubules reabsorb water as well as glucose,
amino acids, vitamins, bicarbonate, and electrolytes.
Reabsorption means that the substances are deposited back
into the blood. The amount thats reabsorbed depends on
what the body needs. If youre dehydrated, the kidneys will
reabsorb even more salt and water than usual. If you drink
too much fluid, the kidneys will allow much more water to
pass into the urinary stream instead of reabsorbing it. Think
of tubular reabsorption as blood reabsorption. The blood
absorbed these nutrients the first time (mostly from the
intestines), but they were filtered out by the glomeruli and
sent to the tubules. The tubules determine which of these
things the blood needs to reabsorb to benefit the body, and
which need to continue along the tubules. The opposite of
reabsorption is tubular secretion. Particles are secreted from
the peritubular (pr-tby-lr) capillaries into the tubular
lumen. Tubular secretion sounds like the opposite of what it
really is, since materials are being secreted into the renal
tubes themselves.
The loop of Henle, also called the nephron loop, concentrates
salt in the tissue surrounding it. The distal convoluted tubule
regulates pH and also produces ATP for active ion transport.
This portion of the tubule is largely regulated by hormones
such as parathyroid and aldosterone. Finally, whats left of
the filtrate passes through the collecting tubule, where water
is reabsorbed into the blood stream if needed. If not needed,
it continues along to the renal papillae, calyces, renal pelvis,
ureters, and eventually the bladder.
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To recap, the nephrons form urine in a three-part process:
1. Filtration (f l-tra shun)Blood pressure forces water and
dissolved substances out of blood, through membranes
of the glomerulus, and into the Bowmans capsule.
2. Reabsorption (re ab-sorp shun)Substances that the
body can use (such as water, glucose, and other nutri-
ents) pass through the renal tubules back into the
bloodstream via adjacent capillaries. Salts such as
sodium, potassium, and chloride will be either reab-
sorbed or retained in the filtrate, depending on the
bodys electrolyte balance.
3. Secretion (se-kre shun)Wastes and excess substances
are secreted directly into the collecting tubules as urine,
which drains through the renal pelvis and ureter into the
bladder.
Besides water, which composes 95 percent of urine, the next
largest component is urea (yu-re ah) (the chief waste product
of protein metabolism). Other nitrogenous wastes in the urine
are uric acid and creatinine. Ammonia will be present, and so
may the electrolytes sodium, potassium, calcium, phosphate,
chloride, and magnesium.
All together, the nephrons draw approximately 180 quarts of
fluid out of the blood daily, and return 97 to 99 percent of
the water back to the body, along with the dissolved sub-
stances the body can use.
Between food and liquid, the average person takes in about
two and a half quarts of water each day. The digestive tract
absorbs most of this water into the bloodstream. Some of the
excess water and metabolic wastes are discharged through
the digestive tract in feces, through the skins glands as
sweat, and through the lungs in the form of water vapor. But
most fluid that leaves the body is excreted through the uri-
nary systemsomewhere around one and a half quarts per
day. However, the volume of urine varies, depending on the
balance of water, acid, and sodium in the body. Figure 5 dia-
grams the process of urine formation and excretion.
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Bloodstream
Glomerulus
Bowmans Capsule
Renal Tubule
Renal Pelvis
Ureter
Bladder
Urethra
Urinary Meatus
Renal Arteriole
Water
Sugar
Salts
Urea/Other Wastes
Urea/Wastes
Salts
Water
Acids
Urine
Urine is expelled
from the body.
Acids
Secretion
Filtration
Reabsorption
Water
Sugar
Salts
FIGURE 5The Process of Urine Formation and Excretion
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Control of Urinary Secretion
The selective reabsorption or secretion of materials in the
urine is regulated by chemical and nervous system control.
Two main systems of chemical control are the ADH system
and the renin-aldosterone system. Antidiuretic (nt-d-y-
rtik) hormone (ADH), is secreted by the hypothalamus in
response to high sodium concentrations in the blood, which
is called hypernatremia (hpr-n-trm-ah). To lower the
salt concentration, ADH works on the tubules to promote
reabsorption of water. This excess water enters the blood-
stream and dilutes the sodium, thus bringing the sodium
concentration back to normal. The name antidiuretic hor-
mone implies that this hormone counteracts the effects of
diuretics. Diuretics are substances that prevent reabsorption
of water into the bloodstream. Thus, ADH allows reabsorption
of water, reducing the amount of water in the urinary filtrate;
whereas diuretics increase the water volume in the urinary
filtrate. Common substances such as alcohol and caffeine are
diuretics. Thats why people have to urinate more often after
drinking alcohol, coffee, and tea. Some drugs are powerful
diuretics that can greatly increase urine output. These drugs
are given to people with congestive heart failure who have too
much intravascular volume. Diuretics allow the kidneys to
eliminate more water volume from the bloodstream.
The aldosterone-renin system works in a different way. The
kidneys can detect blood pressure thats too low. In response,
the kidneys produce a hormone called renin, which in turn
stimulates the adrenal glands to produce aldosterone. This
substance promotes the reabsorption of sodium and water
from the tubules into the bloodstream. This raises the blood
pressure. The kidneys also produce another hormone called
erythropoietin (ERYTHR/O refers to red blood cells). This hor-
mone stimulates the bone marrow to produce red blood cells.
Chronically diseased kidneys dont produce enough erythro-
poietin, which ultimately results in anemia.
Now, review the material youve studied here. Once you feel
you understand the material, complete Self-Check 1. Then
check your answers with those provided at the end of this
study unit. If youve missed any answers, or you feel unsure
of the material, review this section until you feel that you
understand the information presented.
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Self-Check 1
At the end of each section of Excretory, Reproductive, and Immune Systems, youll be
asked to pause and check your understanding of what youve just read by completing a
self-check exercise. Answering these questions will help you review what youve studied
so far. Please complete Self-Check 1 now.
Questions 110: Match the word on the left with its description on the right. Indicate your
choices in the spaces provided.
______ 1. Glucose
______ 2. Hilum
______ 3. Reabsorption
______ 4. Micturition
______ 5. Efferent arteriole
______ 6. Renal
______ 7. Ureter
______ 8. Loop of Henle
______ 9. Urethra
______ 10. Sphincter
Check your answers with those on page 101.
a. The medical term for urination
b. Pertaining to kidneys
c. Tube that empties urine from the bladder
d. A sugar the urinary system sends back into the
bloodstream
e. Useful substances pass back into the bloodstream
f. Tube leading from kidney to bladder
g. Muscular valve that controls the bladder
h. Medial indentation of the kidney
i. The bottom of the nephrons hairpin shape
j. Conducts blood away from the glomerulus
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Pathology of the Urinary System
Believe it or not, healthy urine is sterile. However, it doesnt
take long for bacteria to grow and cause problems. One of the
earliest conditions of the urinary system is diaper rash in
babies, caused by the decomposition of urine into ammonia.
Obstructions and infections of the urinary tract can quickly
lead to renal insufficiency, or the reduction in the kidneys
ability to function. Dysfunction of urinary organs, particu-
larly of the kidneys, can lead to serious problems with other
body systems. As a close look at the pathology of urinary
organs will show, the urinary system must function properly
for the other body systems to function properly. Nowhere is it
more evident that body systems work together as a whole.
Diseases of the Kidney
Pyelonephritis (p e-lo-ne-fr ts), one of the most common dis-
eases of the kidney, is a suppurative (supyu-ra tv), or
pus-forming, inflammation. Suppuration (supyu-ra shun),
also called purulence (pyr-lns), is the bodys formation or
discharge of pus to fight infection. This particular inflamma-
tion of the kidney and renal pelvis is caused by the pyogenic
(p o-jen k) (which also means pus-forming) bacteria
Escherichia coli (esh -rk e-ah ko l) (or E. coli). Abscesses will
form and rupture, and then urinalysis will reveal pyuria (p-
yur e-ah), or pus in the urine, bacteriuria (bak-ter e-yur e-ah)
(bacteria in the urine), and often hematuria (hem aht-yur e-
ah) (blood in the urine) as well. Symptoms of this infection
are chills, fever, sudden back pain, and dysuria (ds-yur e-ah)
(painful urination). Pyelonephritis can become severe if the
abscesses fuse together and fill the kidney with pus. This will
cause renal failure. Antibiotics will counteract the infection.
Pyelitis (p e-l ts), inflammation of the renal pelvis, is a fairly
common disease, often caused by E. coli but sometimes by a
bladder infection (cystitis [ss-t ts]). Symptoms include
painful, frequent urination. Pyelitis is easy to treat with
antibiotics if caught early in its development, but if the infec-
tion spreads it can develop into pyelonephritis.
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Interstitial nephritis (n ter-stsh al ne-fr ts) is an inflamma-
tion that can occur in the connective tissue between the
renal tubules, the renal interstitium (n ter-stsh-um). This
condition may develop as a side effect of certain drug treat-
ments. Fever, rash, and renal insufficiency are some of the
symptoms, which will all be reversed with discontinuation of
the drug that caused the inflammation.
Glomerulonephritis (glo-meryu-lo-ne-fr ts) is inflammation of
the capillary loops of the glomeruli. There are two common
formsacute (ah-kyut) and chronic (kron k). The first form,
acute glomerulonephritis (AGN), is a common disease of chil-
dren and young adults, usually following an infection caused
by streptococci, such as strep throat, scarlet fever, or rheu-
matic fever. AGN is often accompanied by common symptoms
such as headache, fatigue, back pain, and sometimes a fever.
Edema (e-de mah) (puffiness due to fluid retention) of the face
and ankles may also occur. Urinalysis finds albuminuria
(al byu-mn-u re-ah), or the presence of the protein albumin
(al-byu mn) in the urine. Casts (kasts), coagulated masses of
blood and protein that form in the renal tubules and have
taken on their shape, will be present; and blood in the urine
(hematuria) may also be found. There is no pyuria, so the
condition is called nonsuppurative. Bed rest and diet are usu-
ally successful treatments.
In a small number of cases, acute glomerulonephritis can
turn into a chronic condition. Chronic glomerulonephritis
(CGN) can affect someone who never exhibited symptoms.
Repeated acute attacks can also lead to a chronic condition.
There are a variety of rather unpredictable symptoms but one
common denominator: steady, progressive, and permanent
damage to the kidneys. The condition can persist off and on
for years. Many victims exhibit three stages of the disease:
first, a latent stage of few symptoms; next, edema (-dm)
becomes evident in the face and limbs; and finally, renal fail-
ure. At the last stage, the kidneys have atrophied (tr-fd)
(shriveled) and are referred to as granular contracted (granyu-
lar kon-tract ed) kidneys. Kidney failure results in uremia
(yu-re me-ah), a toxic level of urea, creatinine, and other
nitrogenous wastes in the blood. Theres no cure for chronic
glomerulonephritis, but there are treatments that can prolong
life, such as a kidney transplant or hemodialysis (he mo-d-
al s-ss) through an artificial kidney.
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Glomerulonephritis isnt the only condition that can cause
the kidneys to stop secreting urine. Whatever the cause
whether its severe hemorrhage, ingestion of poisons, shock,
or kidney dysfunctionlack of blood flow to the kidneys can
cause renal failure. The kidneys must be able to filter nitroge-
nous wastes from the blood, or uremia will result. Acute renal
failure usually results from severe dehydration or shock, for
instance during surgery or after an incompatible blood trans-
fusion. Symptoms include oliguria (ol -gur e-ah), a sudden
drop in urine volume. Sometimes the drop is total, with no
urine produced, a condition called anuria (ah-nur e-ah). Also,
excess potassium in the bloodstream, termed hyperkalemia
(hper-kah-le me-ah), can lead to muscle weakness and even
slow the heart down to the point of cardiac arrest. Acute
renal failure can usually be treated by restoring the patients
blood volume, correcting the underlying problem, and giving
the kidneys a rest until they can regenerate.
Chronic renal failure (CRF) is another story. Since its the
result of a long-term, degenerative disease, such as chronic
glomerulonephritis, hypertension, or diabetes mellitus,
theres minimal chance of recovery. The accumulation of poi-
sons in the blood has multiple adverse effects on all the
systems of the body.
Also called renal hypernephroma (h per-ne-fro mah), renal
cell carcinoma (kar s-no mah) is a cancerous tumor that will
enlarge and eventually destroy the kidney. Unfortunately,
metastasis often occurs before symptomshematuria and a
palpable abdominal mass (a lump able to be felt by touch)
reveal the presence of the tumor. Some late symptoms are
pain, anorexia, weight loss, and anemia. Surgery is the most
successful treatment.
Wilms tumor (vlmz t mer) is a form of kidney cancer that
develops in young children. It spreads very quickly through
the blood and lymph vessels, but surgery, radiation, and
chemotherapy have a high success rate before metastasis.
Nephrolithiasis (nef ro-l-th ah-ss) is a condition caused by
kidney stones. Medically known as urinary calculi (u r-ner e
kal kyu-l ), kidney stones resemble gallstones in that they can
be present for a long time with no symptoms and then cause
intense pain when they pass through the system (Figure 6).
18
Kidney stones develop when minerals in the urine, especially
excess calcium, settle out of the solution and harden. Small
stones will pass unnoticed in the urine, but larger ones can
get lodged in the ureter, causing spasms of pain called renal
colic (kol k). A type of very large stone called the staghorn
calculus (kal kyu-lus) develops in the renal pelvis, filling it
completely and taking on the antler shape of the calices.
Stones can also form in the bladder and obstruct the flow of
urine, causing urinary tract infections.
Medication can sometimes dissolve kidney stones, and
patients who tend to develop stones can take drugs that pre-
vent new ones from forming. Surgery used to be a common
method of removing larger stones, but lithotripsy (lth o-
trpse ), the crushing of stones by shock waves, has become
the procedure of choice. Lithotripsy breaks hard stones down
into sand-sized particles that will pass in the urine. If the
patient is immersed in a tank of water, the process is called
hydrolithotripsy (h dro-lth o-trp se ), and nephrotripsy
(nef ro-trp se ) takes place out of water. Other related terms
FIGURE 6Urinary Calculi
Multiple Calculi
Renal Pelvis
Ureter
Staghorn
Calculus
19
are percutaneous ultrasonic (per kyu-ta ne-us ul trah-son k)
lithotripsy (PUL) and extracorporeal (eks trah-kor-po re-al)
shock wave lithotripsy (ESWL).
When the kidney becomes dilated with urine from any kind of
obstructiontumor, kidney stones, enlarged prostate, and so
onthe condition is called hydronephrosis (h dro-ne-fro ss)
(Figure 7). The ureters also dilate because of pressure from
backed-up urine, and theyre called hydroureters (h dro-yur-
et erz). A greater degree of blockage will cause more pain.
Infection may develop from the stagnated urine, and fever is
another possible symptom. The first goal of treatment is to
drain the urinary tract. Further treatment depends on the
cause: for instance, antibiotics for bacterial infections, dila-
tion of the ureter or urethra for some obstructions, or surgery
for certain tumors.
The kidney is a secondary site of infection for tuberculosis
(too-ber kyu-lo ss). Within the body, tubercle bacilli
(too berkl bah-sl ) (small nodules of bacteria) can lie dor-
mant for many years. At some time after the primary
tubercular infection in the lungs, a tubercle bacillus reinfects
the body, in this case the kidney. Any organ in the body can
FIGURE 7Hydronephrosis
Dilated Ureters
Bladder
Urethra
Kidney Enlarging
(Compensating)
Bilateral Hydronephrosis Unilateral Hydronephrosis
Obstruction
by Enlarged
Prostate
Obstruction
by Calculus
Kidney
Deteriorating
20
be a secondary site of tuberculosis, but the kidney is proba-
bly the most common. Lesions form, breaking down kidney
tissue and destroying the organ. As the dead tissue passes
through the urine, the infection can spread throughout the
urinary system. Pus, blood, and tubercle bacilli all will be
present in the urine. If antitubercular drugs arent given to
control this disease, kidney failure and death will result.
The polycystic (pol e-ss-tk) kidney is, just as it sounds,
enlarged by masses of cysts. This is a hereditary congenital
(kon-jen -tal) disease, meaning the defect is programmed into
the genes before birth. In children, the disease is called child-
hood polycystic kidney disease (CPKD) and causes pain,
hematuria, urinary tract infection, kidney stones, and other
problems at some point between birth and age 10. The liver
is also affected, with the disease ending in kidney and liver
failure. However, the condition usually doesnt develop until
adulthood. In adult polycystic kidney disease (APKD), the
cysts tend to appear during the patients thirties, and renal
failure will occur by age 60. Theres no cure for polycystic
kidney disease, though renal dialysis and kidney transplants
can prolong life.
Diseases of the Urinary Bladder and Urethra
Cystitis (ss-t ts), inflammation of the urinary bladder, can
ascend through the urethra from outside the body, or
descend to the bladder from an infection present in the kid-
ney. Obviously, the latter descending type is more serious,
since in that case cystitis isnt a lone disease but a complica-
tion. The ascending urinary tract infection (UTI) is more
common in females, since the passage from bladder to sur-
face is short. (The longer male urethra inhibits the passage of
bacteria in the wrong direction.) Simple cystitis is often
caused by the bacteria Escherichia coli (E.coli) present in the
fecesand thus hygienists recommend that women clean
themselves from front to back after defecation or urination.
Cystitis will cause a burning sensation during urination.
Frequency and urgency (ur jen-se ) (immediate need to void)
are also cystitis symptoms. Bacteria, casts, and pus will be
present in the urine. The infection is treated with
antimicrobial agents (an t-m-kro be-al a jents), medications
that kill microorganisms.
21
Bladder cancer is thought to be caused by certain chemicals
used in industry, substances in cigarette smoke, and certain
artificial sweeteners. The bladder is the urinary systems
most common site of malignant neoplasms. Tumors of the
bladder, viewed with a cystoscope (ss to-skop), look like lit-
tle fingers reaching into the bladder. The early symptom is
painless hematuria. Later, after the cancer has spread, there
often may be urinary frequency and dysuria. The appropriate
treatmentdrug therapy, cauterization (kaw ter--za shun)
(burning away cancerous tissue), or surgerydepends on
how far and wide the cancer has gone into the muscular wall
of the bladder.
As youve probably realized by now, just about any part of
the human body can come down with an -ITIS! Urethritis
(yu re-thr ts), inflammation of the urethra, can be caused by
bacteria, viruses, or chemicals. However, the most common
cause in males is a gonococcus (gon o-kok us), the bacteria
that causes gonorrhea, which is the most prevalent sexually
transmitted disease (STD) in the United States. In females,
urethritis frequently tags along with cystitis or is caused by
an obstruction or irritation of the urinary meatus (by tight
pantyhose, for instance). Urethritis causes several symptoms:
discharge of pus, itching of the urinary meatus, and burning
sensation upon urination.
Phimosis (f-mo ss) is purely a male conditionstenosis (ste-
no ss) (narrowing or closing) of the prepuce (pre pus), the
foreskin, over the tip of the penis. Obstructed flow of urine
and infection may result. Treatment is circumcision (ser kum-
szh un), surgical removal of the foreskin.
Problems related to urinary control are urinary incontinence,
urinary retention, and neurogenic bladder. Incontinence is the
inability to control urination. Most people can hold urine in
the bladder until its convenient to urinate. People who are
incontinent may urinate spontaneously or after coughing or
sneezing. This condition is an embarrassing and socially crip-
pling problem. Individuals at risk for developing incontinence
include women who have had multiple children and people
with stroke or spinal cord injuries. Urinary retention is the
opposite problemthe person cant urinate despite having a
22
full bladder. A frequent cause of urinary retention is inges-
tion of drugs that tighten the sphincter between the bladder
and urethra.
23
Self-Check 2
Questions 15: Write the correct -URIA term after its definition.
EXAMPLE: Presence of ketone in urineketonuria
1. Presence of pus in urine____________________________________________________
2. Difficult or painful urination ________________________________________________
3. Blood in urine____________________________________________________________
4. Scanty urination__________________________________________________________
5. Serum protein in urine ____________________________________________________
Questions 610: Briefly define each term.
6. Nephrolithiasis __________________________________________________________
__________________________________________________________
7. Cystitis ________________________________________________________________
__________________________________________________________
8. Polycystic kidney ________________________________________________________
__________________________________________________________
9. Hydronephrosis __________________________________________________________
__________________________________________________________
10. Chronic glomerulonephritis ________________________________________________
__________________________________________________________
24
Tests and Procedures of the
Urinary System
Lower abdominal pain, painful urination, blood or pus in the
urine, and edema are all among the symptoms that indicate
dysfunction of the urinary system. To determine the specific
disease causing such symptoms, the physician will depend
on two general types of tests: laboratory analyses of urine
(and sometimes of blood), and diagnostic procedures that
allow visualization of the urinary tract.
Laboratory Tests
One blood test done to analyze the level of nitrogen is called
blood urea nitrogen (yu-re ah n tro-jen), or BUN. Since a pri-
mary objective of the urinary system is to remove nitrogenous
wastes from the blood, the urea level should be very low. An
elevated blood urea level results from all the major kidney
diseasesfor example, pyelonephritis, glomerulonephritis,
and obstructions caused by cancer or calculi. Similarly, a
serum creatinine (se rum kre-at -nn) test measures the
amount of creatinine (a breakdown product of the acid that
muscles use to create ATP) in the blood. Again, high levels
show the kidney isnt doing a good job of filtering the nitroge-
nous waste from the blood. A creatinine clearance test of
urine measures the glomerular filtration rate (GFR). Both
serum and urine can be tested to determine measurements of
proteins in the albumin/globulin (A/G) ratio.
The laboratory examination of urine, known as urinalysis
(yur -nal -ss) (UA), can help the physician evaluate the
health of various body systems, not just the urinary system.
Urinalysis ranges from macroscopic examination of the
urines color and consistency, to microscopic examination of
substances in the urine, to chemical tests. A urine culture
(kul cher) can be propagated (grown) to determine what
microorganisms are present, and to test the effectiveness of
certain antibiotics against them. Even the odor of urinenor-
mally only slightcan reveal important diagnostic evidence. A
sweet, fruity odor, for instance, indicates the presence of ace-
tone, a substance diabetic individuals produce in abnormal
quantities. Urine testing is probably one of the oldest forms
25
of diagnosis. Ancient and medieval doctors examined urine
by smelling it, looking at it, and even tasting it to determine
all kinds of problems in their patients. Luckily, today, we
dont have to use the taste test!
Heres a sampling of the sorts of elements looked at in a typi-
cal urinalysis:
ColorBecause of the presence of the pigment urochrome
(yu ro-krom) (-CHROME means color, pigment), normal
urine is various shades of yellow, depending on the con-
centration of water and wastes. Blood will tint urine a
reddish-brown called smoky. Pale, almost white urine
indicates that mostly water is being excreted, as with
diabetes or degenerative kidney disease. Normal urine
will be described as clear, straw, or amber.
PusThe product of inflammation, pus makes urine
cloudy, or turbid (tur bd). Pus contains large numbers of
leukocytes, which the body always produces with infec-
tion or inflammation. Pyuria (pus in the urine) indicates
inflammation in the kidney or bladder.
CastsThe accumulation of red blood cells, pus, fat, and
other substances in the renal tubules can form tubule-
shaped objects known as casts. Microscopic examination
of casts helps the physician determine what pathological
condition led to their formation.
Specific gravityThis measurement is calculated as the
weight of a substance compared with the weight of an
equal volume of water, with the specific gravity of water
being 1. The specific gravity of urine normally ranges
from 1.015 to 1.025, but when the kidneys are unable to
concentrate urine, the specific gravity will be fixed very
low (1.001 to 1.010) because so much water will be
passed. High specific gravity (1.025 to 1.030) accompa-
nies hepatic disease, congestive heart failure, and
diabetes mellitis (the latter because of the presence of
sugar in the urine). Specific gravity is measured by an
instrument called a hydrometer (h-drom e-ter).
pHThis measurement reveals the acid-base balance of
a solution. Normal urine is around pH 6.5, slightly
acidic. High acidity goes along with acidosis, fever,
26
emphysema, diarrhea, and dehydration. Alkaline urine is
an indication of some sort of infection or obstruction in
the urinary system.
Glucose (gl kos)Known as sugar, glucose is normally
reabsorbed into the bloodstream. The presence of sugar
in the urine, a condition called glycosuria (gl ko-sur e-
ah), often signals that the patient has diabetes mellitus.
Although diabetes mellitus is a disease of the endocrine
glands of the pancreas, it does have a detrimental effect
on the kidneys.
Protein (pro ten)Normally, protein is present only in
undetectable amounts. Proteinuria (pro te-n-yur e-ah)
(protein in the urine) is a sign of glomerulonephritis or
pyelonephritis. The most common protein in blood serum
is albumin (al-bu mn), and the presence of serum protein
in urine is called albuminuria (al bu-mn-yur e-ah).
Ketone (ke ton) bodies (or acetone [as ah-to n] bodies)
These products of fat metabolism accumulate in the
blood and urine when the body is using fat instead of
sugar to fuel the energy needs of cells. This can result
from diabetes mellitus, loss of carbohydrates to vomiting
and diarrhea, or severe malnutrition. Excessive ketones
cause acidosis.
Bilirubin (bl -r b n)A product of hemoglobin break-
down, bilirubin darkens the urine suggesting either liver
or gallbladder disease. The presence of bilirubin in the
urine is called bilirubinuria (bl -r-bn-yur e-ah) and
indicates that the liver is having trouble removing biliru-
bin from the blood.
Analysis should always be made using fresh urine samples,
since bacterial action can quickly change the urine. To pre-
vent contamination of the urine to be analyzed under the
microscope, the sample may be collected by placing a tube-
like instrument called a catheter into the bladder, a process
known as urinary catheterization (kathe-ter- -za shun). This
process may also be used to drain stagnant, blocked urine
from the urinary tract or to introduce substances for x-ray
contrast or irrigation (washing of a body part or wound by a
stream of water or sterile solution).
27
Urine output testing refers to the amount of urine produced
within a certain amount of time. For instance, a healthy man
weighing 70 kg (kilograms) will produce at least 30 to 50 mL
(milliliters) of urine per hour. Urine output is an excellent
parameter for assessing the overall state of hydration. If a
person is dehydrated, his or her kidneys will produce less
urine in an effort to conserve water. The urine output will be
low in volume. The urine itself will appear dark and concen-
trated. Assessing the state of hydration is very important in
critically ill patients. Most of these patients require continual
monitoring of urine output. This can be done with a urinary
(or Foley) catheter, which is a narrow tube thats inserted
through the urethra into the bladder. The catheter continu-
ally drains urine from the bladder into a container for
measurement.
Visualization Procedures
Just as the various organs of the digestive tract have their
specialized endoscopes, so do the urinary organs. Some
endoscopic procedures include
Cystoscopy (ss-tos k-pe )endoscopic viewing of the
bladder for inflammation, stones, tumors, and other
deformities
Nephroscopy (ne-fros k-pe )endoscopic viewing of the
kidney with the nephroscope, which has three chan-
nels, one each for telescopic analysis, fiber-optic
lighting, and irrigation
Urethroscopy (ure-thros k-pe )endoscopic viewing of
the urethra, often used for lithotripsy
X-ray procedures are also useful in helping physicians see
whats going on in the urinary tract. An x-ray of the kidneys,
ureters, and bladder (known as a KUB) shows the location of
these organs in relation to their neighbors.
A common radiographic technique is pyelography (p e-log
r-fe ), in which a pyelogram (p e-l-gram) (picture of the
renal pelvis) is taken with the help of a contrast medium. Dye
may be injected intravenously (an intravenous pyelogram, IVP
for short), and it goes to the kidneys to be filtered out into
28
the urine and fill the urinary tract. In conjunction with an
IVP, nephrotomography (nefro-to-mag rah-fe ) may be used to
visualize several planes of the kidney.
Dye may also be introduced directly into the bladder and
ureters through a cytoscope, and this is called a retrograde
pyelogram (RP). A similar technique used to visualize the
function of the lower urinary tract is the cystography (ss-
tog rah-fe ), in which a catheter is used to place dye into the
bladder and x-rays are taken.
In excretory urography (eks kre-to-re yu-rog rah-fe ) or voiding
cystourethrogram (ss to-yu-re thro-gram) (VCUG), the bladder
is filled with contrast material and then x-rays are taken as
the patient voids.
Other ways of visualizing the kidneys in the x-ray room are
CT scans and angiography (an je-og rah-fe ), taking pictures
of dye-filled blood vessels.
Ultrasonography refers to pictures taken using sound waves.
This visualization procedure is used to reveal the presence of
tumors, cysts, obstructions, hydronephrosis, and other mani-
festations of disease on a macroscopic level. Radioisotopic
(rd---s-tpk) studies, pictures taken after a radioactive
substance is introduced into the bloodstream, are also used.
Therapeutic Procedures
In a mechanical pro cess called hemodialysis (HD), blood is
pumped through a mem brane by a dialyzer to filter out
wastes. Patients suffering from kidney failure usually need
hemodialysis treatments to remove toxic substances from
their blood. Patients with complete kidney failure require two
or three he mo di al y sis treat ments per week.
A less expensive, more nat u ral treatment for renal fail ure is
continuous am bu la to ry peri to ne al dialysis (am byu-lah-to re
per -to-ne al d-al -ss) (CAPD), in which sterile di al y sis so lu -
tion is drained directly into the patients peri to ne al cav i ty.
The patient can function nor mal ly, with the empty bag hid-
den beneath un der gar ments. After about two to four hours
(sometimes long er), the bag is unfolded and the fluid allowed
to drain back into it by grav i ty. This process will be re peat ed,
29
with fresh solution, three or four times per day. In ter mit tent
(n ter-mt ent) peritoneal dialysis (IPD) is another form of
this treatment.
There are some organs which may need to be partially or
completely removed in the urinary system. A cystectomy is
the partial or complete removal of the bladder. Advanced dis-
ease (usually cancer) may indicate the removal of the
bladder. If the bladder is removed, a replacement can be
made from a section of the ileum or colon. This procedure is
called a ureterosigmoidostomy (y-rtr--sigmoi-dst-m).
Kidney removal due to advanced disease (usually cancer) is a
nephrectomy. Of course, if a patient is donating a kidney, a
nephrectomy is also requiredbut its the removal of a
healthy kidney. The remaining healthy kidney can do the
work of the removed organ. Kidney transplantation is the
operation used to place a donated kidney in a patient who
has lost both kidneys.
Lithotripsy was mentioned as a procedure that breaks up
stones (calculi) in the urinary tract, allowing them to wash
out by themselves with the passage of urine. When the
stones are crushed specifically in the bladder and then
immediately washed out with a catheter, the process is called
lithopaxy. Nephrolithotomy (nfr-l-tht-m) is the surgical
removal of kidney stones, and a percutaneous (perky-tn-
s) nephrolithotomy is kidney stone removal by endoscope.
Ureterolithotomy (y-rtr--li-thot-m) is the removal of
calculi from the ureter.
Fulguration uses high-frequency electricity to burn off lesions
on the bladder wall.
Some forms of incontinence can be helped by fixing the ure-
thra to the pubic bone. This procedure is a urethropexy
(y-rthr-pk-s). Reconstructing or repairing the urethra in
case of stricture is called urethroplasty (y-rthr-plst).
30
Review the following tables that list important terminology
and word forms associated with the urinary and excretory
systems.
In Other Words
Urination = micturition = voiding = excretion
Macroscopic anatomy = gross anatomy
Microscopic anatomy = histology
Hilum = hilus
Loop of Henle = nephron loop
Suppurative = pyogenic = purulent
Renal cell carcinoma = renal hypernephroma
Ketone bodies = acetone bodies
Excretory urography = voiding cystourethrogram
Terms You Should Know
albuminuria (al byu-mn-yu re-ah) presence of serum protein in urine
anuria (an-yur e-ah) without formation of urine
azotemia (az o-te me-ah) nitrogenous wastes in the blood (substances
containing nitrogen and excreted in urine
urea, creatinine, uric acid)
bacteriuria (bak- te r e-yur e-ah) presence of bacteria in urine
bilirubinuria (bl -r-bn-ur e-ah) presence of bilirubin in urine
calciuria (kal s-yur e-ah) presence of calcium in urine
circumcision (sir kum-szh un) removal of the prepuce (foreskin)
cystectomy (ss-tek to-me ) removal of the bladder
cystolithotomy (ss to-l-thot o-me ) incision of the bladder for removal of a calculus
cystoplasty (ss to-plas te ) repair of a cystocele (hernia)
diuresis (dyu-re ss) excessive urination
dysuria (ds-yur e-ah) difficult, painful urination
(Continued)
31
Terms You Should KnowContinued
edema (e-de mah) accumulation of fluid in body tissues
enuresis (enyu-re ss) incontinence; involuntary discharge of urine
frequency (fre kwen-se ) abnormally frequent voiding
glycosuria (gl ko-syur e-ah) presence of glucose in urine
hematuria (hem ah-tyur e-ah) presence of blood in urine
hesitancy (hez -ten-se ) involuntary delay in ability to begin voiding
hypercalciuria (hper-kals-yur e-ah) excessive calcium in urine
hyperkaluria (h per-ka-lyu r e-ah) excessive potassium in urine
incontinence (n-kon t-nens) inability to hold urine
ketonuria (ke to-nyur e-ah) presence of ketone in urine
lithotripsy (lth o-trp se ) crushing of a calculus
nephrectomy (ne-frek to-me ) removal of a kidney
nephrolysis (ne-frol -ss) freeing a kidney from adhesions
nephrorrhaphy (nef-ror ah-fe ) suturing of a kidney
nephrostomy (ne-fros to-me ) creation of an opening into the renal pelvis
nephroureterectomy removal of a kidney and part/all of a ureter
(nef ro-yu re-ter-ek to-me )
nocturia (nok-tyur e-ah) excessive urination during the night
oliguria (ol -gyu r e-ah) scanty urination
polyuria (pol e-yu r e-ah) excessive urination
proteinuria (pro te n-yur e-ah) excessive protein in urine
pyelolithotomy (p e-lo-l-thot o-me ) removal of a calculus from the renal pelvis
pyeloplasty (p e-lo-plas te ) repair of the renal pelvis
pyuria (p-yur e-ah) pus in urine
renal biopsy (re nal b op-se ) removal of tissue sample for microscopic analysis
renal colic (re nal kol k) acute pain of the kidney, caused by passage of
kidney stone
(Continued)
32
renal transplant (re nal trans-plant) the transfer of a living kidney from a donor into
a recipient
residual urine (re-zd u-al yu rn) urine remaining in bladder after voiding
retention (re-ten shun) inability to void when bladder is full
suppression (su-presh un) no urine produced
urgency (ur jen-se ) the need to void immediately
ureterectomy (yu-re-ter-ek to-me ) removal of a ureter
ureteropyelostomy renal anastomosis (connecting) of ureter and pelvis
(yu-re ter-o-p e-los to-me )
ureterovesicostomy placing of a ureter into the bladder
(yu-re ter-o-ves -kos to-me )
urethrectomy (yu re-threk to-me ) removal of part/all of the urethra
urethroplasty (yu-re thro-plas te ) repair of the urethra
Combining Forms You Should Know
CALI/O, CALIC/O calix, calices
CYST/O bladder
GLOMERUL/O glomerulus
MEAT/O meatus
NEPHR/O kidney
PYEL/O renal pelvis
REN/O kidney
TRIGON/O triangular area
UR/O urine, urinary organs
URETER/O ureter
URETHR/O urethra
URIN/O urine
VESIC/O bladder
33
34
Self-Check 3
Questions 110: Label each of the following terms as a laboratory test (LT), a visualization
procedure (VP), or a therapeutic procedure (TP).
______ 1. Fulguration
______ 2. Urinalysis
______ 3. Creatinine clearance
______ 4. Pyelography
______ 5. Lithotripsy
______ 6. Nephroscopy
______ 7. Blood urea nitrogen (BUN)
______ 8. Voiding cystourethrogram
______ 9. Ureterosigmoidostomy
______ 10. Hemodialysis
35
MALE AND FEMALE
REPRODUCTIVE SYSTEMS
As everyone knows, the reproductive system is the one body
system where the anatomy and physiology of males and
females differ greatly! However, the differences work to fulfill
the same goal: survival of the species. The reproductive sys-
tems of both sexes produce hormones that make boys and
girls, and then make boys into men and girls into women. So,
while dysfunction of this system isnt generally dangerous to
your health, if everybodys reproductive system stopped work-
ing, we would be in trouble!
Primary sex characteristics are those related directly to the
growth and function of the reproductive organs themselves.
Secondary sex characteristics refer to those masculine and
feminine body features such as beard growth and breast
development. The hormones that develop all these character-
istics also cause the sex drive leading men and women to
reproduce.
The complex human organism is constantly growing and
changing, from embryo, fetus, infancy, childhood, and ado-
lescence to young adulthood, middle age (4065), and old age
(after 65). Amazingly, it all begins with fertilization, the fusing
of two single cells from a father and a mother.
The reproductive organs of both sexes are designed to pro-
duce and permit fertilization of the germ (jurm) (meaning
seed) cells called gametes (gam e ts). The female gametes are
called ova (o vah) (eggs), and the male gametes are called
spermatozoa (sper m-to-zo ah) (sperm). Gametes are pro-
duced in organs called gonads (gonadz)specifically, the
ovaries (o vah-rez) and testes (tes te z), which are the essential
reproductive organs. Gametes differ from other body cells in
that they carry only half the usual number of chromosomes.
When fertilization occurs, and the gametes from the male
combine with the gametes from the female, the hereditary
material for a new individual is complete. So is the job of the
male reproductive system. But the female system has only
just begun, for it provides nourishment to the developing life
for the approximately nine-month gestation (jes-ta shun)
36
period of pregnancy. Once the baby is born, the female
system lactates (lak tats) to provide the perfect nutrition for
the childs early growth.
Anatomy and Physiology of the Male
Reproductive System
The development of both males and females is essentially
identical except for the development of the reproductive
organs. Early in the gestation period (i.e., growth inside the
mothers uterus), the fetal reproductive organs are said to be
undifferentiated, meaning the fetus is neither male nor female
and the basic structures have the potential to become either
sex. Differentiation begins at two months. The fetus will then
take on either male or female reproductive characteristics.
Lets first take a look at the male reproductive system.
External Genitalia
Physicians generally refer to sexual intercourse as coitus
(ko t-u s) or copulation (kop yu-lashun), and certain sex
organs may be referred to as copulatory (kopyu-la-to re )
organs. The penis (pe ns) is the male copulatory organ com-
posed of three parts: a long shaft; a sensitive tip known as
the glans (glanz); and a cuff of skin called the prepuce
(pre pyu s), or foreskin.
Sexual arousal causes two important reflex actions of the
penis: erection (e-rek shun) and ejaculation (e-jakyu-lashun).
Erection of the penis is made possible by this organs porous
tissue. Arteries bring blood into the penis. This pressure
squeezes against the veins, preventing the blood from going
back out again. Thus, the penis becomes engorged with
blood, causing the erectile tissue of the penis to become firm
and able to enter the female reproductive tract. Ejaculation of
semen (se men) occurs when sexual tension reaches a peak
an event known as orgasm.
A skin-covered sac called the scrotum (skro tum) contains the
males two testes (tes tz) (or testicles [tes t-klz]), which pro-
duce millions of sperm cells each day. Maybe youve
wondered why this organ is located in such a vulnerable
37
position, and not encased in the safety of the pelvic cavity.
Theres good reason for its location. The bodys internal tem-
perature is too hot for spermatogenesis (sperm-to-jen e-ss),
or the creation of spermatozoa, and the scrotum provides a
cooler environment.
Internal Organs
The scrotum and the penis are on the outside of the body,
but the remaining male reproductive organs are all inside the
body. Internal organs of the male system can be divided into
three types:
Testes
Duct systemepididymis, ductus deferens (or vas defer-
ens), urethra, and ejaculatory ducts
Accessory glandsseminal vesicles, bulbourethral
glands, and a prostate gland
Most of the system exists in two parts. Theres one scrotum,
but inside theres a right and left testis, and the connecting
ducts and glands are similarly duplicated on each side of the
body. That is, until they come to the urethra and surround-
ing prostate. Then the system comes together so semen can
continue the final journey as one unit through the penis. Its
easiest to describe the male structures in the singular, but
you should remember that whats happening on one side of
the body is happening simultaneously on the other. Figure 8
provides an overview of the male reproductive system.
38
Testes. The testes originally develop within the abdominal
cavity of the male embryo. A couple months before birth, they
descend into the scrotum through a passageway called the
inguinal canals (ng w-nal kah-nalz). The inguinal canals
close shortly after birth, leaving just enough room for the
spermatic cords (the tube through which the vas deferens
passes) to go through, but not enough for the testes to return
to their original spots. These canals sometimes remain weak
spots in the abdominal wall and are prone to herniation,
especially in men who do a lot of heavy lifting.
The testes are egg-shaped structures that are surrounded by
connective tissue called the tunica albuginea (tn-k l-b-
jn-) and a serous membrane called the tunica vaginalis
(tn-k v-j-nls). This membrane is derived from the
peritoneum when the testes are first formed.
Each testis (tes ts) has about 250 lobules, which hold the
seminiferous (sem -nf er-us) tubules, threadlike coils where
the sperm-manufacturing cells are located. Because the sem-
iniferous tubules perform the organs essential work, theyre
called parenchymal (p-reng k-mal) tissue. Parenchyma is
any organs functional tissue. The stromal (stro mahl) tissue
of any organ provides the framework or other support func-
tion for the organ. Blood vessels, connective tissues, and
sometimes muscle are examples of stroma. You may hear the
terms parenchyma and stroma in relation to many body
organs, not just reproductive ones.
FIGURE 8The Male
Reproductive System
Bladder
Ureter
Seminal
Vesicle
Rectum
Prostate Gland
Pubic Bone
Urethra
Penis
Prepuce
Glans
Penis
Urethral
Orifice
Scrotum
Testis
Epididymis
Ductus
Deferens
Cowpers
Gland
Ejaculatory Duct
Anus
39
Leydig (ldg) cells in the interstitial tissue of the testes (the
space between the seminiferous tubules) produce a class of
hormones called androgens (an dro-jenz). These hormones are
produced in response to luteinizing hormone (lte-n- zng
hor mon) (LH) and follicle-stimulating (fol l-kl) hormone (FSH),
both pituitary hormones. The most important androgen pro-
duced by these cells is testosterone (tes-tos te-ron), the male
sex hormone. Around age 12 or 13, that period of sexual
maturation better known as puberty (pyu ber-te ), testosterone
stimulates the development of secondary sexual characteris-
tics, such as a deep voice, broad chest, and growth of facial
hair. Although a female is born with all of her eggs, a male
doesnt begin producing sperm until puberty. He continues to
produce sperm and testosterone throughout his lifetime.
Although sperm and testosterone production may decline in
later years, they dont ever stop in healthy men.
Once the spermatazoa are produced, theyre secreted from
the seminiferous tubules into the epididymis (ep -dd -m s),
a 16-foot-long tube coiled tightly into a 2-inch space, along
the length of the testicle. Figure 9 illustrates the structure of
the testis and the epididymis.
Spermatic Cord
Testicular Veins
Testicular Artery
Vas Deferens
Epididymis
Seminiferous
Tubules
FIGURE 9Sagittal Section
of Testis, Epididymis, and
Spermatic Cord
40
A single spermatozoon (sperm-t-zon) looks like a micro-
scopic tadpole. Its oblong head region contains genetic
material, and its tail region, called a flagellum (flah-jel um),
enables the sperm to swim up the female reproductive
tract. Each ejaculation of semen contains approximately one
teaspoons worth of fluidincluding 300 million sperm.
Ducts. The epididymis (plural is epididymides) performs two
functions. The first is to act as a storage facility for the sper-
matazoa that were formed in the seminiferous tubules. The
second function is to continue to develop the sperm. When
the sperm enter the epididymis at the caput (kapt) (head),
theyre immature. They have no motility (theyre incapable of
swimming), and theyre unable to fertilize an ovum. During
their journey through the body of the epididymis, known as
the corpus (krps), they mature so that they can perform
these functions. The matured sperm are stored in the caudal
(kahdl) (tail) end of the epididymis.
The epididymis leads to the 2-foot-long vas deferens (vas
def er-enz), also called ductus (duk tus) deferens. The vas def-
erens is a firm, hollow tube that goes straight up through the
spermatic (sper-mat k) corda sheath of connective tissue
that also encases the blood vessels and nerves on their way
to and from the testes. The vas deferens enters the pelvis and
courses over and behind the urinary bladder, where it meets
the accessory gland, the seminal vesicle.
As it emerges from the seminal vesicle, the vas deferens joins
with the ejaculatory (e-jakyu-lah-tore ) duct in the prostate.
The converged ducts pass through the Cowpers glands, and
then join the urethra, the tube leading from the bladder to
the outside of the body. (The prostate and Cowpers glands
are discussed in further detail with the accessory glands.)
From there, the semen passes out of the body through the
urethral orifice (yu-re thral or -fs) or meatus (me-a tus). As
you know, the urethra also expels urine from the body, but
during coitus the sphincter to the bladder stays closed to
keep urine in.
Accessory glands. As you just learned, the vas deferens
passes a few glands on its way from the testis to the urethra.
Semen, or seminal (sem -nal) fluid, contains not just sperm,
but also fluids secreted by the accessory sex glands. A large
41
percentage of the fluid comes from two seminal vesicles (ves -
klz), which are located at the base of the bladder and join
with the two vas deferens to form the two ejaculatory ducts.
Seminal fluid consists of proteins, minerals, fructose,
enzymes, mucus and citric acid. The fluid picked up within
the seminal vesicles makes up about 65% of the fluid in
semen. The thick, yellowish, sugar-rich secretions provide
energy for the sperms long trip.
Another quantity of seminal fluid comes from the prostate
gland, a doughnut-shaped structure located just beneath the
bladder and surrounding the beginning of the urethra. In
fact, the beginning of the urethra is called the prostatic ure-
thra. The prostate closes the urethra during ejaculation,
preventing the passage of urine while semen is being ejacu-
lated. This glands thin, milky, alkaline secretions help the
sperm move along and stay healthy in the acidic environ-
ments of the urethra and the vagina. Furthermore, the
prostates musculature helps push the sperm forward during
ejaculation. Just a note on terminology hereyoull notice
that theres only one r in prostate. The prostate is a gland
in the reproductive system. A similar-looking word that has
another r, and one many people confuse with this one, is
prostrate, which means to lie flat and face down. You can
see that, although they look similar in spelling, they mean
very different things!
Finally, a small but important amount of fluid comes from
the pea-shaped bulbourethal (bul bo-yur-e thrl) glands, also
called Cowpers (kow perz) glands, located just below the
prostate. Their alkaline secretions empty into the urethra to
lubricate it so the sperm will have an easy passage.
42
Self-Check 4
Questions 110: Fill in the blanks.
1. Tubules within the _______ produce sperm cells.
2. Sperm mature and are stored in the _______.
3. Sperm and glandular fluids form _______.
4. The epididymis narrows into the _______.
5. The male gametes are the _______.
6. The testes are housed in the _______, a skin-covered sac outside the body.
7. Androgens are produced by _______ in the interstitial tissue of the testes.
8. The _______ gland located just beneath the bladder releases thin, milky, alkaline secretions.
9. During _______, a period of adolescent maturation, secondary sex characteristics such as a
deep voice and facial hair begin to form.
10. As the vas deferens emerges from the seminal vesicle, it becomes the _______ .
43
Anatomy and Physiology of the
Female Reproductive System
The specialty area that treats the female reproductive system
actually has two components called obstetrics (ob-stetrks)
and gynecology (g-ni kah-luh-je ). The obstetric component
deals with pregnancy and childbirth, and the gynecologic
component deals with diseases and illnesses affecting the
female reproductive tract.
If your eyesight is good enough to see a single speck of dust,
you might be able to see an ovum. Its by far the largest cell
in the body. The female is born with all of the ova shell ever
havesome million immature sex cells. However, only about
400,000 of those will develop as the female matures, and of
those only 350500 will ripen and be released during the fer-
tility period between puberty and menopause (men o-pawz)
(the cessation of ovulation at somewhere around 50 years of
age). Usually, only one ovum a month leaves the ovary and
travels down the fallopian tube (fal-lo pe-an tu b) (also called
the oviduct [o v-dukt], the uterine [yu ter-n] tube, or the
salpinges [sl-pnjz]) where it may meet up with a sperm.
This process is called ovulation (ov-y la-shun). Since sperm
live for about 48 hours after ejaculation, and the ovum for
only 24 hours after ovulation, coitus has to occur the day
before, the day of, or the day after ovulation if fertilization is
to occur. An unfertilized ovum will simply disintegrate. A fer-
tilized ovum will become an embryo (em bre-o ) and move on
down to the uterus (u ter-us) to implant itself there for the
nine-month job of becoming a fully developed baby.
The female reproductive system, unlike the males, functions
cyclically. Males have a relatively constant hormone level and
are always producing sperm. On the other hand, female hor-
mone levels and ovulation patterns follow a monthly
menstrual cycle (men str-al s kl). Every month the uterus
gets itself ready for pregnancy. Menstruation occurs when
pregnancy doesnt; its simply the discarding of old tissues so
that fresh ones can be prepared for the next potential
embryo.
44
The female reproductive organs are often categorized as
essential and accessory. The only essential organs are the
ovaries; indeed, fertilization can take place in a test tube with
just two essential ingredients, ovum and sperm. Accessory
organs of the female system can be divided into three types:
Ductsfallopian tubes, uterus, and vagina
GlandsBartholins glands and breasts
Vulva (vul vah), or external genitaliamons pubis, cli-
toris, labia, vestibule, hymen, and perineum
External Genitalia
The only external genital of females is the
vulva (vul vah). The vulva is composed of a
number of structures (Figure 10):
The mons pubis (monz pyu bs) is the pad
of fat over the symphysis (sm f -ss)
pubis (the place where the two pubic
bones join).
The clitoris (klt ah-rs) is the sensitive,
erectile tissue similar to the male penis.
Also, the clitoris is the primary site of
sexual stimulation.
The labia (la be-ah) are the lips of the
vagina. The larger, outer lips are the labia
majora (ma-jo rah), and the smaller, inner
lips are the labia minora (m-no rah). The
area between the labia majora and the
labia minora is the vestibule (ves t-byu l).
This is where the ducts of the vestibular
glands open to the surface.
The hymen (h men) is a mucous membrane that partly
or completely covers the vaginal opening in childhood
and sometimes into adulthood.
Clitoris
Labia Majora
Labia Minora
Hymen
Perineum
Anus
Opening
of Urethra
Vaginal
Opening
Bartholins Glands
FIGURE 10The Vulva
45
The perineum (per-ne um) is the region between the
vaginal opening and the anus. (In males, the perineum is
the region between the scrotum and the anus.) Perineal
(per -ne al) is the adjective form of perineum. (Dont
confuse perineal with peroneal [per o-ne al], which refers
to the outer part of the leg.)
Internal Organs
Ovaries. Shaped like large almonds, the ovaries on either
side of the uterus are held in place by ovarian ligaments
(Figure 11). Ovaries contain thousands of tiny sacs called
graafian follicles (grahf e-an fol l-klz), each of which con-
tains an ovum in varying stages of maturation. After the
onset of puberty, once a month a graafian follicle ruptures
and a mature ovum leaves the ovary for the journey down the
fallopian tubea process called ovulation (o vyu-la shun).
Then, a very important physiological event happens: the rup-
tured follicle transforms into a yellow, glandular structure
called the corpus luteum (kor pus lu te-um), literally meaning
yellow body.
Opening of
Uterine Tube
Uterine (Fallopian) Tubes
Ovaries
Ovarian
Ligament
Fimbriae
Round Ligament
Cervix
Hymen
Labia Minora
Labia Majora
Vagina
Uterus
Muscular Wall of Uterus
Endometrium
FIGURE 11The Internal
Organs of the Female
Reproductive System
46
The corpus luteum secretes the female hormone progesterone
(pro-jes ter-ro n), which plays a major part in the menstrual
cycle. Progesterone stimulates the uterus to prepare for preg-
nancy, and during pregnancy it causes many changes in the
body to provide the proper environment for the fetus. When
pregnancy doesnt occur, the corpus luteum stops producing
progesterone and decays, forming a mass of scar tissue.
Without the supply of progesterone, the uterus cant main-
tain its lining so it sloughs it off, and menstruation results.
Beginning at puberty around age 12 (anywhere between 11
and 15 is normal), the ovary also secretes the female sex
hormone estrogen (es tro-jen), which causes the development
of the reproductive organs and the secondary sex characteris-
tics that shape a womans figure. The secretion of estrogen
causes the females first menstrual cycle, or menarche (me-
nar ke ). Similar to the male system, the pituitary hormones
FSH and LH stimulate the production of female hormones at
puberty, and they continue to influence ova formation and
ovulation. In fact, the high levels of progesterone and estro-
gen in the bloodstream during pregnancy cause the pituitary
to shut off its production of FSH and LH, and the pregnant
woman wont ovulate. This is the secret to the function of
birth-control pillsthey contain enough estrogen and/or
progesterone to trick the pituitary into stopping ovulation.
Fallopian tubes. Even though theyre called oviducts, the
fallopian tubes arent actually attached to the ovaries. They
actually open into the peritoneal cavity (the abdomen), and
they even move around a bit, so sometimes an ovum will slip
by the tube and end up fertilized in the abdominal cavity.
This is called an ectopic (ek-top k) pregnancy, and the fertil-
ized egg wont develop, as it has no support system outside
the uterus. Another kind of ectopic pregnancy occurs when
the ovum is fertilized in the fallopian tube, but it doesnt
move along as it should and implants itself in the wall of the
fallopian tube. Youll learn more about this in the pathology
portion of this section.
Each fallopian tube curves around to the edge of the ovary. Its
fingerlike fringed edges, called fimbriae (f m bre-a ), catch the
released ovum (refer back to Figure 11). This section of the
tube is called the infundibulum (nfn-dby-lm). Peristalsis
47
of the fallopian tube, combined with the sweeping movement
of hairs called cilia (sl e-ah), moves the ovum toward the next
portion of the tube called the ampulla (m-pll). If coitus
has taken place in the past day or two and no contraceptive
has been used, chances are good that a sperm will fertilize
the ovum. If the ovum is fertilized, it will continue on through
the isthmus (the section of tube that first enters the uterus),
exit into the uterus through the intramural oviduct, and
attach itself to the uterine wall. If the ovum was not fertilized
during its journey through the fallopian tube, it will disinte-
grate, and the uterus will get the message that fertilization
hasnt taken place, initiating the menstrual period.
Uterus. About the size of a pear, and shaped like one, too,
the uterus is mostly musclesome of the strongest muscle in
the human body, in fact (refer back to Figure 11). It has to
be, to do the job of carrying a baby to term and then laboring
to give birth! The normal bent-forward position of the uterus
is called anteflexion (an-te-flek shun). If a uterus is tipped in a
backward direction, its refered to as a retroflexed uterus.
The thin, skinlike, outer layer of uterine tissue is called the
perimetrium (per--me tre-um). The middle layer is the muscu-
lar part and is called the myometrium (m-o-me tre-um). The
inner lining of the uterus, the endometrium (en-do-me tre-um),
is a mucous membrane with a rich supply of blood vessels.
This layer has two parts: the basal endometrium stays in
place all the time, and the functional endometrium is built
upon it when the uterus prepares for pregnancy. Its this
functional endometrium that pulls away from the uterus,
bleeds, and breaks into bits that are passed from the body
during the period of menstruation (or menses [men sez]).
The rounded, upper portion of the uterus where the fallopian
tubes enter is the fundus (fundus), and the large center part
is called the corpus or body. The cervix (ser vks) is the
rounded bulb at the bottom that protrudes into the inner-
most portion of the vagina.
48
Vagina. The vagina (vah-j nah), the female copulatory
organ, is a 3- to 4-inch muscular yet elastic tube lined with
mucous membrane in folds called rugae (r ga ). Its a pas-
sage for the entry of sperm, and the exit of menstrual fluid
and a baby. The vagina opens between the anus and the ure-
thra (Figure 12).
Accessory sex glands. Two Bartholins (bar to-lnz) glands,
also called greater vestibular (ves-tbyu-lar) glands, secrete
mucus-like fluid from duct orifices on either side of the
vagina (Figure 12). Theyre analogous to the bulbourethral
glands in the male. A number of smaller lesser vestibular
glands secrete mucus near the opening of the urethra.
FIGURE 12The Female
Reproductive System Uterine
(Fallopian)
Tube
Fimbriae
Ovary
Coccyx
Rectum
Anus
Bartholins
Gland
Vagina
Labia Majora
Labia Minora
Urethra
Clitoris
Pubic Bone
Bladder
Cervix
Uterus
49
The breasts are also glands of the reproductive system,
attached by connective tissue to the muscles of the chest
(Figure 13). Female breast size is determined by the amount
of adipose (ad -po s) tissue (fat) that surrounds the actual
mammary (mam -re ) glands (milk-secreting glands). The
amount of fat has absolutely nothing to do with the quantity
of milk produced by a nursing mother. The milk-producing
mammary gland is actually a modified sweat gland, but it
doesnt work full-time like the sweat gland. The mammary
gland secretes milk only after the birth of a child.
The milk-secreting tissue is made up of 15 to 20 lobes that
converge at the nipple. These lobes are comprised of many
different smaller lobes, which in turn are made of many milk-
secreting cells in grapelike clusters. Theres one lactiferous
(lak-tf er-us) duct per lobe, and each duct empties through
the nipple. Thus, there are 15 to 20 pores from which milk
leaves the breast. The medical name for the nipple is the
mammary papilla (pah-pl ah), and the pigmented area sur-
rounding the nipple is the areola (ah-re o-lah).
Rib
Pectoralis Major Muscle
Intercostal Muscle
Fat Body of Breast
Alveolus
Mammary Duct
Ampulla
Lactiferous Ducts
Nipple
Areola
Skin
FIGURE 13Structure of
the Breast
50
The mammary glands dont produce milk until approximately
three days after parturition (par-t-rsh n) (childbirth).
During this time, the suckling child will ingest colostrum (ko-
los tru m), a thin, yellow fluid containing protein and lactose
(milk sugar) but little fat. Release of the hormone prolactin
(pro-lak tn) from the pituitary stimulates the production of
milk, and the hormone oxytocin (ok se-to sn) releases the
milk from the glands.
The Menstrual Cycle
Menarche (m-nahrk) is the time when a female experiences
her first menstrual cycle. This time varies greatly, with some
girls experiencing menarche as early as age 9 or as late as
17. Over the past few decades in America, the average age of
menarche has been getting younger. The menstrual cycle is
designed to prepare an egg for fertilization with sperm. The
process of an ovary ejecting a mature egg into the fallopian
tube is known as ovulation, which normally occurs once
approximately every 28 days, although the length of this
cycle actually varies greatly among females. The menstrual
cycle repeats itself about 13 times per year for 30 or 40 years
in most women.
The menstrual, follicular (f-lky-lr), ovulation, and luteal
phases are the four phases of the menstrual cycle.
1. Even though the menstrual phase is technically the last
phase of the cycle (it occurs when the ovulation doesnt
result in a pregnancy), we count it as the beginning
because its the only phase thats measurable without
special equipment. The first day of a womans period
counts as the first day of her cycle. During this time, the
uterus sheds the functional endometrium because there
was no fertilized ovum to implant. The normal time range
for this phase is two to seven days.
2. During the follicular, or proliferative stage, a Graafian fol-
licle grows an ovum to maturity, secreting estrogen to
signal the basal endometrium to start growing a new
functional endometrium, and the cervix starts to produce
a less acidic mucus that will actually assist the sper-
matazoa in their journey to the fallopian tubes. This
phase lasts 6 to 12 days.
51
3. The ovulation phase lasts one or two days and typically
occurs midway through the cycle. When the ovum has
nearly matured, the estrogen level is high enough to trig-
ger the pituitary gland to release luteinizing hormone
(LH). This causes the ovary to release the ovum. As you
know, the ovum then enters the fallopian tube and
awaits fertilization by sperm. If fertilized, the ovum will
immediately begin to develop, still moving through the
fallopian tube. It will take about three days to implant
into the endometrium.
4. The luteal phase, or secretory phase, is dominated by the
corpus luteum, the yellow body created when the ovum
left the ovary. The corpus luteum produces hormones to
make the endometrium receptive to implantation and
early pregnancy. During this phase, a womans body
temperature increases. After ovulation, the hormones
FSH and LH sustain the corpus luteum. The corpus
luteums hormones, however, suppress FSH and LH. If
the egg is fertilized, the resultant embryo will produce
the hormone human chorionic gonadotropin (ko re-on k
gnah-do-tro pn) (hCG), which can support the corpus
luteum instead of LH. If the LH is too low, and theres no
embryo to produce hCG, the corpus luteum will atrophy
and stop producing hormones to prepare the body for
pregnancy. This will be the signal for the endometrium to
slough off, starting the cycle all over again. This final
phase lasts about two weeks.
Conception and Pregnancy
After a young woman has experienced menarche, its possible
for her to become pregnant, and her childbearing years have
officially begun. During sexual intercourse, semen from the
male is deposited into the vagina of the female. The sperm
within that semen will swim up through the uterus toward
the fallopian tube entrances in the uterine wall. If coitus has
occurred on the day before, the day when, or the day after an
ovary has released an ovum, the sperm will meet a mature
ovum. Remember that the ovum is traveling in the opposite
directionits being moved along by peristalsis through the
fallopian tube toward the uterus. The sperm, therefore, are
52
traveling against the movement of the fallopian tube. This is
why only the strongest swimmers will reach the egg and get
a chance to fertilize it. Some other reasons for sperm not
making it to the egg are the high acidity of the female system
and the high temperature inside the body. Eventually a
sperm cell may reach the egg and penetrate the epithelial, or
outside, layer, of the egg by the application of an enzyme that
breaks the barrier and allows it in. When the sperm makes it
to the center and combines its nucleus with the egg nucleus,
a fertilized egg cell called a zygote (z go t) is created.
As soon as the zygote divides itself into two cells, its called
an embryo (em bre-o ). Cell division continues at a rapid pace;
by the time the embryo implants itself on the uterine wall a
few days later, its a cluster of 16 cells. Four weeks later it
has a brain and spinal cord. After the second month, the
product of conception is referred to as a fetus (fe tus).
A number of changes occur in the pregnant womb. Fetal
membranes (fe tal mem branz) form around the embryo. You
may already know about the amnion (am ne-on) or amniotic
sac (amne-ot k sak), a membrane that contains amniotic
fluid. This bag cushions the embryo from injury and main-
tains a consistent body temperature. The outermost
membrane is the chorion (ko re-on). Among other functions, it
forms the fetal part of the placenta (plah-sen tah), the dis-
posable organ that develops to allow nutrients and oxygen to
pass from the mothers bloodstream into the bloodstream of
the embryo/fetus, and to allow waste products from its blood
to pass into the mothers bloodstream. The embryo/fetus is
connected to the placenta at the umbilical cord (um-bl -kal
kord). Also called the afterbirth, the placenta is expelled from
the womb via the birth canal just a few minutes after the
baby is born and the umbilical cord is cut.
Many hormones are present during pregnancy. Particularly
important is human chorionic gonadotropin (hCG). This is
the hormone thats produced by the embryo and sustains the
corpus luteum in place of LH. Its also the identifying hor-
mone in urine tests for pregnancy. This hormone signals the
corpus luteum to grow larger and produce the massive quan-
tities of estrogen and progesterone needed for the uterus to
grow. The uterus is normally low in the pelvis, just behind
the urinary bladder, but during pregnancy it expands so that
53
it nearly fills the abdominopelvic cavity (Figure 14). After
childbirth, it takes between three and six weeks for the
uterus to return to its normal position and size, a period
called the puerperium (pyu er-per e -m).
One in 88 full-term pregnancies will result in the birth of
twins. Fraternal twins are no more alike than any other two
siblings with the same mother and father, for they come from
two separate eggs being fertilized by two different sperm just
as siblings from two different pregnancies do. Identical twins,
3rd Trimester
2nd Trimester
1st Trimester
Placenta
Bladder
Pubic Bone
Vagina
Anus
Rectum
Anus
Rectum
Pubic Bone
Vagina
Bladder
Uterus
Non-pregnant
Woman
Pregnant
Woman
FIGURE 14The Uterus before and during Pregnancy
54
however, have the exact same genetic material because they
come from the same embryo that somehow divides itself into
two separate groups of identical cells.
Menopause
Most people consider menopause (men o-pawz), which is the
cessation of menstruation, to be climacteric (kl-mak ter-k), or
the change of life. This condition is a normal consequence
of aging. In healthy women, the menstrual cycle will continue
repeating until menopause, with some interruptions if preg-
nancies occur. Menopause usually occurs between the ages
of 45 to 55, but it can occur earlier or later. Menopause that
occurs before age 35 is considered premature; if it occurs
after age 58, its considered delayed.
The cause of menopause is the cessation of the production of
eggs and hormones by the ovaries. Without these hormones,
the endometrium never receives a signal to start preparing
for pregnancy, so theres nothing to slough off at the end of
the cycle. Therefore, the menstrual period ends. Once these
events have occurred, the woman can no longer bear chil-
dren. However, menopause isnt an instantaneous event;
rather, it occurs gradually over a few years. The womans
menses become less and less frequent because the ovaries
release ova erratically. When they do release them, the cycle
continues as usual. However, if another egg isnt matured
after the start of menses, the next period will be skipped.
Eventually, the ovaries stop producing progesterone and most
of the estrogen they used to, and the cycle ceases altogether.
Menopause results in dryness and atrophy of the reproduc-
tive organs. Many women experience hot flashes, fatigue,
headaches, depression, anxiety, or irritability.
55
Self-Check 5
Questions 17: Match the description on the left with its proper term on the right. Indicate
your choices in the spaces provided.
______ 1. External genitalia
______ 2. Organ of egg production
______ 3. Site of fertilization
______ 4. Site of embryo implantation
______ 5. Female copulatory organ
______ 6. Neck of the uterus
______ 7. Menopause
8. Name the two primary female sex hormones.
__________________________________________________________
__________________________________________________________
9. Name the two pituitary hormones that stimulate puberty in both male and female reproductive
systems.
__________________________________________________________
__________________________________________________________
10. Name the hormone secreted by the placenta.
__________________________________________________________
__________________________________________________________
a. Fallopian tube
b. Vulva
c. Uterus
d. Ovary
e. Climacteric
f. Vagina
g. Cervix
56
Pathology of the Reproductive System
Inflammations, cancers, and sexually transmitted diseases
(STDs) are the most common types of pathology in the repro-
ductive tracts of both men and women. In addition, the
female reproductive system is subject to abnormalities of
menstruation and pregnancy.
The most frequent site of disease in the reproductive system
of males is the prostate gland, and its infection or enlarge-
ment can lead to problems in the urinary tract.
Sexually Transmitted Diseases
Sexually transmitted diseases (STDs) affect both males and
females. STDs are a major problem among young people
today. STDs can vary according to the type of organisms
involved.
Viral STDs. Genital herpes (herpz) is an STD caused by
the herpes simplex virus. Most genital herpes is caused by
the virus known as HSV-2. The initial signs are usually blis-
ters around the genitals that can break and leave sore ulcers.
The ulcers may take two to four weeks to heal at first. The
infection can stay in the body indefinitely, but outbreaks
tend to become fewer and less severe over the years. Theres
no cure for herpes, but medication is available to prevent
outbreaks. It should be noted that, while transmission from
one person to another is more likely during an outbreak, its
possible to spread the virus even when there are no blisters
or ulcers visible. The risk of spreading the virus can be
reduced by using condoms during sexual intercourse, but not
completely prevented.
There are about 100 types of human papillomavirus (p-p-
lm-v-rs) (HPV), as its a very common virus that most
people come into contact with at some time during their lives.
Approximately 30 of these strains are spread through genital
contact. About 12 of them can cause genital warts, and about
15 are known to cause cervical cancer in women. Treatment
involves application of acid or liquid nitrogen to destroy the
warts. At this time, there are several vaccines available to
prevent women from contracting HPV. The best time to get
this vaccine is before a woman is sexually active.
57
Bacterial STDs. Gonorrhea (gn-r) is caused by the
bacterium Neisseria gonorrhoeae (n-sr- gn-r). Men
have more symptoms, such as dysuria (painful urination) and
discharge of pus from the penis. Although women may also
have dysuria and vaginal discharge, the symptoms are milder
than those in men. However, gonorrhea can cause pelvic
inflammatory disease (PID) and infertility in women if left
untreated. Gonorrhea can be diagnosed with tests that detect
the bacterial genes in a urethral or cervical swab sample.
Treatment is with antibiotics.
Syphilis (sf-ls) is an infection caused by Treponema pal-
lidum. The initial sign is a genital sore called a chancre
(shangker). Chronic infection can affect the vertebrae, heart,
and central nervous system. Treatment is with antibiotics
(usually penicillin).
Other STDs. Chlamydia (klah-mid-) is caused by the bac-
terium Chlamydia trachomatis (klah-mid- tr-km-ts).
Signs of infection include painful urination and penile or vagi-
nal discharge; symptoms are more prominent in men. Like
gonorrhea, this STD can cause PID and infertility in women.
Chlamydia can also be diagnosed with new tests that detect
the bacterial genes in a urethral or cervical swab sample.
Treatment is with antibiotics.
Trichomoniasis (trk o-mo-nia-ss) vaginalis is an infection
caused by the protozoan Trichomonas (trk o-mo nas) vagini-
tis. Symptoms for women include vaginal discharge, burning,
and itching; men usually have no symptoms. Treatment is
with a single dose of antibiotics.
Disorders of the Male Reproductive System
Erectile dysfunction (ED), otherwise known as impotence, is an
inability to achieve or maintain an erection for sexual inter-
course. The cause for this condition may be physical (disease,
injury, or a side effect of certain drugs) or psychological (it
often accompanies conditions like depression, stress, or fear
of sexual failure). There are actually other forms of impotence
than erectile dysfunction, because impotence is any male
condition that interferes with reproduction, such as problems
with ejaculation, sperm count, or even lack of sexual desire.
58
Many men have suffered from impotence at some time in
their lives. This condition becomes more common with
increasing age.
The reproductive problem of infertility may stem from the
male system. Sperm production may be inhibited by
chemotherapy for cancer or autoimmune diseases. Smoking
may also reduce the sperm count. Sperm can have motility
problems, preventing them from swimming up the female
reproductive tract to fertilize the egg. Hypogonadism (h po-
go nad-zm) is less complex than it sounds. Its simply the
minimal production (HYPO-) of sperm by the testes (gonads).
Causes vary; the male might be born with dysfunctional or
undescended testes, or they may fail to develop properly
because of hormone imbalance. Testosterone therapy may
improve the essential function of the gonads.
Not really a disease, cryptorchidism (krp-tor k-dzm) is better
known as undescended testicles. If the testes of the fetal
male dont descend properly into the scrotum, the adult male
will be sterile because the internal body temperature is too
high for spermatogenesis. Not only that, undescended testes
will atrophy (at ro-fe ) (wither, decrease in size) and often
become cancerous.
As mentioned earlier, benign prostatic hypertrophy (BPH), also
known as benign prostatic hyperplasia (be-nn pros-tat k
h per-pla zhah) is enlargement of the prostate gland.
Because the prostate surrounds the urethra, this enlarge-
ment may squeeze the urethra, thus slowing down the
urinary stream. The incidence of BPH increases with age.
Most men older than 60 years have some degree of BPH.
Untreated BPH can cause stagnation of the urine within the
bladder, leading to infection. Treatment includes various
drugs or surgical removal of part of the prostate. The surgery
can be done with an endoscope placed into the urethra.
Prostate cancer is the most common cancer in men as well as
the second most common cause of cancer-related deaths.
Like the occurrence of BPH, the incidence of prostate cancer
increases with age. Many men will die with some evidence of
prostate cancer, although it may not have contributed to
their death. In contrast to the benign hypertrophic prostate,
which is uniformly enlarged and soft, the cancerous prostate
59
is much more firm. Discrete nodules may be present. Levels
of prostate specific antigen (PSA) are usually high. The defini-
tive method of diagnosis is to obtain a biopsy. Men should
receive regular screening and measurement of PSA levels with
prostate examinations. Various clinical societies recommend
that screening should begin at 45 to 50 years old.
Its rare for tumors to develop in the testes, but when they
do, theyre usually malignant. Seminoma (s m-no mah) is a
cancer of the seminiferous tubules thats usually treated with
radiation. TERAT/O means monster, and a teratoma
(terah-to mah) is a monstrous-looking tumor, most often
occurring in the testes (or ovaries in women). It grows from
an immature germ cell and contains all sorts of different tis-
suesskin and bone, hair, oil glands, teeth. In males,
teratoma is highly malignant and quickly metastasizes.
Chemotherapy and radiotherapy are the usual treatments.
Prostatitis (pros tah-t ts) is an infection of the prostate. The
symptoms often mimic those of urinary tract infection (UTI).
Because the bacteria in prostatitis reside deep within the
prostate tissue, the treatment requires a longer course of
antibiotics than does UTI.
Epididymitis (ep -dd -m ts) is an inflammation that can
be caused by urinary tract infection, prostatitis, or, most
commonly, a gonococcus invasion. Symptoms are pain,
swelling, and tenderness in the testicles. Unless the condition
is treated early with antibiotics, abscesses may form and can
create scar tissue, leading to possible sterility (ste-rl -te )
(inability to produce offspring).
Inflammation of the testes, orchitis (or-k ts), has various
causes, most often an injury or an infection with mumps.
Swelling and pain are the symptoms, and sterility can result
from severe cases.
Urethritis (yu re-thr ts), an inflammation of the urethra, may
be caused by a number of things. An infection and trauma to
the penis are the most common. Some infections may be
accompanied by discharge, but the main symptoms are itch-
ing, tenderness or swelling in the penis, pain with sexual
intercourse, or blood in the urine. Treatment for infection is
antibiotics, but inflammation due to trauma may need other
procedures in case of major damage, or simply time if the
trauma was minor.
60
Phimosis (f-mss) is a condition in which the foreskin of the
uncircumcised penis cant be retracted fully. This can be
caused by an inflammation of the penis (balanitis [bl-
nts]) or from stenosis, or fusion of the foreskin to the glans
penis. The condition may cause pain on urination or sexual
intercourse and urinary obstruction.
Peyronies (p-r-nz) disease is a connective tissue disorder.
A benign plaque, or hard lump, forms in the erectile tissue of
the penis, causing it to have an abnormal curve. If the plaque
is on the top of the shaft, the shaft will bend upward, if on
the underside, it bends downward. The process can be
painful, but not always. It sometimes reverses itself or the
damage can be permanent. There may be a genetic compo-
nent to the disease, but it may also be caused by trauma.
Priapism (pr-p-zm) is a disorder in which an erection per-
sists for more than four hours without stimulation. This is a
painful condition and is considered a medical emergency. The
condition can be caused by certain medications, specifically
the drugs given for erectile dysfunction, but it can also be
caused by use of some recreational drugs, such as cocaine.
Untreated, this condition can cause damage to the blood ves-
sels in the penis, clotting of blood, and ischemia (restriction
of blood supply) that can lead to gangrene.
Testicular torsion is a twisting of the spermatic cord that sup-
plies blood to the testicles. Indication of torsion is a sudden
onset of pain in the scrotum. This condition is a medical
emergency. If the cord isnt untwisted within 24 hours, it will
lead to death of the testis and infection from gangrene.
When ejaculation occurs, the urethral sphincter closes the
entrance to the bladder. When this sphincter doesn't work
properly, retrograde ejaculation occurs, and the ejaculate
enters the bladder. The cause of this problem may be in the
nervous system or the prostate. It may also be the side effect
of one of several surgeries, or of some medications that relax
the muscles of the urinary tract. This condition is sometimes
seen as a complication of diabetes because of neurological
damage that occurs with diabetes.
61
Disorders of the Female Reproductive System
Infections. Bacteria, viruses, and parasites can cause infec-
tion that may ascend from the vagina and cervix through the
uterus and fallopian tubes all the way to the ovaries. Pelvic
inflammatory disease (PID) is characterized by inflammation
of the cervix (cervicitis [serv-s ts]), uterus (endometritis
[endo-me-tr ts]), fallopian tubes (salpingitis [sal pn-j ts]),
ovaries (oophoritis [o ah-fah-r ts]), and sometimes the con-
nective tissue of the uterus (parametritis [par ah-me-tr t s]).
The most common cause of PID is the gonococci that cause
gonorrhea. But other dangerous organisms also cause PID by
finding easy entry into the reproductive tract after abortion or
childbirth if the practitioners havent used aseptic (a-sep tk)
techniquepractices of cleanliness to ensure a sterile surgical
environment. Abdominal pain, fever, and vaginal discharge of
pus are all symptoms of PID. Antibiotics are the treatment.
Infection that invades the endometrium after childbirth or
abortion is called puerperal sepsis (pyu-er per-al sep ss).
Because the womb at this time has lesions and blood loss,
its susceptible to invasion by bacteria in the absence of
aseptic technique. Lower abdominal pain, fever, chills, exces-
sive bleeding, and a foul-smelling discharge are symptoms of
the infection. Antibiotic treatment can usually control it.
Inflammation of the vagina, vaginitis (vaj -n ts), is a very
common condition that can be caused by a variety of organ-
isms. The parasite Trichomonas (trk o-mo nas) is a common
cause, as is the fungus Candida albicans (kan dd-ah al b-
kanz). Infection with Trichomonas results in a foul-smelling
whitish-yellowish discharge, or leukorrhea (l ko-re ah),
which in turn causes itching, burning, and soreness in vagi-
nal and vulval tissues. Candidiasis (kan d-d-ah-ss) or
yeast infection causes a curdlike discharge and intense
itching, termed pruritus vulvae (pr-r tus vul va ). (Any itch-
ing is referred to as pruritus, in medical terms.) Ironically,
antibiotics used to combat an infection elsewhere in the body
can lead to vaginitis by changing the normal flora of the
vaginakilling off the harmless microorganisms that live
there and that keep the harmful population low. Antibiotic-
resistant fungi and viruses can then thrive.
62
Salpingitis (sal pn-j ts) often causes sterility or abnormal
pregnancy. An untreated infection with pyogenic organisms
such as gonococcus, streptococcus, and staphylococcus can
disrupt a womans fertility by causing the ends of the
fallopian tubes (salpinx [sal pnks]) to close. The filling of a
tube with pus is called pyosalpinx (p o-sal pnks), and the
watery fluid remaining after treatment with antibiotics is
called hydrosalpinx (h dro-sal pnks). If the outer ends of the
fallopian tubes dont close, then the infection can spread into
the abdominopelvic cavity and cause peritonitis. If a fertilized
ovum cant get out of the fallopian tube, it will implant itself
there, resulting in an ectopic pregnancy. The embryo will
develop for perhaps two months before the tube ruptures, a
dangerous as well as intensely painful condition because
infection can quickly spread throughout the abdominopelvic
cavity. Surgery is necessary to remove the ruptured tube and
embryo.
Toxic shock syndrome (TSS) caused quite a stir in the 1980s,
when it was discovered that the prolonged use of super
absorbency tampons could cause toxic infection with
Staphylococcus aureus (staf -lo-kok us aw re-us) to develop
in some women; the condition rarely affects men and non-
menstruating women. The sudden onset of a high fever,
vomiting, diarrhea, sore muscles, and a peeling rash are the
symptomsfollowed in severe cases by shock and death. The
various symptoms need to be treated in their usual ways,
and antibiotics are given to kill the infection.
Menstrual disturbances. Amenorrhea (-mn-r) is the
absence of menstruation in a woman who should be men-
struating. In the condition known as primary amenorrhea, a
woman has never had a menstrual period. Secondary amen-
orrhea occurs when a menstruating woman stops having
menstrual periods, apart from pregnancy or menopause.
Imbalance of sexual hormones, anorexia, or even psychologi-
cal disturbance can cause amenorrhea. Also, some female
athletes who have lost an extreme amount of body fat are
amenorrheic.
Dysmenorrhea (dismn--r) refers to painful menstruation,
and is mainly characterized by cramps. Most women experi-
ence some degree of dysmenorrhea during their lives.
63
Anti-inflammatory drugs and heat packs are useful for symp-
tomatic relief. In contrast, premenstrual syndrome (PMS)
occurs just before menstruation. Women may experience
water retention, irritability, and mood swings.
Endometriosis. In endometriosis (endo-me tre-o ss),
endometrial tissue embeds itself in locations outside of the
uterus. The cause isnt known, but scientists have some edu-
cated guesses. Perhaps the tissue went in the wrong direction
during menstruation and was expelled out through the fal-
lopian tubes. Or perhaps hormones triggered the abnormal
growth of endometrial cells.
Some women have the condition without noticing symptoms.
Others experience dysmenorrhea (ds men-o-re ah) and also
dyspareunia (dspah-r ne-ah) (painful coitus). The lesions
often interfere with fertility. In younger women who wish to
have children, hormone therapy is given. Depending on the
severity of the condition, the offending tissues may be
removed in surgery and a complete hysterectomy performed
to prevent a recurrence.
Toxemia of pregnancy. Pregnant women may wonder why
physicians insist on frequent checks of their weight, urine,
and blood pressure. Careful prenatal care is vitally important
in the detection and prevention of toxemia (tok-se me-ah) of
pregnancy. This disease isnt really caused by a toxin at all,
though it isnt yet known what does cause the syndrome. Its
primary symptoms are edema, proteinuria, and hypertension
that eventually lead to convulsions. The condition goes by
many names: preeclampsia (pre e-klamp se-ah), EPH complex
(for its primary symptoms), and gestosis (ges-to ss).
Eclampsia (e-klamp se-ah) is the convulsive stage of the dis-
ease. If the symptoms arent caught and controlled early on,
the convulsions may lead to the death of both the mother
and the fetus. In fact, though the condition affects only five
to seven percent of pregnancies, preeclampsia-eclampsia syn-
drome is one of the most frequent causes of death associated
with childbirth. The condition is most common in women
with inadequate nutrition, so a proper diet is another point of
great concern for physicians. Also at risk are women with
preexisting conditions such as heart disease, diabetes melli-
tus, or hypertension.
64
Neoplasms. The breast is the most common site of tumors
in women. Cancer of the breast ducts, intraductal carcinoma
(in trah-duk tal kars-no mah), is the most frequently diag-
nosed malignancy. The high frequency of detection is due in
part to the increase of screening mammography. The carci-
noma spreads through the lymph system to the lungs, liver,
brain, and bone. Women who are over 40 and have a family
history of breast cancer, premature menarche, and delayed
menopause are most at risk. Women who have had no chil-
dren or began having them late in their fertility span (after
age 30) are also at risk.
Breast cancer forms a hard lump that stays in one place
because the tumor is fixed to an underlying structure, as
opposed to a cyst, which will have some movement. The skin
over the tumor may dimple. The nipple may retract and emit
a discharge when squeezed. These symptoms usually present
themselves only after the tumor has advanced quite a bit,
however. Thus, physicians highly recommend frequent self-
examination and yearly exams, with a screening breast x-ray,
known as a mammography (mam-og rah-fe ), every year or two
after the age of 40.
A rare cancer of the nipple is Pagets (paj ets) disease, in
which the nipple develops crusty lesions with discharge, and
the breast becomes edematous (e-dem ah-tus) (retaining fluid)
and takes on a pigskin look. (Pagets disease can also occur
in other areas of the body such as the bones.)
Benign growths of the breast are common. A fibroadenoma
(f bro-ad e-no mah) is a firm tumor that moves around.
Cystic hyperplasia (ss tk h per-pla ze-ah), also known as
fibrocystic (f bro-ss tk) disease, is the development of many
fluid-filled cysts that cause no harm. If they cause pain dur-
ing menstrual periods, they can be aspirated (as p-rat-ed),
meaning the fluid will be removed with a needle. Women who
have fibrocystic disease should be carefully monitored to
ensure that a cancerous tumor wont be mistaken for a cyst.
The development of the Papanicolaou (p-p-nik-low) test,
better known as the Pap smear, has greatly decreased the
number of deaths due to cervical carcinoma. The earliest
stage, abnormal cell growth detected by microscopic study of
cells scraped from the cervix, is minimal cervical dysplasia
65
(ser v-kal ds-pla zhah). The next stage, carcinoma in situ
(kar s-no mah n s tu ), is diagnosed and treated based on
a biopsy of cone-shaped tissue, or conization (kon -za shun).
Carcinoma in situ isnt yet embedded in the underlying tis-
sue, and the abnormal cells can be removed easily with
cryosurgery (kr o-sur jer-e ) or cryocautery (kr o-kaw ter-e ),
the freezing of cells to destroy them. New, normal cells will
grow in the healing process. However, if the situation goes
undetected, malignancy can progress into the vagina, blad-
der, rectum, and pelvic wallaccompanied by vaginal
discharge and nonmenstrual bleeding. Widespread cancer
will be treated with radiation, since its inoperable.
Cancer of the endometrium, a rare form of cancer, primarily
affects childless women after menopause. The malignant
tumor may embed itself in the uterine wall and cause ulcera-
tions and bleeding. The condition often responds to radiation.
If not, surgery is performed.
Between 30 and 40 percent of women in their reproductive
years develop small benign fibroid (f broid) tumors in the
uterus, but they may become very large after age 40. Fibroids
are also called leiomyomas (l o-m-o mahz). Theyre mostly
harmless but can complicate labor and delivery, and if the
tumors are large, they can cause pain by putting pressure on
the nerves in surrounding organs. The usual symptoms are
heavy menstruation and bleeding between periods. A
procedure called myomectomy (m o-mek to-me ) removes
small tumors along with the uterine muscle theyre attached
to. With large tumors, the uterus itself is usually removed, a
procedure called hysterectomy (hs ter-ek tah-me ).
Often, women develop ovarian cysts (o-vr e-an ssts),
benign, fluid-filled capsules. Cysts, especially large ones,
should be removed since they may become cancerous,
become infected, or obstruct proper function of the organ.
Like the male testes, the female ovary can develop a teratoma
(ter ah-to mah), also called a dermoid (der moid) cyst. Unlike
in males, this tumor is usually harmless in females. It will be
removed if it causes pain.
Ovarian cancer is a major cause of death, since the malignant
growth is usually detected only after metastasis. As the
tumor grows, it may cause pain and fullness of the abdomen,
66
abnormal uterine bleeding, urinary problems, and ascites
(accumulation of fluid in the peritoneal cavity). The cancer-
ous ovaries and fallopian tubes must be removed in a
salpingo-oophorectomy (sal-png go-o f-rek to-me ), and
sometimes even a total abdominal hysterectomy is necessary.
After surgery, radiation and chemotherapy will be used to kill
remaining cancer cells.
Have you ever heard of a DES daughter? Decades ago,
many pregnant women were given the synthetic hormone
diethylstilbestrol (d-eth l-stl-bes trol) (DES) to prevent mis-
carriage. Ironically, the drug later proved fatal to some of the
daughters born from those pregnancies because it caused
adenocarcinoma of the vagina, a rare form of cancer.
Hydatidiform (h dah-td -form) means resembling a hydatid
(h dah-td), which is any cystlike structure, most often the
type of cyst formed by larval tapeworms. In the placenta, the
hydatidiform mole does resemble the cysts of tapeworms
because its composed of multiple cysts in grapelike bunches.
This benign tumor may accompany an abnormal pregnancy
or develop after a pregnancy. It secretes hCG, which you
already know leads the uterus to expand. This disease causes
all the symptoms of pregnancy, including the rounded
abdomen, except theres no fetus. The body usually expels
the mole naturally, and then a dilation (d-la shun) and
curettage (ku re-tahzh ) (D & C), or scraping clean the walls
of the uterus with an instrument inserted through the cervi-
cal opening, will be performed.
Another tumor of the placenta, the choriocarcinoma (ko re-o-
kar s-no mah), may develop in the same circumstances as a
hydatidiform mole, or even after a hydatidiform mole. The
choriocarcinoma also secretes hCG and causes false symp-
toms of pregnancy, only this tumor forms on the chorion and
is highly malignant; it metastasizes rapidly and requires
quick chemotherapy.
Miscellaneous pathology. Mentioned previously, premen-
strual syndrome (PMS) was once considered to be primarily
all in the mind. However, it has been shown that PMS is a
real physical as well as psychological phenomenon related to
the female hormone cycle. Sources estimate that PMS affects
between 30 and 50 percent of women between the ages of 25
67
and 40. In the days between ovulation and menstruation, the
woman may experience a variety of symptoms in virtually
every system of the bodyedema, weight gain, bloating, ten-
der breasts, backache, headache, dizziness, moodiness,
fainting, the common cold, sinus infection, asthma, sore
throat, nausea, vomiting, food cravings, compulsive eating,
boils, easy bruising, hives, recurrences of herpes, and more!
Different women have different symptoms, but each woman
will have her own cycle of the same symptoms each month.
In true PMS, the symptoms go away when menstruation
begins.
The best treatment for PMS is self-knowledgecharting the
symptoms and then being able to work ones life around the
good and bad times. So as not to exaggerate the symp-
toms, the PMS sufferer should maintain good nutrition, get
plenty of sleep and exercise, and avoid caffeine, alcohol, and
refined sugar.
Infertility is defined as difficulty in conceiving a child. A
woman can be infertile because of endometriosis or chronic
infection and scarring. Hormonal disturbances can also pre-
vent conception.
When the fetus has a genetic abnormality, a spontaneous
abortion (ah-bor shun), also called miscarriage (ms-kar j),
can occur. In medical terminology, abortion means any termi-
nation of pregnancy before the fetus can live outside of the
womb, whether or not the pregnancy is stopped deliberately.
Abortion of either type requires careful medical care to pre-
vent hemorrhage and infection.
68
Self-Check 6
Questions 110: Identify the disease suggested by each description.
1. Infection of endometrium after childbirth
__________________________________________________________
2. Sore prostate with painful urination and pus at the urethra
__________________________________________________________
3. Curdlike discharge from the vagina accompanied by intense itching
__________________________________________________________
4. Urinary obstruction, enlargement of the prostate gland
__________________________________________________________
5. Cryosurgery used to remove the abnormal cells
__________________________________________________________
6. Benign growths of the uterus
__________________________________________________________
7. Minimal sperm production
__________________________________________________________
8. Infection throughout the organs of the female reproductive system
__________________________________________________________
9. Pyogenic organisms invading the fallopian tubes
__________________________________________________________
10. A monstrous-looking tumor of the testes and ovaries
__________________________________________________________
69
Reproductive System
Tests
There are a number of lab tests performed on blood, urine,
semen, and cell smears to assist physicians in the diagnosis
and treatment of the reproductive system. The most common
is probably the pregnancy test, performed on a sample of a
womans blood or urine to determine the presence of human
chorionic gonadotropin. Since hCG is produced by the pla-
centa, its a fairly sure indication.
A pregnanediol (preg nan-d ol) test of the urine may indicate
a spontaneous abortion or a menstrual disorder.
Other tests performed on women are the Pap smear, which
weve already discussed, and the endometrial (en do-me tre-
al) biopsy or smear. The physician obtains a cell sample by
inserting a thin, hollow curette (ky-ret) (spoon-shaped
instrument) through the cervix and removing some endome-
trial tissue. Another smear examination is the wet map or
wet prep, which puts a sample of vaginal discharge under the
microscope for the identification of bacteria and yeast.
There are also tests for males only. The prostate-specific
antigen immunoassay (an t-jen m u-no-as a ), commonly
referred to as PSA, is a blood-protein test used to detect
prostate disease or prostatic cancer.
A testosterone toxicology (tes-tos te-ro n tok s-kol o-je ) test
may be performed on blood serum to determine the testos-
terone level, which helps in the diagnosis of benign prostatic
hypertrophy, hypogonadism, and other disorders of the male
reproductive organs.
A paternity test looks at blood type, the human leukocyte
antigen (HLA), white blood cells, enzymes and proteins, and
genetic factors. The test can prove for sure who cant be the
genetic father of a child, but it cant prove who is the father.
For that, a highly specialized DNA study can be performed.
70
A semen (se men) test is used to evaluate the fertility of the
male, whether its to find out why a couple cant conceive a
child or to determine if a vasectomy has been successful.
Volume of semen, pH, sperm count, sperm motility, and
structure of the sperm are all examined.
To detect syphilis in both men and women, the fluorescent
treponemal antibody absorption test (flor-es ent trep o-ne
mal an t-bod e ab-sorp shun) (FTA-ABS test), or Treponema
pallidum immobilization test (trep o n-e mah pal -dum m-
mo bl--za shun) (TPI), is performed. This test shows whether
the Treponema pallidum, the causative organism, is present
in the body. Other blood tests for syphilis are the venereal
disease research laboratory test (VDRL test) and the rapid
plasma reagin (r-jn) test (RPR test).
Male Procedures
Circumcision (ser kum-szh un) is the removal of the prepuce
(foreskin) from the penis. This is a procedure that has been
performed since ancient times as part of the religious cus-
toms of many cultures, sometimes when the male is an adult
as a rite of passage, and sometimes when a male child is only
a few days old. Its a controversial custom in the United
States in modern times. Proponents of the procedure state
that there are good reasons to do it, as theres evidence that
circumcised males have fewer UTIs, are at lower risk for
penile cancer, arent at risk for phimosis, and have fewer
hygiene issues. Those opposed to circumcision claim that
removing the foreskin is painful, can lessen sexual pleasure
as an adult, and there are possibilities of complications
inherent with any surgical procedure.
Hydrocelectomy (hdr-s-lkt-m) is the repair of a
hydrocele (hdr-sl), an accumulation of fluid in the tunica
vaginalis testis. If the accumulation becomes large, it may
also fill a portion of the epididymis. The primary symptom is
a soft swelling in the scrotum, and it isnt usually painful.
However, if the fluid does reach the epididymis, it may cause
epididymitis, which can be painful. Hydroceles can be con-
genital, in that sometimes the membrane that surrounds the
testicles in the fetus doesnt close properly and abdominal
fluid flows into the scrotum. In adults, hydroceles may
71
develop slowly if a defect in the tunica vaginalis causes over-
production of fluid. They may also be the result of trauma or
associated with inguinal hernias or even cancer.
Orchiectomy (or ke-ek to-me ), or orchidectomy (or k-dek to-
me ), is the removal of the testicles. The penis and scrotum
are left intact. This procedure stops the production of testos-
terone, and its often performed in cases of prostate cancer,
(since prostate cancer needs testosterone to keep growing).
Orchidopexy (or k-do-pek se ) or orchiopexy (or ke-o-pek se)
is the surgical procedure used in cases of cryptorchidism. An
endoscope is used to locate the testicle and draw it through
the inguinal canal and into the scrotum. Its fixed there so it
doesnt migrate back up through the canal. This procedure
may also be used to relieve testicular torsion if caught early
enough.
Prostatectomy is the removal of all or part of the prostate for
treatment of prostate cancer or BPH. There are many ways to
do this, some of which are transurethral (transy-rthrl)
resection of the prostate (TURP), transurethral incision of the
prostate (TUIP), transurethral microwave thermotherapy
(TUMT), and transurethral needle ablation (TUNA).
Parts of the vasa deferentia are removed during a vasectomy
(v-sek to-me ). This sterilization procedure is often used as a
birth-control technique. Thats where the name vasectomy
comes fromits an excision of the vas.
Female Procedures
Amniocentesis (mn--sn-tss) is a procedure that tests
for certain birth defects, such as Down syndrome, sickle cell
disease, cystic fibrosis, and Tay-Sachs disease. Under ultra-
sound guidance, a long needle is inserted into the pregnant
womans abdomen and into the amniotic sac in the uterus. A
small amount of fluid is withdrawn for testing.
Colposcopy (kl-psk-p) is examination of the cervix with a
lighted electron microscope. This procedure is done when Pap
smear results indicate irregularity in the cells, wen theres
evidence of HPV, or if the cervix appears abnormal during a
pelvic examination.
72
In dilation and curettage (D & C), the uterus is expanded
(dilation) and a thin, sharp instrument called a curette is
used to scrape away a portion of the lining of the uterus for
tissue samples (curettage [kr-tahzh]). This procedure is
used to determine causes for menstrual abnormalities, uter-
ine polyps, fibroid tumors, and endometrial cancer. D & C is
also used when an abortion occurs and the uterus doesnt
empty all the products of the pregnancy.
Hysteroscopy (hster-ahsk-p) is used to view the uterus
through the cervix. The hysteroscope is a very thin scope, so
the procedure doesnt usually involve dilating the cervix. The
uterus does, however, need to be filled with liquid or gas to
visualize it. This procedure can be used to diagnose problems
in the uterus, or it can be used operatively to remove polyps
and adhesions.
Conization or cone biopsy is an extensive cervical biopsy. A
cone-shaped area of abnormal tissue is removed from the
cervix, along with a small amount of normal tissue so that
the two types can be compared under the microscope.
Cesarian (s-zr-n) section (C-section) is used to deliver
babies when they cant be delivered vaginally (for reasons
including impending risk to the baby or mother, failure of
labor to progress, uterine rupture, placental problems, breech
or transverse position of the baby, and many others). An inci-
sion is made in the mothers abdomen and into the uterus,
and the baby is removed directly from the uterus.
Episiotomy (-pz-aht-m) is a surgical incision through
the perineum that enlarges the vagina during childbirth. This
procedure is used to prevent tearing of the skin around the
vagina upon birth of the baby. An intentional incision is eas-
ier to repair than a jagged tear, so this procedure is done to
make healing easier for the mother.
Hysterectomy is the procedure used to remove a uterus. A
complete or total hysterectomy removes the cervix along with
the uterus (this is the most common operation). A partial or
subtotal surgery removes only the upper part of the uterus,
leaving the cervix intact. A radical hysterectomy removes the
uterus, cervix, and upper part of the vagina.
73
Oophorectomy (-f-rekt-m) is the removal of one or both
ovaries. This procedure is the biological equivalent of an
orchiectomy in males. As discussed earlier, removal of the
fallopian tube along with the ovaries is a salpingo-oophorec-
tomy. Many times, removal of the ovaries is performed along
with a hysterectomy. In that case, the entire procedure is
referred to as a total abdominal hysterectomy with bilateral
salpingo-oophorectomy (TAH-BSO).
Tubal ligation (l-gshn) (known as having your tubes tied)
is a procedure in which the fallopian tubes are cut and then
sealed in order to prevent ova from traveling into the uterus.
This is considered a permanent form of sterilization.
Procedures for Males and Females
Treatment of breast cancer varies with the location and
spread of the disease, but usually surgery is necessary. The
goal is to preserve as much healthy tissue as possible. In a
lumpectomy (lum-pek to-me ), only the tumor is removed, and
radiation therapy is given to kill any remaining cancerous
cells. In a simple mastectomy (mas-tek to-me ), the breast is
removed. If the cancer has spread or if previous treatment
has been ineffective, then a radical mastectomy may be per-
formedthe removal of the breast, underlying chest muscles,
and nearby lymph nodes.
Pelvic exenteration (ksn-tr-shn) (or evisceration [-
vsr-shn]) is the surgical removal of all organs from a
persons pelvic cavity, including the bladder, urethra, rectum,
and anus. In a woman, the vagina, cervix, uterus, fallopian
tubes and ovaries and sometimes the vulva are removed. In
men, the prostate is removed. The patient is left with a per-
manent colostomy and vesicostomy (a stoma through which
urine drains). This procedure is used in cases of very
advanced genitourinary cancers in which it would be difficult
to tell if all the disease had been eradicated with a less com-
prehensive surgery.
and word forms associated with the male and female repro-
ductive systems.
74
In Other Words
Germ cell = gamete
Egg = ovum
Sperm = spermatazoa
Coitus = copulation
Testicles = testes
Erectile dysfunction = impotence
Semen = seminal fluid
Prepuce = foreskin
Cowpers glands = bulbourethral glands
Benign prostatic hypertrophy = benign prostatic hyperplasia
Fallopian tube = uterine tube = oviduct = salpinges
Corpus = body
Amnion = amniotic sac
Placenta = afterbirth
Menopause = climacteric
Follicular stage = proliferative stage
Luteal phase = secretory phase
Spontaneous abortion = miscarriage
Toxemia of pregnany = preeclampsia = EPH complex = gestosis
Conization = cone biopsy
Exenteration = evisceration
75
artificial insemination (n-sem -na shun) artificial placement of semen into vagina to
produce fertilization
aspermia (ah-sper me-ah) failure to form or failure to ejaculate semen
azoospermia (a -zo o-sper me-ah) lack of sperm in the semen
castrate (kas tra t) to remove the testicles or ovaries
condom (kon dum) protective rubber sheath worn over the penis
during coitus to prevent pregnancy or STDs
condyloma (kon d-lo mah) venereal wart
epispadias (ep -spa de-as) abnormal location of urethral opening on the
upper side of the penis
eunuch (yu nk) man who has been castrated
gynecomastia (gn e-ko-mas te-ah) excessive development of mammary glands in the
male
hydrocele (h dro-se l) fluid-filled cavity in the testes
hypospadias (hi po-spa de-as) abnormal location of urethral opening on the
under side of the penis
impotence (m po-tens) inability to achieve or maintain an erection
oligospermia (ol -go-sper me-ah) scanty number of sperm in the semen
spermaturia (spermah-tyu re-ah) discharge of semen in urine
varicocele (var -ko-se l) varicose veins of the spermatic cord
venereal (ve-ne r e-al) pertaining to, relating to, or transmitted by
sexual contact
abruptio placenta premature separation of the placenta
(ab-rup she-o plah-sen tah)
anovular (an-ov yu-la r) lack of production and discharge of ova
dystocia (ds-to se-ah) abnormal labor or childbirth
episiotomy (e-pz e-o to-me ) incision of the perineum
eutocia (yu-to se-ah) good, normal childbirth
(Continued)
76
follicular atresia congenital degeneration of ovarian follicles before
(fo-lk u-lar ah-tre ze-ah) they mature
gravida (grav -dah) pregnant woman
hematosalpinx (hem ah-to-sal pngks) blood in the fallopian tube
hysterotomy (hs ter-oto-me ) incision of the uterus performed either
transabdominally or vaginally
multigravida (mul t-grav -dah) woman who has been pregnant two or more times
multipara (mul-tp ah-rah) woman who has borne more than one infant of
at least 20 weeks gestation (live-born or not)
oligomenorrhea (ol -go-men o-re ah) scanty monthly flow
pelvimetry (pel-vm e-tre) measurement of pelvic dimensions
placenta previa (plah-sen tah pre v-a ) placenta located in front of the cervical opening to
the birth canal, usually necessitating C-section
primigravida (pr m-grav -dah) woman during her first pregnancy
primipara (pr-mp ah-rah) woman who has produced one viable infant
tubal ligation (t bal l-ga shun) tying the uterine tubes to prevent pregnancy
vaginismus (vaj -nz mus) painful spasm of the vagina, preventing coitus
Combining Forms and Suffixes You Should Know
AMNI/O amnion
ANDR/O male
BALAN/O glans penis
CERVIC/O neck, cervix
CHORI/O, chorion
CHORION/O
COLP/O vagina
CULD/O cul-de-sac
EPIDIDYM/O epididymis
(Continued)
77
Combining Forms and Suffixes You Should KnowContinued
EPISI/O vulva
GALACT/O milk
GYNEC/O woman, female
HYSTER/O uterus, womb
LACT/O milk
MAMM/O breast
MAST/O breast
MEN/O menses
METR/O uterus
NAT/O birth
OBSTETR/O midwife
OOPHOR/O ovary
ORCH/O testes
OVARI/O ovary
PERINE/O perineum
PROSTAT/O prostate
SALPING/O fallopian tubes
SPERM/O sperm
TEST/O testes
UTER/O uterus
VAGIN/O vagina
VAS/O vas deferens
VESICUL/O seminal vesicle
VULV/O vulva
Suffixes
-ARCHE beginning
-PARA to bear
-SALPINX fallopian tubes
-TOCIA childbirth, labor
78
Self-Check 7
Questions 110: Label the following as either a male test (MT), female test (FT), male
procedure (MP), or female procedure (FP).
______ 1. Hydrocelectomy
______ 2. Conization
______ 3. Pregnanediol
______ 4. Testosterone toxicology
______ 5. Episiotomy
______ 6. Orchidopexy
______ 7. Paternity
______ 8. Endometrial biopsy
______ 9. Dilation and curettage
______ 10. Vasectomy
79
IMMUNE AND
LYMPHATIC SYSTEMS
The immune system is associated with defense against patho-
genic agents and reaction to foreign substances. Immune
responses are made possible by the lymphatic system. The
lymphatic system is a type of circulatory system. The compo-
nents of the lymphatic system are the spleen, the thymus,
bone marrow, lymph nodes, lymphatic vessels and lymph.
Together, these components carry out necessary immune
functions.
This network of capillaries, vessels, ducts, nodes, and organs
perform a number of important jobs. They transport excess
fluid from the tissues back to the circulatory system, filter
bacteria, act as an emergency reservoir of blood, destroy and
remove old red blood cells, and produce monocytes and T-
lymphocytes (two types of white blood cells) for the immune
system. The lymphatic system also absorbs fats from the
small intestine and delivers them into the bloodstream.
Although it does a lot of behind-the-scenes work and isnt as
well-known as the other systems, the lymphatic system is
essential to our survival.
Anatomy and Physiology of the
Lymphatic System
Lymph
Remember from your study of the cardiovascular system that
blood travels through the arteries until it reaches the tiny
capillaries. Here the red blood cells must trickle along in sin-
gle file. The blood cells remain in the capillaries, eventually
passing into the venules and back up through the venous
system to the heart. During this passage, the fluid from the
bloodstream, which is called plasma, diffuses across the cap-
illary walls, carrying oxygen, nutrients, hormones, and
lymphocytes (lm fo-sts) (white blood cells) to the tissues.
80
When plasma seeps out of blood capillary walls between tis-
sue cells, its then known as tissue fluid or interstitial (n
ter-stsh al) fluid. Some fluid remains as interstitial fluid in
the tissue spaces, but some of it deposits its nutrients and
then absorbs waste products and carbon dioxide. Any inter-
stitial fluid not remaining behind in the tissue is absorbed
into lymph capillaries (Figure 15), which look just like regular
capillaries, and network through the tissues. Here, the fluid
becomes lymph (lmf), which means clear water in Latin.
Chyle (kl) is a special kind of lymph collected in the intes-
tines. Here, the interstitial fluid picks up the products of
digestionin particular, the fat extracted from chyme (km)
(partially digested food that goes from the stomach into the
duodenum). In the case of the intestine, the process is the
same in that the plasma diffuses from the capillaries into the
intestinal tissue. The blood plasma in the intestines, though,
has already absorbed fat from the chyme. As the plasma is
squeezed out into the tissue, it contains these fat cells, which
remain bonded when it enters the interstitial tissue and
when it enters the lymph vessels.
Lymph Capillaries
Lymph
Lymph Vessel
(to Lymph Node)
Tissue Cells
Interstitial Fluid
Blood Capillaries
Plasma seeps from
blood capillaries into
surrounding tissue
(interstitial fluid) and
then enters the
lymph vessels (lymph).
FIGURE 15Lymph
Capillaries
81
Lymph Vessels and Nodes
Almost everywhere there are blood vessels, there are lymph
vessels too. There are no lymph vessels in the cartilage, nails,
hair, epidermis, eyeball, inner ear, or spleen. Everywhere
else, lymph vessels closely accompany the vein system. Just
as blood vessels carry blood, all lymph vessels carry lymph.
Lymph, however, is initially deposited into the tiniest of the
vessels embedded in the tissues and flows up to larger and
larger vessels. The vessels resemble veins in that surround-
ing muscles massage or milk the fluid along, and valves
prevent backflow. But the lymphatic vessels are smaller than
the veins. The smallest lymphatic capillaries arent even wide
enough to hold a single red blood cell.
There is one exception to the tiny initial lymph capillaries,
and thats in the intestines. The fat cells in the chyle are
larger than the cells in regular lymph, so they go into special
vessels called lacteals (lak te-alz), which are larger than the
regular initial lymph capillaries in other parts of the body.
They do, however, still connect to the regular lymph system
as the vessels become larger.
In strategic locations along the lymph vessels there are clus-
ters of lymphatic tissue called lymph nodes. Lymph nodes
store lymphocytes that are deposited there by lymph, but
they also may deposit lymphocytes into lymph upon activa-
tion, such as infection. The nodes also contain macrophages
(makrh-fa-jz)cells that eat other cells. The lymph nodes
attempt to isolate and fight off the infection or cancer cells
before further spread occurs. For example, if you cut your
foot on a dirty object, youll notice inflammation in the tissue
around the cut. If the cut becomes infected with bacteria,
some of these bacteria may be picked up by the lymphatic
vessels. The lymph carries the bacteria up the lymphatic ves-
sels. The lymph nodes in your groin will detect the bacteria
and try to trap them. If the infection overwhelms the lymph
nodes, they become tender and swollen. Normally, the lymph
nodes arent easily palpable, but you may be able to feel
them as tender, swollen lumps during times of illness.
Physicians often palpate lymph nodes to check for accumula-
tion of debris as evidence of infection. There are large
numbers of nodes in the cervical (ser v-kal) (neck), axillary
82
(ak s-lar e ) (armpit), mediastinal (me de-as-t nal) (chest),
inguinal (ng gw-nal) (groin), and popliteal (pop-lt e-al) (knee)
regions (Figure 16).
Although you may hear the nodes called glands, this is a
misnomer. The nodes dont secrete anything outside their
structures. Although theyre different sizes, from the size of a
tip of a pin to the size of an almond, they have similar com-
positions. Theyre bean-shaped, like the kidney, and
encapsulated by a fibrous covering. The cortex (outside layer)
consists of connective tissue that surrounds the inner
medulla (except at the hilum [hlm], where the medulla
Submandibular Nodes
Cervical Nodes
Thymus Gland
Axillary Nodes
Pectoral Nodes
Abdominal Nodes
Pelvic and
Inguinal Nodes
Lymph Vessels
Popliteal Nodes
Cisterna Chyli
Spleen
Thoracic Duct
FIGURE 16The
Lymphatic System
83
comes into contact with the surface). Tightly packed lympho-
cytes, known as follicles, make up most of the cortex. In the
medulla, the node is divided into nodules (ndyulz), which
are separated by trabeculae (tr-bek y-le ) made of the same
material as the fibrous capsule, which reach down inside the
medulla-like fingers (Figure 17).
The lymph travels along sinuses, similar to roads, through
the nodules. The subcapsular sinuses are actually located
between the capsule and the cortex. These drain into the
cortical sinuses, which drain into the medullary sinuses. The
walls of the sinuses are lined with reticular cells, fibroblasts,
and macrophages. Reticular cells and fibroblasts produce
some of the building blocks for new cells, and macrophages
surround and consume dead or atypical cells. From the
medullary sinuses, the lymph travels into the efferent vessels
to continue along the path to larger vessels or to other lymph
nodes. During its journey, it has left behind some of the
garbage it picked up in the interstitial tissues, as well as
lymphocytes to help the node continue to fight infection.
Capsule
Sinus
Hilium
Nodule
Cortex
Afferent Lymphatic Vessel
Efferent Lymphatic Vessel
FIGURE 17Structure of a Lymph Node
84
Lymph vessels that empty into lymph nodes are called
afferent vessels, and when the vessels leave the lymph nodes,
theyre called efferent vessels. Remember that afferent vessels
arrive, and efferent vessels exit. Afferent vessels are located
on the rounded, convex part of the node, and efferent vessels
are located at the hilum (refer back to Figure 17).
Eventually, all the lymphatic vessels converge to form the two
largest lymphatic vessels, the right lymphatic duct (lm-fat k
dukt) and the left lymphatic duct, also called the thoracic (tho-
ras k) duct.
The right lymphatic duct receives lymph from the right arm,
right side of the chest, neck and head, and the lower left lobe
of the lung. This duct is in the neck and is a little over a cen-
timeter long. It ends in the right subclavian (sb-kl v-n)
vein. This vein has two valves that prevent blood from going
into it. A subclavian vein is is an extension of the axillary
vein at the outer border of the first rib, and there are two of
them in the human body.
The left, or thoracic, duct is the largest lymph vessel in the
body. In contrast to the tiny right duct, this duct starts in the
abdomen and travels up to the left subclavian vein, for a total
length of about 40 cm. It receives lymph from all the other
areas that the right duct doesnt and, in adults, transports 4
liters of lymph a day. The thoracic duct receives chyle from
the intestines as it travels through larger and larger vessels,
eventually into the intestinal trunk. At the bottom of the tho-
racic duct, there is a pouch where the intestinal trunk and
two lumbar lymphatic trunks meet. This area is called the
cisterna chyli (ss-ter nah k l ). Its where all the lymph from
the lower half of the body enters the thoracic duct. The tho-
racic duct eventually empties into the left subclavian vein.
When the right and left lymphatic ducts empty the lymph
into the subclavian veins, it has been cleaned of infection and
becomes blood plasma again. It joins with the red blood cells
going into the heart, becoming part of the circulatory system,
until its squeezed out at the capillary level into interstitial
tissue, where the process starts all over.
85
Accessory Organs
There are also three accessory lymph organs that play a part
in immune functions: the thymus (th mus), spleen (sple n),
and tonsils (ton slz).
Thymus. We discussed the thymus as an endocrine gland
(Figure 18). Its first function is to develop the newborns
immune response, and in adults the thymus continues to be
important in the maturation of lymphocytes, specifically
T-lymphocytes.
While the bone marrow is responsible for the production of
lymphocytes from stem cells, its responsible for the matura-
tion of only B-cells. T-cells, on the other hand, mature in the
thymus. First, the bone marrow sends some immature lym-
phocytes out to the blood to be deposited in the thymus
gland. Here, the lymphocytes become thymocytes (thm-sts)
and mature to become T-lymphocytes or T-cells (T for thymus,
of course). Thymocytes are cells that develop in the thymus
and undergo several stages of selection and quality control to
ensure maturation results in functional T cells.
Thymus
Interglobular
Septum
Medulla
Cortex
Thymic
Corpuscle
Thymic
Lobule
FIGURE 18The
Thymus
86
T-cells are responsible for cell-mediated immunity. These cells
dont produce antibodies. T-cells simply attack atypical cells,
causing death of the diseased cell by activating macrophages
or inducing a series of chemical reactions that encourage the
cell to die (a process known as apoptosis [pahp-tss]).
Tonsils. The tonsils are masses of lymph tissue, and their
location as guards of the mouth often exposes them to
microorganisms invading the body through food and air. No
wonder theyre so often infected! Like all lymphoid tissue,
they store lymphocytes and release them to fight infection.
There are three types of tonsils (Figure 19):
Palatine (pal ah-t n) tonsils are what most people usually
connect with the term tonsils, those two almond-
shaped masses embedded at the back of the throat.
Lingual (lng gwal) tonsils are below the palatine tonsils,
at the base of the tongue.
Pharyngeal (fah-rn je-al) tonsils are better known as
adenoids, which is the technical term for swollen
pharyngeal tonsils.
Pharyngeal
Tonsil
Nasal
Cavity
Palatine
Tonsil
Lingual
Tonsil
Palatine Tonsil
Lingual Tonsil
Tongue
FIGURE 19The Tonsils
87
Peyers patches. There are patches of lymphoid tissue pres-
ent mostly on areas of the lower intestines (i.e., the ileum),
although they can be present elsewhere along the digestive
system. Because the base of the terminal ileum is so close to
the outside environment, there are more patches there than
anywhere else. Peyers patches are just thickened areas of the
epithelial layer of the intestine (Figure 20). They store lym-
phocytes and act in a way similar to that of the tonsils,
fighting any infection that may come from the many harmful
microorganisms at the end of the digestive tract.
Tonsil
Thoracic Duct
Lymph Nodes
Small Intestine
Peyers Patches
Tissue Lymphatics
Bone Marrow
Large
Intestine
Thymus
Right
Lymphatic
Duct
FIGURE 20Peyers
patches can be found on
the intestines.
88
Spleen. The spleen (Figure 21) is the largest structure of the
lymphatic system. Its a soft, dark red organ located on the
left side of the abdomen, just below the diaphragm. The
spleen performs many functions. It stores lymphocytes and
other blood cells, and it filters out bacteria and viruses from
the arterial blood circulation. The spleen also filters out old
red blood cells. The life span of a red blood cell is approxi-
mately 120 days; during this lifetime, the red blood cells
eventually lose their original shape. The spleen recognizes
these old, misshapen red blood cells and removes them from
circulation. As the old cells are removed, the bone marrow
produces new ones. Trauma, such as gunshot wounds or
automobile accidents, can cause the spleen to rupture.
Because the spleen is so rich in arteries, massive hemorrhage
can ensue. In this case, the spleen must be repaired or even
removed by emergency surgery.
The spleen is covered with tough, fibrous tissue. Blood enters
the spleen via the splenic artery and branches out into
smaller and smaller vessels. The pulpy body of the organ is a
Trabeculae and Veins
Pulp of
the Spleen
Lymphatic
Nodules
Arteries
Vein
Capsule of
the Spleen
Trabeculae
FIGURE 21The Spleen
89
network of these blood vessels and connective tissue. The
blood vessels within the spleen are called splenic sinusoids,
and the connective tissue forms splenic cords in a meshlike
structure that acts as a filter.
There are two kinds of pulp surrounding these two struc-
turesred and white. As the blood passes through red pulp,
it filters the blood, removing defective cells with masses of
macrophages. It actually recycles the parts of blood cells, for
example, the iron. The pulp also retains a large quantity of
the blood that passes through as a reserve in case of emer-
gency. If needed, the blood can be returned to circulation.
Otherwise, it just sits within the red pulp of the spleen.
The white pulp is actually in the form of nodules that act and
look like lymph nodes. As the blood passes through the white
pulp, it comes into contact with lymphocytes that clear the
blood of any infected cells that may be there. There are T-
cells and B-cells in the white pulp. The T-cells, as mentioned
above, work to destroy atypical cells. B-cells produce antibod-
ies that will work to destroy future infections when theyre
recognized again.
The spleen is actually able to produce lymphocytes and red
blood cells, and thats one of its main functions for a fetus.
Before the long bones are fully formed and able to produce
cells, the spleen is where blood cell formation occurs. Once
the bones take over production, though, the spleen focuses
on storing blood, filtering blood and fighting infection.
90
Self-Check 8
1. The accessory organs of the lymphatic system are the _______, _______, and _______.
2. Lymph is the fluid that enters the lymphatic vessels from the _______.
3. _______ is the special lymph thats generated in the intestines.
4. Thickened masses of lymphoid tissue found on the intestines are _______.
5. T-lymphocytes are matured in the _______.
6. The _______ is where the intestinal trunk meets the two lumbar lymphatic trunks.
7. The _______ lymphatic duct is also known as the thoracic duct.
8. The _______ tonsils are located at the back of the tongue.
9. The blood vessels within the spleen are called _______.
10. _______ are lymph vessels in the intestines that are larger than regular lymph capillaries
elsewhere in the body.
91
Pathology of the Lymphatic System
Neoplasms
There are several neoplasms of lymphoid tissues, thought to
be viral in origin. Lymphomas (lm-fo mahz) are classified
according to what type of cell becomes malignant, and how
the disease progresses. This form of cancer generally weak-
ens the bodys immune system. Radiation usually controls a
localized case, but if the cancer has spread through the
lymphatic system, then chemotherapy will be necessary.
Hodgkins (hoj knz) disease (or Hodgkins lymphoma), the
most common form of lymphoma, begins as lymphadenopathy
(disease of the lymph nodes). Its identified by the presence of
a malignant cell called the Reed-Sternberg (re d-stern berg)
cell. The first sign is painless swelling of the lymph nodes,
usually beginning in the neck and spreading to the spleen
and other lymph tissues. Since this swelling is painless, the
first noticeable symptom may be the severe itching that often
accompanies Hodgkins disease (lm-fd-nop-th).
Non-Hodgkins lymphoma includes a number of lymphomas
that dont involve the Reed-Sternberg cell, but otherwise they
resemble the clinical course of Hodgkins. Two examples of
non-Hodgkins lymphoma are lymphocytic lymphoma (lm fo-
st k lm-fo mah) and histiocytic (hs te-o-st k) lymphoma.
Lymph nodes can swell up when engorged with cancer cells.
When physicians check for breast cancer, they not only
check for breast lumps but also feel for swollen lymph nodes
under the arms and near the clavicles. Advanced breast can-
cer spreads by way of lymphatic vessels, so nearby lymph
nodes will enlarge. This principle of cancer cell spread
(metastasis) is also true for many other cancers.
HIV/AIDS
Human immunodeficiency virus (hymn m-y-n-d-
fshn-s vrs) (HIV) is the virus that causes Acquired
immunodeficiency syndrome (AIDS), a disease that suppresses
92
the bodys natural immune system. The virus destroys the T-
lymphocyte cells that fight infection, leaving the patient open
to infections of all sorts.
When HIV infection first began spreading in the United
States, it was thought to be exclusively a disease among the
homosexual male population. Soon thereafter, it became evi-
dent that HIV infection was being passed not only between
homosexual males, but through blood transfusions, intra-
venous drug use, male-to-female sexual contact, female-to-
female sexual contact, mother to baby, and exposure in the
workplace, such as from patient to health care worker.
Although homosexual men still make up a large percentage of
people with HIV/AIDS in the United States, the disease is
spreading primarily among young people. And although the
rates of infection are highest in large metropolitan areas,
smaller metropolitan areas and rural areas are also showing
increased incidence of HIV infection. The numbers of intra-
venous drug users and women contracting HIV are also
rising. Due to the rise in the number of women becoming
infected, the number of infected children is rising as well.
The human immunodeficiency virus is most commonly found
in blood, semen, and vaginal secretions. The greatest risk
factors for contracting HIV infection are participating in
unprotected sexual activity and intravenous drug use. The
virus can also be passed along from mother to fetus and from
mother to infant during delivery. Before 1985, transmission
occurred by transfusion of HIV-contaminated blood products,
but this form of transmission has virtually stopped due to
blood screening. Its important to note that a person can be
infected with HIV for years before developing AIDS. During
this time, the infected person can unknowingly transmit the
virus to others.
Why is AIDS so deadly, and a cure so hard to find? By killing
important lymphocytes, HIV suppresses the immune system
so that it can no longer fight disease, eventually leading to
death. And viruses are tricky microorganisms that are con-
stantly changing and reproducingjust think how difficult it
is for scientists to keep up with the latest flu strain.
93
During the early stage of HIV infection, the patient experi-
ences mild symptoms such as fever, diarrhea, sore throat,
and muscle aches. The ability to fend off disease remains
quite good. A mid-stage period of HIV infection is persistent
generalized lymphadenopathy, in which enlarged lymph
nodes, skin rashes, chronic fatigue, and weight loss occur.
Finally, full-blown AIDS strikes, rendering the immune sys-
tem powerless. The patient becomes subject to opportunistic
(op or-tu-ns tk) infections such as Kaposis sarcoma (kah
p-ze z sar-ko mah), pneumocystis carinii pneumonia (nu mo-
ss tk kah-rn nu-mo ne-ah), and lymphoma.
Theres currently no cure for HIV/AIDS. There are treatments
available now, however, that may prevent the virus from
actually becoming AIDS, and even if the disease progresses,
the medications are helping patients to live longer than they
did when the disease was discovered in the early 1980s.
Other Immune System Disorders
Under certain conditions, the lymph fluid cant properly enter
the lymphatic vessels and instead remains in the interstitial
spaces. As a result, the tissues swell up with the excess
lymph; this condition is called edema.
Lymphadenitis (lm fad- en-ts) is any swelling of the lymph
nodes. This condition is often triggered by an infection that
the lymph node is fighting. It can also be caused if the lymph
node itself becomes infected with the disease its fighting. If
the infection spreads to the vessels surrounding the node,
that inflammation is called lymphangitis (lmfn-jts).
Splenomegaly (sple no-meg ah-le ) is any enlargement of the
spleen. This enlargement can be due to an overwhelming
infection of any kind that requires the spleen to work harder
than usual, or it can be caused by some specific diseases,
such as leukemias or lymphomas. It can be triggered by any
disease thats causing red blood cells to be destroyed in the
spleen. It can also be a sign of portal hypertension.
Tonsillitis (ton s-l ts) is inflammation of the tonsils caused
by either a virus or bacteria. The tonsils become red and
swollen and sometimes have white patches of pus on them.
This condition is usually accompanied by swollen cervical
94
lymph nodes. Many older adults have grown up without their
tonsils because several decades ago childrens tonsils were
commonly removed if these structures became repeatedly
inflamed from throat infections.
Chylothorax (kl-thrks) is a condition in which the tho-
racic lymph duct is blocked, causing lymph to accumulate in
the pleural cavity.
Often called mononucleosis (mon o-nu kle-o ss) or kissing
disease, and sometimes called glandular fever, infectious
mononucleosis is a fairly common disease in children and
young adults, occurring most often in the spring. Its caused
by the Epstein-Barr (ep st n-bar) virus and leads to
headache, sore throat, fatigue, weakness, and sore lymph
nodes. Mononucleosis gets its name from the high number of
mononuclear leukocytes present in the bloodstream. At the
time, theres no effective treatment, but a few weeks of bed
rest usually help the symptoms disappear.
Although the name is often applied to any swelling of the legs
and thickening of the skin tissue, true elephantiasis (el e-
fan-t ah-ss) is caused by a parasitea worm, to be exact.
The larvae invade lymph tissues and grow there, clogging the
lymphatic system and causing excessive edema. These para-
sites thrive in tropical and subtropical areas.
Hypersensitivity (h-per-sen- s-tv-te ), an overactive immune
response to certain substances, is better known as an allergy
(al er-je ). Delayed reaction allergies develop over time, as lym-
phocytes become sensitized to certain allergens (al er-jenz),
such as drugs, cosmetics, and household cleaners. One in 10
people have genetically transmitted atopic (a-top k) allergies
caused by excessive production of certain antibodies against
allergens such as pollen, animal dander, dust, foods, mold
spores, and insect venom.
Exaggerated immune responses to allergens can actually
damage healthy tissues, such as hay fever, allergic rhinitis
(ah-ler jk r-n ts), asthma, and the potentially fatal
anaphylaxis (an ah-f -lak ss), which begins with symptoms
of asthma and hay fever but progresses to an allergic reaction
throughout the body. The best treatment is actually preven-
tionavoiding known allergens. Patients with severe cases
may undergo immunotherapy (-myu no-ther ah-pe ), also
95
referred to as desensitization (de-sen s-t-za shun) or
hyposensitization (h po-sen s-t -za shun), to help the
immune system respond normally to allergens. Medication
can also be given to lessen the symptoms of hay fever and
help prevent asthma attacks.
Sarcoidosis (sar koi-do ss) is a multisystem disease that
most frequently involves the lymph nodes. Lesions resemble
the tubercles of tuberculosis, but the cause of sarcoidosis
isnt known. Mild cases may show no symptoms, but in pro-
nounced cases the patient may have anemia, leukopenia, and
other abnormal blood conditions. Impaired lung function,
swollen joints, and fatigue may also be symptoms. Prolonged
sarcoidosis can cause eye disease, as well. Patients may
receive steroid therapy.
96
Self-Check 9
Questions 15: Choose the correct answer.
1. An overactive immune response is an (allergy/elephantiasis).
2. (Sarcoidosis/Chylothorax) is a multisystem disease involving the lymph nodes.
3. Hodgkins disease is identified by the (Reed-Sternberg cell/Epstein-Barr virus).
4. An opportunistic infection that can accompany AIDS is (tonsillitis/Kaposis sarcoma).
5. (Hay/Glandular) fever is characterized by a large number of mononuclear leukocytes in
the bloodstream.
97
Lymphatic System
Besides the CT scans and MRIs that can be used in most
systems to visualize structures and organs in this system,
there are some other diagnostic tests specifically designed for
the lymphatic system.
A lymphangiogram (lm-fnj--grm) (or lymph node
angiogram) is an x-ray done with a fluoroscope after injection
of dye into vessels. This examination visualizes the lymph
nodes, vessels, ducts, and tissues.
Laboratory results can help diagnose various types of dis-
eases and disorders. For example, a high white blood cell
count (i.e., above 10,000 cells per microliter) can indicate an
infection, or an increased number of red blood cells points to
polycythemia vera, which is a myeloproliferative (m-l-pr-
lfr--tv) disorder (a condition in which bone marrow
components proliferate excessively). The complete blood count
(CBC) is one of the more common laboratory tests ordered by
a physician and can indicate unusual activity in the lym-
phatic system.
There are a number of blood tests that detect the presence of
specific antibodies. One of these is the Coombs (koomz) test
used when hemolytic anemia is suspected; it checks to see if
the immune system is attacking its own red blood cells.
Another test is the enzyme-linked immunosorbent (my-n-
srbnt) assay (ELISA), which is an early screening test for
HIV infection. Western blot is a confirmation test for the pres-
ence of HIV.
Splenectomy (sple-nek to-me ) is the surgical removal of the
spleen, usually due to pathology or injury.
and word forms associated with the lymphatic system.
98
Combining Forms and Suffixes You Should Know
IMMUN/O protection
LYMPH/O lymph
LYMPHADEN/O lymph node, gland
LYMPHANGI/O lymph vessel
MYEL/O bone marrow
PHAG/O swallow
SPLEN/O spleen
Suffixes
-BLAST immature
-CYTOSIS abnormal condition
-EMIA blood condition
-LYTIC destructive
-PENIA deficiency
-PHAGE swallow
-PHORESIS carrying
-POIESIS formation
-STASIS stop
In Other Words
Tissue fluid = interstital fluid
Thoracic duct = left lymphatic duct
T-lymphocytes = T-cells
Hodgkins disease = Hodgkins lymphoma
Hypersensitivity = allergy
Immunotherapy = desensitization = hyposensitization
Lymphangiogram = lymph node angiogram
99
Cisterna chyli (ss-ter nah k l ) Base of thoracic lymph duct
Lacteals (lak te-alz) Lymphatic vessels surrounding the intestines
Lymph (lmf) Clear fluid rich in lymphocytes
Lymphatic duct (lm-fat k dukt) Large lymph vessel that carries lymph back to
veins
Peyers patches Lymphatic tissue on the organs of digestion
Phagocytes (fag o-s ts) Cells that eat other cells
Plasma (plaz mah) Clear fluid in blood
Spleen (sple n) Largest lymphoid organ in lymphatic system
Splenomegaly (sple no-meg ah-le ) Enlargement of spleen
Thymus (th mus) Endocrine gland that matures lymphocytes for
lymphatic system
Tonsils (ton slz) Lymphoid organs in the head
100
Self-Check 10
Questions 15: Match the term on the left with its description on the right. Indicate your
response in the space provided.
______ 1. Coombs test
______ 2. Lymphangiogram
______ 3. ELISA
______ 4. Western blot
______ 5. Splenectomy
a. Surgical removal of the spleen
b. Early screen for HIV infection
c. Tests for hemolytic anemia
d. Confirms presence of HIV
e. Visualizes lymphatic system
101
Self-Check 1
1. d
2. h
3. e
4. a
5. j
6. b
7. f
8. i
9. c
10. g
Self-Check 2
1. Pyuria
2. Dysuria
3. Hematuria
4. Oliguria
5. Albuminuria
6. Kidney stones; urinary calculi
7. Inflammation of the bladder
8. Congenital disease in which kidney is enlarged by
masses of cysts
9. Enlargement of kidney, retaining urine because of
obstruction in the urinary tract
10. Long-term inflammation of glomeruli capillary loops,
causing progressive and permanent damage to kidneys
A
n
s
w
e
r
s
A
n
s
w
e
r
s
Self-Check Answers
102
Self-Check 3
1. TP
2. LT
3. LT
4. VP
5. TP
6. VP
7. LT
8. VP
9. TP
10. TP
Self-Check 4
1. testes
2. epididymis
3. semen
4. vas deferens
5. sperm
6. scrotum
7. Leydig cells
8. prostate
9. puberty
10. ejaculatory duct
Self-Check 5
1. b
2. d
3. a
4. c
5. f
6. g
7. e
8. Progesterone, estrogen
9. LH, FSH
10. hCG
Self-Check 6
1. Puerperal sepsis
2. Prostatits
3. Candidiasis (or yeast infection)
4. Benign prostatic hyperplasia (or benign prostatic
hypertrophy)
5. Carcinoma in situ
6. Fibroid tumors
7. Hypogonadism
8. Pelvic inflammatory disease (PID)
9. Salpingitis
10. Teratoma (or dermoid cyst)
Self-Check 7
1. MP
2. FP
3. FT
4. MT
5. FP
6. MP
7. MT
8. FT
Self-Check Answers
103
9. FP
10. MP
Self-Check 8
1. spleen, tonsils, thymus gland
2. interstitial tissue
3. Chyle
4. Peyers patches
5. thymus
6. cisterna chyli
7. left
8. lingual
9. splenic sinusoids
10. Lacteals
Self-Check 9
1. allergy
2. Sarcoidosis
3. Reed-Sternberg cell
4. Kaposis sarcoma
5. Glandular
Self-Check 10
1. c
2. e
3. b
4. d
5. a
Self-Check Answers
104

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